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Features include always present findings: Hemianopia, Leukoencephalopathy, Secondary amenorrhea, and Lower limb muscle weakness; and very common findings: Loss of ambulation. 7 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Brain and nerves | 3 | Seizure, Leukoencephalopathy, Dysarthria |
EIF2B3 encodes eukaryotic translation initiation factor 2B subunit gamma (452 aa). Acts as a component of the translation initiation factor 2B (eIF2B) complex, which catalyzes the exchange of GDP for GTP on the eukaryotic initiation factor 2 (eIF2) complex gamma subunit. Highest expression in Muscle Skeletal (31.1 TPM) and Nerve Tibial (26.6 TPM).
Leukoencephalopathy with vanishing white matter 3 is caused by mutations in the EIF2B3 gene on chromosome 1.
EIF2B3 is classified as a druggable target with score 0.0.
Childhood ataxia with central nervous system hypomyelination/ vanishing white matter (CACH/VWM) should be suspected in individuals with the following clinical, laboratory, and imaging findings.
Clinical findings
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
No approved treatments are currently available for leukoencephalopathy with vanishing white matter 3. The disease remains an area of unmet medical need.
To establish the extent of disease and needs in an individual diagnosed with childhood ataxia with central nervous system hypomyelination / vanishing white matter (CACH/VWM), the evaluations summarized in this section (if not performed as part of the evaluation that led to the diagnosis) are recommended:
Close surveillance for several days following head trauma or major surgical procedure with anesthesia is indicated because neurologic deterioration (presumably stress related) may follow.
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
Phenotype severity distribution: 4 always present features, 1 very common feature.
No clinical trials have been registered for leukoencephalopathy with vanishing white matter 3.
200 publications have been identified in PubMed for leukoencephalopathy with vanishing white matter 3. Kisho has analyzed 58 by research type. Research spans Basic Science / Preclinical (50%), Epidemiology / Natural History (22%), and Clinical Trial Publication (9%).
Research Type | Count | % of Total |
|---|---|---|
Laboratory research | 29 | 50% |
Data assembled from 7 of 12 sources · Last updated Sep 18, 2026, 12:10 AM UTC
Online Mendelian Inheritance in Man
Muscles
2 |
Lower limb muscle weakness, Loss of ambulation |
Hormones | 1 | Secondary amenorrhea |
Arms and legs | 1 | Lower limb muscle weakness |
Childhood ataxia with central nervous system hypomyelination/ vanishing white matter (CACH/VWM) phenotypes range from a congenital or early-infantile form (onset age 1 year) to an early childhood-onset form (onset age 1 to 4 years), a late-childhood/juvenile-onset form (onset age 4 to 18 years), and an adult-onset form (onset ≥18 years . Both the childhood and juvenile forms have been observed in sibs; the infantile and juvenile/adult forms have never been observed within the same family . Neurology. The neurologic signs depend on the age of onset . In the congenital and early-infantile forms, the encephalopathy is severe, seizures are often a predominant clinical feature, and decline is rapid and followed quickly by death.
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
Although intrafamilial variability exists, correlation between certain homozygous pathogenic variants and age of onset and disease severity has been described . A recent study of 296 individuals with CACH/VWM compared all available groups of at least three affected individuals from different families with the same pathogenic variants. In most groups with a similar genotype, severity measures, such as age of onset and survival, were rather consistent, but some variability was present, especially for pathogenic variants associated with a milder phenotype.
EIF2B5
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
Some adults who are homozygous or compound heterozygous for two disease-causing pathogenic variants in the same gene may be asymptomatic for prolonged periods of time .
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
Table 2. Other Disorders Affecting the White Matter Diffusely During Childhood to Consider in the Differential Diagnosis of CACH/VWM
Disorder | Gene(s) | MOI | Distinguishing MRI findings |
|---|---|---|---|
AARS2 | AR | Extensive or diffuse cerebral WM changes; Involvement of the corpus callosum connecting lesions on both sides; Involvement of long descending tracts Childhood cerebral form of X-linked adrenoleukodystrophy | — |
ABCD1 | XL | Extensive or diffuse cerebral WM changes but, as a rule, no cystic degeneration Arylsulfatase A deficiency (metachromatic leukodystrophy) | ARSA |
GFAP | AD | WM signal changes have a frontal predominance.; The cystic degeneration may affect the subcortical or deep WM.; Basal ganglia thalamic abnormalities are frequently present.; Contrast enhancement of characteristic structures often facilitates diagnosis. | HEPACAM |
MLC1 | ARAD1 | Diffusely abnormal mildly swollen cerebral hemispheric WM that does not show signs of diffuse rarefaction or cystic degeneration; Subcortical cysts are almost always present in the anterior temporal area often in other regions.; Cysts are best seen on proton density FLAIR. | — |
Mitochondrial leukoencephalopathies | See footnote 2. | ADARmt | MRI abnormalities may be similar to those seen in CACH/VWM, but WM cysts are typically well delineated (in contrast to CACH/VWM).; Prominent diffuse WM rarefaction cystic degeneration may be seen in mitochondrial disorders. |
PLP1 | XL | Diffuse hyperintensity of WM on T2-weighted images is also observed in leukodystrophies w/primary hypomyelination (e.g., PLP1-related disorders), but these disorders have a normal or nearly normal WM signal on T1-weighted images CT scan. | — |
NOTCH3 | AD | Consider these disorders in those w/adult-onset CACH/VWM; however, the early constant diffuse symmetric alteration of WM on MRI in eIF2B-related disorders is distinctive. Autosomal dominant leukodystrophy with autonomic disease | LMNB1 |
AD Acquired white matter disorders such as multiple sclerosis | See footnote 3. | See footnote 4. AD = autosomal dominant; AR = autosomal recessive; CACH/VWM = childhood ataxia with central nervous system / hypomyelination / vanishing white matter; MOI = mode of inheritance; mt = mitochondrial; WM = white matter; XL = X-linked 1. | — |
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
Genetic testing for EIF2B3 is available. Testing is considered confirmatory for diagnosis.
Biomarker and diagnostic research for leukoencephalopathy with vanishing white matter 3 has been reported in the published literature.
Brain MRI
Ophthalmologic examination
Neurologic examination
Physical therapy/occupational therapy assessment as needed
Consultation with a clinical geneticist and/or genetic counselor
Note: If an individual is diagnosed while asymptomatic, either because of an affected sib or as an incidental finding on exome sequencing, the above evaluations and the recommendations in should be applied.
The following are appropriate:
Physical therapy and rehabilitation for motor dysfunction (mainly spasticity and ataxia)
Ankle-foot orthotics in individuals with hypotonia and weakness of ankle dorsiflexors
Anti-seizure medication for treatment of seizures and abnormalities of behavior and mood
Considering the known adverse effect of fever, it is important to prevent infections and fever as much as possible (e.g., through the use of vaccinations, including anti-flu vaccination); low-dose maintenance antibiotics during winter, antibiotics for minor infections, and antipyretics for fever are appropriate. For children, wearing a helmet while outside helps minimize the effects of possible head trauma.
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
Avoid the following:
Contact sports and other activities with a high risk of head trauma
Stressful emotional and physical situations (e.g., acute fright, fever and other causes of extreme temperatures, major surgery)
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
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. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "Childhood Ataxia with Central Nervous System Hypomyelination/ Vanishing White Matter"
View trials for leukoencephalopathy with vanishing white matter 3
Disease patterns and progression |
13 |
22% |
Clinical study results | 5 | 9% |
Testing and diagnosis research | 3 | 5% |
Patient case studies | 3 | 5% |
New treatment approaches | 3 | 5% |
Research summaries | 2 | 3% |
Plug BC (2026). [PMID: 41144823](https://pubmed.ncbi.nlm.nih.gov/41144823/). *Ann Neurol*. [Basic Science / Preclinical]
Möhn N (2026). [PMID: 41557340](https://pubmed.ncbi.nlm.nih.gov/41557340/). *JAMA Neurol*. [Gene Therapy / Novel Therapeutics]
Sun Q (2026). [PMID: 41813890](https://pubmed.ncbi.nlm.nih.gov/41813890/). *Nature*. [Basic Science / Preclinical]
Guerra J (2025). [PMID: 40305757](https://pubmed.ncbi.nlm.nih.gov/40305757/). *Brain*. [Basic Science / Preclinical]
Carta S (2025). [PMID: 40829090](https://pubmed.ncbi.nlm.nih.gov/40829090/). *Neurol Neuroimmunol Neuroinflamm*. [Diagnostic / Biomarker]
Wang C (2025). [PMID: 40482033](https://pubmed.ncbi.nlm.nih.gov/40482033/). *Cell Rep*. [Gene Therapy / Novel Therapeutics]
Lee JY (2025). [PMID: 40267374](https://pubmed.ncbi.nlm.nih.gov/40267374/). *Neurology*. [Epidemiology / Natural History]
Zhao Y (2025). [PMID: 40393245](https://pubmed.ncbi.nlm.nih.gov/40393245/). *Phytomedicine*. [Basic Science / Preclinical]
Liu X (2025). [PMID: 41276507](https://pubmed.ncbi.nlm.nih.gov/41276507/). *Nat Commun*. [Basic Science / Preclinical]
Woo MS (2025). [PMID: 40532699](https://pubmed.ncbi.nlm.nih.gov/40532699/). *Cell*. [Basic Science / Preclinical]
AI-curated news mentioning leukoencephalopathy with vanishing white matter 3
Updated Aug 13, 2026
A recent study explores the potential of guanabenz as a mechanism-based treatment for vanishing white matter. This research could pave the way for new therapeutic strategies targeting the underlying mechanisms of the disease.