“…They range from the least severe Björnstad syndrome with neurosensory hearing loss and pili torti, 58,59 a neurologic disease with muscle weakness and optic atrophy 60 to manifestations with encephalopathy, liver failure or tubulopathy, or combinations thereof. 45,61–65 Manifestations with neonatal onset usually present with hepatopathy (V. Fellman and H. Kotarsky, in this issue), the most severe being the GRACILE (growth restriction, aminoaciduria, cholestasis, iron overload, lactic acidosis and early death) syndrome, caused by a homozygous missense mutation (S78G). 66 The phenotype is strikingly consistent, 67 presenting with severe fetal growth restriction, lactacidosis and early death, further described in this issue (V. Fellman).…”