Factors in the pathogenesis of the brain damage and anaemia in the Lesch-Nyhan syndrome.

The possible factors in the pathogenesis of the brain damage and megaloblastic anaemia in the Lesch-Nyhan syndrome are discussed. Disordered growth and function appear to be limited to the brain, bone marrow and general body stature, yet the purine salvage enzyme hypoxanthine-guanine phosphoribosyltransferase (EC 2.4.2.8, HGPRT), although present in variable amounts in different tissues, is ubiquitous, a fact which suggests that other factors than HGPRT deficiency alone determine the pattern of tissue damage. Recent evidence suggests that the specific tissue damage in the Lesch-Nyhan syndrome is due to lack of NGPRT in tissues with relatively reduced purine de novo capability and a greater dependence on purine salvage pathways at certain stages in their development for their supply of purine ribonucleotides. This evidence is presented together with possible mitigating factors operating in the bone marrow.