Aceruloplasminemia is a form of NBIA characterized by iron accumulation, where the iron collects not just in the brain, but in other organs, including the liver.
Aceruloplasminemia is an autosomal recessive disorder in which the gene responsible is CP, which encodes ceruloplasmin.
The disorder has mainly been studied in Japan, where it occurs in about one in 2 million adults. It is unclear how often it occurs in other populations.
The main symptoms are retinal degeneration, diabetes and neurologic disease related to iron build-up in the basal ganglia.
Movement problems include face and neck dystonia (involuntary muscle contractions, with repetitive movements or painful postures), blepharospasm (eyelid spasms), tremors and jerky movements.
Clinical Diagnosis of Aceruloplasminemia
Individuals with aceruloplasminemia often present to doctors with anemia prior to onset of diabetes mellitus or neurologic symptoms.
Physical traits (phenotypic expression), vary, even within families.
Physicians may do an MRI to assist in diagnosing patients. The MRI will show signs of iron accumulation in the brain (striatum, thalamus, dentate nucleus) and liver on both T1- and T2-weighted images. The images also will indicate the absence of serum ceruloplasmin, a copper-containing protein, and some combination of the following: low serum copper concentration, low serum iron concentration, high serum ferritin (a protein that enables cells to store iron) concentration, and increased iron concentration in the liver.
Age at onset is 25 to 60, and older.
Psychiatric problems in patients include depression and cognitive dysfunction in individuals older than age 50.
Retinal degeneration was found in 93 percent of Japanese individuals with aceruloplasminemia [Miyajima, et. al., 2003]. Visual acuity is not affected.
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To establish the extent of disease and the individual’s needs, evaluations for the following are recommended:
Iron deposits. Serum ferritin concentration, brain and abdomen MRI findings, and hepatic (liver) iron and copper content by liver biopsy
Neurologic findings. Brain MRI and protein concentration in cerebral spinal fluid.
Diabetes mellitus. Blood concentrations of insulin and HbA1c, a test of blood sugar levels.
Retinal degeneration. Examination of the optic fundi, the interior linking of the eyeball, and fluorescein angiography, a test to examine blood vessels in the retina, choroid and iris of the eye.
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Iron chelating agents, such as desferrioxamine and deferasiox, are sometimes used to decrease serum ferritin concentration, decrease brain and liver iron stores, and prevent progression of neurologic signs and symptoms in symptomatic individuals with blood hemoglobin concentration higher than 9 grams per deciliter. The chelator is combined with intravenous desferrioxamine and fresh-frozen human plasma to decrease iron content in the liver. Repetitive treatment with the plasma can improve neurologic signs and symptoms.
Also, antioxidants such as vitamin E may be used along with a chelator or oral administration of zinc to prevent tissue damage, particularly to the liver and pancreas.
Annual glucose tolerance tests starting at age 15 are recommended to evaluate for the onset of diabetes mellitus. Also, an ECC evaluation should be performed early in the course of the disease.
Avoid iron supplements.
Please see the link on this page for more detailed information on aceruloplasminemia at Gene Reviews, which was used as a source for some of the above information.
Gene Reviews Author:
Hiroaki Miyajima, MD
First Department of Medicine
Hamamatsu University School of Medicine
Please visit the NBIA Disorders Association website, which was used as a primary source for the above information.