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Zech M, Kopajtich R, Steinbrücker K, Bris C, Gueguen N, Feichtinger RG, Achleitner MT, Duzkale N, Périvier M, Koch J, Engelhardt H, Freisinger P, Wagner M, Brunet T, Berutti R, Smirnov D, Navaratnarajah T, Rodenburg RJ, Pais LS, Austin-Tse C, O’Leary M, Boesch S, Jech R, Bakhtiari S, Jin SC, Wilbert F, Kruer MC, Wortmann SB, Eckenweiler M, Mayr JA, Distelmaier F, Steinfeld R, Winkelmann J, Prokisch H. Variants in Mitochondrial ATP Synthase Cause Variable Neurologic Phenotypes. Ann Neurol 2022; 91:225-237. [PMID: 34954817 PMCID: PMC9939050 DOI: 10.1002/ana.26293] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE ATP synthase (ATPase) is responsible for the majority of ATP production. Nevertheless, disease phenotypes associated with mutations in ATPase subunits are extremely rare. We aimed at expanding the spectrum of ATPase-related diseases. METHODS Whole-exome sequencing in cohorts with 2,962 patients diagnosed with mitochondrial disease and/or dystonia and international collaboration were used to identify deleterious variants in ATPase-encoding genes. Findings were complemented by transcriptional and proteomic profiling of patient fibroblasts. ATPase integrity and activity were assayed using cells and tissues from 5 patients. RESULTS We present 10 total individuals with biallelic or de novo monoallelic variants in nuclear ATPase subunit genes. Three unrelated patients showed the same homozygous missense ATP5F1E mutation (including one published case). An intronic splice-disrupting alteration in compound heterozygosity with a nonsense variant in ATP5PO was found in one patient. Three patients had de novo heterozygous missense variants in ATP5F1A, whereas another 3 were heterozygous for ATP5MC3 de novo missense changes. Bioinformatics methods and populational data supported the variants' pathogenicity. Immunohistochemistry, proteomics, and/or immunoblotting revealed significantly reduced ATPase amounts in association to ATP5F1E and ATP5PO mutations. Diminished activity and/or defective assembly of ATPase was demonstrated by enzymatic assays and/or immunoblotting in patient samples bearing ATP5F1A-p.Arg207His, ATP5MC3-p.Gly79Val, and ATP5MC3-p.Asn106Lys. The associated clinical profiles were heterogeneous, ranging from hypotonia with spontaneous resolution (1/10) to epilepsy with early death (1/10) or variable persistent abnormalities, including movement disorders, developmental delay, intellectual disability, hyperlactatemia, and other neurologic and systemic features. Although potentially reflecting an ascertainment bias, dystonia was common (7/10). INTERPRETATION Our results establish evidence for a previously unrecognized role of ATPase nuclear-gene defects in phenotypes characterized by neurodevelopmental and neurodegenerative features. ANN NEUROL 2022;91:225-237.
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Affiliation(s)
- Michael Zech
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Robert Kopajtich
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Katja Steinbrücker
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Céline Bris
- Unité Mixte de Recherche MITOVASC, CNRS 6015/INSERM 1083, Université d'Angers, Angers, France,Département de Biochimie et Génétique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Naig Gueguen
- Unité Mixte de Recherche MITOVASC, CNRS 6015/INSERM 1083, Université d'Angers, Angers, France,Département de Biochimie et Génétique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - René G. Feichtinger
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Melanie T. Achleitner
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Neslihan Duzkale
- Department of Medical Genetic, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | | | - Johannes Koch
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Harald Engelhardt
- Kinderkrankenhaus St. Marien gGmbH, Zentrum für Kinder- und Jugendmedizin, Landshut, Germany
| | | | - Matias Wagner
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Theresa Brunet
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Riccardo Berutti
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Dmitrii Smirnov
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
| | - Tharsini Navaratnarajah
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Richard J.T. Rodenburg
- Radboud Centre for Mitochondrial Medicine, Department of Paediatrics Radboud Institute for Molecular Life Sciences, Radboud University Nijmegen Medical Centre Nijmegen, The Netherlands
| | - Lynn S Pais
- Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Christina Austin-Tse
- Harvard Medical School & Center for Genomic Medicine, Massachusetts General Hospital, Boston & Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, MA
| | - Melanie O’Leary
- Broad Center for Mendelian Genomics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Sylvia Boesch
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert Jech
- Department of Neurology, Charles University, 1st Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - Somayeh Bakhtiari
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, USA,Departments of Child Health, Neurology, and Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St Louis, Missouri, USA,Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Friederike Wilbert
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael C Kruer
- Pediatric Movement Disorders Program, Division of Pediatric Neurology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, USA,Departments of Child Health, Neurology, and Cellular & Molecular Medicine, and Program in Genetics, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - Saskia B. Wortmann
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria,Radboud Center for Mitochondrial Medicine, Department of Pediatrics, Amalia Children's Hospital, Radboudumc, Nijmegen, The Netherlands
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johannes A. Mayr
- University Children's Hospital, Paracelsus Medical University (PMU), Salzburg, Austria
| | - Felix Distelmaier
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Robert Steinfeld
- Department of Pediatric Neurology, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Juliane Winkelmann
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany,Lehrstuhl für Neurogenetik, Technische Universität München, Munich, Germany,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Holger Prokisch
- Technical University of Munich, Munich, Germany; School of Medicine, Institute of Human Genetics,Institute of Neurogenomics, Helmholtz Zentrum München, Munich, Germany
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