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Carmona Alexandrino H, Ferreira MA, Ramalho D, Jesus NR, Oliveira MJ. Endocrine Challenges in Myoclonic Epilepsy With Ragged Red Fibers Syndrome: A Case Report. Cureus 2023; 15:e51114. [PMID: 38274904 PMCID: PMC10810140 DOI: 10.7759/cureus.51114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Myoclonic epilepsy with ragged red fibers (MERRF) syndrome is a primary mitochondrial disorder characterized by myoclonus, epilepsy, ataxia, and muscle fiber abnormalities. While traditionally associated with neurological features, MERRF's multisystem nature extends to endocrine dysfunction, including diabetes mellitus, thyroid disorders, and adrenal abnormalities. This case report explores the multifaceted nature of MERRF syndrome by presenting the clinical journey of a 70-year-old woman who sought care at the endocrinology clinic due to coexisting Addison's disease and diabetes mellitus, marked by recurrent hypoglycemia and suboptimal metabolic control. Over time, she developed a history of myoclonic epilepsy, effectively managed with lamotrigine, along with mild sensory axonal polyneuropathy and ataxia. The patient was diagnosed with MERRF syndrome following her son's diagnosis, which had a severe form. This case underscores the intricate interplay between mitochondrial dysfunction and endocrine manifestations in MERRF syndrome, highlighting the importance of a comprehensive and multidisciplinary approach to patient care. MERRF syndrome's array of endocrine manifestations substantially impacts patients' quality of life and morbidity. A comprehensive approach, uniting endocrinologists, neurologists, geneticists, and other specialists, is essential for effective patient care. Further research is warranted to unravel the complex mitochondrial-endocrine interactions in MERRF syndrome, offering potential insights for improved management.
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Affiliation(s)
| | - Marta A Ferreira
- Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, PRT
| | - Diogo Ramalho
- Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, PRT
| | - Nuno R Jesus
- Cancer Signalling & Metabolism, Instituto de Investigação e Inovação em Saúde da Universidade do Porto (i3S), Porto, PRT
- Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, PRT
| | - Maria J Oliveira
- Department of Endocrinology, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, PRT
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Long H, Wen C, Zhao J, Wang J, Li Y, Fu X, Huang L. ENT characteristics and therapeutic results in multisystemic disorders of mitochondrial encephalomyopathy. Eur J Med Res 2022; 27:221. [DOI: 10.1186/s40001-022-00832-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 09/28/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractHere we report the evaluation of the frequency of subjective and objective otolaryngologic findings and therapeutic results in 32 patients with mitochondrial encephalomyopathy (MEM) from September 2001 to June 2021. Our analysis included studying the patients’ family histories, the clinical manifestations of MEM, and the therapeutic effects of treatments. The patients’ ages ranged from 2 to 77 years, with a median age of 12.3 years. We found that MEM ENT symptoms were characterized by hearing loss, dysphagia, and facial weakness. Most cases of sensorineural hearing loss were bilateral symmetrical progressive or sudden deafness since adolescence, which were often underestimated. Associated neuromuscular symptoms required mtDNA testing. Dysphagia and facial weakness occurred preferentially in middle-aged patients, and muscle biopsies were advised. Distortion product otoacoustic emissions and auditory brainstem responsetesting were more sensitive and reliable than pure tone averages for objective monitoring of pathogenesis. Administration of the mitochondrial synthase complex benefited patients with acute episodes. If patients did not fully recover and exhibitedresidual language deficits, hearing aids or cochlear implants were recommended. Counsel was given regarding synthetical treatments for facial weakness, endoscopic circopharyngealmyotomy for dysphagia, and surgical correction of ptosis. This study demonstrates that increased awareness of these symptoms is important to address appropriate interventions and avoid complications such as ablepsia, aphasia, social isolation, malnutrition, aspiration pneumonia, and heart failure in the setting of MEM.
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da Silveira WA, Fazelinia H, Rosenthal SB, Laiakis EC, Kim MS, Meydan C, Kidane Y, Rathi KS, Smith SM, Stear B, Ying Y, Zhang Y, Foox J, Zanello S, Crucian B, Wang D, Nugent A, Costa HA, Zwart SR, Schrepfer S, Elworth RAL, Sapoval N, Treangen T, MacKay M, Gokhale NS, Horner SM, Singh LN, Wallace DC, Willey JS, Schisler JC, Meller R, McDonald JT, Fisch KM, Hardiman G, Taylor D, Mason CE, Costes SV, Beheshti A. Comprehensive Multi-omics Analysis Reveals Mitochondrial Stress as a Central Biological Hub for Spaceflight Impact. Cell 2021; 183:1185-1201.e20. [PMID: 33242417 DOI: 10.1016/j.cell.2020.11.002] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/01/2020] [Accepted: 11/02/2020] [Indexed: 12/11/2022]
Abstract
Spaceflight is known to impose changes on human physiology with unknown molecular etiologies. To reveal these causes, we used a multi-omics, systems biology analytical approach using biomedical profiles from fifty-nine astronauts and data from NASA's GeneLab derived from hundreds of samples flown in space to determine transcriptomic, proteomic, metabolomic, and epigenetic responses to spaceflight. Overall pathway analyses on the multi-omics datasets showed significant enrichment for mitochondrial processes, as well as innate immunity, chronic inflammation, cell cycle, circadian rhythm, and olfactory functions. Importantly, NASA's Twin Study provided a platform to confirm several of our principal findings. Evidence of altered mitochondrial function and DNA damage was also found in the urine and blood metabolic data compiled from the astronaut cohort and NASA Twin Study data, indicating mitochondrial stress as a consistent phenotype of spaceflight.
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Affiliation(s)
| | - Hossein Fazelinia
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | | | - Man S Kim
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Cem Meydan
- Weill Cornell Medical College, New York, NY 10065, USA
| | - Yared Kidane
- Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA
| | - Komal S Rathi
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | - Benjamin Stear
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yue Ying
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Yuanchao Zhang
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jonathan Foox
- Weill Cornell Medical College, New York, NY 10065, USA
| | | | | | - Dong Wang
- University of California San Francisco, San Francisco, CA 94115, USA
| | | | | | - Sara R Zwart
- University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Sonja Schrepfer
- University of California San Francisco, San Francisco, CA 94115, USA
| | | | | | | | | | | | | | - Larry N Singh
- Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Douglas C Wallace
- Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | | - Robert Meller
- Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - J Tyson McDonald
- Georgetown University Medical Center, Washington D.C. 20057, USA
| | | | - Gary Hardiman
- Queens University Belfast, Belfast BT9 5DL, UK; Medical University of South Carolina, Charleston, SC 29425, USA
| | - Deanne Taylor
- The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Center for Mitochondrial and Epigenomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | | | - Afshin Beheshti
- KBR, NASA Ames Research Center, Moffett Field, CA 94035, USA.
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Zweers HEE, Janssen MCH, Wanten GJA. Optimal Estimate for Energy Requirements in Adult Patients With the m.3243A>G Mutation in Mitochondrial DNA. JPEN J Parenter Enteral Nutr 2020; 45:158-164. [PMID: 32696575 PMCID: PMC7891583 DOI: 10.1002/jpen.1965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 01/17/2023]
Abstract
Aim We aimed to identify the optimal method to estimate total energy expenditure (TEE) in mitochondrial disease (MD) patients. Methods Resting energy expenditure (REE) was measured in MD patients carrying the m3243A>G mutation using indirect calorimetry (IC) and compared with results of 21 predictive equations (PEs) for REE and with REE‐IC measurements in healthy controls. Physical activity level (PAL) was measured using accelerometery (SenseWear) and compared with a fixed average PAL (1.4) as well as patients’ self‐estimated activity levels. TEE was calculated as REE‐IC × PAL SenseWear and compared with usual care and energy recommendations for healthy adults. Results Thirty‐eight MD patients (age: 48 ± 13 years; body mass index 24 ± 4 kg/m2; male 20%) and 25 matched controls were included. The accuracy of most PEs was between 63% and 76%. The difference in REE‐IC in healthy controls (1532 ± 182 kcal) and MD patients (1430 ± 221) was borderline not significant (P = .052). Patients’ estimations PAL were 18%–34% accurate at the individual level. The fixed activity factor was 53% accurate. Patients overestimated their PAL. Usual care predicted TEE accurately in only 32% of patients. Conclusion TEE is lower in these MD patients than the recommendations for healthy adults because of their lower physical activity. In MD patients, 6 PEs for REE provide a reliable alternative for IC, with an accuracy of 71%–76%. As PAL is highly variable and not reliably estimated by patients, measurement of PAL using accelerometery is recommended in this population.
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Affiliation(s)
- Heidi E E Zweers
- Radboud Center for Mitochondrial Medicine, Nijmegen, the Netherlands.,Department of Gastroenterology and Hepatology-Dietetics, Radboudumc, Nijmegen, the Netherlands
| | - Mirian C H Janssen
- Radboud Center for Mitochondrial Medicine, Nijmegen, the Netherlands.,Department of Internal Medicine, Radboudumc, Nijmegen, the Netherlands
| | - Geert J A Wanten
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, the Netherlands
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Zweers HEE, Bordier V, In 't Hulst J, Janssen MCH, Wanten GJA, Leij-Halfwerk S. Association of Body Composition, Physical Functioning, and Protein Intake in Adult Patients With Mitochondrial Diseases. JPEN J Parenter Enteral Nutr 2020; 45:165-174. [PMID: 32189351 PMCID: PMC7891597 DOI: 10.1002/jpen.1826] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/08/2019] [Accepted: 02/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Whether decreased physical functioning of patients with mitochondrial disease (MD) is related to altered body composition or low protein intake needs clarification at the background of the nutrition state. METHODS In this 2-site cross-sectional study, MD patients were age-, body mass index (BMI)-, and gender-matched to controls. Body composition was assessed by dual-energy x-ray absorptiometry. Physical functioning was measured by handgrip strength, 6-minute walking test, 30-second sit-to-stand test (30SCT), and 6-minute mastication test. Total daily protein intake was calculated by 3-day food records. Malnutrition was assessed by Patient-Generated Subjective Global Assessment and the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia by the 2018 consensus. Data were analyzed using independent samples t-tests, Fisher exact test, and Spearman and Pearson correlation coefficients. RESULTS Thirty-seven MD patients (42 ± 12 years, BMI: 23 ± 4 kg/m2 , 59% females) and 37 matched controls were included. Handgrip strength was moderate, inversely related to fat mass index in both MD patients and controls, whereas it correlated with fat-free mass index in controls solely. Protein intake was associated with muscle strength (handgrip strength and 30SCT) in MD patients but not in controls. Twenty-seven MD patients (73%) were malnourished, and 5 (14%) were classified as sarcopenic. CONCLUSIONS Muscle strength is related to body composition and protein intake in MD patients. This, in combination with the high incidence of both malnutrition and sarcopenia, warrants individual nutrition assessment in MD patients.
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Affiliation(s)
- Heidi E E Zweers
- Department of Gastroenterology and Hepatology-Dietetics, Radboudumc, Nijmegen, the Netherlands.,Department of Nutrition and dietetics, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Valentine Bordier
- Department of Nutrition and dietetics, HAN University of Applied Sciences, Nijmegen, the Netherlands.,Department of Health Science and Technology, ETHZ, Zurich, Switzerland
| | - Jeanne In 't Hulst
- Department of Gastroenterology and Hepatology-Dietetics, Radboudumc, Nijmegen, the Netherlands.,Department of Nutrition and dietetics, HAN University of Applied Sciences, Nijmegen, the Netherlands.,Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | | | - Geert J A Wanten
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, the Netherlands
| | - Susanne Leij-Halfwerk
- Department of Gastroenterology and Hepatology-Dietetics, Radboudumc, Nijmegen, the Netherlands.,Department of Nutrition and dietetics, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Russell BS, Hosek RS, Hoiriis KT, Drake ED. Chronic Progressive External Ophthalmoplegia and Bilateral Vestibular Hypofunction: Balance, Gait, and Eye Movement Before and After Multimodal Chiropractic Care: A Case Study. J Chiropr Med 2019; 18:144-154. [PMID: 31367202 DOI: 10.1016/j.jcm.2018.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/12/2018] [Accepted: 11/02/2018] [Indexed: 12/11/2022] Open
Abstract
Objective The purpose of this report is to describe care of a patient with chronic progressive external ophthalmoplegia and bilateral vestibular hypofunction. Clinical Features A 66-year-old patient presented with limited eye movement and mild ptosis, which led to a diagnosis of chronic progressive external ophthalmoplegia. Rotary chair testing suggested vestibular involvement. Other symptoms included dizziness, problems with balance, and chronic stiffness in his cervical and thoracic regions. He had anxiety about loss of function and limited exercise habits because of fear of falling. Examination methods included balance assessment, kinetic aspects of walking, and videonystagmography. Intervention and Outcome He had already begun regular practice of vestibular rehabilitation exercises before receiving 18 sessions of manual and instrument-assisted chiropractic manipulation, along with mobilization, stretching, and transverse massage, over 37 weeks. In addition to self-reported improvements, there was substantially decreased postural sway during balance assessment and there were small improvements in eye movement, ptosis, and walking. Conclusion This patient showed improvements in balance, eye movements, and walking while undergoing multimodal chiropractic care and practicing eye and balance exercises.
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Affiliation(s)
- Brent S Russell
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
| | - Ronald S Hosek
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
| | - Kathryn T Hoiriis
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
| | - Emily D Drake
- Dr. Sid E. Williams Center for Chiropractic Research, Life University, Marietta, Georgia
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Rinninella E, Mele MC, Merendino N, Cintoni M, Anselmi G, Caporossi A, Gasbarrini A, Minnella AM. The Role of Diet, Micronutrients and the Gut Microbiota in Age-Related Macular Degeneration: New Perspectives from the Gut⁻Retina Axis. Nutrients 2018; 10:nu10111677. [PMID: 30400586 PMCID: PMC6267253 DOI: 10.3390/nu10111677] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022] Open
Abstract
Age-related macular degeneration (AMD) is a complex multifactorial disease and the primary cause of legal and irreversible blindness among individuals aged ≥65 years in developed countries. Globally, it affects 30–50 million individuals, with an estimated increase of approximately 200 million by 2020 and approximately 300 million by 2040. Currently, the neovascular form may be able to be treated with the use of anti-VEGF drugs, while no effective treatments are available for the dry form. Many studies, such as the randomized controlled trials (RCTs) Age-Related Eye Disease Study (AREDS) and AREDS 2, have shown a potential role of micronutrient supplementation in lowering the risk of progression of the early stages of AMD. Recently, low-grade inflammation, sustained by dysbiosis and a leaky gut, has been shown to contribute to the development of AMD. Given the ascertained influence of the gut microbiota in systemic low-grade inflammation and its potential modulation by macro- and micro-nutrients, a potential role of diet in AMD has been proposed. This review discusses the role of the gut microbiota in the development of AMD. Using PubMed, Web of Science and Scopus, we searched for recent scientific evidence discussing the impact of dietary habits (high-fat and high-glucose or -fructose diets), micronutrients (vitamins C, E, and D, zinc, beta-carotene, lutein and zeaxanthin) and omega-3 fatty acids on the modulation of the gut microbiota and their relationship with AMD risk and progression.
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Affiliation(s)
- Emanuele Rinninella
- UOC di Nutrizione Clinica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.
| | - Maria Cristina Mele
- UOC di Nutrizione Clinica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.
| | - Nicolò Merendino
- Laboratorio di Nutrizione Cellulare e Molecolare, Dipartimento di Scienze Ecologiche e Biologiche (DEB), Università della Tuscia, Largo dell'Università snc, 01100 Viterbo, Italy.
| | - Marco Cintoni
- Scuola di Specializzazione in Scienza dell'Alimentazione, Università di Roma Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
| | - Gaia Anselmi
- UOC di Nutrizione Clinica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
| | - Aldo Caporossi
- UOC di Oculistica, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
- Istituto di Oftalmologia, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.
| | - Antonio Gasbarrini
- UOC di Nutrizione Clinica, Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
- Istituto di Patologia Speciale Medica, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.
| | - Angelo Maria Minnella
- UOC di Oculistica, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
- Istituto di Oftalmologia, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy.
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