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Features include always present findings: Delayed speech and language development, Global developmental delay, and 3-Methylglutaconic aciduria; and very common findings: Low muscle tone (hypotonia) and Decreased total neutrophil count. 17 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Brain and nerves | 8 | Bilateral tonic-clonic seizure, Delayed speech and language development, Absent speech |
CLPB encodes ClpB family mitochondrial disaggregase (707 aa). Functions as a regulatory ATPase and participates in secretion/protein trafficking process. Highest expression in Testis (298.5 TPM) and Cells EBV-transformed lymphocytes (16.6 TPM).
3-methylglutaconic aciduria, type VIIA is associated with mutations in the CLPB gene on chromosome 11.
CLPB is classified as a druggable target (Enzyme category) with score 0.0.
CLPB (caseinolytic peptidase B) deficiency should be suspected in individuals with the following clinical, laboratory, and imaging findings.
The disease spectrum of CLPB deficiency ranges from severe to mild. All phenotypes. Congenital or infantile cataracts can be present in individuals with severe to mild phenotypes.
Severe (prenatal/ infantile) phenotype
No approved treatments are currently available for 3-methylglutaconic aciduria, type VIIA. The disease remains an area of unmet medical need.
No clinical practice guidelines for CLPB deficiency have been published. Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with CLPB deficiency, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 4. Recommended Evaluations Following Initial Diagnosis in Individuals with CLPB Deficiency
Table 6. Recommended Surveillance for Individuals with CLPB Deficiency
System/Concern |
|---|
No clinical trials have been registered for 3-methylglutaconic aciduria, type VIIA.
2 publications have been identified in PubMed for 3-methylglutaconic aciduria, type VIIA. Research spans Review / Meta-Analysis (100%).
Messina M (2025). [PMID: 38872485](https://pubmed.ncbi.nlm.nih.gov/38872485/). *J Inherit Metab Dis*. [Review / Meta-Analysis]
Mróz D (2025). [PMID: 40194906](https://pubmed.ncbi.nlm.nih.gov/40194906/). *J Inherit Metab Dis*. [Review / Meta-Analysis]
Data assembled from 6 of 12 sources · Last updated Sep 19, 2026, 6:55 PM UTC
Online Mendelian Inheritance in Man
Muscles | 2 | Shrinkage of the cerebellum (cerebellar atrophy), Low muscle tone (hypotonia) |
Blood and immune system | 2 | Low red blood cell count (anemia), Decreased total neutrophil count |
Head and neck | 1 | Secondary microcephaly |
Pregnancy and birth | 1 | Neonatal omphalitis |
The clinical phenotype of CLPB deficiency ranges from severe to mild as determined by neurologic involvement and neutropenia. Children with neonatal onset or early-infantile onset have severe involvement and may die from complications of their disease, whereas those with late-infantile and early-childhood onset have a milder clinical presentation . To date a total of 32 individuals from 16 families with biallelic CLPB pathogenic variants have been reported in the literature (n=14 , n=5 , n=5 , n=4 , n=2 , and n=1 ). Most have been identified as neonates; all were symptomatic by early childhood. Autosomal dominant CLPB deficiency has been reported in 16 probands (from 16 families) with severe to mild phenotypes . Table 2. CLPB Deficiency: Frequency of Select Features
Feature | Proportion of Persons w/Feature | Comment |
|---|---|---|
AR CLPBdeficiency | AD CLPBdeficiency1 Prenatal manifestations | 17/32 |
Altered muscle tone | 28/32 | 5/16 |
Movement disorder | 20/32 | 0/16 |
Seizures | 18/32 | 7/16 |
Brain atrophy | 14/32 | 4/16 |
DD/ID | 22/262 | 7/16 |
Neutropenia | 26/32 | 15/16 |
Cataracts | 17/32 | 2/16 |
Elevated urinary 3-MGA | 32/32 | 6/16 |
Source: GeneReviews — "CLPB Deficiency"
Individuals with the most severe phenotypes often have pathogenic variants predicted to lead to the complete absence of functional protein. Autosomal dominant CLPB deficiency has been reported in six individuals with the following pathogenic variants: , , , and ; phenotype varied from severe to mild. These variants disturb refoldase and to a lesser extent ATPase activity of CLPB in a dominant-negative manner. Urinary excretion of 3-methylglutaconic acid (3-MGA) was elevated in all six individuals assessed . Six different heterozygous CLPB pathogenic variants, , , , , , and , were identified in ten unrelated individuals with congenital neutropenia with or without neurologic features and/or cataracts.
Source: GeneReviews — "CLPB Deficiency"
Polyhydramnios, fetal contractures, intrauterine growth restriction
Microcephaly
Hyperekplexia, absence of voluntary movements, respiratory insufficiency, and swallowing problems
Moderate (infantile/ early childhood) phenotype
Hypotonia or hypertonia
Seizures
Spasticity
Ataxia, tremor and dystonia, dyskinesia
Intellectual disability
Mild phenotype
No neurologic involvement
Normal intellect
...
Source: GeneReviews — "CLPB Deficiency"
Table 3. Disorders to Consider in the Differential Diagnosis of CLPB Deficiency
Discriminating Feature | Gene(s) | Disorder | MOI | Additional Hallmarks1 of Disorder |
|---|---|---|---|---|
AGK | AGK defect (Sengers syndrome) (See DNA mtDNA Maintenance Defects Overview.) | AR | Characteristic combination of bilateral cataracts, hypertrophic cardiomyopathy, no to mild ID. Can be lethal in neonatal period but survivors to adulthood w/mild involvement are known. | — |
AUH | AUH defect (3-methylglutaconyl-CoA hydratase deficiency) (OMIM 250950) | AR | Adult-onset progressive spasticity dementia w/characteristic slowly developing radiologic picture of extensive leukoencephalopathy3. Uniquely distinguished by urinary excretion of 3-HIVA. | — |
DNAJC19 | DNAJC19 defect (DCMA syndrome) (OMIM 610198) | AR | Characteristic combination of childhood-onset dilated cardiomyopathy, non-progressive cerebellar ataxia, testicular dysgenesis, growth failure | — |
OPA3 | OPA3 defect (See Costeff Syndrome.) | AR | In infants: optic atrophy movement disorder (ataxia or extrapyramidal disorder) | — |
SERAC1 | MEGD(H)EL syndrome (See SERAC1 Deficiency.) | AR | Neonatal hypoglycemia liver failure4. In 2nd yr of life: progressive SNHL neurologic manifestations (truncal hypotonia, spasticity of limbs, dystonia, severe ID/DD, Leigh syndrome-like findings on MRI). | — |
TAFAZZIN (formerly TAZ) | TAZ defect (See Barth syndrome.) | XL | In affected males: growth delay in infancy, cardiomyopathy (left ventricular noncompaction), neutropenia, myopathy, typical facial features, hypocholesterolemia, cognitive phenotype | — |
TMEM70 | TMEM70 defect (OMIM 614052) | AR | No specific syndromic presentation to date. Typically in neonates: hyperammonemia, lactic acidosis, muscular hypotonia, hypertrophic cardiomyopathy, psychomotor retardation. In those surviving neonatal period: DD. | — |
Unknown | Not otherwise specified 3-MGA-uria (former 3-MGCA 4) | Normal 3-methylglutaconyl-CoA hydratase enzyme activity no defect in TAFAZZIN, OPA3, SERAC1, TMEM70, DNAJC5, AUH, or AGK Congenital neutropenia cyclic neutropenia | ELANE | — |
ELANE-related neutropenia | AD | Isolated neutropenia; no involvement of CNS or other organs G6PC3 | — | — |
G6PC3 deficiency | AR | Presence of cardiovascular /or urogenital abnormalities GATA1 | — | — |
GATA1-related X-linked cytopenia | XL | Typical presentation in affected males: bleeding disorder anemia; neutropenia occurs later DNAJC21 EFL1 SBDS SRP54 | — | — |
Shwachman-Diamond syndrome | ARAD5 | Intestinal malabsorption due to exocrine pancreatic dysfunction | — | — |
WAS | X-linked severe congenital neutropenia (See WAS-Related Disorders.) | XL | Isolated neutropenia; no involvement of CNS or other organs Hyperekplexia | — |
ARHGEF9 | Early-infantile epileptic encephalopathy 8 (OMIM 300607) | XL | GLRA1 GLRB SLC6A5 | — |
Hereditary hyperekplexia | ADAR6 | Generalized stiffness ... | — | — |
Source: GeneReviews — "CLPB Deficiency"
Genetic testing for CLPB is available. Testing is considered confirmatory for diagnosis.
System/Concern | Evaluation | Comment |
|---|---|---|
Development | Developmental assessment | To incl motor, adaptive, cognitive, speech/language eval; Eval for early intervention/ special education; Consider IQ testing in persons diagnosed at an older age. |
Musculoskeletal | Orthopedics/ physical medicine rehab/ PT OT eval | To incl assessment of:; Gross motor fine motor skills; Contractures, clubfoot, kyphoscoliosis; Mobility, ADL, need for adaptive devices; Need for PT (to improve gross motor skills) /or OT (to improve fine motor skills) |
Immune function | ANC to determine need for G-CSF treatment. | — |
Eyes | Complete ophthalmologic exam to evaluate for cataracts | Endocrine |
function | TSH to assess thyroid function | Eval of ovarian function per endocrinologist /or gynecologist |
Renal | Renal ultrasound exam to assess for nephrocalcinosis /or cysts | In all persons at diagnosis incl infants Genetic |
counseling | By genetics professionals1 | To inform affected persons their families re nature, MOI, implications of CLPB deficiency to facilitate medical personal decision making Family support resources |
Treatment of Manifestations in Individuals with CLPB Deficiency Manifestation/Concern | Treatment | Considerations/Other Poor weight gain/ |
Failure to thrive | Feeding therapy; gastrostomy tube placement may be required for persistent feeding issues. | Low threshold for clinical feeding eval /or radiographic swallowing study if clinical signs or symptoms of dysphagia |
Epilepsy | Standardized treatment w/ASM by experienced neurologist | Many ASMs may be effective; none has been demonstrated effective specifically for this disorder.; Education of parents/caregivers1 |
Movement disorders | Orthopedics/ physical medicine rehab/ PT OT incl stretching to help avoid contractures falls | Consider need for positioning mobility devices disability parking placard. |
Excessive drooling | Botulinum toxin injection in salivary glands, extirpation of saliva glands, /or rerouting of glandular ducts2 | Developmental delay/ |
Intellectual disability | See . | — |
Neutropenia | Subcutaneous G-CSF | To neutrophil counts frequency of infections, esp in those w/mild or moderate phenotype2 Standard immunizations per pediatric/adult guidelines to prevent infection |
Cataracts | Treatment per ophthalmologist | — |
Endocrine dysfunction | Treatment per endocrinologist | — |
Renal | Treatment per renal specialist | Family/Community |
Source: GeneReviews — "CLPB Deficiency"
Drugs potentially toxic to mitochondria (including chloramphenicol, aminoglycosides, linezolid, valproic acid, and nucleoside reverse transcriptase inhibitors) should be avoided.
Source: GeneReviews — "CLPB Deficiency"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "CLPB Deficiency"
View trials for 3-methylglutaconic aciduria, type VIIA
Evaluation
Frequency |
|---|
Eyes | Ophthalmologic exam | Per ophthalmologist in those w/cataracts |
Endocrine | TSH to assess thyroid function | Annually Follow-up labs/assessment of gonadal function per endocrinologist /or gynecologist |
Community | Assess family need for social work support (e.g., palliative/respite care, home nursing, other local resources) care coordination. | At each visit OT = occupational therapy; PT = physical therapy; TSH = thyroid-stimulating hormone |
Source: GeneReviews — "CLPB Deficiency"
Phenotype severity distribution: 3 always present features, 2 very common features, 5 common features.
AI-curated news mentioning 3-methylglutaconic aciduria, type VIIA
Updated Jul 21, 2026
FDA approved Casgevy CRISPR gene therapy for children as young as 2 with sickle cell disease on July 1, 2026. Here's what families need to know about this milestone. Approximately 5,500 additional American children are now eligible for this established one-time therapy, according to Vertex Pharmaceuticals, Casgevy's developer. Casgevy also covers transfusion-dependent beta-thalassemia in this new age indication. Sickle cell disease is a lifelong inherited blood disorder that warps red blood cells into stiff, crescent shapes that can block blood flow, starving organs and tissues of oxygen. The world's first CRISPR-based gene therapy has been approved for children as young as two years old, opening the possibility of a single, potentially curative treatment to thousands of American children with sickle cell disease before years of organ damage can narrow what medicine can do for them. Families with children aged 2 and older who have sickle cell disease should speak with their pediatric hematologist about whether Casgevy is appropriate to consider at this stage of their child's disease. Ask specifically which authorized treatment centers perform Casgevy in your region. Treatment is available only at specialized sites, and geographic access remains limited. Contact your child's insurance plan or Medicaid office to ask about coverage. Medicaid coverage for gene therapies varies by state, and some states have developed outcomes-based payment models for high-cost therapies. "With today's decision, pediatric patients as young as 2 years of age can now access a critical additional treatment option to treat these debilitating, life-threatening diseases," said Karim Mikhail, acting director of the Office of Therapeutic Products at the FDA's Center for Biologics Evaluation and Research, according to the FDA press announcement. Casgevy is a non-viral, ex vivo CRISPR/Cas9 gene-edited cell therapy.