Déficit en lipase acide lysosomale (LALD)

Lysosomal acid lipase deficiency (LALD) is a rare, chronic and inherited disease that is characterized by not having a functional lysosomal acid lipase enzyme.

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what is lysosomal acid lipase deficiency (LALD)?

Lysosomal acid lipase breaks down fat and cholesterol in cells and a deficiency in this enzyme can lead to health complications. Lysosomal acid lipase deficiency results in fat accumulation (i.e. cholesterol esters and triglycerides) in organs which can lead to organ damage and the development of maladie du foie gras, cirrhosis, et l'insuffisance hépatique.

Infants (also known as Wolman disease):

Infants with LALD begins to show symptoms at around one month of age, which progresses to liver failure and life-threatening complications with death occurring within 6 months to 1 year of age.

en bref

  • Around 50% of children and adults with LALD progress to fibrosis, cirrhose, or greffe de foie within 3 years.
  • The average age of LALD onset is 5.8 years old.
  • Around 50% of infants with LALD have adrenal calcifications (cysts).
  • LALD arises from mutations in the LIPA gene and there are over 130 variants.

symptômes

infants

  • Failure to grow, enlarged abdomen, vomiting and diarrhea, jaundice, malabsorption

children and adults

  • Enlarged liver in a physical exam, abnormal lipid (high triglyceride and cholesterol, HDL deficiency) and enzyme profile from a blood test
  • Easy bruising or bleeding
  • Ascites (fluid buildup in the abdomen)
  • Jaunisse

complications

  • Liver complications: enlarged liver, fibrosis, cirrhose, liver failure
  • Cardiovascular system: lower HDL, higher LDL, heart attacks, strokes
  • Spleen: enlarged spleen, low platelet count
  • Gastrointestinal system: pain, bleeding, diarrhea, poor nutrient absorption, malnutrition

l'impact du mode de vie

  • Abnormal levels of cholesterol
  • Can lead to many health complications in various organs

que puis-je faire ?

la prévention

Lysosomal acid lipase deficiency is a disease caused by genetics, so it cannot be prevented.

diagnostic

An accurate diagnosis of LALD can be made with a blood test that measures the activity of the LAL enzyme. It can also be diagnosed through genetic testing.

traitement

Kanuma is an enzyme replacement therapy that can treat LALD, as it is a recombinant human lysosomal acid lipase. It is provided intravenously. It has been approved by Health Canada to treat LALD in infants, children and adults. Supportive treatments include a low-fat diet, statins and other lipid-lowering agents, stem cell transplants, and liver transplant.

ressources supplémentaires

Voici quelques questions à poser à votre médecin ou à l'équipe médicale :

  • What is my family’s risk of developing LALD? Should my family be tested?
  • What treatment and/or lifestyle modifications are beneficial for someone with LALD?
  • What’s my risk of progressing to fatty liver disease or cirrhosis?