Test Catalog

Test ID: PDCRF    
Pompe Disease Cross-Reactive Immunological Material Status, Fibroblasts

Useful For Suggests clinical disorders or settings where the test may be helpful

Determination of cross-reactive immunologic material status in patients with Pompe disease


Evaluating the best strategy for enzyme replacement therapy for patients with Pompe disease

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

When this test is ordered, a fibroblast culture and cryopreservation for biochemical studies will always be performed at an additional charge. However, for multiple lysosomal enzyme assays on a patient utilizing fibroblast culture, only one culture is required regardless of the number of enzyme assays ordered. If viable cells are not obtained within 10 days, client will be notified.


See Newborn Screen Follow-up for Pompe Disease In Special Instructions

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Pompe disease, also known as glycogen storage disease type II, is an autosomal recessive disorder caused by a deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA; acid maltase) due to alterations in the GAA gene. The estimated incidence is 1 in 40,000 live births. In Pompe disease, glycogen is taken up by lysosomes during physiologic cell turnover and accumulates, causing lysosomal swelling and cell damage, which results in organ dysfunction. Symptoms include progressive muscle weakness, cardiomyopathy, and, eventually, death.


Clinically, Pompe disease is categorized into infantile and late-onset forms based on age of onset, organ involvement, and rate of progression. The infantile form (or classic Pompe disease) is the most severe variant and is characterized by early onset and rapid progression of cardiac, liver, and muscle problems resulting in death within the first year of life. The infantile variant of Pompe disease has a similar age of onset but a milder clinical presentation. Late-onset Pompe disease can present with muscle weakness, cardiomyopathy, and/or respiratory dysfunction in childhood or later, including advanced adulthood. The rate of progression and severity of symptoms is variable, particularly in the late-onset forms.


Treatment with enzyme replacement therapy (ERT) is available, making early diagnosis of Pompe disease desirable because early initiation of treatment improves the prognosis. Treatment with ERT can prolong survival in patients with infantile onset Pompe disease; however the effectiveness of treatment is impacted by the presence or absence of cross-reactive immunologic material (CRIM) to the GAA enzyme. Patients who are CRIM-negative are more likely to develop antibodies against recombinant human GAA than patients who are CRIM-positive, thereby decreasing the effectiveness of treatment. Strategies to decrease the immune response to ERT, such as immunosuppression, rely on determination of CRIM status.


Molecular analysis of the GAA gene can determine CRIM status in over 90% of patients with Pompe disease (GAAZ / Pompe Disease, Full Gene Analysis, Varies). However, for those who have GAA variants that are not classified as either CRIM-negative or -positive, CRIM testing in firboblasts or leukocytes can determine final CRIM status. Therefore, CRIM testing is useful for either confirmation of CRIM status determined by molecular testing or determination of CRIM status if the genotype is not informative.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

An interpretive report will be provided

Interpretation Provides information to assist in interpretation of the test results

The presence of cross-reactive immunologic material (CRIM) indicates a decreased likelihood that a patient affected with Pompe disease (acid alpha-glucosidase: GAA deficiency) will develop an immune response to enzyme replacement therapy with recombinant GAA.


The absence of CRIM in untreated patients with Pompe disease indicates a need to consider additional measures to prevent an immune response to the administration of enzyme replacement therapy with recombinant GAA.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

The test by itself is not diagnostic of Pompe disease, and results need to be interpreted in light of the clinical presentation and other laboratory tests, such as creatine kinase, acid alpha-glucosidase (GAA) activity, and GAA genotype.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Kishnani PS, Goldenberg PC, DeArmey SL, et al: Cross-reactive immunologic material status affects treatment outcomes in Pompe disease infants. Mol Genet Metab. 2010 Jan;99(1):26-33

2. Bali DS, Goldstein JL, Rehder C, et al: Clinical laboratory experience of blood CRIM testing in infantile Pompe disease. Mol Genet Metab Rep. 2015;5:76-79 doi:10.1016/j.ymgmr.2015.10.012

3. Reuser AJ, Hirschhorn R, Kroos MA: Pompe disease: Glycogen storage disease type II, acid alpha-glucosidase (acid maltase) deficiency. In: Valle D, Beaudet AL, Vogelstein B, et al, eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill, 2014. Accessed May 10, 2019.Available at https://ommbid.mhmedical.com/content.aspx?sectionid=225890450&bookid=2709&Resultclick=2

Special Instructions Library of PDFs including pertinent information and forms related to the test