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ALDH18A1-related De Barsy syndrome combines intellectual deficit, bilateral cataracts, and skin and joint hyperlaxity.
Features include always present findings: Moderate intellectual disability, Short stature, Low muscle tone (hypotonia), and Absent speech and others; and common findings: Hypoornithinemia, Cataract, Hip dislocation, and Athetosis and others. 51 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Brain and nerves | 7 | Moderate intellectual disability, Seizure, Intellectual disability |
Bones and joints | 4 | Delayed skeletal maturation, Joint hypermobility, Sideways curvature of the spine (scoliosis) |
Eyes | 3 | Strabismus, Cataract, Corneal arcus |
Growth and development | 3 | Short stature, Failure to thrive, Intrauterine growth retardation |
Skin | 2 | Thin skin, Hyperextensible skin |
Pregnancy and birth | 1 | Congenital hip dislocation |
Muscles | 1 | Low muscle tone (hypotonia) |
Arms and legs | 1 | Lower limb hyperreflexia |
Digestive system | 1 | Episodic vomiting |
Neurocutaneous disorders due to mitochondrial proline synthesis defects comprise PYCR1-related autosomal recessive cutis laxa (ARCL), ALDH18A1-related ARCL, and ALDH18A1-related autosomal dominant cutis laxa (ADCL). These disorders are characterized by a generalized progeroid type of cutis laxa with recognizable dysmorphic features and, often, developmental delay . To date, 154 individuals have been reported: 114 with biallelic pathogenic variants in PYCR1 (PYCR1-related ARCL), 27 with biallelic pathogenic variants in ALDH18A1 (ALDH18A1-related ARCL), and 13 individuals with heterozygous de novo pathogenic variants in ALDH18A1 (ALDH18A1-related ADCL). The following description of the phenotypic features associated with this condition is based on these published reports . Table 2. Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects: Frequency of Select Features
Feature | % of Persons w/Feature | Comment |
|---|---|---|
Cutaneous | Lax wrinkled skin | 100% |
ALDH18A1 encodes aldehyde dehydrogenase 18 family member A1 (795 aa). Bifunctional enzyme that converts glutamate to glutamate 5-semialdehyde, an intermediate in the biosynthesis of proline, ornithine and arginine Highest expression in Cells Cultured fibroblasts (95.6 TPM) and Cells EBV-transformed lymphocytes (93.1 TPM).
ALDH18A1-related de Barsy syndrome is associated with mutations in the ALDH18A1 gene on chromosome 10.
ALDH18A1 is classified as a druggable target (Druggable Genome, Enzyme, and Kinase categories) with score 0.0.
No consensus clinical diagnostic criteria for neurocutaneous disorders due to mitochondrial proline synthesis defects have been published.
Neurocutaneous disorders due to mitochondrial proline synthesis defects comprise PYCR1-related autosomal recessive cutis laxa (ARCL), ALDH18A1-related ARCL, and ALDH18A1-related autosomal dominant cutis laxa (ADCL). These disorders should be suspected in probands with the following clinical, laboratory, and imaging findings.
Clinical findings
Source: GeneReviews — "Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects"
Table 4. Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects: Differential Diagnosis
Gene(s) | Disorder | MOI | Key Features of Disorder |
|---|---|---|---|
ATP6V1E1 | V-ATP-ase-related cutis laxa (ARCL2A, 2C, 2D) (See ATP6V0A2-Related Cutis Laxa.) | AR | Generalized cutis laxa; Affected persons shorter than unaffected sibs; Variable intellectual disability; Seizures |
BANF1 | Nestor-Guillermo progeria syndrome, BANF1-related (OMIM 614008) |
Genetic testing for ALDH18A1 is available. Testing is considered confirmatory for diagnosis.
No approved treatments are currently available for ALDH18A1-related de Barsy syndrome. The disease remains an area of unmet medical need.
No clinical practice guidelines for neurocutaneous disorders due to mitochondrial proline synthesis defects have been published. In the absence of published guidelines, the following recommendations are based on the authors' personal experience managing individuals with these disorders.
To establish the extent of disease and needs in an individual diagnosed with a neurocutaneous disorder due to a mitochondrial proline synthesis defect, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended.
Table 5.
Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects: Recommended Evaluations Following Initial Diagnosis
System/Concern | Evaluation | Comment
| Serum urine amino acids | To identify persons w/ levels of ornithine, citrulline, arginine, proline
| • Assess need for additional care for wound healing.
Assess risk for decubitus.
| Wound healing scarring tends to be normal, but lipodystrophy may risk of severe wounds.
| Brain MRI | To assess for gyral abnormalities, thin corpus callosum, ventricular dilatation, intracranial arterial tortuosity/ aneurysms
EEG | To assess for seizures
Full clinical neurologic exam | To assess tone, presence of movement disorders, spasticity
| Developmental assessment | • To incl motor, adaptive, cognitive, speech-language eval
Eval for early intervention/ special education
| Assess growth. | Consi...
Source: GeneReviews — "Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects"
View trials for ALDH18A1-related de Barsy syndrome
To monitor existing manifestations, the individual's response to supportive care, and the emergence of new manifestations, the evaluations summarized in are recommended. Table 7. Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects: Recommended Surveillance
System/Concern | Evaluation | Frequency |
|---|---|---|
Neurologic | Clinical neurologic exam to assess for new seizures/ changes in seizures, movement disorders, spastic diplegia | Every 6 mos initially, then annually EEG |
Development | Monitor developmental progress educational needs. | Every 6 mos initially, then annually Growth |
Orthopedics | Assess for scoliosis, hip dislocation, joint hypermobility, motor development. | Every 6 mos until age 1 yr, then annually |
Ocular | Anterior chamber eval to assess for corneal clouding cataract | Annually Cardiovascular/ |
Neurovascular | Echocardiography | Every 3 yrs; More frequently in those w/abnormal echocardiogram Brain MR angiogram |
Pulmonary | Peak flow measurements or pulmonary function tests | Every 3 yrs beginning at age 8 yrs (in those who can cooperate) |
Source: GeneReviews — "Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects"
Phenotype severity distribution: 15 always present features, 7 common features.
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).
No clinical trials have been registered for ALDH18A1-related de Barsy syndrome.
1 publication has been identified in PubMed for ALDH18A1-related de Barsy syndrome. Research spans Case Report / Case Series (100%).
Gürbüz BB (2024). [PMID: 38709052](https://pubmed.ncbi.nlm.nih.gov/38709052/). *Am J Med Genet A*. [Case Report / Case Series]
Data assembled from 7 of 12 sources · Last updated Sep 20, 2026, 5:32 PM UTC
Online Mendelian Inheritance in Man
European rare disease database
Genetic and Rare Diseases Info Center
Common questions about ALDH18A1-related de Barsy syndrome
Thin, translucent skin |
90% |
Visible veins |
Neurologic | Developmental delay | 98% |
Hypotonia | 93% | But often brisk reflexes in ALDH18A1-related ADCL |
Corpus callosum dysgenesis | 55% | — |
Athetoid movements | 26% | Most frequent in ALDH18A1-related ARCL |
Spastic diplegia | 10% | Only in ALDH18A1-related ADCL |
Growth | IUGR | 96% |
Postnatal growth deficiency | 85% | — |
Microcephaly | 68% | But neurocranium appears prominent |
Relative macrocephaly | 10% | Only in ALDH18A1-related ADCL |
Connective tissue/ Musculoskeletal | Joint hyperlaxity | 98% |
Osteopenia | 74% | Rarely, fractures |
Adducted thumbs/ clubfoot | 67% | — |
Congenital hip dislocation | 53% | — |
Wormian bones | 49% | — |
Hernias | 46% | — |
Enlarged fontanel w/delayed closure | 37% | — |
Dysmorphic/Progeroid | 95% | Often, prominent chin when older |
Ocular | Cataract | 58% |
Strabismus | 40% | — |
Blue sclerae | 35% | — |
Corneal clouding | 20% | Most frequent in ALDH18A1-related ARCL and ADCL; less frequent in PYCR1-related ARCL Based on , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Cutaneous features. At birth, all affected individuals have cutis laxa with some degree of skin wrinkling. |
Source: GeneReviews — "Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects"
AR
Large neurocranium relative to viscerocranium; Aged appearance1 |
Characteristic facial features w/severely hypoplastic jaw EFEMP1(FBLN3) | EFEMP1-related cutis laxa (ARCL1D) (OMIM 620780) | AR | Translucent skin; Joint laxity2 |
EFEMP2 | EFEMP2-related cutis laxa (ARCL1B) | AR | Thin, translucent skin w/wrinkles |
EMILIN1 | Arterial tortuosity w/bone fragility syndrome (OMIM 620908) | AR | Thin, translucent skin w/wrinkles; Bone fragility3 |
FBLN5 | FBLN5-related cutis laxa (ARCL1A) | AR | Cutis laxa |
GORAB | Geroderma osteodysplasticum, GORAB-related (OMIM 231070) | AR | Generalized cutis laxa (pronounced at hands); Hip dislocation; Short stature; Aged appearance4 |
Hutchinson-Gilford progeria syndrome | AD | Translucent skin; Large neurocranium relative to viscerocranium; Aged appearance | Characteristic facial appearance; Severe growth deficiency; Atherosclerosis; Osteoporosis; Hair loss |
LOX | Arterial tortuosity w/bone fragility syndrome5 | AR | Thin, translucent skin w/wrinkles; Bone fragility |
LTBP1 | Cutis laxa w/craniosynostosis, short stature, brachydactyly, syndactyly, LTBP1-related (OMIM 619451) | AR | Short stature; Cutis laxa6 |
LTBP4-related cutis laxa (ARCL1C) | AR | Cutis laxa | Congenital emphysema; Congenital diaphragmatic hernia; Downslanted palpebral fissures; Generalized cutis laxa w/thick skin folds; Norm... |
Source: GeneReviews — "Neurocutaneous Disorders due to Mitochondrial Proline Synthesis Defects"
AI-curated news mentioning ALDH18A1-related de Barsy syndrome
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.
A new treatment for children aged 2 or older with sickle cell disease has been approved by the U.S. Food & Drug Administration. In a press release on Wednesday, the FDA announced it had approved Casgevy, the first gene therapy for children with sickle cell disease. (NewsNation) — A new treatment for children aged 2 or older with sickle cell disease has been approved by the Food & Drug Administration (FDA). In a Wednesday news release, the FDA announced it had approved Casgevy, the first gene therapy for children with the disease. “Casgevy is a gene therapy consisting of the patient’s own (autologous) hematopoietic (blood) stem cells, administered as a one-time single dose for intravenous infusion,” the release noted. “Pediatric patients as young as 2 years of age can now access a critical additional treatment option to treat these debilitating, life-threatening diseases,” Karim Mikhail, the acting director of the Center for Biologics Evaluation and Research, wrote. “These disorders carry a heavy burden for children and their families, affecting growth, development, and long-term health in profound ways,” Megha Kaushal, acting deputy director of the Office of Therapeutic Products in CBER, said in the release.