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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2025. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="All GeneReviews" href="/books/n/gene/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-gene-lrg.png" alt="Cover of GeneReviews®" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>GeneReviews<sup>®</sup> [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK1197_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK1197_dtls__"><div>Adam MP, Feldman J, Mirzaa GM, et al., editors.</div><div>Seattle (WA): <a href="http://www.washington.edu" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">University of Washington, Seattle</a>; 1993-2025.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/gene/">GeneReviews by Title</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/gene/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search GeneReviews" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search GeneReviews" submit="false" style="padding: 0.1em 0.4em;" /></div></form><div><ul class="inline_list"><li><a href="/books/n/gene/advanced/">GeneReviews Advanced Search</a></li><li style="margin-left:.5em"><a href="/books/n/gene/helpadvsearch/">Help</a></li></ul></div></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/gene/pkd-ad/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/gene/poly/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK1197_"><span class="title" itemprop="name">Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy</span></h1><div itemprop="alternativeHeadline" class="subtitle whole_rhythm">Synonyms: Nasu-Hakola Disease, PLOSL</div><p class="contrib-group"><span itemprop="author">Juha Paloneva</span>, MD, PhD, <span itemprop="author">Taina Autti</span>, MD, PhD, <span itemprop="author">Panu Hakola</span>, MD, PhD, and <span itemprop="author">Matti J Haltia</span>, MD, PhD.</p><a data-jig="ncbitoggler" href="#__NBK1197_ai__" style="border:0;text-decoration:none">Author Information and Affiliations</a><div style="display:none" class="ui-widget" id="__NBK1197_ai__"><div class="contrib half_rhythm"><span itemprop="author">Juha Paloneva</span>, MD, PhD<div class="affiliation small">Department of Surgery<br />Central Finland Hospital Nova<br />Jyvaskyla, Finland<div><span class="email-label">Email: </span><a href="mailto:dev@null" data-email="if.tenmif@avenolap.ahuj" class="oemail">if.tenmif@avenolap.ahuj</a></div></div></div><div class="contrib half_rhythm"><span itemprop="author">Taina Autti</span>, MD, PhD<div class="affiliation small">University of Helsinki<br />Helsinki Medical Imaging Center<br />Helsinki, Finland<div><span class="email-label">Email: </span><a href="mailto:dev@null" data-email="if.suh@ittua.aniatttua" class="oemail">if.suh@ittua.aniatttua</a></div></div></div><div class="contrib half_rhythm"><span itemprop="author">Panu Hakola</span>, MD, PhD<div class="affiliation small">Department of Forensic Medicine<br />Niuvanniemi Hospital<br />University of Kuopio<br />Kuopio, Finland</div></div><div class="contrib half_rhythm"><span itemprop="author">Matti J Haltia</span>, MD, PhD<div class="affiliation small">Department of Pathology<br />Haartman Institute<br />University of Helsinki<br />Helsinki, Finland<div><span class="email-label">Email: </span><a href="mailto:dev@null" data-email="if.iknisleh@aitlah.j.ittam" class="oemail">if.iknisleh@aitlah.j.ittam</a></div></div></div></div><p class="small">Initial Posting: <span itemprop="datePublished">January 24, 2002</span>; Last Update: <span itemprop="dateModified">December 10, 2020</span>.</p><p><em>Estimated reading time: 22 minutes</em></p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="plosl.Summary" itemprop="description"><h2 id="_plosl_Summary_">Summary</h2><div><h4 class="inline">Clinical characteristics.</h4><p>Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) is characterized by fractures (resulting from radiologically demonstrable polycystic osseous lesions), frontal lobe syndrome, and progressive presenile dementia beginning in the fourth decade. The clinical course of PLOSL can be divided into four stages:</p><dl class="temp-labeled-list"><dt>1.</dt><dd><p class="no_top_margin">The <b>latent</b> stage is characterized by normal early development.</p></dd><dt>2.</dt><dd><p class="no_top_margin">The <b>osseous</b> stage (3rd decade of life) is characterized by pain and tenderness, mostly in ankles and feet, usually following strain or injury. Fractures are typically diagnosed several years later, most commonly in the bones of the extremities.</p></dd><dt>3.</dt><dd><p class="no_top_margin">In the <b>early neurologic</b> stage (4th decade of life), a change of personality begins to develop insidiously. Affected individuals show a frontal lobe syndrome (loss of judgment, euphoria, loss of social inhibitions, disturbance of concentration, and lack of insight, libido, and motor persistence) leading to serious social issues.</p></dd><dt>4.</dt><dd><p class="no_top_margin">The <b>late neurologic</b> stage is characterized by progressive dementia and loss of mobility.</p></dd></dl><p>Death usually occurs before age 50 years.</p></div><div><h4 class="inline">Diagnosis/testing.</h4><p>The diagnosis of PLOSL can be established in a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> with radiologically demonstrable polycystic osseous lesions, frontal lobe syndrome, and progressive presenile dementia beginning in the fourth decade. Identification of <a class="def" href="/books/n/gene/glossary/def-item/biallelic/">biallelic</a> pathogenic variants in <i>TYROBP</i> or <i>TREM2</i> can confirm the diagnosis if radiographic and clinical features are inconclusive.</p></div><div><h4 class="inline">Management.</h4><p><i>Treatment of manifestations:</i> Treatment is symptomatic. Orthopedic surgery and/or devices may be of value in individual cases. Anti-seizure medication can be used to prevent epileptic seizures and secondary worsening of the condition.</p><p><i>Prevention of secondary complications:</i> Some of the social consequences of PLOSL may be avoided if family members are informed early about the nature of the disorder.</p><p><i>Surveillance</i>: Intervals for follow up of bone lesions and neurologic and psychiatric manifestations must be determined on an individual basis.</p></div><div><h4 class="inline">Genetic counseling.</h4><p>PLOSL is inherited in an <a class="def" href="/books/n/gene/glossary/def-item/autosomal-recessive/">autosomal recessive</a> manner. If both parents are known to be <a class="def" href="/books/n/gene/glossary/def-item/heterozygous/">heterozygous</a> for a <i>TREM2</i> or <i>TYROBP</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a>, each sib of an affected individual has at conception a 25% chance of being affected, a 50% chance of being an asymptomatic <a class="def" href="/books/n/gene/glossary/def-item/carrier/">carrier</a>, and a 25% chance of being unaffected and not a carrier. Carrier testing for at-risk relatives and <a class="def" href="/books/n/gene/glossary/def-item/prenatal-testing/">prenatal testing</a> for a pregnancy at increased risk are possible if the pathogenic variants in the family have been identified.</p></div></div><div id="plosl.Diagnosis"><h2 id="_plosl_Diagnosis_">Diagnosis</h2><p>No consensus clinical diagnostic criteria for polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) have been published.</p><div id="plosl.Suggestive_Findings"><h3>Suggestive Findings</h3><p>PLOSL <b>should be suspected</b> in individuals with the following features:</p><ul><li class="half_rhythm"><div><b>Radiologically demonstrable polycystic osseous lesions</b> and fractures of the wrists and ankles after minor trauma at the mean age of 27 years (range 18-33 years) [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>]. Cyst-like lesions and loss of bone trabeculae are most conspicuous in the fingers and in the carpal and tarsal bones (see <a class="figpopup" href="/books/NBK1197/figure/plosl.F1/?report=objectonly" target="object" rid-figpopup="figploslF1" rid-ob="figobploslF1">Figure 1</a> and <a class="figpopup" href="/books/NBK1197/figure/plosl.F2/?report=objectonly" target="object" rid-figpopup="figploslF2" rid-ob="figobploslF2">Figure 2</a>) [<a class="bk_pop" href="#plosl.REF.m_kel_.1982.51">Mäkelä et al 1982</a>, <a class="bk_pop" href="#plosl.REF.nwawka.2014.1449">Nwawka et al 2014</a>]. See also Figures 2 and 3 in <a class="bk_pop" href="#plosl.REF.nwawka.2014.1449">Nwawka et al [2014]</a>. If an individual has multiple lytic or cyst-like lesions on radiograph primarily in the distal extremities, CT and MRI are useful in making an accurate diagnosis [<a class="bk_pop" href="#plosl.REF.nwawka.2014.1449">Nwawka et al 2014</a>].</div></li><li class="half_rhythm"><div><b>Frontal lobe syndrome</b> in the fourth decade manifested by euphoria and loss of judgment and social inhibitions</div></li><li class="half_rhythm"><div><b>Progressive presenile dementia</b> beginning in the fourth decade. Dementia is mild at the onset of neurologic symptoms. The disease culminates in severe dementia; affected individuals typically die before age 50 years.</div></li></ul><div class="iconblock whole_rhythm clearfix ten_col fig" id="figploslF1" co-legend-rid="figlgndploslF1"><a href="/books/NBK1197/figure/plosl.F1/?report=objectonly" target="object" title="Figure 1. " class="img_link icnblk_img figpopup" rid-figpopup="figploslF1" rid-ob="figobploslF1"><img class="small-thumb" src="/books/NBK1197/bin/plosl-Image001.gif" src-large="/books/NBK1197/bin/plosl-Image001.jpg" alt="Figure 1. . A radiograph of the hand of a person with PLOSL demonstrates multiple cyst-like lesions and loss of bone trabeculae." /></a><div class="icnblk_cntnt" id="figlgndploslF1"><h4 id="plosl.F1"><a href="/books/NBK1197/figure/plosl.F1/?report=objectonly" target="object" rid-ob="figobploslF1">Figure 1. </a></h4><p class="float-caption no_bottom_margin">A radiograph of the hand of a person with PLOSL demonstrates multiple cyst-like lesions and loss of bone trabeculae. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col fig" id="figploslF2" co-legend-rid="figlgndploslF2"><a href="/books/NBK1197/figure/plosl.F2/?report=objectonly" target="object" title="Figure 2. " class="img_link icnblk_img figpopup" rid-figpopup="figploslF2" rid-ob="figobploslF2"><img class="small-thumb" src="/books/NBK1197/bin/plosl-Image002.gif" src-large="/books/NBK1197/bin/plosl-Image002.jpg" alt="Figure 2. . A radiograph shows a well-demarcated cyst-like lesion (arrow) in the talus of a person with PLOSL, age 28 years." /></a><div class="icnblk_cntnt" id="figlgndploslF2"><h4 id="plosl.F2"><a href="/books/NBK1197/figure/plosl.F2/?report=objectonly" target="object" rid-ob="figobploslF2">Figure 2. </a></h4><p class="float-caption no_bottom_margin">A radiograph shows a well-demarcated cyst-like lesion (arrow) in the talus of a person with PLOSL, age 28 years. Paloneva et al [2001]; reprinted with permission from <i>Neurology</i></p></div></div><p><b>Neuroradiologic findings</b> (<a class="figpopup" href="/books/NBK1197/figure/plosl.F3/?report=objectonly" target="object" rid-figpopup="figploslF3" rid-ob="figobploslF3">Figure 3</a>, <a class="figpopup" href="/books/NBK1197/figure/plosl.F4/?report=objectonly" target="object" rid-figpopup="figploslF4" rid-ob="figobploslF4">Figure 4</a>, <a class="figpopup" href="/books/NBK1197/figure/plosl.F5/?report=objectonly" target="object" rid-figpopup="figploslF5" rid-ob="figobploslF5">Figure 5</a>)</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figploslF3" co-legend-rid="figlgndploslF3"><a href="/books/NBK1197/figure/plosl.F3/?report=objectonly" target="object" title="Figure 3. " class="img_link icnblk_img figpopup" rid-figpopup="figploslF3" rid-ob="figobploslF3"><img class="small-thumb" src="/books/NBK1197/bin/plosl-Image003.gif" src-large="/books/NBK1197/bin/plosl-Image003.jpg" alt="Figure 3. . T2-weighted MRI of a patient age 33 years shows very low signal intensity in the putamina." /></a><div class="icnblk_cntnt" id="figlgndploslF3"><h4 id="plosl.F3"><a href="/books/NBK1197/figure/plosl.F3/?report=objectonly" target="object" rid-ob="figobploslF3">Figure 3. </a></h4><p class="float-caption no_bottom_margin">T<sub>2</sub>-weighted MRI of a patient age 33 years shows very low signal intensity in the putamina. Signal intensities are higher in the central white matter (including internal capsules) than in the deep gray matter structures. The central white matter partially <a href="/books/NBK1197/figure/plosl.F3/?report=objectonly" target="object" rid-ob="figobploslF3">(more...)</a></p></div></div><div class="iconblock whole_rhythm clearfix ten_col fig" id="figploslF4" co-legend-rid="figlgndploslF4"><a href="/books/NBK1197/figure/plosl.F4/?report=objectonly" target="object" title="Figure 4. " class="img_link icnblk_img figpopup" rid-figpopup="figploslF4" rid-ob="figobploslF4"><img class="small-thumb" src="/books/NBK1197/bin/plosl-Image004.gif" src-large="/books/NBK1197/bin/plosl-Image004.jpg" alt="Figure 4. . T2-weighted MRI of a patient age 32 years displays severely enlarged cerebral sulci and lateral ventricles." /></a><div class="icnblk_cntnt" id="figlgndploslF4"><h4 id="plosl.F4"><a href="/books/NBK1197/figure/plosl.F4/?report=objectonly" target="object" rid-ob="figobploslF4">Figure 4. </a></h4><p class="float-caption no_bottom_margin">T<sub>2</sub>-weighted MRI of a patient age 32 years displays severely enlarged cerebral sulci and lateral ventricles. Note high periventricular signal intensity spreading toward periphery. The arcuate fibers are partly spared. Paloneva et al [2001]; reprinted with <a href="/books/NBK1197/figure/plosl.F4/?report=objectonly" target="object" rid-ob="figobploslF4">(more...)</a></p></div></div><div class="iconblock whole_rhythm clearfix ten_col fig" id="figploslF5" co-legend-rid="figlgndploslF5"><a href="/books/NBK1197/figure/plosl.F5/?report=objectonly" target="object" title="Figure 5. " class="img_link icnblk_img figpopup" rid-figpopup="figploslF5" rid-ob="figobploslF5"><img class="small-thumb" src="/books/NBK1197/bin/plosl-Image005.gif" src-large="/books/NBK1197/bin/plosl-Image005.jpg" alt="Figure 5. . Brain MRI." /></a><div class="icnblk_cntnt" id="figlgndploslF5"><h4 id="plosl.F5"><a href="/books/NBK1197/figure/plosl.F5/?report=objectonly" target="object" rid-ob="figobploslF5">Figure 5. </a></h4><p class="float-caption no_bottom_margin">Brain MRI. High-intensity lesions in the bilateral periventricular white matter on an axial FLAIR image (TR: 8000 ms, TE: 120 ms) Kuroda et al [2007]; reprinted with permission from <i>Elsevier</i></p></div></div><ul><li class="half_rhythm"><div><b>Cerebral atrophy.</b> Dilated ventricles, atrophy of the basal ganglia and thalamus, prominent sulci, or thin corpus callosum is a constant finding on CT and MRI and is evident before the appearance of neuropsychiatric symptoms. Cerebellar atrophy may also be present [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>, <a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>, <a class="bk_pop" href="#plosl.REF.solje.2014.1780.e13">Solje et al 2014</a>].</div></li><li class="half_rhythm"><div><b>Bilateral calcifications of the basal ganglia</b> are a common finding on CT. The basal ganglia and thalamus, particularly the putamina, may show very low signal intensities on T<sub>2</sub>-weighted MRI [<a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>]. Calcifications may occur before central nervous system (CNS) symptoms [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>, <a class="bk_pop" href="#plosl.REF.solje.2014.1780.e13">Solje et al 2014</a>].</div></li><li class="half_rhythm"><div><b>Increased signal intensities of the cerebral white matter</b> are usually found on T<sub>2</sub>-weighted images after the appearance of clinical CNS symptoms. These white matter changes are diffuse and have no region of predilection, apart from the frontal lobes. The changes are usually centrally located (periventricular white matter, centrum semiovale, internal capsules). As the disease progresses, the high periventricular signal intensity spreads toward the periphery sparing most of the arcuate fibers. In some instances, the white matter changes also extend to the cortex. However, the white matter may look normal in some individuals with CNS symptoms [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>].</div></li><li class="half_rhythm"><div><b>SPECT and PET findings</b> are variable. Hypoperfusion of the cortical areas, thalamus, and basal ganglia have been reported [<a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>, <a class="bk_pop" href="#plosl.REF.takeshita.2005.309">Takeshita et al 2005</a>].</div></li></ul><p><b>Electroencephalogram</b> is normal early in the disease. With advancing disease, individuals show accentuation of theta and delta activity. Initially, theta is typically rhythmic, 6-8 Hz, dominating in the centrotemporal areas; later, diffuse slowing becomes evident. In the late stage of the disease, irritative activity usually appears on EEG [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>].</p><p><b>Bone biopsy</b> is not required to establish the diagnosis. The cyst-like bone lesions are filled with lipid material that microscopically consists of characteristic 1-2 µm thick lipid membranes and amorphous lipid substance.</p></div><div id="plosl.Establishing_the_Diagnosis"><h3>Establishing the Diagnosis</h3><p>The clinical diagnosis of PLOSL can be <b>established</b> in a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a> based on clinical diagnostic criteria [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>], or the molecular diagnosis can be established in a proband with suggestive findings and <a class="def" href="/books/n/gene/glossary/def-item/biallelic/">biallelic</a> pathogenic (or <a class="def" href="/books/n/gene/glossary/def-item/likely-pathogenic/">likely pathogenic</a>) variants in <i>TREM2</i> or <i>TYROBP</i> identified by <a class="def" href="/books/n/gene/glossary/def-item/molecular-genetic-testing/">molecular genetic testing</a> (see <a href="/books/NBK1197/table/plosl.T.molecular_genetic_testing_used_i/?report=objectonly" target="object" rid-ob="figobploslTmoleculargenetictestingusedi">Table 1</a>).</p><p>Note: (1) Per ACMG/AMP variant interpretation guidelines, the terms "pathogenic variants" and "<a class="def" href="/books/n/gene/glossary/def-item/likely-pathogenic/">likely pathogenic</a> variants" are synonymous in a clinical setting, meaning that both are considered diagnostic and both can be used for clinical decision making [<a class="bk_pop" href="#plosl.REF.richards.2015.405">Richards et al 2015</a>]. Reference to "pathogenic variants" in this section is understood to include any likely pathogenic variants. (2) Identification of <a class="def" href="/books/n/gene/glossary/def-item/biallelic/">biallelic</a> <i>TREM2</i> or <i>TYROBP</i> variants of <a class="def" href="/books/n/gene/glossary/def-item/uncertain-significance/">uncertain significance</a> (or of one known <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> and one variant of uncertain significance) does not establish or rule out the diagnosis.</p><p><b>Clinical diagnosis.</b> The combination of radiologically demonstrable polycystic osseous lesions, frontal lobe syndrome, and progressive presenile dementia beginning in the fourth decade is diagnostic [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>].</p><p><b>Molecular diagnosis.</b> Molecular testing approaches can include a combination of <b><a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> targeted testing</b> (serial single-gene testing, <a class="def" href="/books/n/gene/glossary/def-item/multigene-panel/">multigene panel</a>) and <b>comprehensive <a class="def" href="/books/n/gene/glossary/def-item/genomic/">genomic</a> testing</b> (<a class="def" href="/books/n/gene/glossary/def-item/exome-sequencing/">exome sequencing</a>, <a class="def" href="/books/n/gene/glossary/def-item/exome-array/">exome array</a>, <a class="def" href="/books/n/gene/glossary/def-item/genome-sequencing/">genome sequencing</a>) depending on the <a class="def" href="/books/n/gene/glossary/def-item/phenotype/">phenotype</a>.</p><p>Gene-targeted testing requires that the clinician determine which <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a>(s) are likely involved, whereas <a class="def" href="/books/n/gene/glossary/def-item/genomic/">genomic</a> testing does not. Individuals with the distinctive findings described in <a href="#plosl.Suggestive_Findings">Suggestive Findings</a> are likely to be diagnosed using gene-targeted testing (see <a href="#plosl.Option_1">Option 1</a>), whereas those in whom the diagnosis of PLOSL has not been considered are more likely to be diagnosed using genomic testing (see <a href="#plosl.Option_2">Option 2</a>).</p><div id="plosl.Option_1"><h4>Option 1</h4><p><b>Serial single-<a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a></b>
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<b>testing.</b> The order of testing is based on the individual's ethnicity. In individuals outside of Finland and Japan, <i>TREM2</i> pathogenic variants appear to be more frequent than those in <i>TYROBP</i> [<a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>].</p><dl class="temp-labeled-list"><dt>1.</dt><dd><p class="no_top_margin">Sequence analysis of each <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> is performed first.</p></dd><dt>2.</dt><dd><p class="no_top_margin">If only one or no <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> is found, <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a> is performed next.</p></dd></dl><p><b>A</b>
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<b><a class="def" href="/books/n/gene/glossary/def-item/multigene-panel/">multigene panel</a></b> that includes <i>TREM2</i> and <i>TYROBP</i> and other genes of interest (see <a href="#plosl.Differential_Diagnosis">Differential Diagnosis</a>) may also be considered. Note: (1) The genes included in the panel and the diagnostic <a class="def" href="/books/n/gene/glossary/def-item/sensitivity/">sensitivity</a> of the testing used for each <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> vary by laboratory and are likely to change over time. (2) Some multigene panels may include genes not associated with the condition discussed in this <i>GeneReview</i>; thus, clinicians need to determine which multigene panel is most likely to identify the genetic cause of the condition while limiting identification of variants of <a class="def" href="/books/n/gene/glossary/def-item/uncertain-significance/">uncertain significance</a> and pathogenic variants in genes that do not explain the underlying <a class="def" href="/books/n/gene/glossary/def-item/phenotype/">phenotype</a>. (3) In some laboratories, panel options may include a custom laboratory-designed panel and/or custom phenotype-focused <a class="def" href="/books/n/gene/glossary/def-item/exome/">exome</a> analysis that includes genes specified by the clinician. (4) Methods used in a panel may include <a class="def" href="/books/n/gene/glossary/def-item/sequence-analysis/">sequence analysis</a>, <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a>, and/or other non-sequencing-based tests.</p><p>For an introduction to multigene panels click <a href="/books/n/gene/app5/#app5.Multigene_Panels">here</a>. More detailed information for clinicians ordering genetic tests can be found <a href="/books/n/gene/app5/#app5.Multigene_Panels_FAQs">here</a>.</p></div><div id="plosl.Option_2"><h4>Option 2</h4><p>When the diagnosis of PLOSL has not been considered because an individual has atypical phenotypic features, <b>comprehensive</b>
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<b><a class="def" href="/books/n/gene/glossary/def-item/genomic/">genomic</a> testing</b>, which does not require the clinician to determine which <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> is likely involved, is an option. <b>Exome sequencing</b> is most commonly used; <b><a class="def" href="/books/n/gene/glossary/def-item/genome-sequencing/">genome sequencing</a></b> is also possible.</p><p>If <a class="def" href="/books/n/gene/glossary/def-item/exome-sequencing/">exome sequencing</a> is not diagnostic, <b><a class="def" href="/books/n/gene/glossary/def-item/exome-array/">exome array</a></b> (when clinically available) may be considered to detect (multi)<a class="def" href="/books/n/gene/glossary/def-item/exon/">exon</a> deletions or duplications that cannot be detected by <a class="def" href="/books/n/gene/glossary/def-item/sequence-analysis/">sequence analysis</a>.</p><div id="plosl.T.molecular_genetic_testing_used_i" class="table"><h3><span class="label">Table 1. </span></h3><div class="caption"><p>Molecular Genetic Testing Used in Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy (PLOSL)</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK1197/table/plosl.T.molecular_genetic_testing_used_i/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__plosl.T.molecular_genetic_testing_used_i_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_1" rowspan="2" scope="col" colspan="1" headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_1" style="text-align:left;vertical-align:middle;">Gene <sup>1, 2</sup></th><th id="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_2" rowspan="2" scope="col" colspan="1" headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_2" style="text-align:left;vertical-align:middle;">Proportion of PLOSL Attributed to Pathogenic Variants in Gene</th><th id="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_3" colspan="2" scope="colgroup" rowspan="1" style="text-align:left;vertical-align:middle;">Proportion of Pathogenic Variants <sup>3</sup> Detectable by Method</th></tr><tr><th headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_3" id="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_2_1" colspan="1" scope="colgroup" rowspan="1" style="text-align:left;vertical-align:middle;">Sequence analysis <sup>4</sup></th><th headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_3" id="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_2_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Gene-targeted <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a> <sup>5</sup></th></tr></thead><tbody><tr><td headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<i>TREM2</i>
|
||
</td><td headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">70%</td><td headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_3 hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">>90% <sup>6</sup></td><td headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_3 hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Unknown <sup>7</sup></td></tr><tr><td headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
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<i>TYROBP</i>
|
||
</td><td headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">30% <sup>8</sup></td><td headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_3 hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">>90% in persons of all other ethnicities</td><td headers="hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_1_3 hd_h_plosl.T.molecular_genetic_testing_used_i_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">100% in persons of Finnish ancestry <sup>9</sup></td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1. </dt><dd><div id="plosl.TF.1.1"><p class="no_margin">Genes are listed in alphabetic order.</p></div></dd><dt>2. </dt><dd><div id="plosl.TF.1.2"><p class="no_margin">See <a href="/books/NBK1197/#plosl.molgen.TA">Table A. Genes and Databases</a> for <a class="def" href="/books/n/gene/glossary/def-item/chromosome/">chromosome</a> <a class="def" href="/books/n/gene/glossary/def-item/locus/">locus</a> and protein.</p></div></dd><dt>3. </dt><dd><div id="plosl.TF.1.3"><p class="no_margin">See <a href="#plosl.Molecular_Genetics">Molecular Genetics</a> for information on variants detected in these genes.</p></div></dd><dt>4. </dt><dd><div id="plosl.TF.1.4"><p class="no_margin">Sequence analysis detects variants that are benign, <a class="def" href="/books/n/gene/glossary/def-item/likely-benign/">likely benign</a>, of <a class="def" href="/books/n/gene/glossary/def-item/uncertain-significance/">uncertain significance</a>, <a class="def" href="/books/n/gene/glossary/def-item/likely-pathogenic/">likely pathogenic</a>, or pathogenic. Variants may include small intragenic deletions/insertions and <a class="def" href="/books/n/gene/glossary/def-item/missense/">missense</a>, <a class="def" href="/books/n/gene/glossary/def-item/nonsense-variant/">nonsense</a>, and <a class="def" href="/books/n/gene/glossary/def-item/splice-site/">splice site</a> variants; typically, <a class="def" href="/books/n/gene/glossary/def-item/exon/">exon</a> or whole-<a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> deletions/duplications are not detected. For issues to consider in interpretation of <a class="def" href="/books/n/gene/glossary/def-item/sequence-analysis/">sequence analysis</a> results, click <a href="/books/n/gene/app2/">here</a>.</p></div></dd><dt>5. </dt><dd><div id="plosl.TF.1.5"><p class="no_margin">Gene-targeted <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a> detects intragenic deletions or duplications. Methods used may include a range of techniques such as <a class="def" href="/books/n/gene/glossary/def-item/quantitative-pcr/">quantitative PCR</a>, long-range PCR, multiplex ligation-dependent probe amplification (MLPA), and a <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a>-targeted microarray designed to detect single-<a class="def" href="/books/n/gene/glossary/def-item/exon/">exon</a> deletions or duplications.</p></div></dd><dt>6. </dt><dd><div id="plosl.TF.1.6"><p class="no_margin">Most affected individuals tested to date are <a class="def" href="/books/n/gene/glossary/def-item/homozygous/">homozygous</a> for their <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> [<a class="bk_pop" href="#plosl.REF.paloneva.2000.357">Paloneva et al 2000</a>, <a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>, <a class="bk_pop" href="#plosl.REF.dardiotis.2017.194.e13">Dardiotis et al 2017</a>].</p></div></dd><dt>7. </dt><dd><div id="plosl.TF.1.7"><p class="no_margin">No data on detection rate of <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a>-targeted <a class="def" href="/books/n/gene/glossary/def-item/deletion-duplication-analysis/">deletion/duplication analysis</a> are available.</p></div></dd><dt>8. </dt><dd><div id="plosl.TF.1.8"><p class="no_margin">Pathogenic variants in <i>TYROBP</i> have been detected in 100% of affected persons in Finland and commonly in Japan. Elsewhere <i>TREM2</i> variants appear to be more common [<a class="bk_pop" href="#plosl.REF.paloneva.2000.357">Paloneva et al 2000</a>, <a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>, <a class="bk_pop" href="#plosl.REF.satoh.2016.269">Satoh et al 2016</a>].</p></div></dd><dt>9. </dt><dd><div id="plosl.TF.1.9"><p class="no_margin">All Finnish individuals with PLOSL are <a class="def" href="/books/n/gene/glossary/def-item/homozygous/">homozygous</a> for <a class="def" href="/books/n/gene/glossary/def-item/deletion/">deletion</a> of exons 1-4 (c.-2897_277-1227del5265)<i>.</i> Deletions of exons 1-4 have also been found in affected persons in other countries as well [<a class="bk_pop" href="#plosl.REF.paloneva.2000.357">Paloneva et al 2000</a>, <a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>].</p></div></dd></dl></div></div></div></div></div></div><div id="plosl.Clinical_Characteristics"><h2 id="_plosl_Clinical_Characteristics_">Clinical Characteristics</h2><div id="plosl.Clinical_Description"><h3>Clinical Description</h3><p>The clinical course of polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) can be divided into four stages: latent, osseous, early neurologic, and late neurologic [<a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>].</p><p><b>Latent stage.</b> Early development is normal.</p><p><b>Osseous stage (3rd decade of life).</b> The first symptoms of PLOSL appear in early adulthood as pain and tenderness, mostly in the ankles and feet, usually following strain or a minor accident. Fractures are typically diagnosed several years later, most commonly in the bones of the extremities [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>]. The first fractures usually occur shortly before age 30 years; however, affected individuals may have had pain and swelling of the ankles and wrists after strain for years. The fractures heal well. It is important to note that some individuals may present with neurologic symptoms without any preceding osseous manifestations [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>, <a class="bk_pop" href="#plosl.REF.bock.2013.115">Bock et al 2013</a>].</p><p><b>Early neurologic stage (4th decade of life).</b> Personality changes begin insidiously in the fourth decade. Affected individuals show progressive loss of judgment, leading to serious social consequences, including divorce, unemployment, and financial trouble [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>, <a class="bk_pop" href="#plosl.REF.ilonen.2012.236">Ilonen et al 2012</a>]. Some individuals may attempt suicide. The full-blown picture of frontal lobe syndrome subsequently appears: loss of judgment; euphoria; lack of social inhibitions, including <i>Witzelsucht</i>; disturbance of concentration; and lack of insight, libido, and motor persistence.</p><p>Progressive signs of upper motor neuron involvement (spasticity, extensor plantar reflexes) are noticed. With advancing disease, lack of initiative and activity conceal the aforementioned symptoms [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>].</p><p>Memory disturbances begin at approximately the same age as the personality changes, and are best detectable by psychometric tests [<a class="bk_pop" href="#plosl.REF.vanhanen.2013.10">Vanhanen et al 2013</a>]. The memory disturbance is less severe than the personality change, and affected individuals retain basic personal information until the last stage of the disease.</p><p>Other disturbances of higher cortical function, such as motor aphasia, agraphia, acalculia, and apraxia, appear only at the last stage of the disease.</p><p>Affected individuals may develop postural dyspraxia: they walk or sit in peculiar skewed postures. Involuntary athetotic or choreatic movements or myoclonic twitches are common. Individuals who reach their mid-thirties frequently experience epileptic seizures. In some individuals, impotence or lack of libido and urinary incontinence are among the first symptoms [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>].</p><p><b>Late neurologic stage.</b> In the last stage of the disease, individuals lose their ability to walk and progress to a vegetative state. Primitive reflexes, such as visual and tactile grasp and mouth-opening reflexes, as well as the sucking reflex, may become noticeable. Affected individuals typically die before age 50 years [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>].</p><p><b>Bone pathology.</b> The cyst-like bone lesions are filled with lipid material that microscopically consists of characteristic 1-2 µm thick lipid membranes and amorphous lipid substance [<a class="bk_pop" href="#plosl.REF.kitajima.1989.35">Kitajima et al 1989</a>]. See <a class="figpopup" href="/books/NBK1197/figure/plosl.F6/?report=objectonly" target="object" rid-figpopup="figploslF6" rid-ob="figobploslF6">Figure 6</a>.</p><div class="iconblock whole_rhythm clearfix ten_col fig" id="figploslF6" co-legend-rid="figlgndploslF6"><a href="/books/NBK1197/figure/plosl.F6/?report=objectonly" target="object" title="Figure 6. " class="img_link icnblk_img figpopup" rid-figpopup="figploslF6" rid-ob="figobploslF6"><img class="small-thumb" src="/books/NBK1197/bin/plosl-Image006.gif" src-large="/books/NBK1197/bin/plosl-Image006.jpg" alt="Figure 6. . Contents of a cyst-like bone lesion." /></a><div class="icnblk_cntnt" id="figlgndploslF6"><h4 id="plosl.F6"><a href="/books/NBK1197/figure/plosl.F6/?report=objectonly" target="object" rid-ob="figobploslF6">Figure 6. </a></h4><p class="float-caption no_bottom_margin">Contents of a cyst-like bone lesion. Microscopically, the lesions contain (C) convoluted lipid membrane structures filled with amorphous lipid substance and (F) fat. (B) Bone trabeculae are partially preserved. Scale bar corresponds to 250 μm <a href="/books/NBK1197/figure/plosl.F6/?report=objectonly" target="object" rid-ob="figobploslF6">(more...)</a></p></div></div><p><b>Neuropathology.</b> Generalized cerebral gyral atrophy with frontal accentuation is observed at autopsy. The corpus callosum is abnormally thin. The central white matter is severely reduced in amount, grayish, and tough. The basal ganglia, particularly the caudate nuclei, are variably reduced in size [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>]. All affected individuals show marked <i>hydrocephalus ex vacuo</i>.</p><p>Histologic examination reveals scattered neurons showing features of central chromatolysis. Intraneuronal or glial pathologic inclusions have not been observed [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>]. Neuronal loss as well as astrocytic proliferation and hypertrophy are observed in the caudate nuclei. In addition, scattered calcospherites are seen, particularly in the putamina and globi pallidi [<a class="bk_pop" href="#plosl.REF.kalimo.1994.353">Kalimo et al 1994</a>, <a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>]. Thalamic degeneration may occur [<a class="bk_pop" href="#plosl.REF.kobayashi.2000.98">Kobayashi et al 2000</a>]. Affected individuals show advanced loss of axons and myelin and a pronounced astrocytic reaction in the centrum semiovale, accentuated in the frontal and temporal lobes, with moderate involvement of the gyral white matter. In addition, widespread activation of microglia in the cerebral white matter is seen [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>]. Scattered small arterioles and capillaries in the deep frontal and temporal white matter show concentric thickening of the vascular wall with multiple thickened basement membranes and narrowing or obliteration of the lumen [<a class="bk_pop" href="#plosl.REF.paloneva.2001.1552">Paloneva et al 2001</a>]. The cerebral cortices are less severely affected [<a class="bk_pop" href="#plosl.REF.aoki.2011.135">Aoki et al 2011</a>].</p><p><b>Pathologic findings in other organs.</b> Characteristic lipomembranous changes have been described in systemic adipose tissue [<a class="bk_pop" href="#plosl.REF.nasu.1973.539">Nasu et al 1973</a>]. Pathologic manifestations in organs other than the central nervous system (CNS) and the skeletal system have been insufficiently characterized.</p></div><div id="plosl.GenotypePhenotype_Correlations"><h3>Genotype-Phenotype Correlations</h3><p>Individuals with <a class="def" href="/books/n/gene/glossary/def-item/homozygous/">homozygous</a> pathogenic variants in <i>TYROBP</i> or <i>TREM2</i> develop similar CNS manifestations [<a class="bk_pop" href="#plosl.REF.paloneva.2002.656">Paloneva et al 2002</a>, <a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>].</p><p>Some <i>TREM2</i> pathogenic variants have been reported to cause a dementia syndrome resembling PLOSL without evident osseous manifestations (see <a href="#plosl.Genetically_Related_Allelic_Disord">Genetically Related Disorders</a>).</p></div><div id="plosl.Nomenclature"><h3>Nomenclature</h3><p>Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy may be abbreviated as PLOSL.</p><p>The first affected individuals were described in the 1960s independently by Järvi and Hakola in Finland and Nasu in Japan.</p><p>In the early literature, PLOSL was also known as membranous lipodystrophy. This term is outdated and should not be used.</p></div><div id="plosl.Prevalence"><h3>Prevalence</h3><p>The prevalence of PLOSL is highest in Finland due to a <i>TYROBP</i> <a class="def" href="/books/n/gene/glossary/def-item/founder-variant/">founder variant</a>, <a class="def" href="/books/n/gene/glossary/def-item/deletion/">deletion</a> of exons 1-4 (c.-2897_277-1227del5265), with an estimated prevalence of 1:1,000,000 to 2:1,000,000 [<a class="bk_pop" href="#plosl.REF.pekkarinen.1998.362">Pekkarinen et al 1998</a>]. The prevalence of PLOSL in other countries is lower; no detailed data on the prevalence elsewhere are available. Most affected individuals have been diagnosed in Japan (>100 cases) [<a class="bk_pop" href="#plosl.REF.pekkarinen.1998.362">Pekkarinen et al 1998</a>]. Single families with PLOSL have been diagnosed worldwide [<a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>].</p></div></div><div id="plosl.Genetically_Related_Allelic_Disord"><h2 id="_plosl_Genetically_Related_Allelic_Disord_">Genetically Related (Allelic) Disorders</h2><p>No disorders other than those discussed in this <i>GeneReview</i> are known to be caused by mutation of <i>TYROBP</i>. Other phenotypes associated with <a class="def" href="/books/n/gene/glossary/def-item/germline/">germline</a> pathogenic variants in <i>TREM2</i> are summarized in <a href="/books/NBK1197/table/plosl.T.trem2_allelic_disorders/?report=objectonly" target="object" rid-ob="figobploslTtrem2allelicdisorders">Table 2</a>.</p><div id="plosl.T.trem2_allelic_disorders" class="table"><h3><span class="label">Table 2. </span></h3><div class="caption"><p><i>TREM2</i> Allelic Disorders</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK1197/table/plosl.T.trem2_allelic_disorders/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__plosl.T.trem2_allelic_disorders_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Variant</th><th id="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reference</th><th id="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Disorder</th></tr></thead><tbody><tr><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Homozygous</td><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<a class="bk_pop" href="#plosl.REF.chouery.2008.e194">Chouery et al [2008]</a>
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</td><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_3" rowspan="3" colspan="1" style="text-align:left;vertical-align:middle;">CNS manifestations typical of PLOSL but w/o diagnosed osseous manifestations</td></tr><tr><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Homozygous<br /><a href="/books/NBK1197/table/plosl.T.polycystic_lipomembranous_osteod/?report=objectonly" target="object" rid-ob="figobploslTpolycysticlipomembranousosteod">p.Tyr38Cys</a></td><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<a class="bk_pop" href="#plosl.REF.guerreiro.2013.78">Guerreiro et al [2013]</a>
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</td></tr><tr><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Homozygous<br /><a href="/books/NBK1197/table/plosl.T.polycystic_lipomembranous_osteod/?report=objectonly" target="object" rid-ob="figobploslTpolycysticlipomembranousosteod">p.Thr66Met</a></td><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"><a class="bk_pop" href="#plosl.REF.guerreiro.2013.78">Guerreiro et al [2013]</a>, <a class="bk_pop" href="#plosl.REF.le_ber.2014.2419.e23">Le Ber et al [2014]</a></td></tr><tr><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Heterozygous<br />p.Arg47His</td><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"><a class="bk_pop" href="#plosl.REF.carmona.2018.721">Carmona et al [2018]</a> (See <a href="/books/n/gene/alzheimer/">Alzheimer Disease Overview</a>.)</td><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Rare variant assoc w/odds ratio of ~3.0 for occurrence of late-onset Alzheimer disease (See <a href="/books/n/gene/alzheimer/">Alzheimer Disease Overview</a>.)</td></tr><tr><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Compound <a class="def" href="/books/n/gene/glossary/def-item/heterozygous/">heterozygous</a><br />p.Asp87Asn;<br />p.Phe143fs</td><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
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<a class="bk_pop" href="#plosl.REF.williamson.2019.75">Williamson & Larner [2019]</a>
|
||
</td><td headers="hd_h_plosl.T.trem2_allelic_disorders_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Behavioral variant frontotemporal dementia-like syndrome</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">CNS = central nervous system</p></div></dd></dl></div></div></div></div><div id="plosl.Differential_Diagnosis"><h2 id="_plosl_Differential_Diagnosis_">Differential Diagnosis</h2><p>The combination of frontal-type dementia beginning in the fourth decade and radiologically demonstrable polycystic osseous lesions makes it easy to clinically distinguish polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) from the established forms of <a class="def" href="/books/n/gene/glossary/def-item/familial/">familial</a> and nonfamilial frontotemporal dementia (e.g., Pick disease, nonspecific frontal lobe degeneration, <a href="/books/n/gene/hdls/"><i>CSF1R</i> adult-onset leukoencephalopathy with axonal spheroids and pigmented glia</a>, and the various entities of frontotemporal dementia and parkinsonism linked to pathogenic variants in <a href="/books/n/gene/ftdp-17/"><i>MAPT</i></a>).</p></div><div id="plosl.Management"><h2 id="_plosl_Management_">Management</h2><p>No clinical practice guidelines for polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) have been published.</p><div id="plosl.Evaluations_Following_Initial_Diag"><h3>Evaluations Following Initial Diagnosis</h3><p>To establish the extent of disease and needs in an individual diagnosed with PLOSL, the evaluations summarized in <a href="/books/NBK1197/table/plosl.T.recommended_evaluations_followin/?report=objectonly" target="object" rid-ob="figobploslTrecommendedevaluationsfollowin">Table 3</a> (if not performed as part of the evaluation that led to the diagnosis) are recommended.</p><div id="plosl.T.recommended_evaluations_followin" class="table"><h3><span class="label">Table 3. </span></h3><div class="caption"><p>Recommended Evaluations Following Initial Diagnosis in Individuals with Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK1197/table/plosl.T.recommended_evaluations_followin/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__plosl.T.recommended_evaluations_followin_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">System/Concern</th><th id="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Evaluation</th><th id="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comment</th></tr></thead><tbody><tr><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Polycystic</b>
|
||
<br />
|
||
<b>osseous lesions</b>
|
||
</td><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Radiographs of bones of wrists, hands, ankles, & feet</td><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"><ul><li class="half_rhythm"><div>To determine extent of osseous manifestations</div></li><li class="half_rhythm"><div>A plain radiograph must be taken if skeletal pain ↑ due to risk of pathologic fracture.</div></li></ul>
|
||
</td></tr><tr><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_1" rowspan="2" scope="row" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Neurologic</b>
|
||
<br />
|
||
<b>manifestations</b>
|
||
</td><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Brain CT &/or MRI</td><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">To determine extent of CNS manifestations</td></tr><tr><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">Neurologic & neuropsychological exam</td><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">To establish extent of neurologic impairment & cognitive disturbance</td></tr><tr><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Genetic</b>
|
||
<br />
|
||
<b>counseling</b>
|
||
</td><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">By genetics professionals <sup>1</sup></td><td headers="hd_h_plosl.T.recommended_evaluations_followin_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">To inform affected persons & their families re nature, MOI, & implications of PLOSL to facilitate medical & personal decision making</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">CNS = central nervous system; MOI = <a class="def" href="/books/n/gene/glossary/def-item/mode-of-inheritance/">mode of inheritance</a></p></div></dd><dt>1. </dt><dd><div id="plosl.TF.3.1"><p class="no_margin">Medical geneticist, certified genetic counselor, or certified advanced genetic nurse</p></div></dd></dl></div></div></div></div><div id="plosl.Treatment_of_Manifestations"><h3>Treatment of Manifestations</h3><p>Only symptomatic treatment is available.</p><div id="plosl.T.treatment_of_manifestations_in_i" class="table"><h3><span class="label">Table 4. </span></h3><div class="caption"><p>Treatment of Manifestations in Individuals with Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK1197/table/plosl.T.treatment_of_manifestations_in_i/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__plosl.T.treatment_of_manifestations_in_i_lrgtbl__"><table><thead><tr><th id="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Manifestation/Concern</th><th id="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Treatment</th><th id="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Considerations/Other</th></tr></thead><tbody><tr><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_1" rowspan="3" scope="row" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Polycystic osseous</b>
|
||
<br />
|
||
<b>lesions</b>
|
||
</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Standard orthopedic management of fractures</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr><tr><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">Pain mgmt following treatment of osseous lesions</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reported following curettage & iliac bone grafting of painful lesions in talus [<a class="bk_pop" href="#plosl.REF.ar_kan.2014.458728">Arıkan et al 2014</a>]</td></tr><tr><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">Supportive orthopedic devices</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">May be helpful in some persons</td></tr><tr><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_1" rowspan="2" scope="row" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Psychiatric</b>
|
||
<br />
|
||
<b>manifestations</b>
|
||
</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Psychotropic drugs</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"><ul><li class="half_rhythm"><div>Insufficient data available</div></li><li class="half_rhythm"><div>Not helpful in 1 report [<a class="bk_pop" href="#plosl.REF.yamazaki.2015.324">Yamazaki et al 2015</a>]</div></li></ul>
|
||
</td></tr><tr><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">Psychological support & early education of family members re nature of disorder</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">May prevent some social consequences (e.g., unemployment, divorce, financial troubles, alcoholism) of disorder [<a class="bk_pop" href="#plosl.REF.ilonen.2012.236">Ilonen et al 2012</a>]</td></tr><tr><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Epileptic seizures</b>
|
||
</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Anti-seizure medication</td><td headers="hd_h_plosl.T.treatment_of_manifestations_in_i_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;"></td></tr></tbody></table></div></div></div><div id="plosl.Surveillance"><h3>Surveillance</h3><p>The interval of surveillance for bone lesions, neurologic, and psychiatric manifestations must be determined individually.</p><div id="plosl.T.recommended_surveillance_for_ind" class="table"><h3><span class="label">Table 5. </span></h3><div class="caption"><p>Recommended Surveillance for Individuals with Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK1197/table/plosl.T.recommended_surveillance_for_ind/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__plosl.T.recommended_surveillance_for_ind_lrgtbl__"><table><thead><tr><th id="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">System/Concern</th><th id="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Evaluation</th><th id="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Frequency</th></tr></thead><tbody><tr><td headers="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Polycystic osseous lesions</b>
|
||
</td><td headers="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Clinical eval for evidence of fractures</td><td headers="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_3" rowspan="3" colspan="1" style="text-align:left;vertical-align:middle;">Must be determined on an individual basis</td></tr><tr><td headers="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Neurologic manifestations</b>
|
||
</td><td headers="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Neurologic exam</td></tr><tr><td headers="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<b>Psychiatric manifestations</b>
|
||
</td><td headers="hd_h_plosl.T.recommended_surveillance_for_ind_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Neuropsychological exam</td></tr></tbody></table></div></div></div><div id="plosl.Evaluation_of_Relatives_at_Risk"><h3>Evaluation of Relatives at Risk</h3><p>See <a href="#plosl.Related_Genetic_Counseling_Issues">Genetic Counseling</a> for issues related to testing of at-risk relatives for <a class="def" href="/books/n/gene/glossary/def-item/genetic-counseling/">genetic counseling</a> purposes.</p></div><div id="plosl.Therapies_Under_Investigation"><h3>Therapies Under Investigation</h3><p>Search <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> in the US and <a href="https://www.clinicaltrialsregister.eu/ctr-search/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">EU Clinical Trials Register</a> in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.</p></div><div id="plosl.Other"><h3>Other</h3><p>Calcium substitution alone has been shown to be ineffective in preventing the development of the osseous manifestations. The effect of bisphosphonates has not been studied.</p><p>It has been speculated that nonsteroidal anti-inflammatory drugs could slow the progression of PLOSL; however, clinical trials have not been performed.</p><p>A single individual with PLOSL improved temporarily when taking donepezil [D Hemelsoet, personal observation]. Clinical trials in a series of individuals with PLOSL have not been reported.</p></div></div><div id="plosl.Genetic_Counseling"><h2 id="_plosl_Genetic_Counseling_">Genetic Counseling</h2><p>
|
||
<i>Genetic counseling is the process of providing individuals and families with
|
||
information on the nature, mode(s) of inheritance, and implications of genetic disorders to help them
|
||
make informed medical and personal decisions. The following section deals with genetic
|
||
risk assessment and the use of family history and genetic testing to clarify genetic
|
||
status for family members; it is not meant to address all personal, cultural, or
|
||
ethical issues that may arise or to substitute for consultation with a genetics
|
||
professional</i>. —ED.</p><div id="plosl.Mode_of_Inheritance"><h3>Mode of Inheritance</h3><p>Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy (PLOSL) is inherited in an <a class="def" href="/books/n/gene/glossary/def-item/autosomal-recessive/">autosomal recessive</a> manner.</p></div><div id="plosl.Risk_to_Family_Members"><h3>Risk to Family Members</h3><p>
|
||
<b>Parents of a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a></b>
|
||
</p><ul><li class="half_rhythm"><div>The parents of an affected individual are obligate heterozygotes (i.e., presumed to be carriers of one <i>TREM2</i> or <i>TYROBP</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> based on family history).</div></li><li class="half_rhythm"><div>If a molecular diagnosis has been established in the <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a>, <a class="def" href="/books/n/gene/glossary/def-item/molecular-genetic-testing/">molecular genetic testing</a> of the parents is recommended to confirm that both parents are <a class="def" href="/books/n/gene/glossary/def-item/heterozygous/">heterozygous</a> for a PLOSL-related <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a> and to allow reliable <a class="def" href="/books/n/gene/glossary/def-item/recurrence-risk/">recurrence risk</a> assessment. (<i>De novo</i> variants are known to occur at a low but appreciable rate in <a class="def" href="/books/n/gene/glossary/def-item/autosomal-recessive/">autosomal recessive</a> disorders [<a class="bk_pop" href="#plosl.REF.j_nsson.2017.519">Jónsson et al 2017</a>].)</div></li><li class="half_rhythm"><div>Heterozygotes (carriers) are asymptomatic and are not at risk of developing the disorder.</div></li></ul><p>
|
||
<b>Sibs of a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a></b>
|
||
</p><ul><li class="half_rhythm"><div class="half_rhythm">If both parents are known to be <a class="def" href="/books/n/gene/glossary/def-item/heterozygous/">heterozygous</a> for a PLOSL-related <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a>, each sib of an affected individual has at conception a 25% chance of being affected, a 50% chance of being an asymptomatic <a class="def" href="/books/n/gene/glossary/def-item/carrier/">carrier</a>, and a 25% chance of being unaffected and not a carrier.</div><div class="half_rhythm">Note: Sibs who are younger than age 40 years are at risk for PLOSL. Polycystic osseous lesions in radiographs of the hands and feet of an at-risk adult suggest the diagnosis.</div></li><li class="half_rhythm"><div class="half_rhythm">Heterozygotes (carriers) are asymptomatic and are not at risk of developing the disorder.</div></li></ul><p>
|
||
<b>Offspring of a <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a></b>
|
||
</p><ul><li class="half_rhythm"><div>Unless an affected individual's reproductive partner also has PLOSL or is a <a class="def" href="/books/n/gene/glossary/def-item/carrier/">carrier</a>, offspring will be obligate heterozygotes for a <i>TREM2</i> or <i>TYROBP</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a>.</div></li><li class="half_rhythm"><div>Because of the low <a class="def" href="/books/n/gene/glossary/def-item/carrier-rate/">carrier rate</a> in the general population, the risk that an affected individual would have children with a carrier is very low except in genetic isolates (see <a href="#plosl.Prevalence">Prevalence</a>).</div></li></ul><p><b>Other family members.</b> Each sib of the <a class="def" href="/books/n/gene/glossary/def-item/proband/">proband</a>'s parents is at a 50% risk of being a <a class="def" href="/books/n/gene/glossary/def-item/carrier/">carrier</a> of a <i>TREM2</i> or <i>TYROBP</i> <a class="def" href="/books/n/gene/glossary/def-item/pathogenic-variant/">pathogenic variant</a>.</p></div><div id="plosl.Carrier_Detection"><h3>Carrier Detection</h3><p>Carrier testing for at-risk relatives requires prior identification of the PLOSL-related pathogenic variants in the family.</p></div><div id="plosl.Related_Genetic_Counseling_Issues"><h3>Related Genetic Counseling Issues</h3><p>
|
||
<b>Family planning</b>
|
||
</p><ul><li class="half_rhythm"><div>The optimal time for determination of genetic risk, clarification of <a class="def" href="/books/n/gene/glossary/def-item/carrier/">carrier</a> status, and discussion of the availability of prenatal/<a class="def" href="/books/n/gene/glossary/def-item/preimplantation-genetic-testing/">preimplantation genetic testing</a> is before pregnancy.</div></li><li class="half_rhythm"><div>It is appropriate to offer <a class="def" href="/books/n/gene/glossary/def-item/genetic-counseling/">genetic counseling</a> (including discussion of potential risks to offspring and reproductive options) to young adults who are affected, are carriers, or are at risk of being affected or carriers.</div></li></ul><p>
|
||
<b>Predictive testing (i.e., testing of asymptomatic at-risk individuals)</b>
|
||
</p><ul><li class="half_rhythm"><div>Predictive testing for at-risk relatives is possible once the PLOSL-related pathogenic variants have been identified in an affected family member.</div></li><li class="half_rhythm"><div>Potential consequences of such testing (including but not limited to socioeconomic changes and the need for long-term follow up and evaluation arrangements for individuals with a positive test result) as well as the capabilities and limitations of predictive testing should be discussed in the context of formal <a class="def" href="/books/n/gene/glossary/def-item/genetic-counseling/">genetic counseling</a> prior to testing.</div></li></ul><p>
|
||
<b>Predictive testing in minors (i.e., testing of asymptomatic at-risk individuals younger than age 18 years)</b>
|
||
</p><ul><li class="half_rhythm"><div>For asymptomatic minors at risk for adult-onset conditions for which early treatment would have no beneficial effect on disease morbidity and mortality, predictive genetic testing is considered inappropriate, primarily because it negates the autonomy of the child with no compelling benefit. Further, concern exists regarding the potential unhealthy adverse effects that such information may have on family dynamics, the risk of discrimination and stigmatization in the future, and the anxiety that such information may cause.</div></li><li class="half_rhythm"><div>For more information, see the National Society of Genetic Counselors <a href="https://www.nsgc.org/Policy-Research-and-Publications/Position-Statements/Position-Statements/Post/genetic-testing-of-minors-for-adult-onset-conditions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">position statement</a> on genetic testing of minors for adult-onset conditions and the American Academy of Pediatrics and American College of Medical Genetics and Genomics <a href="https://pediatrics.aappublications.org/content/131/3/620.full.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">policy statement</a>: ethical and policy issues in genetic testing and screening of children.</div></li></ul><p>In a family with an established diagnosis of PLOSL, it is appropriate to consider testing of symptomatic individuals regardless of age.</p><p><b>DNA banking.</b> Because it is likely that testing methodology and our understanding of genes, pathogenic mechanisms, and diseases will improve in the future, consideration should be given to banking DNA from probands in whom a molecular diagnosis has not been confirmed (i.e., the causative pathogenic mechanism is unknown). For more information, see <a class="bk_pop" href="#plosl.REF.huang.2022.389">Huang et al [2022]</a>.</p></div><div id="plosl.Prenatal_Testing_and_Preimplantati"><h3>Prenatal Testing and Preimplantation Genetic Testing</h3><p>Once the <i>TREM2</i> or <i>TYROBP</i> pathogenic variants have been identified in an affected family member, prenatal and <a class="def" href="/books/n/gene/glossary/def-item/preimplantation-genetic-testing/">preimplantation genetic testing</a> for PLOSL are possible.</p><p>Differences in perspective may exist among medical professionals and within families regarding the use of <a class="def" href="/books/n/gene/glossary/def-item/prenatal-testing/">prenatal testing</a>. While most centers would consider use of prenatal testing to be a personal decision, discussion of these issues may be helpful.</p></div></div><div id="plosl.Resources"><h2 id="_plosl_Resources_">Resources</h2><p>
|
||
<i>GeneReviews staff has selected the following disease-specific and/or umbrella
|
||
support organizations and/or registries for the benefit of individuals with this disorder
|
||
and their families. GeneReviews is not responsible for the information provided by other
|
||
organizations. For information on selection criteria, click <a href="/books/n/gene/app4/">here</a>.</i></p>
|
||
<ul><li class="half_rhythm"><div>
|
||
<b>National Library of Medicine Genetics Home Reference</b>
|
||
</div><div>
|
||
<a href="http://ghr.nlm.nih.gov/condition/polycystic-lipomembranous-osteodysplasia-with-sclerosing-leukoencephalopathy" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy</a>
|
||
</div></li></ul>
|
||
</div><div id="plosl.Molecular_Genetics"><h2 id="_plosl_Molecular_Genetics_">Molecular Genetics</h2><p><i>Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —</i>ED.</p><div id="plosl.molgen.TA" class="table"><h3><span class="label">Table A.</span></h3><div class="caption"><p>Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy: Genes and Databases</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK1197/table/plosl.molgen.TA/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__plosl.molgen.TA_lrgtbl__"><table class="no_bottom_margin"><tbody><tr><th id="hd_b_plosl.molgen.TA_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">Gene</th><th id="hd_b_plosl.molgen.TA_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">Chromosome Locus</th><th id="hd_b_plosl.molgen.TA_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">Protein</th><th id="hd_b_plosl.molgen.TA_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">HGMD</th><th id="hd_b_plosl.molgen.TA_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">ClinVar</th></tr><tr><td headers="hd_b_plosl.molgen.TA_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="/gene/54209" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=gene">
|
||
<i>TREM2</i>
|
||
</a>
|
||
</td><td headers="hd_b_plosl.molgen.TA_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/genome/gdv/?context=gene&acc=54209" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">6p21<wbr style="display:inline-block"></wbr>.1</a>
|
||
</td><td headers="hd_b_plosl.molgen.TA_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="http://www.uniprot.org/uniprot/Q9NZC2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Triggering receptor expressed on myeloid cells 2</a>
|
||
</td><td headers="hd_b_plosl.molgen.TA_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="http://www.hgmd.cf.ac.uk/ac/gene.php?gene=TREM2" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">TREM2</a>
|
||
</td><td headers="hd_b_plosl.molgen.TA_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/clinvar/?term=TREM2[gene]" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">TREM2</a>
|
||
</td></tr><tr><td headers="hd_b_plosl.molgen.TA_1_1_1_1" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="/gene/7305" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=gene">
|
||
<i>TYROBP</i>
|
||
</a>
|
||
</td><td headers="hd_b_plosl.molgen.TA_1_1_1_2" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/genome/gdv/?context=gene&acc=7305" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">19q13<wbr style="display:inline-block"></wbr>.12</a>
|
||
</td><td headers="hd_b_plosl.molgen.TA_1_1_1_3" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="http://www.uniprot.org/uniprot/O43914" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">TYRO protein tyrosine kinase-binding protein</a>
|
||
</td><td headers="hd_b_plosl.molgen.TA_1_1_1_4" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="http://www.hgmd.cf.ac.uk/ac/gene.php?gene=TYROBP" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">TYROBP</a>
|
||
</td><td headers="hd_b_plosl.molgen.TA_1_1_1_5" rowspan="1" colspan="1" style="vertical-align:top;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/clinvar/?term=TYROBP[gene]" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">TYROBP</a>
|
||
</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div id="plosl.TFA.1"><p class="no_margin">Data are compiled from the following standard references: <a class="def" href="/books/n/gene/glossary/def-item/gene/">gene</a> from
|
||
<a href="http://www.genenames.org/index.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">HGNC</a>;
|
||
<a class="def" href="/books/n/gene/glossary/def-item/chromosome/">chromosome</a> <a class="def" href="/books/n/gene/glossary/def-item/locus/">locus</a> from
|
||
<a href="http://www.omim.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">OMIM</a>;
|
||
protein from <a href="http://www.uniprot.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">UniProt</a>.
|
||
For a description of databases (Locus Specific, HGMD, ClinVar) to which links are provided, click
|
||
<a href="/books/n/gene/app1/">here</a>.</p></div></dd></dl></div></div></div><div id="plosl.molgen.TB" class="table"><h3><span class="label">Table B.</span></h3><div class="caption"><p>OMIM Entries for Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy (<a href="/omim/221770,604142,605086" ref="pagearea=body&targetsite=entrez&targetcat=term&targettype=omim">View All in OMIM</a>) </p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK1197/table/plosl.molgen.TB/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__plosl.molgen.TB_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="/omim/221770" ref="pagearea=body&targetsite=entrez&targetcat=term&targettype=omim">221770</a></td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">POLYCYSTIC LIPOMEMBRANOUS OSTEODYSPLASIA WITH SCLEROSING LEUKOENCEPHALOPATHY 1; PLOSL1</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="/omim/604142" ref="pagearea=body&targetsite=entrez&targetcat=term&targettype=omim">604142</a></td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TYRO PROTEIN TYROSINE KINASE-BINDING PROTEIN; TYROBP</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<a href="/omim/605086" ref="pagearea=body&targetsite=entrez&targetcat=term&targettype=omim">605086</a></td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">TRIGGERING RECEPTOR EXPRESSED ON MYELOID CELLS 2; TREM2</td></tr></tbody></table></div></div><div id="plosl.Molecular_Pathogenesis"><h3>Molecular Pathogenesis</h3><p>TYROBP is a transmembrane adaptor protein that mediates the activation of a wide variety of cells of myeloid and lymphoid origin. On the cell plasma membrane, TYROBP is expressed as a disulfide-bonded homodimer linked to the associated cell surface receptors. Numerous TYROBP-associated cell surface receptors have been reported [<a class="bk_pop" href="#plosl.REF.lanier.2009.150">Lanier 2009</a>]. The cytoplasmic <a class="def" href="/books/n/gene/glossary/def-item/domain/">domain</a> of TYROBP contains an immunoreceptor tyrosine-based activation motif which on receptor engagement becomes phosphorylated and binds the cytoplasmic protein tyrosine kinases SYK and ZAP70.</p><p>The protein encoded by <i>TREM2</i> is an activating cell-surface receptor that forms a complex with the transmembrane adaptor protein TYROBP. The TREM2-TYROBP protein complex regulates the differentiation and function of osteoclasts, the bone-resorbing cells. The differentiation of osteoclasts in TYROBP-deficient individuals is impaired, and the osteoclasts show a reduced bone resorption capability in vitro [<a class="bk_pop" href="#plosl.REF.cella.2003.645">Cella et al 2003</a>, <a class="bk_pop" href="#plosl.REF.paloneva.2003.669">Paloneva et al 2003</a>].</p><p>TREM2 is expressed by a variety of cells of myeloid origin. TREM2 also activates monocyte-derived dendritic cells and is expressed by macrophages [<a class="bk_pop" href="#plosl.REF.thrash.2009.38">Thrash et al 2009</a>]. In the central nervous system (CNS), TREM2 and TYROBP are expressed by microglial cells. The exact function of TREM2 in the CNS is unknown [<a class="bk_pop" href="#plosl.REF.painter.2015.43">Painter et al 2015</a>]. TREM2/DAP12-mediated signaling has been postulated to promote proliferation, phagocytosis, and migration of microglia by induction and maintenance of microglial activation in the CNS [<a class="bk_pop" href="#plosl.REF.konishi.2018.206">Konishi & Kiyama 2018</a>].</p><p>The intracellular responses underlying the pathogenic mechanisms of PLOSL are poorly understood.</p><p><b>Mechanism of disease causation</b>. Loss of function</p><div id="plosl.T.polycystic_lipomembranous_osteod" class="table"><h3><span class="label">Table 6. </span></h3><div class="caption"><p>Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy: Notable Pathogenic Variants by Gene</p></div><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK1197/table/plosl.T.polycystic_lipomembranous_osteod/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__plosl.T.polycystic_lipomembranous_osteod_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Gene <sup>1</sup></th><th id="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reference Sequences</th><th id="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">DNA Nucleotide Change</th><th id="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Predicted Protein Change</th><th id="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comment [Reference]</th></tr></thead><tbody><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_1" rowspan="7" scope="row" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<i>TREM2</i>
|
||
</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/nuccore/NM_018965.3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NM_018965<wbr style="display:inline-block"></wbr>.3</a>
|
||
</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">c.40+4_40+6delGGA<br />(c.40+3delAGG <sup>1</sup>)</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">--</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" rowspan="3" colspan="1" style="text-align:left;vertical-align:middle;">CNS manifestations typical of PLOSL but w/o diagnosed osseous manifestations [<a class="bk_pop" href="#plosl.REF.chouery.2008.e194">Chouery et al 2008</a>, <a class="bk_pop" href="#plosl.REF.guerreiro.2013.78">Guerreiro et al 2013</a>]</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_2" rowspan="5" colspan="1" scope="row" style="text-align:left;vertical-align:middle;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/nuccore/NM_018965.3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NM_018965<wbr style="display:inline-block"></wbr>.3</a>
|
||
<br />
|
||
<a href="https://www.ncbi.nlm.nih.gov/protein/NP_061838.1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NP_061838<wbr style="display:inline-block"></wbr>.1</a>
|
||
</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">c.113A>G</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Tyr38Cys</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.197C>T</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Thr66Met</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.233G>A</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Trp78Ter</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reported in 2 Swedish families [<a class="bk_pop" href="#plosl.REF.paloneva.2003.669">Paloneva et al 2003</a>]</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.377T>G</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Val126Gly</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reported in 2 persons of Sri Lankan background [<a class="bk_pop" href="#plosl.REF.kl_nemann.2005.1502">Klünemann et al 2005</a>]</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.97C>T</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Gln33Ter</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reported to cause PLOSL w/typical bone pathology but also frontotemporal dementia-like syndrome w/o bone pathology on radiographs</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_2" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/nuccore/NM_018965.3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NM_018965<wbr style="display:inline-block"></wbr>.3</a>
|
||
</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">c.482+2T>C</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">--</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reported in Japanese persons w/PLOSL [<a class="bk_pop" href="#plosl.REF.paloneva.2002.656">Paloneva et al 2002</a>, <a class="bk_pop" href="#plosl.REF.satoh.2016.269">Satoh et al 2016</a>]</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_1" rowspan="3" scope="row" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<i>TYROBP</i>
|
||
</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/nuccore/NM_003332.3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NM_003332<wbr style="display:inline-block"></wbr>.3</a>
|
||
</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">c.-2897_277-1227del5265 <sup>2</sup><br />(5265-bp del; <a class="def" href="/books/n/gene/glossary/def-item/deletion/">deletion</a> of exons 1-4)</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">--</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All Finnish persons w/PLOSL are <a class="def" href="/books/n/gene/glossary/def-item/homozygous/">homozygous</a> for this <a class="def" href="/books/n/gene/glossary/def-item/deletion/">deletion</a>, also found in Swedish & Norwegian families [<a class="bk_pop" href="#plosl.REF.paloneva.2000.357">Paloneva et al 2000</a>, <a class="bk_pop" href="#plosl.REF.tranebjaerg.2000.3196">Tranebjaerg et al 2000</a>]</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_2" rowspan="2" colspan="1" scope="row" style="text-align:left;vertical-align:middle;">
|
||
<a href="https://www.ncbi.nlm.nih.gov/nuccore/NM_003332.3" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NM_003332<wbr style="display:inline-block"></wbr>.3</a>
|
||
<br />
|
||
<a href="https://www.ncbi.nlm.nih.gov/protein/NP_003323.1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NP_003323<wbr style="display:inline-block"></wbr>.1</a>
|
||
</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">c.2T>C</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Met1Thr</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reported in 2 Japanese families [<a class="bk_pop" href="#plosl.REF.kondo.2002.1105">Kondo et al 2002</a>, <a class="bk_pop" href="#plosl.REF.satoh.2016.269">Satoh et al 2016</a>]</td></tr><tr><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_3" colspan="1" scope="row" rowspan="1" style="text-align:left;vertical-align:middle;">c.141delG</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">p.Met48TrpfsTer6</td><td headers="hd_h_plosl.T.polycystic_lipomembranous_osteod_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reported in a number of Japanese families [<a class="bk_pop" href="#plosl.REF.paloneva.2000.357">Paloneva et al 2000</a>, <a class="bk_pop" href="#plosl.REF.kondo.2002.1105">Kondo et al 2002</a>, <a class="bk_pop" href="#plosl.REF.yamazaki.2015.324">Yamazaki et al 2015</a>, <a class="bk_pop" href="#plosl.REF.satoh.2016.269">Satoh et al 2016</a>]</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">Variants listed in the table have been provided by the authors. <i>GeneReviews</i> staff have not independently verified the classification of variants.</p></div></dd><dt></dt><dd><div><p class="no_margin"><i>GeneReviews</i> follows the standard naming conventions of the Human Genome Variation Society (<a href="https://varnomen.hgvs.org/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">varnomen<wbr style="display:inline-block"></wbr>.hgvs.org</a>). See <a href="/books/n/gene/app3/">Quick Reference</a> for an explanation of nomenclature.</p></div></dd><dt>1. </dt><dd><div id="plosl.TF.6.1"><p class="no_margin">Variant designation that does not conform to current naming conventions.</p></div></dd><dt>2. </dt><dd><div id="plosl.TF.6.2"><p class="no_margin">Because the <a class="def" href="/books/n/gene/glossary/def-item/exon/">exon</a> 1-4 <a class="def" href="/books/n/gene/glossary/def-item/deletion/">deletion</a> is an <i>Alu-</i>mediated <a class="def" href="/books/n/gene/glossary/def-item/recombination/">recombination</a> event, the breakpoint is not known precisely.</p></div></dd></dl></div></div></div></div></div><div id="plosl.Chapter_Notes"><h2 id="_plosl_Chapter_Notes_">Chapter Notes</h2><div id="plosl.Revision_History"><h3>Revision History</h3><ul><li class="half_rhythm"><div>10 December 2020 (sw) Comprehensive update posted live</div></li><li class="half_rhythm"><div>12 March 2015 (me) Comprehensive update posted live</div></li><li class="half_rhythm"><div>26 August 2010 (me) Comprehensive update posted live</div></li><li class="half_rhythm"><div>16 April 2009 (jp) Revision: <a class="def" href="/books/n/gene/glossary/def-item/sequence-analysis/">sequence analysis</a> available on a clinical basis for <i>TYROBP</i> and <i>TREM2</i></div></li><li class="half_rhythm"><div>1 May 2006 (me) Comprehensive update posted live</div></li><li class="half_rhythm"><div>15 March 2004 (me) Comprehensive update posted live</div></li><li class="half_rhythm"><div>24 January 2002 (me) Review posted live</div></li><li class="half_rhythm"><div>31 October 2001 (jp) Original submission</div></li></ul></div></div><div id="plosl.References"><h2 id="_plosl_References_">References</h2><div id="plosl.Published_Guidelines__Consensus_St"><h3>Published Guidelines / Consensus Statements</h3><ul><li class="half_rhythm"><div>Committee on Bioethics, Committee on Genetics, and American College of Medical Genetics and Genomics Social, Ethical, Legal Issues Committee. Ethical and policy issues in genetic testing and screening of children. Available <a href="https://pediatrics.aappublications.org/content/131/3/620.full.pdf" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">online</a>. 2013. Accessed 12-30-22.</div></li><li class="half_rhythm"><div>National Society of Genetic Counselors. Position statement on genetic testing of minors for adult-onset conditions. Available <a href="https://www.nsgc.org/Policy-Research-and-Publications/Position-Statements/Position-Statements/Post/genetic-testing-of-minors-for-adult-onset-conditions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">online</a>. 2017. Accessed 12-30-22.</div></li></ul></div><div id="plosl.Literature_Cited"><h3>Literature Cited</h3><ul class="simple-list"><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.aoki.2011.135">Aoki N, Tsuchiya K, Togo T, Kobayashi Z, Uchikado H, Katsuse O, Suzuki K, Fujishiro H, Arai T, Iseki E, Anno M, Kosaka K, Akiyama H, Hirayasu Y. Gray matter lesions in Nasu-Hakola disease: a report on three autopsy cases. <span><span class="ref-journal">Neuropathology. </span>2011;<span class="ref-vol">31</span>:135–43.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/20880319" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20880319</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.ar_kan.2014.458728">Arıkan M, Yıldırım A, Togral G, Ekmekçi AB. Extremity manifestations and surgical treatment for Nasu Hakola disease. <span><span class="ref-journal">Case Rep Orthop. </span>2014;<span class="ref-vol">2014</span>:458728. </span> [<a href="/pmc/articles/PMC3965938/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3965938</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/24711942" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24711942</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.bock.2013.115">Bock V, Botturi A, Gaviani P, Lamperti E, Maccagnano C, Piccio L, Silvani A, Salmaggi A. Polycystic Lipomembranous Osteodysplasia with Sclerosing Leukoencephalopathy (PLOSL): a new report of an Italian woman and review of the literature. <span><span class="ref-journal">J Neurol Sci. </span>2013;<span class="ref-vol">326</span>:115–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23399524" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23399524</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.carmona.2018.721">Carmona S, Zahs K, Wu E, Dakin K, Bras J, Guerreiro R. The role of TREM2 in Alzheimer's disease and other neurodegenerative disorders. <span><span class="ref-journal">Lancet Neurology. </span>2018;<span class="ref-vol">17</span>:721–30.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30033062" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30033062</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.cella.2003.645">Cella M, Buonsanti C, Strader C, Kondo T, Salmaggi A, Colonna M. Impaired differentiation of osteoclasts in TREM-2-deficient individuals. <span><span class="ref-journal">J Exp Med. </span>2003;<span class="ref-vol">198</span>:645–51.</span> [<a href="/pmc/articles/PMC2194167/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2194167</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12913093" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12913093</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.chouery.2008.e194">Chouery E, Delague V, Bergougnoux A, Koussa S, Serre JL, Mégarbané A. Mutations in TREM2 lead to pure early-onset dementia without bone cysts. <span><span class="ref-journal">Hum Mutat. </span>2008;<span class="ref-vol">29</span>:E194–E204.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18546367" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18546367</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.dardiotis.2017.194.e13">Dardiotis E, Siokas V, Pantazi E, Dardioti M, Rikos D, Xiromerisiou G, Markou A, Papadimitriou D, Speletas M, Hadjigeorgiou GM. A novel mutation in TREM2 gene causing Nasu-Hakola disease and review of the literature. <span><span class="ref-journal">Neurobiol Aging. </span>2017;<span class="ref-vol">53</span>:194.e13–194.e22.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28214109" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28214109</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.guerreiro.2013.78">Guerreiro RJ, Lohmann E, Brás JM, Gibbs JR, Rohrer JD, Gurunlian N, Dursun B, Bilgic B, Hanagasi H, Gurvit H, Emre M, Singleton A, Hardy J. Using exome sequencing to reveal mutations in TREM2 presenting as a frontotemporal dementia-like syndrome without bone involvement. <span><span class="ref-journal">JAMA Neurol. </span>2013;<span class="ref-vol">70</span>:78–84.</span> [<a href="/pmc/articles/PMC4001789/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4001789</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23318515" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23318515</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.huang.2022.389">Huang SJ, Amendola LM, Sternen DL. Variation among DNA banking consent forms: points for clinicians to bank on. <span><span class="ref-journal">J Community Genet. </span>2022;<span class="ref-vol">13</span>:389–97.</span> [<a href="/pmc/articles/PMC9314484/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9314484</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35834113" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35834113</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.ilonen.2012.236">Ilonen T, Hakola P, Vanhanen M, Tiihonen J. Rorschach assessment of personality functioning in patients with polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy. <span><span class="ref-journal">Acta Neuropsychiatr. </span>2012;<span class="ref-vol">24</span>:236–44.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25286817" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25286817</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.j_nsson.2017.519">Jónsson H, Sulem P, Kehr B, Kristmundsdottir S, Zink F, Hjartarson E, Hardarson MT, Hjorleifsson KE, Eggertsson HP, Gudjonsson SA, Ward LD, Arnadottir GA, Helgason EA, Helgason H, Gylfason A, Jonasdottir A, Jonasdottir A, Rafnar T, Frigge M, Stacey SN, Th Magnusson O, Thorsteinsdottir U, Masson G, Kong A, Halldorsson BV, Helgason A, Gudbjartsson DF, Stefansson K. 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The genetic causes of basal ganglia calcification, dementia, and bone cysts: DAP12 and TREM2. <span><span class="ref-journal">Neurology. </span>2005;<span class="ref-vol">64</span>:1502–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/15883308" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15883308</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.kobayashi.2000.98">Kobayashi K, Kobayashi E, Miyazu K, Muramori F, Hiramatsu S, Aoki T, Nakamura I, Koshino Y. Hypothalamic haemorrhage and thalamus degeneration in a case of Nasu-Hakola disease with hallucinatory symptoms and central hypothermia. <span><span class="ref-journal">Neuropathol Appl Neurobiol. </span>2000;<span class="ref-vol">26</span>:98–101.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10787346" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10787346</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.kondo.2002.1105">Kondo T, Takahashi K, Kohara N, Takahashi Y, Hayashi S, Takahashi H, Matsuo H, Yamazaki M, Inoue K, Miyamoto K, Yamamura T. Heterogeneity of presenile dementia with bone cysts (Nasu-Hakola disease): three genetic forms. <span><span class="ref-journal">Neurology. </span>2002;<span class="ref-vol">59</span>:1105–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12370476" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12370476</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.konishi.2018.206">Konishi H, Kiyama H. 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A novel compound heterozygous mutation in the DAP12 gene in a patient with Nasu-Hakola disease. <span><span class="ref-journal">J Neurol Sci. </span>2007;<span class="ref-vol">252</span>:88–91.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17125796" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17125796</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.lanier.2009.150">Lanier LL. 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A lipid metabolic disease-"membranous lipodystrophy"-an autopsy case demonstrating numerous peculiar membrane-structures composed of compound lipid in bone and bone marrow and various adipose tissues. <span><span class="ref-journal">Acta Pathol Jpn. </span>1973;<span class="ref-vol">23</span>:539–58.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/4800725" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4800725</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.nwawka.2014.1449">Nwawka OK, Schneider R, Bansal M, Mintz DN, Lane J. 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CNS manifestations of Nasu-Hakola disease: a frontal dementia with bone cysts. <span><span class="ref-journal">Neurology. </span>2001;<span class="ref-vol">56</span>:1552–8.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11402114" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11402114</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.paloneva.2000.357">Paloneva J, Kestilä M, Wu J, Salminen A, Böhling T, Ruotsalainen V, Hakola P, Bakker AB, Phillips JH, Pekkarinen P, Lanier LL, Timonen T, Peltonen L. Loss-of-function mutations in TYROBP (DAP12) result in a presenile dementia with bone cysts. <span><span class="ref-journal">Nat Genet. </span>2000;<span class="ref-vol">25</span>:357–61.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10888890" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10888890</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.paloneva.2003.669">Paloneva J, Mandelin J, Kiialainen A, Bohling T, Prudlo J, Hakola P, Haltia M, Konttinen YT, Peltonen L. DAP12/TREM2 deficiency results in impaired osteoclast differentiation and osteoporotic features. <span><span class="ref-journal">J Exp Med. </span>2003;<span class="ref-vol">198</span>:669–75.</span> [<a href="/pmc/articles/PMC2194176/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2194176</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12925681" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12925681</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.paloneva.2002.656">Paloneva J, Manninen T, Christman G, Hovanes K, Mandelin J, Adolfsson R, Bianchin M, Bird T, Miranda R, Salmaggi A, Tranebjaerg L, Konttinen Y, Peltonen L. Mutations in two genes encoding different subunits of a receptor signaling complex result in an identical disease phenotype. <span><span class="ref-journal">Am J Hum Genet. </span>2002;<span class="ref-vol">71</span>:656–62.</span> [<a href="/pmc/articles/PMC379202/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC379202</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/12080485" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12080485</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.pekkarinen.1998.362">Pekkarinen P, Hovatta I, Hakola P, Järvi O, Kestilä M, Lenkkeri U, Adolfsson R, Holmgren G, Nylander PO, Tranebjaerg L, Terwilliger JD, Lönnqvist J, Peltonen L. Assignment of the locus for PLO-SL, a frontal-lobe dementia with bone cysts, to 19q13. <span><span class="ref-journal">Am J Hum Genet. </span>1998;<span class="ref-vol">62</span>:362–72.</span> [<a href="/pmc/articles/PMC1376898/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1376898</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/9463329" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9463329</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.richards.2015.405">Richards S, Aziz N, Bale S, Bick D, Das S, Gastier-Foster J, Grody WW, Hegde M, Lyon E, Spector E, Voelkerding K, Rehm HL, et al. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. <span><span class="ref-journal">Genet Med. </span>2015;<span class="ref-vol">17</span>:405–24.</span> [<a href="/pmc/articles/PMC4544753/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4544753</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25741868" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25741868</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.satoh.2016.269">Satoh JI, Yanaizu M, Tosaki Y, Sakai K, Kino Y. Targeted sequencing approach to identify genetic mutations in Nasu-Hakola disease. <span><span class="ref-journal">Intractable Rare Dis Res. </span>2016;<span class="ref-vol">5</span>:269–274.</span> [<a href="/pmc/articles/PMC5116862/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5116862</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27904822" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27904822</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.solje.2014.1780.e13">Solje E, Hartikainen P, Valori M, Vanninen R, Tiihonen J, Hakola P, Tienari P, Remes A. The C9ORF72 expansion does not affect the phenotype in Nasu-Hkola disease with the DAP12 mutation. <span><span class="ref-journal">Neurobiology of aging. </span>2014;<span class="ref-vol">35</span>:1780.e13–1780.e17.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/24612676" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24612676</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.takeshita.2005.309">Takeshita T, Kaminaga T, Tatsumi T, Hatanaka Y, Furui S. Regional cerebral blood flow in a patient with Nasu-Hakola disease. <span><span class="ref-journal">Ann Nucl Med. </span>2005;<span class="ref-vol">19</span>:309–12.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/16097640" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16097640</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.thrash.2009.38">Thrash JC, Torbett BE, Carson MJ. Developmental regulation of TREM2 and DAP12 expression in the murine CNS: implications for Nasu-Hakola disease. <span><span class="ref-journal">Neurochem Res. </span>2009;<span class="ref-vol">34</span>:38–45.</span> [<a href="/pmc/articles/PMC2655126/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2655126</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18404378" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18404378</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.tranebjaerg.2000.3196">Tranebjaerg L, Schrader H, Paloneva J. Polycystic lipomembranous osteodysplasia. <span><span class="ref-journal">Tidsskr Nor Laegeforen. </span>2000;<span class="ref-vol">120</span>:3196.</span> [Article in Norwegian] [<a href="https://pubmed.ncbi.nlm.nih.gov/11109371" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11109371</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.vanhanen.2013.10">Vanhanen M, Hakola P, Ilonen T, Tiihonen J. Word list learning in patients with polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy. <span><span class="ref-journal">Dement Geriatr Cogn Dis Extra. </span>2013;<span class="ref-vol">3</span>:10–5.</span> [<a href="/pmc/articles/PMC3618099/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3618099</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23569454" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23569454</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.williamson.2019.75">Williamson JC, Larner AJ. Behavioral variant frontotemporal dementia-like syndrome with novel heterozygous TREM2 frameshift mutation. <span><span class="ref-journal">Alzheimer Dis Assoc Disord. </span>2019;<span class="ref-vol">33</span>:75–76.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/30106757" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30106757</span></a>]</div></li><li class="half_rhythm"><div class="bk_ref" id="plosl.REF.yamazaki.2015.324">Yamazaki K, Yoshino Y, Mori Y, Ochi S, Yoshida T, Ishimaru T, Ueno S. A case of Nasu-Hakola disease without fractures or consanguinity diagnosed using exome sequencing and treated with sodium valproate. <span><span class="ref-journal">Clin Psychopharmacol Neurosci. </span>2015;<span class="ref-vol">13</span>:324–6.</span> [<a href="/pmc/articles/PMC4662179/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4662179</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26598595" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26598595</span></a>]</div></li></ul></div></div><div id="bk_toc_contnr"></div></div></div>
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