Update on lysosomal acid lipase deficiency: Diagnosis, treatment and patient management

Med Clin (Barc). 2017 May 10;148(9):429.e1-429.e10. doi: 10.1016/j.medcli.2016.12.044. Epub 2017 Mar 9.
[Article in English, Spanish]


Lysosomal acid lipase deficiency (LALD) is an ultra-rare disease caused by a congenital disorder of the lipid metabolism, characterized by the deposition of cholesterol esters and triglycerides in the organism. In patients with no enzyme function, the disease develops during the perinatal period and is invariably associated with death during the first year of life. In all other cases, the phenotype is heterogeneous, although most patients develop chronic liver diseases and may also develop an early cardiovascular disease. Treatment for LALD has classically included the use of supportive measures that do not prevent the progression of the disease. In 2015, regulatory agencies approved the use of a human recombinant LAL for the treatment of LALD. This long-term enzyme replacement therapy has been associated with significant improvements in the hepatic and lipid profiles of patients with LALD, increasing survival rates in infants with a rapidly progressive disease. Both the severity of LALD and the availability of a specific treatment highlight the need to identify these patients in clinical settings, although its low prevalence and the existing clinical overlap with other more frequent pathologies limit its diagnosis. In this paper we set out practical recommendations to identify and monitor patients with LALD, including a diagnostic algorithm, along with an updated treatment.

Keywords: Alpha sebelipase; Cholesterol ester storage disease; Deficiencia de lipasa ácida lisosomal; Diagnosis; Diagnóstico; Enfermedad de Wolman; Enfermedad por almacenamiento de ésteres de colesterol; Lysosomal acid lipase deficiency; Sebelipasa alfa; Wolman's disease.

Publication types

  • Consensus Development Conference

MeSH terms

  • Combined Modality Therapy
  • Diagnosis, Differential
  • Disease Progression
  • Enzyme Replacement Therapy / methods
  • Humans
  • Recombinant Proteins / therapeutic use
  • Sterol Esterase / therapeutic use
  • Wolman Disease / diagnosis*
  • Wolman Disease / physiopathology
  • Wolman Disease / therapy*


  • Recombinant Proteins
  • LIPA protein, human
  • Sterol Esterase

Supplementary concepts

  • Lysosomal acid lipase deficiency