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A disease that has its basis in the disruption of glycoprotein metabolic process.
No HPO annotations are available for this condition.
NGLY1-related congenital disorder of deglycosylation (NGLY1-CDDG) is a multisystemic neurodevelopmental disorder in which individuals most commonly exhibit a tetrad of developmental delay / intellectual disability, hyperkinetic movement disorder, hypolacrima, and elevated transaminases during early childhood [, , , , ]. Diagnosis has been achieved at ages ranging from three months to 20 years, mostly through broad molecular testing, such as exome analysis. While most individuals with NGLY1-CDDG survive into early adulthood, with a relatively stable clinical course , death during infancy from unclear causes has been reported.
Formal diagnostic criteria have not been established.
NGLY1-related congenital disorder of deglycosylation (NGLY1-CDDG) should be suspected in individuals with the following clinical features and supportive laboratory findings. Clinical features include:
Developmental delay / intellectual disability, most often in the severe to profound range
No approved treatments are currently available for glycoprotein metabolism disease. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with NGLY1-related congenital disorder of deglycosylation (NGLY1-CDDG), the evaluations summarized (if not performed as part of the initial evaluation that led to diagnosis) are recommended. Table 3. Recommended Evaluations Following Initial Diagnosis of NGLY1-CDDG
In the absence of formal surveillance guidelines, the authors recommend the following:
Annual follow up by:
Pediatrician or internist
Physical medicine and rehabilitation medicine
No clinical trials have been registered for glycoprotein metabolism disease.
247 publications have been identified in PubMed for glycoprotein metabolism disease. Kisho has analyzed 68 by research type. Research spans Basic Science / Preclinical (68%), Review / Meta-Analysis (21%), and Gene Therapy / Novel Therapeutics (6%).
Research Type | Count | % of Total |
|---|---|---|
Laboratory research | 46 | 68% |
Data assembled from 3 of 12 sources · Last updated Sep 19, 2026, 4:32 PM UTC
Source: GeneReviews — "NGLY1-Related Congenital Disorder of Deglycosylation"
Hypo- or alacrima
Supportive laboratory findings include elevated ALT and AST during early childhood that spontaneously normalize. Note: Typical serum screening tests for congenital disorders of glycosylation (i.e., analysis of serum transferrin glycoforms, N and O glycan profiling) will NOT reliably detect NGLY1-CDDG (see , Biochemical).
The diagnosis of NGLY1-CDDG is established...
Source: GeneReviews — "NGLY1-Related Congenital Disorder of Deglycosylation"
The tetrad of developmental delay / cognitive impairment, hyperkinetic movement disorder, hypo/alacrima, and elevated transaminases during early childhood is pathognomonic of NGLY1-CDDG [, , , , ]. However, other multisystemic disorders and conditions that feature variable neurologic phenotypes, including seizures, chorea, athetosis, dystonia, myoclonus, tremors, ataxia, and dysmetria, are in the differential diagnosis.
Table 2.
Disorders to Consider in the Differential Diagnosis of NGLY1-Related Congenital Disorder of Deglycosylation
Disorder | Gene(s) | MOI | Clinical Features
Overlapping | Distinguishing
Congenital disorders of glycosylation (CDGs) (see Congenital Disorders of N-Linked Glycosylation and Multiple Pathway Overview.) | See footnote 1. | ARXL | • Intrauterine growth restriction
Source: GeneReviews — "NGLY1-Related Congenital Disorder of Deglycosylation"
Biomarker and diagnostic research for glycoprotein metabolism disease has been reported in the published literature.
System/Concern | Evaluation | Comment |
|---|---|---|
Eyes | Ophthalmologic eval for hypolacrima retinal disease | — |
ENT/Mouth | Auditory brain stem evoked potentials | — |
Respiratory | Sleep study | If review of systems reveals snoring or symptoms concerning for sleep apnea |
Gastrointestinal | Nutrition eval to optimize intake | Feeding swallowing eval if indicated; Transaminase levels; Eval for constipation |
Musculoskeletal | Radiologic orthopedic assessment incl DXA scan | To evaluate bone health help manage scoliosis, coxa valga, /or contractures |
Skin | QSWEAT analysis to evaluate for hypohydrosis | Neurologic |
Endocrinologic | Vitamin D level | To assess for vitamin D deficiency Hematologic/ |
Lymphatic | Protein C; factor II, IX, XI; fibrinogen levels | Consultation w/hematologist if abnormal Miscellaneous/ |
Other | Speech language eval | Referral to speech therapist if indicated Rehabilitation team eval |
Treatment of Manifestations in Individuals with NGLY1-CDDG Manifestation/Concern | Treatment | Considerations/Other |
Hypolacrima | Lubricating eye drops /or bland ointments | — |
Hearing loss | Standard treatment | See Hereditary Hearing Loss and Deafness Overview. |
Sleep apnea | Routine management | — |
Oromotor deficits leading to feeding problems | Feeding therapy; supplemental tube feeding if indicated | Referral to gastroenterologist |
Constipation | Standard management | Referral to gastroenterologist if refractory to typical medical management |
Abnormal hematologic /or gastroenterologic labs | Follow up w/hematologist gastroenterologist | — |
Scoliosis osteopenia | Routine management | — |
Hypohydrosis | Adequate access to water cool environment (AC, wet T-shirt, /or spray bottle of water) | Cooling vests may be helpful in hot climates. |
Seizures | Standard treatment | Referral to neurologist for those w/refractory or severe seizures |
Vitamin D deficiency | Supplemental vitamin D | — |
Any condition requiring surgical intervention | Surgery best performed in centers w/surgeons anesthesiologists experienced in care of those w/metabolic disorders special needs | AC = air conditioning The following information represents typical management recommendations for individuals with developmental delay / intellectual disability in the United States; standard recommendations may vary from country to country. Ages 0-3 years. |
Source: GeneReviews — "NGLY1-Related Congenital Disorder of Deglycosylation"
Hot environment should be avoided by those with hypohydrosis.
Source: GeneReviews — "NGLY1-Related Congenital Disorder of Deglycosylation"
No FDA-approved treatments for NGLY1-CDDG exist. Enzyme replacement therapy is currently being evaluated in the pre-clinical arena. Pre-clinical screens for endo-beta-N-acetylglucosaminidase (ENGase) inhibitors are underway . Large-scale compound screens on model organisms and cell lines are being evaluated. Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for information on clinical studies for a wide range of diseases and conditions.
Source: GeneReviews — "NGLY1-Related Congenital Disorder of Deglycosylation"
View trials for glycoprotein metabolism disease
Neurology
Nutrition
Follow up as recommended by:
Developmental pediatrician
Gastroenterologist/hepatologist
Audiologist
Clinical or biochemical geneticist
Source: GeneReviews — "NGLY1-Related Congenital Disorder of Deglycosylation"
Research summaries |
14 |
21% |
New treatment approaches | 4 | 6% |
Testing and diagnosis research | 3 | 4% |
Disease patterns and progression | 1 | 1% |
Chen X (2026). [PMID: 41461939](https://pubmed.ncbi.nlm.nih.gov/41461939/). *Nat Nanotechnol*. [Gene Therapy / Novel Therapeutics]
Xi Y (2026). [PMID: 41708863](https://pubmed.ncbi.nlm.nih.gov/41708863/). *Nature*. [Basic Science / Preclinical]
Duarte-Ruiz M (2025). [PMID: 41360765](https://pubmed.ncbi.nlm.nih.gov/41360765/). *Cell Death Dis*. [Basic Science / Preclinical]
Semo D (2025). [PMID: 40429707](https://pubmed.ncbi.nlm.nih.gov/40429707/). *Int J Mol Sci*. [Basic Science / Preclinical]
Tao Y (2025). [PMID: 40935818](https://pubmed.ncbi.nlm.nih.gov/40935818/). *Transl Psychiatry*. [Review / Meta-Analysis]
Chen S (2025). [PMID: 41301426](https://pubmed.ncbi.nlm.nih.gov/41301426/). *Biomolecules*. [Review / Meta-Analysis]
Gu X (2025). [PMID: 39490681](https://pubmed.ncbi.nlm.nih.gov/39490681/). *Transl Res*. [Epidemiology / Natural History]
Hua N (2025). [PMID: 40145840](https://pubmed.ncbi.nlm.nih.gov/40145840/). *Adv Sci (Weinh)*. [Diagnostic / Biomarker]
Yang K (2025). [PMID: 40644312](https://pubmed.ncbi.nlm.nih.gov/40644312/). *J Exp Med*. [Basic Science / Preclinical]
Sapaly D (2025). [PMID: 39197036](https://pubmed.ncbi.nlm.nih.gov/39197036/). *Brain*. [Basic Science / Preclinical]