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Wong LJ. Recognition of mitochondrial DNA deletion syndrome with non-neuromuscular multisystemic manifestation. Genet Med 2001; 3:399-404. [PMID: 11715003 DOI: 10.1097/00125817-200111000-00004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To correlate the molecular characteristics of the mtDNA deletions with clinical phenotypes. METHODS Southern analysis and polymerase chain reaction (PCR)/DNA sequencing were used to determine the size and location of deletions in 16 patients with mtDNA deletion syndrome. An additional 48 reported cases from the literature were also included in the statistical analysis. RESULTS The common 5-kb deletion is found in eight of nine patients with Kearns-Sayre syndrome (KSS), mitochondrial myopathies (MM), or progressive external ophthalmoplegia (PEO). The rare/novel deletions were found in six of seven patients with extra-neuromuscular multisystemic manifestations and infantile/early childhood onset. CONCLUSIONS Patients with mtDNA deletion syndrome who manifest non-neuromuscular multisystemic disorders at a very young age usually harbor mutant mtDNA with novel or rare deletions in every tissue analyzed. For this group of patients, it is possible to use the less invasive blood specimens instead of muscle biopsies for molecular diagnosis. Overwhelmingly, the common 5-kb deletion is mostly seen in the muscle specimens of patients with KSS and age of onset after the second decade of life.
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Affiliation(s)
- L J Wong
- Institute for Molecular and Human Genetics, Georgetown University Medical Center, Washington, DC 20007, USA
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52
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Niers LE, Smeitink JA, Trijbels JM, Sengers RC, Janssen AJ, van den Heuvel LP. Prenatal diagnosis of NADH:ubiquinone oxidoreductase deficiency. Prenat Diagn 2001; 21:871-80. [PMID: 11746133 DOI: 10.1002/pd.162] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
NADH:ubiquinone oxidoreductase (complex I of the mitochondrial respiratory chain) deficiency is a severe disorder with an often early fatal outcome. Prenatal diagnosis for complex I defects currently relies mainly on biochemical assays of complex I in fetal tissues such as chorionic villi (CV), and is only in a minority of cases possible by means of mutational analysis of nuclear-encoded genes of complex I. We report on our experience to date with prenatal diagnosis in pregnancies at risk for complex I deficiency. We measured complex I activity in native CV and/or cultured CV in 23 pregnancies in 15 families. In accordance with the results of the investigations in CV, 15 children were born clinically unaffected. Two prenatally diagnosed unaffected fetuses and two prenatally diagnosed affected fetuses were lost prematurely with spontaneous or provoked abortions, respectively. Two affected children were born (prenatally found to be affected). In two pregnancies a discrepancy between native and cultured cells was found. We conclude that prenatal diagnosis for complex I deficiency can be reliably performed. Pitfalls were encountered in using cultured CV as a result of maternal cell contamination (MCC). Future research on pathogenic nuclear mutations underlying complex I deficiency will extend the possibilities for prenatal diagnosis at the molecular level.
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Affiliation(s)
- L E Niers
- Nijmegen Center for Mitochondrial Disorders, Department of Pediatrics, University Medical Center Nijmegen, Nijmegen, The Netherlands
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53
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Wong LJ, Dai P, Tan D, Lipson M, Grix A, Sifry-Platt M, Gropman A, Chen TJ. Severe lactic acidosis caused by a novel frame-shift mutation in mitochondrial-encoded cytochrome c oxidase subunit II. AMERICAN JOURNAL OF MEDICAL GENETICS 2001; 102:95-9. [PMID: 11471180 DOI: 10.1002/1096-8628(20010722)102:1<95::aid-ajmg1412>3.0.co;2-u] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report the first frame-shift truncation mutation in a mitochondrial DNA (mtDNA)-encoded subunit II of cytochrome c oxidase (COXII). The mutation was identified by temporal temperature gradient gel electrophoresis (TTGE) followed by direct DNA sequencing in an infant who died at 12 days of age following a course of apnea, bradycardia, and severe lactic acidosis. The patient had a twin brother who died at two days of age of similar course. The mutation, 8042delAT, produced a truncated protein that was 72 amino acids shorter than the wild type protein. The mutant protein, missing one third of the amino acid residues at the C-terminal essential for hydrophilic interaction with cytochrome c, ligand binding to CuA and Mg, and the formation of proton and water channels, apparently has devastating effects on mitochondrial respiratory function.
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Affiliation(s)
- L J Wong
- Institute for Molecular and Human Genetics, Georgetown University Medical Center, Washington, DC 2007, USA.
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54
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Karadimas C, Tanji K, Geremek M, Chronopoulou P, Vu T, Krishna S, Sue CM, Shanske S, Bonilla E, DiMauro S, Lipson M, Bachman R. A5814G mutation in mitochondrial DNA can cause mitochondrial myopathy and cardiomyopathy. J Child Neurol 2001; 16:531-3. [PMID: 11453453 DOI: 10.1177/088307380101600715] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a 5-year-old child with hypertrophic cardiomyopathy, mitochondrial myopathy, and lactic acidosis. Mitochondrial DNA analysis showed a heteroplasmic A5814G point mutation in the tRNA(Cys) gene. The mutational load was extremely high (>95%) in muscle, fibroblasts, and blood. This report expands the clinical heterogeneity of the A5814G mutation, which should be considered in the differential diagnosis of hypertrophic cardiomyopathy in childhood.
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Affiliation(s)
- C Karadimas
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, New York, USA
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55
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Vogel H. Mitochondrial myopathies and the role of the pathologist in the molecular era. J Neuropathol Exp Neurol 2001; 60:217-27. [PMID: 11245207 DOI: 10.1093/jnen/60.3.217] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mitochondrial encephalomyopathies are under increasing consideration in the differential diagnosis of diverse metabolic diseases from infancy to late adulthood. This is to be expected considering the vital importance of mitochondria to cellular respiration in all eukaryotes. the vulnerability of the mitochondrial genome to injury, and the expanding appreciation of the role of mitochondria as a common denominator in cell death in ischemia/anoxia, sepsis, and neurodegenerative diseases. Primary disease of the mitochondrial respiratory chain is estimated to occur with an incidence of between 6 and 16/100,000 individuals. Virtually all tissues have been shown to be involved in diverse mitochondriopathies, but none is more appropriate for diagnosis in most cases than skeletal muscle. The conventional histological and ultrastructural diagnosis of mitochondrial disease in muscle has been increasingly supplanted by the biochemical assessment of respiratory chain enzyme deficiencies and definitive genetic diagnosis. The use of such techniques has afforded a greater understanding for the relative lack of specificity of both light and electron microscopic observations. A review of the current situation by placing muscle pathology in the context of biochemical and genetic diagnosis serves as a paradigm for the role of the pathologist in the molecular era.
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Affiliation(s)
- H Vogel
- Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, USA
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56
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Kerst B, Mennerich D, Schuelke M, Stoltenburg-Didinger G, von Moers A, Gossrau R, van Landeghem FK, Speer A, Braun T, Hübner C. Heterozygous myogenic factor 6 mutation associated with myopathy and severe course of Becker muscular dystrophy. Neuromuscul Disord 2000; 10:572-7. [PMID: 11053684 DOI: 10.1016/s0960-8966(00)00150-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myogenic factors (MYF) belong to the basic helix-loop-helix (bHLH) transcription factor family and regulate myogenesis and muscle regeneration. The physiological importance of both functions was demonstrated in homozygous Myf knockout mice and mdx mice. Myf5 and Myod are predominantly expressed in proliferating myoblasts while Myf4 and Myf6 are involved in differentiation of myotubes. In a boy with myopathy and an increase of muscle fibres with central nuclei we detected a heterozygous 387G-->T nucleotide transversion in the MYF6 gene (MIM*159991). Protein-protein interaction of mutant MYF6 was reduced, and DNA-binding potential and transactivation capacity were abolished, thus demonstrating MYF6 haploinsufficiency. The boy's father carried the identical mutation and, in addition, an in-frame deletion of exons 45-47 in his dystrophin gene. This mutation is normally associated with a mild to moderate course of Becker muscular dystrophy but the father suffered from a severe course of Becker muscular dystrophy suggesting MYF6 as a modifier.
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Affiliation(s)
- B Kerst
- Department of Neuropaediatrics, Humboldt University, Charité, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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57
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Vladutiu GD, Bennett MJ, Smail D, Wong LJ, Taggart RT, Lindsley HB. A variable myopathy associated with heterozygosity for the R503C mutation in the carnitine palmitoyltransferase II gene. Mol Genet Metab 2000; 70:134-41. [PMID: 10873395 DOI: 10.1006/mgme.2000.3009] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Adult-onset carnitine palmitoyltransferase II (CPT II) deficiency is an autosomal recessive disease characterized by muscle pain and stiffness with rhabdomyolysis and myoglobinuria in severe cases. Exercise, fasting, viral infection, anesthesia, or extremes in temperature may trigger symptoms. A 54-year-old woman exhibited a 35-year history of progressive weakness and myopathic symptoms. CPT II activity in the patient's lymphoblasts, cultured skin fibroblasts, and skeletal muscle was reduced to 47, 43, and 13% of normal, respectively. Respiratory chain enzymes were also reduced in muscle ranging from 22 to 49% of their respective normal reference means. beta-oxidation enzymes in fibroblasts ranged from 29 to 63% of normal. The patient, her father, and her 26-year-old son were all heterozygous for the R503C mutation. The patient's son has a lifelong history of myopathic symptoms while his grandfather only had mild weakness during childhood. Analysis of the V368I and M647V polymorphisms in the CPT2 gene showed that the mutant allele is linked to 368I and 647M in this family and that the normal allele is linked to 647V in the affected patient and her son, and to 647M in the patient's father. While the variability in CPT2 gene haplotypes may contribute to the phenotypic complexities in this family, it is also possible that an additional gene defect in the transport of mitochondrial proteins contributes to the complex phenotype in the patient. We present biochemical and molecular evidence for vertical transmission of a variable myopathy caused by heterozygosity for a single mutation, R503C, in the CPT2 gene.
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Affiliation(s)
- G D Vladutiu
- Department of Pediatrics, School of Medicine & Biomedical Sciences, State University of New York at Buffalo, 14209, USA.
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58
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Abstract
The metabolic myopathies are distinguished by extensive clinical and genetic heterogeneity within and between individual disorders. There are a number of explanations for the variability observed that go beyond single gene mutations or degrees of heteroplasmy in the case of mitochondrial DNA mutations. Some of the contributing factors include protein subunit interactions, tissue-specificity, modifying genetic factors, and environmental triggers. Advances in the molecular analysis of metabolic myopathies during the last decade have not only improved the diagnosis of individual disorders but also helped to characterize the contributing factors that make these disorders so complex.
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Affiliation(s)
- G D Vladutiu
- Associate Professor, Departments of Pediatrics, Neurology, and Pathology, Division of Genetics, School of Medicine and Biomedical Studies, State University of New York at Buffalo, 14209, USA.
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59
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Lacbawan F, Tifft CJ, Luban NL, Schmandt SM, Guerrera M, Weinstein S, Pennybacker M, Wong LJC. Clinical Heterogeneity in Mitochondrial DNA Deletion Disorders: A Diagnostic Challenge of Pearson Syndrome. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/1096-8628(20001127)95:3<266::aid-ajmg13>3.0.co;2-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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60
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Chen TJ, Boles RG, Wong LJC. Detection of Mitochondrial DNA Mutations by Temporal Temperature Gradient Gel Electrophoresis. Clin Chem 1999. [DOI: 10.1093/clinchem/45.8.1162] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Background: A unique requirement for the molecular diagnosis of mitochondrial DNA (mtDNA) disorders is the ability to detect heteroplasmic mtDNA mutations and to distinguish them from homoplasmic sequence variations before further testing (e.g., sequencing) is performed. We evaluated the potential utility of temporal temperature gradient gel electrophoresis (TTGE) for these purposes in patients with suspected mtDNA mutations.
Methods: DNA samples were selected from patients with known mtDNA mutations and patients suspected of mtDNA disorders without detectable mutations by routine analysis. Six regions of mtDNA were PCR amplified and analyzed by TTGE. Electrophoresis was carried out at 145 V with a constant temperature increment of 1.2 °C/h. Mutations were identified by direct sequencing of the PCR products and confirmed by PCR/allele-specific oligonucleotide or PCR/restriction fragment length polymorphism analysis.
Results: In the experiments using patient samples containing various amounts of mutant mtDNA, TTGE detected as little as 4% mutant heteroplasmy and identified heteroplasmy in the presence of a homoplasmic polymorphism. In 109 specimens with 15 different known mutations, TTGE detected the presence of all mutations and distinguished heteroplasmic mutations from homoplasmic polymorphisms. When 11% of the mtDNA genome was analyzed by TTGE in 104 patients with clinically suspected mitochondrial disorders, 7 cases of heteroplasmy (≈7%) were detected.
Conclusions: TTGE distinguishes heteroplasmic mutation from homoplasmic polymorphisms and appears to be a sensitive tool for detection of sequence variations and heteroplasmy in patients suspected of having mtDNA disorders.
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Affiliation(s)
- Tian-Jian Chen
- Institute for Molecular and Human Genetics, Georgetown University Medical Center, Washington, DC 20007
- Division of Medical Genetics, Children’s Hospital Los Angeles, and Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, CA 90027
| | - Richard G Boles
- Division of Medical Genetics, Children’s Hospital Los Angeles, and Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, CA 90027
| | - Lee-Jun C Wong
- Institute for Molecular and Human Genetics, Georgetown University Medical Center, Washington, DC 20007
- Division of Medical Genetics, Children’s Hospital Los Angeles, and Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, CA 90027
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61
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Smeitink J, van den Heuvel L. Human mitochondrial complex I in health and disease. Am J Hum Genet 1999; 64:1505-10. [PMID: 10330338 PMCID: PMC1377894 DOI: 10.1086/302432] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- J Smeitink
- Department of Pediatrics, Nijmegen Center for Mitochondrial Disorders, University Hospital Nijmegen, Nijmegen, The Netherlands.
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62
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Schuelke M, Smeitink J, Mariman E, Loeffen J, Plecko B, Trijbels F, Stöckler-Ipsiroglu S, van den Heuvel L. Mutant NDUFV1 subunit of mitochondrial complex I causes leukodystrophy and myoclonic epilepsy. Nat Genet 1999; 21:260-1. [PMID: 10080174 DOI: 10.1038/6772] [Citation(s) in RCA: 184] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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63
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Damore ME, Speiser PW, Slonim AE, New MI, Shanske S, Xia W, Santorelli FM, DiMauro S. Early onset of diabetes mellitus associated with the mitochondrial DNA T14709C point mutation: patient report and literature review. J Pediatr Endocrinol Metab 1999; 12:207-13. [PMID: 10392369 DOI: 10.1515/jpem.1999.12.2.207] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a family in which a mother and son were affected with diabetes mellitus and myopathy characterized by ragged red fibers and suggestive of mitochondrial disease. Mitochondrial DNA (mtDNA) analysis of DNA isolated from peripheral blood showed a T-->C point mutation at nucleotide position 14709, in the transfer RNA gene for glutamic acid. We review the association of diabetes and mtDNA mutations. This child's case is unusual because of the early onset of diabetes, which is more typical of mtDNA deletions.
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Affiliation(s)
- M E Damore
- Department of Pediatrics, North Shore University Hospital-New York University School of Medicine, Manhasset 11030, USA
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