Niemann-Pick disease (NPD) is a disorder of fat metabolism that causes abnormalities of the skin, eyes, musculoskeletal system, nervous system, liver, and lymphoid organs. It is named for German pediatricians Albert Niemann (1880-1921) and Ludwig Pick (1898-1935). Six types of the disease have been identified (A, B, C, D, E, and F).
Niemann-Pick disease is inherited through an autosomal recessive trait. The different types of NPD are characterized by an abnormal accumulation of sphingomyelin. A sphingomyelin is any group of sphingolipids (consists of a lipid and a sphingosine) containing phosphorus. It occurs primarily in the tissue of the nervous system.
Some characteristics of Niemann-Pick disease may be common for all types. Common symptoms include jaundice, hepatosplenomegaly (enlargement of the liver and spleen), physical and mental impairment, and feeding difficulties. Symptoms for most types of NPD (A, B, C, and D) are seen in infancy or early childhood.
Alternate names associated with the NPD disorder are lipid histiocytosis, sphingomyelin lipidosis, and sphingomyelinase deficiency.
Niemann-Pick disease is caused by an autosomal recessive genetic trait, therefore the condition will not appear unless a person receives the same defective gene for fat metabolism from each parent. This means that if a person is heterozygous for the trait then they will be a carrier and if they are homozygous then they will show the trait. There is a 25% chance for each pregnancy that the disorder will passed onto the child (ren) if both parents are heterozygous for the trait and a 100% chance if both parents are homozygous for the trait.
The gene for Niemann-Pick disease types A and B has been located on the short arm (p) of chromosome 11. The gene for types C and D has been located on chromosome 18. NPD types C and D are believed to be allelic disorders. This term means that the two types are due to different mutations (a change in building block sequences) of the same gene. Type E is similar to type C and may be a variant form. It is possible that type F is a mild form of type B but as of 2000 there is no supportive research.
Niemann-Pick disease affects males and females equally and has been identified in all races. Type A is the most common form of the disease and is responsible for about 80% of NPD cases.
Types A and B occur mainly in families of eastern European Jewish descent (Ashkenazi). It is estimated that one in 75 may be carriers. Type B is also common in individuals from Tunisia, Morocco, and Algeria. Type C is more common in Spanish-Americans in southern New Mexico and Colorado. As of 2000, it is believed that over 300 people in the United States are affected with type C and an estimated one million worldwide. Type D occurs in French-Canadian descendents from Nova Scotia. Type F has been found to affect people of Spanish descent. As of 2000, it is not clear as to which populations are affected by type E.
This is the infantile or acute form of Niemann-Pick disease. Abnormal accumulation of sphingomyelin is seen in the developing fetus. Sphingomyelin accumulation could represent 2-5% of the total body weight in individuals with type A. Symptoms may progress rapidly and include the following:
This is the chronic form of Niemann-Pick disease. Symptoms progress slowly and begin during infancy or early childhood. Like type A, type B occurs due to a deficiency of the enzyme sphingomyelinase. Neurological involvement is minimal and usually absent. Symptoms are as follows:
This type of Niemann-Pick disease occurs due to the inability to breakdown cholesterol. This may lead to a secondary deficiency of acid sphingomyelinase. Studies have shown that there may be two types of NPD type C, NPC1 and NPC2. NPC2 is believed to be caused by a deficiency of HE1 (human epididymis-1), which is a cholesterol-binding protein. NPD type C can occur at anytime between infancy and adulthood but is usually seen in children between the ages of three and 10. The progression of symptoms in NPD type C is slow and the loss of mental and motor function usually occur in early adulthood. Symptoms are as follows:
This is the Nova Scotia variant of Niemann-Pick disease. Like NPD type C, individuals with type D are unable to metabolize cholesterol properly. Individuals with type D do not suffer from a deficiency of acid sphingomyelinase. The symptoms of type D are very similar to type C but vary from case to case.
As of 2000, many researchers consider this to be a variant form of type C. NPD type E does not usually begin until adulthood and neurological impairment is rare. Symptoms include the following:
This type of Niemann-Pick disease is characterized by a finding of sea-colored blue cells in the blood and/or bone marrow of individuals and therefore may be called Sea-Blue histocyte disease. It affects people of Spanish descent and may be a mild form of type B. Symptoms may include:
As of 2000, there is no objective diagnostic test for Niemann-Pick disease types D, E, and F. Types A and B are diagnosed through DNA testing or by a blood test. Blood tests for individuals with types A and B will show low levels of the enzyme sphingomyelinase in white blood cells and elevated sphingomyelin and free cholesterol.
Symptoms of Niemann-Pick disease may be similar to those of Refsum syndrome (disorder of fat metabolism associated with abnormal accumulation of phytanic acid in the blood and other body tissues), Tay-Sachs disease (disorder found in Eastern European Jewish descendents that results in deterioration of the central nervous system), Sandhoff disease (lipid storage disorder due to a deficiency of the enzyme hexosaminidase), Gaucher's disease (lipid storage disease), and Sialidosis (metabolic disorder due to a deficiency of the enzyme alpha-neuraminidase).
As of 2000, there is no specific treatment available for any type of Niemann-Pick disease. Individuals are treated on a symptomatic basis. As of 2000, individuals with NPD types A and B have not benefited from enzyme replacement therapies or organ transplants. Cholesterol lowering drugs and low cholesterol diets are often used for individuals with NPD types C and D. As of 2000, these have not been effective in slowing the progress of types C and D.
Investigational therapies are being tested for types A, B, C, and D. The possibility of treatment by bone marrow transplantation is being tested for types A and B. Studies have also been completed on the use of stem cell (a cell which produces usable tissues) transplantation as treatment for types A and B. Researchers at the National Institutes of Health are studying combinations of cholesterol lowering drugs for treatment of NPD types C and D.
Individuals diagnosed with Niemann-Pick disease may want to seek counseling or attend support groups that focus on the psychological, physical, and social issues that may result due to the illness.
Parents may want to seek counseling or attend support groups that focus on the lifestyle changes associated with having a child diagnosed with Niemann-Pick disease.
The prognosis for all types of Niemann-Pick disease varies. In type A, death usually results in early childhood. In individuals with types C and D, death usually results in adolescence or early adulthood. Individuals with type B have a prolonged survival due to the decrease of neurological involvement. As of 2000 the prognosis for types E and F has not been adequately researched.
Affected individuals and their families may want to seek genetic counseling. Pregnant women can receive prenatal testing for NPD type C. Pregnant women that are carriers and have a partner that is a carrier should receive genetic counseling regarding the 25 percent chance of the child having Niemann-Pick disease.
Early diagnosis is important. Due to advances in medicine an early diagnosis may increase life expectancy.
Bowden, Vickey R., Susan B. Dickey, and Cindy Smith Greenberg. Children and Their Families: The continuum of care. Philadelphia: W. B. Saunders Company, 1998.
Emery, Alan E. H., MD, and David L. Rimoin, MD, eds. "Sphingomylin Lipidoses (Niemann-Pick disease)." In Principle and Practice of Medical Genetics, Volume 2, New York: Churchhill Livingstone, 1983.
Laith F. Gulli, MD and Tanya Bivins, BS