Kufor-Rakeb syndrome is a rare autosomal recessive ATP13A2-related disorder characterized by juvenile-onset parkinsonism with pyramidal features. Core manifestations include young-onset parkinsonism, spastic paraparesis, supranuclear eye movement abnormalities, and progressive cognitive decline; psychosis may occur as a complication. ATP13A2 encodes a lysosomal P5B-ATPase that transports polyamines. Loss of ATP13A2 function disrupts lysosomal homeostasis, impairs mitochondrial quality control, and contributes to alpha-synuclein accumulation and neurodegeneration.
Conditions with similar clinical presentations that must be differentiated from Kufor-Rakeb syndrome:
This report is retrieval-only and is generated directly from Asta results.
search_papers_by_relevance with snippet_search.name: Kufor-Rakeb syndrome
creation_date: '2026-04-11T17:28:00Z'
updated_date: '2026-04-11T18:31:00Z'
category: Mendelian
description: >-
Kufor-Rakeb syndrome is a rare autosomal recessive ATP13A2-related disorder
characterized by juvenile-onset parkinsonism with pyramidal features. Core
manifestations include young-onset parkinsonism, spastic paraparesis,
supranuclear eye movement abnormalities, and progressive cognitive decline;
psychosis may occur as a complication. ATP13A2 encodes a lysosomal P5B-ATPase
that transports polyamines. Loss of ATP13A2 function disrupts lysosomal
homeostasis, impairs mitochondrial quality control, and contributes to
alpha-synuclein accumulation and neurodegeneration.
disease_term:
preferred_term: Kufor-Rakeb syndrome
term:
id: MONDO:0011706
label: Kufor-Rakeb syndrome
mappings:
mondo_mappings:
- term:
id: MONDO:0011706
label: Kufor-Rakeb syndrome
mapping_predicate: skos:exactMatch
mapping_source: MONDO
parents:
- Early-onset parkinsonism
- Lysosomal disorder
synonyms:
- PARK9
- ATP13A2-related juvenile parkinsonism
inheritance:
- name: Autosomal recessive inheritance
inheritance_term:
preferred_term: Autosomal recessive inheritance
term:
id: HP:0000007
label: Autosomal recessive inheritance
description: >-
Kufor-Rakeb syndrome is inherited in an autosomal recessive pattern and is
caused by biallelic inactivating ATP13A2 variants.
evidence:
- reference: PMID:29966207
reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia.
explanation: >-
This directly establishes autosomal recessive inheritance for Kufor-Rakeb
syndrome.
pathophysiology:
- name: ATP13A2 loss impairs lysosomal polyamine transport
description: >-
ATP13A2 is a lysosomal P5B-ATPase that transports polyamines. In Kufor-Rakeb
syndrome, loss-of-function ATP13A2 variants impair endolysosomal polyamine
transport, producing lysosomal dysfunction and creating a mechanistic basis
for neurodegeneration.
cell_types:
- preferred_term: neuron
term:
id: CL:0000540
label: neuron
biological_processes:
- preferred_term: lysosomal transport
term:
id: GO:0007041
label: lysosomal transport
evidence:
- reference: PMID:34715013
reference_title: "Structural basis of polyamine transport by human ATP13A2 (PARK9)."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Recent studies have suggested that ATP13A2 and its close homologs, collectively known as P5B-ATPases, are polyamine transporters at endo-/lysosomes.
explanation: >-
This mechanistic study identifies ATP13A2 as an endolysosomal polyamine
transporter, defining the core molecular function lost in disease.
- reference: PMID:40848257
reference_title: "Lysosomal polyamine storage upon ATP13A2 loss impairs β-glucocerebrosidase via altered lysosomal pH and electrostatic hydrolase-lipid interactions."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Here, we demonstrate lysosomal polyamine accumulation in ATP13A2 knockout (KO) cell lines and human induced pluripotent stem cell (iPSC)-derived neurons.
explanation: >-
This directly shows that ATP13A2 loss causes lysosomal polyamine storage in
relevant cell models.
downstream:
- target: Lysosomal hydrolase dysfunction
description: Lysosomal polyamine accumulation perturbs hydrolase activity and lysosomal homeostasis
- name: Lysosomal hydrolase dysfunction
description: >-
ATP13A2 deficiency causes lysosomal polyamine accumulation that disrupts
lysosomal pH and impairs β-glucocerebrosidase-mediated substrate hydrolysis.
cell_types:
- preferred_term: dopaminergic neuron
term:
id: CL:0000700
label: dopaminergic neuron
cellular_components:
- preferred_term: lysosome
term:
id: GO:0005764
label: lysosome
evidence:
- reference: PMID:40848257
reference_title: "Lysosomal polyamine storage upon ATP13A2 loss impairs β-glucocerebrosidase via altered lysosomal pH and electrostatic hydrolase-lipid interactions."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Therefore, excess polyamine compromises lysosomes by disrupting pH and electrostatic interactions between GCase and BMP that enable efficient substrate hydrolysis, potentially clarifying pathogenic mechanisms and suggesting convergence on PD-relevant pathways.
explanation: >-
This supports a downstream lysosomal hydrolase defect caused by ATP13A2
loss and links Kufor-Rakeb syndrome to broader Parkinson-relevant lysosomal
biology.
downstream:
- target: Mitochondrial quality-control failure
description: Lysosomal dysfunction converges with impaired mitochondrial maintenance and clearance
- name: Mitochondrial quality-control failure
description: >-
ATP13A2 deficiency impairs maintenance of a healthy mitochondrial pool and
likely compromises mitochondrial clearance, contributing to progressive
neuronal dysfunction.
cell_types:
- preferred_term: fibroblast
term:
id: CL:0000057
label: fibroblast
- preferred_term: dopaminergic neuron
term:
id: CL:0000700
label: dopaminergic neuron
biological_processes:
- preferred_term: mitophagy
modifier: ABNORMAL
term:
id: GO:0000423
label: mitophagy
- preferred_term: autophagy
modifier: ABNORMAL
term:
id: GO:0006914
label: autophagy
evidence:
- reference: PMID:22296644
reference_title: "ATP13A2 mutations impair mitochondrial function in fibroblasts from patients with Kufor-Rakeb syndrome."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
These findings collectively suggest that ATP13A2 contributes to the maintenance of a healthy mitochondrial pool, supporting the hypothesis that impaired mitochondrial clearance represents an important pathogenic mechanism underlying KRS.
explanation: >-
Patient-derived fibroblasts directly support mitochondrial quality-control
failure as a pathogenic mechanism in Kufor-Rakeb syndrome.
- reference: PMID:41306646
reference_title: "Kufor-Rakeb Syndrome in a Guatemalan Patient With an ATP13A2 Gene Pathogenic Variant: A Case Report."
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
This P5B-ATPase dysfunction impairs lysosomal processing, leading to the accumulation of α-synuclein.
explanation: >-
The case report summarizes the accepted disease model linking ATP13A2
dysfunction to impaired lysosomal processing and alpha-synuclein buildup.
phenotypes:
- name: Parkinsonism
category: Neurologic
description: >-
Juvenile- or young-onset parkinsonism is the defining motor syndrome of
Kufor-Rakeb disease.
phenotype_term:
preferred_term: Parkinsonism
term:
id: HP:0001300
label: Parkinsonism
evidence:
- reference: PMID:29966207
reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia.
explanation: >-
This directly identifies young-onset parkinsonism as the core motor
phenotype of Kufor-Rakeb syndrome.
- name: Spastic paraparesis
category: Neurologic
description: >-
Pyramidal involvement with lower-extremity spastic paraparesis is a classic
accompanying motor feature.
phenotype_term:
preferred_term: Spastic paraparesis
term:
id: HP:0002313
label: Spastic paraparesis
evidence:
- reference: PMID:29966207
reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia.
explanation: >-
This directly lists spastic paraparesis as part of the syndrome phenotype.
- name: Vertical supranuclear gaze palsy
category: Neurologic
description: >-
Supranuclear ocular motility abnormalities are part of the characteristic
Kufor-Rakeb syndrome presentation.
phenotype_term:
preferred_term: Vertical supranuclear gaze palsy
term:
id: HP:0000511
label: Vertical supranuclear gaze palsy
evidence:
- reference: PMID:29966207
reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
supports: PARTIAL
evidence_source: HUMAN_CLINICAL
snippet: >-
Kufor-Rakeb syndrome (KRS)/PARK9 presents with autosomal recessive young onset Parkinson's disease (YOPD), spastic paraparesis, abnormal eye movements and facial myokymia.
explanation: >-
The abstract supports abnormal supranuclear ocular motility generally but
does not specify the vertical subtype, so support is partial.
- name: Cognitive impairment
category: Neurologic
description: >-
Progressive cognitive decline is part of the neurodegenerative phenotype of
Kufor-Rakeb syndrome.
phenotype_term:
preferred_term: Cognitive impairment
term:
id: HP:0100543
label: Cognitive impairment
evidence:
- reference: PMID:41306646
reference_title: "Kufor-Rakeb Syndrome in a Guatemalan Patient With an ATP13A2 Gene Pathogenic Variant: A Case Report."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Here, we present the first documented Guatemalan case of KRS, a young woman with progressive motor and cognitive decline.
explanation: >-
This directly supports progressive cognitive impairment as part of the
clinical phenotype.
- name: Psychosis
category: Psychiatric
description: >-
Psychosis can complicate Kufor-Rakeb syndrome in some patients.
phenotype_term:
preferred_term: Psychosis
term:
id: HP:0000709
label: Psychosis
evidence:
- reference: PMID:31232173
reference_title: "Successful treatment of psychosis in a patient with Kufor-Rakeb syndrome with low dose aripiprazole: a case report."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
We present a case of a 32-year-old male with Kufor-Rakeb syndrome (KRS), a form of juvenile parkinsonism due to mutations of the ATP13A2 gene at PARK9 locus. The patient was seen for daily behavioral outbursts and psychotic symptoms.
explanation: >-
This directly documents psychosis as a neuropsychiatric complication in a
patient with Kufor-Rakeb syndrome.
genetic:
- name: ATP13A2
association: Loss-of-function
gene_term:
preferred_term: ATP13A2
term:
id: hgnc:30213
label: ATP13A2
notes: >-
Kufor-Rakeb syndrome is caused by biallelic inactivating ATP13A2 variants.
ATP13A2 encodes the lysosomal P5B-ATPase also known as PARK9.
evidence:
- reference: PMID:29966207
reference_title: "Kufor-Rakeb Syndrome/PARK9: One Novel and One Possible Recurring Ashkenazi ATP13A2 Mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
KRS is caused by homozygous/compound heterozygous inactivating mutations in ATP13A2.
explanation: >-
This directly states the causal genetic mechanism for Kufor-Rakeb syndrome.
treatments:
- name: Pharmacotherapy for psychosis
description: >-
Low-dose aripiprazole can be used to control psychotic symptoms in Kufor-Rakeb
syndrome without major motor worsening in at least isolated reported cases.
treatment_term:
preferred_term: pharmacotherapy
term:
id: MAXO:0000058
label: pharmacotherapy
therapeutic_agent:
- preferred_term: aripiprazole
term:
id: CHEBI:31236
label: aripiprazole
evidence:
- reference: PMID:31232173
reference_title: "Successful treatment of psychosis in a patient with Kufor-Rakeb syndrome with low dose aripiprazole: a case report."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
This significant improvement without drug-induced motor side effects suggests that aripiprazole at low doses (2-5 mg) is effective and tolerated in patients with KRS.
explanation: >-
This directly supports low-dose aripiprazole as a symptomatic treatment
option for psychosis in Kufor-Rakeb syndrome.
- name: Multidisciplinary supportive care
description: >-
Management relies on genetic diagnosis, counseling, and multidisciplinary
supportive care for progressive motor and cognitive disability.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
evidence:
- reference: PMID:41306646
reference_title: "Kufor-Rakeb Syndrome in a Guatemalan Patient With an ATP13A2 Gene Pathogenic Variant: A Case Report."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
This report underscores the importance of recognizing KRS in diverse populations and of using gene-based testing to guide diagnosis, counseling, and multidisciplinary supportive care.
explanation: >-
The case report explicitly frames multidisciplinary supportive care as part
of current management.
differential_diagnoses:
- name: Wilson disease
description: >-
Wilson disease can mimic juvenile parkinsonism with cognitive or psychiatric
features but is distinguished by copper metabolism abnormalities and
hepatic involvement.
distinguishing_features:
- Abnormal copper studies, Kayser-Fleischer rings, and hepatic disease favor Wilson disease.
- Biallelic ATP13A2 variants with spastic paraparesis and supranuclear gaze abnormalities favor Kufor-Rakeb syndrome.
disease_term:
preferred_term: Wilson disease
term:
id: MONDO:0010200
label: Wilson disease
- name: Hereditary spastic paraplegia
description: >-
Hereditary spastic paraplegia may resemble Kufor-Rakeb syndrome when lower
limb spasticity predominates, but typically lacks the characteristic
juvenile parkinsonism syndrome.
distinguishing_features:
- Predominant progressive lower-extremity spasticity without parkinsonism favors hereditary spastic paraplegia.
- Early parkinsonism, supranuclear gaze palsy, and ATP13A2-associated lysosomal dysfunction favor Kufor-Rakeb syndrome.
disease_term:
preferred_term: hereditary spastic paraplegia
term:
id: MONDO:0019064
label: hereditary spastic paraplegia
clinical_trials: []
datasets: []
notes: >-
Asta deep research was run as requested, but most of its retrievals were not
specific to Kufor-Rakeb syndrome. Primary curation therefore relied on direct
ATP13A2 syndrome papers and mechanistic studies reviewed from PubMed.