Article Text

Adaptor protein complex-4 (AP-4) deficiency causes a novel autosomal recessive cerebral palsy syndrome with microcephaly and intellectual disability
  1. Andres Moreno-De-Luca1,
  2. Sandra L Helmers2,
  3. Hui Mao3,
  4. Thomas G Burns4,
  5. Amanda M A Melton4,
  6. Karen R Schmidt1,
  7. Paul M Fernhoff1,
  8. David H Ledbetter1,
  9. Christa L Martin1
  1. 1Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4Department of Neuropsychology, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
  1. Correspondence to Christa L Martin, 615 Michael Street, Suite 301, Atlanta, GA 30322, USA; christa.martin{at}


Background Cerebral palsy is a heterogeneous group of neurodevelopmental brain disorders resulting in motor and posture impairments often associated with cognitive, sensorial, and behavioural disturbances. Hypoxic–ischaemic injury, long considered the most frequent causative factor, accounts for fewer than 10% of cases, whereas a growing body of evidence suggests that diverse genetic abnormalities likely play a major role.

Methods and results This report describes an autosomal recessive form of spastic tetraplegic cerebral palsy with profound intellectual disability, microcephaly, epilepsy and white matter loss in a consanguineous family resulting from a homozygous deletion involving AP4E1, one of the four subunits of the adaptor protein complex-4 (AP-4), identified by chromosomal microarray analysis.

Conclusion These findings, along with previous reports of human and mouse mutations in other members of the complex, indicate that disruption of any one of the four subunits of AP-4 causes dysfunction of the entire complex, leading to a distinct ‘AP-4 deficiency syndrome’.

  • Cerebral palsy
  • microcephaly
  • epilepsy
  • mental retardation
  • gene deletion
  • clinical genetics
  • cytogenetics
  • neurology
  • epilepsy and seizures

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  • Funding This work was funded in part by grant MH074090 (to DHL and CLM) from the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Emory University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.