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Selvanathan A, Teo J, Parayil Sankaran B. Hematologic Manifestations in Primary Mitochondrial Diseases. J Pediatr Hematol Oncol 2024; 46:e338-e347. [PMID: 38857202 DOI: 10.1097/mph.0000000000002890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/23/2024] [Indexed: 06/12/2024]
Abstract
Primary mitochondrial disorders (PMDs) are known for their pleiotropic manifestations in humans, affecting almost any organ or system at any time. Hematologic manifestations, such as cytopenias and sideroblastic anemia, occur in 10% to 30% of patients with confirmed PMDs. These can be the initial presenting features or complications that develop over time. Surveillance for these manifestations allows for prompt identification and treatment. This article provides an overview of the pathophysiology underpinning the hematologic effects of mitochondrial dysfunction, discussing the 3 key roles of the mitochondria in hematopoiesis: providing energy for cell differentiation and function, synthesizing heme, and generating iron-sulfur clusters. Subsequently, the diagnosis and management of mitochondrial disorders are discussed, focusing on hematologic manifestations and the specific conditions commonly associated with them. Through this, we aimed to provide a concise point of reference for those considering a mitochondrial cause for a patient's hematologic abnormality, or for those considering a hematologic manifestation in a patient with known or suspected mitochondrial disease.
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Affiliation(s)
- Arthavan Selvanathan
- Genetic Metabolic Disorders Service, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Juliana Teo
- Haematology Department, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Bindu Parayil Sankaran
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, NSW, Australia
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2
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Siri B, D'Alessandro A, Maiorana A, Porzio O, Ravà L, Dionisi-Vici C, Cappa M, Martinelli D. Adrenocortical function in patients with Single Large Scale Mitochondrial DNA Deletions: a retrospective single centre cohort study. Eur J Endocrinol 2023; 189:485-494. [PMID: 37815532 DOI: 10.1093/ejendo/lvad137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE Single Large Scale Mitochondrial DNA Deletions (SLSMDs), Pearson Syndrome (PS) and Kearns-Sayre Syndrome (KSS), are systemic diseases with multiple endocrine abnormalities. The adrenocortical function has not been systematically investigated with a few anecdotal reports of overt adrenal insufficiency (AI). The study aimed to assess the adrenocortical function in a large cohort of SLSMDs. DESIGN AND METHODS A retrospective monocentric longitudinal study involved a cohort of 18 SLSMDs patients. Adrenocortical function was evaluated by baseline adrenocorticotrophic hormone (ACTH) and cortisol measurements and by high- (HDT) and low-dose (LDT) ACTH stimulation tests and compared with 92 healthy controls (HC). RESULTS Baseline adrenocortical function was impaired in 39% of patients and by the end of the study, 66% of PS and 25% of KSS showed an insufficient increase after ACTH stimulation, with cortisol deficiency due to primary AI in most PS and subclinical AI in KSS. Symptomatic AI was recorded in 44% of patients. Peak cortisol levels after ACTH stimulation tests were significantly lower in patients than in HC (P < .0001), with a more reduced response to LDT vs HDT (P < .05). CONCLUSIONS Our study highlights that cortisol deficiency due to primary AI represents a relevant part of the clinical spectrum in SLSMDs, with more severe impairment in PS than in KSS. Basal and after-stimulus assessment of adrenocortical axis should be early and regularly investigated to identify any degree of adrenocortical dysfunction. The study allowed the elaboration of a diagnostic process designed for the diagnosis, treatment, and follow-up of adrenocortical abnormalities in SLSMDs.
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Affiliation(s)
- Barbara Siri
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
- Department of Paediatrics, Città della Salute e della Scienza, OIRM, University of Turin, 10126 Turin, Italy
| | - Annamaria D'Alessandro
- Clinical Biochemistry Laboratory, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Arianna Maiorana
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Ottavia Porzio
- Clinical Biochemistry Laboratory, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Lucilla Ravà
- Clinical Epidemiology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Marco Cappa
- Research Area of Innovative Therapies in Endocrinopathies, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Diego Martinelli
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
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3
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Hong S, Kim S, Kim K, Lee H. Clinical Approaches for Mitochondrial Diseases. Cells 2023; 12:2494. [PMID: 37887337 PMCID: PMC10605124 DOI: 10.3390/cells12202494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Mitochondria are subcontractors dedicated to energy production within cells. In human mitochondria, almost all mitochondrial proteins originate from the nucleus, except for 13 subunit proteins that make up the crucial system required to perform 'oxidative phosphorylation (OX PHOS)', which are expressed by the mitochondria's self-contained DNA. Mitochondrial DNA (mtDNA) also encodes 2 rRNA and 22 tRNA species. Mitochondrial DNA replicates almost autonomously, independent of the nucleus, and its heredity follows a non-Mendelian pattern, exclusively passing from mother to children. Numerous studies have identified mtDNA mutation-related genetic diseases. The consequences of various types of mtDNA mutations, including insertions, deletions, and single base-pair mutations, are studied to reveal their relationship to mitochondrial diseases. Most mitochondrial diseases exhibit fatal symptoms, leading to ongoing therapeutic research with diverse approaches such as stimulating the defective OXPHOS system, mitochondrial replacement, and allotropic expression of defective enzymes. This review provides detailed information on two topics: (1) mitochondrial diseases caused by mtDNA mutations, and (2) the mechanisms of current treatments for mitochondrial diseases and clinical trials.
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Affiliation(s)
- Seongho Hong
- Korea Mouse Phenotyping Center, Seoul National University, Seoul 08826, Republic of Korea;
- Department of Medicine, Korea University College of Medicine, Seoul 02708, Republic of Korea
| | - Sanghun Kim
- Laboratory Animal Resource and Research Center, Korea Research Institute of Bioscience and Biotechnology, Cheongju 28116, Republic of Korea;
- College of Veterinary Medicine and Research Institute of Veterinary Medicine, Chungbuk National University, Cheongju 28644, Republic of Korea
| | - Kyoungmi Kim
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, Republic of Korea
- Department of Physiology, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Hyunji Lee
- Department of Medicine, Korea University College of Medicine, Seoul 02708, Republic of Korea
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4
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Björkman K, Vissing J, Østergaard E, Bindoff LA, de Coo IFM, Engvall M, Hikmat O, Isohanni P, Kollberg G, Lindberg C, Majamaa K, Naess K, Uusimaa J, Tulinius M, Darin N. Phenotypic spectrum and clinical course of single large-scale mitochondrial DNA deletion disease in the paediatric population: a multicentre study. J Med Genet 2023; 60:65-73. [PMID: 34872991 PMCID: PMC9811091 DOI: 10.1136/jmedgenet-2021-108006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/09/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Large-scale mitochondrial DNA deletions (LMD) are a common genetic cause of mitochondrial disease and give rise to a wide range of clinical features. Lack of longitudinal data means the natural history remains unclear. This study was undertaken to describe the clinical spectrum in a large cohort of patients with paediatric disease onset. METHODS A retrospective multicentre study was performed in patients with clinical onset <16 years of age, diagnosed and followed in seven European mitochondrial disease centres. RESULTS A total of 80 patients were included. The average age at disease onset and at last examination was 10 and 31 years, respectively. The median time from disease onset to death was 11.5 years. Pearson syndrome was present in 21%, Kearns-Sayre syndrome spectrum disorder in 50% and progressive external ophthalmoplegia in 29% of patients. Haematological abnormalities were the hallmark of the disease in preschool children, while the most common presentations in older patients were ptosis and external ophthalmoplegia. Skeletal muscle involvement was found in 65% and exercise intolerance in 25% of the patients. Central nervous system involvement was frequent, with variable presence of ataxia (40%), cognitive involvement (36%) and stroke-like episodes (9%). Other common features were pigmentary retinopathy (46%), short stature (42%), hearing impairment (39%), cardiac disease (39%), diabetes mellitus (25%) and renal disease (19%). CONCLUSION Our study provides new insights into the phenotypic spectrum of childhood-onset, LMD-associated syndromes. We found a wider spectrum of more prevalent multisystem involvement compared with previous studies, most likely related to a longer time of follow-up.
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Affiliation(s)
- Kristoffer Björkman
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John Vissing
- Copenhagen Neuromuscular Centre, Rigshospitalet, Kobenhavn, Denmark
| | - Elsebet Østergaard
- Department of Clinical Genetics, Rigshospitalet, Kobenhavn, Denmark,Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Laurence A Bindoff
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway,Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Irenaeus F M de Coo
- Department of Toxicogenomics, Unit Clinical Genomics, Maastricht University, Maastricht, The Netherlands,Maastricht University School for Mental Health and Neuroscience, Maastricht, The Netherlands
| | - Martin Engvall
- Center for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Omar Hikmat
- Department of Clinical Medicine (K1), University of Bergen, Bergen, Norway,Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Pirjo Isohanni
- Research Programs Unit, Stem Cells and Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland,University of Helsinki Children's Hospital, Helsinki, Finland
| | - Gittan Kollberg
- Department of Clinical Chemistry, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Lindberg
- Department of Neurology, Neuromuscular Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kari Majamaa
- Medical Research Center, Oulu University Faculty of Medicine, Oulu, Finland,Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Karin Naess
- Center for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden,Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Johanna Uusimaa
- PEDEGO Research Unit, Oulu University Faculty of Medicine, Oulu, Finland,Clinic for Children and Adolescents and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Mar Tulinius
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Darin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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5
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Muacevic A, Adler JR, Galligan A, Vitko J. A Case Report on Pearson Syndrome With Emphasis on Genetic Screening in Patients Presenting With Sideroblastic Anemia and Lactic Acidosis. Cureus 2023; 15:e33963. [PMID: 36820126 PMCID: PMC9938677 DOI: 10.7759/cureus.33963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
Pearson marrow-pancreas syndrome is a rare multisystem mitochondrial disease that is a result of defective oxidative phosphorylation caused by mitochondrial DNA mutations. The average prognosis of infants diagnosed with this disease is death within four years of age. The disease often carries an atypical presentation during the neonatal period causing this rare syndrome to be frequently misdiagnosed. The current report details the diagnosis of Pearson syndrome in a three-month-old male with a history of pancytopenia.
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6
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Joshi R, Myers E, Kokhanov A. Congenital Disorders of Red Blood Cells. Neoreviews 2022; 23:e813-e828. [PMID: 36450647 DOI: 10.1542/neo.23-12-e813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
See Bonus NeoBriefs videos and downloadable teaching slides Understanding the physiologic process of red blood cell development in utero and subsequent erythropoiesis in the neonate is crucial as this determines red blood cell structure and therefore function, which is vital to neonatal health. Infants frequently experience anemia, and special consideration must be given to the evaluation of these infants to determine the correct etiology. Traditionally, anemia is conceptualized in terms of inadequate red blood cell production, increased red blood cell destruction, or whole blood loss. This framework translates well to inherited red blood cell defects, which include genetic abnormalities in bone marrow productivity or structure of the red blood cell membrane, enzymes, or hemoglobin. This article highlights fetal and neonatal erythropoiesis and the underlying etiologies of the inherited red blood cell disorders, as well as reviews the appropriate diagnostic evaluation and next steps in management. It is imperative that neonatal clinicians remain informed about these disorders to enable early recognition and treatment, and ultimately to improve outcomes in affected infants.
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Affiliation(s)
- Rhucha Joshi
- Division of Neonatal Medicine, Department of Pediatrics, University of California Irvine, Irvine, CA
| | - Erin Myers
- Department of Pediatrics, University of California Irvine, Irvine, CA
| | - Artemiy Kokhanov
- Department of Neonatology, MemorialCare Miller Children's and Women's Hospital Long Beach, Long Beach, CA
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7
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Yoshimi A, Ishikawa K, Niemeyer C, Grünert SC. Pearson syndrome: a multisystem mitochondrial disease with bone marrow failure. Orphanet J Rare Dis 2022; 17:379. [PMID: 36253820 PMCID: PMC9575259 DOI: 10.1186/s13023-022-02538-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Pearson syndrome (PS) is a rare fatal mitochondrial disorder caused by single large-scale mitochondrial DNA deletions (SLSMDs). Most patients present with anemia in infancy. Bone marrow cytology with vacuolization in erythroid and myeloid precursors and ring-sideroblasts guides to the correct diagnosis, which is established by detection of SLSMDs. Non hematological symptoms suggesting a mitochondrial disease are often lacking at initial presentation, thus PS is an important differential diagnosis in isolated hypogenerative anemia in infancy. Spontaneous resolution of anemia occurs in two-third of patients at the age of 1-3 years, while multisystem non-hematological complications such as failure to thrive, muscle hypotonia, exocrine pancreas insufficiency, renal tubulopathy and cardiac dysfunction develop during the clinical course. Some patients with PS experience a phenotypical change to Kearns-Sayre syndrome. In the absence of curative therapy, the prognosis of patients with PS is dismal. Most patients die of acute lactic acidosis and multi-organ failure in early childhood. There is a great need for the development of novel therapies to alter the natural history of patients with PS.
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Affiliation(s)
- Ayami Yoshimi
- Department of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Kaori Ishikawa
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Charlotte Niemeyer
- Department of Pediatric Hematology and Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sarah C Grünert
- Faculty of Life and Environmental Sciences and Graduate School of Life and Environmental Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
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8
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Leukocyte cytokine responses in adult patients with mitochondrial DNA defects. J Mol Med (Berl) 2022; 100:963-971. [PMID: 35635577 PMCID: PMC9885136 DOI: 10.1007/s00109-022-02206-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/11/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023]
Abstract
Patients with oxidative phosphorylation (OxPhos) defects causing mitochondrial diseases appear particularly vulnerable to infections. Although OxPhos defects modulate cytokine production in vitro and in animal models, little is known about how circulating leukocytes of patients with inherited mitochondrial DNA (mtDNA) defects respond to acute immune challenges. In a small cohort of healthy controls (n = 21) and patients (n = 12) with either the m.3243A > G mutation or single, large-scale mtDNA deletions, we examined (i) cytokine responses (IL-6, TNF-α, IL-1β) in response to acute lipopolysaccharide (LPS) exposure and (ii) sensitivity to the immunosuppressive effects of glucocorticoid signaling (dexamethasone) on cytokine production. In dose-response experiments to determine the half-maximal effective LPS concentration (EC50), relative to controls, leukocytes from patients with mtDNA deletions showed 74-79% lower responses for IL-6 and IL-1β (pIL-6 = 0.031, pIL-1β = 0.009). Moreover, whole blood from patients with mtDNA deletions (pIL-6 = 0.006), but not patients with the m.3243A > G mutation, showed greater sensitivity to the immunosuppressive effects of dexamethasone. Together, these ex vivo data provide preliminary evidence that some systemic OxPhos defects may compromise immune cytokine responses and increase the sensitivity to immune cytokine suppression by glucocorticoids. Further work in larger cohorts is needed to define the nature of immune dysregulation in patients with mitochondrial disease, and their potential implications for disease phenotypes. KEY MESSAGES: Little is known about leukocyte cytokine responses in patients with mitochondrial diseases. Leukocytes of patients with mtDNA deletions show blunted LPS sensitivity and cytokine responses. Leukocytes of patients with mtDNA deletions are more sensitive to glucocorticoid-mediated IL-6 suppression. Work in larger cohorts is needed to delineate potential immune alterations in mitochondrial diseases.
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9
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Lopriore P, Ricciarini V, Siciliano G, Mancuso M, Montano V. Mitochondrial Ataxias: Molecular Classification and Clinical Heterogeneity. Neurol Int 2022; 14:337-356. [PMID: 35466209 PMCID: PMC9036286 DOI: 10.3390/neurolint14020028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 01/25/2023] Open
Abstract
Ataxia is increasingly being recognized as a cardinal manifestation in primary mitochondrial diseases (PMDs) in both paediatric and adult patients. It can be caused by disruption of cerebellar nuclei or fibres, its connection with the brainstem, or spinal and peripheral lesions leading to proprioceptive loss. Despite mitochondrial ataxias having no specific defining features, they should be included in hereditary ataxias differential diagnosis, given the high prevalence of PMDs. This review focuses on the clinical and neuropathological features and genetic background of PMDs in which ataxia is a prominent manifestation.
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10
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Son JS, Seo GH, Kim YM, Kim GH, Jin HK, Bae JS, Im HJ, Yoo HW, Lee BH. Clinical and genetic features of four patients with Pearson syndrome: An observational study. Medicine (Baltimore) 2022; 101:e28793. [PMID: 35119049 PMCID: PMC8812667 DOI: 10.1097/md.0000000000028793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 01/20/2022] [Indexed: 01/04/2023] Open
Abstract
Pearson syndrome (PS) is a multisystem mitochondrial cytopathy arising from deletions in mitochondrial DNA. Pearson syndrome is a sporadic disease that affects the hematopoietic system, pancreas, eyes, liver, and heart and the prognosis is poor. Causes of morbidity include metabolic crisis, bone marrow dysfunction, sepsis, and liver failure in early infancy or childhood. Early diagnosis may minimize complications, but suspicion of the disease is difficult and only mitochondrial DNA gene testing can identify mutations. There is no specific treatment for PS, which remains supportive care according to symptoms; however, hematopoietic stem cell transplantation may be considered in cases of bone marrow failure.We herein describe the clinical and genetic characteristics of four patients with PS. One patient presented with hypoglycemia, two developed pancytopenia, and the final patient had hypoglycemia and acute hepatitis as the primary manifestation. All patients had lactic acidosis. Additionally, all patients showed a variety of clinical features including coagulation disorder, pancreatic, adrenal, and renal tubular insufficiencies. Two patients with pancytopenia died in their early childhood. Our experience expands the phenotypic spectrum associated with PS and its clinical understanding.
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Affiliation(s)
- Ji Soo Son
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Go Hun Seo
- Division of Medical Genetics, 3billion Inc., Seoul, South Korea
| | - Yoon-Myung Kim
- Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Gu-Hwan Kim
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hee Kyung Jin
- Department of Laboratory Animal Medicine, College of Veterinary Medicine, Kyungpook National University, Daegu, South Korea
| | - Jae-sung Bae
- Department of Physiology, Cell and Matrix Research Institute, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ho Joon Im
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Han-Wook Yoo
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Beom Hee Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
- Medical Genetics Center, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
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11
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Castro L, Ferreira AC, Cohen Á, Macedo IJ, Tomé T. Preterm twins with antenatal presentation of Pearson syndrome. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2021-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Pearson syndrome is a mitochondrial cytopathy with multisystemic involvement that typically presents in infancy and has poor prognosis. We aim to present a case that is distinct due to the timing of presentation and associated anomalies.
Case presentation
We report the case of preterm monochorionic twins with transfusion dependent fetal anemia that had post-natal multisystem dysfunction which led to the diagnosis of Pearson syndrome.
Conclusions
This case highlights the possibility of antenatal presentation of Pearson syndrome, which should be considered in cases of severe fetal anemia without an apparent cause.
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Affiliation(s)
- Leonor Castro
- Pediatric and Neonatal Intensive Care Unit, Hospital Central do Funchal , Av. Luís de Camões, nº 57 – 9004-514 Funchal , Madeira , Portugal
| | - Ana C. Ferreira
- Metabolic Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central , Lisboa , Portugal
| | - Álvaro Cohen
- Prenatal Diagnosis Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central , Lisboa , Portugal
| | - Israel J. Macedo
- Neonatal Intensive Care Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central , Lisboa , Portugal
| | - Teresa Tomé
- Neonatal Intensive Care Unit, Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central , Lisboa , Portugal
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12
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Nguyen T, Alzahrani T, Krepp J, Panjrath G. Cardiovascular Outcomes in Patients With Mitochondrial Disease in the United States: A Propensity Score Analysis. Tex Heart Inst J 2021; 48:469117. [PMID: 34383956 DOI: 10.14503/thij-20-7243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Mitochondrial disease comprises a wide range of genetic disorders caused by mitochondrial dysfunction. Its rarity, however, has limited the ability to assess its effects on clinical outcomes. To evaluate this relationship, we collected data from the 2016 National Inpatient Sample, which includes data from >7 million hospital stays. We identified 705 patients (mean age, 22 ± 20.7 yr; 54.2% female; 67.4% white) whose records included the ICD-10-CM code E88.4. We also identified a propensity-matched cohort of 705 patients without mitochondrial disease to examine the effect of mitochondrial disease on major adverse cardiovascular events, including all-cause in-hospital death, cardiac arrest, and acute congestive heart failure. Patients with mitochondrial disease were at significantly greater risk of major adverse cardiovascular events (odds ratio [OR]=2.42; 95% CI, 1.29-4.57; P=0.005), systolic heart failure (OR=2.37; 95% CI, 1.08-5.22; P=0.027), and all-cause in-hospital death (OR=14.22; 95% CI, 1.87-108.45; P<0.001). These findings suggest that mitochondrial disease significantly increases the risk of inpatient major adverse cardiovascular events.
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Affiliation(s)
- Tran Nguyen
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC
| | - Talal Alzahrani
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC
| | - Joseph Krepp
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC
| | - Gurusher Panjrath
- Division of Cardiology, Department of Medicine, George Washington University, Washington, DC
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13
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Two Novel Variants in YARS2 Gene Are Responsible for an Extended MLASA Phenotype with Pancreatic Insufficiency. J Clin Med 2021; 10:jcm10163471. [PMID: 34441767 PMCID: PMC8397107 DOI: 10.3390/jcm10163471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/02/2021] [Indexed: 11/17/2022] Open
Abstract
Pathogenic variants in the mitochondrial tyrosyl-tRNA synthetase gene (YARS2) were associated with myopathy, lactic acidosis, and sideroblastic anemia (MLASA). However, patients can present mitochondrial myopathy, with exercise intolerance and muscle weakness, leading from mild to lethal phenotypes. Genes implicated in mtDNA replication were studied by Next Generation Sequencing (NGS) and whole exome sequence with the TruSeq Rapid Exome kit (Illumina, San Diego, CA, USA). Mitochondrial protein translation was studied following the Sasarman and Shoubridge protocol and oxygen consumption rates with Agilent Seahorse XF24 Analyzer Mitostress Test, (Agilent, Santa Clara, CA, USA). We report two siblings with two novel compound heterozygous pathogenic variants in YARS2 gene: a single nucleotide deletion in exon 1, c.314delG (p.(Gly105Alafs*4)), which creates a premature stop codon in the amino acid 109, and a single nucleotide change in exon 5 c.1391T>C (p.(Ile464Thr)), that cause a missense variant in amino acid 464. We demonstrate the pathogenicity of these new variants associated with reduced YARS2 mRNA transcript, reduced mitochondrial protein translation and dysfunctional organelle function. These pathogenic variants are responsible for late onset MLASA, herein accompanied by pancreatic insufficiency, observed in both brothers, clinically considered as Pearson's syndrome. Molecular study of YARS2 gene should be considered in patients presenting Pearson's syndrome characteristics and MLASA related phenotypes.
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14
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Bernardino Gomes TM, Ng YS, Pickett SJ, Turnbull DM, Vincent AE. Mitochondrial DNA disorders: From pathogenic variants to preventing transmission. Hum Mol Genet 2021; 30:R245-R253. [PMID: 34169319 PMCID: PMC8490015 DOI: 10.1093/hmg/ddab156] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/27/2022] Open
Abstract
Mitochondrial DNA (mtDNA) disorders are recognized as one of the most common causes of inherited metabolic disorders. The mitochondrial genome occurs in multiple copies resulting in both homoplasmic and heteroplasmic pathogenic mtDNA variants. A biochemical defect arises when the pathogenic variant level reaches a threshold, which differs between variants. Moreover, variants can segregate, clonally expand, or be lost from cellular populations resulting in a dynamic and tissue-specific mosaic pattern of oxidative deficiency. MtDNA is maternally inherited but transmission patterns of heteroplasmic pathogenic variants are complex. During oogenesis, a mitochondrial bottleneck results in offspring with widely differing variant levels to their mother, whilst highly deleterious variants, such as deletions, are not transmitted. Complemented by a complex interplay between mitochondrial and nuclear genomes, these peculiar genetics produce marked phenotypic variation, posing challenges to the diagnosis and clinical management of patients. Novel therapeutic compounds and several genetic therapies are currently under investigation, but proven disease-modifying therapies remain elusive. Women who carry pathogenic mtDNA variants require bespoke genetic counselling to determine their reproductive options. Recent advances in in vitro fertilization techniques, have greatly improved reproductive choices, but are not without their challenges. Since the first pathogenic mtDNA variants were identified over 30 years ago, there has been remarkable progress in our understanding of these diseases. However, many questions remain unanswered and future studies are required to investigate the mechanisms of disease progression and to identify new disease-specific therapeutic targets.
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Affiliation(s)
- Tiago M Bernardino Gomes
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE2 4HH, UK
| | - Yi Shiau Ng
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,NHS Highly Specialised Service for Rare Mitochondrial Disorders, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE2 4HH, UK
| | - Sarah J Pickett
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Doug M Turnbull
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Amy E Vincent
- Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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15
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Finsterer J. Comprehensive clinical and genetic work-up of patients carrying single mtDNA deletions is warranted. Transl Pediatr 2021; 10:1755-1756. [PMID: 34295792 PMCID: PMC8261587 DOI: 10.21037/tp-21-79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/21/2021] [Indexed: 12/04/2022] Open
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16
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Rius R, Compton AG, Baker NL, Welch AE, Coman D, Kava MP, Minoche AE, Cowley MJ, Thorburn DR, Christodoulou J. Application of Genome Sequencing from Blood to Diagnose Mitochondrial Diseases. Genes (Basel) 2021; 12:genes12040607. [PMID: 33924034 PMCID: PMC8072654 DOI: 10.3390/genes12040607] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/16/2021] [Accepted: 04/17/2021] [Indexed: 12/23/2022] Open
Abstract
Mitochondrial diseases can be caused by pathogenic variants in nuclear or mitochondrial DNA-encoded genes that often lead to multisystemic symptoms and can have any mode of inheritance. Using a single test, Genome Sequencing (GS) can effectively identify variants in both genomes, but it has not yet been universally used as a first-line approach to diagnosing mitochondrial diseases due to related costs and challenges in data analysis. In this article, we report three patients with mitochondrial disease molecularly diagnosed through GS performed on DNA extracted from blood to demonstrate different diagnostic advantages of this technology, including the detection of a low-level heteroplasmic pathogenic variant, an intragenic nuclear DNA deletion, and a large mtDNA deletion. Current technical improvements and cost reductions are likely to lead to an expanded routine diagnostic usage of GS and of the complementary “Omic” technologies in mitochondrial diseases.
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Affiliation(s)
- Rocio Rius
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (R.R.); (A.G.C.); (N.L.B.) (A.E.W.); (D.R.T.)
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Alison G. Compton
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (R.R.); (A.G.C.); (N.L.B.) (A.E.W.); (D.R.T.)
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
| | - Naomi L. Baker
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (R.R.); (A.G.C.); (N.L.B.) (A.E.W.); (D.R.T.)
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Victorian Clinical Genetic Services, Melbourne, VIC 3052, Australia
| | - AnneMarie E. Welch
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (R.R.); (A.G.C.); (N.L.B.) (A.E.W.); (D.R.T.)
| | - David Coman
- Department of Metabolic Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia;
- School of Clinical Medicine, University of Queensland, Brisbane, QLD 4072, Australia
- School of Medicine, Griffith University, Gold Coast, QLD 4222, Australia
| | - Maina P. Kava
- Department of Neurology, Perth Children’s Hospital, Perth, WA 6009, Australia;
- Department of Metabolic Medicine and Rheumatology, Perth Children’s Hospital, Perth, WA 6009, Australia
| | - Andre E. Minoche
- Kinghorn Centre for Clinical Genomics, Garvan Institute, University of New South Wales, Randwick, NSW 2010, Australia;
| | - Mark J. Cowley
- Precision Medicine Theme, Children’s Cancer Institute, Kensington, NSW 2750, Australia;
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW 2031, Australia
| | - David R. Thorburn
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (R.R.); (A.G.C.); (N.L.B.) (A.E.W.); (D.R.T.)
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Victorian Clinical Genetic Services, Melbourne, VIC 3052, Australia
| | - John Christodoulou
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia; (R.R.); (A.G.C.); (N.L.B.) (A.E.W.); (D.R.T.)
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Victorian Clinical Genetic Services, Melbourne, VIC 3052, Australia
- Correspondence: ; Tel.: +61-39936-6353
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17
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Maghbooli M, Ghaffarpour M, Ghazizadeh T, Shalbaf NA, MalekMahmoudi G. Clinicogenetical Variants of Progressive External Ophthalmoplegia - An Especial Review of Non-ophthalmic Manifestations. Neurol India 2020; 68:760-768. [PMID: 32859811 DOI: 10.4103/0028-3886.293454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Progressive external ophthalmoplegia (PEO) is a slowly progressive myopathy characterized by extraocular muscles involvement, leading to frozen eyes without diplopia. The pattern of inheritance may be mitochondrial, autosomal dominant or, rarely, autosomal recessive. Sporadic forms were also reported. Muscular involvement other than extraocular muscles may occur with varying degrees of weakness, but this mostly happens many years after the disease begins. There are also scattered data about systemic signs besides ophthalmoplegia. This article aims to review non-ophthalmic findings of PEO from a clinicogenetical point of view.
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Affiliation(s)
- Mehdi Maghbooli
- Department of Neurology, Zanjan University of Medical Sciences, Vali-e-Asr Hospital, Zanjan, Iran
| | - Majid Ghaffarpour
- Department of Neurology, Tehran University of Medical Sciences, Iranian Center of Neurological Research, Tehran, Iran
| | - Taher Ghazizadeh
- Department of Neurology, Zanjan University of Medical Sciences, Vali-e-Asr Hospital, Zanjan, Iran
| | - Nazanin Azizi Shalbaf
- Department of Neurology, Zanjan University of Medical Sciences, Vali-e-Asr Hospital, Zanjan, Iran
| | - Ghazal MalekMahmoudi
- Department of Neurology, Zanjan University of Medical Sciences, Vali-e-Asr Hospital, Zanjan, Iran
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18
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Lawless C, Greaves L, Reeve AK, Turnbull DM, Vincent AE. The rise and rise of mitochondrial DNA mutations. Open Biol 2020; 10:200061. [PMID: 32428418 PMCID: PMC7276526 DOI: 10.1098/rsob.200061] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/23/2020] [Indexed: 12/24/2022] Open
Abstract
How mitochondrial DNA mutations clonally expand in an individual cell is a question that has perplexed mitochondrial biologists for decades. A growing body of literature indicates that mitochondrial DNA mutations play a major role in ageing, metabolic diseases, neurodegenerative diseases, neuromuscular disorders and cancers. Importantly, this process of clonal expansion occurs for both inherited and somatic mitochondrial DNA mutations. To complicate matters further there are fundamental differences between mitochondrial DNA point mutations and deletions, and between mitotic and post-mitotic cells, that impact this pathogenic process. These differences, along with the challenges of investigating a longitudinal process occurring over decades in humans, have so far hindered progress towards understanding clonal expansion. Here we summarize our current understanding of the clonal expansion of mitochondrial DNA mutations in different tissues and highlight key unanswered questions. We then discuss the various existing biological models, along with their advantages and disadvantages. Finally, we explore what has been achieved with mathematical modelling so far and suggest future work to advance this important area of research.
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Affiliation(s)
| | | | | | - Doug M. Turnbull
- Wellcome Centre for Mitochondrial Research, Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle NE2 4HH, UK
| | - Amy E. Vincent
- Wellcome Centre for Mitochondrial Research, Clinical and Translational Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle NE2 4HH, UK
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19
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Nissanka N, Moraes CT. Mitochondrial DNA heteroplasmy in disease and targeted nuclease-based therapeutic approaches. EMBO Rep 2020; 21:e49612. [PMID: 32073748 DOI: 10.15252/embr.201949612] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/11/2019] [Accepted: 01/29/2020] [Indexed: 12/31/2022] Open
Abstract
Mitochondrial DNA (mtDNA) encodes a subset of the genes which are responsible for oxidative phosphorylation. Pathogenic mutations in the human mtDNA are often heteroplasmic, where wild-type mtDNA species co-exist with the pathogenic mtDNA and a bioenergetic defect is only seen when the pathogenic mtDNA percentage surpasses a threshold for biochemical manifestations. mtDNA segregation during germline development can explain some of the extreme variation in heteroplasmy from one generation to the next. Patients with high heteroplasmy for deleterious mtDNA species will likely suffer from bona-fide mitochondrial diseases, which currently have no cure. Shifting mtDNA heteroplasmy toward the wild-type mtDNA species could provide a therapeutic option to patients. Mitochondrially targeted engineered nucleases, such as mitoTALENs and mitoZFNs, have been used in vitro in human cells harboring pathogenic patient-derived mtDNA mutations and more recently in vivo in a mouse model of a pathogenic mtDNA point mutation. These gene therapy tools for shifting mtDNA heteroplasmy can also be used in conjunction with other therapies aimed at eliminating and/or preventing the transfer of pathogenic mtDNA from mother to child.
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Affiliation(s)
- Nadee Nissanka
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Carlos T Moraes
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
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20
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Reddy JM, Jose J, Prakash A, Devi S. Pearson syndrome: a rare inborn error of metabolism with bone marrow morphology providing a clue to diagnosis. Sudan J Paediatr 2020; 19:161-164. [PMID: 31969746 DOI: 10.24911/sjp.106-1534158413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pearson syndrome is a rare disorder of mitochondrial metabolism presenting in infancy with transfusion dependent refractory anaemia and multisystem involvement. We report a case of a 3-month-old infant presenting with anaemia requiring multiple transfusions. The presence of lactic acidosis, hyperglycaemia and cytoplasmic vacuoles in erythroid precursors on bone marrow aspiration study helped to suspect the diagnosis. However, the baby succumbed to metabolic crisis before he could be offered definitive therapy. This case report aims to emphasise the typical bone marrow aspiration finding which serves as a useful marker for establishing the diagnosis of this rare disorder, which is mostly fatal without bone marrow transplantation.
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Affiliation(s)
- Jyothi Muni Reddy
- Department of Paediatrics, St John's Medical College Hospital, Bangalore, India
| | - Joe Jose
- Department of Paediatrics, St John's Medical College Hospital, Bangalore, India
| | - Anand Prakash
- Department of Paediatrics, St John's Medical College Hospital, Bangalore, India
| | - Shanthala Devi
- Department of Transfusion Medicine and Immunohematology, St John's Medical College Hospital, Bangalore, India
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21
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Wild KT, Goldstein AC, Muraresku C, Ganetzky RD. Broadening the phenotypic spectrum of Pearson syndrome: Five new cases and a review of the literature. Am J Med Genet A 2019; 182:365-373. [PMID: 31825167 DOI: 10.1002/ajmg.a.61433] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/05/2022]
Abstract
Pearson syndrome (PS) is a multisystem mitochondrial respiratory chain disorder typically characterized by sideroblastic anemia and exocrine pancreatic insufficiency. PS is caused by a single large-scale mitochondrial DNA (mtDNA) deletion. PS classically presents in the first year of life and may be fatal in infancy. Children who survive PS may progress to develop Kearns-Sayre syndrome later in life. The full phenotypic spectrum and prognosis of the condition continue to evolve. Here we report five new patients with PS with unique clinical presentations, including four patients with onset later than previously reported in the literature, and one patient with prenatal onset of symptoms. The timing and unique features of these presentations support an expanded phenotypic spectrum of single large-scale mtDNA deletion syndromes (SLSMDS) and reinforce the importance of including SLSMDS in the differential for children with complex multisystem presentations.
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Affiliation(s)
- K Taylor Wild
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amy C Goldstein
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Mitochondrial Medicine Frontier Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Colleen Muraresku
- Mitochondrial Medicine Frontier Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecca D Ganetzky
- Division of Human Genetics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Mitochondrial Medicine Frontier Program, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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22
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Pronman L, Rondinelli M, Burkardt DD, Velayuthan S, Khalili AS, Bedoyan JK. Pearson Syndrome: A Rare Cause of Failure to Thrive in Infants. Clin Pediatr (Phila) 2019; 58:819-824. [PMID: 30845838 DOI: 10.1177/0009922819834285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lauren Pronman
- 1 University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Monica Rondinelli
- 1 University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | | | - Sujithra Velayuthan
- 1 University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Ali Salar Khalili
- 1 University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Jirair K Bedoyan
- 1 University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,2 Rainbow Babies and Children's Hospital, Cleveland, OH, USA.,3 Case Western Reserve University, Cleveland, OH, USA
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23
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Cardiovascular Manifestations of Mitochondrial Disease. BIOLOGY 2019; 8:biology8020034. [PMID: 31083569 PMCID: PMC6628328 DOI: 10.3390/biology8020034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/13/2019] [Accepted: 04/22/2019] [Indexed: 02/06/2023]
Abstract
Genetic mitochondrial cardiomyopathies are uncommon causes of heart failure that may not be seen by most physicians. However, the prevalence of mitochondrial DNA mutations and somatic mutations affecting mitochondrial function are more common than previously thought. In this review, the pathogenesis of genetic mitochondrial disorders causing cardiovascular disease is reviewed. Treatment options are presently limited to mostly symptomatic support, but preclinical research is starting to reveal novel approaches that may lead to better and more targeted therapies in the future. With better understanding and clinician education, we hope to improve clinician recognition and diagnosis of these rare disorders in order to improve ongoing care of patients with these diseases and advance research towards discovering new therapeutic strategies to help treat these diseases.
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24
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Set KK, Sen K, Huq AHM, Agarwal R. Mitochondrial Disorders of the Nervous System: A Review. Clin Pediatr (Phila) 2019; 58:381-394. [PMID: 30607979 DOI: 10.1177/0009922818821890] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kallol K Set
- 1 Dayton Children's Hospital, Dayton, OH, USA.,2 Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Kuntal Sen
- 3 Children's Hospital of Michigan, Detroit, MI, USA.,4 Wayne State University School of Medicine, Detroit, MI, USA
| | - A H M Huq
- 3 Children's Hospital of Michigan, Detroit, MI, USA.,4 Wayne State University School of Medicine, Detroit, MI, USA
| | - Rajkumar Agarwal
- 1 Dayton Children's Hospital, Dayton, OH, USA.,2 Wright State University Boonshoft School of Medicine, Dayton, OH, USA
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25
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Nissanka N, Minczuk M, Moraes CT. Mechanisms of Mitochondrial DNA Deletion Formation. Trends Genet 2019; 35:235-244. [PMID: 30691869 DOI: 10.1016/j.tig.2019.01.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 02/02/2023]
Abstract
Mitochondrial DNA (mtDNA) encodes a subset of genes which are essential for oxidative phosphorylation. Deletions in the mtDNA can ablate a number of these genes and result in mitochondrial dysfunction, which is associated with bona fide mitochondrial disorders. Although mtDNA deletions are thought to occur as a result of replication errors or following double-strand breaks, the exact mechanism(s) behind deletion formation have yet to be determined. In this review we discuss the current knowledge about the fate of mtDNA following double-strand breaks, including the molecular players which mediate the degradation of linear mtDNA fragments and possible mechanisms of recircularization. We propose that mtDNA deletions formed from replication errors versus following double-strand breaks can be mediated by separate pathways.
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Affiliation(s)
- Nadee Nissanka
- Department of Neurology, University of Miami, Miller School of Medicine, FL 33136, USA
| | - Michal Minczuk
- Medical Research Council (MRC) Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK
| | - Carlos T Moraes
- Department of Neurology, University of Miami, Miller School of Medicine, FL 33136, USA.
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26
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Finsterer J, Scorza FA, Scorza CA. Broad Phenotypic Heterogeneity and Multisystem Involvement in Single mtDNA Deletion-associated Pearson Syndrome. Med Arch 2018; 72:234-236. [PMID: 30061775 PMCID: PMC6021152 DOI: 10.5455/medarh.2018.72.234-236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Fulvio A Scorza
- Disciplina de Neurociência. Escola Paulista de Medicina/Universidade Federal de São Paulo/(EPM/UNIFESP). São Paulo, Brasil
| | - Carla A Scorza
- Disciplina de Neurociência. Escola Paulista de Medicina/Universidade Federal de São Paulo/(EPM/UNIFESP). São Paulo, Brasil
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27
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Clinical syndromes associated with mtDNA mutations: where we stand after 30 years. Essays Biochem 2018; 62:235-254. [DOI: 10.1042/ebc20170097] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 01/16/2023]
Abstract
The landmark year 1988 can be considered as the birthdate of mitochondrial medicine, when the first pathogenic mutations affecting mtDNA were associated with human diseases. Three decades later, the field still expands and we are not ‘scraping the bottom of the barrel’ yet. Despite the tremendous progress in terms of molecular characterization and genotype/phenotype correlations, for the vast majority of cases we still lack a deep understanding of the pathogenesis, good models to study, and effective therapeutic options. However, recent technological advances including somatic cell reprogramming to induced pluripotent stem cells (iPSCs), organoid technology, and tailored endonucleases provide unprecedented opportunities to fill these gaps, casting hope to soon cure the major primary mitochondrial phenotypes reviewed here. This group of rare diseases represents a key model for tackling the pathogenic mechanisms involving mitochondrial biology relevant to much more common disorders that affect our currently ageing population, such as diabetes and metabolic syndrome, neurodegenerative and inflammatory disorders, and cancer.
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28
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Tadiotto E, Maines E, Degani D, Balter R, Bordugo A, Cesaro S. Bone marrow features in Pearson syndrome with neonatal onset: A case report and review of the literature. Pediatr Blood Cancer 2018; 65. [PMID: 29286581 DOI: 10.1002/pbc.26939] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/25/2017] [Accepted: 11/30/2017] [Indexed: 11/06/2022]
Abstract
Pearson syndrome (PS) is a rare mitochondrial disorder that usually presents with transfusion-dependent macrocytic anemia, exocrine pancreatic dysfunction, and lactic acidosis. Typical bone marrow (BM) features are vacuolization in hematopoietic progenitors, hypocellularity, and ringed sideroblasts. At the neonatal age, PS may have a variable clinical onset. Moreover, there is little information about BM features at this age and the timing of their presentation. We report a neonatal case of PS that presented with refractory anemia and atypical BM features. We reviewed the BM findings in neonatal-onset PS cases to stress the importance and limitations of BM evaluation at this age.
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Affiliation(s)
- Elisa Tadiotto
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Evelina Maines
- Pediatric Unit, Provincial Centre for Rare Diseases, Department of Maternal and Child Health, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Daniela Degani
- Pediatric Clinic, Department of Life and Reproduction Sciences, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rita Balter
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Bordugo
- Department of Pediatrics, Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology Unit, Department of Pediatrics, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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29
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Preferential amplification of a human mitochondrial DNA deletion in vitro and in vivo. Sci Rep 2018; 8:1799. [PMID: 29379065 PMCID: PMC5789095 DOI: 10.1038/s41598-018-20064-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 12/27/2017] [Indexed: 01/19/2023] Open
Abstract
We generated induced pluripotent stem cells (iPSCs) from patient fibroblasts to yield cell lines containing varying degrees of heteroplasmy for a m.13514 A > G mtDNA point mutation (2 lines) and for a ~6 kb single, large scale mtDNA deletion (3 lines). Long term culture of the iPSCs containing a single, large-scale mtDNA deletion showed consistent increase in mtDNA deletion levels with time. Higher levels of mtDNA heteroplasmy correlated with increased respiratory deficiency. To determine what changes occurred in deletion level during differentiation, teratomas comprising all three embryonic germ layers were generated from low (20%) and intermediate heteroplasmy (55%) mtDNA deletion clones. Regardless of whether iPSCs harbouring low or intermediate mtDNA heteroplasmy were used, the final levels of heteroplasmy in all teratoma germ layers increased to a similar high level (>60%). Thus, during human stem cell division, cells not only tolerate high mtDNA deletion loads but seem to preferentially replicate deleted mtDNA genomes. This has implications for the involvement of mtDNA deletions in both disease and ageing.
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30
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Abstract
INTRODUCTION Pearson syndrome (PS) is a sporadic and very rare syndrome classically associated with single large-scale deletions of mitochondrial DNA and characterized by refractory sideroblastic anemia during infancy. Areas covered: This review presents an analysis and interpretation of the published data that forms the basis for our understanding of PS. PubMed, Google Scholarand Thompson ISI Web of Knowledge were searched for relevant data. Expert commentary: PS is a very rare mitochodrial disease that involves different organs and systems. Clinical phenotype is extremely variable and may change over the course of disease itself with the possibility both of worsenings and improvements. Outcome is invariably lethal and at the moment no cure is available. Accurate supportive treatment and follow up program in centres with experience in mitochondrial diseases and marrow failure may positively influence quality and duration of life.
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Affiliation(s)
- Piero Farruggia
- a Pediatric Hematology and Oncology Unit, Oncology Department , A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli , Palermo , Italy
| | - Floriana Di Marco
- a Pediatric Hematology and Oncology Unit, Oncology Department , A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli , Palermo , Italy
| | - Carlo Dufour
- b Clinical and Experimental Hematology Unit, G. Gaslini Children's Hospital , Genova , Italy
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31
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Urrego-Díaz JA, Frías-Ordoñez JS, Figueroa-Echandía G, Durán-Silva G. Acute corneal edema without epithelium compromise. A case report and literature review. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n3.56637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El edema de córnea es una entidad que se produce por un gran número de causas y tiene diversas formas de presentación y diferentes grados de afección. En este artículo se reporta el caso de un hombre con edema de córnea agudo sin compromiso epitelial, en el que el cuadro clínico, el examen oftalmológico y los estudios de extensión no lograron establecer su etiología. Además, se hace una revisión de la literatura disponible respecto a todas las posibles causas de edema de córnea agudo, agrupándolas en aquellas que ocasionan el edema por lesión o inflamación epitelial o estromal, por disfunción endotelial o por un aumento en la presión intraocular.
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Vallabh NA, Romano V, Willoughby CE. Mitochondrial dysfunction and oxidative stress in corneal disease. Mitochondrion 2017; 36:103-113. [PMID: 28549842 DOI: 10.1016/j.mito.2017.05.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 01/23/2017] [Accepted: 05/18/2017] [Indexed: 12/13/2022]
Abstract
The cornea is the anterior transparent surface and the main refracting structure of the eye. Mitochondrial dysfunction and oxidative stress are implicated in the pathogenesis of inherited (e.g. Kearns Sayre Syndrome) and acquired corneal diseases (e.g. keratoconus and Fuchs endothelial corneal dystrophy). Both antioxidants and reactive oxygen species are found in the healthy cornea. There is increasing evidence of imbalance in the oxidative balance and mitochondrial function in the cornea in disease states. The cornea is vulnerable to mitochondrial dysfunction and oxidative stress due to its highly exposed position to ultraviolet radiation and high oxygen tension. The corneal endothelium is vulnerable to accumulating mitochondrial DNA (mtDNA) damage due to the post- mitotic nature of endothelial cells, yet their mitochondrial genome is continually replicating and mtDNA mutations can develop and accumulate with age. The unique physiology of the cornea predisposes this structure to oxidative damage, and there is interplay between inherited and acquired mitochondrial dysfunction, oxidative damage and a number of corneal diseases. By targeting mitochondrial dysfunction in corneal disease, emerging treatments may prevent or reduce visual loss.
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Affiliation(s)
- Neeru A Vallabh
- Corneal and External Eye Service, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; Institute of Ageing and Chronic Disease, Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom
| | - Vito Romano
- Corneal and External Eye Service, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Colin E Willoughby
- Corneal and External Eye Service, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom; Institute of Ageing and Chronic Disease, Department of Eye and Vision Science, University of Liverpool, Liverpool, United Kingdom.
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Chen XY, Zhao SY, Wang Y, Wang D, Dong CH, Yang Y, Wang ZH, Wu YM. WITHDRAWN: A novel mitochondrial DNA deletion in a patient with Pearson syndrome and neonatal diabetes mellitus provides insight into disease etiology, severity and progression. Eur J Med Genet 2015:S1769-7212(15)30037-9. [PMID: 26518169 DOI: 10.1016/j.ejmg.2015.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 10/23/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Xin-Yu Chen
- Department of Biochemistry and Molecular Biology, Xi'an, Shaanxi, China; Center for DNA Typing, Xi'an, Shaanxi, China; Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Si-Yu Zhao
- Department of Neurology, Xi'an Children's Hospital, Xi'an, Shaanxi, China.
| | - Yan Wang
- Department of Neurology, Xi'an Children's Hospital, Xi'an, Shaanxi, China.
| | - Dong Wang
- Department of Neurology, Xi'an Children's Hospital, Xi'an, Shaanxi, China.
| | - Chang-Hu Dong
- Second Affiliated Hospital of Shaanxi College of Chinese Medicine, Xianyang, Shaanxi, China.
| | - Ying Yang
- Department of Biochemistry and Molecular Biology, Xi'an, Shaanxi, China; Center for DNA Typing, Xi'an, Shaanxi, China; Fourth Military Medical University, Xi'an, Shaanxi, China.
| | - Zhi-Hua Wang
- Department of Endocrinology and Metabolism, Xi'an Children's Hospital, Xi'an, Shaanxi, China.
| | - Yuan-Ming Wu
- Department of Biochemistry and Molecular Biology, Xi'an, Shaanxi, China; Center for DNA Typing, Xi'an, Shaanxi, China; Fourth Military Medical University, Xi'an, Shaanxi, China.
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Pearson Syndrome: A Retrospective Cohort Study from the Marrow Failure Study Group of A.I.E.O.P. (Associazione Italiana Emato-Oncologia Pediatrica). JIMD Rep 2015; 26:37-43. [PMID: 26238250 DOI: 10.1007/8904_2015_470] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/02/2015] [Accepted: 06/06/2015] [Indexed: 12/25/2022] Open
Abstract
Pearson syndrome (PS) is a very rare and often fatal multisystemic mitochondrial disorder involving the liver, kidney, pancreas, and hematopoietic and central nervous system. It is characterized principally by a transfusion-dependent anemia that usually improves over time, a tendency to develop severe infections, and a high mortality rate. We describe a group of 11 PS patients diagnosed in Italy in the period 1993-2014. The analysis of this reasonably sized cohort of patients contributes to the clinical profile of the disease and highlights a rough incidence of 1 case/million newborns. Furthermore, it seems that some biochemical parameters like increased serum alanine and urinary fumaric acid can help to address an early diagnosis.
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Chen XY, Zhao SY, Wang Y, Wang D, Dong CH, Yang Y, Wang ZH, Wu YM. A novel mitochondrial DNA deletion in a patient with Pearson syndrome and neonatal diabetes mellitus provides insight into disease etiology, severity and progression. Mitochondrial DNA A DNA Mapp Seq Anal 2015; 27:2492-5. [PMID: 26016877 DOI: 10.3109/19401736.2015.1033712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pearson syndrome (PS) is a rare, mitochondrial DNA (mtDNA) deletion disorder mainly affecting hematopoietic system and exocrine pancreas in early infancy, which is characterized by multi-organ involvement, variable manifestations and poor prognosis. Since the clinical complexity and uncertain outcome of PS, the ability to early diagnose and anticipate disease progression is of great clinical importance. We described a patient with severe anemia and hyperglycinemia at birth was diagnosed with neonatal diabetes mellitus, and later with PS. Genetic testing revealed that a novel mtDNA deletion existed in various non-invasive tissues from the patient. The disease course was monitored by mtDNA deletion heteroplasmy and mtDNA/nucleus DNA genome ratio in different tissues and at different time points, showing a potential genotype-phenotype correlation. Our findings suggest that for patient suspected for PS, it may be therapeutically important to first perform detailed mtDNA analysis on non-invasive tissues at the initial diagnosis and during disease progression.
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Affiliation(s)
- Xin-Yu Chen
- a Department of Biochemistry and Molecular Biology , Fourth Military Medical University , Xi'an , Shaanxi , China .,b Center for DNA Typing, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Si-Yu Zhao
- c Department of Neurology , Xi'an Children's Hospital , Xi'an , Shaanxi , China
| | - Yan Wang
- c Department of Neurology , Xi'an Children's Hospital , Xi'an , Shaanxi , China
| | - Dong Wang
- c Department of Neurology , Xi'an Children's Hospital , Xi'an , Shaanxi , China
| | - Chang-Hu Dong
- d Second Affiliated Hospital of Shaanxi College of Chinese Medicine , Xianyang , Shaanxi , China , and
| | - Ying Yang
- a Department of Biochemistry and Molecular Biology , Fourth Military Medical University , Xi'an , Shaanxi , China .,b Center for DNA Typing, Fourth Military Medical University , Xi'an , Shaanxi , China
| | - Zhi-Hua Wang
- e Department of Endocrinology and Metabolism , Xi'an Children's Hospital , Xi'an , Shaanxi , China
| | - Yuan-Ming Wu
- a Department of Biochemistry and Molecular Biology , Fourth Military Medical University , Xi'an , Shaanxi , China .,b Center for DNA Typing, Fourth Military Medical University , Xi'an , Shaanxi , China
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Broomfield A, Sweeney MG, Woodward CE, Fratter C, Morris AM, Leonard JV, Abulhoul L, Grunewald S, Clayton PT, Hanna MG, Poulton J, Rahman S. Paediatric single mitochondrial DNA deletion disorders: an overlapping spectrum of disease. J Inherit Metab Dis 2015; 38:445-57. [PMID: 25352051 PMCID: PMC4432108 DOI: 10.1007/s10545-014-9778-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 09/27/2014] [Accepted: 10/01/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Single large-scale mitochondrial DNA (mtDNA) deletions (SLSMDs) are amongst the most frequently diagnosed mtDNA disorders in childhood, yet their natural history remains poorly understood. We report the natural history of a large multicentre cohort of such children. METHODS We reviewed case notes from three different UK centres to determine the clinical course of 34 patients (16 female, 18 male) with childhood-onset mitochondrial disease caused by SLSMDs. Kaplan-Meier analysis was used to compare survival of patients presenting with haematological features (Pearson syndrome) and those with nonhaematological presentations. RESULTS The most frequent initial presentation was with isolated ptosis (16/34, 47%). Eleven (32%) patients presented with transfusion-dependent anaemia soon after birth and were diagnosed with Pearson syndrome, whilst ten were classified as having Kearns-Sayre syndrome, three as having progressive external ophthalmoplegia (PEO) and seven as having PEO-plus. Three patients did not conform to any specific mitochondrial syndrome. The most frequently affected organ during the disease course was the kidney, with documented tubular or glomerular dysfunction in 17 of 20 (85%) cases who had detailed investigations. SLSMDs were present in blood and/or urine cells in all cases tested, indicating that muscle biopsy is not necessary for diagnosis in the paediatric age range. Kaplan-Meier survival analysis revealed significantly worse mortality in patients with Pearson syndrome compared with the rest of the cohort. CONCLUSIONS Mitochondrial disease caused by SLSMDs is clinically heterogeneous, and not all cases conform to a classical mitochondrial syndrome. Multisystem disease is the norm, with anaemia, renal impairment and endocrine disturbance being the most frequent extraneurological features. SLSMDs should be considered in the differential diagnosis of all children presenting with ptosis.
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Affiliation(s)
- Alexander Broomfield
- Genetic Medicine, Central Manchester University Hospitals NHS Foundation trust, St Mary’s Hospital, 6th Floor, Oxford Road, Manchester, M 13 9WL UK
| | - Mary G. Sweeney
- Neurogenetics Unit, National Hospital for Neurology & Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Cathy E. Woodward
- Neurogenetics Unit, National Hospital for Neurology & Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Carl Fratter
- Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Trust, The Churchill Hospital, Oxford, OX3 7LE UK
| | - Andrew M. Morris
- Genetic Medicine, Central Manchester University Hospitals NHS Foundation trust, St Mary’s Hospital, 6th Floor, Oxford Road, Manchester, M 13 9WL UK
| | | | - Lara Abulhoul
- Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, Institute of Child Health, Great Ormond Street, London, WC1N 3JH UK
| | - Stephanie Grunewald
- Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, Institute of Child Health, Great Ormond Street, London, WC1N 3JH UK
- Genetics and Genomic Medicine, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Peter T. Clayton
- Genetics and Genomic Medicine, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - Michael G. Hanna
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Joanna Poulton
- NDOG, Level 3, Women’s Centre, John Radcliffe Hospital, Oxford, Oxfordshire OX3 9DU UK
| | - Shamima Rahman
- Metabolic Unit, Great Ormond Street Hospital NHS Foundation Trust, Institute of Child Health, Great Ormond Street, London, WC1N 3JH UK
- Genetics and Genomic Medicine, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
- Mitochondrial Research Group, Genetics and Genomic Medicine, UCL Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
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37
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Diagnostic approach in infants and children with mitochondrial diseases. Pediatr Neonatol 2015; 56:7-18. [PMID: 25151629 DOI: 10.1016/j.pedneo.2014.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/27/2014] [Indexed: 01/06/2023] Open
Abstract
Mitochondrial diseases are a heterogeneous group of disorders affecting energy production in the human body. The diagnosis of mitochondrial diseases represents a challenge to clinicians, especially for pediatric cases, which show enormous variation in clinical presentations, as well as biochemical and genetic complexity. Different consensus diagnostic criteria for mitochondrial diseases in infants and children are available. The lack of standardized diagnostic criteria poses difficulties in evaluating diagnostic methodologies. Even though there are many diagnostic tools, none of them are sensitive enough to make a confirmative diagnosis without being used in combination with other tools. The current approach to diagnosing and classifying mitochondrial diseases incorporates clinical, biochemical, neuroradiological findings, and histological criteria, as well as DNA-based molecular diagnostic testing. The confirmation or exclusion of mitochondrial diseases remains a challenge in clinical practice, especially in cases with nonspecific clinical phenotypes. Therefore, follow-up evolution of clinical symptoms/signs and biochemical data is crucial. The purpose of this study is to review the molecular classification scheme and associated phenotypes in infants and children with mitochondrial diseases, in addition to providing an overview of the basic biochemical reactions and genetic characteristics in the mitochondrion, clinical manifestations, and diagnostic methods. A diagnostic algorithm for identifying mitochondrial disorders in pediatric neurology patients is proposed.
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38
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Pinto M, Moraes CT. Mitochondrial genome changes and neurodegenerative diseases. Biochim Biophys Acta Mol Basis Dis 2013; 1842:1198-207. [PMID: 24252612 DOI: 10.1016/j.bbadis.2013.11.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/06/2013] [Accepted: 11/08/2013] [Indexed: 12/12/2022]
Abstract
Mitochondria are essential organelles within the cell where most of the energy production occurs by the oxidative phosphorylation system (OXPHOS). Critical components of the OXPHOS are encoded by the mitochondrial DNA (mtDNA) and therefore, mutations involving this genome can be deleterious to the cell. Post-mitotic tissues, such as muscle and brain, are most sensitive to mtDNA changes, due to their high energy requirements and non-proliferative status. It has been proposed that mtDNA biological features and location make it vulnerable to mutations, which accumulate over time. However, although the role of mtDNA damage has been conclusively connected to neuronal impairment in mitochondrial diseases, its role in age-related neurodegenerative diseases remains speculative. Here we review the pathophysiology of mtDNA mutations leading to neurodegeneration and discuss the insights obtained by studying mouse models of mtDNA dysfunction.
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Affiliation(s)
- Milena Pinto
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Cell Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Carlos T Moraes
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Neuroscience Graduate Program, University of Miami Miller School of Medicine, Miami, FL 33136, USA; Department of Cell Biology, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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39
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Scheibye-Knudsen M, Croteau DL, Bohr VA. Mitochondrial deficiency in Cockayne syndrome. Mech Ageing Dev 2013; 134:275-83. [PMID: 23435289 PMCID: PMC3663877 DOI: 10.1016/j.mad.2013.02.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/24/2013] [Accepted: 02/08/2013] [Indexed: 01/05/2023]
Abstract
Cockayne syndrome is a rare inherited disorder characterized by accelerated aging, cachectic dwarfism and many other features. Recent work has implicated mitochondrial dysfunction in the pathogenesis of this disease. This is particularly interesting since mitochondrial deficiencies are believed to be important in the aging process. In this review, we discuss recent findings of mitochondrial pathology in Cockayne syndrome and suggest possible mechanisms for the mitochondrial dysfunction.
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Affiliation(s)
| | - Deborah L. Croteau
- Laboratory of Molecular Gerontology, National Institute on Aging, NIH, USA
| | - Vilhelm A. Bohr
- Laboratory of Molecular Gerontology, National Institute on Aging, NIH, USA
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40
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Abstract
The mitochondrial DNA (mtDNA) is a compact genome inherited through the maternal lineage. Mutations in mtDNA lead to many of the earliest identified syndromic mitochondrial diseases and display a diverse range of age of onset, symptoms, and outcomes-from isolated childhood onset vision or hearing loss to a multisystemic neurodegenerative disorder with strokes, neuropathy, ophthalmoparesis, and epilepsy beginning at any age. As a heterogeneous group, mitochondrial diseases represent one of the most common metabolic disorders in children and adults, frequently seen by both pediatric and adult specialists. Although the myriad of diseases can make diagnosis seems daunting, the need for extensive supportive care and treatment (the latter for at least a select few mitochondrial disorders) and a rapid and accurate recognition of these disorders is necessary. Here, we provide a review of the most common mitochondrial disease syndromes due to mtDNA mutations.
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Affiliation(s)
- Suzanne Debrosse
- Center for Human Genetics, University Hospitals, Case Medical Center, Cleveland, OH 44195, USA
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41
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Pitceathly R, Rahman S, Hanna M. Single deletions in mitochondrial DNA – Molecular mechanisms and disease phenotypes in clinical practice. Neuromuscul Disord 2012; 22:577-86. [DOI: 10.1016/j.nmd.2012.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 02/26/2012] [Accepted: 03/21/2012] [Indexed: 12/20/2022]
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42
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Finsterer J, Zarrouk Mahjoub S. Leukoencephalopathies in Mitochondrial Disorders: Clinical and MRI Findings. J Neuroimaging 2012; 22:e1-11. [DOI: 10.1111/j.1552-6569.2011.00693.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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43
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Finsterer J. Inherited Mitochondrial Disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 942:187-213. [DOI: 10.1007/978-94-007-2869-1_8] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Nogueira C, Carrozzo R, Vilarinho L, Santorelli FM. Infantile-onset disorders of mitochondrial replication and protein synthesis. J Child Neurol 2011; 26:866-75. [PMID: 21572058 DOI: 10.1177/0883073811402072] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Most inherited mitochondrial diseases in infants result from mutations in nuclear genes encoding proteins with specific functions targeted to the mitochondria rather than primary mutations in the mitochondrial DNA (mtDNA) itself. In the past decade, a growing number of syndromes associated with dysfunction resulting from tissue-specific depletion of mtDNA have been reported in infants. MtDNA depletion syndrome is transmitted as an autosomal recessive trait and causes respiratory chain dysfunction with prominent neurological, muscular, and hepatic involvement. Mendelian diseases characterized by defective mitochondrial protein synthesis and combined respiratory chain defects have also been described in infants and are associated with mutations in nuclear genes that encode components of the translational machinery. In the present work, we reviewed current knowledge of clinical phenotypes, their relative frequency, spectrum of mutations, and possible pathogenic mechanisms responsible for infantile disorders of oxidative metabolism involved in correct mtDNA maintenance and protein production.
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Affiliation(s)
- Célia Nogueira
- Department of Genetics, Centro de Genética Médica Jacinto de Magalhães/INSA, Porto, Portugal
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45
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A Tunisian patient with Pearson syndrome harboring the 4.977 kb common deletion associated to two novel large-scale mitochondrial deletions. Biochem Biophys Res Commun 2011; 411:381-6. [DOI: 10.1016/j.bbrc.2011.06.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Accepted: 06/24/2011] [Indexed: 11/23/2022]
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46
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Mazunin IO, Volodko NV, Starikovskaya EB, Sukernik RI. Mitochondrial genome and human mitochondrial diseases. Mol Biol 2010. [DOI: 10.1134/s0026893310050018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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47
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Abstract
Pearson syndrome is a multiorgan mitochondrial cytopathy that results from defective oxidative phosphorylation owing to mitochondrial DNA deletions. Prognosis is severe and death occurs in infancy or early childhood. This article describes 2 cases with a severe neonatal onset of the disease. A review of the literature reveals the atypical presentation of the disease in the neonatal period, which is often overlooked and underdiagnosed.
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48
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Collin-Ducasse H, Maillotte AM, Monpoux F, Boutté P, Ferrero-Vacher C, Paquis V. [Neonatal Pearson syndrome. two case studies]. Arch Pediatr 2009; 17:38-41. [PMID: 19914050 DOI: 10.1016/j.arcped.2009.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/10/2009] [Accepted: 10/06/2009] [Indexed: 11/18/2022]
Abstract
Among the etiologies of anemia in the newborn, those related to mitochondrial cytopathies are rare. Pearson syndrome is mostly diagnosed during infancy and characterized by refractory sideroblastic anemia with vacuolization of marrow progenitor cells and exocrine pancreatic dysfunction. We describe two diagnosed cases of Pearson syndrome in the early neonatal period caused by severe macrocytic aregenerative anemia. Bone marrow aspiration revealed sideroblastic anemia and vacuolization of erythroblastic precursors. The diagnosis was confirmed by genetic analysis revealing a deletion in the mitochondrial DNA. These two newborns received monthly transfusions. Five other newborns suffering from Pearson syndrome with various clinical symptoms were found in literature. Pearson syndrome, rarely diagnosed in newborns, should be suspected in the presence of macrocytic aregenerative anemia and requires a bone marrow aspirate followed by a genetic analysis from a blood sample.
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MESH Headings
- Anemia, Macrocytic/genetics
- Anemia, Macrocytic/pathology
- Anemia, Neonatal/genetics
- Anemia, Neonatal/pathology
- Anemia, Sideroblastic/genetics
- Anemia, Sideroblastic/pathology
- Biopsy, Needle
- Bone Marrow/pathology
- Consanguinity
- DNA Mutational Analysis
- DNA, Mitochondrial/genetics
- Diagnosis, Differential
- Female
- Humans
- Infant, Newborn
- Syndrome
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Affiliation(s)
- H Collin-Ducasse
- Pôle de pédiatrie, hôpital de l'Archet II, 151, route de Saint-Antoine-de-Ginestière, 06202 Nice cedex 3, France.
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Abstract
Mitochondrial disorders (MIDs) are an increasingly recognized condition. The second most frequently affected organ in MIDs is the central nervous system. One of the most prevalent clinical CNS manifestations of MIDs is ataxia. Ataxia may be even the dominant manifestation of a MID. This is why certain MIDs should be included in the classification of heredoataxias or at least considered as differentials of classical heredoataxias. MIDs due to mutations of the mitochondrial DNA, which develop ataxia include the MERRF, NARP, MILS, or KSS syndrome. More rarely, ataxia may be a feature of MELAS, LHON, PS, MIDD, or MSL. MIDs due to mutations of the nuclear DNA, which develop ataxia include LS, SANDO, SCAE, AHS, XSLA/A, IOSCA, MIRAS, MEMSA, or LBSL syndrome. More rarely ataxia can be found in AD-CPEO, AR-CPEO, MNGIE, DIDMOAD, CoQ-deficiency, ADOAD, DCMA, or PDC-deficiency. MIDs most frequently associated with ataxia are the non-syndromic MIDs. Syndromic and non-syndromic MIDs with ataxia should be delineated from classical heredoataxias to initiate appropriate symptomatic or supportive treatment.
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50
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