Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Clinical utility gene card for: ALG6 defective congenital disorder of glycosylation

1. Disease characteristics

1.1 Name of the disease (synonyms)

Deficiency of Dol-P-Glc: Man9GlcNAc2-PP-Dol α-1,3-glucosyltransferase, glucosyltransferase 1 deficiency, ALG6-CDG, CDG-Ic.

1.2 OMIM# of the disease


1.3 Name of the analysed genes or DNA/chromosome segments


1.4 OMIM# of the gene


1.5 Mutational spectrum

Twenty-three variants have been reported, including 11 missense variants, 1 nonsense variant, 5 deletion variants, 4 splicing variants, and 1 duplication variant. In one patient, a portion of chromosome 1 including ALG6 was deleted as a de novo event1, 2, 3, 4 ( The standard reference sequence indicating reported variants (ENSG00000088035) and a reference for exon numbering (ENST00000371108) can be found at

1.6 Analytical methods

Sanger sequencing of the 14 coding exons and flanking intronic sequences of the ALG6 gene (NCBI reference sequence: NM_013339.3).

1.7 Analytical validation

Sanger sequencing identifies variants in >99% of patients. Deep intronic variants, large deletions and duplications would not be detected using this approach. Novel variants with uncertain pathogenic nature are of course possible.

1.8 Estimated frequency of the disease (incidence at birth (‘birth prevalence’) or population prevalence)

If known to be variable between ethnic groups, please report):

Fifty-four patients have been reported.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 The frequency and the prevalence of the disease are not known.

1.9 Diagnostic setting

Comment: ALG6-CDG is an autosomal recessive disorder. Its phenotype is mostly characterized by a mild to moderately severe neurological disorder (psychomotor disability, epilepsy, hypotonia, optic dysfunction/hypotrophy, and, on brain imaging, a thin corpus callosum and cerebral/cerebellar hypotrophy) and feeding problems. A minority of patients show a severe, early-onset neuro-gastrointestinal presentation.3, 10, 12, 14 Other reported manifestations are facial dysmorphy, skeletal abnormalities such as brachytelephalangy, bleeding/clotting problems, hepatomegaly, cardiomyopathy, and recurrent infections. Striking biochemical abnormalities are unusually low levels of serum cholesterol, blood coagulation factor XI, and anticoagulation factors antithrombin, protein C, and protein S, as well as variable hypoalbuminemia, increased serum transaminases, low serum LDL-cholesterol, and endocrinological abnormalities. Serum transferrin isoelectrofocusing shows a type 1 pattern, and fibroblast dolichol-linked oligosaccharide (DLO) analysis an increase of Man9GlcNAc2. The diagnosis has to be confirmed by mutation analysis of ALG6. Since the DLO analysis is cumbersome, produces sometimes equivocal results, and is only available in very few centers, an upcoming strategy is to subject the DNA to a CDG panel of genes known to be involved in CDG. The identification of the pathogenic variant will permit heterozygote detection in the family, and prenatal diagnosis.

2. Test characteristics

2.1 Analytical sensitivity

(proportion of positive tests if the genotype is present)

Close to 100% when using the serum transferrin isoelectrofocusing test.

2.2 Analytical specificity

(proportion of negative tests if the genotype is not present)

Close to 100% when using the serum transferrin isoelectrofocusing test. This test can be positive in secondary glycosylation disturbances such as galactosemia and hereditary fructose intolerance, and due to bacterial sialidase.18, 19, 20

2.3 Clinical sensitivity

(proportion of positive tests if the disease is present)

The clinical sensitivity can be dependent on variable factors such as age or family history. In such cases a general statement should be given, even if a quantification can only be made case by case.

Close to 100%.

2.4 Clinical specificity

(proportion of negative tests if the disease is not present)

The clinical specificity can be dependent on variable factors such as age or family history. In such cases a general statement should be given, even if a quantification can only be made case by case.

Close to 100%.

2.5 Positive clinical predictive value

(lifetime risk to develop the disease if the test is positive)

100%, based on positive serum transferrin isoelectrofocusing screening and ALG6 mutation analysis.

2.6 Negative clinical predictive value

(probability not to develop the disease if the test is negative)

Assume an increased risk based on family history for a non-affected person. Allelic and locus heterogeneity may need to be considered.

Index case in that family had been tested:


Index case in that family had not been tested:


3. Clinical utility

3.1 (Differential) diagnostics: The tested person is clinically affected

(To be answered if in 1.9 ‘A’ was marked.)

3.1.1 Can a diagnosis be made other than through a genetic test?

3.1.2 Describe the burden of alternative diagnostic methods to the patient

The blood sampling for the serum transferrin isoelectrofocusing screening test and that for the mutation analysis is a minor burden to the patient.

3.1.3 How is the cost effectiveness of alternative diagnostic methods to be judged?

It differs among countries. In Belgium and The Netherlands the cost of these tests is largely carried by the national assurance organism.

3.1.4 Will disease management be influenced by the result of a genetic test?

3.2 Predictive setting: The tested person is clinically unaffected but carries an increased risk based on family history

(To be answered if in 1.9 ‘B’ was marked.)

3.2.1 Will the result of a genetic test influence lifestyle and prevention?

If the test result is positive (please describe):

Not applicable.

If the test result is negative (please describe):

Not applicable.

3.2.2 Which options in view of lifestyle and prevention does a person at risk have if no genetic test has been done (please describe)?

Not applicable.

3.3 Genetic risk assessment in family members of a diseased person

(To be answered if in 1.9 ‘C’ was marked.)

3.3.1 Does the result of a genetic test resolve the genetic situation in that family?

Usually yes, by testing the potential heterozygous persons (carriers) in the family.

3.3.2 Can a genetic test in the index patient save genetic or other tests in family members?


3.3.3 Does a positive genetic test result in the index patient enable a predictive test in a family member?

Not applicable.

3.4 Prenatal diagnosis

(To be answered if in 1.9 ‘D’ was marked.)

3.4.1 Does a positive genetic test result in the index patient enable a prenatal diagnosis?

Yes. Prenatal diagnosis should be performed by molecular analysis; fetal transferrin isoelectrofocusing leads to false results.21

4. If applicable, further consequences of testing

Please assume that the result of a genetic test has no immediate medical consequences. Is there any evidence that a genetic test is nevertheless useful for the patient or his/her relatives? (Please describe)

Knowledge of the diagnosis will stop unnecessary further investigations, and will help the parents in the process of accepting the disease although no curative treatment is available.


  1. 1

    Haeuptle MA, Hennet T : Congenital disorders of glycosylation: an update on defects affecting the biosynthesis of dolichol-linked oligosaccharides. Hum Mutat 2009; 30: 1628–1641.

    CAS  Article  Google Scholar 

  2. 2

    Al-Owain M, Mohamed S, Kaya N, Zagal A, Matthijs G, Jaeken J : A novel mutation and first report of dilated cardiomyopathy in ALG6-CDG (CDG-Ic): a case report. Orphanet J Rare Dis 2010; 5: 7.

    Article  Google Scholar 

  3. 3

    Dercksen M, Crutchley AC, Honey EM et al: ALG6-CDG in South Africa: genotype-phenotype description of five novel patients. JIMD Rep 2013; 8: 17–23.

    CAS  Article  Google Scholar 

  4. 4

    Ichikawa K, Kadoya M, Wada Y, Okamoto N : Congenital disorder of glycosylation type Ic: report of a Japanese case. Brain Dev 2013; 35: 586–589.

    Article  Google Scholar 

  5. 5

    Körner C, Knauer R, Holzbach U, Hanefeld F, Lehle L, von Figura K : Carbohydrate-deficient glycoprotein syndrome type V: deficiency of dolichyl-P-Glc:Man9GlcNAc2-PP-dolichyl glucosyltransferase. Proc Natl Acad Sci USA 1998; 95: 13200–13205.

    Article  Google Scholar 

  6. 6

    Imbach T, Burda P, Kuhnert P et al: A mutation in the human ortholog of the Saccharomyces cerevisiae ALG6 gene causes carbohydrate-deficient glycoprotein-syndrome type Ic. Proc Natl Acad Sci USA 1999; 96: 6982–6987.

    CAS  Article  Google Scholar 

  7. 7

    Grünewald S, Imbach T, Huijben K et al: Clinical and biochemical characteristics of congenital disorder of glycosylation type Ic, the first recognized endoplasmic reticulum defect in N-glycan synthesis. Ann Neurol 2000; 47: 776–781.

    Article  Google Scholar 

  8. 8

    Hanefeld F, Körner C, Holzbach-Eberle U, von Figura K : Congenital disorder of glycosylation-Ic: case report and genetic defect. Neuropediatrics 2000; 31: 60–62.

    CAS  Article  Google Scholar 

  9. 9

    Imbach T, Grünewald S, Schenk B et al: Multi-allelic origin of congenital disorder of glycosylation (CDG)-Ic. Hum Genet 2000; 106: 538–545.

    CAS  Article  Google Scholar 

  10. 10

    Westphal V, Murch S, Kim S et al: Reduced heparan sulphate accumulation in enterocytes contributes to the protein-losing enteropathy in a congenital disorder of glycosylation. Am J Pathol 2000; 157: 1917–1925.

    CAS  Article  Google Scholar 

  11. 11

    Westphal V, Schottstadt C, Marquardt T, Freeze HH : Analysis of multiple mutations in the hALG6 gene in a patient with congenital disorder of glycosylation Ic. Mol Genet Metab 2000; 70: 219–223.

    CAS  Article  Google Scholar 

  12. 12

    Newell JW, Seo NS, Enns GM, McCraken M, Mantovani JF, Freeze HH : Congenital disorder of glycosylation Ic in patients of Indian origin. Mol Genet Metab 2003; 79: 221–228.

    CAS  Article  Google Scholar 

  13. 13

    Westphal V, Xiao M, Kwok PY, Freeze HH : Identification of a frequent variant in ALG6, the cause of congenital disorder of glycosylation-Ic. Hum Mutat 2003; 22: 420–421.

    Article  Google Scholar 

  14. 14

    Damen G, de Klerk H, Huijmans J, den Hollander J, Sinaasappel M : Gastrointestinal and other clinical manifestations in 17 children with congenital disorders of glycosylation type Ia, Ib, and Ic. J Pediatr Gastroenterol Nutr 2004; 38: 282–287.

    Article  Google Scholar 

  15. 15

    Sun L, Eklund EA, Van Hove JL, Freeze HH, Thomas JA : Clinical and molecular characterization of the first adult congenital disorder of glycosylation (CDG) type Ic patient. Am J Med Genet A 2005; 137: 22–26.

    Article  Google Scholar 

  16. 16

    Eklund EA, Sun L, Yang SP, Pasion RM, Thorland EC, Freeze HH : Congenital disorder of glycosylation Ic due to a de novo deletion and an hALG-6 mutation. Biochem Biophys Res Commun 2006; 339: 755–760.

    CAS  Article  Google Scholar 

  17. 17

    Drijvers JM, Lefeber DJ, de Munnik SA et al: Skeletal dysplasia with brachytelephalangy in a patient with a congenital disorder of glycosylation due to ALG6 gene mutations. Clin Genet 2010; 77: 507–509.

    CAS  Article  Google Scholar 

  18. 18

    Jaeken J, Pirard M, Adamowicz M, Pronicka E, Van Schaftingen E : Inhibition of phosphomannose isomerase by fructose 1-phosphate: an explanation for defective N-glycosylation in hereditary fructose intolerance. Pediatr Res 1996; 40: 764–766.

    CAS  Article  Google Scholar 

  19. 19

    Sturiale L, Barone R, Fiumara A et al: Hypoglycosylation with increased fucosylation and branching of serum transferrin N-glycans in untreated galactosemia. Glycobiology 2005; 15: 1268–1276.

    CAS  Article  Google Scholar 

  20. 20

    Lefeber DJ, Morava E, Jaeken J : How to find and diagnose a CDG due to defective N-glycosylation. J Inherit Metab Dis 2011; 34: 849–852.

    Article  Google Scholar 

  21. 21

    Matthijs G, Schollen E, Cassiman JJ et al: Prenatal diagnosis in CDG 1 families: beware of heterogeneity. Eur J Hum Genet 1998; 6: 99–104.

    CAS  Article  Google Scholar 

Download references


This work was supported by EuroGentest2 (Unit 2: ‘Genetic testing as part of health care’), a Coordination Action under FP7 (Grant Agreement Number 261469) and the European Society of Human Genetics.

Author information



Corresponding author

Correspondence to Jaak Jaeken.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jaeken, J., Lefeber, D. & Matthijs, G. Clinical utility gene card for: ALG6 defective congenital disorder of glycosylation. Eur J Hum Genet 23, 1–3 (2015).

Download citation

Further reading


Quick links