WHAT IS LAL-D?

 

Lysosomal Acid Lipase Deficiency (LAL-D) is a rare, inherited, and progressive genetic disorder caused by mutations in the LIPA gene, which result in the absence or deficiency of the enzyme lysosomal acid lipase (LAL).
This enzyme is essential for metabolizing fats and cholesterol within cells. Without it, cholesterol esters and triglycerides accumulate in the liver, spleen, intestine, and blood vessels, progressively damaging the body.

CLINICAL FORMS:

Enfermedad de Wolman

Wolman Disease

 

(Severe, rapid-onset infantile form)
It appears within the first months of life with persistent diarrhea, abdominal distension (hepatosplenomegaly), vomiting, growth retardation, anemia, and calcifications in the adrenal glands. Without proper nutrition and treatment, it often has fatal consequences before the first year of life.

CESD

Cholesteryl Ester Storage Disease (CESD)

(Late infantile, juvenile, or adult forms)
This form generally progresses more slowly than Wolman disease, with variable severity depending on the patient. It presents with progressive liver involvement (fatty liver, fibrosis/cirrhosis, and risk of liver failure) and significant lipid abnormalities (elevated LDL, low HDL, and sometimes elevated triglycerides), increasing the risk of cardiovascular disease (heart attack or stroke) at an early age.

Both forms are manifestations of the same disorder, differing in severity according to the level of enzyme activity.

DIAGNOSIS

CESD

Lysosomal Acid Lipase Deficiency (LAL-D) is confirmed by a dried blood spot (DBS) enzyme assay, which measures LAL enzyme activity.

Genetic testing of the LIPA gene identifies the causative mutations, confirming the diagnosis and enabling genetic counseling for families.

Early diagnosis is essential: the sooner it is detected, the sooner treatment can begin—significantly improving prognosis and quality of life.

TREATMENT

CESD

Since 2015, a specific treatment has been available: enzyme replacement therapy (ERT), which replaces the missing enzyme. It can save lives in severe cases and improve outcomes in patients of all ages. It is administered intravenously every one or two weeks.

The earlier treatment is started, the better the results—hence the importance of early diagnosis and newborn screening.

In addition, medical follow-up includes monitoring liver function, lipid profile, and providing specialized nutritional support.

DIFFERENTIAL DIAGNOSIS

 

Differential diagnosis is essential to identify lysosomal acid lipase deficiency (LAL-D) and distinguish it from other conditions with similar symptoms, such as metabolic or liver diseases. An accurate evaluation allows for the initiation of appropriate treatment and improves patient prognosis.

Reference:
de las Heras, J.; Almohalla, C.; Blasco-Alonso, J.; Bourbon, M.; Couce, M.-L.; de Castro López, M.J.; García Jiménez, M.C.; Gil Ortega, D.; González-Diéguez, L.; Meavilla, S.; et al. Practical Recommendations for the Diagnosis and Management of Lysosomal Acid Lipase Deficiency with a Focus on Wolman Disease. Nutrients 2024, 16, 4309. https://doi.org/10.3390/nu16244309

Dieta LAL-D

LAL-D Cookbook

Learn more about LAL-D on the LAL-D Your Way website, where you’ll find additional information about Lysosomal Acid Lipase Deficiency (LAL-D).
You can also access the LAL-D Cookbook, specially designed for people living with LAL-D and their families.

Managing LAL-D can seem overwhelming, but with proper nutrition, you can take an active step toward a healthier lifestyle.
The cookbook offers delicious and easy recipes, tailored to specific dietary needs and created by healthcare professionals.

Download it and discover new recipes!

ORPHA:275761

Lysosomal acid lipase deficiency

 

Synonym(s):

  • LAL deficiency
  • LALD

Source: PubMed ID 31213932 37028992

Prevalence: 1-9 / 100 000

Inheritance: Autosomal recessive

Age of onset: Adolescent, Adult, Childhood, Infancy, Neonatal

ICD-10: E75.5

ICD-11: 5C56.0Y

OMIM: 278000

UMLS: C5574740

GARD: 12097

MedDRA: 10077267

ORPHA:75233

Wolman disease

Prevalence: Unknown

Inheritance: Autosomal recessive

Age of onset: Infancy, Neonatal

ICD-10: E75.5

ICD-11: 5C56.0Y

OMIM: 278000

UMLS: C0043208

MeSH: D015223

GARD: 7899

MedDRA: 10053687

ORPHA:75234

Cholesteryl ester storage disease

Synonym(s): Cholesterol ester storage disease
Prevalence: Unknown

Inheritance: Autosomal recessive

Age of onset: Adolescent, Adult, Childhood

ICD-10: E75.5

ICD-11: 5C56.0Y

OMIM: 278000

UMLS: C0008384

MeSH: D015217

GARD: 12099