Aceruloplasminemia is an autosomal recessive CP-related iron metabolism disorder characterized by absent ceruloplasmin ferroxidase activity, multi-organ iron accumulation, and progressive neurologic, retinal, metabolic, and hematologic disease.
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Conditions with similar clinical presentations that must be differentiated from aceruloplasminemia:
name: aceruloplasminemia
creation_date: "2026-04-15T17:35:00Z"
updated_date: "2026-05-20T11:51:03Z"
description: >-
Aceruloplasminemia is an autosomal recessive CP-related iron metabolism
disorder characterized by absent ceruloplasmin ferroxidase activity,
multi-organ iron accumulation, and progressive neurologic, retinal, metabolic,
and hematologic disease.
category: Mendelian
parents:
- hereditary disease
- neurodegeneration with brain iron accumulation
disease_term:
preferred_term: aceruloplasminemia
term:
id: MONDO:0011426
label: aceruloplasminemia
inheritance:
- name: Autosomal recessive inheritance
inheritance_term:
preferred_term: Autosomal recessive inheritance
term:
id: HP:0000007
label: Autosomal recessive inheritance
description: >-
Aceruloplasminemia is caused by biallelic pathogenic variants in CP.
evidence:
- reference: PMID:39990010
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Plain Language Summary: Aceruloplasminemia is a rare autosomal recessive iron metabolism disorder.
explanation: >-
This case series directly states the canonical inheritance pattern.
pathophysiology:
- name: Ceruloplasmin ferroxidase deficiency
description: >-
Loss of ceruloplasmin impairs ferroxidase-dependent iron handling and
disrupts normal copper and iron metabolism.
genes:
- preferred_term: CP
term:
id: hgnc:2295
label: CP
biological_processes:
- preferred_term: iron ion transport
term:
id: GO:0006826
label: iron ion transport
modifier: ABNORMAL
- preferred_term: intracellular iron ion homeostasis
term:
id: GO:0006879
label: intracellular iron ion homeostasis
modifier: ABNORMAL
molecular_functions:
- preferred_term: ferroxidase activity
term:
id: GO:0004322
label: ferroxidase activity
modifier: DECREASED
chemical_entities:
- preferred_term: iron
term:
id: CHEBI:18248
label: iron atom
modifier: ABNORMAL
- preferred_term: copper
term:
id: CHEBI:28694
label: copper atom
modifier: DECREASED
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Ceruloplasmin gene encodes ceruloplasmin protein, which has ferroxidase activity and is involved in copper and iron metabolism.
explanation: >-
This directly supports loss of ceruloplasmin ferroxidase function as the
initiating molecular defect.
downstream:
- target: Multi-organ iron accumulation
description: Loss of ceruloplasmin ferroxidase activity causes progressive tissue iron deposition.
- target: Serum ceruloplasmin
description: Ceruloplasmin loss is reflected clinically by very low serum ceruloplasmin levels.
causal_link_type: DIRECT
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Anemia was accompanied by microcytosis, high ferritin, and low copper and ceruloplasmin levels.
explanation: This disease-specific case report supports low ceruloplasmin as a biochemical readout of the CP/ceruloplasmin defect.
- target: Serum copper
description: Low serum copper accompanies severe ceruloplasmin loss because most circulating copper is ceruloplasmin-bound.
causal_link_type: DIRECT
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Anemia was accompanied by microcytosis, high ferritin, and low copper and ceruloplasmin levels.
explanation: Disease-specific laboratory findings support low copper together with low ceruloplasmin.
- target: Transferrin saturation
description: Ceruloplasmin-dependent iron export failure presents clinically with low transferrin saturation despite tissue iron loading.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- impaired cellular iron export and iron sequestration
evidence:
- reference: PMID:39990010
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Patients with aceruloplasminemia often present with microcytic anemia, low transferrin saturation ratio, and high serum ferritin levels before the onset of symptoms.
explanation: The case series supports low transferrin saturation as part of the aceruloplasminemia iron-misdistribution laboratory pattern.
- name: Multi-organ iron accumulation
description: >-
Impaired ceruloplasmin-dependent iron handling causes progressive iron
deposition in the brain, liver, pancreas, and retina.
biological_processes:
- preferred_term: iron ion transport
term:
id: GO:0006826
label: iron ion transport
modifier: ABNORMAL
- preferred_term: intracellular iron ion homeostasis
term:
id: GO:0006879
label: intracellular iron ion homeostasis
modifier: ABNORMAL
chemical_entities:
- preferred_term: iron
term:
id: CHEBI:18248
label: iron atom
modifier: INCREASED
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Aceruloplasminemia inherited autosomal recessively in the ceruloplasmin gene is a progressive disease with iron accumulation in various organs such as the brain, liver, pancreas, and retina.
explanation: >-
This directly supports progressive multi-organ iron deposition as the key
downstream pathological event.
downstream:
- target: Microcytic anemia
description: Systemic iron dysregulation produces early microcytic anemia.
- target: Retinopathy
description: Retinal iron deposition contributes to progressive retinopathy.
- target: Diabetes mellitus
description: Pancreatic iron deposition contributes to diabetes mellitus.
- target: Brain iron accumulation
description: Cerebral iron deposition drives the neurologic disease branch.
- target: Tissue iron accumulation
description: Multi-organ iron deposition is directly reflected by increased tissue iron burden.
causal_link_type: DIRECT
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Aceruloplasminemia inherited autosomal recessively in the ceruloplasmin gene is
a progressive disease with iron accumulation in various organs such as the
brain, liver, pancreas, and retina.
explanation: Disease-specific review text directly supports increased iron across multiple organs.
- target: Ferritin
description: Systemic iron misdistribution and storage are reflected by high serum ferritin.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- increased iron storage and ferritin release
evidence:
- reference: PMID:39990010
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Patients with aceruloplasminemia often present with microcytic anemia, low transferrin saturation ratio, and high serum ferritin levels before the onset of symptoms.
explanation: The case series supports high serum ferritin as a recurring biochemical feature of aceruloplasminemia-related iron dysregulation.
- name: Brain iron accumulation
description: >-
Progressive iron deposition in deep gray matter and cerebellar structures
drives the neurologic manifestations of aceruloplasminemia.
biological_processes:
- preferred_term: iron ion transport
term:
id: GO:0006826
label: iron ion transport
modifier: ABNORMAL
- preferred_term: intracellular iron ion homeostasis
term:
id: GO:0006879
label: intracellular iron ion homeostasis
modifier: ABNORMAL
chemical_entities:
- preferred_term: iron
term:
id: CHEBI:18248
label: iron atom
modifier: INCREASED
evidence:
- reference: PMID:40729217
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Brain MRI revealed significant iron accumulation in multiple brain regions, including the dentate nuclei, cerebellar cortex, basal ganglia, thalamus, brainstem nuclei, and hypothalamus.
explanation: >-
This case report directly supports brain iron accumulation as the
immediate pathophysiologic driver of neurologic disease.
downstream:
- target: Cognitive impairment
description: Brain iron accumulation contributes to cognitive decline.
- target: Postural instability
description: Brain iron accumulation contributes to gait and postural dysfunction.
- target: Brain MRI iron accumulation
description: Brain iron accumulation is measured by characteristic MRI susceptibility abnormalities.
causal_link_type: DIRECT
evidence:
- reference: PMID:40729217
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Brain MRI revealed significant iron accumulation in multiple brain regions,
including the dentate nuclei, cerebellar cortex, basal ganglia, thalamus,
brainstem nuclei, and hypothalamus.
explanation: MRI findings directly report increased iron burden in the affected brain regions.
phenotypes:
- name: Microcytic anemia
category: Hematologic
description: >-
Persistent microcytic anemia is often an early clinical clue and can precede
the later neurologic syndrome.
phenotype_term:
preferred_term: Microcytic anemia
term:
id: HP:0001935
label: Microcytic anemia
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
In addition, microcytic anemia accompanied by high ferritin and low ceruloplasmin level that develop at earlier ages can be first manifestation.
explanation: >-
This directly supports microcytic anemia as an early disease phenotype.
- name: Retinopathy
category: Ophthalmologic
description: >-
Progressive retinal involvement develops as part of the later disease
course.
phenotype_term:
preferred_term: Retinopathy
term:
id: HP:0000488
label: Retinopathy
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Progressive neurotoxicity, retinopathy, and diabetes may develop in about 40-60 decades.
explanation: >-
This directly supports retinopathy as part of the classic later phenotype.
- name: Diabetes mellitus
category: Endocrine
description: >-
Pancreatic iron deposition can contribute to diabetes mellitus later in the
disease course.
phenotype_term:
preferred_term: Diabetes mellitus
term:
id: HP:0000819
label: Diabetes mellitus
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Progressive neurotoxicity, retinopathy, and diabetes may develop in about 40-60 decades.
explanation: >-
This directly supports diabetes mellitus as a recognized later
manifestation.
- name: Cognitive impairment
category: Neurologic
description: >-
Cognitive decline can emerge as part of the neurologic phenotype in patients
with progressive brain iron deposition.
phenotype_term:
preferred_term: Cognitive impairment
term:
id: HP:0100543
label: Cognitive impairment
evidence:
- reference: PMID:40729217
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Here, we report the first case of ACP in Greece. Case Presentation: Our patient was a 53-year-old male who was referred to our movement disorders center for a 6-month history of mild, unspecific, episodic dizziness and postural instability, and attention and memory deficits.
explanation: >-
Attention and memory deficits in a disease-specific case report support
cognitive impairment as part of the neurologic spectrum.
- name: Postural instability
category: Neurologic
description: >-
Postural instability can emerge as part of the movement-disorder spectrum in
patients with brain iron accumulation.
phenotype_term:
preferred_term: Postural instability
term:
id: HP:0002172
label: Postural instability
evidence:
- reference: PMID:40729217
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Here, we report the first case of ACP in Greece. Case Presentation: Our patient was a 53-year-old male who was referred to our movement disorders center for a 6-month history of mild, unspecific, episodic dizziness and postural instability, and attention and memory deficits.
explanation: >-
This disease-specific case report directly supports postural instability
as part of the neurologic phenotype.
genetic:
- name: CP
association: Loss of function mutation
gene_term:
preferred_term: CP
term:
id: hgnc:2295
label: CP
evidence:
- reference: PMID:40729217
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Background and Clinical Significance: Aceruloplasminemia (ACP), a member of the neurodegeneration with brain iron accumulation (NBIA) spectrum of disorders, is a rare disorder caused by mutations in the ceruloplasmin (CP) gene.
explanation: >-
This directly identifies CP as the disease gene.
- reference: CGGV:assertion_c54ee607-edd6-42dc-a4ac-f4060ae6b209-2025-11-26T180000.000Z
reference_title: "CP / aceruloplasminemia (Definitive)"
supports: SUPPORT
evidence_source: OTHER
snippet: "CP | HGNC:2295 | aceruloplasminemia | MONDO:0011426 | AR | Definitive"
explanation: ClinGen classifies the CP-aceruloplasminemia gene-disease relationship as definitive with autosomal recessive inheritance.
diagnosis:
- name: CP molecular genetic testing
description: >-
Molecular testing confirms the diagnosis by identifying biallelic
pathogenic variants in CP in the context of the characteristic iron-study
profile.
diagnosis_term:
preferred_term: molecular genetic testing
term:
id: MAXO:0000533
label: molecular genetic testing
qualifiers:
- predicate:
preferred_term: has participant
term:
id: RO:0000057
label: has participant
value:
preferred_term: CP
term:
id: hgnc:2295
label: CP
results: Biallelic pathogenic CP variant.
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
A novel homozygous c.690delG variant was detected in ceruloplasmin by whole exome sequencing.
explanation: >-
This directly supports molecular confirmation of aceruloplasminemia by
identifying a homozygous pathogenic CP variant.
biochemical:
- name: Serum ceruloplasmin
presence: DECREASED
context: >-
Very low serum ceruloplasmin is a core laboratory abnormality.
readouts:
- target: Ceruloplasmin ferroxidase deficiency
relationship: READOUT_OF
direction: NEGATIVE
endpoint_context: DIAGNOSTIC
interpretation: Low serum ceruloplasmin directly reports the CP/ceruloplasmin deficiency state.
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Anemia was accompanied by microcytosis, high ferritin, and low copper and ceruloplasmin levels.
explanation: >-
This directly supports low ceruloplasmin as a key biochemical hallmark.
- name: Serum copper
presence: DECREASED
context: >-
Serum copper is low in aceruloplasminemia because loss of circulating
ceruloplasmin reduces the major copper-bearing plasma protein pool.
biomarker_term:
preferred_term: copper
term:
id: CHEBI:28694
label: copper atom
readouts:
- target: Ceruloplasmin ferroxidase deficiency
relationship: READOUT_OF
direction: NEGATIVE
endpoint_context: DIAGNOSTIC
interpretation: Low serum copper tracks with severe loss of circulating ceruloplasmin.
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Anemia was accompanied by microcytosis, high ferritin, and low copper and ceruloplasmin levels.
explanation: Disease-specific case evidence directly documents low copper with low ceruloplasmin.
- reference: PMID:40729217
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Subsequent testing revealed extremely low serum CP and low serum copper.
explanation: Independent case evidence supports low serum copper as part of the diagnostic laboratory pattern.
- name: Ferritin
presence: INCREASED
context: >-
Hyperferritinemia reflects systemic iron overload and is often present before
major neurologic manifestations.
readouts:
- target: Multi-organ iron accumulation
relationship: READOUT_OF
direction: POSITIVE
endpoint_context: DIAGNOSTIC
interpretation: Elevated ferritin reports systemic iron storage and iron misdistribution in aceruloplasminemia.
evidence:
- reference: PMID:39990010
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Patients with aceruloplasminemia often present with microcytic anemia, low transferrin saturation ratio, and high serum ferritin levels before the onset of symptoms.
explanation: >-
This directly supports elevated ferritin as a recurring pre-symptomatic
laboratory clue.
- name: Transferrin saturation
presence: DECREASED
context: >-
Low transferrin saturation is an early laboratory clue that accompanies the
microcytic anemia and hyperferritinemia pattern.
readouts:
- target: Ceruloplasmin ferroxidase deficiency
relationship: READOUT_OF
direction: NEGATIVE
endpoint_context: DIAGNOSTIC
interpretation: Low transferrin saturation reflects impaired ceruloplasmin-dependent iron mobilization despite tissue iron loading.
evidence:
- reference: PMID:39990010
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Patients with aceruloplasminemia often present with microcytic anemia, low transferrin saturation ratio, and high serum ferritin levels before the onset of symptoms.
explanation: >-
This directly supports decreased transferrin saturation as a recurrent
biochemical feature of aceruloplasminemia.
- name: Tissue iron accumulation
presence: INCREASED
context: >-
Iron accumulates across multiple organs, including brain, liver, pancreas,
and retina, downstream of ceruloplasmin-dependent iron handling failure.
biomarker_term:
preferred_term: iron
term:
id: CHEBI:18248
label: iron atom
readouts:
- target: Multi-organ iron accumulation
relationship: READOUT_OF
direction: POSITIVE
endpoint_context: DIAGNOSTIC
interpretation: Increased tissue iron burden reports the central multi-organ iron accumulation mechanism.
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Aceruloplasminemia inherited autosomal recessively in the ceruloplasmin gene is
a progressive disease with iron accumulation in various organs such as the
brain, liver, pancreas, and retina.
explanation: Disease-specific review text directly identifies multi-organ tissue iron accumulation.
- name: Brain MRI iron accumulation
presence: INCREASED
context: >-
MRI can show increased iron burden in multiple brain regions, including
dentate nuclei, cerebellar cortex, basal ganglia, thalamus, brainstem nuclei,
and hypothalamus.
biomarker_term:
preferred_term: iron
term:
id: CHEBI:18248
label: iron atom
readouts:
- target: Brain iron accumulation
relationship: READOUT_OF
direction: POSITIVE
endpoint_context: DIAGNOSTIC
interpretation: MRI-visible brain iron reports the neurologic iron-accumulation branch.
evidence:
- reference: PMID:40729217
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Brain MRI revealed significant iron accumulation in multiple brain regions,
including the dentate nuclei, cerebellar cortex, basal ganglia, thalamus,
brainstem nuclei, and hypothalamus.
explanation: MRI evidence directly documents the brain iron accumulation readout.
treatments:
- name: Iron chelation therapy
description: >-
Iron chelation is used to reduce systemic and neurologic iron-related
toxicity.
treatment_term:
preferred_term: chelator agent therapy
term:
id: MAXO:0001223
label: chelator agent therapy
therapeutic_agent:
- preferred_term: deferiprone
term:
id: CHEBI:68554
label: deferiprone
target_mechanisms:
- target: Multi-organ iron accumulation
treatment_effect: MODULATES
description: Iron chelation is used to reduce iron-related toxicity downstream of multi-organ iron accumulation.
evidence:
- reference: PMID:36308763
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Iron chelation may be utilized in the treatment to reduce the toxicity.
explanation: Disease-specific review text supports iron chelation as a treatment aimed at reducing iron-related toxicity.
evidence:
- reference: PMID:33839643
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
In particular, deferiprone is currently being exploited to treat several NBIA diseases (Vroegindeweij et al., 2020, Klopstock et al., 2019).
explanation: >-
This directly supports deferiprone-based iron chelation as a disease-relevant
treatment strategy within the NBIA spectrum that includes aceruloplasminemia.
differential_diagnoses:
- name: Wilson disease
description: >-
Wilson disease overlaps through low ceruloplasmin and hepatic-neurologic
manifestations, but has primary copper transport failure rather than
ceruloplasmin-linked iron overload.
distinguishing_features:
- Wilson disease is primarily an ATP7B-related copper overload disorder.
- Aceruloplasminemia instead shows microcytic anemia, low transferrin saturation, and hyperferritinemia before the neurologic syndrome.
disease_term:
preferred_term: Wilson disease
term:
id: MONDO:0010200
label: Wilson disease
evidence:
- reference: PMID:39990010
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
It is important to differentiate aceruloplasminemia from Wilson disease, another disease with low ceruloplasmin.
explanation: >-
This directly supports Wilson disease as a key differential diagnosis.
clinical_trials: []
datasets: []
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