De Novo ABCD1 Gene Mutation in an Indian Patient With Adrenoleukodystrophy

A large number of ABCD1 gene mutations have been reported all over the world, but not previously in India. We report on the first known patient with childhood cerebral adrenoleukodystrophy and a de novo 3′ splice-site mutation in this gene. Magnetic resonance imaging of the brain revealed large, confluent, hyperintense areas in the bilateral cerebral white matter, predominantly parieto-occipital, with extensions into posterior regions that led to breakdown of the blood-brain barrier. An increased level of very long chain fatty acids was also consistent with the biochemical defect for adrenoleukodystrophy. Sequencing of the ABCD1 gene of this patient identified a 3′ splice-site mutation in the intervening sequence 4 (−2a > g). We did not find any mutation in the gene of the proband's mother, which confirms its de novo occurrence.