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Wilton KM, Morales‐Rosado JA, Selcen D, Muthusamy K, Ewing S, Agre K, Nickels K, Klee EW, Ho M, Morava E. Developmental brain abnormalities and acute encephalopathy in a patient with myopathy with extrapyramidal signs secondary to pathogenic variants in MICU1. JIMD Rep 2020; 53:22-28. [PMID: 32395406 PMCID: PMC7203647 DOI: 10.1002/jmd2.12114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/09/2020] [Accepted: 03/03/2020] [Indexed: 01/01/2023] Open
Abstract
Mitochondria play a variety of roles in the cell, far beyond their widely recognized role in ATP generation. One such role is the regulation and sequestration of calcium, which is done with the help of the mitochondrial calcium uniporter (MCU) and its regulators, MICU1 and MICU2. Genetic variations in MICU1 and MICU2 have been reported to cause myopathy, developmental disability and neurological symptoms typical of mitochondrial disorders. The symptoms of MICU1/2 deficiency have generally been attributed to calcium regulation in the metabolic and biochemical roles of mitochondria. Here, we report a female child with heterozygous MICU1 variants and multiple congenital brain malformations on MRI. Specifically, she shows anterior perisylvian polymicrogyria, dysmorphic basal ganglia, and cerebellar dysplasia in addition to white matter abnormalities. These novel findings suggest that MICU1 is necessary for proper neurodevelopment through a variety of potential mechanisms, including calcium-mediated regulation of the neuronal cytoskeleton, Miro1-MCU complex-mediated mitochondrial movement, or enhancing ATP production. This case provides new insight into the molecular pathogenesis of MCU dysfunction and may represent a novel diagnostic feature of calcium-based mitochondrial disease.
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Affiliation(s)
- Katelynn M. Wilton
- Medical Scientist Training Program, Mayo Clinic Alix College of MedicineMayo ClinicRochesterMinnesotaUSA
| | - Joel A. Morales‐Rosado
- Center for Individualized MedicineMayo ClinicRochesterMinnesotaUSA
- Department of Health Science Research, Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMinnesotaUSA
| | - Duygu Selcen
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - Sarah Ewing
- Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
| | - Katherine Agre
- Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
| | | | - Eric W. Klee
- Center for Individualized MedicineMayo ClinicRochesterMinnesotaUSA
- Department of Health Science Research, Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMinnesotaUSA
- Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
| | - Mai‐Lan Ho
- Department of RadiologyNationwide Children's HospitalColumbusOhioUSA
| | - Eva Morava
- Center for Individualized MedicineMayo ClinicRochesterMinnesotaUSA
- Department of Clinical GenomicsMayo ClinicRochesterMinnesotaUSA
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Béhin A, Acquaviva-Bourdain C, Souvannanorath S, Streichenberger N, Attarian S, Bassez G, Brivet M, Fouilhoux A, Labarre-Villa A, Laquerrière A, Pérard L, Kaminsky P, Pouget J, Rigal O, Vanhulle C, Eymard B, Vianey-Saban C, Laforêt P. Multiple acyl-CoA dehydrogenase deficiency (MADD) as a cause of late-onset treatable metabolic disease. Rev Neurol (Paris) 2016; 172:231-41. [PMID: 27038534 DOI: 10.1016/j.neurol.2015.11.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/11/2015] [Accepted: 11/15/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Late-onset multiple acyl-CoA dehydrogenase deficiency (MADD) is a rare, treatable, beta-oxidation disorder responsible for neuromuscular symptoms in adults. This case series describes the clinical and biochemical features of 13 French patients with late-onset MADD. METHODS AND RESULTS Thirteen ambulant patients (eight women, five men), with a median age at onset of 27 years, initially experienced exercise intolerance (n=9), isolated muscle weakness (n=1) and a multisystemic pattern with either central nervous system or hepatic dysfunction (n=3). During the worsening period, moderate rhabdomyolysis (n=5), a pseudomyasthenic pattern (n=5) and acute respiratory failure (n=1) have been observed. Weakness typically affected the proximal limbs and axial muscles, and there was sometimes facial asymmetry (n=3). Moderate respiratory insufficiency was noted in one case. Median baseline creatine kinase was 190IU/L. Lactacidemia was sometimes moderately increased at rest (3/10) and after exercise (1/3). The acylcarnitine profile was characteristic, with increases in all chain-length acylcarnitine species. Electromyography revealed a myogenic pattern, while muscle biopsy showed lipidosis, sometimes with COX-negative fibers (n=2). The mitochondrial respiratory chain was impaired in five cases, with coenzyme Q10 decreased in two cases. All patients harbored mutations in the ETFDH gene (four homozygous, seven compound heterozygous, two single heterozygous), with nine previously unidentified mutations. All patients were good responders to medical treatment, but exercise intolerance and/or muscular weakness persisted in 11 of them. CONCLUSION Late-onset forms of MADD may present as atypical beta-oxidation disorders. Acylcarnitine profiling and muscle biopsy remain the most decisive investigations for assessing the diagnosis. These tests should thus probably be performed more widely, particularly in unexplained cases of neuromuscular and multisystemic disorders.
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Affiliation(s)
- A Béhin
- AP-HP, Centre de Référence de Pathologie Neuromusculaire Paris-Est, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
| | - C Acquaviva-Bourdain
- Centre de Référence des Maladies Héréditaires du Métabolisme, Inserm U820, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, 69500 Bron, France
| | - S Souvannanorath
- AP-HP, Centre de Référence de Pathologie Neuromusculaire Paris-Est, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - N Streichenberger
- Service de Neuropathologie, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Université Claude Bernard Lyon I, 69500 Bron, France
| | - S Attarian
- AP-HM, Centre de Référence des Maladies Neuromusculaires et de la SLA, CHU de La Timone, 13005 Marseille, France
| | - G Bassez
- AP-HP, Centre de Référence de Pathologie Neuromusculaire Paris-Ouest, CHU Henri-Mondor, Créteil, France
| | - M Brivet
- AP-HP, Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Robert-Debré, 75020 Paris, France
| | - A Fouilhoux
- Centre de Référence lyonnais des Maladies Héréditaires du Métabolisme, Groupement Hospitalier Est, Hôpital Femme Mère-Enfant, CHU de Lyon, 69500 Bron, France
| | - A Labarre-Villa
- Centre de Référence Rhône-Alpes des Maladies Neuromusculaires, CHU de Grenoble, 38000 Grenoble, France
| | - A Laquerrière
- Service d'Anatomie et Cytologie pathologiques, CHU de Rouen, 76000 Rouen, France
| | - L Pérard
- Service de Médecine Interne, Hôpital Édouard-Herriot, 69437 Lyon cedex 03, France
| | - P Kaminsky
- Centre de Référence des Maladies Neuromusculaires, CHU de Nancy (Hôpitaux de Brabois), 54500 Vandœuvre-Lès-Nancy, France
| | - J Pouget
- AP-HM, Centre de Référence des Maladies Neuromusculaires et de la SLA, CHU de La Timone, 13005 Marseille, France
| | - O Rigal
- AP-HP, Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Robert-Debré, 75020 Paris, France
| | - C Vanhulle
- Centre de Compétences Pathologies Neuromusculaires Enfants, Néonatalogie et Réanimation Pédiatrique, CHU de Rouen, 76000 Rouen, France
| | - B Eymard
- AP-HP, Centre de Référence de Pathologie Neuromusculaire Paris-Est, Groupe Hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| | - C Vianey-Saban
- Centre de Référence des Maladies Héréditaires du Métabolisme, Inserm U820, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, 69500 Bron, France
| | - P Laforêt
- AP-HP, Service de Biochimie, Hôpital de Bicêtre, 94270 Le Kremlin-Bicêtre, France
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Mechanisms underlying metabolic and neural defects in zebrafish and human multiple acyl-CoA dehydrogenase deficiency (MADD). PLoS One 2009; 4:e8329. [PMID: 20020044 PMCID: PMC2791221 DOI: 10.1371/journal.pone.0008329] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 11/19/2009] [Indexed: 12/01/2022] Open
Abstract
In humans, mutations in electron transfer flavoprotein (ETF) or electron transfer flavoprotein dehydrogenase (ETFDH) lead to MADD/glutaric aciduria type II, an autosomal recessively inherited disorder characterized by a broad spectrum of devastating neurological, systemic and metabolic symptoms. We show that a zebrafish mutant in ETFDH, xavier, and fibroblast cells from MADD patients demonstrate similar mitochondrial and metabolic abnormalities, including reduced oxidative phosphorylation, increased aerobic glycolysis, and upregulation of the PPARG-ERK pathway. This metabolic dysfunction is associated with aberrant neural proliferation in xav, in addition to other neural phenotypes and paralysis. Strikingly, a PPARG antagonist attenuates aberrant neural proliferation and alleviates paralysis in xav, while PPARG agonists increase neural proliferation in wild type embryos. These results show that mitochondrial dysfunction, leading to an increase in aerobic glycolysis, affects neurogenesis through the PPARG-ERK pathway, a potential target for therapeutic intervention.
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Abstract
Magnetic resonance imaging (MRI) has emerged as a powerful tool in the study of normal and abnormal brain structure, function, and biochemistry. In particular, functional MRI has come into its own as a tool to study normal and abnormal brain functions such as learning, memory, and motor learning, as well as delineation of neurogenetic cognitive phenotypes. White matter microstructure can be studied using diffusion tensor imaging, which may allow abnormal white matter to be visualized prior to abnormalities on anatomic MRI. Magnetic resonance spectroscopy, a noninvasive method to study brain biochemistry, may allow for the delineation of regional metabolic changes as a result of disease progression and/or therapeutic intervention. With MRI techniques, one can investigate the relationship between structure, function, genes, and behavior. This report discusses the research applications of MRI to the study of neurogenetic disorders of childhood.
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Affiliation(s)
- Andrea Gropman
- Departments of Pediatrics and Neurology, Georgetown University Medical Center, 3800 Reservoir Road NW, 2PHC, Washington, DC 20007, USA.
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Abstract
Cerebral magnetic resonance imaging and spectroscopy form an integral part in the diagnosis and management of the vast spectrum of metabolic and degenerative disorders in children. These varied disorders have been classified in many different ways, according to anatomic location, head size, enzyme disorder, or cellular morphology and function. The clinical features and magnetic resonance imaging appearances of the most common disorders are discussed.
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Affiliation(s)
- Eric N Faerber
- MCP-Hahnemann School of Medicine, and the Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania 19134, USA.
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Abstract
We report three children, each of whom seemed to have a primary mitochondrial disorder at presentation but was eventually diagnosed with an extramitochondrial inherited metabolic disease. The first patient presented at 6 months with developmental delay. Magnetic resonance imaging showed an abnormal signal in the white matter, and magnetic resonance spectroscopy showed elevated lactate peaks. A muscle biopsy showed complex IV deficiency, but leukocyte measurement of galactosylceramide beta-galactosidase activity was markedly diminished, consistent with Krabbe's disease. The second patient presented at birth with seizures and later had developmental delays. There was brain atrophy on neuroimaging. Serum and cerebrospinal fluid lactate levels were elevated. She had persistently elevated urine thiosulfate, which was diagnostic for molybdenum cofactor deficiency. The third child presented at 2 months with seizures and hypotonia. Magnetic resonance imaging showed an abnormal signal in the basal ganglia and surrounding white matter, whereas magnetic resonance spectroscopy showed elevated lactate peaks. A brain biopsy was diagnostic for Alexander's disease. These cases and others in the literature suggest that lactic acid elevation in the central nervous system can be found in a number of extramitochondrial neurologic diseases. Such diseases would constitute a third category of lactic acidosis.
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Affiliation(s)
- P B Kang
- Division of Neurology, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, 19104, USA
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Novotny E, Ashwal S, Shevell M. Proton magnetic resonance spectroscopy: an emerging technology in pediatric neurology research. Pediatr Res 1998; 44:1-10. [PMID: 9667363 DOI: 10.1203/00006450-199807000-00001] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Proton magnetic resonance spectroscopy (MRS) is an emerging technology that allows for the quantitative noninvasive assessment of regional brain biochemistry. The capacity to carry out MRS studies requires existing magnetic resonance imaging (MRI) technology platforms and the purchase of commercially available software modifications. In this review, the physical basis for MRS will be presented leading to an understanding of its potential applications and limitations within the clinical research milieu. Thus far, within pediatric neurology, proton MRS studies have been used to assist in the prediction of outcome in a variety of settings of acquired brain injuries (perinatal asphyxia, near drowning). In addition, proton MRS has been used to document disturbances in oxidative metabolism in neurometabolic disorders, assisting in defining phenotype and the response to therapeutic interventions. In epilepsy, spectroscopic studies have been useful in localizing the epileptogenic zone in intractable focal epilepsies. Future applications of proton MRS will also be highlighted. These include its use as a means of observing the transport and metabolism of various compounds in the brain, its concurrent application with other nuclear magnetic resonance techniques such as MRI and functional MRI, and finally its potential as a means of assessing the short-term effects of any CNS targeted pharmacologic interventions.
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Affiliation(s)
- E Novotny
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06510, USA
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