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A lysosomal disorder from the GM2 gangliosidosis family, caused by biallelic pathogenic variants in the HEXB gene, characterized by GM2 ganglioside accumulation in the nervous system and progressive central nervous system degeneration.
Data assembled from 10 of 12 sources · Last updated Sep 18, 2026, 7:12 PM UTC
Online Mendelian Inheritance in Man
European rare disease database
Genetic and Rare Diseases Info Center
Features include always present findings: Exaggerated startle response, Cherry red spot of the macula, Overactive reflexes (hyperreflexia), and Loss of previously acquired skills (developmental regression) and others; and common findings: Bilateral tonic-clonic seizure, Low muscle tone (hypotonia), Myoclonic seizure, and Macrocephaly and others. 34 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Brain and nerves | 9 | Bilateral tonic-clonic seizure, Exaggerated startle response, Ataxia |
Muscles | 4 | Low muscle tone (hypotonia), Fasciculations, Muscle weakness |
Digestive system | 4 | Enlarged liver (hepatomegaly), Episodic abdominal pain, Hepatosplenomegaly |
Kidneys and urinary system | 2 | Urinary incontinence, Increased urinary N-acetylglucosamine-rich oligosaccharide level |
Eyes | 2 | Cherry red spot of the macula, Blindness |
Head and neck | 2 | Coarse facial features, Macrocephaly |
Skin | 2 | Excessive sweating (hyperhidrosis), Decreased sweating (hypohidrosis) |
Metabolism | 1 | Abnormal fat metabolism (abnormal glycosphingolipid metabolism) |
Bones and joints | 1 | Skeletal muscle atrophy |
Heart and blood vessels | 1 | Enlarged heart (cardiomegaly) |
Age of onset: infancy.
The phenotypes of Sandhoff disease comprise a continuum ranging from acute infantile to subacute juvenile and late-onset Sandhoff disease. Although classification into these phenotypes is somewhat arbitrary, the classification is helpful in understanding the variation observed in the timing of disease onset, presenting manifestations, rate of progression, and life span. Despite numerous case reports of individuals with Sandhoff disease from specific ethnic backgrounds, few prospective studies have delineated the progression of disease by phenotype.
Affected infants are generally normal at birth. Progressive weakness, exaggerated startle, and slowing of developmental progress is typically noted between ages three and six months. Decreasing visual attentiveness...
Source: GeneReviews — "Sandhoff Disease"
HEXB encodes hexosaminidase subunit beta (556 aa). Hydrolyzes the non-reducing end N-acetyl-D-hexosamine and/or sulfated N-acetyl-D-hexosamine of glycoconjugates, such as the oligosaccharide moieties from proteins and neutral glycolipids, or from certain mucopolysaccharides. Highest expression in Cells Cultured fibroblasts (137.7 TPM) and Artery Aorta (121.2 TPM).
Sandhoff disease is caused by mutations in the HEXB gene on chromosome 5.
HEXB is classified as a druggable target (Enzyme category) with score 2.6.
The following HEXB variants are associated with acute infantile Sandhoff disease in the homozygous state or in a compound heterozygous state with null variants:
•
•
•
In general, individuals with two null (nonexpressing) variants have the acute infantile phenotype, individuals with one null variant and one missense variant have the subacute juvenile phenotype, and individuals with two missense variants have the late-onset phenotype. This reflects the inverse correlation of the level of the residual hexosaminidase B (HEX B) enzyme activity with disease severity: the lower the enzymatic activity, the more severe the phenotype is likely to be. Nonetheless, clinical variability can be observed among family members with the subacute juvenile and late-onset phenotypes.
Source: GeneReviews — "Sandhoff Disease"
No consensus clinical diagnostic criteria for Sandhoff disease have been published.
Sandhoff disease should be suspected in individuals with the following findings by phenotype.
Acute Infantile Sandhoff Disease (onset age 6 months)
Clinical findings
• Neurologic
Progressive weakness or loss of motor skills
Decreased attentiveness
Exaggerated startle response
Hypotonia
Hyperreflexia
Seizures
• Other
Cherry-red macula (seen in virtually all children with infantile disease)
Progressive macrocephaly
Hepatosplenomegaly
Brain MRI findings
Source: GeneReviews — "Sandhoff Disease"
Acute Infantile Sandhoff Disease Table 2. Genetic Disorders of Interest in the Differential Diagnosis of Acute Infantile Sandhoff Disease
Gene | DiffDx Disorder1 | Clinical Features of DiffDx Disorder |
|---|---|---|
Cherry-red macula (≤12 mos) | Onset of neurologic regression | Other features / Comments |
≤6 mos | Macrocephaly, head lag, hypotonia, seizures | Leukoencephalopathy CLN5 CLN6 CLN8 CTSD MFSD8 PPT1 TPP1 |
≤6 mos |
Genetic testing for HEXB is available. Testing is considered confirmatory for diagnosis.
Biomarker and diagnostic research for Sandhoff disease has been reported in the published literature.
No approved treatments are currently available for Sandhoff disease. An additional 3 compounds hold orphan drug designation.
While no drugs are FDA-approved specifically for Sandhoff disease, some of the following designated compounds may be used off-label in clinical practice. Treatment decisions should be made in consultation with a specialist familiar with this condition.
The following drugs have received orphan drug designation from the FDA for Sandhoff disease. Orphan designation reflects regulatory interest and does not indicate approval for treatment.
Brand Name | Generic Name | Sponsor | Designated | Exclusivity End | Designation Status |
|---|---|---|---|---|---|
Biphenyl-substituted L-ido configured deoxynojirimycin derivative | Biphenyl-substituted L-ido configured deoxynojirimycin derivative | Azafaros BV | 2022 | — | Designated |
recombinant adeno- associated virus vector AAV2/rh8 expressing human B-hexosaminidase A and B subunits | recombinant adeno- associated virus vector AAV2/rh8 expressing human B-hexosaminidase A and B subunits | Nat'l Tay-Sachs & Allied Diseases Association | 2013 | — | Designated |
pyrimethamine | pyrimethamine | ExSAR Corporation | 2011 | — | Designated |
No clinical practice guidelines for Sandhoff disease have been published. Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with Sandhoff disease, the evaluations summarized in , , and (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 5. Recommended Evaluations Following Initial Diagnosis in Individuals with Acute Infantile Sandhoff Disease
System/Concern | Evaluation | Comment |
|---|---|---|
Neurologic | Neurology eval | To incl brain MRI; Consider EEG if seizures are a concern. Musculoskeletal |
system | Physical medicine rehab/ PT OT eval | To incl assessment of:; Gross motor fine motor skills; Need for adaptive devices; Need for PT (to prevent deformities) Gastrointestinal/ |
For individuals with acute infantile Sandhoff disease, avoid:
Positioning that increases aspiration risk during feedings;
Seizure medication dosages that result in excessive sedation.
For individuals with subacute juvenile Sandhoff disease, avoid:
Situations that increase the likelihood of contractures or pressure sores, such as extended periods of immobility;
Circumstances that exacerbate the risk of falls.
For individuals with late-onset Sandhoff disease, avoid:
Situations that exacerbate fall risk (i.e., walking on uneven or unstable surfaces);
Psychiatric medications that have been associated with disease worsening in late-onset Tay-Sachs disease, a similar disorder (e.g., haloperidol, risperidone, chlorpromazine) .
Source: GeneReviews — "Sandhoff Disease"
In-progress or recently concluded studies:
Source: GeneReviews — "Sandhoff Disease"
6 trials found
There are no formal guidelines for surveillance for individuals with Sandhoff disease. , , and provide suggestions for periodic evaluations to monitor existing disease manifestations and to identify new manifestations requiring modification of supportive care. Table 11. Recommended Surveillance for Individuals with Acute Infantile Sandhoff Disease
System/Concern | Evaluation | Frequency |
|---|---|---|
Neurologic decline | By pediatric neurologist w/attention to seizure severity response to ASM | Every 3-6 mos Abnormal tone / Impaired mobility |
Recommended Surveillance for Individuals with Subacute Juvenile Sandhoff Disease System/Concern | Evaluation | Frequency |
Neurologic decline | Neurology eval for tone, cognition, seizure onset/control | Annually or as needed for seizures |
Development | Developmental/educational needs | Annually Speech-language |
development / Dysarthria | By speech-language pathologist | Per treating clinician Musculoskeletal system |
Source: GeneReviews — "Sandhoff Disease"
Phenotype severity distribution: 5 always present features, 5 common features.
Estimated prevalence: 1-9 in 1,000,000 (Rare).
6 clinical trials registered, 3 recruiting. Interventions under study include biologic therapy, drug therapy, and other interventions. Pipeline includes 1 PHASE2, 1 PHASE1. Research is sponsored by a mix of industry and academic institutions.
NCT ID | Title | Phase | Sponsor | Status |
|---|---|---|---|---|
[NCT07445490](https://clinicaltrials.gov/study/NCT07445490) | Translational Potential of ex Vivo Gene Therapy in GM2 Gangliosidosis | — | Assistance Publique - Hôpitaux de Paris | NOT_YET_RECRUITING |
[NCT02254863](https://clinicaltrials.gov/study/NCT02254863) | UCB Transplant of Inherited Metabolic Diseases With Administration of Intrathecal UCB Derived Oligodendrocyte-Like Cells | PHASE1 | Joanne Kurtzberg, MD | RECRUITING |
[NCT03333200](https://clinicaltrials.gov/study/NCT03333200) | Longitudinal Study of Neurodegenerative Disorders | — | University of Pittsburgh | RECRUITING |
[NCT06614569](https://clinicaltrials.gov/study/NCT06614569) | Long-Term Follow-Up of Subjects Treated With AXO-AAV-GM2 for Tay-Sachs or Sandhoff Disease | — | Terence Flotte | ACTIVE_NOT_RECRUITING |
[NCT00668187](https://clinicaltrials.gov/study/NCT00668187) | A Natural History Study of the Gangliosidoses | — | University of Minnesota | RECRUITING |
51 publications have been identified in PubMed for Sandhoff disease. Research spans Basic Science / Preclinical (37%), Gene Therapy / Novel Therapeutics (18%), and Diagnostic / Biomarker (10%).
Research Type | Count | % of Total |
|---|---|---|
Laboratory research | 19 | 37% |
New treatment approaches | 9 | 18% |
Testing and diagnosis research | 5 | 10% |
Clinical study results | 5 | 10% |
Disease patterns and progression | 5 | 10% |
Research summaries | 4 |
Landskroner K (2026). [PMID: 41500827](https://pubmed.ncbi.nlm.nih.gov/41500827/). *Journal of inherited metabolic disease*. [Basic Science / Preclinical]
Tang Y (2026). [PMID: 42087242](https://pubmed.ncbi.nlm.nih.gov/42087242/). *Acta Neuropathol Commun*. [Case Report / Case Series]
Kitakaze K (2026). [PMID: 42025166](https://pubmed.ncbi.nlm.nih.gov/42025166/). *Cell Rep Med*. [Gene Therapy / Novel Therapeutics]
Jovanovic VM (2026). [PMID: 41795546](https://pubmed.ncbi.nlm.nih.gov/41795546/). *Stem cell research*. [Diagnostic / Biomarker]
Mushtaheed A (2026). [PMID: 41911625](https://pubmed.ncbi.nlm.nih.gov/41911625/). *Clin Neurophysiol*. [Diagnostic / Biomarker]
Steiner MA (2026). [PMID: 42157966](https://pubmed.ncbi.nlm.nih.gov/42157966/). *Mol Ther Adv*. [Gene Therapy / Novel Therapeutics]
Hammoud M (2026). [PMID: 42167572](https://pubmed.ncbi.nlm.nih.gov/42167572/). *Anal Biochem*. [Diagnostic / Biomarker]
Tifft CJ (2026). [PMID: 41108138](https://pubmed.ncbi.nlm.nih.gov/41108138/). *Genetics in medicine : official journal of the American College of Medical Genetics*. [Clinical Trial Publication]
Cui K (2026). [PMID: 41701133](https://pubmed.ncbi.nlm.nih.gov/41701133/). *Ophthalmology. Retina*. [Case Report / Case Series]
Mengel KE (2026). [PMID: 42234134](https://pubmed.ncbi.nlm.nih.gov/42234134/). *Nervenarzt*. [Review / Meta-Analysis]
Abnormal ERG |
CTSA | Galactosialidosis (OMIM 256540) | + |
≤6 mos | Seizures | Leukodystrophy, peripheral neuropathy, irritability |
GBA1 (GBA) | Gaucher disease type 2 | — |
≤6 mos | Seizures in some persons | Oculomotor abnormalities, hypertonia, opisthotonos |
GFAP | Alexander disease, infantile form | — |
≤6 mos | Macrocephaly, seizures | Leukodystrophy |
GLB1 | GM1 gangliosidosis type 1 (See GLB1 Disorders.) | + |
GM2A | Activator-deficient TSD2 (See GM2 Activator Deficiency.) | + |
GNPTAB | Mucolipidosis II (I-cell disease) (See GNPTAB Disorders.) | ≤12 mos |
HEXA | Tay-Sachs disease (See HEXA Disorders.) | + |
NEU1 | Sialidosis type II (OMIM 256550) | + |
SMPD1 | Niemann-Pick disease type A (See Acid Sphingomyelinase Deficiency.) | + |
Source: GeneReviews — "Sandhoff Disease"
Feeding | Gastroenterology/ nutrition/ feeding team eval | To incl swallow study for eval of aspiration risk nutritional status; Consider eval for gastrostomy tube placement in those w/dysphagia /or aspiration risk.; Assess for constipation. |
Eyes | Ophthalmologic exam | Eval for macular degeneration, cherry-red macula, visual loss |
Respiratory | Evaluate for aspiration risk. | Assess need for airway hygiene. Genetic |
counseling | By genetics professionals1 | To obtain a pedigree inform affected persons families re nature, MOI, implications of this disorder to facilitate medical personal decision making Family support resources |
Ethics consultation | Clinical ethics services | Assess health care decisions in the context of the best interest of the child values preferences of the family.; For difficult life-prolonging decisions or for clarification of treatment options, consider further consultation w/independent clinical teams. |
Recommended Evaluations Following Initial Diagnosis in Individuals with Subacute Juvenile Sandhoff Disease System/Concern | Evaluation | Comment |
Neurologic | Neurology eval | To incl brain MRI; Consider EEG if seizures are a concern.; Evaluate for spasticity. |
Development | Developmental assessment | To incl motor, adaptive, cognitive, speech-language eval; Eval for IEP Speech-language development / |
Dysarthria | Speech-language eval | By speech-language pathologist Musculoskeletal |
system | Physical medicine rehab/ PT OT eval | To incl assessment of:; Gross motor fine motor skills; Mobility, independence in ADL, need for adaptive devices; Need for PT (to prevent fixed deformities) Gastrointestinal/ |
Feeding | Gastroenterology/ nutrition/ feeding team eval | To incl swallow study for eval of aspiration risk nutritional status; Consider eval for gastrostomy tube placement in those w/dysphagia /or aspiration risk.; Assess for constipation. |
Eyes | Ophthalmologic exam | Assess visual acuity. |
Respiratory | Eval for aspiration risk | Assess need for airway hygiene percussion vest. Genetic |
counseling | By genetics professionals1 | To obtain a pedigree inform affected persons families re nature, MOI, implications of this disorder to facilitate medical personal decision making Family support resources |
Source: GeneReviews — "Sandhoff Disease"
Patient case studies | 4 | 8% |
AI-curated news mentioning Sandhoff disease
Updated Aug 19, 2026
Andelyn Biosciences is set to develop and manufacture a gene therapy known as AAV9-GM2, for Queen’s University to treat GM2 gangliosidoses, including Tay-Sachs and Sandhoff diseases. Andelyn Biosciences is set to develop and manufacture a gene therapy known as AAV9-GM2, for Queen’s University to treat GM2 gangliosidoses, including Tay-Sachs and Sandhoff diseases. Using its platform, Andelyn Biosciences plans to implement a multi-phase programme. Credit: Gorodenkoff / Shutterstock.com. ... The partnership aims to progress this gene therapy using Andelyn’s AAV Curator Platform. GM2 gangliosidosis is a rare genetic disorder that leads to the progressive loss of nerve cells in the brain and spinal cord. The condition belongs to the group of lysosomal storage disorders and results from genetic mutations that impair lysosomal function, leading to harmful accumulation within cells and severe neurological symptoms. Andelyn Biosciences will implement a multi-phase programme using its Curator Platform, which features a cell line and a modular approach intended to adapt manufacturing processes to specific programme needs. Queen’s University medical geneticist and department of paediatrics professor Dr Jagdeep Walia said: “This partnership with Andelyn is very strategic as they have the established expertise of producing vectors for many gene therapy programmes. In August 2025, Andelyn Biosciences entered a collaboration with Amplo Biotechnology to manufacture adeno-associated virus (AAV) gene therapies to address conditions affecting the neuromuscular junction.
18, 2026 /PRNewswire/ -- Andelyn ... cell and gene therapy Contract Development and Manufacturing Organization (CDMO), has partnered with Queen's University to develop and manufacture AAV9-GM2, a gene therapy candidate for the treatment of GM2 gangliosidoses, such as Tay-Sachs and Sandhoff diseases. GM2 gangliosidosis is a rare, inherited disorder that progressively ... 18, 2026 /PRNewswire/ -- Andelyn Biosciences, Inc., a leading patient-focused cell and gene therapy Contract Development and Manufacturing Organization (CDMO), has partnered with Queen's University to develop and manufacture AAV9-GM2, a gene therapy candidate for the treatment of GM2 gangliosidoses, such as Tay-Sachs and Sandhoff diseases. GM2 gangliosidosis is a rare, inherited disorder that progressively destroys nerve cells in the brain and spinal cord. This partnership reflects Andelyn's continued commitment to supporting innovative gene therapy programs targeting rare and ultra-rare diseases, where speed, quality, and manufacturing expertise are critical to advancing therapies to patients. ... Andelyn Biosciences is a full-service cell and gene therapy CDMO focused on the development, characterization, and production of viral vectors for gene therapy. The AAV Curator® Platform is Andelyn's long-standing, regulatory-proven viral vector process, complete with a cell line and a modular approach to adapting unit operations to program requirements. With this methodology, both yield and quality are delivered. "We are proud to partner with Queen's University to advance this gene therapy candidate for the benefit of patients and families facing the challenges of GM2 gangliosidoses," said Matt Niloff, Chief Commercial Officer at Andelyn Biosciences. Operating out of its development and manufacturing facilities in Columbus, Ohio, Andelyn supports its clients in developing cell and gene therapies from concept through plasmid engineering and manufacturing, process and analytical development, and cGMP clinical and commercial manufacturing.
18, 2026 /PRNewswire/ -- Andelyn ... cell and gene therapy Contract Development and Manufacturing Organization (CDMO), has partnered with Queen's University to develop and manufacture AAV9-GM2, a gene therapy candidate for the treatment of GM2 gangliosidoses, such as Tay-Sachs and Sandhoff diseases. GM2 gangliosidosis is a rare, inherited disorder that progressively ... 18, 2026 /PRNewswire/ -- Andelyn Biosciences, Inc., a leading patient-focused cell and gene therapy Contract Development and Manufacturing Organization (CDMO), has partnered with Queen's University to develop and manufacture AAV9-GM2, a gene therapy candidate for the treatment of GM2 gangliosidoses, such as Tay-Sachs and Sandhoff diseases. GM2 gangliosidosis is a rare, inherited disorder that progressively destroys nerve cells in the brain and spinal cord. This partnership reflects Andelyn's continued commitment to supporting innovative gene therapy programs targeting rare and ultra-rare diseases, where speed, quality, and manufacturing expertise are critical to advancing therapies to patients. ... Andelyn Biosciences is a full-service cell and gene therapy CDMO focused on the development, characterization, and production of viral vectors for gene therapy. The AAV Curator® Platform is Andelyn's long-standing, regulatory-proven viral vector process, complete with a cell line and a modular approach to adapting unit operations to program requirements. With this methodology, both yield and quality are delivered. "We are proud to partner with Queen's University to advance this gene therapy candidate for the benefit of patients and families facing the challenges of GM2 gangliosidoses," said Matt Niloff, Chief Commercial Officer at Andelyn Biosciences. Operating out of its development and manufacturing facilities in Columbus, Ohio, Andelyn supports its clients in developing cell and gene therapies from concept through plasmid engineering and manufacturing, process and analytical development, and cGMP clinical and commercial manufacturing.
A recent study explores adult-onset Sandhoff disease, revealing a motor neuron disease phenotype through patient-derived models. This research provides new mechanistic insights that could inform future therapeutic strategies.
Researchers have successfully generated and characterized induced pluripotent stem cell lines from patients with Tay-Sachs and Sandhoff disease. This advancement may facilitate further studies into the pathophysiology and potential therapies for these lysosomal storage disorders.