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Zerem A, Yosovich K, Rappaport YC, Libzon S, Blumkin L, Ben-Sira L, Lev D, Lerman-Sagie T. Metabolic stroke in a patient with bi-allelic OPA1 mutations. Metab Brain Dis 2019; 34:1043-1048. [PMID: 30972688 DOI: 10.1007/s11011-019-00415-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/31/2019] [Indexed: 02/07/2023]
Abstract
OPA1 related disorders include: classic autosomal dominant optic atrophy syndrome (ADOA), ADOA plus syndrome and a bi-allelic OPA1 complex neurological disorder. We describe metabolic stroke in a patient with bi-allelic OPA1 mutations. A twelve-year old girl presented with a complex neurological disorder that includes: early onset optic atrophy at one year of age, progressive gait ataxia, dysarthria, tremor and learning impairment. A metabolic stroke occurred at the age of 12 years. The patient was found to harbor a de novo heterozygous frame shift mutation c.1963_1964dupAT; p.Lys656fs (NM_015560.2) and a missense mutation c.1146A > G; Ile382Met (NM_015560.2) inherited from her mother. The mother, aunt, and grandmother are heterozygous for the Ile382Met mutation and are asymptomatic. The co-occurrence of bi-allelic mutations can explain the severity and the early onset of her disease. This case adds to a growing number of patients recently discovered with bi-allelic OPA1 mutations presenting with a complex and early onset neurological disorder resembling Behr syndrome. To the best of our knowledge metabolic stroke has not been described before as an OPA1 related manifestation. It is important to be aware of this clinical feature for a prompt diagnosis and consideration of available treatment.
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Affiliation(s)
- Ayelet Zerem
- Metabolic Neurogenetic Service, Pediatric Neurology Unit, Wolfson Medical Center, Halochamim 62, Holon, Israel.
- Sackler Faculty of Medicine, Tel-Aviv University, Haim Levanon 55, Tel-Aviv, Israel.
| | - Keren Yosovich
- Metabolic Neurogenetic Service, Genetics Institute, Wolfson Medical Center, Halochamim 62, Holon, Israel
| | - Yael Cohen Rappaport
- Metabolic Neurogenetic Service, Pediatric Neurology Unit, Wolfson Medical Center, Halochamim 62, Holon, Israel
| | - Stephanie Libzon
- Metabolic Neurogenetic Service, Pediatric Neurology Unit, Wolfson Medical Center, Halochamim 62, Holon, Israel
| | - Lubov Blumkin
- Metabolic Neurogenetic Service, Pediatric Neurology Unit, Wolfson Medical Center, Halochamim 62, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Haim Levanon 55, Tel-Aviv, Israel
| | - Liat Ben-Sira
- Sackler Faculty of Medicine, Tel-Aviv University, Haim Levanon 55, Tel-Aviv, Israel
- Division of Pediatric Radiology, Department of Radiology, Dana Children's Hospital, Tel-Aviv Medical Center, Weizmann 6, Tel Aviv, Israel
| | - Dorit Lev
- Sackler Faculty of Medicine, Tel-Aviv University, Haim Levanon 55, Tel-Aviv, Israel
- Metabolic Neurogenetic Service, Genetics Institute, Wolfson Medical Center, Halochamim 62, Holon, Israel
| | - Tally Lerman-Sagie
- Metabolic Neurogenetic Service, Pediatric Neurology Unit, Wolfson Medical Center, Halochamim 62, Holon, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Haim Levanon 55, Tel-Aviv, Israel
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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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Affiliation(s)
- Patrick Yu-Wai-Man
- 1 Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic
Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
| | - Patrick F. Chinnery
- 1 Wellcome Trust Centre for Mitochondrial Research, Institute of Genetic
Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK
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Ayrignac X, Liauzun C, Lenaers G, Renard D, Amati-Bonneau P, de Sèze J, Dollfus H, Hamel C, Bonneau D, Labauge P. OPA3--related autosomal dominant optic atrophy and cataract with ataxia and areflexia. Eur Neurol 2012; 68:108-10. [PMID: 22797356 DOI: 10.1159/000339310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 05/06/2012] [Indexed: 11/19/2022]
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Affiliation(s)
- Patrick Yu-Wai-Man
- Mitochondrial Research Group, Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, NE1 3BZ, UK; Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK
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Baker MR, Fisher KM, Whittaker RG, Griffiths PG, Yu-Wai-Man P, Chinnery PF. Subclinical multisystem neurologic disease in "pure" OPA1 autosomal dominant optic atrophy. Neurology 2011; 77:1309-12. [PMID: 21917770 PMCID: PMC3179647 DOI: 10.1212/wnl.0b013e318230a15a] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- M R Baker
- Institute of Neuroscience, The Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
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Eiberg H, Hansen L, Kjer B, Hansen T, Pedersen O, Bille M, Rosenberg T, Tranebjaerg L. Autosomal dominant optic atrophy associated with hearing impairment and impaired glucose regulation caused by a missense mutation in the WFS1 gene. J Med Genet 2006; 43:435-40. [PMID: 16648378 PMCID: PMC2649014 DOI: 10.1136/jmg.2005.034892] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Autosomal dominant optic atrophy (ADOA) is genetically heterogeneous, with OPA1 on 3q28 being the most prevalently mutated gene. Additional loci are OPA3, OPA4, and OPA5, located at 19q13.2, 18q12.2, and 22q12.1-q13.1, respectively. Mutations in the WFS1 gene, at 4p16.3, are associated with either optic atrophy (OA) as part of the autosomal recessive Wolfram syndrome or with autosomal dominant progressive low frequency sensorineural hearing loss (LFSNHL) without any ophthalmological abnormalities. Linkage and sequence mutation analyses of the ADOA candidate genes OPA1, OPA3, OPA4, and OPA5, including the genes WFS1, GJB2, and GJB6 associated with recessive inherited OA or dominant LFSNHL, were performed. We identified one novel WFS1 missense mutation E864K, c.2590G-->A in exon 8 that co-segregates with ADOA combined with hearing impairment and impaired glucose regulation. This is the first example of autosomal dominant optic atrophy and hearing loss associated with a WFS1 mutation, supporting the notion that mutations in WFS1 as well as in OPA1 may lead to ADOA combined with impaired hearing.
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Affiliation(s)
- H Eiberg
- Department of Medical Biochemistry and Genetics, Panum Institute, University of Copenhagen, DK-2200 Copenhagen N, Denmark.
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Walters JW, Gaume A, Pate L. Short wavelength-automated perimetry compared with standard achromatic perimetry in autosomal dominant optic atrophy. Br J Ophthalmol 2006; 90:1267-70. [PMID: 16837542 PMCID: PMC1857431 DOI: 10.1136/bjo.2006.097196] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Autosomal dominant optic atrophy (ADOA, Kjer-type) is a heterogeneous, non-inflammatory degeneration of retinal ganglion cells. The diagnosis of ADOA can be challenging owing to its insidious onset and large variability in phenotypic expression, both within and between individual pedigrees. The earliest literature reports relatively mild centrocaecal scatomas to white targets in ADOA, but extensive and dense peripheral field loss to coloured targets, especially blue, with Bjerrum perimetry. The phrase "inverted peripheral visual fields to coloured targets" has been used to describe this phenomenon. METHODS Humphrey standard achromatic perimetry (SAP) and short wavelength-automated perimetry (SWAP) were carried out on five patients with ADOA. RESULTS Regardless of wide variations in patient age, visual acuity, disc appearance and colour vision, the SWAP mean deviation (MD) was between 10 and 20 times more depressed than the SAP MD. The actual differences ranged from 9.38 to 13.78 dB. CONCLUSIONS These data are consistent with the original reports suggesting that, early in this disease process, the blue-target deficits are typically peripheral and that this difference between SAP and SWAP perimetry may be a robust indicator of ADOA in both early and late stages of this disease.
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Affiliation(s)
- J W Walters
- College of Optometry, University of Houston, J Davis Armistead Building, Houston, TX 77204-6052, USA.
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Newman NJ. Hereditary optic neuropathies: from the mitochondria to the optic nerve. Am J Ophthalmol 2005; 140:517-23. [PMID: 16083845 DOI: 10.1016/j.ajo.2005.03.017] [Citation(s) in RCA: 110] [Impact Index Per Article: 5.8] [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: 12/28/2004] [Revised: 03/01/2005] [Accepted: 03/02/2005] [Indexed: 12/22/2022]
Abstract
PURPOSE To review our current knowledge of inherited optic neuropathies. DESIGN Perspective. METHODS Literature review. RESULTS The hereditary optic neuropathies consist of a group of disorders in which optic nerve dysfunction figures solely or prominently and direct inheritance is clinically or genetically proven. The most common of these disorders are autosomal dominant optic atrophy (Kjers' disease) and maternally-inherited Leber's hereditary optic neuropathy. Other inherited neurologic and systemic syndromic diseases will frequently manifest optic neuropathy. A selective vulnerability of the optic nerve to perturbations in mitochondrial function may underlie a final common pathway among these disorders. CONCLUSIONS The ophthalmologist should be familiar with the clinical characteristics and diagnosis of the hereditary optic neuropathies. Recent advances in our understanding of the underlying pathophysiology of the inherited optic neuropathies may provide insight into their treatment and the treatment of acquired optic nerve disorders.
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Affiliation(s)
- Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Emory Eye Center, 1365-B Clifton Road NE, Atlanta, GA 30322, USA.
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Reynier P, Amati-Bonneau P, Verny C, Olichon A, Simard G, Guichet A, Bonnemains C, Malecaze F, Malinge MC, Pelletier JB, Calvas P, Dollfus H, Belenguer P, Malthièry Y, Lenaers G, Bonneau D. OPA3 gene mutations responsible for autosomal dominant optic atrophy and cataract. J Med Genet 2005; 41:e110. [PMID: 15342707 PMCID: PMC1735897 DOI: 10.1136/jmg.2003.016576] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
AIMS To provide a clinical update on the hereditary optic neuropathies. METHODS Review of the literature. RESULTS The hereditary optic neuropathies comprise a group of disorders in which the cause of optic nerve dysfunction appears to be hereditable, based on familial expression or genetic analysis. In some hereditary optic neuropathies, optic nerve dysfunction is typically the only manifestation of the disease. In others, various neurologic and systemic abnormalities are regularly observed. CONCLUSION The most common hereditary optic neuropathies are autosomal dominant optic atrophy (Kjer's disease) and maternally inherited Leber's hereditary optic neuropathy. We review the clinical phenotypes of these and other inherited disorders with optic nerve involvement.
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MESH Headings
- Dysautonomia, Familial/complications
- Dysautonomia, Familial/genetics
- Female
- Friedreich Ataxia/complications
- Friedreich Ataxia/genetics
- Humans
- Male
- Muscular Dystrophies/complications
- Muscular Dystrophies/genetics
- Optic Atrophies, Hereditary/complications
- Optic Atrophies, Hereditary/genetics
- Optic Atrophies, Hereditary/physiopathology
- Optic Atrophy, Autosomal Dominant/complications
- Optic Atrophy, Autosomal Dominant/genetics
- Optic Atrophy, Autosomal Dominant/physiopathology
- Optic Atrophy, Hereditary, Leber/complications
- Optic Atrophy, Hereditary, Leber/genetics
- Optic Atrophy, Hereditary, Leber/physiopathology
- Pedigree
- Spinocerebellar Ataxias/complications
- Spinocerebellar Ataxias/genetics
- Vision Disorders/etiology
- Vision Disorders/genetics
- Vision Disorders/physiopathology
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Affiliation(s)
- N J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA 30022, USA.
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Abstract
Dominant optic atrophy is the most common heredodegenerative optic neuropathy. Typically, patients present with slowly progressive, bilaterally decreased central visual acuity. Subtle central or cecocentral visual field defect and normal peripheral isopters are demonstrated with perimetry. A defect in blue-yellow discrimination (tritan error axis) is the most common type of dyschromatopsia, however protan and deutan axes may be superimposed. A characteristic optic disk appearance includes temporal disk pallor with excavation. An autosomal dominant inheritance pattern can often be elicited from the family history.
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Affiliation(s)
- Lawrence M Buono
- Neuro-Ophthalmology Service, Wills Eye Hospital/Thomas Jefferson Medical College, Philadelphia, Pennsylvania 19107, USA
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Abstract
PURPOSE To present the detailed clinical findings of a large family with hereditary motor and sensory neuropathy type VI (HMSN VI), a syndrome featuring optic atrophy. DESIGN Observational case series. METHODS A detailed history was obtained and physical examination was made of the extended family of the proband for evidence of neurologic dysfunction. The OPA1 gene was screened for mutations by direct DNA sequencing. RESULTS Twelve of 97 family members examined are affected with signs of HMSN VI. Three other members have either optic atrophy or peripheral neuropathy, thus allowing an appreciation of the full clinical spectrum of disease. No mutations were found in the OPA1 gene. CONCLUSIONS This family demonstrates the variable expressivity of this disorder as well as incomplete penetrance. This is the largest known family with HMSN VI. No association was found with changes in the OPA1 gene.
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Affiliation(s)
- Irene Voo
- Department of Ophthalmology, UCLA School of Medicine, Jules Stein Eye Institute, Los Angeles, California 90095, USA
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Singh SK, Singh R, Maurya VK. Primary optic atrophy and autosomal dominant osteopetrosis type II. J Assoc Physicians India 2002; 50:850. [PMID: 12240863] [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)
- S K Singh
- Department of Endocrinology, Diabetic and Endocrine Centre and Koshika Children Hospital, Varanasi
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