Neutral Lipid Storage Disease

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 6 min read
Patient Tools

Read, save, and share this guide

Use these quick tools to make this medical article easier to read, print, save, or share with a family member.

Patient Mode

Understand this article easily

Switch between simple English and easy Bangla patient notes. This is for education and does not replace a doctor consultation.

Neutral Lipid Storage Disease (NLSD) is a rare health condition where fats (lipids) accumulate abnormally in cells throughout the body. Instead of being broken down and used or stored properly, these lipids pile up in cells and can cause various problems. Types of NLSD: There...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

এই তথ্য শিক্ষা ও সচেতনতার জন্য। এটি ডাক্তারি পরীক্ষা, রোগ নির্ণয় বা প্রেসক্রিপশনের বিকল্প নয়।

Article Summary

Neutral Lipid Storage Disease (NLSD) is a rare health condition where fats (lipids) accumulate abnormally in cells throughout the body. Instead of being broken down and used or stored properly, these lipids pile up in cells and can cause various problems. Types of NLSD: There are several types of NLSD, each caused by mutations in different genes. Here are the main types: NLSD Type 1:...

Key Takeaways

  • This article explains Causes of NLSD: in simple medical language.
  • This article explains Symptoms of NLSD: in simple medical language.
  • This article explains Diagnostic Tests for NLSD: in simple medical language.
  • This article explains Treatments for NLSD: in simple medical language.
Educational health guideWritten for patient understanding and clinical awareness.
Reviewed content workflowUse writer and reviewer profiles for stronger trust.
Emergency safety firstUrgent warning signs are highlighted below.
Choose your reading view

Patient View highlights a simple learning journey. Clinical View reveals structure, evidence, and editorial completeness.

Seek urgent medical care if you notice

These warning signs are general safety guidance. Local emergency numbers and clinical judgment should always come first.

  • Severe symptoms, breathing difficulty, fainting, confusion, or rapidly worsening illness.
  • New weakness, severe pain, high fever, or symptoms after a serious injury.
  • Any symptom that feels urgent, unusual, or unsafe for the patient.
1

Emergency now

Use emergency care for severe, sudden, rapidly worsening, or life-threatening symptoms.

2

See a doctor

Book a professional medical evaluation if symptoms persist, worsen, recur often, affect daily activities, or occur in a high-risk patient.

3

Learn safely

Use this article to understand possible causes, tests, treatment options, prevention, and questions to ask your clinician.

Before reading

RX Patient Tools

Use these quick guides before reading the article, or return to them when you need help preparing questions for a doctor.

Start here Choose the right pathway for symptoms, reports, medicines, or urgent warning signs. Disease article roadmap Read this topic step by step: meaning, symptoms, warning signs, diagnosis, treatment, prevention, and follow-up. Treatment planner Prepare questions about treatment choices, benefits, risks, side effects, and follow-up. Family & caregiver guide Organize symptoms, reports, medicines, questions, and follow-up safely. Nutrition & diet guide Prepare food, hydration, supplement, and medicine-timing questions safely. Prevention guide Organize risk factors, protective habits, screening, and warning signs. Recovery guide Prepare a safe plan for activity, rehabilitation, warning signs, and follow-up.
Definition

Neutral Lipid Storage Disease (NLSD) is a rare health condition where fats (lipids) accumulate abnormally in cells throughout the body. Instead of being broken down and used or stored properly, these lipids pile up in cells and can cause various problems.

Types of NLSD:

There are several types of NLSD, each caused by mutations in different genes. Here are the main types:

  1. NLSD Type 1: This type is also known as Chanarin-Dorfman syndrome. It’s caused by mutations in the ABHD5 gene. People with NLSD Type 1 have trouble breaking down and storing fats in their cells.
  2. NLSD Type 2: This type is caused by mutations in the CGI-58 gene. It leads to a buildup of fats in various tissues and organs.
  3. NLSD Type 3: This type results from mutations in the PNPLA2 gene. People with NLSD Type 3 have problems with fat breakdown, particularly in their muscles and liver.

Causes of NLSD:

NLSD is caused by genetic mutations. That means if there’s an error in certain genes, it can lead to this disease. Here are the primary causes:

  1. Mutations in the DGAT2 gene.
  2. Mutations in the PNPLA2 gene.
  3. Inherited in an autosomal recessive manner. 4-20. Currently, only the two genes mentioned above have been directly linked with NLSD. Other factors might play a role, but the major culprits are these gene mutations.

Symptoms of NLSD:

The symptoms of NLSD can vary depending on the type and severity of the disorder. Here are some common symptoms:

  1. Skin Issues: People with NLSD may have dry, scaly skin due to the abnormal fat accumulation in their skin cells.
  2. Muscle Weakness: NLSD can lead to muscle weakness, making it difficult to move or exercise.
  3. Enlarged Liver: In some cases, the liver can become enlarged, which can cause abdominal discomfort.
  4. Fatty Deposits in Organs: NLSD can result in the accumulation of fat in various organs, such as the heart, muscles, and eyes.
  5. Eye Problems: Some people with NLSD may experience eye problems due to fat buildup in the cornea.
  6. Neurological Issues: NLSD can affect the nervous system, leading to problems like seizures and developmental delays in children.
  7. Low Blood Platelets: A reduced number of platelets can lead to easy bruising and bleeding.
  8. Vision Impairment: Accumulation of fat in the eyes can cause vision problems.
  9. Cataracts: NLSD may also lead to cataracts, a clouding of the eye’s lens.
  10. Growth Retardation: Children with NLSD may not grow at a normal rate.
  11. Difficulty Swallowing: Some people with NLSD may have trouble swallowing food.
  12. Respiratory Problems: In severe cases, NLSD can lead to respiratory issues, which can be life-threatening.
  13. Cardiac Complications: NLSD can affect the heart, leading to irregular heart rhythms or even heart failure.
  14. Difficulty Breathing: Accumulation of fat in the respiratory muscles can make it hard to breathe.
  15. Digestive Problems: NLSD may cause gastrointestinal issues, such as diarrhea and abdominal pain.
  16. High Cholesterol: NLSD can lead to elevated cholesterol levels in the blood.
  17. Joint Problems: Joint pain and stiffness can be a symptom of NLSD.
  18. Delayed Puberty: Some individuals may experience delayed puberty due to hormonal imbalances.
  19. Hearing Loss: Accumulation of fat in the ears can result in hearing problems.
  20. Skeletal Abnormalities: NLSD can affect bone development, leading to skeletal abnormalities.

Diagnostic Tests for NLSD:

  1. Blood Tests: To check enzyme levels and triglycerides.
  2. Muscle Biopsy: Taking a small sample of muscle tissue.
  3. Liver Biopsy: Examining a piece of liver tissue.
  4. Electromyography (EMG): Tests muscle function.
  5. MRI of Muscles: To check for abnormalities.
  6. DNA Testing: To look for genetic mutations.
  7. Skin Biopsy: For those with ichthyosis.
  8. Echocardiogram: To check the heart’s function.
  9. Electrocardiogram (ECG): Measures heart rhythm.
  10. Eye Examination: To detect cataracts.
  11. Hearing Test.
  12. Triglyceride Levels Test.
  13. Creatine Kinase Test.
  14. Physical Examination: Looking for muscle weakness.
  15. Neurological Examination.
  16. Lipid Analysis: Of blood and tissues.
  17. Nerve Conduction Studies.
  18. Urine Tests: Checking for protein and other signs.
  19. Skin Examination: For scales and dryness.
  20. Pulmonary Function Tests: Checking lung function.

Treatments for NLSD:

  1. Physical Therapy: Helps maintain muscle strength.
  2. Speech Therapy: For those with speech difficulties.
  3. Occupational Therapy: Helps with daily activities.
  4. Dietary Modifications: Low-fat diet can be beneficial.
  5. Weight Control: To avoid putting extra tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।" data-rx-term="strain" data-rx-definition="A strain is injury to a muscle or tendon. সহজ বাংলা: মাংসপেশি/টেনডনে টান।">strain on muscles.
  6. Regular Exercise: Under supervision, to maintain muscle health.
  7. Skincare Regimens: For ichthyosis.
  8. Heart Medications: For those with cardiomyopathy.
  9. Pain Relievers: For muscle pain.
  10. Vitamin Supplements: Especially vitamin E.
  11. Avoidance of Alcohol: Prevents further liver damage.
  12. Liver Transplant: In severe cases.
  13. Hearing Aids: For hearing loss.
  14. Cataract Surgery: If vision becomes severely affected.
  15. Regular Monitoring: Regular check-ups to monitor progression.
  16. Avoidance of Certain Drugs: That might worsen symptoms.
  17. Respiratory Support: For those with breathing issues.
  18. Genetic Counseling: To understand inheritance and risks.
  19. Orthopedic Devices: Braces to support weakened muscles.
  20. Psychological Counseling: Coping with the emotional side of NLSD. 21-30. Research is ongoing, and newer treatments might emerge over time.

Drugs for NLSD:

  1. Statins: Reduce cholesterol.
  2. Fibrates: Reduce triglycerides.
  3. Omega-3 Fatty Acids: Reduce triglycerides.
  4. Beta-Blockers: For heart issues.
  5. ACE Inhibitors: For heart problems.
  6. Antiarrhythmics: Control heart rhythm.
  7. Pain Relievers: Like acetaminophen or ibuprofen.
  8. Topical Creams: For skin dryness.
  9. Antioxidants: Like vitamin E.
  10. Loop Diuretics: Help reduce fluid in those with cardiomyopathy.
  11. Calcium Channel Blockers: For heart issues.
  12. Angiotensin II Receptor Blockers (ARBs): For heart problems.
  13. Insulin Sensitizers: Help with insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।" data-rx-term="diabetes" data-rx-definition="Diabetes is a condition where blood sugar stays too high because insulin is low or not working well. সহজ বাংলা: রক্তে চিনি বেশি থাকার রোগ।">diabetes if it develops.
  14. Diuretics: Reduce fluid accumulation.
  15. Anticoagulants: Prevent blood clots.
  16. Digitalis: Strengthens the heart muscle.
  17. Corticosteroids: For skin issues.
  18. Coenzyme Q10: Helps with muscle function.
  19. infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।" data-rx-term="anti-inflammatory" data-rx-definition="Anti-inflammatory means reducing inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।">Anti-inflammatory Drugs.
  20. Immunosuppressants: In rare cases.

In conclusion, Neutral Lipid Storage Disease is a rare, genetic disorder that affects fat storage and metabolism in the body. While there’s no cure, proper medical care can help manage its symptoms and improve the quality of life for affected individuals. If you suspect you or someone you know might have NLSD, it’s crucial to consult with a medical professional for proper diagnosis and treatment.

 

Disclaimer: Each person’s journey is unique, always seek the advice of a medical professional before trying any treatments to ensure to find the best plan for you. This guide is for general information and educational purposes only. If you or someone are suffering from this disease condition bookmark this page or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. Thank you for giving your valuable time to read the article.

  1. https://medlineplus.gov/skinconditions.html
  2. https://www.aad.org/about/burden-of-skin-disease
  3. https://www.usa.gov/federal-agencies/national-institute-of-arthritis-musculoskeletal-and-skin-diseases
  4. https://www.cdc.gov/niosh/topics/skin/default.html
  5. https://www.skincancer.org/
  6. https://illnesshacker.com/
  7. https://endinglines.com/
  8. https://www.jaad.org/
  9. https://www.psoriasis.org/about-psoriasis/
  10. https://books.google.com/books?
  11. https://www.niams.nih.gov/health-topics/skin-diseases
  12. https://cms.centerwatch.com/directories/1067-fda-approved-drugs/topic/292-skin-infections-disorders
  13. https://www.fda.gov/files/drugs/published/Acute-Bacterial-Skin-and-Skin-Structure-Infections—Developing-Drugs-for-Treatment.pdf
  14. https://dermnetnz.org/topics
  15. https://www.aaaai.org/conditions-treatments/allergies/skin-allergy
  16. https://www.sciencedirect.com/topics/medicine-and-dentistry/occupational-skin-disease
  17. https://aafa.org/allergies/allergy-symptoms/skin-allergies/
  18. https://www.nibib.nih.gov/
  19. https://rxharun.com/resources/category/resources/rxharun/article-types/skin-care-beauty/skin-diseases-types-symptoms-treatment/
  20. https://www.nei.nih.gov/
  21. https://en.wikipedia.org/wiki/List_of_skin_conditions
  22. https://en.wikipedia.org/?title=List_of_skin_diseases&redirect=no
  23. https://en.wikipedia.org/wiki/Skin_condition
  24. https://oxfordtreatment.com/
  25. https://www.nidcd.nih.gov/health/
  26. https://consumer.ftc.gov/articles/w
  27. https://www.nccih.nih.gov/health
  28. https://catalog.ninds.nih.gov/
  29. https://www.aarda.org/diseaselist/
  30. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets
  31. https://www.nibib.nih.gov/
  32. https://www.nia.nih.gov/health/topics
  33. https://www.nichd.nih.gov/
  34. https://www.nimh.nih.gov/health/topics
  35. https://www.nichd.nih.gov/
  36. https://www.niehs.nih.gov
  37. https://www.nimhd.nih.gov/
  38. https://www.nhlbi.nih.gov/health-topics
  39. https://obssr.od.nih.gov/
  40. https://www.nichd.nih.gov/health/topics
  41. https://rarediseases.info.nih.gov/diseases
  42. https://beta.rarediseases.info.nih.gov/diseases
  43. https://orwh.od.nih.gov/

 

RX Clinical Pathway Engine

Continue through a complete learning pathway

Move from understanding the topic to symptoms, tests, treatment, medicines, monitoring, and prevention.

Search the complete library
  1. Understand the condition Begin with the essential facts and a clear explanation of the topic.
  2. Recognize symptoms Learn common symptoms, signs, and patterns of presentation.
  3. Know when to seek help Review urgent warning signs and when professional assessment may be needed.
  4. Understand causes and risks Explore causes, risk factors, mechanisms, and contributing conditions.
  5. Explore tests and diagnosis Learn how clinicians assess the condition and which investigations may be discussed.
  6. Learn treatment approaches Review general treatment categories and management principles.
  7. Understand medicines safely Continue to medicine education, uses, precautions, and monitoring.
  8. Plan monitoring and follow-up Understand monitoring, complications, rehabilitation, and follow-up learning.
  9. Review prevention and self-care Explore prevention, healthy routines, and questions to discuss with a clinician.

Conditions & Diseases

Background, symptoms, causes, diagnosis, and care.

Explore this library

Medicines

Uses, safety, monitoring, and related medicine knowledge.

Explore this library

Cancer Knowledge

Cancer types, screening, oncology, and treatment education.

Explore this library
Doctor visit helper

Prepare before seeing a doctor

A simple rural-patient checklist to help you explain symptoms clearly, ask better questions, and avoid unsafe self-treatment.

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider
Tests to discuss with doctor
  • Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
  • Relevant blood, urine, imaging, or specialist tests only after clinical assessment
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Neutral Lipid Storage Disease

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

RX Patient Help

Ask a health question safely

Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

Continue exploring

Explore this topic across the RX Medical Library

Open a focused A–Z pathway or continue with closely related indexed articles. These links are educational and do not replace personal medical care.

Search this topic
Diseases A–Z Drugs A–Z Lab Tests A–Z Cancer A–Z
More from this topic
  1. Congenital Enterocyte Heparan Sulfate Deficiency

    DefinitionCongenital? enterocyte heparan sulfate deficiency is a very rare, severe, genetic intestinal disease. In this condition, the small bowel lining cells, called enterocytes, do not show...

    April 3, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  2. Congenital ectropion uveae

    DefinitionCongenital? ectropion uveae, often shortened to CEU, is a very rare eye condition present from birth. In this condition, the dark pigment layer that normally stays...

    April 2, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  3. Congenital Dyserythropoietic Anemia, Type III

    DefinitionCongenital? dyserythropoietic anemia?, type III, also called CDA type III, is a very rare inherited blood disease. In this disease, the bone marrow tries to make...

    April 2, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  4. Congenital Dyserythropoietic Anemia Type I

    DefinitionCongenital? dyserythropoietic anemia?, type I, usually called CDA type I, is a rare inherited blood disease. In this disease, the bone marrow tries to make red...

    April 1, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  5. Congenital Dyserythropoietic Anemia Due to KLF1 Mutation

    DefinitionCongenital? dyserythropoietic anemia? due to KLF1 mutation is a very rare inherited red blood cell disease. In most reported cases, doctors describe it as congenital? dyserythropoietic...

    April 1, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  6. Congenital Dyserythropoietic Anemia Due to KLF1 Mutation

    DefinitionCongenital? dyserythropoietic anemia? due to KLF1 mutation is a very rare inherited red blood cell disease. In most reported cases, doctors describe it as congenital? dyserythropoietic...

    April 1, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  7. HEMPAS – Hereditary Erythroblast Multinuclearity with Positive Acid Serum Test

    DefinitionHEMPAS – Hereditary Erythroblast Multinuclearity with Positive Acid Serum Test is a rare inherited blood disease. Its full old name is hereditary erythroblastic multinuclearity with positive...

    April 1, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  8. Congenital Dyserythropoietic Anemia Type 2

    DefinitionCongenital? dyserythropoietic anemia? type 2, also called CDA type II, is a rare inherited blood disease. In this disease, the body makes red blood cells in...

    April 1, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  9. Component of Oligomeric Golgi Complex 2–Congenital Disorder of Glycosylation

    DefinitionComponent of oligomeric Golgi complex 2–congenital? disorder of glycosylation is usually called COG2-CDG. It is a very rare inherited metabolic disease. In this disease, both copies...

    April 1, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)
  10. Congenital Disorder of Glycosylation, Type IIq

    DefinitionCongenital? disorder of glycosylation, type IIq, is a very rare inherited metabolic disease. It is now also commonly called COG2-CDG because it is caused by harmful...

    April 1, 2026 • Rx Autoimmune, Genetic and Rare Diseases (A - Z)