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Genetics Home Reference: your guide to understanding genetic conditions     A service of the U.S. National Library of Medicine®

Cholesteryl ester storage disease

Reviewed October 2007

What is cholesteryl ester storage disease?

Cholesteryl ester storage disease is a rare inherited condition involving the breakdown and use of fats and cholesterol in the body (lipid metabolism). In affected individuals, harmful amounts of lipids accumulate in cells and tissues throughout the body. The liver is most severely affected. An enlarged liver (hepatomegaly) is one of the key signs of the disease. In addition, chronic liver disease (cirrhosis) can develop. An accumulation of fatty deposits on the artery walls (atherosclerosis) is usually seen early in life. The deposits narrow the arteries and can eventually block them, increasing the chance of having a heart attack or stroke.

The symptoms of cholesteryl ester storage disease are highly variable. Some people have such mild symptoms that they go undiagnosed until late adulthood, while others can have liver dysfunction in early childhood. The expected lifespan of those with cholesteryl ester storage disease depends on the severity of the associated complications.

How common is cholesteryl ester storage disease?

Cholesteryl ester storage disease appears to be a rare disorder. About 50 individuals affected by this condition have been reported worldwide.

What genes are related to cholesteryl ester storage disease?

Mutations in the LIPA gene cause cholesteryl ester storage disease.

The LIPA gene provides instructions for making an enzyme called lysosomal acid lipase. This enzyme is found in the lysosomes (compartments that digest and recycle materials in the cell), where it breaks down lipids such as cholesteryl esters and triglycerides.

In the body, cholesterol works with high-density lipoproteins (HDL), often referred to as "good cholesterol." High-density lipoproteins carry cholesterol from the body's tissues to the liver for removal. When the cholesterol is attached to a fatty acid it is a cholesteryl ester. Normally, cholesteryl esters are broken down by lysosomal acid lipase into cholesterol and a fatty acid. Then the cholesterol can be transported by HDL to the liver for removal.

Mutations in the LIPA gene lead to a shortage of lysosomal acid lipase and prevent the body from using lipids properly. Without the activity of lysosomal acid lipase, the cholesteryl esters stay in the blood and tissues and are not able to be transported to the liver for excretion. The resulting buildup of triglycerides, cholesteryl esters, and other fats within the cells and tissues cause the signs and symptoms of cholesteryl ester storage disease.

Related Gene(s)

Changes in this gene are associated with cholesteryl ester storage disease.

  • LIPA

How do people inherit cholesteryl ester storage disease?

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.

Where can I find information about diagnosis or management of cholesteryl ester storage disease?

These resources address the diagnosis or management of cholesteryl ester storage disease and may include treatment providers.

  • Genetic Testing Registry: Lysosomal acid lipase deficiency (
  • MedlinePlus Encyclopedia: Atherosclerosis (
  • MedlinePlus Encyclopedia: Cirrhosis (

You might also find information on the diagnosis or management of cholesteryl ester storage disease in 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 cholesteryl ester storage disease?

You may find the following resources about cholesteryl ester storage disease helpful. These materials are written for the general public.

You may also be interested in these resources, which are designed for healthcare professionals and researchers.

What other names do people use for cholesteryl ester storage disease?

  • CESD
  • cholesterol ester hydrolase deficiency
  • cholesterol ester storage disease
  • LAL deficiency
  • LIPA deficiency
  • lysosomal acid lipase deficiency

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.

What if I still have specific questions about cholesteryl ester storage disease?

Ask the Genetic and Rare Diseases Information Center (

What glossary definitions help with understanding cholesteryl ester storage disease?

arteries ; artery ; atherosclerosis ; autosomal ; autosomal recessive ; breakdown ; cell ; cholesterol ; chronic ; cirrhosis ; deficiency ; enzyme ; esters ; excretion ; gene ; HDL ; heart attack ; hydrolase ; inherited ; lipase ; lipid ; metabolism ; recessive ; triglycerides

You may find definitions for these and many other terms in the Genetics Home Reference Glossary.


  • Aslanidis C, Ries S, Fehringer P, Büchler C, Klima H, Schmitz G. Genetic and biochemical evidence that CESD and Wolman disease are distinguished by residual lysosomal acid lipase activity. Genomics. 1996 Apr 1;33(1):85-93. (
  • Boldrini R, Devito R, Biselli R, Filocamo M, Bosman C. Wolman disease and cholesteryl ester storage disease diagnosed by histological and ultrastructural examination of intestinal and liver biopsy. Pathol Res Pract. 2004;200(3):231-40. (
  • Lohse P, Maas S, Lohse P, Elleder M, Kirk JM, Besley GT, Seidel D. Compound heterozygosity for a Wolman mutation is frequent among patients with cholesteryl ester storage disease. J Lipid Res. 2000 Jan;41(1):23-31. (
  • Pagani F, Pariyarath R, Garcia R, Stuani C, Burlina AB, Ruotolo G, Rabusin M, Baralle FE. New lysosomal acid lipase gene mutants explain the phenotype of Wolman disease and cholesteryl ester storage disease. J Lipid Res. 1998 Jul;39(7):1382-8. (
  • Ries S, Büchler C, Schindler G, Aslanidis C, Ameis D, Gasche C, Jung N, Schambach A, Fehringer P, Vanier MT, Belli DC, Greten H, Schmitz G. Different missense mutations in histidine-108 of lysosomal acid lipase cause cholesteryl ester storage disease in unrelated compound heterozygous and hemizygous individuals. Hum Mutat. 1998;12(1):44-51. (


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.

Reviewed: October 2007
Published: February 8, 2016