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Kobayashi M, Miyauchi A, Jimbo EF, Oishi N, Aoki S, Watanabe M, Yoshikawa Y, Akiyama Y, Yamagata T, Osaka H. Synthetic aporphine alkaloids are potential therapeutics for Leigh syndrome. Sci Rep 2024; 14:11561. [PMID: 38773300 PMCID: PMC11109252 DOI: 10.1038/s41598-024-62445-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/16/2024] [Indexed: 05/23/2024] Open
Abstract
Mitochondrial diseases are mainly caused by dysfunction of mitochondrial respiratory chain complexes and have a variety of genetic variants or phenotypes. There are only a few approved treatments, and fundamental therapies are yet to be developed. Leigh syndrome (LS) is the most severe type of progressive encephalopathy. We previously reported that apomorphine, an anti- "off" agent for Parkinson's disease, has cell-protective activity in patient-derived skin fibroblasts in addition to strong dopamine agonist effect. We obtained 26 apomorphine analogs, synthesized 20 apomorphine derivatives, and determined their anti-cell death effect, dopamine agonist activity, and effects on the mitochondrial function. We found three novel apomorphine derivatives with an active hydroxy group at position 11 of the aporphine framework, with a high anti-cell death effect without emetic dopamine agonist activity. These synthetic aporphine alkaloids are potent therapeutics for mitochondrial diseases without emetic side effects and have the potential to overcome the low bioavailability of apomorphine. Moreover, they have high anti-ferroptotic activity and therefore have potential as a therapeutic agent for diseases related to ferroptosis.
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Affiliation(s)
- Mizuki Kobayashi
- Department of Pediatrics, Division of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Akihiko Miyauchi
- Department of Pediatrics, Division of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Eriko F Jimbo
- Department of Pediatrics, Division of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Natsumi Oishi
- Department of Pediatrics, Division of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Shiho Aoki
- Department of Pediatrics, Division of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Miyuki Watanabe
- Department of Pediatrics, Division of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Yasushi Yoshikawa
- School of Life Science and Technology, Tokyo Institute of Technology, Yokohama, 226-8501, Japan
- Department of Computer Science, School of Computing, Tokyo Institute of Technology, Meguro-ku, Tokyo, 152-8550, Japan
- Middle-Molecule IT-Based Drug Discovery Laboratory (MIDL), Tokyo Institute of Technology, Kawasaki, Kanagawa, 210-0821, Japan
| | - Yutaka Akiyama
- School of Life Science and Technology, Tokyo Institute of Technology, Yokohama, 226-8501, Japan
- Department of Computer Science, School of Computing, Tokyo Institute of Technology, Meguro-ku, Tokyo, 152-8550, Japan
- Middle-Molecule IT-Based Drug Discovery Laboratory (MIDL), Tokyo Institute of Technology, Kawasaki, Kanagawa, 210-0821, Japan
| | - Takanori Yamagata
- Department of Pediatrics, Division of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Division of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
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2
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Sasaki M, Okanishi T, Matsuoka T, Yoshimura A, Maruyama S, Shiohama T, Hoshino H, Mori T, Majima H, Matsumoto H, Kobayashi S, Chiyonobu T, Matsushige T, Nakamura K, Kubota K, Tanaka R, Fujita T, Enoki H, Suzuki Y, Nakamura S, Fujimoto A, Maegaki Y. Infantile Epileptic Spasms Syndrome Complicated by Leigh Syndrome and Leigh-Like Syndrome: A Retrospective, Nationwide, Multicenter Case Series. Pediatr Neurol 2024; 157:29-38. [PMID: 38848614 DOI: 10.1016/j.pediatrneurol.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Six percent of patients with Leigh syndrome (LS) present with infantile epileptic spasms syndrome (IESS). However, treatment strategies for IESS with LS remain unclear. This retrospective study aimed to evaluate the efficacy and safety of treatment strategies in patients with IESS complicated by LS and Leigh-like syndrome (LLS). METHODS We distributed questionnaires to 750 facilities in Japan, and the clinical data of 21 patients from 15 hospitals were collected. The data comprised treatment strategies, including adrenocorticotropic hormone (ACTH) therapy, ketogenic diet (KD) therapy, and antiseizure medications (ASMs); effectiveness of each treatment; and the adverse events. RESULTS The median age at LS and LLS diagnosis was 7 months (range: 0 to 50), whereas that at the onset of epileptic spasms was 7 (range: 3 to 20). LS was diagnosed in 17 patients and LLS in four patients. Seven, two, five, and seven patients received ACTH + ASMs, ACTH + KD + ASMs, KD + ASMs, and ASMs only, respectively. Four (44%) of nine patients treated with ACTH and one (14%) of seven patients treated with KD achieved electroclinical remission within one month of treatment. No patients treated with only ASMs achieved electroclinical remission. Seven patients (33%) achieved electroclinical remission by the last follow-up. Adverse events were reported in four patients treated with ACTH, none treated with KD therapy, and eight treated with ASMs. CONCLUSION ACTH therapy shows the best efficacy and rapid action in patients with IESS complicated by LS and LLS. The effectiveness of KD therapy and ASMs in this study was insufficient.
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Affiliation(s)
- Michiru Sasaki
- Course of Medicine for Children with Disabilities, Faculty of Medicine and Graduate School of Medical Sciences, Tottori University, Yonago, Japan
| | - Tohru Okanishi
- Faculty of Medicine, Division of Child Neurology, Institute of Neurological Science, Tottori University, Yonago, Japan.
| | - Tsuyoshi Matsuoka
- Division of Child Neurology and Child Psychiatry, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center and Children's Medical Center, Haebaru, Japan
| | - Ayumi Yoshimura
- Department of Pediatrics, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shinsuke Maruyama
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tadashi Shiohama
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroki Hoshino
- Department of Pediatrics, Toho University Medical Center Sakura Hospital, Chiba, Japan
| | - Tatsuo Mori
- Department of Pediatrics, Graduate School of Medical Sciences, Tokushima University, Tokushima, Japan
| | - Hisakazu Majima
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Hiroshi Matsumoto
- Department of Pediatrics, National Defense Medical College, Tokorozawa, Japan
| | - Satoru Kobayashi
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya, Japan
| | - Tomohiro Chiyonobu
- Department of Molecular Diagnostics and Therapeutics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Matsushige
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kazuyuki Nakamura
- Department of Pediatrics, Yamagata University Hospital, Yamagata, Japan
| | - Kazuo Kubota
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Ryuta Tanaka
- Department of Pediatrics, Ibaraki Children's Hospital, Mito, Japan
| | - Takako Fujita
- Faculty of Medicine, Department of Pediatrics, Fukuoka University, Fukuoka, Japan
| | - Hideo Enoki
- Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Yasuhiro Suzuki
- Department of Pediatric Neurology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Sadao Nakamura
- Department of Pediatrics, Graduate School of Medicine, University of the Ryukyus, Nishihara, Japan
| | - Ayataka Fujimoto
- Comprehensive Epilepsy Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yoshihiro Maegaki
- Faculty of Medicine, Division of Child Neurology, Institute of Neurological Science, Tottori University, Yonago, Japan
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3
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Abou Haidar L, Harris RC, Pachnis P, Chen H, Gotway GK, Ni M, DeBerardinis RJ. Novel pathogenic UQCRC2 variants in a female with normal neurodevelopment. Cold Spring Harb Mol Case Stud 2023; 9:a006295. [PMID: 37709555 PMCID: PMC10815277 DOI: 10.1101/mcs.a006295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Electron transport chain (ETC) disorders are a group of rare, multisystem diseases caused by impaired oxidative phosphorylation and energy production. Deficiencies in complex III (CIII), also known as ubiquinol-cytochrome c reductase, are particularly rare in humans. Ubiquinol-cytochrome c reductase core protein 2 (UQCRC2) encodes a subunit of CIII that plays a crucial role in dimerization. Several pathogenic UQCRC2 variants have been identified in patients presenting with metabolic abnormalities that include lactic acidosis, hyperammonemia, hypoglycemia, and organic aciduria. Almost all previously reported UQCRC2-deficient patients exhibited neurodevelopmental involvement, including developmental delays and structural brain anomalies. Here, we describe a girl who presented at 3 yr of age with lactic acidosis, hyperammonemia, and hypoglycemia but has not shown any evidence of neurodevelopmental dysfunction by age 15. Whole-exome sequencing revealed compound heterozygosity for two novel variants in UQCRC2: c.1189G>A; p.Gly397Arg and c.437T>C; p.Phe146Ser. Here, we discuss the patient's clinical presentation and the likely pathogenicity of these two missense variants.
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Affiliation(s)
- Lea Abou Haidar
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Howard Hughes Medical Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Robert C Harris
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Howard Hughes Medical Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Panayotis Pachnis
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Hongli Chen
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Garrett K Gotway
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Min Ni
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA;
- Howard Hughes Medical Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas 75390, USA
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Strasser L, Doja A, Davila J, Chakraborty P, Bourque DK. The mitochondrial tRNA MT-TW m.5537_5538insT variant presents with significant intra-familial clinical variability. Am J Med Genet A 2023; 191:2890-2897. [PMID: 37654102 DOI: 10.1002/ajmg.a.63378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 06/12/2023] [Accepted: 07/29/2023] [Indexed: 09/02/2023]
Abstract
Mitochondrial disorders can present with a wide range of clinical and biochemical phenotypes. Mitochondrial DNA variants may be influenced by factors such as degree of heteroplasmy and tissue distribution. We present a four-generation family in which 10 individuals carry a pathogenic mitochondrial variant (m.5537_5538insT, MT-TW gene) with differing levels of heteroplasmy and clinical features. This genetic variant has been documented in two prior reports, both in individuals with Leigh syndrome. In the current family, three individuals have severe mitochondrial symptoms including Leigh syndrome (patient 1, 100% in blood), MELAS (patient 2, 97% heteroplasmy in muscle), and MELAS-like syndrome (patient 3, 50% heteroplasmy in blood and 100% in urine). Two individuals have mild mitochondrial symptoms (patient 4, 50% in blood and 67% in urine and patient 5, 50% heteroplasmy in blood and 30% in urine). We observe that this variant is associated with multiple mitochondrial presentations and phenotypes, including MELAS syndrome for which this variant has not previously been reported. We also demonstrate that the level of heteroplasmy of the mitochondrial DNA variant correlates with the severity of clinical presentation; however, not with the specific mitochondrial syndrome.
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Affiliation(s)
- Lauren Strasser
- Division of Pediatric Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Asif Doja
- Division of Pediatric Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Davila
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Pranesh Chakraborty
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Division of Metabolics and Newborn Screening, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Danielle K Bourque
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Division of Metabolics and Newborn Screening, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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5
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Felhi R, Sfaihi L, Charif M, Frikha F, Aoiadni N, Kamoun T, Lenaers G, Fakhfakh F. Vitamin B1 deficiency leads to high oxidative stress and mtDNA depletion caused by SLC19A3 mutation in consanguineous family with Leigh syndrome. Metab Brain Dis 2023; 38:2489-2497. [PMID: 37642897 DOI: 10.1007/s11011-023-01280-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Leigh syndrome (LS) and Leigh-like spectrum are the most common infantile mitochondrial disorders characterized by heterogeneous neurologic and metabolic manifestations. Pathogenic variants in SLC carriers are frequently reported in LS given their important role in transporting various solutes across the blood-brain barrier. SLC19A3 (THTR2) is one of these carriers transporting vitamin-B1 (vitB1, thiamine) into the cell. Targeted NGS of nuclear genes involved in mitochondrial diseases was performed in a patient belonging to a consanguineous Tunisian family with LS and revealed a homozygous c.1264 A > G (p.T422A) variant in SLC19A3. Molecular docking revealed that the p.T422A aa change is located at a key position interacting with vitB1 and causes conformational changes compromising vitB1 import. We further disclosed decreased plasma antioxidant activities of CAT, SOD and GSH enzymes, and a 42% decrease of the mtDNA copy number in patient blood.Altogether, our results disclose that the c.1264 A > G (p.T422A) variant in SLC19A3 affects vitB1 transport, induces a mtDNA depletion and reduces the expression level of oxidative stress enzymes, altogether contributing to the LS phenotype of the patient.
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Affiliation(s)
- Rahma Felhi
- Molecular and Functional Genetics Laboratory, Faculty of Science of Sfax, University of Sfax, Route Soukra. Km 3., Sfax, Tunisia.
| | - Lamia Sfaihi
- Departments of Pediatry, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Majida Charif
- Genetics and Immuno-Cell Therapy Team, Mohammed First University, Oujda, Morocco
| | - Fakher Frikha
- Laboratory of Molecular and Cellular Screening Processes, Center of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Nissaf Aoiadni
- Laboratory of Animal Eco-Physiology, Faculty of Sciences of Sfax, Sfax, Tunisia
| | - Thouraya Kamoun
- Departments of Pediatry, University Hospital Hedi Chaker, Sfax, Tunisia
| | - Guy Lenaers
- Université d'Angers, Unité MitoVasc, INSERM U1083, CNRS 6015, SFR- ICAT, Equipe MitoLab, 49933, Angers, France
- Service de Neurologie, CHU d'Angers, 49100, Angers, France
| | - Faiza Fakhfakh
- Molecular and Functional Genetics Laboratory, Faculty of Science of Sfax, University of Sfax, Route Soukra. Km 3., Sfax, Tunisia
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6
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Kishita Y, Sugiura A, Onuki T, Ebihara T, Matsuhashi T, Shimura M, Fushimi T, Ichino N, Nagatakidani Y, Nishihata H, Nitta KR, Yatsuka Y, Imai-Okazaki A, Wu Y, Osaka H, Ohtake A, Murayama K, Okazaki Y. Strategic validation of variants of uncertain significance in ECHS1 genetic testing. J Med Genet 2023; 60:1006-1015. [PMID: 37055166 DOI: 10.1136/jmg-2022-109027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/03/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Enoyl-CoA hydratase short-chain 1 (ECHS1) is an enzyme involved in the metabolism of branched chain amino acids and fatty acids. Mutations in the ECHS1 gene lead to mitochondrial short-chain enoyl-CoA hydratase 1 deficiency, resulting in the accumulation of intermediates of valine. This is one of the most common causative genes in mitochondrial diseases. While genetic analysis studies have diagnosed numerous cases with ECHS1 variants, the increasing number of variants of uncertain significance (VUS) in genetic diagnosis is a major problem. METHODS Here, we constructed an assay system to verify VUS function for ECHS1 gene. A high-throughput assay using ECHS1 knockout cells was performed to index these phenotypes by expressing cDNAs containing VUS. In parallel with the VUS validation system, a genetic analysis of samples from patients with mitochondrial disease was performed. The effect on gene expression in cases was verified by RNA-seq and proteome analysis. RESULTS The functional validation of VUS identified novel variants causing loss of ECHS1 function. The VUS validation system also revealed the effect of the VUS in the compound heterozygous state and provided a new methodology for variant interpretation. Moreover, we performed multiomics analysis and identified a synonymous substitution p.P163= that results in splicing abnormality. The multiomics analysis complemented the diagnosis of some cases that could not be diagnosed by the VUS validation system. CONCLUSIONS In summary, this study uncovered new ECHS1 cases based on VUS validation and omics analysis; these analyses are applicable to the functional evaluation of other genes associated with mitochondrial disease.
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Affiliation(s)
- Yoshihito Kishita
- Department of Life Science, Faculty of Science and Engineering, Kindai University, Higashiosaka, Osaka, Japan
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ayumu Sugiura
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Takanori Onuki
- Department of Metabolism, Chiba Children's Hospital, Midori-ku, Chiba, Japan
| | - Tomohiro Ebihara
- Department of Neonatology, Chiba Children's Hospital, Midori-ku, Chiba, Japan
| | - Tetsuro Matsuhashi
- Department of Metabolism, Chiba Children's Hospital, Midori-ku, Chiba, Japan
| | - Masaru Shimura
- Department of Metabolism, Chiba Children's Hospital, Midori-ku, Chiba, Japan
| | - Takuya Fushimi
- Department of Metabolism, Chiba Children's Hospital, Midori-ku, Chiba, Japan
| | - Noriko Ichino
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yoshie Nagatakidani
- Department of Life Science, Faculty of Science and Engineering, Kindai University, Higashiosaka, Osaka, Japan
| | - Hitomi Nishihata
- Department of Life Science, Faculty of Science and Engineering, Kindai University, Higashiosaka, Osaka, Japan
| | - Kazuhiro R Nitta
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Atsuko Imai-Okazaki
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Yibo Wu
- Chemical Biology Mass Spectrometry Platform (CHEMBIOMS), Faculty of Sciences, University of Geneva, Geneve, Switzerland
- YCI Laboratory for Next-Generation Proteomics, RIKEN Center of Integrative Medical Sciences, Yokohama, Kanagawa, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Akira Ohtake
- Department of Pediatrics & Clinical Genomics, Faculty of Medicine, Saitama Medical University, Moroyama, Saitama, Japan
- Center for Intractable Diseases, Saitama Medical University Hospital, Moroyama, Saitama, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Midori-ku, Chiba, Japan
- Center for Medical Genetics, Chiba Children's Hospital, Midori-ku, Chiba, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Laboratory for Comprehensive Genomic Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Kanagawa, Japan
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7
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Ohyama-Tamagake A, Kaneko K, Itami R, Nakano M, Namioka Y, Izumi R, Sato H, Suzuki H, Takeda A, Yatsuka Y, Okazaki Y, Abe T, Murayama K, Sugeno N, Misu T, Aoki M. Reply to the Letter "Reversible Vasoconstriction Syndrome Is a Complication of SARS-CoV-2 Infection/Vaccination Rather than That of Leigh Syndrome". Intern Med 2023; 62:2159-2160. [PMID: 37081677 PMCID: PMC10400391 DOI: 10.2169/internalmedicine.1962-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 03/12/2023] [Indexed: 04/22/2023] Open
Affiliation(s)
| | | | - Ryo Itami
- Department of Neurology, Tokyo General Hospital, Japan
| | | | | | - Rumiko Izumi
- Departments of Neurology, Tohoku University Hospital, Japan
| | - Haruka Sato
- Department of Cardiology, Tohoku University Hospital, Japan
| | - Hideaki Suzuki
- Department of Cardiology, Tohoku University Hospital, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Japan
- Laboratory for Comprehensive Genomic Analysis, RIKEN Center for Integrative Medical Sciences, Japan
| | - Takaaki Abe
- Department of Clinical Biology and Hormonal Regulation, Tohoku University Hospital, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Japan
| | - Naoto Sugeno
- Departments of Neurology, Tohoku University Hospital, Japan
| | - Tatsuro Misu
- Departments of Neurology, Tohoku University Hospital, Japan
| | - Masashi Aoki
- Departments of Neurology, Tohoku University Hospital, Japan
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8
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Ohyama-Tamagake A, Kaneko K, Itami R, Nakano M, Namioka Y, Izumi R, Sato H, Suzuki H, Takeda A, Okazaki Y, Yatsuka Y, Abe T, Murayama K, Sugeno N, Misu T, Aoki M. Adult-onset Leigh Syndrome with a m.9176T>C Mutation Manifested As Reversible Cerebral Vasoconstriction Syndrome. Intern Med 2023; 62:1995-1998. [PMID: 36543208 PMCID: PMC10372267 DOI: 10.2169/internalmedicine.0773-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
A 26-year-old woman developed a sudden headache, ptosis, and diplopia. Magnetic resonance imaging and angiography demonstrated a symmetrical lesion from the midbrain to the brainstem, involving the solitary nucleus and multifocal cerebral artery narrowing. Reversible cerebral vasoconstriction syndrome (RCVS) was suspected, and the patient improved after vasodilatation. Leigh syndrome was suspected due to the elevated serum pyruvate level, so mitochondrial DNA was analyzed, and an m.9176T>C mutation was detected. The final diagnosis was adult-onset Leigh syndrome manifesting as RCVS. An uncontrolled baroreflex due to a solitary nuclear lesion or endothelial dysfunction may have contributed to her unique presentation.
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Affiliation(s)
| | | | - Ryo Itami
- Department of Neurology, Tokyo General Hospital, Japan
| | | | | | - Rumiko Izumi
- Department of Neurology, Tohoku University Hospital, Japan
| | - Haruka Sato
- Department of Cardiology, Tohoku University Hospital, Japan
| | - Hideaki Suzuki
- Department of Cardiology, Tohoku University Hospital, Japan
| | - Atsuhito Takeda
- Department of Pediatrics, Hokkaido University Hospital, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Japan
- Laboratory for Comprehensive Genomic Analysis, RIKEN Center for Integrative Medical Sciences, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Japan
| | - Takaaki Abe
- Department of Clinical Biology and Hormonal Regulation, Graduate School of Medicine, Tohoku University, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Japan
| | - Naoto Sugeno
- Department of Neurology, Tohoku University Hospital, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Hospital, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Hospital, Japan
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9
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Naganuma T, Imasawa T, Nukui I, Wakasugi M, Kitamura H, Yatsuka Y, Kishita Y, Okazaki Y, Murayama K, Jinguji Y. Focal segmental glomerulosclerosis with a mutation in the mitochondrially encoded NADH dehydrogenase 5 gene: A case report. Mol Genet Metab Rep 2023; 35:100963. [PMID: 36941957 PMCID: PMC10024046 DOI: 10.1016/j.ymgmr.2023.100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023] Open
Abstract
NADH dehydrogenase 5 (ND5) is one of 44 subunits composed of Complex I in mitochondrial respiratory chain. Therefore, a mitochondrially encoded ND5 (MT-ND5) gene mutation causes mitochondrial oxidative phosphorylation (OXPHOS) disorder, resulting in the development of mitochondrial diseases. Focal segmental glomerulosclerosis (FSGS) which had podocytes filled with abnormal mitochondria is induced by mitochondrial diseases. An MT-ND5 mutation also causes FSGS. We herein report a Japanese woman who was found to have proteinuria and renal dysfunction in an annual health check-up at 29 years old. Because her proteinuria and renal dysfunction were persistent, she had a kidney biopsy at 33 years of age. The renal histology showed FSGS with podocytes filled with abnormal mitochondria. The podocytes also had foot process effacement and cytoplasmic vacuolization. In addition, the renal pathological findings showed granular swollen epithelial cells (GSECs) in tubular cells, age-inappropriately disarranged and irregularly sized vascular smooth muscle cells (AiDIVs), and red-coloured podocytes (ReCPos) by acidic dye. A genetic analysis using peripheral mononuclear blood cells and urine sediment cells detected the m.13513 G > A variant in the MT-ND5 gene. Therefore, this patient was diagnosed with FSGS due to an MT-ND5 gene mutation. Although this is not the first case report to show that an MT-ND5 gene mutation causes FSGS, this is the first to demonstrate podocyte injuries accompanied with accumulation of abnormal mitochondria in the cytoplasm.
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Key Words
- ATP, adenosine triphosphate
- AiDIVs, age-inappropriately disarranged and irregularly sized vascular smooth muscle cells
- COX IV, cytochrome c oxidase subunit 4
- Case report
- Cr, creatinine
- FSGS, focal segmental glomerulosclerosis
- Focal segmental glomerulosclerosis
- GSECs, granular swollen epithelial cells
- MELAS, mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes
- MRC, mitochondrial respiratory chain
- MT-ND5, mitochondrially encoded ND5
- Mitochondrial nephropathy
- NADH dehydrogenase 5
- ND5, NADH dehydrogenase 5
- OXPHOS:, oxidative phosphorylation
- Podocyte
- ReCPos, red-coloured podocytes
- eGFR, estimated glomerular filtration rate
- mtDNA, mitochondrial DNA
- nDNA, nuclear DNA
- sCr, serum creatinine
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Affiliation(s)
- Tsukasa Naganuma
- Division of Nephrology, Department of Internal Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-0027, Japan
| | - Toshiyuki Imasawa
- Department of Nephrology, National Hospital Organization Chiba-Higashi National Hospital, 673 Nitona-cho, Chuoh-ku, Chiba-city, Chiba 206-8712, Japan
- Corresponding author.
| | - Ikuo Nukui
- Division of Nephrology, Department of Internal Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-0027, Japan
| | - Masakiyo Wakasugi
- Division of Nephrology, Department of Internal Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-0027, Japan
| | - Hiroshi Kitamura
- Department of Clinical Pathology, National Hospital Organization Chiba-Higashi National Hospital, 673 Nitona-cho, Chuoh-ku, Chiba-city, Chiba 206-8712, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshihito Kishita
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Department of Life Science, Faculty of Science and Engineering, Kindai University, 3-4-1 Kowakae, Higashiosaka, Osaka 577-8502, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kei Murayama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1, Heta-cho, Midori-ku, Chiba 266-0007, Japan
| | - Yoshimi Jinguji
- Division of Nephrology, Department of Internal Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu, Yamanashi 400-0027, Japan
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10
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Sugiyama Y, Murayama K. Acute Encephalopathy Caused by Inherited Metabolic Diseases. J Clin Med 2023; 12:jcm12113797. [PMID: 37297992 DOI: 10.3390/jcm12113797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Acute encephalopathy is a critical medical condition that typically affects previously healthy children and young adults and often results in death or severe neurological sequelae. Inherited metabolic diseases that can cause acute encephalopathy include urea cycle disorders, amino acid metabolism disorders, organic acid metabolism disorders, fatty acid metabolism disorders, mutations in the thiamine-transporter gene, and mitochondrial diseases. Although each inherited metabolic disease is rare, its overall incidence is reported as 1 in 800-2500 patients. This narrative review presents the common inherited metabolic diseases that cause acute encephalopathy. Since diagnosing inherited metabolic diseases requires specific testing, early metabolic/metanolic screening tests are required when an inherited metabolic disease is suspected. We also describe the symptoms and history associated with suspected inherited metabolic diseases, the various tests that should be conducted in case of suspicion, and treatment according to the disease group. Recent advancements made in the understanding of some of the inherited metabolic diseases that cause acute encephalopathy are also highlighted. Acute encephalopathy due to inherited metabolic diseases can have numerous different causes, and recognition of the possibility of an inherited metabolic disease as early as possible, obtaining appropriate specimens, and proceeding with testing and treatment in parallel are crucial in the management of these diseases.
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Affiliation(s)
- Yohei Sugiyama
- Department of Metabolism, Chiba Children's Hospital, Chiba 266-0007, Japan
- Department of Pediatrics, Faculty of Medicine, Juntendo University, Tokyo 113-8431, Japan
| | - Kei Murayama
- Center for Medical Genetics, Chiba Children's Hospital, Chiba 266-0007, Japan
- Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo 113-8431, Japan
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11
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Insulin Resistance in Mitochondrial Diabetes. Biomolecules 2023; 13:biom13010126. [PMID: 36671511 PMCID: PMC9855690 DOI: 10.3390/biom13010126] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/14/2022] [Accepted: 12/27/2022] [Indexed: 01/10/2023] Open
Abstract
Mitochondrial diabetes (MD) is generally classified as a genetic defect of β-cells. The main pathophysiology is insulin secretion failure in pancreatic β-cells due to impaired mitochondrial ATP production. However, several reports have mentioned the presence of insulin resistance (IR) as a clinical feature of MD. As mitochondrial dysfunction is one of the important factors causing IR, we need to focus on IR as another pathophysiology of MD. In this special issue, we first briefly summarized the insulin signaling and molecular mechanisms of IR. Second, we overviewed currently confirmed pathogenic mitochondrial DNA (mtDNA) mutations from the MITOMAP database. The variants causing diabetes were mostly point mutations in the transfer RNA (tRNA) of the mitochondrial genome. Third, we focused on these variants leading to the recently described "tRNA modopathies" and reviewed the clinical features of patients with diabetes. Finally, we discussed the pathophysiology of MD caused by mtDNA mutations and explored the possible mechanism underlying the development of IR. This review should be beneficial to all clinicians involved in diagnostics and therapeutics related to diabetes and mitochondrial diseases.
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12
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Watanabe C, Osaka H, Watanabe M, Miyauchi A, Jimbo EF, Tokuyama T, Uosaki H, Kishita Y, Okazaki Y, Onuki T, Ebihara T, Aizawa K, Murayama K, Ohtake A, Yamagata T. Total and reduced/oxidized forms of coenzyme Q 10 in fibroblasts of patients with mitochondrial disease. Mol Genet Metab Rep 2023; 34:100951. [PMID: 36632326 PMCID: PMC9826971 DOI: 10.1016/j.ymgmr.2022.100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/22/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Coenzyme Q10 (CoQ10) is involved in ATP production through electron transfer in the mitochondrial respiratory chain complex. CoQ10 receives electrons from respiratory chain complex I and II to become the reduced form, and then transfers electrons at complex III to become the oxidized form. The redox state of CoQ10 has been reported to be a marker of the mitochondrial metabolic state, but to our knowledge, no reports have focused on the individual quantification of reduced and oxidized CoQ10 or the ratio of reduced to total CoQ10 (reduced/total CoQ10) in patients with mitochondrial diseases. We measured reduced and oxidized CoQ10 in skin fibroblasts from 24 mitochondrial disease patients, including 5 primary CoQ10 deficiency patients and 10 respiratory chain complex deficiency patients, and determined the reduced/total CoQ10 ratio. In primary CoQ10 deficiency patients, total CoQ10 levels were significantly decreased, however, the reduced/total CoQ10 ratio was not changed. On the other hand, in mitochondrial disease patients other than primary CoQ10 deficiency patients, total CoQ10 levels did not decrease. However, the reduced/total CoQ10 ratio in patients with respiratory chain complex IV and V deficiency was higher in comparison to those with respiratory chain complex I deficiency. Measurement of CoQ10 in fibroblasts proved useful for the diagnosis of primary CoQ10 deficiency. In addition, the reduced/total CoQ10 ratio may reflect the metabolic status of mitochondrial disease.
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Affiliation(s)
- Chika Watanabe
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
- Corresponding author at: Department of Pediatrics, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan.
| | - Miyuki Watanabe
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Akihiko Miyauchi
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Eriko F. Jimbo
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Takeshi Tokuyama
- Division of Regenerative Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Hideki Uosaki
- Division of Regenerative Medicine, Center for Molecular Medicine, Jichi Medical University, Tochigi, Japan
| | - Yoshihito Kishita
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
- Department of Life Science, Faculty of Science and Engineering, Kindai University, Osaka, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
- Laboratory for Comprehensive Genomic Analysis, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Takanori Onuki
- Center for Medical Genetics and Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Tomohiro Ebihara
- Center for Medical Genetics and Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Kenichi Aizawa
- Division of Clinical Pharmacology, Department of Pharmacology, Jichi Medical University, Tochigi, Japan
| | - Kei Murayama
- Center for Medical Genetics and Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Akira Ohtake
- Department of Clinical Genomics & Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
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Abstract
Mitochondrial dysfunction, especially perturbation of oxidative phosphorylation and adenosine triphosphate (ATP) generation, disrupts cellular homeostasis and is a surprisingly frequent cause of central and peripheral nervous system pathology. Mitochondrial disease is an umbrella term that encompasses a host of clinical syndromes and features caused by in excess of 300 different genetic defects affecting the mitochondrial and nuclear genomes. Patients with mitochondrial disease can present at any age, ranging from neonatal onset to late adult life, with variable organ involvement and neurological manifestations including neurodevelopmental delay, seizures, stroke-like episodes, movement disorders, optic neuropathy, myopathy, and neuropathy. Until relatively recently, analysis of skeletal muscle biopsy was the focus of diagnostic algorithms, but step-changes in the scope and availability of next-generation sequencing technology and multiomics analysis have revolutionized mitochondrial disease diagnosis. Currently, there is no specific therapy for most types of mitochondrial disease, although clinical trials research in the field is gathering momentum. In that context, active management of epilepsy, stroke-like episodes, dystonia, brainstem dysfunction, and Parkinsonism are all the more important in improving patient quality of life and reducing mortality.
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Affiliation(s)
- Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Robert McFarland
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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14
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Bansept C, Gaignard P, Lebigot E, Eyer D, Delplancq G, Hoebeke C, Mazodier K, Ledoyen A, Rouzier C, Fragaki K, Ait-El-Mkadem Saadi S, Philippe C, Bruel AL, Faivre L, Feillet F, Abi Warde MT. UQCRC2-related mitochondrial complex III deficiency, about 7 patients. Mitochondrion 2023; 68:138-144. [PMID: 36509339 DOI: 10.1016/j.mito.2022.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/09/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Isolated complex III defect is a relatively rare cause of mitochondrial disorder. New genes involved were identified in the last two decades, with only a few cases described for each deficiency. UQCRC2, which encodes ubiquinol-cytochrome c reductase core protein 2, is one of the eleven structural subunits of complex III. We report seven French patients with UQCRC2 deficiency to complete the phenotype reported so far. We highlight the similarities with neoglucogenesis defect during decompensations - hypoglycaemias, liver failure and lactic acidosis - and point out the rapid improvement with glucose fluid infusion, which is a remarkable feature for a mitochondrial disorder. Finally, we discuss the relevance of coenzyme Q10 supplementation in this defect.
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Affiliation(s)
- Claire Bansept
- Service de Pédiatrie, GHRMSA, 69 avenue du Dr Léon Mangeney, 68100 Mulhouse, France.
| | - Pauline Gaignard
- Laboratoire de Biochimie, AP-HP, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Elise Lebigot
- Laboratoire de Biochimie, AP-HP, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Didier Eyer
- Service de Pédiatrie, Hôpital de Haguenau, 64 avenue du Professeur René Leriche, 67500 Haguenau, France.
| | - Geoffroy Delplancq
- Service de Neuropédiatrie, CHRU Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France; Oncobiologie Génétique Bioinformatique, PCBio, CHRU Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France.
| | - Célia Hoebeke
- Service de Neurométabolisme Pédiatrique, AP-HM, CHU Timone, 264 Rue Saint-Pierre, 13005 Marseille, France.
| | - Karin Mazodier
- Service de Médecine Interne, AP-HM, CHU Conception, 147 boulevard Baille, 13005 Marseille, France.
| | - Anaïs Ledoyen
- Service de Pédiatrie, Centre hospitalier d'Ajaccio, 27 avenue de l'Impératrice Eugénie, 20000 Ajaccio, France.
| | - Cécile Rouzier
- Centre de référence des Maladies Mitochondriales, Service de Génétique Médicale, CHU de Nice, 151 route de Saint-Antoine, 06200 Nice, France; Université Côte d'Azur, CNRS, INSERM, IRCAN, 28 avenue de Valombrose, 06107 Nice Cedex 02, France.
| | - Konstantina Fragaki
- Centre de référence des Maladies Mitochondriales, Service de Génétique Médicale, CHU de Nice, 151 route de Saint-Antoine, 06200 Nice, France; Université Côte d'Azur, CNRS, INSERM, IRCAN, 28 avenue de Valombrose, 06107 Nice Cedex 02, France.
| | - Samira Ait-El-Mkadem Saadi
- Centre de référence des Maladies Mitochondriales, Service de Génétique Médicale, CHU de Nice, 151 route de Saint-Antoine, 06200 Nice, France; Université Côte d'Azur, CNRS, INSERM, IRCAN, 28 avenue de Valombrose, 06107 Nice Cedex 02, France.
| | - Christophe Philippe
- Unité Fonctionnelle Innovation en Diagnostic Génomique des maladies rares, CHU Dijon Bourgogne, FHU TRANSLAD, 14 Rue Paul Gaffarel, 21000 Dijon, France; INSERM UMR1231 GAD, F-21000, Dijon, France.
| | - Ange-Line Bruel
- Unité Fonctionnelle Innovation en Diagnostic Génomique des maladies rares, CHU Dijon Bourgogne, FHU TRANSLAD, 14 Rue Paul Gaffarel, 21000 Dijon, France; INSERM UMR1231 GAD, F-21000, Dijon, France.
| | - Laurence Faivre
- INSERM UMR1231 GAD, F-21000, Dijon, France; Centre de Référence Maladies Rares "Anomalies du développement et syndromes malformatifs", Centre de Génétique, FHU TRANSLAD et Institut GIMI, CHU Dijon Bourgogne, 14 Rue Paul Gaffarel, 21000 Dijon, France.
| | - François Feillet
- Centre de Référence des Maladies Métaboliques, Inserm U1256 NGERE, Service de Médecine Infantile, CHRU Brabois Enfants, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - Marie-Thérèse Abi Warde
- Service de Neuropédiatrie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France.
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15
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Lotta S, Lisa B. Congenital or Early Developing Neuromuscular Diseases Affecting Feeding, Swallowing and Speech – A Review of the Literature from January 1998 to August 2021. J Neuromuscul Dis 2022; 9:581-596. [PMID: 35848032 PMCID: PMC9535595 DOI: 10.3233/jnd-210772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The knowledge about the impact of oral motor impairment in neuromuscular diseases (NMDs) is limited but increasing. Objective: The aim of this review was to collect and compile knowledge on how muscle weakness in congenital or early developing NMDs directly or indirectly affects feeding, swallowing, speech and saliva control. Methods: A literature search was performed in PubMed from January 1, 1998, to August 31, 2021. The keywords “feeding”, “dysphagia”, “swallowing”, “dysarthria”, “speech”, “drooling” and “sialorrhea” were used in combination with “paediatric neuromuscular disease” or specific diagnoses. Results: Sixty-five studies were selected for the review, 33 focused on feeding and swallowing, 11 on speech, four on a combination of feeding, swallowing, saliva control or speech and 17 general descriptions. Most of the studies reported on patients with a disorder affecting muscles. These studies show that muscle weakness and impaired motility affecting the muscles innervated by the cranial nerves may influence feeding, swallowing, and speech, and that respiratory function, general health and neurodevelopmental delay also influence these functions. Feeding impairment and breathing difficulties are common in NMDs. Lifesaving interventions such as tube feeding and ventilatory support are common in severe cases. Conclusions: Feeding impairment, dysphagia and dysarthria are prevalent in NMDs with congenital or early age of onset. Feeding and swallowing has been studied more than speech and saliva control. More children with NMD survive thanks to new treatment options and it is therefore urgent to follow up how these therapies may impact the development of feeding, swallowing, and speech.
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Affiliation(s)
- Sjögreen Lotta
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
| | - Bengtsson Lisa
- Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Public Dental Service, Medicinaregatan, Gothenburg, Sweden
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16
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Ebihara T, Nagatomo T, Sugiyama Y, Tsuruoka T, Osone Y, Shimura M, Tajika M, Matsuhashi T, Ichimoto K, Matsunaga A, Akiyama N, Ogawa-Tominaga M, Yatsuka Y, Nitta KR, Kishita Y, Fushimi T, Imai-Okazaki A, Ohtake A, Okazaki Y, Murayama K. Neonatal-onset mitochondrial disease: clinical features, molecular diagnosis and prognosis. Arch Dis Child Fetal Neonatal Ed 2022; 107:329-334. [PMID: 34625524 PMCID: PMC9046829 DOI: 10.1136/archdischild-2021-321633] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/14/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Neonatal-onset mitochondrial disease has not been fully characterised owing to its heterogeneity. We analysed neonatal-onset mitochondrial disease in Japan to clarify its clinical features, molecular diagnosis and prognosis. DESIGN Retrospective observational study from January 2004 to March 2020. SETTING Population based. PATIENTS Patients (281) with neonatal-onset mitochondrial disease diagnosed by biochemical and genetic approaches. INTERVENTIONS None. MAIN OUTCOME MEASURES Disease types, initial symptoms, biochemical findings, molecular diagnosis and prognosis. RESULTS Of the 281 patients, multisystem mitochondrial disease was found in 194, Leigh syndrome in 26, cardiomyopathy in 38 and hepatopathy in 23 patients. Of the 321 initial symptoms, 236 occurred within 2 days of birth. Using biochemical approaches, 182 patients were diagnosed by mitochondrial respiratory chain enzyme activity rate and 89 by oxygen consumption rate. The remaining 10 patients were diagnosed using a genetic approach. Genetic analysis revealed 69 patients had nuclear DNA variants in 36 genes, 11 of 15 patients had mitochondrial DNA variants in five genes and four patients had single large deletion. The Cox proportional hazards regression analysis showed the effects of Leigh syndrome (HR=0.15, 95% CI 0.04 to 0.63, p=0.010) and molecular diagnosis (HR=1.87, 95% CI 1.18 to 2.96, p=0.008) on survival. CONCLUSIONS Neonatal-onset mitochondrial disease has a heterogenous aetiology. The number of diagnoses can be increased, and clarity regarding prognosis can be achieved by comprehensive biochemical and molecular analyses using appropriate tissue samples.
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Affiliation(s)
- Tomohiro Ebihara
- Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Taro Nagatomo
- Department of Pediatrics, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Yohei Sugiyama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Tomoko Tsuruoka
- Department of Neonatology, Chiba Children's Hospital, Chiba, Japan
| | - Yoshiteru Osone
- Department of Neonatology, Chiba University Hospital, Chiba, Japan
| | - Masaru Shimura
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Makiko Tajika
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | | | - Keiko Ichimoto
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Ayako Matsunaga
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Nana Akiyama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | | | - Yukiko Yatsuka
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuhiro R Nitta
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yoshihito Kishita
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan,Department of Life Science, Faculty of Science and Engineering, Kindai University, Higashiosaka, Osaka, Japan
| | - Takuya Fushimi
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
| | - Atsuko Imai-Okazaki
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Akira Ohtake
- Department of Pediatrics and Clinical Genomics, Saitama Medical University, Moroyama, Saitama, Japan
| | - Yasushi Okazaki
- Department of Diagnostics and Therapeutics of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Chiba, Japan
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17
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Na J, Lee Y. Genotype-phenotype analysis of MT-ATP6-associated Leigh syndrome. Acta Neurol Scand 2022; 145:414-422. [PMID: 34877647 DOI: 10.1111/ane.13566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Mitochondrial DNA (mtDNA)-associated Leigh syndrome (LS) is characterized by maternal inheritance, and the heteroplasmic mutant load of mtDNA pathogenic variants is known to affect clinical phenotypes. Among mtDNA pathogenic variants, variants of the MT-ATP6 gene account for most of reported cases. In this report, we aimed to describe the clinical and genetic findings of MT-ATP6-associated LS patients diagnosed at a single tertiary institution in Korea. METHODS Thirteen patients with genetically confirmed MT-ATP6-associated LS were selected. We reviewed each patient's clinical findings, including general characteristics, biochemical parameters, brain MR images, muscle biopsy results, and heteroplasmic mutant load over a long-term follow-up period. RESULTS MT-ATP6-associated LS was of predominantly early onset (age <2 years), although we identified 2 late-onset (>60 months) LS patients. The heteroplasmic mutant load estimated by next-generation sequencing was 96%-100% in all nucleotide change groups. Compared with other forms of MT-ATP6-associated LS, the m.8993T>G point mutation elicited a significantly higher rate of symptom onset before 2 years of age. Brain MRI showed bilateral basal ganglia involvement in all patients, followed by cerebral atrophy, brainstem and thalamus involvement, and cerebellar atrophy. After follow-up (median 7.2 years, range 1.4 to 11.5 years), LS with m.8993T>G point mutations had a slightly more severe clinical progression compared with other forms of MT-ATP6-associated LS. CONCLUSIONS MT-ATP6-associated LS patients presented with a broad spectrum of clinical diagnoses and had a very high heteroplasmic mutant load. This study provides valuable data on MT-ATP6-associated LS that will inform subsequent studies on LS.
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Affiliation(s)
- Ji‐Hoon Na
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
| | - Young‐Mock Lee
- Department of Pediatrics Yonsei University College of Medicine Seoul Korea
- Epilepsy Research Institute Yonsei University College of Medicine Seoul Korea
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18
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Stenton SL, Tesarova M, Sheremet NL, Catarino C, Carelli V, Ciara E, Curry K, Engvall M, Fleming LR, Freisinger P, Iwanicka-Pronicka K, Jurkiewicz E, Klopstock T, Koenig MK, Kolářová H, Kousal B, Krylova T, La Morgia C, Nosková L, Piekutowska-Abramczuk D, Russo SN, Stránecký V, Tóthová I, Träisk F, Prokisch H. DNAJC30 defect: a frequent cause of recessive Leber hereditary optic neuropathy and Leigh syndrome. Brain 2022; 145:1624-1631. [PMID: 35148383 PMCID: PMC9166554 DOI: 10.1093/brain/awac052] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
The recent description of biallelic DNAJC30 variants in Leber hereditary optic neuropathy (LHON) and Leigh syndrome challenged the longstanding assumption for LHON to be exclusively maternally inherited and broadened the genetic spectrum of Leigh syndrome, the most frequent paediatric mitochondrial disease. Herein, we characterize 28 so far unreported individuals from 26 families carrying a homozygous DNAJC30 p.Tyr51Cys founder variant, 24 manifesting with LHON, two manifesting with Leigh syndrome, and two remaining asymptomatic. This collection of unreported variant carriers confirms sex-dependent incomplete penetrance of the homozygous variant given a significant male predominance of disease and the report of asymptomatic homozygous variant carriers. The autosomal recessive LHON patients demonstrate an earlier age of disease onset and a higher rate of idebenone-treated and spontaneous recovery of vision in comparison to reported figures for maternally inherited disease. Moreover, the report of two additional patients with childhood- or adult-onset Leigh syndrome further evidences the association of DNAJC30 with Leigh syndrome, previously only reported in a single childhood-onset case.
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Affiliation(s)
- Sarah L Stenton
- Institute of Human Genetics, School of Medicine, Technische Universität München, München, Germany.,Institute of Neurogenomics, Helmholtz Zentrum München, München, Germany
| | - Marketa Tesarova
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Natalia L Sheremet
- Federal State Budgetary Institution of Science "Research Institute of Eye Diseases", Moscow, Russia
| | - Claudia Catarino
- Department of Neurology, Friedrich-Baur-Institute, University Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany
| | - Valerio Carelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogentica, Bologna, Italy.,Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy
| | - Elżbieta Ciara
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Kathryn Curry
- Genetics and Metabolic Clinic, St. Luke's Health System, Boise, USA
| | - Martin Engvall
- Centre for Inherited Metabolic Diseases (CMMS), Karolinska University Hospital, Stockholm, Sweden
| | - Leah R Fleming
- Genetics and Metabolic Clinic, St. Luke's Health System, Boise, USA
| | | | | | - Elżbieta Jurkiewicz
- Department of Diagnostic Imaging, The Children's Memorial Health Institute, Warsaw, Poland
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur-Institute, University Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster of Systems Neurology (SyNergy), Munich, Germany
| | - Mary K Koenig
- Center for the Treatment of Pediatric Neurodegenerative Disease, The University of Texas McGovern Medical School at Houston, Houston, USA
| | - Hana Kolářová
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Bohdan Kousal
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | | | - Chiara La Morgia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma di Neurogentica, Bologna, Italy.,Unit of Neurology, Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Italy
| | - Lenka Nosková
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | | | - Sam N Russo
- Center for the Treatment of Pediatric Neurodegenerative Disease, The University of Texas McGovern Medical School at Houston, Houston, USA
| | - Viktor Stránecký
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Iveta Tóthová
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Frank Träisk
- Department of Neuro-Ophthalmology, St Erik Eye Hospital, Stockholm, Sweden
| | - Holger Prokisch
- Institute of Human Genetics, School of Medicine, Technische Universität München, München, Germany.,Institute of Neurogenomics, Helmholtz Zentrum München, München, Germany
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19
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Stenton SL, Zou Y, Cheng H, Liu Z, Wang J, Shen D, Jin H, Ding C, Tang X, Sun S, Han H, Ma Y, Zhang W, Jin R, Wang H, Sun D, Lv JL, Prokisch H, Fang F. Leigh syndrome: a study of 209 patients at the Beijing Children's Hospital. Ann Neurol 2022; 91:466-482. [PMID: 35094435 DOI: 10.1002/ana.26313] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Sarah L. Stenton
- Institute of Human Genetics, School of Medicine Technical University of Munich Munich Germany
- Institute of Neurogenomics Helmholtz Zentrum München Neuherberg Germany
| | - Ying Zou
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Hua Cheng
- Image Center, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Zhimei Liu
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Junling Wang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Danmin Shen
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Hong Jin
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Changhong Ding
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Xiaolu Tang
- Image Center, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Suzhen Sun
- Department of Neurology Children's Hospital of Hebei Province Shijiazhuang China
| | - Hong Han
- Department of Neurology Children's Hospital of Shanxi Province Taiyuan China
| | - Yanli Ma
- Department of Neurology Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital Zhengzhou China
| | - Weihua Zhang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
- Department of Neurology Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital Zhengzhou China
| | - Ruifeng Jin
- Department of Neurology Qilu Children's Hospital of Shandong University Jinan China
| | - Hua Wang
- Department of Pediatrics Shengjing Hospital of China Medical University Shenyang China
| | - Dan Sun
- Department of Neurology Wuhan Children's Hospital Wuhan China
| | - Jun Lan Lv
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
| | - Holger Prokisch
- Institute of Human Genetics, School of Medicine Technical University of Munich Munich Germany
- Institute of Neurogenomics Helmholtz Zentrum München Neuherberg Germany
| | - Fang Fang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital Capital Medical University Beijing China
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20
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Nakashima K, Bo R, Awano H, Nishiyama M, Iijima K. Frequent recurrence of pancreatitis in a patient with Leigh syndrome. Pediatr Int 2022; 64:e15021. [PMID: 35278257 DOI: 10.1111/ped.15021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/17/2021] [Accepted: 09/30/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Kengo Nakashima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Bo
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Nishiyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
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21
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Kim J, Lee J, Jang DH. NDUFAF6-Related Leigh Syndrome Caused by Rare Pathogenic Variants: A Case Report and the Focused Review of Literature. Front Pediatr 2022; 10:812408. [PMID: 35664867 PMCID: PMC9157758 DOI: 10.3389/fped.2022.812408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Leigh syndrome is a neurodegenerative disorder that presents with fluctuation and stepwise deterioration, such as neurodevelopmental delay and regression, dysarthria, dysphagia, hypotonia, dystonia, tremor, spasticity, epilepsy, and respiratory problems. The syndrome characteristically presents symmetric necrotizing lesions in the basal ganglia, brainstem, cerebellum, thalamus, and spinal cord on cranial magnetic resonance imaging. To date, more than 85 genes are known to be associated with Leigh syndrome. Here, we present a rare case of a child who developed Leigh syndrome due to pathogenic variants of NDUFAF6, which encodes an assembly factor of complex I, a respiratory chain subunit. A targeted next-generation sequencing analysis related to mitochondrial disease revealed a missense variant (NM_152416.4:c.371T > C; p.Ile124Thr) and a frameshift variant (NM_152416.4:c.233_242del; p.Leu78GInfs*10) inherited biparentally. The proband underwent physical therapy and nutrient cocktail therapy, but his physical impairment gradually worsened.
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Affiliation(s)
- Jaewon Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jaewoong Lee
- Department of Laboratory Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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22
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Shimura M, Onuki T, Sugiyama Y, Matsuhashi T, Ebihara T, Fushimi T, Tajika M, Ichimoto K, Matsunaga A, Tsuruoka T, Nitta KR, Imai-Okazaki A, Yatsuka Y, Kishita Y, Ohtake A, Okazaki Y, Murayama K. Development of Leigh syndrome with a high probability of cardiac manifestations in infantile-onset patients with m.14453G > A. Mitochondrion 2021; 63:1-8. [PMID: 34933128 DOI: 10.1016/j.mito.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
The m.14453G > A mutation in MT-ND6 has been described in a few patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes or Leigh syndrome.However, the clinical spectrum and molecular characteristics are unclear.Here, we present four infantile-onset patients with m.14453G > A-associated Leigh syndrome. All four patients had brainstem lesions with basal ganglia lesions, and two patients had cardiac manifestations. Decreased ND6 protein expression and immunoreactivity were observed in patient-derived samples. There was no clear correlation between heteroplasmy levels and onset age or between heteroplasmy levels and phenotype; however, infantile onset was associated with Leigh syndrome.
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Affiliation(s)
- Masaru Shimura
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Takanori Onuki
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Yohei Sugiyama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tetsuro Matsuhashi
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tomohiro Ebihara
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Takuya Fushimi
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Makiko Tajika
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Keiko Ichimoto
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Ayako Matsunaga
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Tomoko Tsuruoka
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan
| | - Kazuhiro R Nitta
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Atsuko Imai-Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yukiko Yatsuka
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yoshihito Kishita
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan; Department of Life Science, Faculty of Science and Engineering, Kindai University, 3-4-1 Kowakae, Higashiosaka, Osaka 577-8502, Japan
| | - Akira Ohtake
- Department of Pediatrics & Clinical Genomics, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama, Saitama 350-0495, Japan
| | - Yasushi Okazaki
- Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kei Murayama
- Center for Medical Genetics, Department of Metabolism, Chiba Children's Hospital, 579-1 Heta-cho Midori-ku, Chiba 266-0007, Japan; Diagnostics and Therapeutic of Intractable Diseases, Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Hongo 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan.
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23
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Lee IC, Chiang KL. Clinical Diagnosis and Treatment of Leigh Syndrome Based on SURF1: Genotype and Phenotype. Antioxidants (Basel) 2021; 10:antiox10121950. [PMID: 34943053 PMCID: PMC8750222 DOI: 10.3390/antiox10121950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022] Open
Abstract
SURF1 encodes the assembly factor for maintaining the antioxidant of cytochrome c oxidase (COX) stability in the human electron respiratory chain. Mutations in SURF1 can cause Leigh syndrome (LS), a subacute neurodegenerative encephalopathy, characterized by early onset (infancy), grave prognosis, and predominant symptoms presenting in the basal ganglia, thalamus, brainstem, cerebellum, and peripheral nerves. To date, more than sixty different SURF1 mutations have been found to cause SURF1-associated LS; however, the relationship between genotype and phenotype is still unclear. Most SURF1-associated LS courses present as typical LS and cause early mortality (before the age of ten years). However, 10% of the cases present with atypical courses with milder symptoms and increased life expectancy. One reason for this inconsistency may be due to specific duplications or mutations close to the C-terminus of the SURF1 protein appearing to cause less protein decay. Furthermore, the treatment for SURF1-associated LS is unsatisfactory. A ketogenic diet is most often prescribed and has proven to be effective. Supplementing with coenzyme Q and other cofactors is also a common treatment option; however, the results are inconsistent. Importantly, anti-epileptic drugs such as valproate—which cause mitochondrial dysfunction—should be avoided in patients with SURF1-associated LS presenting with seizures.
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Affiliation(s)
- Inn-Chi Lee
- Division of Pediatric Neurology, Department of Pediatrics, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Correspondence: ; Tel.: +886-4-2473-9535; Fax: +886-4-2471-0934
| | - Kuo-Liang Chiang
- Department of Pediatric Neurology, Kuang-Tien General Hospital, Taichung 43303, Taiwan;
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24
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Shi Y, Chen G, Sun D, Hu C, Liu Z, Shen D, Wang J, Song T, Zhang W, Li J, Ren X, Han T, Ding C, Wang Y, Fang F. Phenotypes and genotypes of mitochondrial diseases with mtDNA variations in Chinese children: A multi-center study. Mitochondrion 2021; 62:139-150. [PMID: 34800692 DOI: 10.1016/j.mito.2021.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 10/29/2021] [Accepted: 11/12/2021] [Indexed: 11/24/2022]
Abstract
Mitochondrial DNA (mtDNA) associated mitochondrial diseases hold a crucial position but comprehensive and systematic studies are relatively rare. Among the 262 patients of four children's hospitals in China, 96%-point mutations (30 alleles in 11 genes encoding tRNA, rRNA, Complex I and V) and 4%-deletions (seven of ten had not been reported before) were identified as the cause of 14 phenotypes. MILS presented the highest genetic heterogeneity, while the m.3243A > G mutation was the only "hotspot" mutation with a wide range of phenotypes. The degrees of heteroplasmy in the leukocytes of MM were higher than MELAS. The heteroplasmy level of patients was higher than that in mild and carrier group, while we found low-level heteroplasmy pathogenic mutations as well. Some homoplasmic variations (e.g., m.9176 T > C mutation) are having high incomplete penetrance. For a suspected MELAS, m.3243A > G mutation was recommended to detect first; while for a suspected LS, trios-WES and mtDNA genome sequencing by NGS were recommended first in both blood and urine.
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Affiliation(s)
- Yuqing Shi
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Guohong Chen
- Department of Neurology, Zhengzhou University Affiliated Children's Hospital (Zhengzhou Children's Hospital), Zhengzhou 450053, Henan, China
| | - Dan Sun
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430015, China
| | - Chaoping Hu
- Department of Neurology, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Zhimei Liu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Danmin Shen
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Junling Wang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Tianyu Song
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Weihua Zhang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jiuwei Li
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiaotun Ren
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Tongli Han
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Changhong Ding
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai 201102, China.
| | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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25
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Lim AZ, Ng YS, Blain A, Jiminez-Moreno C, Alston CL, Nesbitt V, Simmons L, Santra S, Wassmer E, Blakely EL, Turnbull DM, Taylor RW, Gorman GS, McFarland R. Natural History of Leigh Syndrome: A Study of Disease Burden and Progression. Ann Neurol 2021; 91:117-130. [PMID: 34716721 PMCID: PMC9534328 DOI: 10.1002/ana.26260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/21/2022]
Abstract
Objective This observational cohort study aims to quantify disease burden over time, establish disease progression rates, and identify factors that may determine the disease course of Leigh syndrome. Methods Seventy‐two Leigh syndrome children who completed the Newcastle Paediatric Mitochondrial Disease Scale (NPMDS) at baseline at 3.7 years (interquartile range [IQR] = 2.0–7.6) and follow‐up assessments at 7.5 years (IQR = 3.7–11.0) in clinics were enrolled. Eighty‐two percent of this cohort had a confirmed genetic diagnosis, with pathogenic variants in the MT‐ATP6 and SURF1 genes being the most common cause. The total NPMDS scores denoted mild (0–14), moderate (15–25), and severe (>25) disease burden. Detailed clinical, neuroradiological, and molecular genetic findings were also analyzed. Results The median total NPMDS scores rose significantly (Z = −6.9, p < 0.001), and the percentage of children with severe disease burden doubled (22% → 42%) over 2.6 years of follow‐up. Poor function (especially mobility, self‐care, communication, feeding, and education) and extrapyramidal features contributed significantly to the disease burden (τb ≈ 0.45–0.68, p < 0.001). These children also deteriorated to wheelchair dependence (31% → 57%), exclusive enteral feeding (22% → 46%), and one‐to‐one assistance for self‐care (25% → 43%) during the study period. Twelve children (17%) died after their last NPMDS scores were recorded. These children had higher follow‐up NPMDS scores (disease burden; p < 0.001) and steeper increase in NPMDS score per annum (disease progression; p < 0.001). Other predictors of poor outcomes include SURF1 gene variants (p < 0.001) and bilateral caudate changes on neuroimaging (p < 0.01). Interpretation This study has objectively defined the disease burden and progression of Leigh syndrome. Our analysis has also uncovered potential influences on the trajectory of this neurodegenerative condition. ANN NEUROL 2022;91:117–130
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Affiliation(s)
- Albert Z Lim
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Alasdair Blain
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Cecilia Jiminez-Moreno
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Charlotte L Alston
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Victoria Nesbitt
- National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK
| | | | | | | | - Emma L Blakely
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Robert W Taylor
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Gráinne S Gorman
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
| | - Robert McFarland
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,National Health Service Highly Specialised Services for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, UK
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26
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Ardissone A, Bruno C, Diodato D, Donati A, Ghezzi D, Lamantea E, Lamperti C, Mancuso M, Martinelli D, Primiano G, Procopio E, Rubegni A, Santorelli F, Schiaffino MC, Servidei S, Tubili F, Bertini E, Moroni I. Clinical, imaging, biochemical and molecular features in Leigh syndrome: a study from the Italian network of mitochondrial diseases. Orphanet J Rare Dis 2021; 16:413. [PMID: 34627336 PMCID: PMC8501644 DOI: 10.1186/s13023-021-02029-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leigh syndrome (LS) is a progressive neurodegenerative disorder associated with primary or secondary dysfunction of mitochondrial oxidative phosphorylation and is the most common mitochondrial disease in childhood. Numerous reports on the biochemical and molecular profiles of LS have been published, but there are limited studies on genetically confirmed large series. We reviewed the clinical, imaging, biochemical and molecular data of 122 patients with a diagnosis of LS collected in the Italian Collaborative Network of Mitochondrial Diseases database. RESULTS Clinical picture was characterized by early onset of several neurological signs dominated by central nervous system involvement associated with both supra- and sub-tentorial grey matter at MRI in the majority of cases. Extraneurological organ involvement is less frequent in LS than expected for a mitochondrial disorder. Complex I and IV deficiencies were the most common biochemical diagnoses, mostly associated with mutations in SURF1 or mitochondrial-DNA genes encoding complex I subunits. Our data showed SURF1 as the genotype with the most unfavorable prognosis, differently from other cohorts reported to date. CONCLUSION We report on a large genetically defined LS cohort, adding new data on phenotype-genotype correlation, prognostic factors and possible suggestions to diagnostic workup.
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Affiliation(s)
- Anna Ardissone
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy.
| | - Claudio Bruno
- Center of Translational and Experimental Myology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Daria Diodato
- Muscular and Neurodegenerative Disease Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Alice Donati
- Metabolic and Neuromuscular Unit, Meyer Children Hospital-University of Florence, Florence, Italy
| | - Daniele Ghezzi
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, 20122, Milan, Italy
| | - Eleonora Lamantea
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Costanza Lamperti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | | | - Guido Primiano
- UOC Neurofisiopatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italia
| | - Elena Procopio
- Metabolic and Neuromuscular Unit, Meyer Children Hospital-University of Florence, Florence, Italy
| | - Anna Rubegni
- Molecular Medicine, IRCCS Fondazione Stella Maris, Pisa, Italy
| | | | | | - Serenella Servidei
- UOC Neurofisiopatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Dipartimento Universitario di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italia
| | - Flavia Tubili
- Metabolic and Neuromuscular Unit, Meyer Children Hospital-University of Florence, Florence, Italy
| | - Enrico Bertini
- Muscular and Neurodegenerative Disease Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Isabella Moroni
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
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27
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Arai Y, Kosugiyama K, Tamura T, Matsumoto S, Sudo A, Shiraishi H, Ivor C, Ohtake A, Nagumo K. Successful recovery from severe hypertension in a patient with Leigh syndrome. Mol Genet Metab Rep 2021; 25:100684. [PMID: 34589414 PMCID: PMC8461110 DOI: 10.1016/j.ymgmr.2020.100684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/14/2020] [Accepted: 11/15/2020] [Indexed: 11/27/2022] Open
Abstract
Hypertension is a rare complication of Leigh Syndrome (LS), but prognosis of patients with hypertension is poor and its presence is indicative of the terminal stage of the disease. Herein, we report a four-year-old girl case diagnosed with LS at 15 months of age who subsequently developed severe hypertension and respiratory failure. Physical examination and laboratory findings did not indicate a secondary cause of hypertension. Her respiratory failure was treated with non-invasive ventilation and hypertension controlled with enalapril, furosemide and spironolactone. To our knowledge, this is the first case of a patient with LS recovering from severe hypertension.
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Affiliation(s)
- Yuto Arai
- Department of Pediatrics, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Kiyotaka Kosugiyama
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan
| | - Takuya Tamura
- Department of Pediatrics, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Sasagu Matsumoto
- Department of Pediatrics, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Akira Sudo
- Social Welfare Corporation Nire-no-kai Children's Clinic, Sapporo, Japan
| | - Hideaki Shiraishi
- Department of Pediatrics, Hokkaido University School of Medicine, Sapporo, Japan
| | - Cammack Ivor
- Department of Clinical Residency Training, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Akira Ohtake
- Center for Intractable Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Kiyoshi Nagumo
- Department of Pediatrics, Teine-Keijinkai Hospital, Sapporo, Japan
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28
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Bakare AB, Lesnefsky EJ, Iyer S. Leigh Syndrome: A Tale of Two Genomes. Front Physiol 2021; 12:693734. [PMID: 34456746 PMCID: PMC8385445 DOI: 10.3389/fphys.2021.693734] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/22/2021] [Indexed: 12/21/2022] Open
Abstract
Leigh syndrome is a rare, complex, and incurable early onset (typically infant or early childhood) mitochondrial disorder with both phenotypic and genetic heterogeneity. The heterogeneous nature of this disorder, based in part on the complexity of mitochondrial genetics, and the significant interactions between the nuclear and mitochondrial genomes has made it particularly challenging to research and develop therapies. This review article discusses some of the advances that have been made in the field to date. While the prognosis is poor with no current substantial treatment options, multiple studies are underway to understand the etiology, pathogenesis, and pathophysiology of Leigh syndrome. With advances in available research tools leading to a better understanding of the mitochondria in health and disease, there is hope for novel treatment options in the future.
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Affiliation(s)
- Ajibola B. Bakare
- Department of Biological Sciences, J. William Fulbright College of Arts and Sciences, University of Arkansas, Fayetteville, AR, United States
| | - Edward J. Lesnefsky
- Division of Cardiology, Pauley Heart Center, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Department of Physiology/Biophysics, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Department of Biochemistry and Molecular Biology, School of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Shilpa Iyer
- Department of Biological Sciences, J. William Fulbright College of Arts and Sciences, University of Arkansas, Fayetteville, AR, United States
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29
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Gong K, Xie L, Wu ZS, Xie X, Zhang XX, Chen JL. Clinical exome sequencing reveals a mutation in PDHA1 in Leigh syndrome: A case of a Chinese boy with lethal neuropathy. Mol Genet Genomic Med 2021; 9:e1651. [PMID: 33661577 PMCID: PMC8123737 DOI: 10.1002/mgg3.1651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/18/2021] [Accepted: 02/18/2021] [Indexed: 12/28/2022] Open
Abstract
Background Leigh syndrome, the most common mitochondrial syndrome in pediatrics, has diverse clinical manifestations and is genetically heterogeneous. Pathogenic mutations in more than 75 genes of two genomes (mitochondrial and nuclear) have been identified. PDHA1 encoding the E1 alpha subunit is an X‐chromosome gene whose mutations cause pyruvate dehydrogenase complex deficiency. Methods Here, we have described a 12‐year‐old boy with lethal neuropathy who almost died of a sudden loss of breathing and successive cardiac arrest. Extracorporeal membrane oxygenation rescued his life. His diagnosis was corrected from Guillain–Barré syndrome to Leigh syndrome 1 month later by clinical exome sequencing. Furthermore, we used software to predict the protein structure caused by frameshift mutations. We treated the boy with vitamin B1, coenzyme Q10, and a ketogenic diet. Results A PDHA1 mutation (NM_000284.4:c.1167_1170del) was identified as the underlying cause. The amino acid mutation was p.Ser390LysfsTer33. Moreover, the protein structure prediction results suggested that the protein structure has changed. The parents of the child were negative, so the mutation was de novo. The comprehensive assessment of the mutation was pathogenic. His condition gradually improved after receiving treatment. Conclusion This case suggests that gene detection should be popularized to improve diagnosis accuracy, especially in developing countries such as China.
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Affiliation(s)
- Ke Gong
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Li Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Zhong-Shi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Xia Xie
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Xing-Xing Zhang
- Department of Pediatrics, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
| | - Jin-Lan Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China
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30
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Ogawa E, Fushimi T, Ogawa‐Tominaga M, Shimura M, Tajika M, Ichimoto K, Matsunaga A, Tsuruoka T, Ishige M, Fuchigami T, Yamazaki T, Kishita Y, Kohda M, Imai‐Okazaki A, Okazaki Y, Morioka I, Ohtake A, Murayama K. Mortality of Japanese patients with Leigh syndrome: Effects of age at onset and genetic diagnosis. J Inherit Metab Dis 2020; 43:819-826. [PMID: 31967322 PMCID: PMC7383885 DOI: 10.1002/jimd.12218] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 01/30/2023]
Abstract
Leigh syndrome is a major phenotype of mitochondrial diseases in children. With new therapeutic options being proposed, assessing the mortality and clinical condition of Leigh syndrome patients is crucial for evaluating therapeutics. As data are scarce in Japan, we analysed the mortality rate and clinical condition of Japanese Leigh syndrome patients that we diagnosed since 2007. Data from 166 Japanese patients diagnosed with Leigh syndrome from 2007 to 2017 were reviewed. Patients' present status, method of ventilation and feeding, and degree of disability as of April 2018 was analysed. Overall, 124 (74.7%) were living, 40 (24.1%) were deceased, and 2 (1.2%) were lost to follow-up. Median age of living patients was 8 years (1-39 years). Median length of disease course was 91 months for living patients and 23.5 months for deceased patients. Nearly 90% of deaths occurred by age 6. Mortality rate of patients with onset before 6 months of age was significantly higher than that of onset after 6 months. All patients with neonatal onset were either deceased or bedridden. MT-ATP6 deficiency caused by m.8993T>G mutation and MT-ND5 deficiency induced a severe form of Leigh syndrome. Patients with NDUFAF6, ECHS1, and SURF1 deficiency had relatively mild symptoms and better survival. The impact of onset age on prognosis varied across the genetic diagnoses. The clinical condition of many patients was poor; however, few did not require mechanical ventilation or tube-feeding and were not physically dependent. Early disease onset and genetic diagnosis may have prognostic value.
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Affiliation(s)
- Erika Ogawa
- Department of MetabolismChiba Children's HospitalChibaJapan
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Takuya Fushimi
- Department of MetabolismChiba Children's HospitalChibaJapan
| | | | - Masaru Shimura
- Department of MetabolismChiba Children's HospitalChibaJapan
| | - Makiko Tajika
- Department of MetabolismChiba Children's HospitalChibaJapan
| | - Keiko Ichimoto
- Department of MetabolismChiba Children's HospitalChibaJapan
| | | | | | - Mika Ishige
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Tatsuo Fuchigami
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Taro Yamazaki
- Department of PediatricsSaitama Medical UniversitySaitamaJapan
| | - Yoshihito Kishita
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Masakazu Kohda
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Atsuko Imai‐Okazaki
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Yasushi Okazaki
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
| | - Ichiro Morioka
- Department of Pediatrics and Child HealthNihon University School of MedicineTokyoJapan
| | - Akira Ohtake
- Department of PediatricsSaitama Medical UniversitySaitamaJapan
- Department of Clinical GenomicsSaitama Medical UniversitySaitamaJapan
| | - Kei Murayama
- Department of MetabolismChiba Children's HospitalChibaJapan
- Intractable Disease Research CenterGraduate School of Medicine, Juntendo UniversityTokyoJapan
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