The G
M2 gangliosidoses are a group of inherited neurodegenerative disorders, characterized by a deficiency in the degradation of G
M2 ganglioside and related substrates.
1 They are caused by mutations in any of three genes; the
HEXA gene, causing Tay-Sachs disease; the
HEXB gene, causing Sandhoff disease; and the
GM2A gene, causing the G
M2 activator deficiency.
2 3 The
HEXA and
HEXB genes encode the α and β subunits of lysosomal β-hexosaminidase (Hex), which dimerize to produce three isozymes: HexA (αβ), HexB (ββ), and HexS (αα). The
GM2A gene encodes the G
M2-activator protein. The HexA isozyme and G
M2-activator protein are necessary for the degradation of G
M2 ganglioside in lysosomes.
2 Accordingly, the absence of either HexA (Tay-Sachs disease, Sandhoff disease) or G
M2-activator protein (G
M2 activator deficiency) leads to lysosomal storage of G
M2 ganglioside and other glycolipids throughout the nervous system
1 2 3 . These diseases, in both infantile and late-onset forms, have similar clinical courses and neuropathology. The infantile forms of G
M2 gangliosidoses are characterized by progressive muscular weakness, mental retardation, blindness, and death in early childhood.
1 Ophthalmoscopic examination reveals a cherry-red spot surrounded by a white halo in the macula of the retina.
4 5 The perimacular halo is due to the thickening of the retinal ganglion cell layer caused by neuronal storage, and the cherry-red spot at the macula is the result of the relative absence of ganglion cells, which causes the underlying choroid to be clearly seen.
4 The histologic changes in the retina of G
M2 gangliosidoses, such as loss of ganglion cells, ballooning of the remaining neurons, and atrophy of the optic nerve fibers, are similar to those in the brain.
6