Table Of ContentLysosomal Storage Disorders
Lysosomal Storage Disorders
Jo hn A. Barranger, M.D., Ph.D.
Mario A. Cabrera-Salazar, M.D.
John A. Barranger, MD, PhD Mario A. Cabrera-Salazar, MD
Department of Human Genetics Genzyme Corporation
University of Pittsburgh Framingham, MA 01701–9322
Pittsburgh, PA 15261 USA
USA
To all those colleagues and friends
 who made this text as good 
 as it is, I remain in debt. 
 Thank you for your thoughtful contributions. 
 
John A. Barranger
 
To my parents Jorge and Sonia  
and Luis Antonio, my grandfather;  
a teacher who mastered the science  
of educating generations. 
 
Mario A. Cabrera-Salazar
To all patients with lysosomal storage
 disorders, thank you for all the lessons
 given to us
Preface  
Scientific progress has been rapid in lysosomal biology during the last six decades. Its
application to human disease is nothing less than spectacular. In no other group of 
disorders has knowledge and clinical utility progressed so speedily. Recall that the 
organelle was described in just 1955. Since then, the biochemical alterations and storage 
materials were described, the enzyme deficiencies discovered, the gene coding of 
these glycoproteins cloned and thousands of mutations defined. These advances have 
resulted in highly improved diagnosis for more than 50 diseases. For five diseases, 
including the most common lysosomal storage disorder, molecular therapy is a reality, 
extremely effective and very safe. This higher plateau of medical approaches to human 
disease is something to which all translational scientists aspire and only a few actually 
witness. The relief of pain and suffering is a tribute to the ideas and work of many 
dedicated investigators. Much of that work is presented in this text. 
Despite our ability to treat some of these diseases through enzyme replacement therapy 
(ERT) and, accurately define different diseases that look alike, there is much to be learned 
about lysosomal disease. With each step up the barrier to knowledge, a new point of view 
is attained, a fresh perspective. Much is seen more clearly and many “allegories of the 
cave” are dispelled forever. Yet, our new view demands a new vision drawing us to find 
better definitions of what we see. This is how it has been with lysosomal diseases. No 
sooner had the little vesicle been described when a defect in it was shown to cause  
a human disease. With each advance came the hope for better diagnosis and visions of 
therapy. Nowhere was its value more evident than in the clear separation of the mucopoly-
saccharidoses into reliable diagnostic categories according to the enzyme that was deficient 
in them. Long-standing debates and controversies were settled forever.  
Still though, as in all lysosomal storage disease, what makes the difference in the 
spectrum of iduronidase deficient disease from severe Hurler syndrome to mild Scheie 
disease remains to be defined. There is no doubt that multiple genes are involved in these 
complex diseases. Just when we thought that they were monogeneic, whole new visions
of the diseases have emerged. One even suggests that lysosomal storage may not be the 
primary pathogenetic step, but rather, protesomal activation in an attempt to rid the cell  
of improperly folded lysosomal enzyme. The universality of this theory remains to be 
demonstrated. However, this new approach may provide another tool in the physician’s 
bag to define and treat disease. It is with this enthusiasm that we should look forward to 
new definitions of the lysosome and lysosomal disease. This text provides a thoughtful intro-
duction to a wide variety of data, concepts, and approaches to lysosomal storage disorders. 
 
John A. Barranger
University of Pittsburgh, Pittsburgh, PA
May 2007
Contents 
Preface ..............................................................................................................................vii 
Contributors ..................................................................................................................... xiii 
Chapter 1.  From Lysosomes to Storage Diseases and Back:
A Personal Reminiscence ..............................................................................1 
Christian de Duve 
Chapter 2.  Lysosomal Biogenesis and Disease ...............................................................7 
Doug Brooks and Emma Parkinson-Lawrence 
Chapter 3.  The Concept of Treatment in Lysosomal Storage Diseases ........................37 
Roscoe O. Brady  
Chapter 4.  Complex Lipid Catabolism  .........................................................................45 
Roscoe O. Brady and Roscoe O. Brady, Jr. 
Chapter 5.  Retroviral Vectors for Gene Therapy ..........................................................53 
Seon-Hee Kim and Paul D. Robbins 
Chapter 6.  Adenovirus in Gene Therapy ......................................................................69 
 
Angela Montecalvo, Andrea Gambotto, and Leonardo D’Aiuto 
Chapter 7.  Setting Back the Clock: Adenoviral-Mediated Gene Therapy  
for Lysosomal Storage Disorders ................................................................81 
Dolan Sondhi, Neil R. Hackett, Stephen M. Kaminksy,  
and Ronald G. Crystal 
Chapter 8.  Adeno-Associated Viral-Mediated Gene Therapy of Lysosomal  
Storage Disorders ........................................................................................97 
Mario A. Cabrera-Salazar and Seng H. Cheng  
Chapter 9.  Herpes Simplex Virus Vectors for Gene Therapy of Lysosomal  
Storage Disorders ......................................................................................111 
Edward A. Burton and Joseph C. Glorioso
x  Contents 
Chapter 10.  Gene Therapy of Lysosomal Storage Disorders by 
Lentiviral Vectors ......................................................................................133 
Alessandra Biffi and Luigi Naldini 
Chapter 11.  Substrate Reduction Therapy .....................................................................153 
Frances M. Platt and Terry D. Butters 
Chapter 12.  Newborn Screening for Lysosomal Storage Disorders .............................169 
C. Ronald Scott, Frantisek Turecek,  
and Michael H. Gelb 
Chapter 13.  Genetic Counseling for Lysosomal Storage Diseases ...............................179 
Erin O’Rourke, Dawn Laney, Cindy Morgan,  
Kim Mooney, and Jennifer Sullivan 
Chapter 14.  Neural Stem Cell Therapy in Lysosomal Storage Disorders ....................197 
Jean-Pyo Lee, Dan Clark, Mylvaganam Jeyakumar,  
Rodolfo Gonzalez, Scott Mckercher, Franz-Josef Muller,  
Rahul Jandial, Rosanne M. Taylor, Kook In Park,  
Thomas N. Seyfried, Frances M. Platt, and Evan Y. Snyder 
Chapter 15.  The GM1 Gangliosidoses ..........................................................................217 
Gustavo Charria-Ortiz  
Chapter 16.  The GM2 Gangliosidoses ..........................................................................229 
Gustavo A. Charria-Ortiz 
Chapter 17.  Acid Sphingomyelinase-Deficient Niemann–Pick Disease ......................257 
Edward H. Schuchmann, Margaret Mc Govern, Calogera  
M. Simonaro, Melissa P. Wasserstein, and Robert J. Desnick 
Chapter 18.  Krabbe Disease (Globoid Cell Leukodystrophy) ......................................269 
Junko Matsuda and Kunihiko Suzuki 
Chapter 19.  Metachromatic Leukodystrophy ................................................................285 
Volkmar Gieselmann 
Chapter 20.  Fabry Disease ............................................................................................307 
Roscoe O. Brady 
Chapter 21.  Gaucher Disease: Review and Perspectives on Treatment .......................319 
Mario A. Cabrera-Salazar and John A. Barranger
Contents  xi 
Chapter 22.  Therapeutic Goals in the Treatment of Gaucher Disease ..........................345 
Neal Weinreb 
Chapter 23.  The Neuronal Ceroid Lipofuscinoses: Clinical Features  
and Molecular Basis of Disease ................................................................371 
Beverly L. Davidson, Mario A. Cabrera-Salazar, and David A. Pearce 
Chapter 24.  Mucopolysaccharidosis I ...........................................................................389 
Lorne A. Clarke  
Chapter 25.  Mucopolysaccharidosis II (Hunter Syndrome) ..........................................407 
Lorne A. Clarke 
Chapter 26.  Sanfilippo Syndrome: Clinical Genetic Diagnosis and Therapies ............415 
John J. Hopwood 
Chapter 27.  Mucopolysaccharidosis IV (Morquio Syndrome) ..................................... 433 
Shunji Tomatsu, Adriana M. Montaño, Tatsuo Nishioka,  
and Tadao Orii 
Chapter 28.  Mucopolysaccharidosis Type VI 
(Maroteaux–Lamy Syndrome) ..................................................................447 
J. E. Wraith 
Chapter 29.  Mucopolysaccharidosis Type VII (Sly Disease): Clinical, Genetic  
Diagnosis and Therapies ...........................................................................457 
Denise J. Norato 
Chapter 30.  Pompe Disease-Glycogenosis Type II: Acid Maltase Deficiency ............473 
Arnold Reuser and Marian Kroos 
Chapter 31.  Lysosomal Free Sialic Acid Storage Disorders: Salla  
Disease and ISSD ......................................................................................499 
Amanda Helip-Wooley, Robert Kleta, and William A. Gahl 
Chapter 32.  Cystinosis ..................................................................................................513 
Robert Kleta, Amanda Helip-Wooley, and William A. Gahl 
Chapter 33.  I-Cell Disease ............................................................................................529 
Doug Brooks, Chris Turner, Viv Muller, John Hopwood,  
and Peter Meikle  
Index ...............................................................................................................................539
Contributors 
John A. Barranger 
Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA 15261, USA,
xiv  Contributors 
Seng H. Cheng 
Genetic Diseases Science, Genzyme Corporation, Framingham, MA 01701-9322, USA,