Krabbe disease

disease
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Also known as diffuse globoid body sclerosisgalactocerebrosidase deficiencygalactosylceramidase deficiencygalactosylceramide lipidosisGALC deficiencyGALC enzyme deficiencyGLDgloboid cell leukodystrophygloboid cell leukoencephalopathyKrabbe leukodystrophyKrabbe's leukodystrophylater onset Krabbe diseaselater-onset Krabbe diseaseLeukodystrophy, Krabbe's

Summary

Krabbe disease (MONDO:0009499) is a disease caused by GALC (GenCC Definitive), with 3 cohort genes and 18 clinical trials. Top therapeutic interventions include cyclophosphamide anhydrous, alemtuzumab, and busulfan.

At a glance

  • Prevalence: 1-9 / 100 000 (Europe) [Orphanet-validated]
  • Causal gene: GALC (GenCC Definitive)
  • Cohort genes: 3
  • ClinVar variants: 1,406
  • Phenotypes (HPO): 50
  • Clinical trials: 18

Clinical features

Epidemiology

Prevalence records

12 prevalence record(s), Orphanet:

TypeClassValueGeographyValidation
Prevalence at birth1-9 / 1 000 0000.7WorldwideValidated
Point prevalence1-9 / 100 0001EuropeValidated
Prevalence at birth1-9 / 1 000 0000.327United StatesValidated
Prevalence at birth1-9 / 1 000 0000.7FranceValidated
Prevalence at birth1-9 / 1 000 0000.71AustraliaValidated
Prevalence at birth1-9 / 100 0001.35NetherlandsValidated
Prevalence at birth1-9 / 100 0001.21PortugalValidated
Prevalence at birth1-9 / 1 000 0000.6GermanyValidated
Prevalence at birth1-9 / 100 0001TurkeyValidated
Prevalence at birth1-9 / 1 000 0000.4Czech RepublicValidated
Prevalence at birth1-9 / 100 0001.9SwedenValidated
Prevalence at birth1-9 / 100 0001EuropeNot yet validated

Signs & symptoms

Clinical features (HPO)

50 HPO clinical features (Orphanet curated; top 50 by frequency):

HPO IDTermFrequency
HP:0000365Hearing impairmentVery frequent (80-99%)
HP:0000407Sensorineural hearing impairmentVery frequent (80-99%)
HP:0000505Visual impairmentVery frequent (80-99%)
HP:0000708Atypical behaviorVery frequent (80-99%)
HP:0000763Sensory neuropathyVery frequent (80-99%)
HP:0001172Abnormal thumb morphologyVery frequent (80-99%)
HP:0001251AtaxiaVery frequent (80-99%)
HP:0001257SpasticityVery frequent (80-99%)
HP:0001263Global developmental delayVery frequent (80-99%)
HP:0001939Abnormality of metabolism/homeostasisVery frequent (80-99%)
HP:0002676Cloverleaf skullVery frequent (80-99%)
HP:0003457EMG abnormalityVery frequent (80-99%)
HP:0009830Peripheral neuropathyVery frequent (80-99%)
HP:0010318Aplasia/Hypoplasia of the abdominal wall musculatureVery frequent (80-99%)
HP:0011968Feeding difficultiesVery frequent (80-99%)
HP:0034322Reduced galactocerebrosidase activityVery frequent (80-99%)
HP:0000737IrritabilityFrequent (30-79%)
HP:0001250SeizureFrequent (30-79%)
HP:0001288Gait disturbanceFrequent (30-79%)
HP:0001508Failure to thriveFrequent (30-79%)
HP:0001945FeverFrequent (30-79%)
HP:0002013VomitingFrequent (30-79%)
HP:0002123Generalized myoclonic seizureFrequent (30-79%)
HP:0002205Recurrent respiratory infectionsFrequent (30-79%)
HP:0002313Spastic paraparesisFrequent (30-79%)
HP:0002376Developmental regressionFrequent (30-79%)
HP:0003134Abnormality of peripheral nerve conductionFrequent (30-79%)
HP:0004374Hemiplegia/hemiparesisFrequent (30-79%)
HP:0033031HyperpyrexiaFrequent (30-79%)
HP:0000020Urinary incontinenceOccasional (5-29%)
HP:0000618BlindnessOccasional (5-29%)
HP:0000648Optic atrophyOccasional (5-29%)
HP:0001188Hand clenchingOccasional (5-29%)
HP:0001265HyporeflexiaOccasional (5-29%)
HP:0001324Muscle weaknessOccasional (5-29%)
HP:0001336MyoclonusOccasional (5-29%)
HP:0001761Pes cavusOccasional (5-29%)
HP:0001824Weight lossOccasional (5-29%)
HP:0002179OpisthotonusOccasional (5-29%)
HP:0002312ClumsinessOccasional (5-29%)
HP:0002359Frequent fallsOccasional (5-29%)
HP:0002421Poor head controlOccasional (5-29%)
HP:0002445TetraplegiaOccasional (5-29%)
HP:0002878Respiratory failureOccasional (5-29%)
HP:0002922Increased CSF protein concentrationOccasional (5-29%)
HP:0025013Decerebrate rigidityOccasional (5-29%)
HP:0030211Slow pupillary light responseOccasional (5-29%)
HP:0100639Erectile dysfunctionOccasional (5-29%)
HP:0100963HyperesthesiaOccasional (5-29%)
HP:0001288Gait disturbanceOccasional (5-29%)

Identifiers

Disease identifiers

FieldValue
Canonical nameKrabbe disease
Mondo IDMONDO:0009499
MeSHD007965
OMIM245200
Orphanet487
DOIDDOID:10587
ICD-10-CME75.23
ICD-11796317173
NCITC61254
SNOMED CT189979005, 192782005
UMLSC0023521
MedGen44131
GARD0006844
MedDRA10023492
NORD1368
Is cancer (heuristic)no

Also known as: diffuse globoid body sclerosis · galactocerebrosidase deficiency · galactosylceramidase deficiency · galactosylceramide lipidosis · GALC deficiency · GALC enzyme deficiency · GLD · globoid cell leukodystrophy · globoid cell leukoencephalopathy · Krabbe disease · Krabbe leukodystrophy · Krabbe’s leukodystrophy · later onset Krabbe disease · later-onset Krabbe disease · Leukodystrophy, Krabbe’s

Data availability: 1,406 ClinVar variants · 6 GenCC gene-disease records · 15 cell lines.

Disease family

An umbrella term covering 3 Mondo subtypes.

Classification path: disease › human disease › disease by body system or component › disorder of orbital regioneye disorder › eye degenerative disorder › Krabbe disease

Related subtypes (8): blind hypertensive eye, vitreous syneresis, degenerative myopia, choroidal sclerosis, muscular atrophy-ataxia-retinitis pigmentosa-diabetes mellitus syndrome, corneal-cerebellar syndrome, multiple mitochondrial dysfunctions syndrome 4, tremor-ataxia-central hypomyelination syndrome

Subtypes (3): infantile Krabbe disease, late-infantile/juvenile Krabbe disease, adult Krabbe disease

Genetics & variants

GWAS landscape

No GWAS associations recorded — common-variant (GWAS) studies don’t cover this disease (typical for Mendelian / rare diseases). See the curated gene cohort and Mendelian overlap below.

Variant details and genetic-evidence tiers

ClinVar germline variants

600 retrieved; paginated sample, class counts are floors:

271 likely benign, 120 uncertain significance, 77 pathogenic, 49 likely pathogenic, 31 conflicting classifications of pathogenicity, 29 pathogenic/likely pathogenic, 22 benign, 1 benign/likely benign

ClinVarVariant (HGVS)GeneClassificationReview
1058786NM_000153.4(GALC):c.821A>C (p.Glu274Ala)GALCPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1066093NM_000153.4(GALC):c.1987del (p.Trp663fs)GALCPathogeniccriteria provided, single submitter
1066196NM_000153.4(GALC):c.349A>C (p.Met117Leu)GALCPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1066870NM_000153.4(GALC):c.2056T>C (p.Ter686Gln)GALCPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1070140NC_000014.8:g.(?_88391504)_88423173delGALCPathogeniccriteria provided, single submitter
1070141NC_000014.8:g.(?_88391504)_88423174delGALCPathogeniccriteria provided, single submitter
1070539NM_000153.4(GALC):c.181_182insAG (p.Val61fs)GALCPathogeniccriteria provided, single submitter
1070765NM_000153.4(GALC):c.432_433dup (p.Thr145fs)GALCPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1070766NM_000153.4(GALC):c.302_308dup (p.Gly104fs)GALCPathogeniccriteria provided, single submitter
1070767NM_000153.4(GALC):c.176del (p.Gly59fs)GALCPathogeniccriteria provided, multiple submitters, no conflicts
1071897NM_000153.4(GALC):c.1884del (p.Lys628fs)GALCPathogeniccriteria provided, multiple submitters, no conflicts
1071955NM_000153.4(GALC):c.1762_1763del (p.Leu588fs)GALCPathogeniccriteria provided, single submitter
1072645NM_000153.4(GALC):c.37C>T (p.Arg13Ter)GALCPathogeniccriteria provided, single submitter
1073890NM_000153.4(GALC):c.498del (p.Asn167fs)GALCPathogeniccriteria provided, multiple submitters, no conflicts
1073951NC_000014.8:g.(?_88391503)_88423172delGALCPathogeniccriteria provided, single submitter
1074198NM_000153.4(GALC):c.1411_1432del (p.Thr471fs)GALCPathogeniccriteria provided, single submitter
1074616NM_000153.4(GALC):c.332del (p.Gly111fs)GALCPathogeniccriteria provided, single submitter
1210861NM_000153.4(GALC):c.1858G>A (p.Gly620Arg)GALCPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1298354NM_000153.4(GALC):c.1964del (p.Pro655fs)GALCPathogeniccriteria provided, single submitter
1299228NM_000153.4(GALC):c.1821dup (p.Thr608fs)GALCPathogeniccriteria provided, single submitter
1299585NM_000153.4(GALC):c.396G>A (p.Trp132Ter)GALCPathogeniccriteria provided, multiple submitters, no conflicts
1320177NM_000153.4(GALC):c.688_694del (p.Trp230fs)GALCPathogeniccriteria provided, single submitter
1322976NM_000153.4(GALC):c.1736_1739del (p.Ala579fs)GALCPathogeniccriteria provided, multiple submitters, no conflicts
1322977NM_000153.4(GALC):c.622-1G>TGALCPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1331457NM_000153.4(GALC):c.683_694delinsCTC (p.Asn228_Ser232delinsThrPro)GALCPathogeniccriteria provided, multiple submitters, no conflicts
1332732NM_000153.4(GALC):c.1252-1G>CGALCPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1364954NM_000153.4(GALC):c.1815dup (p.Arg606fs)GALCPathogeniccriteria provided, single submitter
1374650NM_000153.4(GALC):c.967G>T (p.Gly323Trp)GALCPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1378825NM_000153.4(GALC):c.1648dup (p.Ser550fs)GALCPathogeniccriteria provided, single submitter
1385679NM_000153.4(GALC):c.782_783dup (p.Asp262fs)GALCPathogeniccriteria provided, single submitter

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 6 · Orphanet: 9 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

GenCC gene–disease validity (cohort genes)

the Disease column is the GenCC-asserted condition — a cohort gene’s strongest validity may be for a related predisposition syndrome.

GeneClassificationInheritanceDiseaseRecords
GALCDefinitiveAutosomal recessiveKrabbe disease6

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
GALCOrphanet:206436Infantile Krabbe disease
GALCOrphanet:206443Late-infantile/juvenile Krabbe disease
GALCOrphanet:206448Adult Krabbe disease
PSAPOrphanet:139406Encephalopathy due to prosaposin deficiency
PSAPOrphanet:206436Infantile Krabbe disease
PSAPOrphanet:309252Atypical Gaucher disease due to saposin C deficiency
PSAPOrphanet:309256Metachromatic leukodystrophy, late infantile form
PSAPOrphanet:309263Metachromatic leukodystrophy, juvenile form
PSAPOrphanet:309271Metachromatic leukodystrophy, adult form

Cohort genes → proteins

3 cohort genes, 3 distinct canonical proteins.

Evidence partition

SubsetGenes
multi_evidence3

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
GALCHGNC:4115ENSG00000054983P54803Galactocerebrosidasegencc,clinvar
MTCH1HGNC:17586ENSG00000137409Q9NZJ7Mitochondrial carrier homolog 1clinvar
PSAPHGNC:9498ENSG00000197746P07602Prosaposinclinvar

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
GALCGalactocerebrosidaseHydrolyzes the galactose ester bonds of glycolipids such as galactosylceramide and galactosylsphingosine.
MTCH1Mitochondrial carrier homolog 1Protein insertase that mediates insertion of transmembrane proteins into the mitochondrial outer membrane.
PSAPProsaposinSaposin-A and saposin-C stimulate the hydrolysis of glucosylceramide by beta-glucosylceramidase (EC 3.2.1.45) and galactosylceramide by beta-galactosylceramidase (EC 3.2.1.46).

Protein-family classification

Druggable: 1 · Difficult: 0 · Unknown: 2 · Druggable fraction: 0.33

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Enzyme (other)14.0×0.460
Other/Unknown21.2×0.587

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
GALCEnzyme (other)yes3.2.1.46Glyco_hydro_59, Aldolase_TIM, GH_hydrolase_sf
MTCH1Other/UnknownnoMCP_transmembrane, MCP_dom_sf
PSAPOther/UnknownnoSAP_A, SapB_1, SapB_2

Expression context

Cohort genes with no expression data: 0.

3 cohort genes are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)3
unknown0

Top tissues across cohort

TissueCohort genes
adrenal tissue1
bronchial epithelial cell1
jejunal mucosa1
Brodmann (1909) area 231
endothelial cell1
middle temporal gyrus1
leukocyte1
monocyte1
mononuclear cell1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
GALC295ubiquitousmarkeradrenal tissue, bronchial epithelial cell, jejunal mucosa
MTCH1288ubiquitousmarkerendothelial cell, Brodmann (1909) area 23, middle temporal gyrus
PSAP295ubiquitousmarkermonocyte, mononuclear cell, leukocyte

Protein interactions among cohort

Intra-cohort edges: 0.

Hub genes (top 10 by interactor count)

SymbolInteractor count
MTCH11,570
GALC1,154
PSAP217

Structural data

PDB: 1 · AlphaFold-only: 2 · No structure: 0

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
PSAPP0760220

AlphaFold-only cohort genes (top 30 by pLDDT)

SymbolUniProtpLDDT
GALCP5480394.56
MTCH1Q9NZJ776.29

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 19. Enrichment computed across 3 evidence-associated genes (2 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 2 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Glycosphingolipid catabolism2292.8×2e-04GALC, PSAP
Glycosphingolipid metabolism1150.3×0.058PSAP
Sphingolipid metabolism184.0×0.058PSAP
Response to elevated platelet cytosolic Ca2+181.6×0.058PSAP
Platelet activation, signaling and aggregation152.9×0.064PSAP
Platelet degranulation143.9×0.064PSAP
Class A/1 (Rhodopsin-like receptors)137.1×0.064PSAP
Peptide ligand-binding receptors137.1×0.064PSAP
GPCR ligand binding132.1×0.065PSAP
GPCR downstream signalling121.7×0.080PSAP
Signaling by GPCR120.0×0.080PSAP
G alpha (i) signalling events119.5×0.080PSAP
Hemostasis118.0×0.080PSAP
Metabolism of lipids115.8×0.085PSAP
Innate Immune System112.8×0.097PSAP
Neutrophil degranulation111.5×0.101PSAP
Immune System16.5×0.166PSAP
Metabolism15.8×0.174PSAP
Signal Transduction15.1×0.187PSAP

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 3 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
ganglioside GM1 transport to membrane15617.3×0.003PSAP
galactosylceramide catabolic process12808.7×0.003GALC
neuronal ion channel clustering11872.4×0.003MTCH1
epithelial cell differentiation involved in prostate gland development11123.5×0.004PSAP
prostate gland growth1702.2×0.005PSAP
glycosphingolipid catabolic process1510.7×0.006GALC
protein insertion into mitochondrial outer membrane1432.1×0.006MTCH1
sphingolipid metabolic process1330.4×0.006PSAP
lysosomal transport1234.1×0.008PSAP
regulation of lipid metabolic process1144.0×0.012PSAP
regulation of signal transduction189.2×0.016MTCH1
myelination183.8×0.016GALC
regulation of autophagy180.2×0.016PSAP
adenylate cyclase-inhibiting G protein-coupled receptor signaling pathway173.0×0.017PSAP
gene expression126.6×0.042PSAP
positive regulation of apoptotic process118.9×0.055MTCH1
apoptotic process19.6×0.101MTCH1

Therapeutics

Drugs indicated for this disease

No approved or late-stage (phase ≥3) drug is indicated for this disease; the following are in earlier-phase trials only.

Earlier-phase candidates (phase 2, investigational — efficacy not yet established): Busulfan.

Drug target analysis

Approved (phase 4): 0 · Phase ≥3: 1 · Phased (≥1): 1 · Undrugged: 2

Druggability breadth: 2 of 3 evidence-associated genes (67%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Top cohort targets by molecule count

SymbolMoleculesMax phase
PSAP13
GALC00
MTCH100

Drugs targeting cohort genes (top 30)

MoleculeMax phaseTargets in cohort
FENRETINIDE3PSAP

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 1.

Cohort genes with ChEMBL bioactivity (full, sorted by assay count)

SymbolAssaysType breakdown
PSAP12Binding:8, ADMET:4
GALC3Binding:2, Functional:1

Cohort enzymes (BRENDA EC)

SymbolEC numbersNames
GALC3.2.1.46galactosylceramidase

Pharmacogenomics

Cohort genes with a PharmGKB record: 3; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Chemical tractability of cohort targets

1 approved/phased compounds have measured bioactivity against a cohort gene (and aren’t yet in disease-level trials). This is a research / tractability signal, NOT a therapeutic recommendation — a bioactivity row often reflects off-target or screening binding (e.g. promiscuous kinase inhibitors against a cohort kinase), implying no disease mechanism.

CompoundMax phaseCohort target (bioactivity)
FENRETINIDE3PSAP

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)0
BPhased (≥1) drug, not yet approved1PSAP
CDruggable family + PDB, no drug0
DDruggable family + AlphaFold only, no drug1GALC
EDifficult family or no structure, no drug1MTCH1

Undrugged target profiles

2 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
GALC3
MTCH10

Clinical trials & evidence

Clinical trials

Clinical trials: 18.

Phase distribution (across all retrieved trials)

PhaseTrials
Not specified10
PHASE24
PHASE1/PHASE23
PHASE2/PHASE31

Top trials by phase / activity

NCTPhaseStatusTitle
NCT00176904PHASE2/PHASE3COMPLETEDStem Cell Transplant for Inborn Errors of Metabolism
NCT02171104PHASE2ACTIVE_NOT_RECRUITINGMT2013-31: Allo HCT for Metabolic Disorders and Severe Osteopetrosis
NCT04693598PHASE1/PHASE2ACTIVE_NOT_RECRUITINGGene Transfer Clinical Trial for Krabbe Disease
NCT05739643PHASE1/PHASE2ACTIVE_NOT_RECRUITINGGene Transfer Clinical Trial for Infantile and Late Infantile Krabbe Disease Treated Previously With HSCT
NCT00383448PHASE2COMPLETEDHSCT for High Risk Inherited Inborn Errors
NCT00668564PHASE2TERMINATEDHematopoietic Stem Cell Transplantation (HCT) for Inborn Errors of Metabolism
NCT01043640PHASE2COMPLETEDAllogeneic Bone Marrow Transplant for Inherited Metabolic Disorders
NCT01372228PHASE1/PHASE2TERMINATEDPhase I/II Pilot Study of Mixed Chimerism to Treat Inherited Metabolic Disorders
NCT00787865Not specifiedACTIVE_NOT_RECRUITINGDiffusion Tensor Imaging (DTI) in Infants With Krabbe Disease
NCT02993796Not specifiedRECRUITINGKrabbe Disease Global Patient Registry
NCT03047369Not specifiedRECRUITINGThe Myelin Disorders Biorepository Project
NCT03333200Not specifiedRECRUITINGLongitudinal Study of Neurodegenerative Disorders
NCT03655223Not specifiedENROLLING_BY_INVITATIONEarly Check: Expanded Screening in Newborns
NCT00005900Not specifiedUNKNOWNStudy of Pulmonary Complications in Pediatric Patients With Storage Disorders Undergoing Allogeneic Hematopoietic Stem Cell Transplantation
NCT01425489Not specifiedWITHDRAWNBiomarker for Krabbe Disease (BioKrabbe)
NCT01938014Not specifiedCOMPLETEDLysosomal Storage Disease: Health, Development, and Functional Outcome Surveillance in Preschool Children
NCT02699190Not specifiedCOMPLETEDLeukoSEQ: Whole Genome Sequencing as a First-Line Diagnostic Tool for Leukodystrophies
NCT06308718Not specifiedTERMINATEDLong-term Follow-up Study to Evaluate Safety and Efficacy of FBX-101 in Krabbe Patients

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
CYCLOPHOSPHAMIDE ANHYDROUS43
ALEMTUZUMAB41
BUSULFAN41
CLOFARABINE41
HYDROXYUREA41