Skip to main content
American Journal of Human Genetics logoLink to American Journal of Human Genetics
. 1998 Feb;62(2):301–310. doi: 10.1086/301699

Ataxia with isolated vitamin E deficiency: heterogeneity of mutations and phenotypic variability in a large number of families.

L Cavalier 1, K Ouahchi 1, H J Kayden 1, S Di Donato 1, L Reutenauer 1, J L Mandel 1, M Koenig 1
PMCID: PMC1376876  PMID: 9463307

Abstract

Ataxia with vitamin E deficiency (AVED), or familial isolated vitamin E deficiency, is a rare autosomal recessive neurodegenerative disease characterized clinically by symptoms with often striking resemblance to those of Friedreich ataxia. We recently have demonstrated that AVED is caused by mutations in the gene for alpha-tocopherol transfer protein (alpha-TTP). We now have identified a total of 13 mutations in 27 families. Four mutations were found in >=2 independent families: 744delA, which is the major mutation in North Africa, and 513insTT, 486delT, and R134X, in families of European origin. Compilation of the clinical records of 43 patients with documented mutation in the alpha-TTP gene revealed differences from Friedreich ataxia: cardiomyopathy was found in only 19% of cases, whereas head titubation was found in 28% of cases and dystonia in an additional 13%. This study represents the largest group of patients and mutations reported for this often misdiagnosed disease and points to the need for an early differential diagnosis with Friedreich ataxia, in order to initiate therapeutic and prophylactic vitamin E supplementation before irreversible damage develops.

Full Text

The Full Text of this article is available as a PDF (295.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Amiel J., Maziere J. C., Beucler I., Koenig M., Reutenauer L., Loux N., Bonnefont D., Féo C., Landrieu P. Familial isolated vitamin E deficiency. Extensive study of a large family with a 5-year therapeutic follow-up. J Inherit Metab Dis. 1995;18(3):333–340. doi: 10.1007/BF00710425. [DOI] [PubMed] [Google Scholar]
  2. Arita M., Sato Y., Miyata A., Tanabe T., Takahashi E., Kayden H. J., Arai H., Inoue K. Human alpha-tocopherol transfer protein: cDNA cloning, expression and chromosomal localization. Biochem J. 1995 Mar 1;306(Pt 2):437–443. doi: 10.1042/bj3060437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Babcock M., de Silva D., Oaks R., Davis-Kaplan S., Jiralerspong S., Montermini L., Pandolfo M., Kaplan J. Regulation of mitochondrial iron accumulation by Yfh1p, a putative homolog of frataxin. Science. 1997 Jun 13;276(5319):1709–1712. doi: 10.1126/science.276.5319.1709. [DOI] [PubMed] [Google Scholar]
  4. Ben Hamida C., Doerflinger N., Belal S., Linder C., Reutenauer L., Dib C., Gyapay G., Vignal A., Le Paslier D., Cohen D. Localization of Friedreich ataxia phenotype with selective vitamin E deficiency to chromosome 8q by homozygosity mapping. Nat Genet. 1993 Oct;5(2):195–200. doi: 10.1038/ng1093-195. [DOI] [PubMed] [Google Scholar]
  5. Ben Hamida M., Belal S., Sirugo G., Ben Hamida C., Panayides K., Ionannou P., Beckmann J., Mandel J. L., Hentati F., Koenig M. Friedreich's ataxia phenotype not linked to chromosome 9 and associated with selective autosomal recessive vitamin E deficiency in two inbred Tunisian families. Neurology. 1993 Nov;43(11):2179–2183. doi: 10.1212/wnl.43.11.2179. [DOI] [PubMed] [Google Scholar]
  6. Burck U., Goebel H. H., Kuhlendahl H. D., Meier C., Goebel K. M. Neuromyopathy and vitamin E deficiency in man. Neuropediatrics. 1981 Aug;12(3):267–278. doi: 10.1055/s-2008-1059657. [DOI] [PubMed] [Google Scholar]
  7. Doerflinger N., Linder C., Ouahchi K., Gyapay G., Weissenbach J., Le Paslier D., Rigault P., Belal S., Ben Hamida C., Hentati F. Ataxia with vitamin E deficiency: refinement of genetic localization and analysis of linkage disequilibrium by using new markers in 14 families. Am J Hum Genet. 1995 May;56(5):1116–1124. [PMC free article] [PubMed] [Google Scholar]
  8. Duclos F., Rodius F., Wrogemann K., Mandel J. L., Koenig M. The Friedreich ataxia region: characterization of two novel genes and reduction of the critical region to 300 kb. Hum Mol Genet. 1994 Jun;3(6):909–914. doi: 10.1093/hmg/3.6.909. [DOI] [PubMed] [Google Scholar]
  9. Dürr A., Cossee M., Agid Y., Campuzano V., Mignard C., Penet C., Mandel J. L., Brice A., Koenig M. Clinical and genetic abnormalities in patients with Friedreich's ataxia. N Engl J Med. 1996 Oct 17;335(16):1169–1175. doi: 10.1056/NEJM199610173351601. [DOI] [PubMed] [Google Scholar]
  10. Foury F., Cazzalini O. Deletion of the yeast homologue of the human gene associated with Friedreich's ataxia elicits iron accumulation in mitochondria. FEBS Lett. 1997 Jul 14;411(2-3):373–377. doi: 10.1016/s0014-5793(97)00734-5. [DOI] [PubMed] [Google Scholar]
  11. Gotoda T., Arita M., Arai H., Inoue K., Yokota T., Fukuo Y., Yazaki Y., Yamada N. Adult-onset spinocerebellar dysfunction caused by a mutation in the gene for the alpha-tocopherol-transfer protein. N Engl J Med. 1995 Nov 16;333(20):1313–1318. doi: 10.1056/NEJM199511163332003. [DOI] [PubMed] [Google Scholar]
  12. Harding A. E. Friedreich's ataxia: a clinical and genetic study of 90 families with an analysis of early diagnostic criteria and intrafamilial clustering of clinical features. Brain. 1981 Sep;104(3):589–620. doi: 10.1093/brain/104.3.589. [DOI] [PubMed] [Google Scholar]
  13. Harding A. E., Matthews S., Jones S., Ellis C. J., Booth I. W., Muller D. P. Spinocerebellar degeneration associated with a selective defect of vitamin E absorption. N Engl J Med. 1985 Jul 4;313(1):32–35. doi: 10.1056/NEJM198507043130107. [DOI] [PubMed] [Google Scholar]
  14. Hentati A., Deng H. X., Hung W. Y., Nayer M., Ahmed M. S., He X., Tim R., Stumpf D. A., Siddique T., Ahmed Human alpha-tocopherol transfer protein: gene structure and mutations in familial vitamin E deficiency. Ann Neurol. 1996 Mar;39(3):295–300. doi: 10.1002/ana.410390305. [DOI] [PubMed] [Google Scholar]
  15. Kohlschütter A., Hübner C., Jansen W., Lindner S. G. A treatable familial neuromyopathy with vitamin E deficiency, normal absorption, and evidence of increased consumption of vitamin E. J Inherit Metab Dis. 1988;11 (Suppl 2):149–152. doi: 10.1007/BF01804221. [DOI] [PubMed] [Google Scholar]
  16. Koutnikova H., Campuzano V., Foury F., Dollé P., Cazzalini O., Koenig M. Studies of human, mouse and yeast homologues indicate a mitochondrial function for frataxin. Nat Genet. 1997 Aug;16(4):345–351. doi: 10.1038/ng0897-345. [DOI] [PubMed] [Google Scholar]
  17. Krendel D. A., Gilchrist J. M., Johnson A. O., Bossen E. H. Isolated deficiency of vitamin E with progressive neurologic deterioration. Neurology. 1987 Mar;37(3):538–540. doi: 10.1212/wnl.37.3.538. [DOI] [PubMed] [Google Scholar]
  18. Laplante P., Vanasse M., Michaud J., Geoffroy G., Brochu P. A progressive neurological syndrome associated with an isolated vitamin E deficiency. Can J Neurol Sci. 1984 Nov;11(4 Suppl):561–564. doi: 10.1017/s0317167100035046. [DOI] [PubMed] [Google Scholar]
  19. Ouahchi K., Arita M., Kayden H., Hentati F., Ben Hamida M., Sokol R., Arai H., Inoue K., Mandel J. L., Koenig M. Ataxia with isolated vitamin E deficiency is caused by mutations in the alpha-tocopherol transfer protein. Nat Genet. 1995 Feb;9(2):141–145. doi: 10.1038/ng0295-141. [DOI] [PubMed] [Google Scholar]
  20. Rayner R. J., Doran R., Roussounis S. H. Isolated vitamin E deficiency and progressive ataxia. Arch Dis Child. 1993 Nov;69(5):602–603. doi: 10.1136/adc.69.5.602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Sharp D., Blinderman L., Combs K. A., Kienzle B., Ricci B., Wager-Smith K., Gil C. M., Turck C. W., Bouma M. E., Rader D. J. Cloning and gene defects in microsomal triglyceride transfer protein associated with abetalipoproteinaemia. Nature. 1993 Sep 2;365(6441):65–69. doi: 10.1038/365065a0. [DOI] [PubMed] [Google Scholar]
  22. Shorer Z., Parvari R., Bril G., Sela B. A., Moses S. Ataxia with isolated vitamin E deficiency in four siblings. Pediatr Neurol. 1996 Nov;15(4):340–343. doi: 10.1016/s0887-8994(96)00223-8. [DOI] [PubMed] [Google Scholar]
  23. Sokol R. J., Kayden H. J., Bettis D. B., Traber M. G., Neville H., Ringel S., Wilson W. B., Stumpf D. A. Isolated vitamin E deficiency in the absence of fat malabsorption--familial and sporadic cases: characterization and investigation of causes. J Lab Clin Med. 1988 May;111(5):548–559. [PubMed] [Google Scholar]
  24. Stumpf D. A., Sokol R., Bettis D., Neville H., Ringel S., Angelini C., Bell R. Friedreich's disease: V. Variant form with vitamin E deficiency and normal fat absorption. Neurology. 1987 Jan;37(1):68–74. doi: 10.1212/wnl.37.1.68. [DOI] [PubMed] [Google Scholar]
  25. Traber M. G., Ramakrishnan R., Kayden H. J. Human plasma vitamin E kinetics demonstrate rapid recycling of plasma RRR-alpha-tocopherol. Proc Natl Acad Sci U S A. 1994 Oct 11;91(21):10005–10008. doi: 10.1073/pnas.91.21.10005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Traber M. G., Sokol R. J., Burton G. W., Ingold K. U., Papas A. M., Huffaker J. E., Kayden H. J. Impaired ability of patients with familial isolated vitamin E deficiency to incorporate alpha-tocopherol into lipoproteins secreted by the liver. J Clin Invest. 1990 Feb;85(2):397–407. doi: 10.1172/JCI114452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Traber M. G., Sokol R. J., Kohlschütter A., Yokota T., Muller D. P., Dufour R., Kayden H. J. Impaired discrimination between stereoisomers of alpha-tocopherol in patients with familial isolated vitamin E deficiency. J Lipid Res. 1993 Feb;34(2):201–210. [PubMed] [Google Scholar]
  28. Trabert W., Stober T., Mielke U., Heck F. S., Schimrigk K. Isolierter Vitamin-E-Mangel. Fortschr Neurol Psychiatr. 1989 Nov;57(11):495–501. doi: 10.1055/s-2007-1001146. [DOI] [PubMed] [Google Scholar]
  29. Yokota T., Shiojiri T., Gotoda T., Arai H. Retinitis pigmentosa and ataxia caused by a mutation in the gene for the alpha-tocopherol-transfer protein. N Engl J Med. 1996 Dec 5;335(23):1770–1771. doi: 10.1056/NEJM199612053352315. [DOI] [PubMed] [Google Scholar]
  30. Yokota T., Shiojiri T., Gotoda T., Arita M., Arai H., Ohga T., Kanda T., Suzuki J., Imai T., Matsumoto H. Friedreich-like ataxia with retinitis pigmentosa caused by the His101Gln mutation of the alpha-tocopherol transfer protein gene. Ann Neurol. 1997 Jun;41(6):826–832. doi: 10.1002/ana.410410621. [DOI] [PubMed] [Google Scholar]
  31. Yokota T., Wada Y., Furukawa T., Tsukagoshi H., Uchihara T., Watabiki S. Adult-onset spinocerebellar syndrome with idiopathic vitamin E deficiency. Ann Neurol. 1987 Jul;22(1):84–87. doi: 10.1002/ana.410220119. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Human Genetics are provided here courtesy of American Society of Human Genetics

RESOURCES