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Pizzamiglio C, Bugiardini E, Macken WL, Woodward CE, Hanna MG, Pitceathly RDS. Mitochondrial Strokes: Diagnostic Challenges and Chameleons. Genes (Basel) 2021; 12:1643. [PMID: 34681037 PMCID: PMC8535945 DOI: 10.3390/genes12101643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 01/18/2023] Open
Abstract
Mitochondrial stroke-like episodes (SLEs) are a hallmark of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). They should be suspected in anyone with an acute/subacute onset of focal neurological symptoms at any age and are usually driven by seizures. Suggestive features of an underlying mitochondrial pathology include evolving MRI lesions, often originating within the posterior brain regions, the presence of multisystemic involvement, including diabetes, deafness, or cardiomyopathy, and a positive family history. The diagnosis of MELAS has important implications for those affected and their relatives, given it enables early initiation of appropriate treatment and genetic counselling. However, the diagnosis is frequently challenging, particularly during the acute phase of an event. We describe four cases of mitochondrial strokes to highlight the considerable overlap that exists with other neurological disorders, including viral and autoimmune encephalitis, ischemic stroke, and central nervous system (CNS) vasculitis, and discuss the clinical, laboratory, and imaging features that can help distinguish MELAS from these differential diagnoses.
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Affiliation(s)
- Chiara Pizzamiglio
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (C.P.); (E.B.); (W.L.M.); (M.G.H.)
| | - Enrico Bugiardini
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (C.P.); (E.B.); (W.L.M.); (M.G.H.)
| | - William L. Macken
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (C.P.); (E.B.); (W.L.M.); (M.G.H.)
| | - Cathy E. Woodward
- Neurogenetics Unit, The National Hospital for Neurology and Neurosurgery, London WC1N 3BH, UK;
| | - Michael G. Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (C.P.); (E.B.); (W.L.M.); (M.G.H.)
| | - Robert D. S. Pitceathly
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (C.P.); (E.B.); (W.L.M.); (M.G.H.)
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Pappalardo P, Benoist JF, Bax BE, Carra-Dallière C, Marelli C, Levene M, Begue L, Rolland A, Flori N, Rivier F, Blanchet C, Munnich A, Altwegg R, Meyer P, Roubertie A. Pregnancy in MNGIE: a clinical and metabolic honeymoon. Ann Clin Transl Neurol 2020; 7:2484-2488. [PMID: 33159497 PMCID: PMC7732247 DOI: 10.1002/acn3.51202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an inherited disease caused by a deficiency in thymidine phosphorylase and characterized by elevated systemic deoxyribonucleotides and gastrointestinal (GI) and neurological manifestations. We report the clinical and biochemical manifestations that were evaluated in a single patient before, during, and after pregnancy, over a period of 7 years. GI symptoms significantly improved, and plasma deoxyribonucleotide concentrations decreased during pregnancy. Within days after delivery, the patient's digestive symptoms recurred, coinciding with a rapid increase in plasma deoxyribonucleotide concentrations. We hypothesize that the clinico-metabolic improvements could be attributed to the enzyme replacement action of the placental thymidine phosphorylase.
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Affiliation(s)
| | | | - Bridget E Bax
- Molecular and Clinical Sciences, St George's University of London, London, SW17 0RE, UK
| | - Clarisse Carra-Dallière
- Département de Neurologie, CHU Gui de Chauliac, Inserm U1198 MMDN, Univ Montpellier, Montpellier, France
| | - Cecilia Marelli
- Département de Neurologie, CHU Gui de Chauliac, Inserm U1198 MMDN, Univ Montpellier, Montpellier, France
| | - Michele Levene
- Molecular and Clinical Sciences, St George's University of London, London, SW17 0RE, UK
| | - Laetitia Begue
- Département de Gynéco-obstétrique, CHU Arnaud de Villeneuve, Montpellier, France
| | - Anne Rolland
- Département de Pédiatrie, CHU Nantes, Nantes, France
| | - Nicolas Flori
- Département des Soins de Support, Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - François Rivier
- Département de Neuropédiatrie, CHU Gui de Chauliac, Montpellier, France
- U1046 INSERM, UMR9214 CNRS, Université de Montpellier, Montpellier, France
| | - Catherine Blanchet
- Service d'ORL et Chirurgie Cervico Faciale, CHU Gui de Chauliac, Montpellier, France
| | | | - Romain Altwegg
- Département de Gastroentérologie, CHU St Eloi, Montpellier, France
| | - Pierre Meyer
- Département de Neuropédiatrie, CHU Gui de Chauliac, Montpellier, France
- U1046 INSERM, UMR9214 CNRS, Université de Montpellier, Montpellier, France
| | - Agathe Roubertie
- Département de Neuropédiatrie, CHU Gui de Chauliac, Montpellier, France
- Institut des Neurosciences de Montpellier, INSERM U1051, Université de Montpellier, Montpellier, France
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Kripps K, Nakayuenyongsuk W, Shayota BJ, Berquist W, Gomez-Ospina N, Esquivel CO, Concepcion W, Sampson JB, Cristin DJ, Jackson WE, Gilliland S, Pomfret EA, Kueht ML, Pettit RW, Sherif YA, Emrick LT, Elsea SH, Himes R, Hirano M, Van Hove JLK, Scaglia F, Enns GM, Larson AA. Successful liver transplantation in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). Mol Genet Metab 2020; 130:58-64. [PMID: 32173240 PMCID: PMC8399858 DOI: 10.1016/j.ymgme.2020.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/19/2022]
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a fatal disorder characterized by progressive gastrointestinal dysmotility, peripheral neuropathy, leukoencephalopathy, skeletal myopathy, ophthalmoparesis, and ptosis. MNGIE stems from deficient thymidine phosphorylase activity (TP) leading to toxic elevations of plasma thymidine. Hematopoietic stem cell transplant (HSCT) restores TP activity and halts disease progression but has high transplant-related morbidity and mortality. Liver transplant (LT) was reported to restore TP activity in two adult MNGIE patients. We report successful LT in four additional MNGIE patients, including a pediatric patient. Our patients were diagnosed between ages 14 months and 36 years with elevated thymidine levels and biallelic pathogenic variants in TYMP. Two patients presented with progressive gastrointestinal dysmotility, and three demonstrated progressive peripheral neuropathy with two suffering limitations in ambulation. Two patients, including the child, had liver dysfunction and cirrhosis. Following LT, thymidine levels nearly normalized in all four patients and remained low for the duration of follow-up. Disease symptoms stabilized in all patients, with some manifesting improvements, including intestinal function. No patient died, and LT appeared to have a more favorable safety profile than HSCT, especially when liver disease is present. Follow-up studies will need to document the long-term impact of this new approach on disease outcome. Take Home Message: Liver transplantation is effective in stabilizing symptoms and nearly normalizing thymidine levels in patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) and may have an improved safety profile over hematopoietic stem cell transplant.
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Affiliation(s)
- KimberlyA Kripps
- Department of Pediatrics, Section of Genetics and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Brian J Shayota
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - William Berquist
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Natalia Gomez-Ospina
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Carlos O Esquivel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Waldo Concepcion
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jacinda B Sampson
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - David J Cristin
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Samuel Gilliland
- Department of Anesthesia, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth A Pomfret
- Division of Transplant Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael L Kueht
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Rowland W Pettit
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Youmna A Sherif
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Lisa T Emrick
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Ryan Himes
- Department of Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Houston, TX, USA
| | - Michio Hirano
- Department of Neurology, Columbia University Medical Center, New York City, NY, USA
| | - Johan L K Van Hove
- Department of Pediatrics, Section of Genetics and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA
| | - Fernando Scaglia
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, USA; Joint BCM-CUHK Center of Medical Genetics, Prince of Wales Hospital, ShaTin, Hong Kong
| | - Gregory M Enns
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Austin A Larson
- Department of Pediatrics, Section of Genetics and Metabolism, University of Colorado School of Medicine, Aurora, CO, USA.
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Pacitti D, Bax BE. The development of an in vitro cerebral organoid model for investigating the pathomolecular mechanisms associated with the central nervous system involvement in Mitochondrial Neurogastrointestinal Encephalomyopathy (MNGIE). Nucleosides Nucleotides Nucleic Acids 2018; 37:603-617. [PMID: 30587077 DOI: 10.1080/15257770.2018.1492139] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/14/2018] [Indexed: 02/08/2023]
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare disorder caused by mutations in the thymidine phosphorylase gene (TYMP), leading to secondary aberrations to the mitochondrial genome. The disease is characterised by gastrointestinal dysmotility, sensorimotor peripheral neuropathy and leukoencephalopathy. The understanding of the molecular mechanisms that underlie the central nervous system (CNS) is hindered by the lack of a representative disease model; to address this we have developed an in vitro 3-D cerebral organoid of MNGIE. Induced pluripotent stem cells (iPSCs) generated from peripheral blood mononuclear cells (PBMCs) of a healthy control and a patient with MNGIE were characterised to ascertain bona fide pluripotency through the evaluation of pluripotency markers and the differentiation to the germ layers. iPSC lines were differentiated into cerebral organoids. Thymidine phosphorylase expression in PBMCs, iPSCs and Day 92 organoids was evaluated by immunoblotting and intact organoids were sampled for histological evaluation of neural markers. iPSCs demonstrated the expression of pluripotency markers SOX2 and TRA1-60 and the plasticity to differentiate into the germ layers. Cerebral organoids stained positive for the neural markers GFAP, O4, Tuj1, Nestin, SOX2 and MBP. Consistent with the disease phenotypes, MNGIE cells did not display thymidine phosphorylase expression whereas control PBMCs and Day 92 organoids did. Remarkably, control iPSCs did not stain positive for thymidine phosphorylase. We have established for the first time a MNGIE iPSC line and cerebral organoid model, which exhibited the expression of cells relevant to the study of the disease, such as neural stem cells, astrocytes and myelinating oligodendrocytes.
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Affiliation(s)
- Dario Pacitti
- a Molecular & Clinical Sciences Research Institute, St. George's, University of London, United Kingdom
| | - Bridget E Bax
- a Molecular & Clinical Sciences Research Institute, St. George's, University of London, United Kingdom
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Affiliation(s)
- Fabrizio Elia
- High Dependency Unit, San Giovanni Bosco Hospital, Turin, Italy.
| | - Michele Covella
- Department of Medical Sciences, Città della Salute e della Scienza, Turin, Italy
| | | | - Franco Aprà
- High Dependency Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Vincenzo Crupi
- Department of Philosophy and Education, Center for Logic, Language and Cognition, University of Turini, Turin, Italy
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Bruni F, Di Meo I, Bellacchio E, Webb BD, McFarland R, Chrzanowska‐Lightowlers ZM, He L, Skorupa E, Moroni I, Ardissone A, Walczak A, Tyynismaa H, Isohanni P, Mandel H, Prokisch H, Haack T, Bonnen PE, Enrico B, Pronicka E, Ghezzi D, Taylor RW, Diodato D. Clinical, biochemical, and genetic features associated with VARS2-related mitochondrial disease. Hum Mutat 2018; 39:563-578. [PMID: 29314548 PMCID: PMC5873438 DOI: 10.1002/humu.23398] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/21/2017] [Accepted: 12/28/2017] [Indexed: 01/17/2023]
Abstract
In recent years, an increasing number of mitochondrial disorders have been associated with mutations in mitochondrial aminoacyl‐tRNA synthetases (mt‐aaRSs), which are key enzymes of mitochondrial protein synthesis. Bi‐allelic functional variants in VARS2, encoding the mitochondrial valyl tRNA‐synthetase, were first reported in a patient with psychomotor delay and epilepsia partialis continua associated with an oxidative phosphorylation (OXPHOS) Complex I defect, before being described in a patient with a neonatal form of encephalocardiomyopathy. Here we provide a detailed genetic, clinical, and biochemical description of 13 patients, from nine unrelated families, harboring VARS2 mutations. All patients except one, who manifested with a less severe disease course, presented at birth exhibiting severe encephalomyopathy and cardiomyopathy. Features included hypotonia, psychomotor delay, seizures, feeding difficulty, abnormal cranial MRI, and elevated lactate. The biochemical phenotype comprised a combined Complex I and Complex IV OXPHOS defect in muscle, with patient fibroblasts displaying normal OXPHOS activity. Homology modeling supported the pathogenicity of VARS2 missense variants. The detailed description of this cohort further delineates our understanding of the clinical presentation associated with pathogenic VARS2 variants and we recommend that this gene should be considered in early‐onset mitochondrial encephalomyopathies or encephalocardiomyopathies.
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Affiliation(s)
- Francesco Bruni
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Ivano Di Meo
- Molecular Neurogenetics UnitFoundation IRCCS Neurological Institute C. BestaMilanItaly
| | - Emanuele Bellacchio
- Genetics and Rare DiseasesResearch Division‘Bambino Gesù’ Children HospitalRomeItaly
| | - Bryn D. Webb
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew York
| | - Robert McFarland
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | | | - Langping He
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Ewa Skorupa
- Department of BiochemistryRadioimmunology and Experimental MedicineThe Children's Memorial Health InstituteWarsawPoland
| | - Isabella Moroni
- Child Neurology UnitFoundation IRCCS Neurological Institute “C. Besta”MilanItaly
| | - Anna Ardissone
- Molecular Neurogenetics UnitFoundation IRCCS Neurological Institute C. BestaMilanItaly
- Child Neurology UnitFoundation IRCCS Neurological Institute “C. Besta”MilanItaly
- Department of Molecular and Translational Medicine DIMETUniversity of Milan‐BicoccaMilanItaly
| | - Anna Walczak
- Department of Medical GeneticsCentre of BiostructureMedical University of WarsawWarsawPoland
| | - Henna Tyynismaa
- Research Programs UnitMolecular NeurologyUniversity of HelsinkiHelsinkiFinland
| | - Pirjo Isohanni
- Research Programs UnitMolecular NeurologyUniversity of HelsinkiHelsinkiFinland
- Department of Pediatric NeurologyChildren's HospitalUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | - Hanna Mandel
- Institute of Human Genetics and Metabolic DiseasesGalilee Medical CenterNahariyaIsrael
| | - Holger Prokisch
- Institute of Human GeneticsTechnische Universität MünchenMunichGermany
- Institute of Human GeneticsHelmholtz Zentrum MünchenNeuherbergGermany
| | - Tobias Haack
- Institute of Human GeneticsHelmholtz Zentrum MünchenNeuherbergGermany
| | - Penelope E. Bonnen
- Department of Molecular and Human GeneticsBaylor College of MedicineHoustonTexas
| | - Bertini Enrico
- Unit of Neuromuscular and Neurodegenerative DisordersLaboratory of Molecular Medicine‘Bambino Ges.’ Children's Research HospitalRomeItaly
| | - Ewa Pronicka
- Department of PediatricsNutrition and Metabolic DiseasesThe Children's Memorial Health InstituteWarsawPoland
| | - Daniele Ghezzi
- Molecular Neurogenetics UnitFoundation IRCCS Neurological Institute C. BestaMilanItaly
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - Robert W. Taylor
- Wellcome Centre for Mitochondrial ResearchInstitute of NeuroscienceNewcastle UniversityNewcastle upon TyneUnited Kingdom
| | - Daria Diodato
- Unit of Neuromuscular and Neurodegenerative DisordersLaboratory of Molecular Medicine‘Bambino Ges.’ Children's Research HospitalRomeItaly
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Tatla SK, Holsti L, Andrews GS, Feichtinger L, Steele R, Siden H. Charting the territory: Describing the functional abilities of children with progressive neurological conditions. Res Dev Disabil 2017; 71:191-199. [PMID: 29054023 DOI: 10.1016/j.ridd.2017.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 09/15/2017] [Accepted: 10/02/2017] [Indexed: 06/07/2023]
Abstract
AIMS Little is known about the functional abilities of children with progressive genetic, metabolic, or neurological conditions (PNCs). In this study, children with PNCs were followed over a 2-year period to assess their functional abilities over time. Specific aims were to: 1) describe the changes in functional skills and the effects of age for children with PNCs, 2) assess changes in these children's need for caregiver assistance over time, and 3) examine relationships between these children's functional skills and need for caregiver assistance. METHODS This study involved a longitudinal, descriptive design with three assessments occurring at Baseline, Year 1, Year 2. Functional skills and caregiver assistance were assessed by the Pediatric Evaluation of Disability Inventory (PEDI). The PEDI questionnaire was completed at baseline and then yearly by parents, along with the assistance of a trained research assistant (RA). RESULTS The study was completed with 83 children (mean age at Baseline=7.1yrs, SD=4.6). Mean Functional skills scores were in the low ranges at Baseline and did not change significantly across time points (F(2, 71)=0.437, p=0.58). Time point had no effect on caregiver assistance ratings (p<0.2); however, children required greater amounts of help with self-care at later time points than for other functional domains. Statistically significant correlations were found between PEDI-Functional skills and caregiver assistance ratings (r=0.80-0.90, p<0.01). CONCLUSIONS Functional skills were low for these children overall, irrespective of age. In children with PNCs: 1) mean functional skills did not change significantly over time; 2) caregiver assistance scores remained stable and 3) functional skills and levels of caregiver assistance were strongly positively correlated. Further research to explore the long-term functional trajectory in children with a PNC is recommended.
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Affiliation(s)
- Sandy K Tatla
- BC Children's and Women's Health Centre, BC Children's Hospital Research Institute, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Liisa Holsti
- Department of Occupational Science and Occupational Therapy, University of British Columbia and BC Children's Hospital Research Institute, Clinical Support Building, V3-327, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Gail Stephanie Andrews
- University of British Columbia, BC Children's Hospital Research Institute, F611-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Leanne Feichtinger
- University of British Columbia, BC Children's Hospital Research Institute, F611-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Rose Steele
- School of Nursing, Faculty of Health, York University, Room 342 HNES Building, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Harold Siden
- Department of Pediatrics, University of British Columbia, BC Children's Hospital Research Institute, F612a-4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
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Wang HF, Wang J, Wang YL, Fan JJ, Mo GL, Gong FY, Chai ZM, Zhang J, Meng HX, Li CX, Guo JH, Pu CQ. A novel thymidine phosphorylase mutation in a Chinese MNGIE patient. Acta Neurol Belg 2017; 117:259-267. [PMID: 27709505 DOI: 10.1007/s13760-016-0701-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/19/2016] [Indexed: 01/06/2023]
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder associated with mitochondrial alterations. MNGIE is characterized by severe gastrointestinal dysmotility, cachexia, ophthalmoplegia, ptosis, peripheral neuropathy, and leukoencephalopathy. The condition is caused by mutation of the TYMP gene. We studied the clinical and biochemical characteristics of a family with MNGIE. The proband was a 48-year-old male presenting with diarrhea and progressive weight loss. He also had ptosis and exhibited eyeball fixation. His blood and cerebrospinal fluid lactate levels were elevated. Magnetic resonance imaging of the brain revealed diffuse leukoencephalopathy. Ragged red fibers and cytochrome c oxidase-deficient fibers were apparent on muscle biopsy. His vision and ptosis deteriorated significantly during follow-up. Our clinical diagnosis of MNGIE was confirmed by TYMP gene analysis. We discovered a homozygous TYMP c.1193-1216 dup-GGGCGCTGCCGCTGGCGCTGGTGC mutation (a duplication). Some of the family members were heterozygous for the mutation but had no clinical features. We predicted the function of this mutation using PredictProtein and found that the secondary structure had changed in the region of the helix and strand, the transmembrane region, and the protein-protein binding sites. The family described herein exhibited biochemically, genetically, and functionally confirmed MNGIE syndrome.
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Affiliation(s)
- Hui-Fang Wang
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China
- Department of Neurology, Chinese People's Liberation Army General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China
| | - Juan Wang
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China
| | - Yan-Ling Wang
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China
| | - Jian-Jian Fan
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China
| | - Gui-Lin Mo
- Department of Molecular Genetics, Guangzhou Kingmed Center for Clinical Laboratory Co., Ltd., Guangzhou, 510330, Guangdong, People's Republic of China
| | - Feng-Yin Gong
- Department of Endocrinology, Key Laboratory of Endocrinology of the Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, People's Republic of China
| | - Zhi-Ming Chai
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China
| | - Jin Zhang
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China
| | - Hua-Xing Meng
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China
| | - Chang-Xin Li
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China
| | - Jun-Hong Guo
- Department of Neurology, ShanXi Medical Univeristy of First Hospital, No. 85, Jiefang South Road, Taiyuan, 030001, ShanXi, People's Republic of China.
| | - Chuan-Qiang Pu
- Department of Neurology, Chinese People's Liberation Army General Hospital, No. 28, Fuxing Road, Beijing, 100853, People's Republic of China.
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Tashiro R, Onoue N, Rikimaru H, Tsukita K, Fujita H, Yamaguchi N, Ishizuka T, Suzuki Y, Suzuki H, Shinozaki T. Mitochondrial Cardiomyopathy with a Unique 99mTc-MIBI/ 123I-BMIPP Mismatch Pattern. Intern Med 2017; 56:321-325. [PMID: 28154277 PMCID: PMC5348457 DOI: 10.2169/internalmedicine.56.7525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 42-year-old man was referred to our hospital due to chest pain, diabetes mellitus, and sensorineural hearing loss. Transthoracic echocardiography revealed diffuse left ventricular hypokinesis. He was diagnosed with mitochondrial disease and a c.A3243G mutation was identified in his mitochondrial DNA. This case of mitochondrial cardiomyopathy demonstrated a low uptake of 123I-BMIPP, while the uptake of 99mTc-MIBI was preserved. In contrast, previous reports have noted the increased uptake of123I-BMIPP and the decreased uptake of 99mTc-MIBI. This is the first study to show this unique 99mTc-MIBI/123I-BMIPP mismatch pattern. We also discuss the relationships among the cardiac scintigraphy, cardiac magnetic resonance imaging, and histopathology findings.
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Affiliation(s)
- Ryosuke Tashiro
- Division of Cardiology, Sendai Medical Center, National Hospital Organization, Japan
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Selim L, Van Coster R, Mehaney D, Hassan F, Vanlander A, Smet J, De Latter E, Vandemeulebroecke K, Mohamed Abdou D, Nakhla G, Mostafa M, Habets D, Bakker J, Abdel Bary A. Mitochondrial Neurogastrointestinal Encephalopathy: Clinical, Biochemical and Molecular Study in Three Egyptian Patients. Genet Couns 2016; 27:193-205. [PMID: 29485812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Mitochondrial Neurogastrointestinal Encephalopathy syndrome is a rare autosomal recessive disorder. The disease is caused by mutations in the thymidine phosphorylase gene. This article reports the clinical, biochemical and molecular findings in three Egyptian patients with Mitochondrial Neurogastrointestinal Encephalopathy sundrome from two different pedigrees. SUBJECTS AND METHODS The three patients were subjected to thorough neurologic examination. Brain Magtnetic Resonance Imaging. Histochemical and biochemical assay of the mitochondrial respiratory chain complexes in muscle homogenate was performed (1/3). Thymidine Phosphorylase enzyme activity was performed in 2/3 patients and Thymidine Phosphorylase gene sequencing was done (2/3) to confirm the diagnosis. RESULTS All patients presented with symptoms of severe gastrointestinal dysmotility with progressive cachexia, neuropathy, sensory neural hearing loss, asymptomatic leukoencephalopathy. Histochemical analysis of themuscle biopsy revealed deficient cytochrome C oxidase and mitochrondrial respiratory chain enzyme assay revealed isolated complex 1 deficiency (1/3). Thymidine Phosphorylase enzyme activity revealed complete absence of enzyme activity in 2/3 patients. Direct sequencing of Thymidine Phosphorylase gene revealed c.3371 A>C homozygous mutation. Molecular screening of both families revealed heterozygous mutation in both parents and 4 siblings. CONCLUSIONS Mitochondrial Neurogastrointestinal Encephalopathy syndrome is a rare mitochondrial disorder with an important diagnostic delay. In case of pathogenic mutations in Thymidine Phosphorylase gene in the family, carrier testing and prenatal diagmosis of at risk members is recommended for early detection. The possibility of new therapeutic options makes it necessary to diagnose the disease in an early state.
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11
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Magner M, Kolářová H, Honzik T, Švandová I, Zeman J. Clinical manifestation of mitochondrial diseases. Dev Period Med 2015; 19:441-449. [PMID: 26982751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Mitochondrial disorders (MD) represent a clinically, biochemically and genetically heterogeneous group of diseases associated with dysfunction of the oxidative phosphorylation system and pyruvate dehydrogenase complex. Our aim was to illustrate the most common clinical presentation of MD on the example of selected diseases and syndromes. The minimal prevalence of MD is estimated as 1 to 5,000. MD may manifest at any age since birth until late-adulthood with acute manifestation or as a chronic progressive disease. Virtually any organ may be impaired, but the organs with the highest energetic demands are most frequently involved, including brain, muscle, heart and liver. Some MD may manifest as a characteristic cluster of clinical features (e.g. MELAS syndrome, Kearns-Sayre syndrome). Diagnostics includes detailed history, the comprehensive clinical examination, results of specialized examinations (especially cardiology, visual fundus examination, brain imaging, EMG), laboratory testing of body fluids (lactate, aminoacids, organic acids), and analysis of bioptic samples of muscle, skin, and liver, eventually. Normal lactate level in blood does not exclude the possibility of MD. Although the aimed molecular genetic analyses may be indicated in some of mitochondrial diseases, the methods of next generation sequencing come into focus. Examples of treatment are arginine supplementation in MELAS syndrome, ketogenic diet in pyruvate oxidation disorders or quinone analogs in patients with LHON. Conclusion: The clinical suspicion of a mitochondrial disorder is often delayed, or the disease remains undiagnosed. The correct diagnosis and adequate treatment can improve prognosis of the patient. Access to genetic counseling is also of great importance.
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Affiliation(s)
| | | | | | | | - Jiří Zeman
- Department of Paediatrics and Adolescent Medicine, Ke Karlovu 2, 128 08 Praha 2, Czech Republic, tel. +420-224967733, fax +420-224967113, e-mail: jzem @lf1.cuni.cz
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12
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Grechanina IB. [Mitochondrial neurogastrointestinal encephalopathy syndrome]. Lik Sprava 2014:146-148. [PMID: 25528855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The article presents a case report of clinical observations of syndrome mitochondrial neurogastroenterology encephalomyopathy (MNGIE syndrome).
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13
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Mancuso M, Orsucci D, Angelini C, Bertini E, Carelli V, Comi GP, Donati A, Minetti C, Moggio M, Mongini T, Servidei S, Tonin P, Toscano A, Uziel G, Bruno C, Ienco EC, Filosto M, Lamperti C, Catteruccia M, Moroni I, Musumeci O, Pegoraro E, Ronchi D, Santorelli FM, Sauchelli D, Scarpelli M, Sciacco M, Valentino ML, Vercelli L, Zeviani M, Siciliano G. The m.3243A>G mitochondrial DNA mutation and related phenotypes. A matter of gender? J Neurol 2014; 261:504-10. [PMID: 24375076 DOI: 10.1007/s00415-013-7225-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
The m.3243A>G "MELAS" (mitochondrial encephalopathy with lactic acidosis and stroke-like episodes) mutation is one of the most common point mutations of the mitochondrial DNA, but its phenotypic variability is incompletely understood. The aim of this study was to revise the phenotypic spectrum associated with the mitochondrial m.3243A>G mutation in 126 Italian carriers of the mutation, by a retrospective, database-based study ("Nation-wide Italian Collaborative Network of Mitochondrial Diseases"). Our results confirmed the high clinical heterogeneity of the m.3243A>G mutation. Hearing loss and diabetes were the most frequent clinical features, followed by stroke-like episodes. "MIDD" (maternally-inherited diabetes and deafness) and "PEO" (progressive external ophthalmoplegia) are nosographic terms without any real prognostic value, because these patients may be even more prone to the development of multisystem complications such as stroke-like episodes and heart involvement. The "MELAS" acronym is convincing and useful to denote patients with histological, biochemical and/or molecular evidence of mitochondrial disease who experience stroke-like episodes. Of note, we observed for the first time that male gender could represent a risk factor for the development of stroke-like episodes in Italian m.3243A>G carriers. Gender effect is not a new concept in mitochondrial medicine, but it has never been observed in MELAS. A better elucidation of the complex network linking mitochondrial dysfunction, apoptosis, estrogen effects and stroke-like episodes may hold therapeutic promises.
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14
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Chapman TP, Hadley G, Fratter C, Cullen SN, Bax BE, Bain MD, Sapsford RA, Poulton J, Travis SP. Unexplained gastrointestinal symptoms: think mitochondrial disease. Dig Liver Dis 2014; 46:1-8. [PMID: 23768727 DOI: 10.1016/j.dld.2013.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/06/2013] [Accepted: 04/14/2013] [Indexed: 02/08/2023]
Abstract
Defects in mitochondrial function are increasingly recognised as central to the pathogenesis of many diseases, both inherited and acquired. Many of these mitochondrial defects arise from abnormalities in mitochondrial DNA and can result in multisystem disease, with gastrointestinal involvement common. Moreover, mitochondrial disease may present with a range of non-specific symptoms, and thus can be easily misdiagnosed, or even considered to be non-organic. We describe the clinical, histopathological and genetic findings of six patients from three families with gastrointestinal manifestations of mitochondrial disease. In two of the patients, anorexia nervosa was considered as an initial diagnosis. These cases illustrate the challenges of both diagnosing and managing mitochondrial disease and highlight two important but poorly understood aspects, the clinical and the genetic. The pathophysiology of gastrointestinal involvement in mitochondrial disease is discussed and emerging treatments are described. Finally, we provide a checklist of investigations for the gastroenterologist when mitochondrial disease is suspected.
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Affiliation(s)
- Thomas P Chapman
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Gina Hadley
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Carl Fratter
- Oxford Medical Genetics Laboratories, Churchill Hospital, Oxford, UK
| | - Sue N Cullen
- Buckinghamshire Hospitals NHS Trust, Department of Gastroenterology, Level 6, Queen Alexandra Road, High Wycombe, UK
| | - Bridget E Bax
- Division of Clinical Sciences, St. George's University of London, London, UK
| | - Murray D Bain
- Division of Clinical Sciences, St. George's University of London, London, UK
| | | | - Joanna Poulton
- Nuffield Dept Obstetrics and Gynaecology, University of Oxford, The Women's Centre, Oxford, UK
| | - Simon P Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
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15
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Liu Y, Xue J, Zhao D, Chen L, Yuan Y, Wang Z. Audiological evaluation in Chinese patients with mitochondrial encephalomyopathies. Chin Med J (Engl) 2014; 127:2304-2309. [PMID: 24931247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Hearing impairment has been reported to be common in patients with mitochondrial disorders, a group of diseases characterized by pleiomorphic clinical manifestations due to defects in oxidative phosphorylation of mitochondria. This study aimed to investigate the audiological characteristics in a large cohort of patients with mitochondrial disease. METHODS Comprehensive audiological evaluations, including pure tone audiometry, tympanometry, speech audiometry, otoacoustic emissions, electrocochleography and auditory brainstem evoked potentials, were performed in 73 Chinese patients with mitochondrial encephalomyopathy and with confirmed mitochondrial DNA (mtDNA) defects. RESULTS Among the patients, 71% had hearing impairment. However, the incidence rate and severity of hearing impairment were much less in the chronic progressive external ophthalmoplegia (CPEO) subtype than in the mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS), myoclonic epilepsy with ragged red fibers (MERRF) and Kearns-Sayre syndrome (KSS) subtypes. While most of our patients had a predominantly cochlea origin for the hearing deficit, five patients had an auditory neuropathy spectrum disorder and three patients had impairment of both cochlea and auditory cortex. CONCLUSIONS Various portions of the auditory system could be involved in patients with mitochondrial diseases, including cochlea, auditory nerve, auditory pathway and cortex. Hearing loss was more associated with multisystem involvement. Genotype, mutant load of mtDNA and other unknown factors could contribute to heterogeneity of hearing impairment in mitochondrial disease.
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Affiliation(s)
- Yuhe Liu
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China
| | - Junfang Xue
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China
| | - Danhua Zhao
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Li Chen
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China.
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16
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Abstract
Primary mitochondrial disorders are clinically and genetically heterogeneous, caused by an alteration(s) in either mitochondrial DNA or nuclear DNA, and affect the respiratory chain's ability to undergo oxidative phosphorylation, leading to decreased production of adenosine triphosphophate and subsequent energy failure. These disorders may present at any age, but children tend to have an acute onset of disease compared with subacute or slowly progressive presentation in adults. Varying organ involvement also contributes to the phenotypic spectrum seen in these disorders. The childhood presentation of primary mitochondrial disease is mainly due to nuclear DNA mutations, with mitochondrial DNA mutations being less frequent in childhood and more prominent in adulthood disease. The clinician should be aware of the pediatric presentation of mitochondrial disease and have an understanding of the myriad of nuclear genes responsible for these disorders. The nuclear genes can be best understood by utilizing a classification system of location and function within the mitochondria.
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Affiliation(s)
- Amy C Goldstein
- Division of Child Neurology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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17
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László A, Ambrus E, Vörös E, Svékus A, Kóbor J, Bereg E, Palatka J, Pávics L. 99-mTc-HMPAO single photon emission computed tomography examinations in genetically determined neurometabolic disorders. Ideggyogy Sz 2009; 62:168-177. [PMID: 19579665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED The aim of our study was to determine regional cerebral blood flow (rCBF) abnormalities in different types of enzymopathies. PATIENTS AND METHODS Among the patients with genetically determined enzymopathies 3 patients had aminoacidopathies, and 11 had different types of encephalopathies, from which 10 had mitochondrial encephalomyopathy (MEMP), and 1 patient had hyperuricaemic encephalopathy. Besides the mentioned 14 patients, 1 had ceroid lipofuscinosis and another patient had tuberous sclerosis. The further distribution of the MEMP patients' group was the following--5 patients had MEMP with lactic acidosis, 5 had Leigh's disease (subacute necrotizing encephalopathy), from which 1 had cytochrome-c-oxidase deficiency (COX). Additionally in all patients were performed cerebral MRI and SPECT examination 10 min. after intravenous administration of 20 Mbq/kg 99 mTc-HMPAO. RESULTS Fourteen out of 16 SPECT findings were pathologic, showing decreased focal frontal/temporal/temporoparietal cerebral blood perfusion. Aminoacidopathic group--all the 3 patients revealed pathologic signs from the aminoacidopathic patients' group. Among them the ornithine transcarbamylase (OTC) heterozygous female patient with left-sided hemiparesis caused by hyperammonemic stroke at 10 month-age, showed right sided temporoparietal, occipital and left frontal hypoperfusion, nearly 6 years after the cerebral vascular attack. This finding might be resulted because of diaschisis. Mitochondrial encephalo-myopathic (MEMP) group--all the four patients with MEMP and lactic acidosis showed focal hypoperfusion in the temporal region, while the perfusion was normal in the COX deficient patient and in 2 Leigh's disease (subacute necrotizing encephalopathy) patients. In the remaining 1 Leigh's patient frontotemporal hypoperfusion was found. In all patients there were non specific structural abnormalities detected by MRI: cortical and subcortical atrophy, and scattered demyelination foci. In the case of ceroid lipofuscinosis the MRI showed cerebral atrophy and cerebellar hypoplasia, and the SPECT showed right frontal and occipital hypoperfusion, bilateral parietal physiological riping process. The patient with tuberous sclerosis showed bilateral temporo-occipital hypoperfusion. CONCLUSION (1) SPECT images demonstrated hypoperfusion rCBF changes in 14 out of all 16 patients. (2) Regional cerebral/cerebellar hypoperfusion was detected by SPECT in mitochondrial encephalomyopathies, with lactate acidosis and aminoacidopathies giving high informative value about the cerebral perfusion.
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MESH Headings
- Amino Acids/metabolism
- Brain/diagnostic imaging
- Brain/metabolism
- Brain/pathology
- Brain/physiopathology
- Brain Diseases, Metabolic, Inborn/diagnostic imaging
- Brain Diseases, Metabolic, Inborn/genetics
- Brain Diseases, Metabolic, Inborn/pathology
- Brain Diseases, Metabolic, Inborn/physiopathology
- Child
- Child, Preschool
- Contrast Media
- Electroencephalography
- Electron Transport Complex IV/genetics
- Female
- Genetic Predisposition to Disease
- Humans
- Infant
- Leigh Disease/diagnostic imaging
- Leigh Disease/genetics
- Magnetic Resonance Imaging
- Male
- Mitochondrial Encephalomyopathies/diagnostic imaging
- Mitochondrial Encephalomyopathies/genetics
- Mitochondrial Encephalomyopathies/pathology
- Mitochondrial Encephalomyopathies/physiopathology
- Radiopharmaceuticals
- Technetium Tc 99m Exametazime
- Tomography, Emission-Computed, Single-Photon/methods
- Tomography, X-Ray Computed
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Affiliation(s)
- Aranka László
- Department of Pediatrics, University of Szeged Albert Szent-Györgyi Medical and Pharmaceutical Centre, Szeged.
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18
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Abstract
A brief and comprehensive review on mitochondrial cytopathies is reported showing the extreme clinical and genetic heterogeneity of these disorders. Syndromes of mitochondrial cytopathiesencompass most of the medical specialties and diagnosis of mitochondrial cytopathies is complicated,needing the combination of multiple expertise: muscle morphology, neuroradiology, biochemistry(enzymology, chemical analysis), and genetics.
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Affiliation(s)
- Enrico Bertini
- Bambino Gesu' Children's Research Hospital, Department of Laboratory Medicine, Rome, Italy.
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19
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Abstract
Proper management of chemotoxicity in transplant patients requires detailed knowledge of the biochemical mechanisms underlying immunosuppressant toxicity. Neurotoxicity is one of the most significant clinical side effects of the immunosuppressive undecapeptide cyclosporine, occurring at some degree in up to 60% of transplant patients. The clinical symptoms of cyclosporine-mediated neurotoxicity consist of decreased responsiveness, hallucinations, delusions, seizures, cortical blindness, and stroke-like episodes that mimic those clinical symptoms of mitochondrial encephalopathy. Clinical computed tomography (CT) and magnetic resonance imaging (MRI) studies have revealed a correlation between clinical symptoms of cyclosporine-mediated neurotoxicity and morphological changes in the brain, such as hypodensity of white matter, cerebral edema, metabolic encephalopathy, and hypoxic damages. Paradoxically, in animal models cyclosporine protects the brain from ischemia-reperfusion (I/R) injury. Interestingly, cyclosporine appears to mediate both neurotoxicity (under normoxic conditions) and I/R protection across the same range of drug concentration. Both toxicity and protection might arise from the intersection of cyclosporine with mitochondrial energy metabolism. This review addresses basic biochemical mechanisms of: 1) cyclosporine toxicity in normoxic brain, and 2) its protective effects in the same organ during I/R. The marked and unparallel potential of magnetic resonance spectroscopy (MRS) as a novel quantitative approach to evaluate metabolic drug toxicity is described.
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Affiliation(s)
- Natalie J Serkova
- Department of Anesthesiology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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20
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Oishi M, Miki K, Morita A, Fujioka K, Aoki S, Nishino I, Nonaka I, Goto YI, Mizutani T. Mitochondrial encephalomyopathy associated with diabetes mellitus, cataract, and corpus callosum atrophy. Intern Med 2008; 47:441-4. [PMID: 18310979 DOI: 10.2169/internalmedicine.47.0579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 44-year-old woman with mitochondrial encephalomyopathy noticed weakness of the lower extremities at the age of 30 years. She also has type 2 diabetes mellitus, posterior subcapsular cataracts in both eyes, and corpus callosum atrophy. Family history showed that a maternal cousin had a myopathy, 3 maternal aunts had diabetes mellitus, and her mother and 2 maternal aunts had cataracts. External ophthalmoplegia, proximal myopathy, and absent deep tendon reflexes were noted. The mitochondrial DNA 3243 point mutation was negative. Muscle biopsy showed ragged-red fibers, cytochrome c oxidase (COX)-positive fibers, and COX-negative fibers.
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Affiliation(s)
- Minoru Oishi
- Department of Neurology, Nihon University Nerima Hikarigaoka Hospital, Tokyo.
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Yavuz H, Ozel A, Christensen M, Christensen E, Schwartz M, Elmaci M, Vissing J. Treatment of mitochondrial neurogastrointestinal encephalomyopathy with dialysis. ACTA ACUST UNITED AC 2007; 64:435-8. [PMID: 17353390 DOI: 10.1001/archneur.64.3.435] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To study the effect of continuous ambulatory peritoneal dialysis on nucleoside levels and clinical course in a patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). Patient We studied a patient with genetically verified MNGIE, who prior to treatment had lost weight progressively, developed amenorrhea, vomited multiple times daily, and had abdominal pain. Intervention The patient was treated with peritoneal dialysis for 3 years, and the effect on symptoms and plasma concentrations of thymidine and deoxyuridine were monitored. RESULTS Dialysis stopped vomiting and reduced abdominal pain, and the patient gained 5 kg in weight and started to menstruate again. Symptoms returned if dialysis was paused. Dialysis did not affect plasma nucleoside levels. CONCLUSIONS This study shows an unambiguous clinical benefit of peritoneal dialysis on gastrointestinal symptoms in MNGIE. Dialysis did not affect nucleoside levels, indicating elevated thymidine and deoxyuridine levels are not solely responsible for the pathogenesis of MNGIE.
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Affiliation(s)
- Halûk Yavuz
- Department of Pediatrics, Meram Medical Faculty, Selcuk University, Konya, Turkey
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22
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Schüpbach WMM, Vadday KM, Schaller A, Brekenfeld C, Kappeler L, Benoist JF, Xuan-Huong CNT, Burgunder JM, Seibold F, Gallati S, Mattle HP. Mitochondrial neurogastrointestinal encephalomyopathy in three siblings. J Neurol 2007; 254:146-53. [PMID: 17294068 DOI: 10.1007/s00415-006-0255-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 04/12/2006] [Indexed: 01/19/2023]
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive disorder in which a nuclear mutation of the thymidine phosphorylase (TP) gene causes mitochondrial genomic dysfunction. Patients suffer from gastrointestinal dysmotility, cachexia, ptosis, external ophthalmoparesis, myopathy and polyneuropathy. Magnetic resonance imaging (MRI) shows leukoencephalopathy. We describe clinical, genetic and neuroradiological features of three brothers affected with MNGIE. Clinical examination, laboratory analyses, MRI and magnetic resonance spectroscopy (MRS) of the brain, and genetic analysis have been performed in all six members of the family with the three patients with MNGIE. Two of them are monozygous twins. They all suffered from gastrointestinal dysmotility, cachexia, ophthalmoplegia, muscular atrophies, and polyneuropathy. Urinary thymidine was elevated in the patients related to the severity of clinical disease, and urinary thymidine (normally not detectable) was also found in a heterozygous carrier. Brain MRI showed leukoencephalopathy in all patients; however, their cognitive functioning was normal. Brain MRS demonstrated reduced N-acetylaspartate and choline in severely affected areas. MRI of heterozygous carriers was normal. A new mutation (T92N) in the TP gene was identified. Urinary thymidine is for the first time reported to be detectable in a heterozygous carrier. MRS findings indicate loss of neurons, axons, and glial cells in patients with MNGIE, but not in heterozygous carriers.
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Affiliation(s)
- W M M Schüpbach
- Department of Neurology, University Hospital-Inselspital, 3010 Bern, Switzerland
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Ikawa M, Kawai Y, Arakawa K, Tsuchida T, Miyamori I, Kuriyama M, Tanaka M, Yoneda M. Evaluation of respiratory chain failure in mitochondrial cardiomyopathy by assessments of 99mTc-MIBI washout and 123I-BMIPP/99mTc-MIBI mismatch. Mitochondrion 2007; 7:164-70. [PMID: 17280875 DOI: 10.1016/j.mito.2006.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 11/09/2006] [Indexed: 01/01/2023]
Abstract
Cardiomyopathy is one of the main features that determines prognosis in patients with mitochondrial encephalomyopathy. We investigated respiratory chain failure using 99mTc-MIBI- and 123I-BMIPP-SPECT in vivo in five patients with mitochondrial cardiomyopathty. With the lowering of cardiac function, the 99mTc-MIBI-washout rate (WOR) increased, and the 99mTc-MIBI-uptake decreased, conversely. In patients who showed severe cardiac involvement, 99mTc-MIBI-uptake was markedly reduced, and by contrast, 123I-BMIPP-uptake increased (123I-BMIPP/99mTc-MIBI mismatch). There were significant correlations between the WOR on 99mTc-MIBI-SPECT and interventricular septal thickness (IVST) on echocardiography and between WOR and left ventricular ejection fraction (LVEF) on 99mTc-MIBI-SPECT. The increased WOR and decreased uptake of 99mTc-MIBI were reflected by the lowered mitochondrial membrane potential created by mitochondrial respiratory chain whereas 123I-BMIPP/99mTc-MIBI mismatch may be created by the enhanced triglyceride-pool. These nuclear medicine techniques are the potential tools to evaluate the energy state in mitochondrial cardiomyopathy.
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Affiliation(s)
- Masamichi Ikawa
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimoaiduki, Matsuoka, Fukui 910-1193, Japan
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24
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Gamez J, Minoves T. Abnormal brainstem auditory evoked responses in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): Evidence of delayed central conduction time. Clin Neurophysiol 2006; 117:2385-91. [PMID: 16949865 DOI: 10.1016/j.clinph.2006.07.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 07/04/2006] [Accepted: 07/10/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the usefulness of brain auditory evoked potentials (BAEPs) in the study of asymptomatic white matter alterations in brain MRI observed in mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) patients. METHODS The authors studied the neurophysiological characteristics of the BAEPs in four genetically confirmed MNGIE patients who presented varying degrees of leukoencephalopathy in brain MRI. RESULTS Prolonged I-III and I-V interpeak latencies were the most common abnormalities found, with a correlation between the extent of brain MRI lesions and BAEPs. CONCLUSIONS The findings suggest a delayed central conduction time along the brainstem. BAEPs may be useful in the neurophysiological evaluation of central white matter lesions in MNGIE. Similar neurophysiological findings have been reported in other myelin disorders in the central nervous system. SIGNIFICANCE The BAEPs abnormalities identified should be interpreted as an indirect sign of CNS involvement in MNGIE patients and provide comprehensive and integrated information concerning brainstem dysfunction. Further studies are necessary in order to identify whether there is a correlation between BAEPs and the clinical progression of the disease.
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Affiliation(s)
- Josep Gamez
- Department of Neurology, Hospital Universitari Vall d'Hebron, UAB, Barcelona, Spain.
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25
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Sperl W, Jesina P, Zeman J, Mayr JA, Demeirleir L, VanCoster R, Pícková A, Hansíková H, Houst'ková H, Krejcík Z, Koch J, Smet J, Muss W, Holme E, Houstek J. Deficiency of mitochondrial ATP synthase of nuclear genetic origin. Neuromuscul Disord 2006; 16:821-9. [PMID: 17052906 DOI: 10.1016/j.nmd.2006.08.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Revised: 06/28/2006] [Accepted: 08/03/2006] [Indexed: 11/18/2022]
Abstract
We present clinical and laboratory data from 14 cases with an isolated deficiency of the mitochondrial ATP synthase (7-30% of control) caused by nuclear genetic defects. A quantitative decrease of the ATP synthase complex was documented by Blue-Native electrophoresis and Western blotting and was supported by the diminished activity of oligomycin/aurovertin-sensitive ATP hydrolysis in fibroblasts (10 cases), muscle (6 of 7 cases), and liver (one case). All patients had neonatal onset and elevated plasma lactate levels. In 12 patients investigated 3-methyl-glutaconic aciduria was detected. Seven patients died, mostly within the first weeks of life and surviving patients showed psychomotor and various degrees of mental retardation. Eleven patients had hypertrophic cardiomyopathy; other clinical signs included hypotonia, hepatomegaly, facial dysmorphism and microcephaly. This phenotype markedly differs from the severe central nervous system changes of ATP synthase disorders caused by mitochondrial DNA mutations of the ATP6 gene presenting mostly as NARP and MILS.
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Affiliation(s)
- W Sperl
- Department of Pediatrics, Paracelsus Private Medical University, Salzburg, Austria
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26
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Abstract
The scope of pediatric autonomic disorders is not well recognized. The goal of this review is to increase awareness of the expanding spectrum of pediatric autonomic disorders by providing an overview of the autonomic nervous system, including the roles of its various components and its pervasive influence, as well as its intimate relationship with sensory function. To illustrate further the breadth and complexities of autonomic dysfunction, some pediatric disorders are described, concentrating on those that present at birth or appear in early childhood.
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Affiliation(s)
- Felicia B Axelrod
- Dysautonomia Treatment and Evaluation Center, Department of Pediatrics and Neurology, New York University School of Medicine, 530 First Ave, Suite 9Q, New York, New York 10016, USA.
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27
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Peker S, Necmettin Pamir M. Trigeminal neuralgia in a patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). J Clin Neurosci 2006; 12:172-4. [PMID: 15749422 DOI: 10.1016/j.jocn.2004.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2003] [Accepted: 02/13/2004] [Indexed: 11/24/2022]
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal-recessive disease associated with multiple deletions of mitochondrial DNA in skeletal muscle. MNGIE is a multisystem syndrome affecting muscle, peripheral, and central nervous systems and the gastrointestinal tract. A 25-year-old man is presented with 3 years history of right sided trigeminal neuralgia. He has been diagnosed as MNGIE based on clinical, neurophysiological and pathological findings. He had also received medical therapy and two radiofrequency thermocoagulations for the treatment of trigeminal neuralgia. Gamma Knife radiosurgery was performed and resulted in partial relief. To our knowledge, this is the first case in the literature of MNGIE with trigeminal neuralgia. An analogy is suggested between multiple sclerosis and MNGIE as a cause for trigeminal neuralgia in this patient.
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Affiliation(s)
- Selçuk Peker
- Department of Neurosurgery, Marmara University, Marmara University Neurological Sciences Institute, Istanbul, Turkey.
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28
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Hutchison WM, Thyagarajan D, Poulton J, Marchington DR, Kirby DM, Manji SSM, Dahl HHM. Clinical and molecular features of encephalomyopathy due to the A3302G mutation in the mitochondrial tRNA(Leu(UUR)) gene. ACTA ACUST UNITED AC 2006; 62:1920-3. [PMID: 16344351 DOI: 10.1001/archneur.62.12.1920] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The mitochondrial DNA mutation A3302G in the tRNA(Leu(UUR)) gene causes respiratory chain complex I deficiency. The main clinical feature appears to be a progressive mitochondrial myopathy with proximal muscle weakness. OBJECTIVE To report on clinical and molecular features in 4 novel patients with the A3302G mutation. DESIGN Case reports. PATIENTS Four patients (3 of whom are from the same family) with a myopathy caused by the A3302G mitochondrial DNA mutation. MAIN OUTCOME MEASURE Identification of the A3302G mutation by DNA sequencing. RESULTS All 4 patients had an adult-onset progressive mitochondrial myopathy with proximal muscle weakness, resulting in exercise intolerance. In 2 unrelated patients, upper limb reflexes were absent with preservation of at least some lower limb reflexes. Other features including hearing loss, recurrent headaches, ptosis, progressive external ophthalmoplegia, and depression were present. CONCLUSION While the dominant clinical features of the A3302G mutation were exercise intolerance and proximal muscle weakness, other features of mitochondrial encephalomyopathies, previously not described for this mutation, were present.
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Affiliation(s)
- Wendy M Hutchison
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
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29
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Da Pozzo P, Federico A. Commentary to mitDNA research for the pathogenesis of mitochondrial disorders. Biochem Biophys Res Commun 2005; 336:1003-4. [PMID: 16125136 DOI: 10.1016/j.bbrc.2005.07.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Affiliation(s)
- Paola Da Pozzo
- Unit of Neurology and Neurometabolic Diseases, Department of Neurological and Behavioural Sciences, Centre for Research, Therapy and Prevention of Neurohandicap, University of Siena, Italy
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30
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Arpa-Gutiérrez FJ, Cruz-Martínez A, Campos-González Y, Gutiérrez-Molina M, Santiago-Pérez S, Pérez-Conde MC, López-Pajares MR, Martín-Casarrubias MA, Rubio-Muñoz JC, del Hoyo P, Arpa-Fernández A, Arenas-Barbero J. [Mitochondrial respiratory chain diseases. Evaluation and variability in 52 patients]. Rev Neurol 2005; 41:449-54. [PMID: 16224730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Clinical, electrophysiological, genetic and biochemical deficiencies variability were evaluated in 52 patients diagnosed of mitochondrial respiratory chain diseases (MRCD). PATIENTS AND METHODS 26 men and 26 women, aged 19 to 79 years, were tested by clinical examination, electrophysiological techniques, muscle biopsy and genetic and biochemical studies. RESULTS The patients were classified into seven phenotypes: myopathy, chronic progressive external ophthalmoplegia, progressive ophthalmoplegia plus ataxia, Kearns-Sayre syndrome, mitochondrial encephalomyopathy with lactic acidosis and stroke episodes (MELAS), myoclonic encephalopathy with ragged-red fibers (MERRF), and encephalopathies. Each phenotype may begin by different ways. The electromiography showed myopathy in 39 cases and various types of neuropathy in 10. Ragged-red COX negative fibers or widespread electron microscopic abnormalities were found in 47 cases. Simple deletions, multiple deletions and three different point mutations were observed. Deficiency of complexes I, II, III and IV were found alone or in different associations. CONCLUSIONS MRCD shows wide variations in clinical, genetic and biochemical studies. Some patients with nonspecific manifestations, mainly of central nervous system, need careful attention and to be on account of diagnostic suspicion.
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31
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Abstract
Muscle biopsy provides the best tissue to confirm a mitochondrial cytopathy. Histochemical features often correlate with specific syndromes and facilitate the selection of biochemical and genetic studies. Ragged-red fibres nearly always indicate a combination defect of respiratory complexes I and IV. Increased punctate lipid within myofibers is a regular feature of Kearns-Sayre and PEO, but not of MELAS and MERRF. Total deficiency of succinate dehydrogenase indicates a severe defect in Complex II; total absence of cytochrome-c-oxidase activity in all myofibres correlates with a severe deficiency of Complex IV or of coenzyme-Q10. The selective loss of cytochrome-c-oxidase activity in scattered myofibers, particularly if accompanied by strong succinate dehydrogenase staining in these same fibres, is good evidence of mitochondrial cytopathy and often of a significant mtDNA mutation, though not specific for Complex IV disorders. Glycogen may be excessive in ragged-red zones. Ultrastructure provides morphological evidence of mitochondrial cytopathy, in axons and endothelial cells as well as myocytes. Abnormal axonal mitochondria may contribute to neurogenic atrophy of muscle, a secondary chronic feature. Quantitative determinations of respiratory chain enzyme complexes, with citrate synthase as an internal control, confirm the histochemical impressions or may be the only evidence of mitochondrial disease. Biological and technical artifacts may yield falsely low enzymatic activities. Genetic studies screen common point mutations in mtDNA. The brain exhibits characteristic histopathological alterations in mitochondrial diseases. Skin biopsy is useful for mitochondrial ultrastructure in smooth erector pili muscles and axons; skin fibroblasts may be grown in culture. Mitochondrial alterations occur in many nonmitochondrial diseases and also may be induced by drugs and toxins.
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32
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Pulkes T, Liolitsa D, Eunson LH, Rose M, Nelson IP, Rahman S, Poulton J, Marchington DR, Landon DN, Debono AG, Morgan-Hughes JA, Hanna MG. New phenotypic diversity associated with the mitochondrial tRNA(SerUCN) gene mutation. Neuromuscul Disord 2005; 15:364-71. [PMID: 15833431 DOI: 10.1016/j.nmd.2005.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 01/15/2005] [Accepted: 01/21/2005] [Indexed: 01/29/2023]
Abstract
We performed detailed clinical, histopathological, biochemical, in vitro translation and molecular genetic analysis in patients from two unrelated families harbouring the tRNA(SerUCN) 7472C-insertion mutation. Proband 1 developed a progressive neurodegenerative phenotype characterised by myoclonus, epilepsy, cerebellar ataxia and progressive hearing loss. Proband 2 had a comparatively benign phenotype characterised by isolated myopathy with exercise intolerance. Both patients had the 7472C-insertion mutation in identical proportions and they exhibited a similar muscle biochemical and histopathological phenotype. However, proband 2 also had a previously unreported homoplasmic A to C transition at nucleotide position 7472 in the tRNA(SerUCN) gene. This change lengthens further the homopolymeric C run already expanded by the 7472C-insertion. These data extend the phenotypic range associated with the 7472C-insertion to include isolated skeletal myopathy, as well as a MERRF-like phenotype.
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MESH Headings
- Adolescent
- Adult
- DNA Mutational Analysis/methods
- DNA, Mitochondrial/genetics
- Electron Transport Complex IV/metabolism
- Electrophoresis/methods
- Female
- Humans
- Male
- Microscopy, Electron, Transmission/methods
- Mitochondria, Muscle/pathology
- Mitochondrial Encephalomyopathies/enzymology
- Mitochondrial Encephalomyopathies/genetics
- Mitochondrial Encephalomyopathies/pathology
- Mitochondrial Encephalomyopathies/physiopathology
- Mitochondrial Proteins/metabolism
- Muscle, Skeletal/enzymology
- Muscle, Skeletal/pathology
- Muscle, Skeletal/ultrastructure
- Mutation
- Nucleic Acid Conformation
- Phenotype
- RNA, Transfer, Ser/chemistry
- RNA, Transfer, Ser/genetics
- Serine/metabolism
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Affiliation(s)
- T Pulkes
- Centre for Neuromuscular Disease, Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
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33
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Abstract
A genetic classification of the mitochondrial encephalomyopathies includes disorders due to defects of mitochondrial DNA (mtDNA) and disorders due to defects of nuclear DNA (nDNA). Recent progress in mtDNA-related diseases includes: (i) new pathogenic mutations in protein-coding genes, especially those encoding subunits of complex I (ND genes); (ii) the pathogenic nature of homoplasmic mutations, whose expression is regulated by environmental and genetic factors; (iii) increasing interest in the functional and pathophysiological role of haplotypes. Advances in mendelian mitochondrial diseases include: (i) new mutations in genes for complex I subunits; (ii) identification of new mutant ancillary proteins associated with complex IV and complex V deficiencies; (iii) better molecular understanding of disorders due to faulty intergenomic communication, which are associated with multiple mtDNA deletions, mtDNA depletion, or defects of mtDNA translation; (iv) the pathogenic role of alterations of the inner mitochondrial membrane phospholipid components, especially cardiolipin; (v) the emerging importance of defects in mitochondrial motility, fission, or fusion.
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Affiliation(s)
- Salvatore DiMauro
- Department of Neurology, Columbia University Medical Center, College of Physicians and Surgeons, Room 4-420, 630 West 168th Street, New York, NY 10032, USA.
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34
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Da Pozzo P, Cardaioli E, Radi E, Federico A. Sequence analysis of the complete mitochondrial genome in patients with mitochondrial encephaloneuromyopathies lacking the common pathogenic DNA mutations. Biochem Biophys Res Commun 2004; 324:360-4. [PMID: 15465027 DOI: 10.1016/j.bbrc.2004.09.058] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to identify novel mitochondrial deoxyribonucleic acid (mtDNA) mutations in a series of patients with clinical and/or morphological features of mitochondrial dysfunction, but still no genetic diagnosis. A heterogeneous group of clinical disorders is caused by mutations in mtDNA that damage respiratory chain function of cell energy production. We developed a method to systematically screen the entire mitochondrial genome. The sequence-data were obtained with a rapid automated system. In the six mitochondrial genomes analysed we found 20 variants of the revised Cambridge reference sequence [Nat. Genet. 23 (1999) 147]. In skeletal muscle nineteen novel mtDNA variants were homoplasmic, suggesting secondary pathogenicity or co-responsibility in determination of the disease. In one patient we identified a novel heteroplasmic mtDNA mutation which presumably has a pathogenic role. This screening is therefore useful to extend the mtDNA polymorphism database and should facilitate definition of disease-related mutations in human mtDNA.
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Affiliation(s)
- Paola Da Pozzo
- Unit of Neurology and Neurometabolic Diseases, Department of Neurological and Behavioural Sciences and Centre for Research, Therapy and Prevention of Neurohandicap, University of Siena, Italy
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35
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Blanco-Barca O, Pintos-Martínez E, Alonso-Martín A, Escribano-Rey MD, Campos-González Y, Arenas-Barbero J, Eirís-Puñal J, Castro-Gago M. [Mitochondrial encephalomyopathies and West's syndrome: a frequently underdiagnosed association]. Rev Neurol 2004; 39:618-23. [PMID: 15490346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
INTRODUCTION West's syndrome is known to have symptomatic, cryptogenetic and idiopathic forms. Greater knowledge of the different pathologies and the development of new diagnostic techniques have allowed the list of symptomatic forms to be extended and congenital disorders of the metabolism account for a significant percentage as an aetiopathogenic factor. Yet, although it is known that mitochondrial cytopathies can trigger the development of West's syndrome, few reports exist concerning their association. AIMS Our aim in this paper is to report on four cases of West's syndrome in which a mitochondrial cytopathy was shown to be an aetiopathogenic factor. CASE REPORTS Two females and two males aged between 2 and 10 months, who were suffering from West's syndrome. Biochemical and neuroimaging findings suggested a possible mitochondrial cytopathy, which was later confirmed in the four cases on observing a partial deficiency of some of the complexes of the mitochondrial respiratory chain in muscles; this was found to be simple in the first three (complexes III, I and IV, respectively) and combined in the fourth (complexes I and IV). CONCLUSIONS Infantile spasms should be considered as one of the ways mitochondrial encephalomyopathies manifest themselves. As part of the process of diagnosing West's syndrome, we recommend tests be carried out to determine the levels of lactic and pyruvic acid, carnitine and amino acids in plasma, and possibly in the cerebrospinal fluid, as well as those of amino acids and organic acids in urine. A muscular biopsy must also be carried out in patients who are strongly suspected of having a mitochondrial cytopathy, as well as the corresponding molecular genetic study.
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Affiliation(s)
- O Blanco-Barca
- Departamento de Pediatría, Servicio de Neuropediatría, Hospital Clínico Universitario, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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36
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Bielefeldt-Ohmann H, Bellanca RU, Crockett CM, Curnow E, Eiffert K, Gillen M, Glanister D, Hayes E, Kelley S, Minoshima S, Vogel K. Subacute necrotizing encephalopathy in a pig-tailed macaque (Macaca nemestrina) that resembles mitochondrial encephalopathy in humans. Comp Med 2004; 54:422-33. [PMID: 15357324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
A male pig-tailed macaque (Macaca nemestrina), approximately 5 years old, was found to be vision-impaired and to have profound behavioral abnormalities, including hyperactivity and self-injurious behavior that was not amenable to amelioration by environmental enrichment. Facial and skeletal dysmorphisms also were noted. Magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning revealed areas of possible infarction in the occipital lobes and megaventriculosis. At necropsy, following euthanasia for humane reasons, severe polio- and leukoencephalomalacia accompanied by megaventriculosis were seen in both occipital lobes and in several sulci of the parietal and frontal lobes. Light microscopic findings included loss of neocortical structure, with necrosis, neuronal loss, astrogliosis, vascular proliferation, mild spongiosis, and demyelination. The extent and severity of lesions were most pronounced in the occipital lobes and were greater in the left than in the right hemisphere. Other lesions included mild bilateral atrophy of the optic nerves, thymic involution, necrotizing dermatitis due to trauma, and a spectrum of spermatozoal abnormalities. The imaging and gross and light microscopic changes found in this animal resemble the mitochondrial encephalopathies of humans; this was corroborated by results of immunohistochemical analysis demonstrating decreased expression of enzymes of the mitochondrial oxidative complex ([OC]-I, -III, and -IV) in brain and muscle, and detection of fibrinogen immunoreactivity in neurons and glial cells. The spermatozoal defects may represent yet another aspect of a mitochondrial defect.
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Affiliation(s)
- Helle Bielefeldt-Ohmann
- Washington National Primate Research Center, University of Washington, Seattle, Washington 98195-7330, USA
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37
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Abstract
Mitochondrial diseases have extremely heterogeneous clinical presentations due to the ubiquitous nature of mitochondria and the dual genetic control of the respiratory chain. Thus, mitochondrial disorders can be multisystemic (mitochondrial encephalomyopathies) or confined to a single tissue, and they can be sporadic or transmitted by mendelian or maternal inheritance. Mendelian disorders are usually inherited as autosomal recessive traits, tend to present earlier in life, and usually "breed true" in each family. By contrast, mitochondrial DNA-related diseases usually start later and vary in their presentation within members of the same family. Precise diagnosis is often a challenge; we go through the traditional steps of the diagnostic process, trying to highlight clues to mitochondrial dysfunction in the family history, physical and neurological examinations, routine and special laboratory tests, and histo-chemical and biochemical results of the muscle biopsy. The ultimate goal is to reach, whenever possible, a definitive molecular diagnosis, which permits rational genetic counseling and a prenatal diagnosis.
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Affiliation(s)
- Salvatore Dimauro
- Department of Neurology, Columbia University College of Physicians Surgeons, New York, New York 10032, USA.
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38
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Abstract
Mitochondrial diseases, such as MELAS, MERRF, and CPEO syndromes, are associated with specific point mutations or large-scale deletions of mitochondrial DNA (mtDNA), which impair mitochondrial respiratory functions and result in decreased production of ATP in affected tissues. Recently, mitochondria have been recognized to act as key players in the regulation of cell death. To investigate whether a pathogenic mutation of mtDNA exerts any effect on the process of apoptosis of human cells, we constructed a series of cybrid human cells harboring different proportions of mtDNA with the A3243G or the A8344G transition, or with the 4,977-bp deletion, by cytoplasmic fusion of patients' skin fibroblasts with mtDNA-depleted rho(0) cells of an immortal human osteosarcoma cell line (143B). We observed that the decrease in cell viability upon staurosporine treatment or exposure to ultraviolet (UV) irradiation was more pronounced in the cybrids harboring high levels of mutated mtDNA compared with the control cybrids. Using DNA fragmentation analysis, we found that the cell death induced by treatment with 100 nM staurosporine or by exposure to UV irradiation at 20 J/m(2) was caused by apoptosis, not necrosis. Moreover, we demonstrated activation of caspase 3 by Western blot and enhanced release of cytochrome c after 100 nM staurosporine treatment or 20 J/m(2) UV irradiation of the cybrids harboring high levels of the three mtDNA mutations. Furthermore, as compared with parental osteosarcoma 143B cells, the rho(0) cells were found to be more susceptible to apoptosis, which was accompanied by caspase 3 activation and cytochrome c release. This indicates that mtDNA plays an important role in the regulation of apoptosis in human cells. Taken together, these findings suggest that mutation and depletion of mtDNA increase the susceptibility of human cells to apoptosis triggered by exogenous stimuli such as UV irradiation or staurosporine.
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Affiliation(s)
- Chun-Yi Liu
- Department of Biochemistry, National Yang-Ming University, Taipei, Taiwan 112
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39
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Abstract
Therapy for mitochondrial diseases is woefully inadequate. How-ever, lack of cure does not equate with lack of treatment. In this review, we consider sequentially several different therapeutic approaches. Palliative therapy is dictated by good medical practice and includes anticonvulsant medication, control of endocrine dysfunction, and surgical procedures. Removal of noxious metabolites is centered on combating lactic acidosis, but it extends to other metabolites, such as thymidine in patients with the mitochondrial neurogastrointestinal encephalomyopathy syndrome. Attempts to bypass blocks in the respiratory chain by administration of artificial electron acceptors have not been successful, but this concept may be amenable to genetic engineering. Administration of metabolites and cofactors is the mainstay of real-life therapy and includes both components of the respiratory chain and other natural compounds. There is increasing interest in the administration of reactive oxygen species scavengers both in primary mitochondrial diseases and in neurodegenerative diseases directly or indirectly related to mitochondrial dysfunction. Aerobic exercise and physical therapy prevent or correct deconditioning and improve exercise tolerance in patients with mitochondrial myopathies due to mtDNA mutations. Gene therapy is a challenge because of polyplasmy and heteroplasmy, but interesting experimental approaches are being pursued and include, for example, decreasing the ratio of mutant to wild-type mitochondrial genomes (gene shifting), converting mutated mtDNA genes into normal nDNA genes (allotropic expression), importing cognate genes from other species, or correcting mtDNA mutations with specific restriction endonucleases. Germline therapy raises ethical problems but is being seriously considered to prevent maternal transmission of mtDNA mutations. Preventive therapy through genetic counseling and prenatal diagnosis is still limited for mtDNA-related disorders but is becoming increasingly important for nDNA-related disorders.
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Affiliation(s)
- Salvatore Dimauro
- Department of Neurology, Columbia University College of Physicians Surgeons, New York, New York 10032, USA.
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40
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Barboni P, Savini G, Plazzi G, Bellan M, Valentino ML, Zanini M, Montagna P, Hirano M, Carelli V. Ocular findings in mitochondrial neurogastrointestinal encephalomyopathy: a case report. Graefes Arch Clin Exp Ophthalmol 2004; 242:878-80. [PMID: 15042378 DOI: 10.1007/s00417-004-0914-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 02/13/2004] [Accepted: 02/26/2004] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To describe the ocular features of a patient with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) due to a homozygous G1443A mutation in the thymidine-phosphorylase gene. METHODS A case report with extensive ophthalmological investigation over a 9-year period, until death at age 38 years. Measures used included standard ophthalmological examination, visual field examination and optical coherence tomography (OCT). RESULTS Ptosis and external ophthalmoplegia progressively worsened during the follow-up, as did the neurological and general status. Corneal and optic disc alterations were also observed at the last visit. Glaucomatous changes of the optic disc were confirmed by the visual field examination and OCT. CONCLUSION In addition to previously described alterations such as ptosis and external ophthalmoplegia, MNGIE may be associated with glaucomatous-like optic neuropathy.
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Affiliation(s)
- Piero Barboni
- Centro di Oftalmologia Salus, via Saffi 4H, 40131 Bologna, Italy.
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41
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Abstract
BACKGROUND Mitochondrial encephalomyopathies are clinically and genetically heterogeneous because mitochondria are the products of 2 genomes: mitochondrial DNA (mtDNA) and nuclear DNA (nDNA). Among the mendelian-inherited mitochondrial diseases are defects of intergenomic communication, disorders due to nDNA mutations that cause depletion and multiple deletions of mtDNA. REVIEW SUMMARY Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder of intergenomic communication and is defined clinically by 1) severe gastrointestinal dysmotility; 2) cachexia; 3) ptosis, ophthalmoparesis, or both; 4) peripheral neuropathy; and 5) leukoencephalopathy. Skeletal muscle biopsies of patients have revealed abnormalities of mtDNA and mitochondrial respiratory chain enzymes. The disease is caused by mutations in the thymidine phosphorylase (TP) gene. TP protein catalyzes phosphorolysis of thymidine to thymine and deoxyribose 1-phosphate. In MNGIE patients, TP enzyme activity is reduced drastically, and plasma thymidine and deoxyuridine are elevated dramatically. We have hypothesized that alterations of nucleoside metabolism cause an imbalanced mitochondrial nucleotide pool that leads to depletion and deletions of mtDNA. CONCLUSIONS MNGIE is a recognizable clinical syndrome caused by mutations in TP. The diagnosis can be confirmed by measuring TP activity in buffy coat or plasma levels of thymidine and deoxyuridine. Reduction of circulating thymidine and deoxyuridine in MNGIE patients may be therapeutic.
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Affiliation(s)
- Michio Hirano
- Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY, USA.
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42
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Bedlack RS, Vu T, Hammans S, Sparr SA, Myers B, Morgenlander J, Hirano M. MNGIE neuropathy: Five cases mimicking chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2004; 29:364-8. [PMID: 14981734 DOI: 10.1002/mus.10546] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report five patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) who had demyelinating peripheral neuropathy. The MNGIE neuropathy had clinical and electrodiagnostic features typical of acquired, rather than inherited, etiologies. In fact, three patients were actually treated for chronic inflammatory demyelinating polyneuropathy (CIDP). We discuss findings that may help distinguish patients with MNGIE from those with CIDP.
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Affiliation(s)
- Richard S Bedlack
- Division of Neurology, Duke University Medical Center, 932 Morreene Road, Box 3333, Durham, North Carolina 27707, USA.
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43
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Müller W, Mennel HD, Bewermeyer K, Bewermeyer H. Is there a final common pathway in mitochondrial encephalomyopathies? Considerations based on an autopsy case of Kearns-Sayre syndrome. Clin Neuropathol 2003; 22:240-5. [PMID: 14531549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
A case of Kearns-Sayre syndrome (KSS) diagnosed 18 years prior to death due to stroke and heart failure with postnatal onset was followed over 15 years and confirmed by postmortem examination. Within the brain, an old cystic infarction of the left hemisphere was found. Other features included white matter gliosis and cerebellar atrophy. Equal or similar features were observed in other conditions thought to be due to failure of mitochondrial metabolism, therefore, a common evolution of neuropathological changes must be discussed.
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Affiliation(s)
- W Müller
- Department of Neurology, Cologne Municipal Hospital, Marburg, Germany
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44
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Abstract
Mitochondrial encephalomyopathies are diseases caused by defective oxidative phosphorylation (OXPHOS), and affect the nervous system and/or skeletal muscle. They have emerged as a major entity among the neurometabolic diseases of childhood with an incidence of 1 in 11,000 children, and also have a high prevalence in adults. The first pathogenic mutation of human mitochondrial DNA (mtDNA) was discovered in 1988. Since then more than 100 mutations of mtDNA have been reported, including point mutations of genes encoding transfer RNA, ribosomal RNA, and proteins, as well as large-scale deletions. The first nuclear-DNA gene mutation causing OXPHOS disease was described in 1995. Mutations in nuclear genes may affect the respiratory chain by various mechanisms. Pathogenic mutations of nuclear-DNA-encoded subunits of complex I and II have been demonstrated as have mutations of respiratory chain assembly proteins. Several nuclear genes associated with mtDNA maintenance have been found to be associated with mitochondrial disorders since mutations in these genes predispose to multiple mtDNA deletions and/or reduced copy number of mtDNA. The genotype-phenotype correlation is not yet entirely clear, but new animal models will enhance our ability to study the pathophysiology of OXPHOS disorders.
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Affiliation(s)
- Anders Oldfors
- Department of Pathology, Sahlgrenska University Hospital, Goteborg, Sweden.
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45
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Teitelbaum JE, Berde CB, Nurko S, Buonomo C, Perez-Atayde AR, Fox VL. Diagnosis and management of MNGIE syndrome in children: case report and review of the literature. J Pediatr Gastroenterol Nutr 2002; 35:377-83. [PMID: 12352533 DOI: 10.1097/00005176-200209000-00029] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) syndrome is a rare disorder that presents in childhood; however, marked delay in diagnosis is common. We report a case and review the literature describing the typical features that should alert pediatricians to the diagnosis. We also describe a novel management strategy for providing symptomatic relief.
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Affiliation(s)
- J E Teitelbaum
- Department of Pediatrics, Divison of Gastroenteroloy and Nustrition, Monmouth Mediacal Center, MCP Hahnemann Medical School, Long Branch, New Jersey 07740, USA.
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Gamez J, Ferreiro C, Accarino ML, Guarner L, Tadesse S, Martí RA, Andreu AL, Raguer N, Cervera C, Hirano M. Phenotypic variability in a Spanish family with MNGIE. Neurology 2002; 59:455-7. [PMID: 12177387 DOI: 10.1212/wnl.59.3.455] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Clinical, biochemical, and genetic features of a Spanish family with mitochondrial neurogastrointestinal encephalomyopathy are reported. The proband presented with severe gastrointestinal dysmotility and the affected sister had extraocular muscle weakness. In both affected individuals, biochemical defects of thymidine phosphorylase and a pathogenic G-to-A transition mutation at nucleotide 435 in the thymidine phosphorylase gene were identified. The first thymidine phosphorylase mutation identified in Spain showed phenotypic variability at onset.
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Affiliation(s)
- J Gamez
- Department of Neurology, Hospital Gral, Vall d'Hebron, Barcelona, Spain
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47
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Nagata K. [Glucose metabolism in the brain]. Nihon Rinsho 2002; 60 Suppl 7:314-23. [PMID: 12238066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- Ken Nagata
- Department of Neurology, Research Institute for Brain and Blood Vessels
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48
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Ikezoe K, Nakagawa M, Yan C, Kira JI, Goto YI, Nonaka I. Apoptosis is suspended in muscle of mitochondrial encephalomyopathies. Acta Neuropathol 2002; 103:531-40. [PMID: 12012084 DOI: 10.1007/s00401-001-0502-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2001] [Indexed: 11/27/2022]
Abstract
Over the past few years, many studies have been done on the apoptotic involvement in muscle fiber degeneration in various myopathies, but the occurrence of apoptosis in muscles of mitochondrial encephalomyopathies is still controversial. To confirm whether apoptotic processes are truly related to muscle fiber degeneration in mitochondrial encephalomyopathies, we performed the TUNEL method not only at the light microscopic (LM) but also at the electron microscopic (EM) level for muscles of five MELAS, five CPEO and five MERRF patients and five control muscles. Immunohistochemical studies of Bcl-2, Bax, cytochrome c, Apaf-1, activated caspase-3 and human inhibitor of apoptosis protein XIAP, and immunoblotting of Apaf-1 and XIAP were also carried out. In LM-TUNEL, MELAS, CPEO and MERRF patients had only very small numbers of TUNEL-positive myonuclei: 0.13+/-0.10%, 0.15+/-0.14% and 0.04+/-0.09%, respectively. Almost all of them were seen in ragged-red fibers (RRFs). EM-TUNEL showed no significant increase of DNA fragmentation in RRFs despite mild peripheral chromatin condensation. However, Bax and Apaf-1 expression and cytochrome c release from mitochondria were seen in RRFs. Caspase-3 activation was confirmed in 9.0+/-3.7%, 12.0+/-4.4% and 12.4+/-3.8% of RRFs in MELAS, CPEO and MERRF, respectively, but not in control muscles. Almost all RRFs showed sarcoplasmic expression of XIAP. Thus, there is a possibility that, although apoptotic reactions started in muscles of mitochondrial encephalomyopathies, their execution is rarely completed. Sarcoplasmic expression of XIAP probably leads to the suspension of the apoptotic process in mitochondrial encephalomyopathies.
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Affiliation(s)
- Koji Ikezoe
- Department of Neurology, Kyushu Koseinenkin Hospital, Kitakyushu, Fukuoka, 806-8501, Japan
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49
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Honjo K, Mimori Y, Morino H, Katayama S, Nakamura S. [A case of late onset mitochondrial neuromyopathy]. Nihon Ronen Igakkai Zasshi 2002; 39:318-21. [PMID: 12073596 DOI: 10.3143/geriatrics.39.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 68-year-old woman was admitted with dysesthesia on both soles, hands and buttocks. She first noticed the dysesthesia in the left first toe two years before admission. One year before admission, serum creatine kinase and lactate dehydrogenase levels were elevated but she had no clinical symptoms suggesting myopathy. Nerve conduction study showed no apparent abnormalities, and an electromyogram showed mild myogenic change. Computed tomography of the muscle showed fatty degeneration of the trunk, major gluteus muscle, and biceps femoris muscle and atrophic change of the biceps femoris muscle. Muscle biopsy revealed a slight variation in fiber size, the presence of cytochrome c oxidase (CCO)-negative fibers by CCO staining, ragged-red fibers by Gomori trichrome staining, and mild denervation fiber by neuron specific enolase (NSE) staining. Analysis of her mitochondrial DNA (mtDNA) revealed a large deletion of mtDNA (approximately 8.5 Kb), and mitochondrial neuromyophy was diagnosed. The frequency of mtDNA deletion increases with aging. Although her mtDNA abnormality was compatible with chronic progressive external ophthalmoplegia (CPEO), we speculate that the aging process may be contributed to the mtDNA abnormality, which would be related to the late onset of her symptoms. As the phenotype of this mitochondrial disorder shows a wide variation and mtDNA abnormality is more frequent among elderly people, we should consider the possibility of mitochondrial disorders even in elderly people.
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Affiliation(s)
- Kie Honjo
- Third Department of Internal Medicine, Hiroshima University School of Medicine
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50
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Hiromatsu Y. [Hypothyroidism in mitochondrial encephalomyopathy]. Nihon Rinsho 2002; 60 Suppl 4:583-6. [PMID: 12013948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- Yuji Hiromatsu
- Department of Endocrinology and Metabolism, Kurume University School of Medicine
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