Clinical Information

Krabbe disease (globoid cell leukodystrophy) is an autosomal recessive disorder caused by a deficiency of the enzyme, galactocerebrosidase (GALC). GALC facilitates the lysosomal degradation of psychosine (galactosylsphingosine) and 3 other substrates (galactosylceramide, lactosylceramide, and lactosylsphingosine causing severe demyelination throughout the brain. Krabbe disease is caused by variants in the GALC gene, and it has an estimated frequency of 1 in 100,000 births. Although rare, a few infants with an infantile Krabbe disease-like phenotype due to deficiency of saposin A have been found. Saposin-A is a sphingolipid activator protein that assists galactocerebrosidase in its action on galactosylceramide.

Severely affected infants typically present between 3 to 6 months of age with increasing irritability and sensitivity to stimuli. Rapid neurodegeneration including white matter disease follows, with death usually occurring by age 2 years. Some individuals have later onset forms of the disease that are characterized by ataxia, vision loss, weakness, and psychomotor regression presenting anywhere from age 6 months to the seventh decade of life. The clinical course of Krabbe disease can be variable, even within the same family.

Newborn screening for Krabbe disease has been implemented in some states. The early (presymptomatic) identification and subsequent testing of infants at risk for Krabbe disease may be helpful in reducing the morbidity and mortality associated with this disease. While treatment is mostly supportive, hematopoietic stem cell transplantation has shown some success if performed early, prior to onset of neurologic damage.

Reduced or absent galactocerebrosidase in leukocytes can indicate a diagnosis of Krabbe disease; however, a number of alterations in the GALC gene have been identified that result in reduced galactocerebrosidase activity in vitro but do not cause disease. The biomarker, psychosine (PSY / Psychosine, Blood Spot or PSYR / Psychosine, Whole Blood or PSYCF / Psychosine, Spinal Fluid), has been shown to be elevated in patients with active Krabbe disease. Molecular sequencing of the GALC gene (KRABZ / Krabbe Disease, Full Gene Analysis and Large [30 kb] Deletion, Varies) is necessary for differentiating alterations from disease-causing variants in affected patients and for carrier detection in family members.