GRACILE (growth retardation, aminoaciduria, cholestasis, iron overload, lactic acidosis, and early death) syndrome is a devastating inherited disorder characterized by fetal growth retardation, iron overload in the liver, buildup of a chemical called lactic acid, elevated molecules called amino acids in the urine caused by kidney problems, and cholestasis (reduced production and release of bile). Affected infants normally do not live past the first several months of life, with about half only living a few days after birth. GRACILE syndrome is caused by pathogenic variants in the BCS1L gene.