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Yagi K, Okazaki S, Ohbatake A, Nakaya M, Liu J, Arite E, Miyamoto Y, Ito N, Nakano K, Yamaaki N, Honoki H, Fujisaka S, Chujo D, Tsunoda SI, Yanagimoto K, Nozue T, Yamada M, Ooe K, Araki T, Nakashima A, Azami Y, Sodemoto Y, Tadokoro K, Nagano M, Noguchi T, Nohara A, Origasa H, Niida Y, Tada H. Negative correlation between organ heteroplasmy, particularly hepatic heteroplasmy, and age at death revealed by post-mortem studies of m.3243A > G cases. Mol Genet Metab 2023; 140:107691. [PMID: 37660570 DOI: 10.1016/j.ymgme.2023.107691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
Mitochondrial DNA m.3243A > G mutation causes mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) and its associated multi-organ disorders, including diabetes. To clarify associations between m.3243A > G organ heteroplasmy and clinical phenotypes, including the age at death, we combined genetic and pathological examinations from seven unreported and 36 literature cases of autopsied subjects. Clinical characteristics of subjects were as follows: male, 13; female, 28; unknown, 2; the age at death, 36.9 ± 20.2 [4-82] years; BMI, 16.0 ± 2.9 [13.0-22.3]; diabetes, N = 21 (49%), diabetes onset age 38.6 ± 14.2 years; deafness, N = 27 (63%); stroke-like episodes (StLEp), N = 25 (58%); congestive heart failure (CHF), N = 15 (35%); CHF onset age, 51.3 ± 14.5 years. Causes of death (N = 32) were as follows: cardiac, N = 13 (41%); infection, N = 8 (25%); StLEp, N = 4 (13%); gastrointestinal, N = 4 (13%); renal, N = 2 (6%); hepatic, N = 1 (2%). High and low heteroplasmies were confirmed in non-regenerative and regenerative organs, respectively. Heteroplasmy of the liver, spleen, leukocytes, and kidney for all subjects was significantly associated with the age at death. Furthermore, the age at death was related to juvenile-onset (any m.3243A > G-related symptoms appeared before 20) and stroke-like episodes. Multiple linear regression analysis with the age at death as an objective variable showed the significant contribution of liver heteroplasty and juvenile-onset to the age at death. m.3243A > G organ heteroplasmy levels, particularly hepatic heteroplasmy, are significantly associated with the age at death in deceased cases.
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Affiliation(s)
- Kunimasa Yagi
- Center for Clinical Genomics, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan; Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan; First Department of Internal Medicine, Toyama University, Toyama 934-0194, Japan.
| | - Satoko Okazaki
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Azusa Ohbatake
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Masako Nakaya
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Jianhui Liu
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan; First Department of Internal Medicine, Toyama University, Toyama 934-0194, Japan
| | - Eiko Arite
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Yukiko Miyamoto
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Naoko Ito
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Kaoru Nakano
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Naoto Yamaaki
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Hisae Honoki
- First Department of Internal Medicine, Toyama University, Toyama 934-0194, Japan
| | - Shiho Fujisaka
- First Department of Internal Medicine, Toyama University, Toyama 934-0194, Japan
| | - Daisuke Chujo
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan; First Department of Internal Medicine, Toyama University, Toyama 934-0194, Japan
| | - Shin-Ichiro Tsunoda
- Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama 247-8581, Japan
| | - Kunio Yanagimoto
- Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama 247-8581, Japan
| | - Tsuyoshi Nozue
- Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama 247-8581, Japan
| | - Masayo Yamada
- Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, Yokohama 247-8581, Japan
| | - Kotaro Ooe
- Department of Internal Medicine, Saiseikai Kanazawa Hospital, Kanazawa 920-0353, Japan
| | - Tsutomu Araki
- Department of Internal Medicine, Saiseikai Kanazawa Hospital, Kanazawa 920-0353, Japan
| | - Akikatsu Nakashima
- Department of Internal Medicine, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Japan
| | | | | | - Kenichi Tadokoro
- Bio Medical Laboratory (BML), Inc., 1361-1 Matoba, Kawagoe, Saitama 350-1101, Japan
| | - Makoto Nagano
- Bio Medical Laboratory (BML), Inc., 1361-1 Matoba, Kawagoe, Saitama 350-1101, Japan
| | - Tohru Noguchi
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
| | - Atushi Nohara
- Department of Internal Medicine, Ishikawa Prefectural Central Hospital, Kanazawa 920-8530, Japan
| | - Hideki Origasa
- The Institute of Statistical Mathematics, Toyama University, Toyama 934-0194, Japan
| | - Yo Niida
- Center for Clinical Genomics, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan
| | - Hayato Tada
- Second Department of Internal Medicine, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8641, Japan
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Durrleman C, Grevent D, Aubart M, Kossorotoff M, Roux CJ, Kaminska A, Rio M, Barcia G, Boddaert N, Munnich A, Nabbout R, Desguerre I. Clinical and radiological description of 120 pediatric stroke-like episodes. Eur J Neurol 2023; 30:2051-2061. [PMID: 37046408 DOI: 10.1111/ene.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AND PURPOSE Stroke-like episodes (SLEs) are defined as acute onset of neurological symptoms mimicking a stroke and radiological lesions non-congruent to vascular territory. We aimed to analyze the acute clinical and radiological features of SLEs to determine their pathophysiology. METHODS We performed a monocenter retrospective analysis of 120 SLEs in 60 children over a 20-year period. Inclusion criteria were compatible clinical symptoms and stroke-like lesions on brain magnetic resonance imaging (MRI; performed for all 120 events) with focal hyperintensity on diffusion-weighted imaging in a non-vascular territory. RESULTS Three groups were identified: children with mitochondrial diseases (n = 22) involving mitochondrial DNA mutations (55%) or nuclear DNA mutations (45%); those with other metabolic diseases or epilepsy disorders (n = 22); and those in whom no etiology was found despite extensive investigations (n = 16). Age at first SLE was younger in the group with metabolic or epilepsy disorders (18 months vs. 128 months; p < 0.0001) and an infectious trigger was more frequent (69% vs. 20%; p = 0.0001). Seizures occurred in 75% of episodes, revealing 50% episodes of SLEs and mainly leading to status epilepticus (90%). Of the 120 MRI scans confirming the diagnosis, 28 were performed within a short and strict 48-h period and were further analyzed to better understand the underlying mechanisms. The scans showed primary cortical hyperintensity (n = 28/28) with decreased apparent diffusion coefficient in 52% of cases. Systematic hyperperfusion was found on spin labeling sequences when available (n = 18/18). CONCLUSION Clinical and radiological results support the existence of a vicious circle based on two main mechanisms: energy deficit and neuronal hyperexcitability at the origin of SLE.
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Affiliation(s)
- Chloe Durrleman
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - David Grevent
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
- Lumiere Platform, Université Paris Cité, Paris, France
| | - Melodie Aubart
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Charles-Joris Roux
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Anna Kaminska
- Neurophysiology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Marlene Rio
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Giulia Barcia
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Nathalie Boddaert
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
- Lumiere Platform, Université Paris Cité, Paris, France
| | - Arnold Munnich
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Rima Nabbout
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
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Alves CAPF, Zandifar A, Peterson JT, Tara SZ, Ganetzky R, Viaene AN, Andronikou S, Falk MJ, Vossough A, Goldstein AC. MELAS: Phenotype Classification into Classic-versus-Atypical Presentations. AJNR Am J Neuroradiol 2023; 44:602-610. [PMID: 37024306 PMCID: PMC10171385 DOI: 10.3174/ajnr.a7837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND AND PURPOSE An increased number of pathogenic variants have been described in mitochondrial encephalomyopathy lactic acidosis and strokelike episodes (MELAS). Different imaging presentations have emerged in parallel with a growing recognition of clinical and outcome variability, which pose a diagnostic challenge to neurologists and radiologists and may impact an individual patient's response to therapeutic interventions. By evaluating clinical, neuroimaging, laboratory, and genetic findings, we sought to improve our understanding of the sources of potential phenotype variability in patients with MELAS. MATERIALS AND METHODS This retrospective single-center study included individuals who had confirmed mitochondrial DNA pathogenic variants and a diagnosis of MELAS and whose data were reviewed from January 2000 through November 2021. The approach included a review of clinical, neuroimaging, laboratory, and genetic data, followed by an unsupervised hierarchical cluster analysis looking for sources of phenotype variability in MELAS. Subsequently, experts identified "victory-variables" that best differentiated MELAS cohort clusters. RESULTS Thirty-five patients with a diagnosis of mitochondrial DNA-based MELAS (median age, 12 years; interquartile range, 7-24 years; 24 female) were eligible for this study. Fifty-three discrete variables were evaluated by an unsupervised cluster analysis, which revealed that two distinct phenotypes exist among patients with MELAS. After experts reviewed the variables, they selected 8 victory-variables with the greatest impact in determining the MELAS subgroups: developmental delay, sensorineural hearing loss, vision loss in the first strokelike episode, Leigh syndrome overlap, age at the first strokelike episode, cortical lesion size, regional brain distribution of lesions, and genetic groups. Ultimately, 2-step differentiating criteria were defined to classify atypical MELAS. CONCLUSIONS We identified 2 distinct patterns of MELAS: classic MELAS and atypical MELAS. Recognizing different patterns in MELAS presentations will enable clinical and research care teams to better understand the natural history and prognosis of MELAS and identify the best candidates for specific therapeutic interventions.
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Affiliation(s)
- C A P F Alves
- From the Division of Neuroradiology (C.A.P.F.A., A.Z., S.A., A.V.), Department of Radiology
| | - A Zandifar
- From the Division of Neuroradiology (C.A.P.F.A., A.Z., S.A., A.V.), Department of Radiology
| | - J T Peterson
- Mitochondrial Medicine Frontier Program (J.T.P., S.Z.T., R.G., M.J.F., A.C.G.), Division of Human Genetics, Department of Pediatrics
| | - S Z Tara
- Mitochondrial Medicine Frontier Program (J.T.P., S.Z.T., R.G., M.J.F., A.C.G.), Division of Human Genetics, Department of Pediatrics
| | - R Ganetzky
- Mitochondrial Medicine Frontier Program (J.T.P., S.Z.T., R.G., M.J.F., A.C.G.), Division of Human Genetics, Department of Pediatrics
- Departments of Pediatrics (R.G., M.J.F., A.C.G.)
| | - A N Viaene
- Department of Pathology and Laboratory Medicine (A.N.V.), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Pathology and Laboratory Medicine (A.N.V.)
| | - S Andronikou
- From the Division of Neuroradiology (C.A.P.F.A., A.Z., S.A., A.V.), Department of Radiology
- Radiology (S.A., A.V.), Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - M J Falk
- Mitochondrial Medicine Frontier Program (J.T.P., S.Z.T., R.G., M.J.F., A.C.G.), Division of Human Genetics, Department of Pediatrics
- Departments of Pediatrics (R.G., M.J.F., A.C.G.)
| | - A Vossough
- From the Division of Neuroradiology (C.A.P.F.A., A.Z., S.A., A.V.), Department of Radiology
- Radiology (S.A., A.V.), Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - A C Goldstein
- Mitochondrial Medicine Frontier Program (J.T.P., S.Z.T., R.G., M.J.F., A.C.G.), Division of Human Genetics, Department of Pediatrics
- Departments of Pediatrics (R.G., M.J.F., A.C.G.)
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4
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Ng YS, Gorman GS. Stroke-like episodes in adult mitochondrial disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 194:65-78. [PMID: 36813321 DOI: 10.1016/b978-0-12-821751-1.00005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Stroke-like episode is a paroxysmal neurological manifestation which affects a specific group of patients with mitochondrial disease. Focal-onset seizures, encephalopathy, and visual disturbances are prominent findings associated with stroke-like episodes, with a predilection for the posterior cerebral cortex. The most common cause of stroke-like episodes is the m.3243A>G variant in MT-TL1 gene followed by recessive POLG variants. This chapter aims to review the definition of stroke-like episode and delineate the clinical phenomenology, neuroimaging and EEG findings typically seen in patients. In addition, several lines of evidence supporting neuronal hyper-excitability as the key mechanism of stroke-like episodes are discussed. The management of stroke-like episodes should focus on aggressive seizure management and treatment for concomitant complications such as intestinal pseudo-obstruction. There is no robust evidence to prove the efficacy of l-arginine for both acute and prophylactic settings. Progressive brain atrophy and dementia are the sequalae of recurrent stroke-like episode, and the underlying genotype in part predicts prognosis.
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Affiliation(s)
- Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
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5
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Kitamura T, Shijo M, Yokoi M, Maruyama T, Osaki M, Nakamura U, Arakawa S. Stroke-like lesions confined to the cerebellum in MELAS and a possible association with neuronal hyperexcitability. J Neurol 2023; 270:565-568. [PMID: 36152051 DOI: 10.1007/s00415-022-11397-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/07/2022] [Accepted: 09/19/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Taisuke Kitamura
- Department of Cerebrovascular Medicine and Neurology, Steel Memorial Yawata Hospital, Kitakyushu, Japan.
| | - Masahiro Shijo
- Department of Internal Medicine, Fukuoka Dental College Medical and Dental Hospital, Fukuoka, Japan
| | - Mio Yokoi
- Department of Cerebrovascular Medicine and Neurology, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Takako Maruyama
- Department of Cerebrovascular Medicine and Neurology, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Masato Osaki
- Department of Cerebrovascular Medicine and Neurology, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Udai Nakamura
- Diabetes Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Medicine and Neurology, Steel Memorial Yawata Hospital, Kitakyushu, Japan
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6
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Ng YS, Lax NZ, Blain AP, Erskine D, Baker MR, Polvikoski T, Thomas RH, Morris CM, Lai M, Whittaker RG, Gebbels A, Winder A, Hall J, Feeney C, Farrugia ME, Hirst C, Roberts M, Lawthom C, Chrysostomou A, Murphy K, Baird T, Maddison P, Duncan C, Poulton J, Nesbitt V, Hanna MG, Pitceathly RDS, Taylor RW, Blakely EL, Schaefer AM, Turnbull DM, McFarland R, Gorman GS. Forecasting stroke-like episodes and outcomes in mitochondrial disease. Brain 2022; 145:542-554. [PMID: 34927673 PMCID: PMC9014738 DOI: 10.1093/brain/awab353] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/16/2021] [Accepted: 08/06/2021] [Indexed: 12/03/2022] Open
Abstract
In this retrospective, multicentre, observational cohort study, we sought to determine the clinical, radiological, EEG, genetics and neuropathological characteristics of mitochondrial stroke-like episodes and to identify associated risk predictors. Between January 1998 and June 2018, we identified 111 patients with genetically determined mitochondrial disease who developed stroke-like episodes. Post-mortem cases of mitochondrial disease (n = 26) were identified from Newcastle Brain Tissue Resource. The primary outcome was to interrogate the clinico-radiopathological correlates and prognostic indicators of stroke-like episode in patients with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes syndrome (MELAS). The secondary objective was to develop a multivariable prediction model to forecast stroke-like episode risk. The most common genetic cause of stroke-like episodes was the m.3243A>G variant in MT-TL1 (n = 66), followed by recessive pathogenic POLG variants (n = 22), and 11 other rarer pathogenic mitochondrial DNA variants (n = 23). The age of first stroke-like episode was available for 105 patients [mean (SD) age: 31.8 (16.1)]; a total of 35 patients (32%) presented with their first stroke-like episode ≥40 years of age. The median interval (interquartile range) between first and second stroke-like episodes was 1.33 (2.86) years; 43% of patients developed recurrent stroke-like episodes within 12 months. Clinico-radiological, electrophysiological and neuropathological findings of stroke-like episodes were consistent with the hallmarks of medically refractory epilepsy. Patients with POLG-related stroke-like episodes demonstrated more fulminant disease trajectories than cases of m.3243A>G and other mitochondrial DNA pathogenic variants, in terms of the frequency of refractory status epilepticus, rapidity of progression and overall mortality. In multivariate analysis, baseline factors of body mass index, age-adjusted blood m.3243A>G heteroplasmy, sensorineural hearing loss and serum lactate were significantly associated with risk of stroke-like episodes in patients with the m.3243A>G variant. These factors informed the development of a prediction model to assess the risk of developing stroke-like episodes that demonstrated good overall discrimination (area under the curve = 0.87, 95% CI 0.82-0.93; c-statistic = 0.89). Significant radiological and pathological features of neurodegeneration were more evident in patients harbouring pathogenic mtDNA variants compared with POLG: brain atrophy on cranial MRI (90% versus 44%, P < 0.001) and reduced mean brain weight (SD) [1044 g (148) versus 1304 g (142), P = 0.005]. Our findings highlight the often idiosyncratic clinical, radiological and EEG characteristics of mitochondrial stroke-like episodes. Early recognition of seizures and aggressive instigation of treatment may help circumvent or slow neuronal loss and abate increasing disease burden. The risk-prediction model for the m.3243A>G variant can help inform more tailored genetic counselling and prognostication in routine clinical practice.
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Affiliation(s)
- Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Nichola Z Lax
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Alasdair P Blain
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Daniel Erskine
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Mark R Baker
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Campus for Ageing and Vitality, Newcastle Brain Tissue Resource, Newcastle University, Edwardson Building, Newcastle upon Tyne NE4 5PL, UK
| | - Tuomo Polvikoski
- Campus for Ageing and Vitality, Newcastle Brain Tissue Resource, Newcastle University, Edwardson Building, Newcastle upon Tyne NE4 5PL, UK
| | - Rhys H Thomas
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Christopher M Morris
- Campus for Ageing and Vitality, Newcastle Brain Tissue Resource, Newcastle University, Edwardson Building, Newcastle upon Tyne NE4 5PL, UK
| | - Ming Lai
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Roger G Whittaker
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Alasdair Gebbels
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Amy Winder
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Julie Hall
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
| | - Catherine Feeney
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Maria Elena Farrugia
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Claire Hirst
- Trust Headquarters, One Talbot Gateway, Baglan Energy Park, Baglan, Port Talbot SA12 7BR, UK
| | - Mark Roberts
- Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Salford M6 8HD, UK
| | - Charlotte Lawthom
- Aneurin Bevan Epilepsy Specialist Team, Aneurin Bevan University Health Board, Newport, NP20 2UB, UK
| | - Alexia Chrysostomou
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Kevin Murphy
- Department of Neurology, Sligo University Hospital, Sligo F91 H684, Ireland
| | - Tracey Baird
- Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Paul Maddison
- Department of Neurology, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Callum Duncan
- Department of Neurology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen AB25 2ZN, UK
| | - Joanna Poulton
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Victoria Nesbitt
- Department of Paediatrics, Medical Sciences Division, Oxford University, Oxford OX3 9DU, UK
- Department of Paediatrics, The Children's Hospital, Oxford, OX3 9DU, UK
| | - Michael G Hanna
- Department of Neuromuscular Diseases, University College London Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Robert D S Pitceathly
- Department of Neuromuscular Diseases, University College London Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Emma L Blakely
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Andrew M Schaefer
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute; NIHR Newcastle Biomedical Research Centre and Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Directorate of Neurosciences, Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK
- Department of Neurosciences, NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne NE2 4HH, UK
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Valiente-Pallejà A, Tortajada J, Bulduk BK, Vilella E, Garrabou G, Muntané G, Martorell L. Comprehensive summary of mitochondrial DNA alterations in the postmortem human brain: A systematic review. EBioMedicine 2022; 76:103815. [PMID: 35085849 PMCID: PMC8790490 DOI: 10.1016/j.ebiom.2022.103815] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mitochondrial DNA (mtDNA) encodes 37 genes necessary for synthesizing 13 essential subunits of the oxidative phosphorylation system. mtDNA alterations are known to cause mitochondrial disease (MitD), a clinically heterogeneous group of disorders that often present with neuropsychiatric symptoms. Understanding the nature and frequency of mtDNA alterations in health and disease could be a cornerstone in disentangling the relationship between biochemical findings and clinical symptoms of brain disorders. This systematic review aimed to summarize the mtDNA alterations in human brain tissue reported to date that have implications for further research on the pathophysiological significance of mtDNA alterations in brain functioning. METHODS We searched the PubMed and Embase databases using distinct terms related to postmortem human brain and mtDNA up to June 10, 2021. Reports were eligible if they were empirical studies analysing mtDNA in postmortem human brains. FINDINGS A total of 158 of 637 studies fulfilled the inclusion criteria and were clustered into the following groups: MitD (48 entries), neurological diseases (NeuD, 55 entries), psychiatric diseases (PsyD, 15 entries), a miscellaneous group with controls and other clinical diseases (5 entries), ageing (20 entries), and technical issues (5 entries). Ten entries were ascribed to more than one group. Pathogenic single nucleotide variants (pSNVs), both homo- or heteroplasmic variants, have been widely reported in MitD, with heteroplasmy levels varying among brain regions; however, pSNVs are rarer in NeuD, PsyD and ageing. A lower mtDNA copy number (CN) in disease was described in most, but not all, of the identified studies. mtDNA deletions were identified in individuals in the four clinical categories and ageing. Notably, brain samples showed significantly more mtDNA deletions and at higher heteroplasmy percentages than blood samples, and several of the deletions present in the brain were not detected in the blood. Finally, mtDNA heteroplasmy, mtDNA CN and the deletion levels varied depending on the brain region studied. INTERPRETATION mtDNA alterations are well known to affect human tissues, including the brain. In general, we found that studies of MitD, NeuD, PsyD, and ageing were highly variable in terms of the type of disease or ageing process investigated, number of screened individuals, studied brain regions and technology used. In NeuD and PsyD, no particular type of mtDNA alteration could be unequivocally assigned to any specific disease or diagnostic group. However, the presence of mtDNA deletions and mtDNA CN variation imply a role for mtDNA in NeuD and PsyD. Heteroplasmy levels and threshold effects, affected brain regions, and mitotic segregation patterns of mtDNA alterations may be involved in the complex inheritance of NeuD and PsyD and in the ageing process. Therefore, more information is needed regarding the type of mtDNA alteration, the affected brain regions, the heteroplasmy levels, and their relationship with clinical phenotypes and the ageing process. FUNDING Hospital Universitari Institut Pere Mata; Institut d'Investigació Sanitària Pere Virgili; Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación (PI18/00514).
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Affiliation(s)
- Alba Valiente-Pallejà
- Research Department, Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), 43201 Reus, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - Juan Tortajada
- Research Department, Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), 43201 Reus, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - Bengisu K Bulduk
- Research Department, Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), 43201 Reus, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - Elisabet Vilella
- Research Department, Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), 43201 Reus, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain
| | - Glòria Garrabou
- Laboratory of Muscle Research and Mitochondrial Function, Department of Internal Medicine-Hospital Clínic of Barcelona (HCB); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Faculty of Medicine and Health Sciences, Universitat de Barcelona (UB), 08036 Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Rare Diseases (CIBERER), 28029 Madrid, Spain
| | - Gerard Muntané
- Research Department, Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), 43201 Reus, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain; Institute of Evolutionary Biology (IBE), Universitat Pompeu Fabra (UPF), 08003 Barcelona, Catalonia, Spain
| | - Lourdes Martorell
- Research Department, Hospital Universitari Institut Pere Mata (HUIPM); Institut d'Investigació Sanitària Pere Virgili (IISPV); Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili (URV), 43201 Reus, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), 28029 Madrid, Spain.
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8
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Fan HC, Lee HF, Yue CT, Chi CS. Clinical Characteristics of Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-Like Episodes. Life (Basel) 2021; 11:life11111111. [PMID: 34832987 PMCID: PMC8617702 DOI: 10.3390/life11111111] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 12/12/2022] Open
Abstract
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome, a maternally inherited mitochondrial disorder, is characterized by its genetic, biochemical and clinical complexity. The most common mutation associated with MELAS syndrome is the mtDNA A3243G mutation in the MT-TL1 gene encoding the mitochondrial tRNA-leu(UUR), which results in impaired mitochondrial translation and protein synthesis involving the mitochondrial electron transport chain complex subunits, leading to impaired mitochondrial energy production. Angiopathy, either alone or in combination with nitric oxide (NO) deficiency, further contributes to multi-organ involvement in MELAS syndrome. Management for MELAS syndrome is amostly symptomatic multidisciplinary approach. In this article, we review the clinical presentations, pathogenic mechanisms and options for management of MELAS syndrome.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan; (H.-C.F.); (C.-T.Y.)
- Department of Medical Research, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Life Sciences, Agricultural Biotechnology Center, National Chung Hsing University, Taichung 402, Taiwan
| | - Hsiu-Fen Lee
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung 407, Taiwan;
| | - Chen-Tang Yue
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan; (H.-C.F.); (C.-T.Y.)
| | - Ching-Shiang Chi
- Department of Pediatrics, Tungs’ Taichung Metroharbor Hospital, Wuchi, Taichung 435, Taiwan; (H.-C.F.); (C.-T.Y.)
- Correspondence: ; Tel.: +886-4-26581919-4301
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9
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Almannai M, El-Hattab AW. Nitric Oxide Deficiency in Mitochondrial Disorders: The Utility of Arginine and Citrulline. Front Mol Neurosci 2021; 14:682780. [PMID: 34421535 PMCID: PMC8374159 DOI: 10.3389/fnmol.2021.682780] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022] Open
Abstract
Mitochondrial diseases represent a growing list of clinically heterogeneous disorders that are associated with dysfunctional mitochondria and multisystemic manifestations. In spite of a better understanding of the underlying pathophysiological basis of mitochondrial disorders, treatment options remain limited. Over the past two decades, there is growing evidence that patients with mitochondrial disorders have nitric oxide (NO) deficiency due to the limited availability of NO substrates, arginine and citrulline; decreased activity of nitric oxide synthase (NOS); and NO sequestration. Studies evaluating the use of arginine in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) presenting with stroke-like episodes showed symptomatic improvement after acute administration as well as a reduction in the frequency and severity of stroke-like episodes following chronic use. Citrulline, another NO precursor, was shown through stable isotope studies to result in a greater increase in NO synthesis. Recent studies showed a positive response of arginine and citrulline in other mitochondrial disorders besides MELAS. Randomized-controlled studies with a larger number of patients are warranted to better understand the role of NO deficiency in mitochondrial disorders and the efficacy of NO precursors as treatment modalities in these disorders.
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Affiliation(s)
- Mohammed Almannai
- Section of Medical Genetics, Children's Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.,College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ayman W El-Hattab
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Clinical Genetics, University Hospital Sharjah, Sharjah, United Arab Emirates
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10
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Gonçalves FG, Alves CAPF, Heuer B, Peterson J, Viaene AN, Reis Teixeira S, Martín-Saavedra JS, Andronikou S, Goldstein A, Vossough A. Primary Mitochondrial Disorders of the Pediatric Central Nervous System: Neuroimaging Findings. Radiographics 2021; 40:2042-2067. [PMID: 33136487 DOI: 10.1148/rg.2020200052] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Primary mitochondrial disorders (PMDs) constitute the most common cause of inborn errors of metabolism in children, and they frequently affect the central nervous system. Neuroimaging findings of PMDs are variable, ranging from unremarkable and nonspecific to florid and highly suggestive. An overview of PMDs, including a synopsis of the basic genetic concepts, main clinical symptoms, and neuropathologic features, is presented. In addition, eight of the most common PMDs that have a characteristic imaging phenotype in children are reviewed in detail. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Fabrício Guimarães Gonçalves
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - César Augusto Pinheiro Ferreira Alves
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - Beth Heuer
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - James Peterson
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - Angela N Viaene
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - Sara Reis Teixeira
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - Juan Sebastián Martín-Saavedra
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - Savvas Andronikou
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - Amy Goldstein
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
| | - Arastoo Vossough
- From the Department of Radiology, Division of Neuroradiology (F.G.G., C.A.P.F.A., S.R.T., J.S.M.S., S.A., A.V.), Department of Pathology (A.N.V.), and Mitochondrial Medicine Frontier Program, Division of Human Genetics, Department of Pediatrics (B.H., J.P., A.G.), Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104-4399; and Departments of Pediatrics (A.G.) and Radiology (S.A., A.V.), University of Pennsylvania Perelman School of Medicine (A.N.V.), Philadelphia, Pa
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11
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Quantifying Mitochondrial Dynamics in Patient Fibroblasts with Multiple Developmental Defects and Mitochondrial Disorders. Int J Mol Sci 2021; 22:ijms22126263. [PMID: 34200828 PMCID: PMC8230542 DOI: 10.3390/ijms22126263] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
Mitochondria are dynamic organelles that undergo rounds of fission and fusion and exhibit a wide range of morphologies that contribute to the regulation of different signaling pathways and various cellular functions. It is important to understand the differences between mitochondrial structure in health and disease so that therapies can be developed to maintain the homeostatic balance of mitochondrial dynamics. Mitochondrial disorders are multisystemic and characterized by complex and variable clinical pathologies. The dynamics of mitochondria in mitochondrial disorders is thus worthy of investigation. Therefore, in this study, we performed a comprehensive analysis of mitochondrial dynamics in ten patient-derived fibroblasts containing different mutations and deletions associated with various mitochondrial disorders. Our results suggest that the most predominant morphological signature for mitochondria in the diseased state is fragmentation, with eight out of the ten cell lines exhibiting characteristics consistent with fragmented mitochondria. To our knowledge, this is the first comprehensive study that quantifies mitochondrial dynamics in cell lines with a wide array of developmental and mitochondrial disorders. A more thorough analysis of the correlations between mitochondrial dynamics, mitochondrial genome perturbations, and bioenergetic dysfunction will aid in identifying unique morphological signatures of various mitochondrial disorders in the future.
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12
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van den Ameele J, Hong YT, Manavaki R, Kouli A, Biggs H, MacIntyre Z, Horvath R, Yu-Wai-Man P, Reid E, Williams-Gray CH, Bullmore ET, Aigbirhio FI, Fryer TD, Chinnery PF. [ 11C]PK11195-PET Brain Imaging of the Mitochondrial Translocator Protein in Mitochondrial Disease. Neurology 2021; 96:e2761-e2773. [PMID: 33883237 PMCID: PMC8205464 DOI: 10.1212/wnl.0000000000012033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/04/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To explore the possibilities of radioligands against the mitochondrial outer membrane translocator protein (TSPO) as biomarkers for mitochondrial disease, we performed brain PET-MRI with [11C]PK11195 in 14 patients with genetically confirmed mitochondrial disease and 33 matched controls. METHODS Case-control study of brain PET-MRI with the TSPO radioligand [11C]PK11195. RESULTS Forty-six percent of symptomatic patients had volumes of abnormal radiotracer binding greater than the 95th percentile in controls. [11C]PK11195 binding was generally greater in gray matter and significantly decreased in white matter. This was most striking in patients with nuclear TYMP or mitochondrial m.3243A>G MT-TL1 mutations, in keeping with differences in mitochondrial density seen postmortem. Some regional binding patterns corresponded to clinical presentation and underlying mutation, even in the absence of structural changes on MRI. This was most obvious for the cerebellum, where patients with ataxia had decreased binding in the cerebellar cortex, but not necessarily volume loss. Overall, there was a positive correlation between aberrant [11C]PK11195 binding and clinical severity. CONCLUSION These findings endorse the use of PET imaging with TSPO radioligands as a noninvasive in vivo biomarker of mitochondrial pathology. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that brain PET-MRI with TSPO radioligands identifies mitochondrial pathology.
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Affiliation(s)
- Jelle van den Ameele
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Young T Hong
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Roido Manavaki
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Antonina Kouli
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Heather Biggs
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Zoe MacIntyre
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Rita Horvath
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Patrick Yu-Wai-Man
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Evan Reid
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Caroline H Williams-Gray
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Ed T Bullmore
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Franklin I Aigbirhio
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Tim D Fryer
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK
| | - Patrick F Chinnery
- From the Departments of Clinical Neurosciences (J.v.d.A., Y.T.H., A.K., H.B., Z.M., R.H., P.Y.-W.M., C.H.W.-G., F.I.A., T.D.F., P.F.C.), Radiology (R.M.), Medical Genetics (E.R.), and Psychiatry (E.T.B.), Cambridge Institute for Medical Research (E.R.), Cambridge Biomedical Campus, and MRC Mitochondrial Biology Unit (J.v.d.A., P.F.C.), University of Cambridge; Moorfields Eye Hospital NHS Foundation Trust (P.Y.-W.M.); and Institute of Ophthalmology (P.Y.-W.M.), University College London, UK.
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13
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Klein Gunnewiek TM, Van Hugte EJH, Frega M, Guardia GS, Foreman K, Panneman D, Mossink B, Linda K, Keller JM, Schubert D, Cassiman D, Rodenburg R, Vidal Folch N, Oglesbee D, Perales-Clemente E, Nelson TJ, Morava E, Nadif Kasri N, Kozicz T. m.3243A > G-Induced Mitochondrial Dysfunction Impairs Human Neuronal Development and Reduces Neuronal Network Activity and Synchronicity. Cell Rep 2021; 31:107538. [PMID: 32320658 DOI: 10.1016/j.celrep.2020.107538] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 02/13/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Epilepsy, intellectual and cortical sensory deficits, and psychiatric manifestations are the most frequent manifestations of mitochondrial diseases. How mitochondrial dysfunction affects neural structure and function remains elusive, mostly because of a lack of proper in vitro neuronal model systems with mitochondrial dysfunction. Leveraging induced pluripotent stem cell technology, we differentiated excitatory cortical neurons (iNeurons) with normal (low heteroplasmy) and impaired (high heteroplasmy) mitochondrial function on an isogenic nuclear DNA background from patients with the common pathogenic m.3243A > G variant of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). iNeurons with high heteroplasmy exhibited mitochondrial dysfunction, delayed neural maturation, reduced dendritic complexity, and fewer excitatory synapses. Micro-electrode array recordings of neuronal networks displayed reduced network activity and decreased synchronous network bursting. Impaired neuronal energy metabolism and compromised structural and functional integrity of neurons and neural networks could be the primary drivers of increased susceptibility to neuropsychiatric manifestations of mitochondrial disease.
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Affiliation(s)
- Teun M Klein Gunnewiek
- Department of Anatomy, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands; Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands
| | - Eline J H Van Hugte
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands
| | - Monica Frega
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands; Department of Clinical Neurophysiology, University of Twente, 7522 NB Enschede, the Netherlands
| | - Gemma Solé Guardia
- Department of Anatomy, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands; Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands
| | - Katharina Foreman
- Department of Cognitive Neuroscience, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands
| | - Daan Panneman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Britt Mossink
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands
| | - Katrin Linda
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands
| | - Jason M Keller
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands
| | - Dirk Schubert
- Department of Cognitive Neuroscience, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands
| | - David Cassiman
- Department of Hepatology, UZ Leuven, 3000 Leuven, Belgium
| | - Richard Rodenburg
- Radboud Center for Mitochondrial Disorders, Radboudumc, 6500 HB Nijmegen, the Netherlands
| | - Noemi Vidal Folch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | - Devin Oglesbee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Timothy J Nelson
- Division of General Internal Medicine, Division of Pediatric Cardiology, Departments of Medicine, Molecular Pharmacology, and Experimental Therapeutics, Mayo Clinic Center for Regenerative Medicine, Rochester, MN 55905, USA
| | - Eva Morava
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; Department of Clinical Genomics, Mayo Clinic, Rochester, MN 55905, USA
| | - Nael Nadif Kasri
- Department of Human Genetics, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands.
| | - Tamas Kozicz
- Department of Anatomy, Radboudumc, Donders Institute for Brain, Cognition, and Behaviour, 6500 HB Nijmegen, the Netherlands; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA; Department of Clinical Genomics, Mayo Clinic, Rochester, MN 55905, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, 55905 Rochester, MN, USA.
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14
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Mancardi MM, Nesti C, Febbo F, Cordani R, Siri L, Nobili L, Lampugnani E, Giacomini T, Granata T, Marucci G, Consales A, Rossi A, Luria G, Santorelli FM, Buratti S. Focal status and acute encephalopathy in a 13-year-old boy with de novo DNM1L mutation: Video-polygraphic pattern and clues for differential diagnosis. Brain Dev 2021; 43:644-651. [PMID: 33485697 DOI: 10.1016/j.braindev.2020.12.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pathogenic variants in the dynamin 1 like gene are related to abnormal mitochondrial dynamics and distributions and are associated to variable clinical phenotypes. A few patients harboring the p.Arg403Cys missense variant appears to be different from the classical, more severe phenotypes, showing sudden onset of drug resistant seizures after a previously normal or slightly delayed development. CASE REPORT We report on a boy with abrupt onset of focal status and coma at the age of 13, initially treated as autoimmune encephalitis, with final diagnosis of de novo missense p.Arg403Cys variant in the DNM1L gene. DISCUSSION We compare his clinical, electrophysiological, biochemical, neuroradiological and histopathological picture to the rare cases reported to date and provide diagnostic clues that can help clinicians in differentiate p.Arg403Cys-related phenotype from that of immune-mediated encephalopathies. CONCLUSION The clinical picture related to p.Arg403Cys mutations should be considered alongside acquired pathologies in the differential diagnosis of young patients with focal refractory epilepsy and encephalopathy, also occurring during late childhood or adolescence. Prompt genetic testing allows to avoid unnecessary treatments and procedures and to better define the prognosis and management strategies.
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Affiliation(s)
- Maria Margherita Mancardi
- Unit of Child Neuropsichiatry, Department of Clinical and Surgical Neurosciences and Rehabilitation, IRCCS Giannina Gaslini, Genoa, Italy.
| | - Claudia Nesti
- Molecular Medicine, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Francesca Febbo
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care, IRCCS Giannina Gaslini, Genova, Italy
| | - Ramona Cordani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Laura Siri
- Unit of Child Neuropsichiatry, Department of Clinical and Surgical Neurosciences and Rehabilitation, IRCCS Giannina Gaslini, Genoa, Italy
| | - Lino Nobili
- Unit of Child Neuropsichiatry, Department of Clinical and Surgical Neurosciences and Rehabilitation, IRCCS Giannina Gaslini, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Elisabetta Lampugnani
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care, IRCCS Giannina Gaslini, Genova, Italy
| | - Thea Giacomini
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Tiziana Granata
- Department of Pediatric Neuroscience, Istituto Neurologico Carlo Besta, Milan, Italy
| | - Gianluca Marucci
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandro Consales
- Unit of Neurosurgery, Department of Clinical and Surgical Neurosciences and Rehabilitation, IRCCS Giannina Gaslini, Genoa, Italy
| | - Andrea Rossi
- Neuroradiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | | | | | - Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit, Department of Critical Care, IRCCS Giannina Gaslini, Genova, Italy
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15
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Sudden Unexpected Death in MELAS Syndrome Due to Diabetic Ketoacidosis. Am J Forensic Med Pathol 2021; 41:331-332. [PMID: 32732592 DOI: 10.1097/paf.0000000000000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case report of a 25 year-old man with MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes) syndrome, who died suddenly and unexpectedly from diabetic ketoacidosis. This case report illustrates why it is important for medical examiners to be familiar with the clinical and autopsy features of MELAS syndrome and to be aware of the common complications, which may lead to sudden unexpected death.
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16
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Ewida A, Ahmed R, Luo A, Ghonim HT, Anilkumar AC. Mitochondrial Myopathy, Encephalopathy, Lactic acidosis and Stroke-Like Episodes Syndrome Presenting With Anton-Babinski Syndrome and Concurrent Occipital Lobe Seizures. Cureus 2021; 13:e12908. [PMID: 33654593 PMCID: PMC7904536 DOI: 10.7759/cureus.12908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) is a complex group of disorders with multisystem involvement that have a wide range of biochemical and genetic defects. The earliest symptoms of MELAS typically include easy fatigability, muscle weakness, encephalopathy with stroke-like episodes, recurrent headaches and seizures. The pathogenesis of stroke-like episodes manifesting as focal deficits like acute cortical blindness is not fully understood. We present an eight-year-old, right-handed boy with MELAS confirmed by the presence of pathogenic missense variant mutation (mt.3243A>G) presenting with acute intermittent reversible episodes of cortical blindness and Anton-Babinski Syndrome secondary to concurrent occipital lobe seizures captured during video electroencephalography (V-EEG) monitoring, in addition to the neuro-imaging which was not consistent with acute ischemic stroke. This case highlights the importance of the V-EEG monitoring besides clinical testing and radiographic correlation during acute cortical blindness episodes in MELAS as occipital lobe seizures could be a part of the symptomatology.
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Affiliation(s)
- Amr Ewida
- Neurology, Upstate University Hospital, Syracuse, USA
| | - Rashid Ahmed
- Neurology, Upstate University Hospital, Syracuse, USA
| | - Anqi Luo
- Neurology, University of Texas (UT) Health Science Center at San Antonio, San Antonio, USA
| | - Hesham T Ghonim
- Neurology, University of Pittsburgh Medical Center, Pittsburgh, USA
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17
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Castora FJ, Conyers BL, Gershon BS, Kerns KA, Campbell R, Simsek-Duran F. The T9861C Mutation in the mtDNA-Encoded Cytochrome C Oxidase Subunit III Gene Occurs in High Frequency but with Unequal Distribution in the Alzheimer's Disease Brain. J Alzheimers Dis 2020; 72:257-269. [PMID: 31561357 DOI: 10.3233/jad-190176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mitochondrial dysfunction is recognized as a critical component in the pathogenesis of neurodegenerative diseases, including Alzheimer's disease (AD). Deficits in oxidative capacity and, specifically, cytochrome c oxidase (CO) activity have been reported in AD brains and platelets. We previously identified a point mutation at np 9861 in AD brain mitochondrial DNA (mtDNA) that alters amino acid 219 of subunit III of CO from phenylalanine to leucine. We rapidly screened and quantitated levels of T9861C in samples using mismatched PCR-RFLP and nucleotide extension assays. Six of 40 AD brains possessed the T9861C mutation (designated AD+) compared to zero of 40 age-matched control brains. The 15% frequency of T9861C in AD brain is 115-fold higher than the frequency (0.13%) reported in 9,986 human mtDNA samples queried in world-wide databases. T9861C is heteroplasmic, with mutant load varying from 11% to >95%. Detected initially in parietal cortex, T9861C is not localized to that region but is also found in temporal cortex and caudate but not in hippocampus. The mutant load is unequally distributed throughout these brain regions with the highest load occurring in the parietal or temporal cortex. CO activity normalized to citrate synthase (CS) is reduced an average of 48.5% in AD+ brains. CO/CS ratios amongst controls and the two AD populations (AD and AD+) were significantly different (p = 0.001). Post hoc differences were also significant between controls and AD+ (p = 0.001) and controls and AD (p = 0.019). There was no significant difference between AD and AD+ (p = 0.317).
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Affiliation(s)
- Frank J Castora
- Department of Physiological Sciences, Division of Biochemistry, Eastern Virginia Medical School, Norfolk, VA, USA.,Department of Neurology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Barbara L Conyers
- Department of Physiological Sciences, Division of Biochemistry, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Blake S Gershon
- Department of Physiological Sciences, Division of Biochemistry, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Kimberly A Kerns
- Department of Physiological Sciences, Division of Biochemistry, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Robert Campbell
- School of Health Professions, MPH Program, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Fatma Simsek-Duran
- Department of Physiological Sciences, Division of Biochemistry, Eastern Virginia Medical School, Norfolk, VA, USA
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18
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Oh M, Kim SA, Yoo HJ. Higher Lactate Level and Lactate-to-Pyruvate Ratio in Autism Spectrum Disorder. Exp Neurobiol 2020; 29:314-322. [PMID: 32921643 PMCID: PMC7492845 DOI: 10.5607/en20030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022] Open
Abstract
Mitochondrial dysfunction is considered one of the pathophysiological mechanisms of autism spectrum disorder (ASD). However, previous studies of biomarkers associated with mitochondrial dysfunction in ASD have revealed inconsistent results. The objective of this study was to evaluate biochemical markers associated with mitochondrial dysfunction in subjects with ASD and their unaffected family members. Lactate and pyruvate levels, as well as the lactate-to-pyruvate ratio, were examined in the peripheral blood of probands with ASD (Affected Group, AG) and their unaffected family members (biological parents and unaffected siblings, Unaffected Group, UG). Lactate ≥22 mg/dl, pyruvate ≥1.4 mg/dl, and lactate-to-pyruvate ratio >25 were defined as abnormal. The clinical variables were compared between subjects with higher (>25) and lower (≤25) lactate-to-pyruvate ratios within the AG. The AG (n=59) had a significantly higher lactate and lactate-to-pyruvate ratio than the UG (n=136). The frequency of subjects with abnormally high lactate levels and lactate-to-pyruvate ratio was significantly higher in the AG (lactate 31.0% vs. 9.5%, ratio 25.9% vs. 7.3%, p<0.01). The relationship between lactate level and the repetitive behavior domain of the Autism Diagnostic Interview-Revised was statistically significant. These results suggest that biochemical markers related to mitochondrial dysfunction, especially higher lactate levels and lactate-to-pyruvate ratio, might be associated with the pathophysiology of ASD. Further larger studies using unrelated individuals are needed to control for the possible effects of age and sex on chemical biomarker levels.
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Affiliation(s)
- Miae Oh
- Department of Psychiatry, Kyung Hee University Hospital, Seoul 02447, Korea
| | - Soon Ae Kim
- Department of Pharmacology, School of Medicine, Eulji University, Daejon 34824, Korea
| | - Hee Jeong Yoo
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam 13620, Korea.,Seoul National University College of Medicine, Seoul 08826, Korea
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19
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Kalashnikova LA, Dobrynina LA, Dreval MV, Gubanova MV, Krotenkova MV, Konovalov RN, Legenko MS. [Intracerebral hemorrhage in the late period of internal carotid artery dissection]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:28-34. [PMID: 31825359 DOI: 10.17116/jnevro201911908228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cervical artery dissection is the common cause of ischemic stroke in young and middle-age patients. According to our previous studies, dissection is related to arterial wall dysplastic changes, which in their turn are due to mitochondrial cytopathy. The authors describe three male patients who at the age of 53, 25 and 35 years underwent internal artery (ICA) dissection with occlusion of its lumen and subsequent recanalization in one of them. In 3.5 months, 13.5 years and 3 years respectively, patients developed intracerebral hemorrhage (IСH), which was not related to arterial hypertension, cerebral arterial aneurysms and anticoagulants. IСH were located on the side of ICA occluded after dissection (2 patients) or bilaterally in the territory of patent ICA (1 patient). Multivoxel 1H-MR spectroscopy performed in one patient on 40 and 48 days after ICH revealed a high lactate peak in the externally unchanged hemispheric white matter. It is assumed that mitochondrial cytopathy in patients with dissection may involve large as well as small intracerebral arteries (mitochondrial microangiopathy), which could be the cause of ICH.
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Affiliation(s)
| | | | - M V Dreval
- Research Center of Nevrology, Moscow, Russia
| | | | | | | | - M S Legenko
- Research Center of Nevrology, Moscow, Russia
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20
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Boggan RM, Lim A, Taylor RW, McFarland R, Pickett SJ. Resolving complexity in mitochondrial disease: Towards precision medicine. Mol Genet Metab 2019; 128:19-29. [PMID: 31648942 DOI: 10.1016/j.ymgme.2019.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/12/2022]
Abstract
Mitochondrial diseases, caused by mutations in either the nuclear or mitochondrial genomes (mtDNA), are the most common form of inherited neurometabolic disorders. They are remarkably heterogeneous, both in their clinical presentation and genetic etiology, presenting challenges for diagnosis, clinical management and elucidation of molecular mechanism. The multifaceted nature of these diseases, compounded by the unique characteristics of mitochondrial genetics, cement their space in the field of complex disease. In this review we examine the m.3243A>G variant, one of the most prevalent mitochondrial DNA mutations, using it as an exemplar to demonstrate the challenges presented by these complex disorders. Disease caused by m.3243A>G is one of the most phenotypically diverse of all mitochondrial diseases; we outline known causes of this heterogeneity including mtDNA heteroplasmy, mtDNA copy number and nuclear genetic factors. We consider the impact that this has in the clinic, discussing the personalized management of common manifestations attributed to this pathogenic mtDNA variant, including hearing impairment, diabetes mellitus, myopathy, cardiac disease, stroke-like episodes and gastrointestinal disturbances. Future research into this complex disorder must account for this heterogeneity, benefitting from the use of large patient cohorts to build upon current clinical expertise. Through multi-disciplinary collaboration, the complexities of this mitochondrial disease can be addressed with the variety of diagnostic, prognostic, and treatment approaches that are moulded to best fit the needs of each individual patient.
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Affiliation(s)
- Róisín M Boggan
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Albert Lim
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
| | - Sarah J Pickett
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
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21
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Yamadera M, Fujimura H, Shimizu Y, Matsui M, Nakamichi I, Yokoe M, Sakoda S. Increased number of mitochondria in capillaries distributed in stroke‐like lesions of two patients with MELAS. Neuropathology 2019; 39:404-410. [DOI: 10.1111/neup.12593] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/14/2019] [Accepted: 07/14/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Misaki Yamadera
- Department of PathologyOsaka Police Hospital Osaka Japan
- Department of NeurologyNational Hospital Organization Toneyama National Hospital Toyonaka Japan
| | - Harutoshi Fujimura
- Department of NeurologyNational Hospital Organization Toneyama National Hospital Toyonaka Japan
| | - Yuri Shimizu
- Department of Diabetes, Metabolism and EndocrinologyMinoh City Hospital Minoh Japan
| | - Misa Matsui
- Department of NeurologyNational Hospital Organization Toneyama National Hospital Toyonaka Japan
| | | | - Masaru Yokoe
- Department of NeurologyMinoh City Hospital Minoh Japan
| | - Saburo Sakoda
- Department of NeurologyNational Hospital Organization Toneyama National Hospital Toyonaka Japan
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22
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Grandhi S, Gould L, Wang J, Grandhi A, LaFramboise T. Mitochondrial genomics in the cancer cell line encyclopedia and a scoring method to effectively pair cell lines for cytoplasmic hybridization. Mitochondrion 2019; 46:256-261. [DOI: 10.1016/j.mito.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/25/2018] [Accepted: 07/13/2018] [Indexed: 12/30/2022]
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23
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Grady JP, Pickett SJ, Ng YS, Alston CL, Blakely EL, Hardy SA, Feeney CL, Bright AA, Schaefer AM, Gorman GS, McNally RJ, Taylor RW, Turnbull DM, McFarland R. mtDNA heteroplasmy level and copy number indicate disease burden in m.3243A>G mitochondrial disease. EMBO Mol Med 2019; 10:emmm.201708262. [PMID: 29735722 PMCID: PMC5991564 DOI: 10.15252/emmm.201708262] [Citation(s) in RCA: 173] [Impact Index Per Article: 34.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mitochondrial disease associated with the pathogenic m.3243A>G variant is a common, clinically heterogeneous, neurogenetic disorder. Using multiple linear regression and linear mixed modelling, we evaluated which commonly assayed tissue (blood N = 231, urine N = 235, skeletal muscle N = 77) represents the m.3243A>G mutation load and mitochondrial DNA (mtDNA) copy number most strongly associated with disease burden and progression. m.3243A>G levels are correlated in blood, muscle and urine (R2 = 0.61–0.73). Blood heteroplasmy declines by ~2.3%/year; we have extended previously published methodology to adjust for age. In urine, males have higher mtDNA copy number and ~20% higher m.3243A>G mutation load; we present formulas to adjust for this. Blood is the most highly correlated mutation measure for disease burden and progression in m.3243A>G‐harbouring individuals; increasing age and heteroplasmy contribute (R2 = 0.27, P < 0.001). In muscle, heteroplasmy, age and mtDNA copy number explain a higher proportion of variability in disease burden (R2 = 0.40, P < 0.001), although activity level and disease severity are likely to affect copy number. Whilst our data indicate that age‐corrected blood m.3243A>G heteroplasmy is the most convenient and reliable measure for routine clinical assessment, additional factors such as mtDNA copy number may also influence disease severity.
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Affiliation(s)
- John P Grady
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah J Pickett
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte L Alston
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,NHS Highly Specialised Mitochondrial Diagnostic Laboratory, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emma L Blakely
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,NHS Highly Specialised Mitochondrial Diagnostic Laboratory, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Steven A Hardy
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,NHS Highly Specialised Mitochondrial Diagnostic Laboratory, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Catherine L Feeney
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Alexandra A Bright
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew M Schaefer
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Jq McNally
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,NHS Highly Specialised Mitochondrial Diagnostic Laboratory, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Smeitink J, Koene S, Beyrath J, Saris C, Turnbull D, Janssen M. Mitochondrial Migraine: Disentangling the angiopathy paradigm in m.3243A>G patients. JIMD Rep 2019; 46:52-62. [PMID: 31240155 PMCID: PMC6498836 DOI: 10.1002/jmd2.12017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 12/12/2022] Open
Abstract
Migraine, characterized by recurrent attacks of predominantly unilateral throbbing headache, affects approximately 15% of the adult population and is an important cause of disability worldwide. Knowledge required for the development of new classes of antimigraine drugs might come from studying rare metabolic diseases associated with migraine. An illustrative example of a monogenetic disorder associated with migraine is the spectrum of disorders caused by the m.3243A>G mutation in the mitochondrial transfer RNA Leucine. Reported migraine prevalence figures in patients with this particular mutation vary considerably, but compared to the general population, m.3243A>G patients have a higher migraine prevalence. This burdensome symptom might sometimes even be the only clinical feature in maternal relatives carrying the m.3243A>G mutation. Although the exact sequence of events and the relative importance of factors underlying migraine in m.3243A>G MELAS spectrum disorders are still enigmatic, substantial evidence in man exist that dysfunctional mitochondria in both the vascular, the smooth muscle cells and the neuronal system and the interaction between these are at the starting point of the migraine developing pathophysiological cascade. Exclusively based on results of studies performed in patients harboring the m.3243A>G mutation, either in vivo or ex vivo, we here summarize our current understanding of mitochondrial angiopathy associated migraine in m.3243A>G patients which knowledge might lead to potential new avenues for migraine drug development.
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Affiliation(s)
- Jan Smeitink
- Radboud Center for Mitochondrial Medicine at the Department of Pediatrics, Radboud University Medical Center6500 HB, NijmegenThe Netherlands
- Khondrion BVNijmegenThe Netherlands
| | - Saskia Koene
- Radboud Center for Mitochondrial Medicine at the Department of Pediatrics, Radboud University Medical Center6500 HB, NijmegenThe Netherlands
| | | | - Christiaan Saris
- Department of NeurologyRadboud Center for Mitochondrial Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical CenterNijmegenThe Netherlands
| | - Douglas Turnbull
- Welcome Centre for Mitochondrial Research, Department of NeurologyNewcastle UniversityNewcastle upon TyneUK
| | - Mirian Janssen
- Radboud Center for Mitochondrial Medicine at the Department of Pediatrics, Radboud University Medical Center6500 HB, NijmegenThe Netherlands
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25
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Koga Y, Povalko N, Inoue E, Nakamura H, Ishii A, Suzuki Y, Yoneda M, Kanda F, Kubota M, Okada H, Fujii K. Therapeutic regimen of L-arginine for MELAS: 9-year, prospective, multicenter, clinical research. J Neurol 2018; 265:2861-2874. [PMID: 30269300 PMCID: PMC6244654 DOI: 10.1007/s00415-018-9057-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 12/26/2022]
Abstract
Objective To examine the efficacy and safety of the therapeutic regimen using oral and intravenous l-arginine for pediatric and adult patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). Methods In the presence and absence of an ictus of stroke-like episodes within 6 h prior to efficacy assessment, we correspondingly conducted the systematic administration of oral and intravenous l-arginine to 15 and 10 patients with MELAS in two, 2-year, prospective, multicenter clinical trials at 10 medical institutions in Japan. Subsequently, patients were followed up for 7 years. The primary endpoint in the clinical trial of oral l-arginine was the MELAS scale, while that for intravenous l-arginine was the improvement rates of headache and nausea/vomiting at 2 h after completion of the initial intravenous administration. The relationships between the ictuses of stroke-like episodes and plasma arginine concentrations were examined. Results Oral l-arginine extended the interictal phase (p = 0.0625) and decreased the incidence and severity of ictuses. Intravenous l-arginine improved the rates of four major symptoms—headache, nausea/vomiting, impaired consciousness, and visual disturbance. The maximal plasma arginine concentration was 167 μmol/L when an ictus developed. Neither death nor bedriddenness occurred during the 2-year clinical trials, and the latter did not develop during the 7-year follow-up despite the progressively neurodegenerative and eventually life-threatening nature of MELAS. No treatment-related adverse events occurred, and the formulations of l-arginine were well tolerated. Conclusions The systematic administration of oral and intravenous l-arginine may be therapeutically beneficial and clinically useful for patients with MELAS.
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Affiliation(s)
- Yasutoshi Koga
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0001, Japan.
| | - Nataliya Povalko
- Department of Pediatrics and Child Health, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0001, Japan.,Institute of Fundamental Medicine and Biology, Open Lab Gene and Cell Technology, Kazan Federal University, Kazan, Russia
| | - Eisuke Inoue
- Division of Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hidefumi Nakamura
- Center for Clinical Research and Development, National Center for Child Health and Development, Setagaya, Japan
| | - Akiko Ishii
- Department of Neurology, Tsukuba University School of Medicine, Tsukuba, Japan
| | - Yasuhiro Suzuki
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Makoto Yoneda
- Department of Neurology, Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University, Fukui, Japan
| | - Fumio Kanda
- Department of Neurology, Kobe University Hospital, Kobe, Japan
| | - Masaya Kubota
- Division of Neurology, National Center for Child Health and Development, Setagaya, Japan
| | - Hisashi Okada
- Department of Neurology, Nagoya Medical Center, Nagoya, Japan
| | - Katsunori Fujii
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan
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26
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Clinical syndromes associated with mtDNA mutations: where we stand after 30 years. Essays Biochem 2018; 62:235-254. [DOI: 10.1042/ebc20170097] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 01/16/2023]
Abstract
The landmark year 1988 can be considered as the birthdate of mitochondrial medicine, when the first pathogenic mutations affecting mtDNA were associated with human diseases. Three decades later, the field still expands and we are not ‘scraping the bottom of the barrel’ yet. Despite the tremendous progress in terms of molecular characterization and genotype/phenotype correlations, for the vast majority of cases we still lack a deep understanding of the pathogenesis, good models to study, and effective therapeutic options. However, recent technological advances including somatic cell reprogramming to induced pluripotent stem cells (iPSCs), organoid technology, and tailored endonucleases provide unprecedented opportunities to fill these gaps, casting hope to soon cure the major primary mitochondrial phenotypes reviewed here. This group of rare diseases represents a key model for tackling the pathogenic mechanisms involving mitochondrial biology relevant to much more common disorders that affect our currently ageing population, such as diabetes and metabolic syndrome, neurodegenerative and inflammatory disorders, and cancer.
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27
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Hikmat O, Naess K, Engvall M, Klingenberg C, Rasmussen M, Tallaksen CME, Brodtkorb E, Fiskerstrand T, Isohanni P, Uusimaa J, Darin N, Rahman S, Bindoff LA. Elevated cerebrospinal fluid protein inPOLG-related epilepsy: Diagnostic and prognostic implications. Epilepsia 2018; 59:1595-1602. [DOI: 10.1111/epi.14459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Omar Hikmat
- Department of Pediatrics; Haukeland University Hospital; Bergen Norway
- Department of Clinical Medicine (K1); University of Bergen; Bergen Norway
| | - Karin Naess
- Center for Inherited Metabolic Diseases; Karolinska University Hospital; Stockholm Sweden
- Department of Medical Biochemistry and Biophysics; Karolinska Institute; Stockholm Sweden
| | - Martin Engvall
- Center for Inherited Metabolic Diseases; Karolinska University Hospital; Stockholm Sweden
- Department of Molecular Medicine and Surgery; Karolinska Institute; Stockholm Sweden
| | - Claus Klingenberg
- Department of Pediatric and Adolescent Medicine; University Hospital of North Norway; Tromso Norway
- Pediatric Research Group; Department of Clinical Medicine; UiT-Arctic University of Norway; Tromso Norway
| | - Magnhild Rasmussen
- Women and Children's Division; Department of Clinical Neurosciences for Children; Oslo University Hospital; Oslo Norway
- Unit for Congenital and Hereditary Neuromuscular Disorders; Department of Neurology; Oslo University Hospital; Oslo Norway
| | - Chantal M. E. Tallaksen
- Department of Neurology; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; Faculty of Medicine; University of Oslo; Oslo Norway
| | - Eylert Brodtkorb
- Department of Neuroscience; Norwegian University of Science and Technology; Trondheim Norway
- Department of Neurology and Clinical Neurophysiology; St. Olav's University Hospital; Trondheim Norway
| | - Torunn Fiskerstrand
- Department of Medical Genetics and Molecular Medicine; Haukeland University Hospital; Bergen Norway
- Department of Clinical Science (K2); University of Bergen; Bergen Norway
| | - Pirjo Isohanni
- Department of Pediatric Neurology; Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
- Research Programs Unit; Molecular Neurology; Biomedicum Helsinki; University of Helsinki; Helsinki Finland
| | - Johanna Uusimaa
- PEDEGO Research Unit and Biocenter Oulu; University of Oulu; Oulu Finland
- Department of Children and Adolescents; Medical Research Center; Oulu University Hospital; Oulu Finland
| | - Niklas Darin
- Department of Pediatrics; Queen Silvia Children's Hospital; University of Gothenburg; Gothenburg Sweden
| | - Shamima Rahman
- Mitochondrial Research Group; University College London Great Ormond Street Institute of Child Health; London UK
- Metabolic Unit; Great Ormond Street Hospital for Children; National Health Service Foundation Trust; London UK
| | - Laurence A. Bindoff
- Department of Clinical Medicine (K1); University of Bergen; Bergen Norway
- Department of Neurology; Haukeland University Hospital; Bergen Norway
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28
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Liao J, Tian X, Wang H, Xiao Z. Epilepsy and migraine-Are they comorbidity? Genes Dis 2018; 5:112-118. [PMID: 30258939 PMCID: PMC6146266 DOI: 10.1016/j.gendis.2018.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/17/2018] [Indexed: 12/13/2022] Open
Abstract
Epilepsy and migraine often co-occur. From the clinical symptoms, they often have some signs of symptoms before onset; from the pathogenesis of epilepsy and migraine, both of them have a high degree of neuronal excitement and ion channel abnormalities; in terms of treatment, many antiepileptic drugs are work in migraine. All of this indicates that they interact with each other. But it is undeniable that there are interactions and relationships between them, and there are also some differences such as the different clinical episodes, the different ways of neuronal haperexcitability and the different drug treatment programs. And are they comorbidity? If we can better understand the correlation between seizures and migraines, then this will help develop better guidelines for clinical diagnosis and treatment.
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Affiliation(s)
- Jin Liao
- Neurology Department at Chongqing Medical University, Chongqing, China
| | - Xin Tian
- Neurology Department at Chongqing Medical University, Chongqing, China
| | - Hao Wang
- Neurology Department at Chongqing Medical University, Chongqing, China
| | - Zheng Xiao
- Neurology Department at the First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Street, Yuanjiagang, Yuzhong District, Chongqing, China
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29
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DNA Methylation-a Potential Source of Mitochondria DNA Base Mismatch in the Development of Diabetic Retinopathy. Mol Neurobiol 2018; 56:88-101. [PMID: 29679259 DOI: 10.1007/s12035-018-1086-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 04/11/2018] [Indexed: 01/09/2023]
Abstract
In the development of diabetic retinopathy, retinal mitochondria are dysfunctional, and mitochondrial DNA (mtDNA) is damaged with increased base mismatches and hypermethylated cytosines. DNA methylation is also a potential source of mutation, and in diabetes, the noncoding region, the displacement loop (D-loop), experiences more methylation and base mismatches than other regions of the mtDNA. Our aim was to investigate a possible crosstalk between mtDNA methylation and base mismatches in the development of diabetic retinopathy. The effect of inhibition of Dnmts (by 5-aza-2'-deoxycytidine or Dnmt1-siRNA) on glucose-induced mtDNA base mismatches was investigated in human retinal endothelial cells by surveyor endonuclease digestion and validated by Sanger sequencing. The role of deamination factors on increased base mismatches was determined in the cells genetically modulated for mitochondrial superoxide dismutase (Sod2) or cytidine-deaminase (APOBEC3A). The results were confirmed in an in vivo model using retinal microvasculature from diabetic mice overexpressing Sod2. Inhibition of DNA methylation, or regulation of cytosine deamination, significantly inhibited an increase in base mismatches at the D-loop and prevented mitochondrial dysfunction. Overexpression of Sod2 in mice also prevented diabetes-induced D-loop hypermethylation and increase in base mismatches. The crosstalk between DNA methylation and base mismatches continued even after termination of hyperglycemia, suggesting its role in the metabolic memory phenomenon associated with the progression of diabetic retinopathy. Inhibition of DNA methylation limits the availability of methylated cytosine for deamination, suggesting a crosstalk between DNA methylation and base mismatches. Thus, regulation of DNA methylation, or its deamination, should impede the development of diabetic retinopathy by preventing formation of base mismatches and mitochondrial dysfunction.
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30
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Pickett SJ, Grady JP, Ng YS, Gorman GS, Schaefer AM, Wilson IJ, Cordell HJ, Turnbull DM, Taylor RW, McFarland R. Phenotypic heterogeneity in m.3243A>G mitochondrial disease: The role of nuclear factors. Ann Clin Transl Neurol 2018; 5:333-345. [PMID: 29560378 PMCID: PMC5846390 DOI: 10.1002/acn3.532] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/21/2017] [Indexed: 01/23/2023] Open
Abstract
Objective The pathogenic mitochondrial DNA m.3243A>G mutation is associated with a wide range of clinical features, making disease prognosis extremely difficult to predict. We aimed to understand the cause of this heterogeneity. Methods We examined the phenotypic profile of 238 adult m.3243A>G carriers (patients and asymptomatic carriers) from the UK MRC Mitochondrial Disease Patient Cohort using the Newcastle Mitochondrial Disease Adult Scale. We modeled the role of risk factors for the development of specific phenotypes using proportional odds logistic regression. As mitochondria are under the dual control of their own and the nuclear genome, we examined the role of additive nuclear genetic factors in the development of these phenotypes within 46 pedigrees from the cohort. Results Seizures and stroke‐like episodes affect 25% and 17% of patients, respectively; more common features include hearing impairment, gastrointestinal disturbance, psychiatric involvement, and ataxia. Age, age‐adjusted blood heteroplasmy levels, and sex are poor predictors of phenotypic severity. Hearing impairment, diabetes, and encephalopathy show the strongest associations, but pseudo‐R2 values are low (0.14–0.17). We found a high heritability estimate for psychiatric involvement (h2=0.76, P = 0.0003) and moderate estimates for cognition (h2=0.46, P = 0.0021), ataxia (h2 = 0.45, P = 0.0011), migraine (h2 = 0.41, P = 0.0138), and hearing impairment (h2 = 0.40, P = 0.0050). Interpretation Our results provide good evidence for the presence of nuclear genetic factors influencing clinical outcomes in m.3234A>G‐related disease, paving the way for future work identifying these through large‐scale genetic linkage and association studies, increasing our understanding of the pathogenicity of m.3243A>G and providing improved estimates of prognosis.
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Affiliation(s)
- Sarah J Pickett
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - John P Grady
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne UK.,Present address: Kinghorn Centre for Clinical Genomics Garvan Institute Sydney NSW Australia
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - Andrew M Schaefer
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - Ian J Wilson
- Institute of Genetic Medicine Newcastle University Newcastle upon Tyne UK
| | - Heather J Cordell
- Institute of Genetic Medicine Newcastle University Newcastle upon Tyne UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research Institute of Neuroscience Newcastle University Newcastle upon Tyne UK
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31
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Haast RAM, Ivanov D, IJsselstein RJT, Sallevelt SCEH, Jansen JFA, Smeets HJM, de Coo IFM, Formisano E, Uludağ K. Anatomic & metabolic brain markers of the m.3243A>G mutation: A multi-parametric 7T MRI study. NEUROIMAGE-CLINICAL 2018; 18:231-244. [PMID: 29868447 PMCID: PMC5984598 DOI: 10.1016/j.nicl.2018.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/13/2017] [Accepted: 01/15/2018] [Indexed: 02/08/2023]
Abstract
One of the most common mitochondrial DNA (mtDNA) mutations, the A to G transition at base pair 3243, has been linked to changes in the brain, in addition to commonly observed hearing problems, diabetes and myopathy. However, a detailed quantitative description of m.3243A>G patients' brains has not been provided so far. In this study, ultra-high field MRI at 7T and volume- and surface-based data analyses approaches were used to highlight morphology (i.e. atrophy)-, microstructure (i.e. myelin and iron concentration)- and metabolism (i.e. cerebral blood flow)-related differences between patients (N = 22) and healthy controls (N = 15). The use of quantitative MRI at 7T allowed us to detect subtle changes of biophysical processes in the brain with high accuracy and sensitivity, in addition to typically assessed lesions and atrophy. Furthermore, the effect of m.3243A>G mutation load in blood and urine epithelial cells on these MRI measures was assessed within the patient population and revealed that blood levels were most indicative of the brain's state and disease severity, based on MRI as well as on neuropsychological data. Morphometry MRI data showed a wide-spread reduction of cortical, subcortical and cerebellar gray matter volume, in addition to significantly enlarged ventricles. Moreover, surface-based analyses revealed brain area-specific changes in cortical thickness (e.g. of the auditory cortex), and in T1, T2* and cerebral blood flow as a function of mutation load, which can be linked to typically m.3243A>G-related clinical symptoms (e.g. hearing impairment). In addition, several regions linked to attentional control (e.g. middle frontal gyrus), the sensorimotor network (e.g. banks of central sulcus) and the default mode network (e.g. precuneus) were characterized by alterations in cortical thickness, T1, T2* and/or cerebral blood flow, which has not been described in previous MRI studies. Finally, several hypotheses, based either on vascular, metabolic or astroglial implications of the m.3243A>G mutation, are discussed that potentially explain the underlying pathobiology. To conclude, this is the first 7T and also the largest MRI study on this patient population that provides macroscopic brain correlates of the m.3243A>G mutation indicating potential MRI biomarkers of mitochondrial diseases and might guide future (longitudinal) studies to extensively track neuropathological and clinical changes.
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Key Words
- 15-WLT, 15-Words Learning Task
- 7T MRI
- ADL, Activities daily life
- ASL, Arterial spin labeling
- Brain
- CBF, Cerebral blood flow
- CN, Caudate nucleus
- CNR, Contrast-to-noise ratio
- CSF, Cerebral spinal fluid
- DN, Dentate nucleus
- EPI, Echo planar imaging
- FWHM, Full-width half maximum
- GM, Gray matter
- GP, Globus pallidus
- IQR, Interquartile range
- LDST, Letter-Digit Substitution test
- Leu, Leucine
- MANOVA, Multivariate analysis of variance
- MELAS, Mitochondrial encephalopathy lactic acidosis and stroke-like episodes
- MIDD, Mitochondrial inherited deafness and diabetes
- Mitochondrial
- NMDAS, Newcastle Mitochondrial Disease Adult Scale
- OXPHOS, Oxidative phosphorylation
- Pu, Putamen
- Quantitative
- RF, Radio frequency
- RN, Red nucleus
- ROI, Region of interest
- SLEs, Stroke-like cortical episodes
- SN, Substantia nigra
- SNR, Signal-to-noise ratio
- T, Tesla
- UECs, Urine epithelial cells
- UHF, Ultra-high field
- WM, White matter
- WMLs, White matter lesions
- cGM, Cortical gray matter
- eTIV, Estimated total intracranial volume
- m.3243A>G
- mtDNA, Mitochondrial DNA
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Affiliation(s)
- Roy A M Haast
- Department of Cognitive Neuroscience, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands; Maastricht Centre for Systems Biology, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands.
| | - Dimo Ivanov
- Department of Cognitive Neuroscience, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands
| | | | - Suzanne C E H Sallevelt
- Department of Clinical Genetics, Maastricht University Medical Centre, PO Box 5800, 6202AZ Maastricht, Netherlands
| | - Jacobus F A Jansen
- Department of Radiology, Maastricht University Medical Centre and School for Mental Health and Neuroscience, Maastricht University, PO Box 5800, 6202AZ Maastricht, Netherlands
| | - Hubert J M Smeets
- Department of Genetics and Cell Biology, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands; NeMo Expertise Centre, Postbus 2060, 3000CB Rotterdam, Netherlands; Research School GROW, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands
| | - Irenaeus F M de Coo
- Department of Neurology, Erasmus MC, Postbus 2040, 3000CA Rotterdam, Netherlands; NeMo Expertise Centre, Postbus 2060, 3000CB Rotterdam, Netherlands
| | - Elia Formisano
- Department of Cognitive Neuroscience, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands; Maastricht Centre for Systems Biology, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands
| | - Kâmil Uludağ
- Department of Cognitive Neuroscience, Maastricht University, PO Box 616, 6200MD Maastricht, Netherlands.
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Bindu PS, Sonam K, Govindaraj P, Govindaraju C, Chiplunkar S, Nagappa M, Kumar R, Vekhande CC, Arvinda HR, Gayathri N, Srinivas Bharath MM, Ponmalar JNJ, Philip M, Vandana VP, Khan NA, Nunia V, Paramasivam A, Sinha S, Thangaraj K, Taly AB. Outcome of epilepsy in patients with mitochondrial disorders: Phenotype genotype and magnetic resonance imaging correlations. Clin Neurol Neurosurg 2017; 164:182-189. [PMID: 29272804 DOI: 10.1016/j.clineuro.2017.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Studies exploring the outcome of epilepsy in patients with mitochondrial disorders are limited. This study examined the outcome of epilepsy in patients with mitochondrial disorders and its relation with the clinical phenotype, genotype and magnetic resonance imaging findings. PATIENTS AND METHODS The cohort was derived from the database of 67 patients with definite genetic diagnosis of mitochondrial disorders evaluated over a period of 11years (2006-2016). Among this, 27 had epilepsy and were included in final analysis. Data were analyzed with special reference to clinical phenotypes, genotypes, epilepsy characteristics, EEG findings, anti epileptic drugs used, therapeutic response, and magnetic resonance imaging findings. Patients were divided into three groups according to the seizure frequency at the time of last follow up: Group I- Seizure free; Group II- Infrequent seizures; Group III- uncontrolled seizures. For each group the clinical phenotype, genotype, magnetic resonance imaging and duration of epilepsy were compared. RESULTS The phenotypes & genotypes included Mitochondrial Encephalopathy Lactic Acidosis and Stroke like episodes (MELAS) & m.3243A>G mutation (n = 10), Myoclonic Epilepsy Ragged Red Fiber syndrome (MERRF) & m.8344A>G mutation (n = 4), Chronic Progressive External Ophthalmoplegia plus &POLG1 mutation (CPEO, n = 6), episodic neuroregression due to nuclear mutations (n = 6; NDUFV1 (n = 3), NDUFA1, NDUFS2, MPV17-1 one each), and one patient with infantile basal ganglia stroke syndrome, mineralizing angiopathy &MT-ND5 mutations. Seven patients (25.9%) were seizure free; seven had infrequent seizures (25.9%), while thirteen (48.1%) had frequent uncontrolled seizures. Majority of the subjects in seizure free group had episodic neuroregression & leukoencephalopathy due to nuclear mutations (85.7%). Patients in group II with infrequent seizures had CPEO, POLG1 mutation and a normal MRI (71%) while 62% of the subjects in group III had MELAS, m.3243A>G mutation and stroke like lesions on MRI. CONCLUSIONS A fair correlation exists between the outcome of epilepsy, clinical phenotypes, genotypes and magnetic resonance imaging findings in patients with mitochondrial disorders. The recognition of these patterns is important clinically because of the therapeutic and prognostic implications.
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Affiliation(s)
- Parayil Sankaran Bindu
- Dept. of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Neuromuscular lab-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Kothari Sonam
- Dept. of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Neuromuscular lab-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Periyasamy Govindaraj
- Dept. of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Neuromuscular lab-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Chikkanna Govindaraju
- Dept. of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shwetha Chiplunkar
- Dept. of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Neuromuscular lab-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Madhu Nagappa
- Dept. of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Neuromuscular lab-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rakesh Kumar
- Dept. of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Hanumanthapura R Arvinda
- Dept. of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Narayanappa Gayathri
- Dept. of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Neuromuscular lab-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - M M Srinivas Bharath
- Dept. of Neurochemistry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - J N Jessiena Ponmalar
- Neuromuscular lab-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Mariyamma Philip
- Dept. of Biostatistics, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - V P Vandana
- Dept. of Speech Pathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Vandana Nunia
- CSIR-Centre for Cellular and Molecular Biology, Hyderabad, India
| | | | - Sanjib Sinha
- Dept. of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | | | - Arun B Taly
- Dept. of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India; Neuromuscular lab-Neurobiology Research Centre, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
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Whitehead MT, Wien M, Lee B, Bass N, Gropman A. Black Toenail Sign in MELAS Syndrome. Pediatr Neurol 2017; 75:61-65. [PMID: 28818358 DOI: 10.1016/j.pediatrneurol.2017.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 06/26/2017] [Accepted: 06/29/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome is a mitochondrial disorder often causing progressive brain injury that is not confined to large arterial territories. Severe insults ultimately lead to gyral necrosis affecting the cortex and juxtacortical white matter; the neuroimaging correlate is partial gyral signal suppression on T2/FLAIR sequences that resemble black toenails. We aimed to characterize the imaging features and the natural history of MELAS-related gyral necrosis. MATERIALS AND METHODS Databases at two children's hospitals were searched for brain magnetic resonance imaging studies of individuals with MELAS. Examinations with motion artifact and those lacking T2/FLAIR sequences were excluded. The location, the cumulative number, and the maximum transverse diameter of necrotic gyral lesions were assessed using T2-weighted images and T2/FLAIR sequences. Wilcoxon signed-rank test was employed to evaluate the relationship between disease duration and the number of necrotic lesions. RESULTS One hundred twenty-four examinations from patients with 14 unique MELAS patients (16 ± 3 years) were evaluated. Six of the eight patients who developed brain lesions also developed gyral necroses (mean 13, range 0 to 44). Necrotic lesions varied in maximal diameter from 4 to 25 mm. Cumulative necrotic lesions correlated with disease duration (P < 0.001). CONCLUSIONS The black toenail sign signifying gyral necrosis is a common imaging feature in individuals with MELAS syndrome. The extent of gyral necrosis correlates with disease duration.
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Affiliation(s)
- Matthew T Whitehead
- Department of Neuroradiology, Children's National Medical Center, Washington, District of Columbia; Department of Radiology, George Washington University School of Medicine, Washington, District of Columbia.
| | - Michael Wien
- Rainbow Babies and Children's Hospital, University Hospital Cleveland Medical Center, Cleveland, Ohio; Department of Radiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Bonmyong Lee
- Department of Radiology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Nancy Bass
- Rainbow Babies and Children's Hospital, University Hospital Cleveland Medical Center, Cleveland, Ohio; Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Andrea Gropman
- Department of Neurology, Children's National Medical Center, Washington, District of Columbia
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Reda HM, Copen WA, Karaa A, Oakley DH. Case 13-2017. A 41-Year-Old Man with Hearing Loss, Seizures, Weakness, and Cognitive Decline. N Engl J Med 2017; 376:1668-1678. [PMID: 28445665 DOI: 10.1056/nejmcpc1616022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Haatem M Reda
- From the Departments of Neurology (H.M.R.), Radiology (W.A.C.), Pediatrics (A.K.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Neurology (H.M.R.), Radiology (W.A.C.), Pediatrics (A.K.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - William A Copen
- From the Departments of Neurology (H.M.R.), Radiology (W.A.C.), Pediatrics (A.K.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Neurology (H.M.R.), Radiology (W.A.C.), Pediatrics (A.K.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Amel Karaa
- From the Departments of Neurology (H.M.R.), Radiology (W.A.C.), Pediatrics (A.K.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Neurology (H.M.R.), Radiology (W.A.C.), Pediatrics (A.K.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
| | - Derek H Oakley
- From the Departments of Neurology (H.M.R.), Radiology (W.A.C.), Pediatrics (A.K.), and Pathology (D.H.O.), Massachusetts General Hospital, and the Departments of Neurology (H.M.R.), Radiology (W.A.C.), Pediatrics (A.K.), and Pathology (D.H.O.), Harvard Medical School - both in Boston
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Tzoulis C, Henriksen E, Miletic H, Bindoff LA. No evidence of ischemia in stroke-like lesions of mitochondrial POLG encephalopathy. Mitochondrion 2017; 32:10-15. [DOI: 10.1016/j.mito.2016.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 11/15/2022]
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Alston CL, Rocha MC, Lax NZ, Turnbull DM, Taylor RW. The genetics and pathology of mitochondrial disease. J Pathol 2016; 241:236-250. [PMID: 27659608 PMCID: PMC5215404 DOI: 10.1002/path.4809] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 12/30/2022]
Abstract
Mitochondria are double-membrane-bound organelles that are present in all nucleated eukaryotic cells and are responsible for the production of cellular energy in the form of ATP. Mitochondrial function is under dual genetic control - the 16.6-kb mitochondrial genome, with only 37 genes, and the nuclear genome, which encodes the remaining ∼1300 proteins of the mitoproteome. Mitochondrial dysfunction can arise because of defects in either mitochondrial DNA or nuclear mitochondrial genes, and can present in childhood or adulthood in association with vast clinical heterogeneity, with symptoms affecting a single organ or tissue, or multisystem involvement. There is no cure for mitochondrial disease for the vast majority of mitochondrial disease patients, and a genetic diagnosis is therefore crucial for genetic counselling and recurrence risk calculation, and can impact on the clinical management of affected patients. Next-generation sequencing strategies are proving pivotal in the discovery of new disease genes and the diagnosis of clinically affected patients; mutations in >250 genes have now been shown to cause mitochondrial disease, and the biochemical, histochemical, immunocytochemical and neuropathological characterization of these patients has led to improved diagnostic testing strategies and novel diagnostic techniques. This review focuses on the current genetic landscape associated with mitochondrial disease, before focusing on advances in studying associated mitochondrial pathology in two, clinically relevant organs - skeletal muscle and brain. © 2016 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Charlotte L Alston
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Mariana C Rocha
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Nichola Z Lax
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Doug M Turnbull
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Robert W Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, UK
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Baertling F, Klee D, Haack TB, Prokisch H, Meitinger T, Mayatepek E, Schaper J, Distelmaier F. The many faces of paediatric mitochondrial disease on neuroimaging. Childs Nerv Syst 2016; 32:2077-2083. [PMID: 27449766 DOI: 10.1007/s00381-016-3190-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 07/08/2016] [Indexed: 01/11/2023]
Abstract
The knowledge about the genetic spectrum underlying paediatric mitochondrial diseases is rapidly growing. As a consequence, the range of neuroimaging findings associated with mitochondrial diseases became extremely broad. This has important implications for radiologists and clinicians involved in the care of these patients. Here, we provide a condensed overview of brain magnetic resonance imaging (MRI) findings in children with genetically confirmed mitochondrial diseases. The neuroimaging spectrum ranges from classical Leigh syndrome with symmetrical lesions in basal ganglia and/or brain stem to structural abnormalities including cerebellar hypoplasia and corpus callosum dysgenesis. We highlight that, although some imaging patterns can be suggestive of a genetically defined mitochondrial syndrome, brain MRI-based candidate gene prioritization is only successful in a subset of patients.
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Affiliation(s)
- Fabian Baertling
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Dirk Klee
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Tobias B Haack
- Institute of Human Genetics, Technische Universität München, Trogerstr. 32, 81675, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Holger Prokisch
- Institute of Human Genetics, Technische Universität München, Trogerstr. 32, 81675, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technische Universität München, Trogerstr. 32, 81675, Munich, Germany
- Institute of Human Genetics, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jörg Schaper
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Felix Distelmaier
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany.
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Mancuso M, Montano V, Orsucci D, Peverelli L, Caputi L, Gambaro P, Siciliano G, Lamperti C. Mitochondrial m.3243A > G mutation and carotid artery dissection. Mol Genet Metab Rep 2016; 9:12-4. [PMID: 27656415 PMCID: PMC5021764 DOI: 10.1016/j.ymgmr.2016.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/30/2022] Open
Abstract
The common m.3243A > G mutation of the mitochondrial DNA tRNALeu (UUR) gene is a maternally inherited mutation causing a wide spectrum of neurological and multisystemic disorders, including MELAS, characterized by recurrent cerebral infarction from young age. Vascular pathology in mitochondrial diseases has been described for small vessels, while large vessels involvement in mitochondrial diseases is considered rare. Here we report two female patients harboring the m.3243A > G mutation, in whom the diagnosis of mitochondrial disease was made after acute dissection of the internal carotid arteries. Our cases expand the clinical spectrum of this mutation, and support the idea of large vessels vasculopathy due to impaired mitochondrial function in the vessel wall that may lead to arterial wall weakness. Thus, stroke in mitochondrial diseases could also be related to large vessels disease, but further studies are strongly needed. Moreover, mitochondrial aetiology should be kept in mind in patients with large vessel dissection, especially in those with additional mitochondrial red flags.
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Affiliation(s)
- Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - Vincenzo Montano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - Daniele Orsucci
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - Lorenzo Peverelli
- Unit of Molecular Neurogenetics, The Foundation "Carlo Besta" Institute of Neurology - IRCCS Milan, Italy
| | - Luigi Caputi
- Unit of Neurovascular diseases, The Foundation "Carlo Besta" Institute of Neurology - IRCCS, Milan, Italy
| | - Paola Gambaro
- Department of Neurology, L. Sacco Hospital, University of Milan, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, Neurological Clinic, University of Pisa, Italy
| | - Costanza Lamperti
- Unit of Molecular Neurogenetics, The Foundation "Carlo Besta" Institute of Neurology - IRCCS Milan, Italy
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Tsujikawa K, Senda J, Yasui K, Hasegawa Y, Hoshiyama M, Katsuno M, Sobue G. Distinctive distribution of brain volume reductions in MELAS and mitochondrial DNA A3243G mutation carriers: A voxel-based morphometric study. Mitochondrion 2016; 30:229-35. [PMID: 27558483 DOI: 10.1016/j.mito.2016.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 07/08/2016] [Accepted: 08/19/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the clinically latent brain atrophy of patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) harboring a mitochondrial DNA A3243G mutation (A3243G) and A3243G carriers without stroke-like episodes (SEs). METHODS We used voxel-based morphometry (VBM) with magnetic resonance imaging to investigate gray matter (GM) and white matter (WM) volume reductions in four MELAS patients and in five A3243G carriers compared to 16 healthy controls. In addition, we investigated the regions of previous SEs using conventional MRI. RESULTS All four MELAS patients showed significant GM volume reductions in the left superior parietal lobule (SPL), right precuneus, right middle temporal gyrus (MTG), and bilateral posterior lobes of the cerebellum. These areas of GM volume reduction were beyond the regions of previous SEs. As for A3243G carriers, GM volume reductions in the left SPL, right precuneus, right MTG, and bilateral posterior lobes of the cerebellum were detected in three, one, two, and five subjects, respectively. All four MELAS patients showed significant WM volume reductions in the bilateral or unilateral temporal sub-gyral regions, which were included in the regions of previous SEs. No A3243G carriers showed WM volume reductions. CONCLUSION The distribution patterns of GM volume reductions in VBM may reflect a common vulnerability of the brains among MELAS patients and A3243G carriers.
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Affiliation(s)
- Koyo Tsujikawa
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Joe Senda
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Neurology, Komaki City Hospital, Komaki, Japan
| | - Keizo Yasui
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, Nagoya Daini Red Cross Hospital, Nagoya, Japan; Department of Occupational Therapy, College of Life and Health Sciences, Chubu University, Kasugai, Japan
| | - Minoru Hoshiyama
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Lax NZ, Gorman GS, Turnbull DM. Review: Central nervous system involvement in mitochondrial disease. Neuropathol Appl Neurobiol 2016; 43:102-118. [PMID: 27287935 PMCID: PMC5363248 DOI: 10.1111/nan.12333] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/03/2016] [Accepted: 06/11/2016] [Indexed: 12/13/2022]
Abstract
Mitochondrial respiratory chain defects are an important cause of inherited disorders affecting approximately 1 in 5000 people in the UK population. Collectively these disorders are termed ‘mitochondrial diseases’ and they result from either mitochondrial DNA mutations or defects in nuclear DNA. Although they are frequently multisystem disorders, neurological deficits are particularly common, wide‐ranging and disabling for patients. This review details the manifold neurological impairments associated with mitochondrial disease, and describes the efforts to understand how they arise and progressively worsen in patients with mitochondrial disease. We describe advances in our understanding of disease pathogenesis through detailed neuropathological studies and how this has spurred the development of cellular and animal models of disease. We underscore the importance of continued clinical, molecular genetic, neuropathological and animal model studies to fully characterize mitochondrial diseases and understand mechanisms of neurodegeneration. These studies are instrumental for the next phase of mitochondrial research that has a particular emphasis on finding novel ways to treat mitochondrial disease to improve patient care and quality of life.
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Affiliation(s)
- N Z Lax
- The Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - G S Gorman
- The Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D M Turnbull
- The Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Abstract
BACKGROUND the maternally inherited MTTL1 A3243G mutation in the mitochondrial genome causes MelaS (Mitochondrial encephalopathy lactic acidosis with Stroke-like episodes), a condition that is multisystemic but affects primarily the nervous system. Significant intra-familial variation in phenotype and severity of disease is well recognized. METHODS retrospective and ongoing study of an extended family carrying the MTTL1 A3243G mutation with multiple symptomatic individuals. tissue heteroplasmy is reviewed based on the clinical presentations, imaging studies, laboratory findings in affected individuals and pathological material obtained at autopsy in two of the family members. RESULTS there were seven affected individuals out of thirteen members in this three generation family who each carried the MTTL1 A3243G mutation. the clinical presentations were varied with symptoms ranging from hearing loss, migraines, dementia, seizures, diabetes, visual manifestations, and stroke like episodes. three of the family members are deceased from MelaS or to complications related to MelaS. CONCLUSIONS the results of the clinical, pathological and radiological findings in this family provide strong support to the current concepts of maternal inheritance, tissue heteroplasmy and molecular pathogenesis in MelaS. neurologists (both adult and paediatric) are the most likely to encounter patients with MelaS in their practice. genetic counselling is complex in view of maternal inheritance and heteroplasmy. newer therapeutic options such as arginine are being used for acute and preventative management of stroke like episodes.
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Finsterer J, Zarrouk-Mahjoub S. Mitochondrial vasculopathy. World J Cardiol 2016; 8:333-339. [PMID: 27231520 PMCID: PMC4877362 DOI: 10.4330/wjc.v8.i5.333] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 01/16/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
Mitochondrial disorders (MIDs) are usually multisystem disorders (mitochondrial multiorgan disorder syndrome) either on from onset or starting at a point during the disease course. Most frequently affected tissues are those with a high oxygen demand such as the central nervous system, the muscle, endocrine glands, or the myocardium. Recently, it has been shown that rarely also the arteries may be affected (mitochondrial arteriopathy). This review focuses on the type, diagnosis, and treatment of mitochondrial vasculopathy in MID patients. A literature search using appropriate search terms was carried out. Mitochondrial vasculopathy manifests as either microangiopathy or macroangiopathy. Clinical manifestations of mitochondrial microangiopathy include leukoencephalopathy, migraine-like headache, stroke-like episodes, or peripheral retinopathy. Mitochondrial macroangiopathy manifests as atherosclerosis, ectasia of arteries, aneurysm formation, dissection, or spontaneous rupture of arteries. The diagnosis relies on the documentation and confirmation of the mitochondrial metabolic defect or the genetic cause after exclusion of non-MID causes. Treatment is not at variance compared to treatment of vasculopathy due to non-MID causes. Mitochondrial vasculopathy exists and manifests as micro- or macroangiopathy. Diagnosing mitochondrial vasculopathy is crucial since appropriate treatment may prevent from severe complications.
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Lorenzoni PJ, Werneck LC, Kay CSK, Silvado CES, Scola RH. When should MELAS (Mitochondrial myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like episodes) be the diagnosis? ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 73:959-67. [PMID: 26517220 DOI: 10.1590/0004-282x20150154] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 06/23/2015] [Indexed: 12/13/2022]
Abstract
Mitochondrial myopathy, Encephalopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) is a rare mitochondrial disorder. Diagnostic criteria for MELAS include typical manifestations of the disease: stroke-like episodes, encephalopathy, evidence of mitochondrial dysfunction (laboratorial or histological) and known mitochondrial DNA gene mutations. Clinical features of MELAS are not necessarily uniform in the early stages of the disease, and correlations between clinical manifestations and physiopathology have not been fully elucidated. It is estimated that point mutations in the tRNALeu(UUR) gene of the DNAmt, mainly A3243G, are responsible for more of 80% of MELAS cases. Morphological changes seen upon muscle biopsy in MELAS include a substantive proportion of ragged red fibers (RRF) and the presence of vessels with a strong reaction for succinate dehydrogenase. In this review, we discuss mainly diagnostic criterion, clinical and laboratory manifestations, brain images, histology and molecular findings as well as some differential diagnoses and current treatments.
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Affiliation(s)
- Paulo José Lorenzoni
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Lineu Cesar Werneck
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Cláudia Suemi Kamoi Kay
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Rosana Herminia Scola
- Departamento de Clínica Médica, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Fryer RH, Bain J, De Vivo D. Mitochondrial Encephalomyopathy Lactic Acidosis and Stroke-Like Episodes (MELAS): A Case Report and Critical Reappraisal of Treatment Options. Pediatr Neurol 2016; 56:59-61. [PMID: 26797286 PMCID: PMC4789111 DOI: 10.1016/j.pediatrneurol.2015.12.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 12/15/2015] [Indexed: 01/31/2023]
Abstract
IMPORTANCE Stroke-like episodes signal progression and significant disability in the mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes syndrome. Arginine is widely used as a treatment for stroke-like episode, although there is little evidence for this intervention. We discuss the management of a patient with mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes who presented with a stroke-like episode. OBSERVATION During a seizure, which triggers the stroke-like episode, neurons are forced to utilize glycolysis as a source of adenosine triphosphate. Glycolytic by-products are damaging to the neuron. Breakdown of the blood-brain barrier leads to vasogenic edema. CONCLUSION Treatment of stroke-like episode should include anticonvulsants interictally to prevent seizures and dexamethasone ictally to help repair the blood-brain barrier.
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Affiliation(s)
- Robert H. Fryer
- Department of Neurology, Columbia University Medical Center, New York, NY,Corresponding Author: Robert H. Fryer, MD, PHD, 180 Fort Washington Avenue, Harkness 5th floor, New York, NY 10032, 212-342-2919 (P), 212-342-6865 (F),
| | - Jennifer Bain
- Department of Neurology, Columbia University Medical Center, New York, NY
| | - Darryl De Vivo
- Department of Neurology, Columbia University Medical Center, New York, NY
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Shah NH, Adams D. Episodic Aphasia Associated With Cortical Spreading Depression After Subdural Hemorrhage Evacuation. Neurohospitalist 2016; 6:NP1-4. [PMID: 26740859 DOI: 10.1177/1941874415583118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Cortical spreading depression (CSD) has been associated with many pathological entities including migraine, trauma, hemorrhage, and mitochondrial disease. The clinical diagnosis remains challenging without the other concomitant features such as headache because CSD can mimic seizure or acute stroke. Wereport of a 77 year-old right handed man with a left subdural hematoma evacuation that subsequently developed episodic aphasia, slurred speech, right nasolabial fold flattening, and right pronator drift. In this case report, we discuss our multimodal diagnostic approach and treatment in a patient with episodic aphasia and neurological deficits in order to propose the diagnosis of cortical spreading depression. CSD should be considered when focal deficits in brief episodes occur after stroke and seizures have been ruled out. Treatment choices as illustrated by this case report can have an impact on outcome and resolution of episodes.
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Affiliation(s)
- Nirav H Shah
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
| | - David Adams
- Department of Neurology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA
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Kwong KK, Chan ST. Neuroprotection and acidosis induced by cortical spreading depression. Neuropsychiatr Dis Treat 2016; 12:3191-3194. [PMID: 28003755 PMCID: PMC5161389 DOI: 10.2147/ndt.s125677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kenneth K Kwong
- Department of Radiology, MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Suk-Tak Chan
- Department of Radiology, MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
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48
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Kiruluta AJ, González RG. Magnetic resonance angiography. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:137-149. [PMID: 27432663 DOI: 10.1016/b978-0-444-53485-9.00007-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Whittaker RG, Devine HE, Gorman GS, Schaefer AM, Horvath R, Ng Y, Nesbitt V, Lax NZ, McFarland R, Cunningham MO, Taylor RW, Turnbull DM. Epilepsy in adults with mitochondrial disease: A cohort study. Ann Neurol 2015; 78:949-57. [PMID: 26381753 PMCID: PMC4737309 DOI: 10.1002/ana.24525] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of this work was to determine the prevalence and progression of epilepsy in adult patients with mitochondrial disease. METHODS We prospectively recruited a cohort of 182 consecutive adult patients attending a specialized mitochondrial disease clinic in Newcastle upon Tyne between January 1, 2005 and January 1, 2008. We then followed this cohort over a 7-year period, recording primary outcome measures of occurrence of first seizure, status epilepticus, stroke-like episode, and death. RESULTS Overall prevalence of epilepsy in the cohort was 23.1%. Mean age of epilepsy onset was 29.4 years. Prevalence varied widely between genotypes, with several genotypes having no cases of epilepsy, a prevalence of 34.9% in the most common genotype (m.3243A>G mutation), and 92.3% in the m.8344A>G mutation. Among the cohort as a whole, focal seizures, with or without progression to bilateral convulsive seizures, was the most common seizure type. Conversely, all of the patients with the m.8344A>G mutation and epilepsy experienced myoclonic seizures. Patients with the m.3243A>G mutation remain at high risk of developing stroke-like episodes (1.16% per year). However, although the standardized mortality ratio for the entire cohort was high (2.86), this ratio did not differ significantly between patients with epilepsy (2.96) and those without (2.83). INTERPRETATION Epilepsy is a common manifestation of mitochondrial disease. It develops early in the disease and, in the case of the m.3243A>G mutation, often presents in the context of a stroke-like episode or status epilepticus. However, epilepsy does not itself appear to contribute to the increased mortality in mitochondrial disease.
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Affiliation(s)
- Roger G Whittaker
- Institute of Neuroscience, Henry Wellcome Building for Neuroecology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Helen E Devine
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Grainne S Gorman
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Andrew M Schaefer
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rita Horvath
- Institute of Genetic Medicine, International Center for Life, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Yi Ng
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Victoria Nesbitt
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Nichola Z Lax
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert McFarland
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark O Cunningham
- Institute of Neuroscience, Henry Wellcome Building for Neuroecology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Robert W Taylor
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Douglass M Turnbull
- Wellcome Trust Center for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
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50
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Bindu PS, Arvinda H, Taly AB, Govindaraju C, Sonam K, Chiplunkar S, Kumar R, Gayathri N, Bharath Mm S, Nagappa M, Sinha S, Khan NA, Govindaraj P, Nunia V, Paramasivam A, Thangaraj K. Magnetic resonance imaging correlates of genetically characterized patients with mitochondrial disorders: A study from south India. Mitochondrion 2015; 25:6-16. [PMID: 26341968 DOI: 10.1016/j.mito.2015.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/16/2015] [Accepted: 08/21/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Large studies analyzing magnetic resonance imaging correlates in different genotypes of mitochondrial disorders are far and few. This study sought to analyze the pattern of magnetic resonance imaging findings in a cohort of genetically characterized patients with mitochondrial disorders. METHODS The study cohort included 33 patients (age range 18 months-50 years, M:F - 0.9:1) with definite mitochondrial disorders seen over a period of 8 yrs. (2006-2013). Their MR imaging findings were analyzed retrospectively. RESULTS The patients were classified into three groups according to the genotype, Mitochondrial point mutations and deletions (n=21), SURF1 mutations (n=7) and POLG1 (n=5). The major findings included cerebellar atrophy (51.4%), cerebral atrophy (24.2%), signal changes in basal ganglia (45.7%), brainstem (34.2%) & white matter (18.1%) and stroke like lesions (25.7%). Spinal cord imaging showed signal changes in 4/6 patients. Analysis of the special sequences revealed, basal ganglia mineralization (7/22), lactate peak on magnetic resonance spectrometry (10/15), and diffusion restriction (6/22). Follow-up images in six patients showed that the findings are dynamic. Comparison of the magnetic resonance imaging findings in the three groups showed that cerebral atrophy and cerebellar atrophy, cortical signal changes and basal ganglia mineralization were seen mostly in patients with mitochondrial mutation. Brainstem signal changes with or without striatal lesions were characteristically noted in SURF1 group. There was no consistent imaging pattern in POLG1 group. CONCLUSION Magnetic resonance imaging findings in mitochondrial disorders are heterogeneous. Definite differences were noted in the frequency of anatomical involvement in the three groups. Familiarity with the imaging findings in different genotypes of mitochondrial disorders along with careful analysis of the family history, clinical presentation, biochemical findings, histochemical and structural analysis will help the physician for targeted metabolic and genetic testing.
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Affiliation(s)
- Parayil Sankaran Bindu
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Hanumanthapura Arvinda
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Arun B Taly
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India.
| | - Chikanna Govindaraju
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Kothari Sonam
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Shwetha Chiplunkar
- Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rakesh Kumar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Narayanappa Gayathri
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Srinivas Bharath Mm
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Madhu Nagappa
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Sanjib Sinha
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Nahid Akthar Khan
- Centre for Scientific and Industrial Research-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, India
| | - Periyasamy Govindaraj
- Centre for Scientific and Industrial Research-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, India
| | - Vandana Nunia
- Centre for Scientific and Industrial Research-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, India
| | - Arumugam Paramasivam
- Centre for Scientific and Industrial Research-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, India
| | - Kumarasamy Thangaraj
- Centre for Scientific and Industrial Research-Centre for Cellular and Molecular Biology (CSIR-CCMB), Hyderabad, India
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