GRACILE syndrome
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Reviewed March 2014
What is GRACILE syndrome?
GRACILE syndrome is a severe disorder that begins before birth.
GRACILE stands for the condition's characteristic features: growth
retardation, aminoaciduria, cholestasis, iron overload, lactic acidosis,
and early death.
In GRACILE syndrome, growth before birth is slow (intrauterine growth
retardation). Affected newborns are smaller than average and have an
inability to grow and gain weight at the expected rate (failure to
thrive). A characteristic of GRACILE syndrome is excess iron in the
liver, which likely begins before birth. Iron levels may begin to
improve after birth, although they typically remain elevated. Within the
first day of life, infants with GRACILE syndrome have a buildup of a
chemical called lactic acid in the body (lactic acidosis). They also
have kidney problems that lead to an excess of molecules called amino
acids in the urine (aminoaciduria). Babies with GRACILE syndrome have
cholestasis, which is a reduced ability to produce and release a
digestive fluid called bile. Cholestasis leads to irreversible liver
disease (cirrhosis) in the first few months of life.
Because of the severe health problems caused by GRACILE syndrome,
infants with this condition do not survive for more than a few months,
and about half die within a few days of birth.
GRACILE stands for the condition's characteristic features: growth
retardation, aminoaciduria, cholestasis, iron overload, lactic acidosis,
and early death.
In GRACILE syndrome, growth before birth is slow (intrauterine growth
retardation). Affected newborns are smaller than average and have an
inability to grow and gain weight at the expected rate (failure to
thrive). A characteristic of GRACILE syndrome is excess iron in the
liver, which likely begins before birth. Iron levels may begin to
improve after birth, although they typically remain elevated. Within the
first day of life, infants with GRACILE syndrome have a buildup of a
chemical called lactic acid in the body (lactic acidosis). They also
have kidney problems that lead to an excess of molecules called amino
acids in the urine (aminoaciduria). Babies with GRACILE syndrome have
cholestasis, which is a reduced ability to produce and release a
digestive fluid called bile. Cholestasis leads to irreversible liver
disease (cirrhosis) in the first few months of life.
Because of the severe health problems caused by GRACILE syndrome,
infants with this condition do not survive for more than a few months,
and about half die within a few days of birth.
How common is GRACILE syndrome?
GRACILE syndrome is found almost exclusively in Finland, where it is
estimated to affect 1 in 47,000 infants. At least 32 affected infants
have been described in the medical literature.
estimated to affect 1 in 47,000 infants. At least 32 affected infants
have been described in the medical literature.
What genes are related to GRACILE syndrome?
GRACILE syndrome is caused by a mutation in the BCS1L
gene. The protein produced from this gene is found in cell structures
called mitochondria, which convert the energy from food into a form that
cells can use. In mitochondria, the BCS1L protein plays a role in
oxidative phosphorylation, which is a multistep process through which
cells derive much of their energy. The BCS1L protein is critical for the
formation of a group of proteins known as complex III, which is one of
several protein complexes involved in oxidative phosphorylation.
The genetic change involved in GRACILE syndrome alters the BCS1L
protein, and the abnormal protein is broken down more quickly than the
normal protein. What little protein remains is able to help form some
complete complex III, although the amount is severely reduced,
particularly in the liver and kidneys. As a result, complex III activity
and oxidative phosphorylation are decreased in these organs in people
with GRACILE syndrome. Without energy, these organs become damaged,
leading to many of the features of GRACILE syndrome. It is not clear why
a change in the BCS1L gene leads to iron accumulation in people with this condition.
Read more about the BCS1L gene.
gene. The protein produced from this gene is found in cell structures
called mitochondria, which convert the energy from food into a form that
cells can use. In mitochondria, the BCS1L protein plays a role in
oxidative phosphorylation, which is a multistep process through which
cells derive much of their energy. The BCS1L protein is critical for the
formation of a group of proteins known as complex III, which is one of
several protein complexes involved in oxidative phosphorylation.
The genetic change involved in GRACILE syndrome alters the BCS1L
protein, and the abnormal protein is broken down more quickly than the
normal protein. What little protein remains is able to help form some
complete complex III, although the amount is severely reduced,
particularly in the liver and kidneys. As a result, complex III activity
and oxidative phosphorylation are decreased in these organs in people
with GRACILE syndrome. Without energy, these organs become damaged,
leading to many of the features of GRACILE syndrome. It is not clear why
a change in the BCS1L gene leads to iron accumulation in people with this condition.
Read more about the BCS1L gene.
How do people inherit GRACILE syndrome?
This condition is inherited in an autosomal recessive pattern, which
means both copies of the gene in each cell have mutations. The parents
of an individual with an autosomal recessive condition each carry one
copy of the mutated gene, but they typically do not show signs and
symptoms of the condition.
means both copies of the gene in each cell have mutations. The parents
of an individual with an autosomal recessive condition each carry one
copy of the mutated gene, but they typically do not show signs and
symptoms of the condition.
Where can I find information about diagnosis or management of GRACILE syndrome?
These resources address the diagnosis or management of GRACILE syndrome and may include treatment providers.
Educational resources and Patient support.
General information about the diagnosis and management of genetic conditions is available in the Handbook.
Read more about genetic testing, particularly the difference between clinical tests and research tests.
To locate a healthcare provider, see How can I find a genetics professional in my area? in the Handbook.
- Genetic Testing Registry: GRACILE
syndrome - MedlinePlus Encyclopedia:
Aminoaciduria - MedlinePlus Encyclopedia:
Cholestasis
Educational resources and Patient support.
General information about the diagnosis and management of genetic conditions is available in the Handbook.
Read more about genetic testing, particularly the difference between clinical tests and research tests.
To locate a healthcare provider, see How can I find a genetics professional in my area? in the Handbook.
Where can I find additional information about GRACILE syndrome?
You may find the following resources about GRACILE syndrome helpful. These materials are written for the general public.
MedlinePlus - Health information (5 links)
Educational resources - Information pages (4 links)- Patient support - For patients and families
Genetic Testing Registry - Repository of genetic test information (1 link)PubMed - Recent literatureOMIM - Genetic disorder catalog
What other names do people use for GRACILE syndrome?
- Fellman syndrome
- Finnish lactic acidosis with hepatic hemosiderosis
- Finnish lethal neonatal metabolic syndrome
- growth retardation, amino aciduria, cholestasis, iron overload, lactic acidosis, and early death
For more information about naming genetic conditions, see the Genetics Home Reference
Condition Naming Guidelines
and
How are genetic conditions and genes named? in the Handbook.
Condition Naming Guidelines
and
How are genetic conditions and genes named? in the Handbook.
What if I still have specific questions about GRACILE syndrome?
Where can I find general information about genetic conditions?
The Handbook provides basic information about genetics in clear language.
What does it mean if a disorder seems to run in my family?
What are the different ways in which a genetic condition can be inherited?
If a genetic disorder runs in my family, what are the chances that my children will have the condition?
Why are some genetic conditions more common in particular ethnic groups?
What glossary definitions help with understanding GRACILE syndrome?
acidosis ;
acids ;
aciduria ;
autosomal ;
autosomal recessive ;
bile ;
cell ;
cirrhosis ;
digestive ;
failure to thrive ;
gene ;
hepatic ;
intrauterine growth retardation ;
iron ;
kidney ;
lactic acid ;
lactic acidosis ;
mitochondria ;
mutation ;
neonatal ;
oxidative phosphorylation ;
phosphorylation ;
protein ;
recessive ;
syndrome
You may find definitions for these and many other terms in the Genetics Home Reference
Glossary.
See also Understanding Medical Terminology.
acids ;
aciduria ;
autosomal ;
autosomal recessive ;
bile ;
cell ;
cirrhosis ;
digestive ;
failure to thrive ;
gene ;
hepatic ;
intrauterine growth retardation ;
iron ;
kidney ;
lactic acid ;
lactic acidosis ;
mitochondria ;
mutation ;
neonatal ;
oxidative phosphorylation ;
phosphorylation ;
protein ;
recessive ;
syndrome
You may find definitions for these and many other terms in the Genetics Home Reference
Glossary.
See also Understanding Medical Terminology.
References (3 links)
The resources on this site should not be used as a substitute for
professional medical care or advice. Users seeking information about
a personal genetic disease, syndrome, or condition should consult with a qualified
healthcare professional.
See How can I find a genetics professional in my area? in the Handbook.
professional medical care or advice. Users seeking information about
a personal genetic disease, syndrome, or condition should consult with a qualified
healthcare professional.
See How can I find a genetics professional in my area? in the Handbook.
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