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Niemann-Pick disease

Reviewed January 2015

What is Niemann-Pick disease?

Niemann-Pick disease is a condition that affects many body systems. It has a wide range of symptoms that vary in severity. Niemann-Pick disease is divided into four main types: type A, type B, type C1, and type C2. These types are classified on the basis of genetic cause and the signs and symptoms of the condition.

Infants with Niemann-Pick disease type A usually develop an enlarged liver and spleen (hepatosplenomegaly) by age 3 months and fail to gain weight and grow at the expected rate (failure to thrive). The affected children develop normally until around age 1 year when they experience a progressive loss of mental abilities and movement (psychomotor regression). Children with Niemann-Pick disease type A also develop widespread lung damage (interstitial lung disease) that can cause recurrent lung infections and eventually lead to respiratory failure. All affected children have an eye abnormality called a cherry-red spot, which can be identified with an eye examination. Children with Niemann-Pick disease type A generally do not survive past early childhood.

Niemann-Pick disease type B usually presents in mid-childhood. The signs and symptoms of this type are similar to type A, but not as severe. People with Niemann-Pick disease type B often have hepatosplenomegaly, recurrent lung infections, and a low number of platelets in the blood (thrombocytopenia). They also have short stature and slowed mineralization of bone (delayed bone age). About one-third of affected individuals have the cherry-red spot eye abnormality or neurological impairment. People with Niemann-Pick disease type B usually survive into adulthood.

The signs and symptoms of Niemann-Pick disease types C1 and C2 are very similar; these types differ only in their genetic cause. Niemann-Pick disease types C1 and C2 usually become apparent in childhood, although signs and symptoms can develop at any time. People with these types usually develop difficulty coordinating movements (ataxia), an inability to move the eyes vertically (vertical supranuclear gaze palsy), poor muscle tone (dystonia), severe liver disease, and interstitial lung disease. Individuals with Niemann-Pick disease types C1 and C2 have problems with speech and swallowing that worsen over time, eventually interfering with feeding. Affected individuals often experience progressive decline in intellectual function and about one-third have seizures. People with these types may survive into adulthood.

How common is Niemann-Pick disease?

Niemann-Pick disease types A and B is estimated to affect 1 in 250,000 individuals. Niemann-Pick disease type A occurs more frequently among individuals of Ashkenazi (eastern and central European) Jewish descent than in the general population. The incidence within the Ashkenazi population is approximately 1 in 40,000 individuals.

Combined, Niemann-Pick disease types C1 and C2 are estimated to affect 1 in 150,000 individuals; however, type C1 is by far the more common type, accounting for 95 percent of cases. The disease occurs more frequently in people of French-Acadian descent in Nova Scotia. In Nova Scotia, a population of affected French-Acadians were previously designated as having Niemann-Pick disease type D, however, it was shown that these individuals have mutations in the gene associated with Niemann-Pick disease type C1.

What genes are related to Niemann-Pick disease?

Niemann-Pick disease types A and B is caused by mutations in the SMPD1 gene. This gene provides instructions for producing an enzyme called acid sphingomyelinase. This enzyme is found in lysosomes, which are compartments within cells that break down and recycle different types of molecules. Acid sphingomyelinase is responsible for the conversion of a fat (lipid) called sphingomyelin into another type of lipid called ceramide. Mutations in SMPD1 lead to a shortage of acid sphingomyelinase, which results in reduced break down of sphingomyelin, causing this fat to accumulate in cells. This fat buildup causes cells to malfunction and eventually die. Over time, cell loss impairs function of tissues and organs including the brain, lungs, spleen, and liver in people with Niemann-Pick disease types A and B.

Mutations in either the NPC1 or NPC2 gene cause Niemann-Pick disease type C. The proteins produced from these genes are involved in the movement of lipids within cells. Mutations in these genes lead to a shortage of functional protein, which prevents movement of cholesterol and other lipids, leading to their accumulation in cells. Because these lipids are not in their proper location in cells, many normal cell functions that require lipids (such as cell membrane formation) are impaired. The accumulation of lipids as well as the cell dysfunction eventually leads to cell death, causing the tissue and organ damage seen in Niemann-Pick disease types C1 and C2.

Related Gene(s)

Changes in these genes are associated with Niemann-Pick disease.

  • NPC1
  • NPC2
  • SMPD1

How do people inherit Niemann-Pick 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 Niemann-Pick disease?

These resources address the diagnosis or management of Niemann-Pick disease and may include treatment providers.

  • Baby's First Test (http://www.babysfirsttest.org/newborn-screening/conditions/niemann-pick-disease)
  • Gene Review: Acid Sphingomyelinase Deficiency (http://www.ncbi.nlm.nih.gov/books/NBK1370)
  • Gene Review: Niemann-Pick Disease Type C (http://www.ncbi.nlm.nih.gov/books/NBK1296)
  • Genetic Testing Registry: Niemann-pick disease, intermediate, protracted neurovisceral (http://www.ncbi.nlm.nih.gov/gtr/conditions/C2675646)
  • Genetic Testing Registry: Niemann-Pick disease, type A (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0268242)
  • Genetic Testing Registry: Niemann-Pick disease, type B (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0268243)
  • Genetic Testing Registry: Niemann-Pick disease, type C (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0220756)
  • Genetic Testing Registry: Niemann-Pick disease, type D (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0268247)
  • Genetic Testing Registry: Niemann-Pick disease type C1 (http://www.ncbi.nlm.nih.gov/gtr/conditions/C3179455)
  • Genetic Testing Registry: Niemann-Pick disease type C2 (http://www.ncbi.nlm.nih.gov/gtr/conditions/C1843366)
  • Genetic Testing Registry: Sphingomyelin/cholesterol lipidosis (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0028064)
  • MedlinePlus Encyclopedia: Niemann-Pick Disease (http://www.nlm.nih.gov/medlineplus/ency/article/001207.htm)

You might also find information on the diagnosis or management of Niemann-Pick disease in Educational resources (http://ghr.nlm.nih.gov/condition/niemann-pick-disease/show/Educational+resources) and Patient support (http://ghr.nlm.nih.gov/condition/niemann-pick-disease/show/Patient+support).

General information about the diagnosis (http://ghr.nlm.nih.gov/handbook/consult/diagnosis) and management (http://ghr.nlm.nih.gov/handbook/consult/treatment) of genetic conditions is available in the Handbook. Read more about genetic testing (http://ghr.nlm.nih.gov/handbook/testing), particularly the difference between clinical tests and research tests (http://ghr.nlm.nih.gov/handbook/testing/researchtesting).

To locate a healthcare provider, see How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.

Where can I find additional information about Niemann-Pick disease?

You may find the following resources about Niemann-Pick 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 Niemann-Pick disease?

  • lipid histiocytosis
  • neuronal cholesterol lipidosis
  • neuronal lipidosis
  • NPD
  • sphingomyelinase deficiency
  • sphingomyelin/cholesterol lipidosis
  • sphingomyelin lipidosis

For more information about naming genetic conditions, see the Genetics Home Reference Condition Naming Guidelines (http://ghr.nlm.nih.gov/ConditionNameGuide) and How are genetic conditions and genes named? (http://ghr.nlm.nih.gov/handbook/mutationsanddisorders/naming) in the Handbook.

What if I still have specific questions about Niemann-Pick disease?

Ask the Genetic and Rare Diseases Information Center (http://rarediseases.info.nih.gov/gard).

What glossary definitions help with understanding Niemann-Pick disease?

ataxia ; autosomal ; autosomal recessive ; cell ; cell membrane ; cholesterol ; deficiency ; dystonia ; enzyme ; failure to thrive ; gene ; hepatosplenomegaly ; incidence ; inherited ; lipid ; metabolism ; muscle tone ; neurological ; palsy ; platelets ; population ; protein ; psychomotor ; recessive ; regression ; respiratory ; short stature ; stature ; thrombocytopenia ; tissue

You may find definitions for these and many other terms in the Genetics Home Reference Glossary (http://ghr.nlm.nih.gov/glossary).

References

  • Gabandé-Rodríguez E, Boya P, Labrador V, Dotti CG, Ledesma MD. High sphingomyelin levels induce lysosomal damage and autophagy dysfunction in Niemann Pick disease type A. Cell Death Differ. 2014 Jun;21(6):864-75. doi: 10.1038/cdd.2014.4. Epub 2014 Jan 31. (http://www.ncbi.nlm.nih.gov/pubmed/24488099?dopt=Abstract)
  • Garver WS, Francis GA, Jelinek D, Shepherd G, Flynn J, Castro G, Walsh Vockley C, Coppock DL, Pettit KM, Heidenreich RA, Meaney FJ. The National Niemann-Pick C1 disease database: report of clinical features and health problems. Am J Med Genet A. 2007 Jun 1;143A(11):1204-11. (http://www.ncbi.nlm.nih.gov/pubmed/17497724?dopt=Abstract)
  • Hollak CE, de Sonnaville ES, Cassiman D, Linthorst GE, Groener JE, Morava E, Wevers RA, Mannens M, Aerts JM, Meersseman W, Akkerman E, Niezen-Koning KE, Mulder MF, Visser G, Wijburg FA, Lefeber D, Poorthuis BJ. Acid sphingomyelinase (Asm) deficiency patients in The Netherlands and Belgium: disease spectrum and natural course in attenuated patients. Mol Genet Metab. 2012 Nov;107(3):526-33. doi: 10.1016/j.ymgme.2012.06.015. Epub 2012 Jun 30. (http://www.ncbi.nlm.nih.gov/pubmed/22818240?dopt=Abstract)
  • Irun P, Mallén M, Dominguez C, Rodriguez-Sureda V, Alvarez-Sala LA, Arslan N, Bermejo N, Guerrero C, Perez de Soto I, Villalón L, Giraldo P, Pocovi M. Identification of seven novel SMPD1 mutations causing Niemann-Pick disease types A and B. Clin Genet. 2013 Oct;84(4):356-61. doi: 10.1111/cge.12076. Epub 2013 Jan 4. (http://www.ncbi.nlm.nih.gov/pubmed/23252888?dopt=Abstract)
  • McGovern MM, Aron A, Brodie SE, Desnick RJ, Wasserstein MP. Natural history of Type A Niemann-Pick disease: possible endpoints for therapeutic trials. Neurology. 2006 Jan 24;66(2):228-32. (http://www.ncbi.nlm.nih.gov/pubmed/16434659?dopt=Abstract)
  • McGovern MM, Lippa N, Bagiella E, Schuchman EH, Desnick RJ, Wasserstein MP. Morbidity and mortality in type B Niemann-Pick disease. Genet Med. 2013 Aug;15(8):618-23. doi: 10.1038/gim.2013.4. Epub 2013 Feb 14. (http://www.ncbi.nlm.nih.gov/pubmed/23412609?dopt=Abstract)
  • Mengel E, Klünemann HH, Lourenço CM, Hendriksz CJ, Sedel F, Walterfang M, Kolb SA. Niemann-Pick disease type C symptomatology: an expert-based clinical description. Orphanet J Rare Dis. 2013 Oct 17;8:166. doi: 10.1186/1750-1172-8-166. Review. (http://www.ncbi.nlm.nih.gov/pubmed/24135395?dopt=Abstract)
  • Patterson MC, Mengel E, Wijburg FA, Muller A, Schwierin B, Drevon H, Vanier MT, Pineda M. Disease and patient characteristics in NP-C patients: findings from an international disease registry. Orphanet J Rare Dis. 2013 Jan 16;8:12. doi: 10.1186/1750-1172-8-12. Erratum in: Orphanet J Rare Dis. 2013;8:73. (http://www.ncbi.nlm.nih.gov/pubmed/23324478?dopt=Abstract)
  • Sturley SL, Patterson MC, Balch W, Liscum L. The pathophysiology and mechanisms of NP-C disease. Biochim Biophys Acta. 2004 Oct 11;1685(1-3):83-7. Review. (http://www.ncbi.nlm.nih.gov/pubmed/15465429?dopt=Abstract)
  • Vance JE. Lipid imbalance in the neurological disorder, Niemann-Pick C disease. FEBS Lett. 2006 Oct 9;580(23):5518-24. Epub 2006 Jun 15. Review. (http://www.ncbi.nlm.nih.gov/pubmed/16797010?dopt=Abstract)
  • Walkley SU, Suzuki K. Consequences of NPC1 and NPC2 loss of function in mammalian neurons. Biochim Biophys Acta. 2004 Oct 11;1685(1-3):48-62. Review. (http://www.ncbi.nlm.nih.gov/pubmed/15465426?dopt=Abstract)
  • Wasserstein MP, Desnick RJ, Schuchman EH, Hossain S, Wallenstein S, Lamm C, McGovern MM. The natural history of type B Niemann-Pick disease: results from a 10-year longitudinal study. Pediatrics. 2004 Dec;114(6):e672-7. Epub 2004 Nov 15. (http://www.ncbi.nlm.nih.gov/pubmed/15545621?dopt=Abstract)

 

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? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.

 
Reviewed: January 2015
Published: March 2, 2015