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 causes lysosomal polyamine storage, disrupts glucocerebrosidase-dependent substrate handling, impairs mitochondrial quality control, and contributes to alpha-synuclein accumulation and neurodegeneration.
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Conditions with similar clinical presentations that must be differentiated from Kufor-Rakeb syndrome:
name: Kufor-Rakeb syndrome
creation_date: '2026-04-11T17:28:00Z'
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 causes lysosomal
polyamine storage, disrupts glucocerebrosidase-dependent substrate handling,
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.
genes:
- preferred_term: ATP13A2
term:
id: hgnc:30213
label: ATP13A2
cell_types:
- preferred_term: neuron
term:
id: CL:0000540
label: neuron
cellular_components:
- preferred_term: lysosome
term:
id: GO:0005764
label: lysosome
molecular_functions:
- preferred_term: ATPase-coupled transmembrane transporter activity
modifier: DECREASED
term:
id: GO:0042626
label: ATPase-coupled transmembrane transporter activity
biological_processes:
- preferred_term: polyamine transport
modifier: DECREASED
term:
id: GO:0015846
label: polyamine transport
- preferred_term: lysosomal transport
modifier: DECREASED
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 polyamine storage
description: Loss of ATP13A2 polyamine export causes polyamine accumulation in lysosomes.
causal_link_type: DIRECT
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: >-
Here, we demonstrate lysosomal polyamine accumulation in ATP13A2 knockout (KO) cell lines and human induced pluripotent stem cell (iPSC)-derived neurons.
explanation: >-
Cell and iPSC-derived neuron evidence directly shows lysosomal
polyamine storage after ATP13A2 loss.
- name: Lysosomal polyamine storage
description: >-
ATP13A2 loss produces primary lysosomal storage of polyamines in cell lines
and human iPSC-derived neurons. This primary storage perturbs lysosomal pH
and electrostatic lipid-hydrolase interactions, setting up secondary
lysosomal substrate storage.
cell_types:
- preferred_term: neuron
term:
id: CL:0000540
label: neuron
cellular_components:
- preferred_term: lysosome
term:
id: GO:0005764
label: lysosome
biological_processes:
- preferred_term: lysosomal transport
modifier: ABNORMAL
term:
id: GO:0007041
label: lysosomal transport
- preferred_term: polyamine transport
modifier: DECREASED
term:
id: GO:0015846
label: polyamine transport
chemical_entities:
- preferred_term: polyamine
modifier: INCREASED
term:
id: CHEBI:88061
label: polyamine
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: >-
Here, we demonstrate lysosomal polyamine accumulation in ATP13A2 knockout (KO) cell lines and human induced pluripotent stem cell (iPSC)-derived neurons.
explanation: >-
Direct cell-based evidence supports polyamine accumulation as the storage
event downstream of ATP13A2 loss.
downstream:
- target: Lysosomal hydrolase dysfunction
description: >-
Primary polyamine storage disrupts GCase/BMP interactions and impairs
lysosomal substrate hydrolysis.
causal_link_type: DIRECT
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: >-
Polyamine accumulation inhibited lysosomal GCase activity in cells, and this was reversed by lysosome reacidification or BMP supplementation.
explanation: >-
The abstract directly links polyamine accumulation to reversible
inhibition of lysosomal GCase activity.
- 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
molecular_functions:
- preferred_term: glucosylceramidase activity
modifier: DECREASED
term:
id: GO:0004348
label: glucosylceramidase activity
biological_processes:
- preferred_term: glycosphingolipid catabolic process
modifier: DECREASED
term:
id: GO:0046479
label: glycosphingolipid catabolic process
chemical_entities:
- preferred_term: beta-D-glucosylsphingosine
modifier: INCREASED
term:
id: CHEBI:71981
label: beta-D-glucosylsphingosine
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
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- Impaired lysosomal substrate hydrolysis and autophagy-lysosome stress
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-fibroblast evidence supports mitochondrial clearance failure in
KRS, while the lysosome-to-mitochondria direction is represented as an
indirect convergence.
- target: Glucosylsphingosine accumulation
description: Impaired GCase-mediated hydrolysis is accompanied by secondary accumulation of its substrate glucosylsphingosine.
causal_link_type: DIRECT
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: MODEL_ORGANISM
snippet: >-
Primary polyamine storage caused secondary storage of lysosomal anionic phospholipid bis(monoacylglycero)phosphate (BMP) and an age-dependent increase in the β-glucocerebrosidase (GCase) substrate glucosylsphingosine in Atp13a2 KO brains.
explanation: >-
Model-organism evidence directly links ATP13A2-related lysosomal
storage to increased glucosylsphingosine.
- target: Progressive Neurodegeneration
description: >-
Lysosomal hydrolase dysfunction converges on Parkinson-relevant
neurodegenerative pathways.
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
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: >-
The cell-based study supports convergence on Parkinson-relevant
mechanisms but does not by itself prove the full human clinical cascade.
- name: Glucosylsphingosine accumulation
description: >-
Secondary lysosomal hydrolase dysfunction downstream of ATP13A2 loss is
associated with accumulation of the GCase substrate glucosylsphingosine in
Atp13a2 knockout brains.
cell_types:
- preferred_term: neuron
term:
id: CL:0000540
label: neuron
cellular_components:
- preferred_term: lysosome
term:
id: GO:0005764
label: lysosome
biological_processes:
- preferred_term: glycosphingolipid catabolic process
modifier: DECREASED
term:
id: GO:0046479
label: glycosphingolipid catabolic process
chemical_entities:
- preferred_term: beta-D-glucosylsphingosine
modifier: INCREASED
term:
id: CHEBI:71981
label: beta-D-glucosylsphingosine
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: MODEL_ORGANISM
snippet: >-
Primary polyamine storage caused secondary storage of lysosomal anionic phospholipid bis(monoacylglycero)phosphate (BMP) and an age-dependent increase in the β-glucocerebrosidase (GCase) substrate glucosylsphingosine in Atp13a2 KO brains.
explanation: >-
This supports glucosylsphingosine as a secondary lysosomal storage
readout in ATP13A2 loss models.
- 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: SUPPORT
evidence_source: OTHER
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.
downstream:
- target: Progressive Neurodegeneration
description: >-
Mitochondrial dysfunction and impaired mitochondrial clearance are
downstream mechanisms contributing to the progressive neurodegenerative
phenotype.
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
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 fibroblast evidence supports mitochondrial clearance
failure as an important KRS pathogenic mechanism.
- name: Progressive Neurodegeneration
description: >-
KRS is an ATP13A2-related juvenile parkinsonism syndrome in which lysosomal
and mitochondrial dysfunction converge on progressive neuronal injury,
particularly affecting dopaminergic motor circuitry and broader cognitive
and neuropsychiatric function.
cell_types:
- preferred_term: dopaminergic neuron
term:
id: CL:0000700
label: dopaminergic neuron
- preferred_term: neuron
term:
id: CL:0000540
label: neuron
biological_processes:
- preferred_term: neuron apoptotic process
modifier: INCREASED
term:
id: GO:0051402
label: neuron apoptotic process
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: >-
The human case report supports progressive motor and cognitive decline as
a clinical expression of KRS neurodegeneration.
- 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: OTHER
snippet: >-
Parkinson's disease (PD) is a neurodegenerative condition characterized by progressive loss of dopaminergic neurons and by heterogeneous etiologies and clinical manifestations.
explanation: >-
This background statement supports dopaminergic neurodegeneration as the
relevant parkinsonism biology, but it is not KRS-specific and is therefore
partial support.
downstream:
- target: Parkinsonism
description: Degeneration of dopaminergic motor circuitry produces young-onset parkinsonism.
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
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: >-
The human case series summary identifies young-onset parkinsonism as a
core clinical output of KRS.
- target: Spastic paraparesis
description: Corticospinal or pyramidal involvement contributes to lower-extremity spastic paraparesis.
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
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: >-
The same clinical series places spastic paraparesis within the KRS
neurologic phenotype.
- target: Abnormal eye movements
description: Neurodegenerative motor-system involvement can include abnormal ocular motility.
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
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: >-
The clinical abstract directly lists abnormal eye movements in KRS.
- target: Facial myokymia
description: Facial nerve-innervated muscle myokymia is part of the KRS motor phenotype.
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
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: >-
The clinical abstract directly lists facial myokymia in KRS.
- target: Cognitive impairment
description: Progressive KRS neurodegeneration includes cognitive decline.
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
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: >-
The human case report directly supports cognitive decline in KRS.
- target: Psychosis
description: Neuropsychiatric complications can arise in the progressive KRS syndrome.
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
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: >-
The patient was seen for daily behavioral outbursts and psychotic symptoms.
explanation: >-
The human case report supports psychotic symptoms as a KRS
neuropsychiatric complication.
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: Abnormal eye movements
category: Neurologic
description: >-
Abnormal ocular motility is part of the characteristic Kufor-Rakeb syndrome
presentation; some clinical descriptions specify supranuclear gaze
abnormalities.
phenotype_term:
preferred_term: Abnormal eye movements
term:
id: HP:0000496
label: Abnormality of eye movement
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: >-
The abstract directly lists abnormal eye movements in the syndrome.
- name: Facial myokymia
category: Neurologic
description: >-
Fine involuntary contractions of facial nerve-innervated muscles are listed
among the canonical Kufor-Rakeb syndrome motor features.
phenotype_term:
preferred_term: Facial myokymia
term:
id: HP:0000317
label: Facial myokymia
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: >-
The abstract directly lists facial myokymia as a feature of KRS.
- 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.
biochemical:
- name: Lysosomal polyamine accumulation
presence: INCREASED
context: >-
Mechanistic cell and iPSC-derived neuron readout of ATP13A2 loss; not
established as a routine clinical diagnostic biomarker.
biomarker_term:
preferred_term: polyamine
term:
id: CHEBI:88061
label: polyamine
readouts:
- target: Lysosomal polyamine storage
relationship: READOUT_OF
direction: POSITIVE
endpoint_context: PHARMACODYNAMIC
interpretation: >-
Increased lysosomal polyamine signal reports the primary storage event
caused by ATP13A2 loss.
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: >-
Here, we demonstrate lysosomal polyamine accumulation in ATP13A2 knockout (KO) cell lines and human induced pluripotent stem cell (iPSC)-derived neurons.
explanation: >-
The readout is the measured storage event in ATP13A2-loss cells and
iPSC-derived neurons.
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: >-
Here, we demonstrate lysosomal polyamine accumulation in ATP13A2 knockout (KO) cell lines and human induced pluripotent stem cell (iPSC)-derived neurons.
explanation: >-
Directly supports polyamine accumulation as an ATP13A2-loss biochemical
readout in cellular disease models.
- name: Glucosylsphingosine accumulation
presence: INCREASED
context: >-
Secondary model-system readout of impaired GCase substrate handling after
ATP13A2 loss.
biomarker_term:
preferred_term: beta-D-glucosylsphingosine
term:
id: CHEBI:71981
label: beta-D-glucosylsphingosine
readouts:
- target: Glucosylsphingosine accumulation
relationship: READOUT_OF
direction: POSITIVE
endpoint_context: MONITORING
interpretation: >-
Increased glucosylsphingosine tracks the secondary lysosomal substrate
storage branch downstream of impaired GCase activity.
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: MODEL_ORGANISM
snippet: >-
Primary polyamine storage caused secondary storage of lysosomal anionic phospholipid bis(monoacylglycero)phosphate (BMP) and an age-dependent increase in the β-glucocerebrosidase (GCase) substrate glucosylsphingosine in Atp13a2 KO brains.
explanation: >-
The readout maps directly to the secondary substrate-storage node in
ATP13A2 knockout brains.
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: MODEL_ORGANISM
snippet: >-
Primary polyamine storage caused secondary storage of lysosomal anionic phospholipid bis(monoacylglycero)phosphate (BMP) and an age-dependent increase in the β-glucocerebrosidase (GCase) substrate glucosylsphingosine in Atp13a2 KO brains.
explanation: >-
Model evidence supports glucosylsphingosine accumulation downstream of
ATP13A2 loss.
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.
- reference: CGGV:assertion_0ba5cb4f-3f7f-44dc-b2a5-0a2d62e510d4-2022-04-14T160000.000Z
reference_title: "ATP13A2 / Kufor-Rakeb syndrome (Definitive)"
supports: SUPPORT
evidence_source: OTHER
snippet: "ATP13A2 | HGNC:30213 | Kufor-Rakeb syndrome | MONDO:0011706 | AR | Definitive"
explanation: ClinGen classifies the ATP13A2-Kufor-Rakeb syndrome gene-disease relationship as definitive with autosomal recessive inheritance.
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: NCIT:C15986
label: Pharmacotherapy
therapeutic_agent:
- preferred_term: aripiprazole
term:
id: CHEBI:31236
label: aripiprazole
target_phenotypes:
- 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: >-
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: NCIT:C15747
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.
Deep research results are used as seeds for research; they do not undergo the same validation as the main records and may contain errors. How we use deep research.
Record 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.
This report is retrieval-only and is generated directly from Asta results.
search_papers_by_relevance with snippet_search.