Leukoencephalopathy with vanishing white matter (VWM) is a severe inherited neurodegenerative disease (
35). This condition is also known as childhood ataxia with diffuse central nervous system hypomyelination (
34). Clinically, this condition is characterized by progressive ataxia, spasticity, and variable optic atrophy, as well as seizures. Mental decline, if seen, is usually mild. More rapid deterioration is associated with minor head injury or fever, and the latter often results in coma. Death occurs after a variable time period, from several years up to decades. In magnetic resonance imaging, a diagnostic pattern with diffuse abnormality of cerebral white matter is observed (
35,
36). Over time, the abnormal white matter vanishes to be replaced by cerebrospinal fluid or tissue water. There is considerable phenotypic variation. For example, the so-called “Cree” leukoencephalopathy seen in North American Indians is especially severe, leading to very early onset of neurological deterioration (3 to 9 months) and death before 21 months (
8). Recent work has revealed additional serious forms of VWM that involve very early onset and early death (
7,
8). In some cases, the ovaries are also affected (
35).
VWM shows autosomal recessive inheritance. Linkage analysis initially assigned a VWM locus to a 5-centimorgan interval on chromosome 3q27 (
21). Subsequent work showed that that mutations in the gene for the

subunit of the translation factor eukaryotic initiation factor 2B (eIF2B) were associated with VWM. These included several point or frameshift mutations within this gene. In some patients, linkage analysis did not point to a role for the eIF2B

(or
EIF2B5) gene. In several of them, VWM was found to be associated with mutations in the β subunit of eIF2B, a heteropentamer (
22). Subsequent work showed that mutations in any eIF2B gene can cause VWM (
37). All VWM patients have now been found to have mutations in one or other of the genes for the subunits of eIF2B. Affected individuals carry two mutated copies of a given eIF2B gene; i.e., inheritance shows an autosomal recessive pattern. The particularly severe Cree form of this disease is linked to a point mutation (R195H) in eIF2B

(
8), and a second severe form is linked to a different point mutation in the same gene (
7).
eIF2B is a guanine nucleotide exchange factor that plays a key role in the initiation of mRNA translation and in its control (
28). It promotes GDP/GTP exchange on initiation factor eIF2. In its GTP-bound state, eIF2 recruits the initiator Met-tRNA to the 40S subunit during translation initiation. Since it is the anticodon of this tRNA that recognizes the start codon in the mRNA, active eIF2 is required for all normal translation initiation events. eIF2B activity can be regulated in a number of ways. The best documented of these is the phosphorylation of the α subunit of eIF2 at Ser51 (
4), which converts it from a substrate of eIF2B into a potent competitive inhibitor (
30). Phosphorylation of eIF2α is increased under a wide range of cellular stress conditions and can be catalyzed by several different protein kinases (
3). Since active eIF2.GTP is required for all translation initiation events, inhibition of eIF2B activity causes a decrease in general protein synthesis. However, reduced eIF2B activity actually enhances the translation of certain mRNAs by virtue of the presence of upstream open reading frames (uORFs) in their 5′ untranslated regions (UTRs). Examples include the mRNAs for the transcription regulators GCN4 in (
16) and ATF4 in mammals (
13). Since these proteins modulate transcription of multiple genes, decreased eIF2B activity may also affect the expression of many genes.
eIF2B is composed of five nonidentical subunits, α through

(
16). Of these, eIF2B

displays catalytic activity when expressed alone, and the minimal catalytic region of the yeast ortholog was recently delineated (
9). The corresponding region of the mammalian protein contains the site that is phosphorylated by glycogen synthase kinase 3 and that inactivates eIF2B (
39). The other subunits do not possess a region homologous to this catalytic segment and appear not to be involved in catalysis. However, eIF2Bγ shows similarity to the N-terminal part of eIF2B

and forms a binary complex with eIF2B

in yeast, which is referred to as the catalytic subcomplex (
25). The other three subunits, α, β and δ, also show mutual sequence similarity and form a trimeric subcomplex in yeast. Evidence from careful genetic studies with yeast indicates that these subunits play a key role in sensitizing the eIF2B holocomplex to inhibition by eIF2[αP] (
20,
24,
40). Indeed, recombinant eIF2α can bind to the αβδ subcomplex, which has been termed the regulatory subcomplex (
25). Although eIF2B

itself can mediate guanine nucleotide exchange, its activity is greatly enhanced by its association with the other subunits (
6,
10).
VWM is the first example of an inherited human disease caused by mutations in a component of the basal translational machinery. A clear priority is now to establish how mutations in eIF2B lead to VWM and the other lesions associated with this condition. It will also be important to understand why they give rise primarily to a neurological disease and why its severity and age of onset are so variable. Here, as an essential first step, we have studied how they affect the integrity and function of the eIF2B complex. Our data show that all the VWM mutations tested cause partial loss of activity of human eIF2B. However, the magnitude of the effect differs between mutations. Most interestingly, the basis of the decreased activity differs between mutations, prompting the possibility that the variable phenotype of the condition may reflect the distinct ways in which different mutations affect the eIF2B complex.