{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:20:25Z","timestamp":1787026825011,"version":"build-2736575974"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,2,14]],"date-time":"2024-02-14T00:00:00Z","timestamp":1707868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Early-onset progressive encephalopathy with brain edema and\/or leukoencephalopathy (PEBEL-1) is an autosomal recessive disorder whereby a fluctuating clinical course is exacerbated by febrile illnesses. Pathogenic NAD(P)HX epimerase (\n                      <jats:italic>NAXE<\/jats:italic>\n                      ) gene mutations underpin this disorder. This mutation damages the metabolite repair system involved in regenerating crucial redox carriers. Longer survival has rarely been reported in this potentially actionable entity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      This case study aims to report a milder phenotype of a patient with\n                      <jats:italic>NAXE<\/jats:italic>\n                      gene mutation and his longitudinal follow-up of more than 20\u2009years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>\n                      A 24-year-old man first became symptomatic in infancy with frequent initial neurological decompensations in the setting of infections with subsequent clinical improvement followed by stability with residual cerebellar dysfunction. Clinical features noted over the years include chronic ataxia, nystagmus, ptosis, mild spasticity of lower limbs, and neuropsychiatric symptoms. Cerebellar and spinal cord atrophy were noted in cranial and spinal MR imaging. Biallelic homozygous variants in the\n                      <jats:italic>NAXE<\/jats:italic>\n                      gene (c.733 A&amp;gt;C) were identified on whole exome sequencing. Symptom management included the initiation of a mitochondrial cocktail with carnitine, coenzyme Q, and thiamine. Subsequently, niacin (Vitamin B3), which is involved in the cellular biosynthesis of NAD+, was added, given its potentially beneficial therapeutic impact.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      A missense homozygous variant in the\n                      <jats:italic>NAXE<\/jats:italic>\n                      gene is described in this patient with a milder clinical phenotype of the disease. Supplementation with niacin in addition to a mitochondrial cocktail presents a potential supportive therapeutic option to reduce disease progression.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2024.1204848","type":"journal-article","created":{"date-parts":[[2024,2,13]],"date-time":"2024-02-13T23:37:00Z","timestamp":1707867420000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Long-term follow-up of an attenuated presentation of NAXE-related disease, a potentially actionable neurometabolic disease: a case report"],"prefix":"10.3389","volume":"15","author":[{"given":"Montaha","family":"Almudhry","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chitra","family":"Prasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Anthony","family":"Rupar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keng Yeow","family":"Tay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asuri N.","family":"Prasad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,2,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"E27548","DOI":"10.1097\/MD.0000000000027548","article-title":"NAXE gene mutation-related progressive encephalopathy: a case report and literature review","volume":"100","author":"Chiu","year":"2021","journal-title":"Medicine"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1007\/s13760-019-01242-z","article-title":"Early-onset progressive encephalopathy associated with NAXE gene variants: a case report of a Turkish child","volume":"120","author":"Incec\u0131k","year":"2020","journal-title":"Acta Neurol Belg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1007\/s13760-021-01717-y","article-title":"A novel homozygous missense variant in the NAXE gene in an Iranian family with progressive encephalopathy with brain edema and leukoencephalopathy","volume":"122","author":"Mohammadi","year":"2022","journal-title":"Acta Neurol Belg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1093\/brain\/awy310","article-title":"NAD(P)HX dehydratase (NAXD) deficiency: a novel neurodegenerative disorder exacerbated by febrile illnesses","volume":"142","author":"Van Bergen","year":"2019","journal-title":"Brain"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1007\/s00415-019-09640-2","article-title":"Novel NAXE variants as a cause for neurometabolic disorder: implications for 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leukoencephalopathy","volume":"17","author":"Spiegel","year":"2016","journal-title":"Neurogenetics"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.ymgme.2022.04.003","article-title":"NAXE deficiency: a neurometabolic disorder of NAD(P)HX repair amenable for metabolic correction","volume":"136","author":"Manor","year":"2022","journal-title":"Mol Genet Metab"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1016\/j.ajhg.2016.07.018","article-title":"NAXE mutations disrupt the cellular NAD(P)HX repair system and cause a lethal Neurometabolic disorder of early childhood","volume":"99","author":"Kremer","year":"2016","journal-title":"Am J Hum Genet"}],"container-title":["Frontiers in 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