[Peroxisomal hereditary diseases].

Nearly two tens of diseases are known to be caused by impairment of several metabolic functions of peroxisomes, or by deficiency in individual peroxisomal enzymes. With the exception of X-bound adrenoleukodystrophy, all diseases are based on autosomally recessive type of inheritance and a majority of them are characteristic by specific neurologic symptoms. The group of diseases in which patients develop a generalised loss of peroxisomal functions includes: Zellweger's cerebro-hepato-renal syndrome, neonatal adrenoleukodystrophy, infantile Refsum's disease, hyperpipecolic acidaemia. Other diseases, such as rhizomelic chondrodysplasia punctata and Zellweger-like syndrome are accompanied by a deficiency in several enzymatic activities. X-bound adrenoleukodystrophy, pseudo-Zellweger's syndrome, hyperoxaluria 1, adult form of Refsum's disease and acatalasaemia are peroxisomal diseases with a deficiency of a single enzyme. In clinically most severe diseases (generalised loss of peroxisomal functions), the impairment of peroxisomal biogenesis is caused assumedly due to the defect in some of the peroxisomal membrane proteins. The biochemical findings are brought about by insufficiency in such metabolic functions as oxidation of fatty acids with very long chains, oxidation of the phytanic and pipecolic acids, synthesis of cholesterol, bile salts and plasmalogenes. Rhizomelic chondrodysplasia punctata and Zellweger's syndrome are more moderate forms which are dominantly biochemically manifestant by an impairment in the synthesis of plasmalogenes. Among the diseases characterised by a deficiency in individual peroxisomal enzymes, most frequent is the X-bound andrenoleukodystrophy which has several clinical phenotypes manifestant in childhood, as well as a clinically less severe form manifestant in adulthood-adrenomyeloneuropathy. The diagnosis of peroxisomal diseases is performed by use of a wide range of methods (morphological, biochemical, immunochemical and molecular genetic examinations) which enable both postnatal and prenatal diagnostics. (Tab. 1, Ref. 104.)