Hurler Syndrome, Hurler-Scheie Syndrome, and Scheie Syndrome (Mucopolysaccharidosis Type I)

Hurler Syndrome, Hurler-Scheie Syndrome, and Scheie Syndrome (Mucopolysaccharidosis Type I)

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The mucopolysaccharidoses (MPSs) are a family of metabolic disorders caused by deficiency of lysosomal enzymes needed to degrade glycosaminoglycans (GAGs), or mucopolysaccharides. [1] GAG is an important constituent of the extracellular matrix, joint fluid, and connective tissue throughout the body. Progressive accumulation of GAG within the cells of various organs ultimately compromises their function. The major sites of disease differ depending on the specific enzyme deficiency; therefore, clinical presentation and approaches to therapy differ for the various disease types.

Mucopolysaccharidosis type I (MPS I) is the most common type of MPS. MPS I is heterogeneous, and symptom severity varies widely. Historically, the most-to-least severe subtypes of MPS I were as follows: Hurler syndrome (MPS IH, OMIM #607014), Hurler-Scheie syndrome (MPS I-HS, OMIM #607015), and Scheie syndrome (MPS IS, OMIM #6076016). Currently, since no biochemical differences between these subtypes have been identified and their clinical findings overlap, MPS I is now divided into two subtypes: severe MPS I and attenuated MPS I. Patients with severe MPS I typically have an earlier onset of symptoms, a decline in intellectual function, and a shorter lifespan.

Mucopolysaccharidosis type I (MPS I) is a rare, inherited lysosomal storage disorder caused by a deficiency of the lysosomal enzyme, alpha-L-iduronidase. The disease is inherited in an autosomal recessive manner. Alpha-L-iduronidase deficiency results in an inability of the lysosome to break down GAGs, namely dermatan sulfate (DS) and heparan sulfate (HS). This process is essential for normal growth and homeostasis of tissues. In this disease, GAGs progressively accumulate in the lysosomes, ultimately causing cell, tissue, and organ dysfunction by largely unknown pathophysiological mechanisms. Biochemically, alpha-L-iduronidase deficiency, as seen in patients with MPS I, causes an increase in the urinary excretion of dermatan sulfate (DS) and heparan sulfate (HS).

Hurler syndrome is caused by mutation in the gene (IDUA) that encodes alpha-L-iduronidase on chromosome 4. [15] Many different mutations have been found at this locus, including mutations that cause MPS IH (Hurler syndrome), MPS IS (Scheie syndrome), and MPS I-HS (Hurler-Scheie syndrome), among others. MPS I and all subtypes are discussed in detail below.

United States

The estimated incidence of severe mucopolysaccharidosis type I (MPS I) is about 1 in 100,000 newborns. Attenuated MPS I is less common and occurs in about 1 in 500,000 newborns.


The birth prevalence of mucopolysaccharidosis type I (MPS I) in England and Wales from 1981-2003 was 1.07 cases per 100,000 births. [2]

Lifespan in mucopolysaccharidosis type I (MPS I) encompasses a wide range. Death in early childhood can occur in the more severe form and can range to an adulthood lifespan in the attenuated form.

Mucopolysaccharidosis type I (MPS I) is inherited as autosomal recessive and equally affects both sexes.

MPS I-HS and MPS IS are considered attenuated forms. Symptoms tend to develop later in life, starting in the teenaged years and into the early third decade of life. Symptoms are milder than those observed in MPS IH (Hurler syndrome).

Genetic counseling should be provided to families to explain autosomal recessive inheritance. Organizations and support groups for patients and families affected by MPS disorders include the following:

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D’Aco K, Underhill L, Rangachari L, Arn P, Cox GF, Giugliani R, et al. Diagnosis and treatment trends in mucopolysaccharidosis I: findings from the MPS I Registry. Eur J Pediatr. 2012 Jan 11. [Medline].

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de Ru MH, Boelens JJ, Das AM, Jones SA, van der Lee JH, Mahlaoui N, et al. Enzyme replacement therapy and/or hematopoietic stem cell transplantation at diagnosis in patients with mucopolysaccharidosis type I: results of a European consensus procedure. Orphanet J Rare Dis. 2011 Aug 10. 6:55. [Medline]. [Full Text].

Dornelles AD, de Camargo Pinto LL, de Paula AC, Steiner CE, Lourenço CM, Kim CA, et al. Enzyme replacement therapy for Mucopolysaccharidosis Type I among patients followed within the MPS Brazil Network. Genet Mol Biol. 2014 Mar. 37(1):23-9. [Medline]. [Full Text].

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Neufeld EF, Muenzer J. The mucopolysaccharidoses. Scriver CR, Beaudet AL, Sly W, Valle D, eds. The Metabolic & Molecular Bases of Inherited Disease. 8th ed. New York, NY: McGraw Hill; 2001. Vol 3: 3421-52.

Pasqualim G, Gonçalves Ribeiro M, Guida Godinho da Fonseca G, Szlago M, Schenone A, Lemes A, et al. p.L18P: A novel IDUA mutation that causes a distinct attenuated phenotype in Mucopolysaccharidosis type I patients. Clin Genet. 2014 Sep 25. [Medline].

Germaine L Defendi, MD, MS, FAAP Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Maria Descartes, MD Professor, Department of Human Genetics and Department of Pediatrics, University of Alabama at Birmingham School of Medicine

Maria Descartes, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Medical Genetics and Genomics, American Medical Association, American Society of Human Genetics, Society for Inherited Metabolic Disorders, International Skeletal Dysplasia Society, Southeastern Regional Genetics Group

Disclosure: Nothing to disclose.

Karl S Roth, MD Retired Professor and Chair, Department of Pediatrics, Creighton University School of Medicine

Karl S Roth, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Nutrition, American Pediatric Society, American Society for Nutrition, American Society of Nephrology, Association of American Medical Colleges, Medical Society of Virginia, New York Academy of Sciences, Sigma Xi, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Maryam Banikazemi, MD Assistant Professor of Clinical Pediatrics, New York Medical College

Maryam Banikazemi, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Human Genetics

Disclosure: Nothing to disclose.

Hurler Syndrome, Hurler-Scheie Syndrome, and Scheie Syndrome (Mucopolysaccharidosis Type I)

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