Content Reviewers:Kelly Johnson, MS
Cerebrotendinous xanthomatosis, also called CTX, is a rare genetic disorder caused by alterations in the CYP27A1 gene that adversely affect the body’s ability to convert cholesterol to the bile acids chenodeoxycholic acid and cholic acid.
The symptoms and progression of CTX may differ greatly from person-to-person with symptoms that can range from mild to severe and that can appear from infancy through adulthood.
Neurological symptoms can appear in childhood or later in life and may include cognitive impairment such as difficulty with memory, concentration, and reasoning.
Other symptoms may include epilepsy and spasticity, causing difficulties in movement and speech.
In early adulthood, tendinous xanthomas may appear where fatty bumps or nodules form around the elbows, hands, knees, and heels.
If the disease remains untreated and continues to progress, affected individuals may become wheelchair bound and continued neurological decline may lead to early dementia.
CTX is a genetic disorder caused by disease-causing genetic alterations, or pathogenic variants, in the CYP27A1 gene.
The substances formed from cholesterol in the production of bile acids, known as bile acid pathway intermediates, remain unused in patients with CTX and accumulate, along with compounds called cholestanol and bile alcohols.
CTX is inherited in an autosomal recessive pattern so a child must inherit a pathogenic variant in the CYP27A1 gene from both parents, who are carriers, in order to be affected.
Parents who are carriers have one normal CYP27A1 gene and one pathogenic CYP27A1 gene variant, and have a 25% chance to have an affected child with another carrier, regardless of whether the child is male or female.
Diagnosis begins with an assessment of the individual’s medical history and includes genetic and biochemical testing for confirmation of disease.