Sjögren-Larsson syndrome: a complex metabolic disease with a distinctive ocular phenotype

ABSTRACT

Purpose: Sjögren-Larsson Syndrome (SLS) is a rare genetic disorder characterized by a distinctive crystalline maculopathy, congenital ichthyosis, spasticity and intellectual disability. We review the genetic, biochemical and clinical aspects of SLS with a particular focus on the ophthalmologic features of the disease.Methods: Published reports of SLS are combined with clinical experience to provide an overview of this disease.Results: SLS is caused by bi-allelic mutations in ALDH3A2, which codes for fatty aldehyde dehydrogenase, a key enzyme needed for the metabolism of long-chain aliphatic aldehydes and alcohols. SLS patients display perifoveal crystalline inclusions (glistening white dots) that appear in early childhood, vary from sparse to florid and are located in the inner retina. Other findings include retinal thinning, cystic macular degeneration, retinal pigment epithelium atrophy and deficiency of macular pigment. Photophobia is common. Visual evoked potentials are often absent or delayed, whereas electroretinography studies are usually normal. Mild-moderate deficits in visual acuity are common but vision is usually preserved into adulthood. The maculopathy is thought to be due to the accumulation of fatty aldehydes and/or alcohols, which alter membrane function. Defective macular pigment metabolism may also contribute to a unique susceptibility to photo-oxidative damage in the retina.Conclusions: The distinctive retinal phenotype, together with the neurologic and cutaneous symptoms, allows the ophthalmologist to reliably diagnose SLS. Although no effective treatment exists for the ocular symptoms, emerging insight into the pathogenic mechanisms at play in the eye promises to bring effective therapy for SLS in the future.

KEYWORDS:

• Sjogren-Larsson syndrome
• crystalline inclusions
• maculopathy
• fatty aldehyde
• fatty alcohol

Acknowledgments

We gratefully acknowledge funding from 1) the Sterol and Isoprenoid Research Consortium of the Rare Disease Clinical Research Network, grant U54 HD061939 from the Eunice Kennedy Shriver National Institutes of Child Health & Human Development and National Center for Advancing Translational Sciences, NIH; 2) the Sjögren-Larsson Syndrome Research Fund of the University of Nebraska Foundation, and 3) the Department of Pediatrics.

Contributions of authors

Manuscript preparation (WBR, SFJ); Manuscript review (WBR, SFJ, DWS), Manuscript approval (all authors).

Financial conflicts

S. Fouzdar-Jain: none; D. Suh: none; W.B. Rizzo: funding from Aldeyra Therapeutics for research on ADX-102