All three forms of MLD are caused by mutations in the ARSA gene. Mutations that result in no enzyme activity are called I alleles while mutations that result in some residual enzyme activity are called A alleles. Pseudodeficiency mutations, called Pd alleles, which result in lower enzyme activity but are not disease-causing have been described. Diagnostic sequencing analysis of the ARSA gene coding region is available for patients with metachromatic leukodystrophy and their at-risk relatives on a clinical basis.
For patients with mutations not identified by full gene sequencing, a separate deletion/duplication assay is available using a targeted CGH array
For questions about testing for MLD, call the Emory Genetics Laboratory at (404) 778-8499 or (855) 831-7447. For further clinical information about lysosomal storage diseases, including management and treatment, call the Emory Lysosomal Storage Disease Center at (404) 778-8565 or (800) 200-1524.
1). Bertelli, M., S. Gallo, A. Buda, S. Cecchin, A. Fabbri, C. Lapucci, G. Andrighetto, V. Sidoti, L. Lorusso, and M. Pandolfo, Novel mutations in the arylsulfatase A gene in eight Italian families with metachromatic leukodystrophy. J Clin Neurosci, 2006. 13(4): p. 443-8.
2). Berna, L., V. Gieselmann, H. Poupetova, M. Hrebicek, M. Elleder, and J. Ledvinova, Novel mutations associated with metachromatic leukodystrophy: phenotype and expression studies in nine Czech and Slovak patients. Am J Med Genet A, 2004. 129(3): p. 277-81.
3). Gort, L., M.J. Coll, and A. Chabas, Identification of 12 novel mutations and two new polymorphisms in the arylsulfatase A gene: haplotype and genotype-phenotype correlation studies in Spanish metachromatic leukodystrophy patients. Hum Mutat, 1999. 14(3): p. 240-8.
4). Holve, S., D. Hu, and S.E. McCandless, Metachromatic leukodystrophy in the Navajo: fallout of the American-Indian wars of the nineteenth century. Am J Med Genet, 2001. 101(3): p. 203-8.
- Confirmation of a clinical diagnosis of metachromatic leukodystrophy.
- Prenatal testing for known familial mutation.
- Assessment of carrier status in high risk family members known mutation analysis.
Analytical Sensitivity: ~99%
Prevalence: ~ 1 / 2,500 of western Navajo Nation . The estimated prevalence of all lysosomal storage disorders is 2-5 per 100,000. The prevalence of MLD is not specifically known, but is likely to be rare and may vary by ethnicity.
Results of molecular analysis must be interpreted in the context of the patient's clinical and/or biochemical phenotype.
Submit only 1 of the following specimen types
Preferred specimen type: Whole Blood
Type: Whole Blood
Specimen Requirements:In EDTA (purple top) or ACD (yellow top) tube:
Infants (<2 years): 2-3 ml
Children (>2 years): 3-5 ml
Older Children & Adults: 5-10 ml
Specimen Collection and Shipping: Refrigerate until time of shipment. Ship sample within 5 days of collection at room temperature with overnight delivery.
Specimen Requirements:OrageneTM Saliva Collection kit (available through EGL) used according to manufacturer instructions.
Specimen Collection and Shipping: Store sample at room temperature. Ship sample within 5 days of collection at room temperature with overnight delivery.
- Arylsulfatase A Enzyme Assay is available for diagnosis.
- Lysosomal Enzyme Screening Panel is available to assess for 13 lysosomal storage diseases.
- Mutation Analysis for Pseudodeficiency Allele may be available upon request.
- Known Mutation Analysis (KM) is available to test family members.
- Deletion/Duplication Assay is available separately for individuals where mutations are not identified by sequence analysis. Refer to the test requisition or contact the laboratory for more information.
- Prenatal testing is available for known familial mutations only. Please call the Laboratory Genetic Counselor for specific requirements for prenatal testing before collecting a fetal sample.