Canavan disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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Canavan disease
ICD-9 330.0
OMIM 271900
DiseasesDB 29780
MedlinePlus 001586

Overview

Canavan disease is an inherited disorder that causes progressive damage to nerve cells in the brain. This disease is one of a group of genetic disorders called leukodystrophies. Leukodystrophies are characterized by degeneration of myelin, which covers the phospholipid layer of neuron insulating the axon.

Historical Perspective

Current Research

A team of researchers headed by Paola Leone are currently at the University of Medicine and Dentistry of New Jersey, in Camden, New Jersey. The brain gene therapy is conducted at Cooper University Hospital. The procedure involves the insertion of six catheters into the brain that deliver a solution containing 600 billion to 900 billion engineered virus particles. The virus, a modified version of AAV, is designed to replace the aspartoacylase enzyme. Children treated with this procedure to date have shown marked improvements, including the growth of myelin with decreased levels of the n-acetyl-aspartate toxin.

Classification

Pathophysiology

Causes

Canavan disease is inherited in an autosomal recessive fashion.

Canavan disease is caused by a defective ASPA gene which is responsible for the production of the enzyme aspartoacylase. This enzyme breaks down the concentrated brain molecule N-acetyl aspartate. Decreased aspartoacylase activity prevents the normal breakdown of N-acetyl aspartate, and the lack of breakdown somehow interferes with growth of the myelin sheath of the nerve fibers in the brain. The myelin sheath is the fatty covering surrounding nerve cells that acts as an insulator, and allows for efficient transmission of nerve impulses.

Differentiating Canavan disease from Other Diseases

Epidemiology and Demographics

Although Canavan disease may occur in any ethnic group, it affects persons of Eastern European Jewish ancestry more frequently. About 1/40 individuals of Eastern European (Ashkenazi) Jewish ancestry are carriers. Canavan disease is inherited in an autosomal recessive fashion. If both parents are carriers, there is a 25% chance of having an affected child. Genetic counseling and genetic testing is recommended for families who may be carriers.

Risk Factors

Screening

Natural History, Complications, and Prognosis

Death usually occurs before age 4 untreated, although some children may survive into their twenties via newer treatments which have extended life expectancy. There is no known cure.

Diagnosis

Diagnostic Criteria

History and Symptoms

Symptoms of Canavan disease, which appear in early infancy and progress rapidly, may include mental retardation, loss of previously acquired motor skills, feeding difficulties, abnormal muscle tone (i.e., floppiness or stiffness), poor head control, and megalocephaly (abnormally enlarged head). Paralysis, blindness, or seizures may also occur.

Physical Examination

Laboratory Findings

Imaging Findings

Other Diagnostic Studies

Treatment

There is no cure for Canavan disease, nor is there a standard course of treatment. Treatment is symptomatic and supportive. The life expectancy of Canavan patients is not known because new treatments have extended their lives beyond earlier projections. Today, Canavan children often survive into their teens and beyond.

Research involving triacetin supplementation in patients with Canavan disease has shown some promising results. Glyceryl Tricetate study Triacetin, which can be enzymatically cleaved to form acetate, enters the brain more readily than the negatively charged acetate.

Medical Therapy

Surgery

Prevention

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