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Cunha AM, Vilares-Morgado R, Moleiro AF, Falcão-Reis F, Faria O. Childhood-Onset Leber Hereditary Optic Neuropathy: Particular Features. Int Med Case Rep J 2021; 14:163-169. [PMID: 33737839 PMCID: PMC7966410 DOI: 10.2147/imcrj.s303460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/16/2021] [Indexed: 11/23/2022] Open
Abstract
Background Leber hereditary optic neuropathy (LHON) is an optic neuropathy of mitochondrial inheritance. Childhood-onset disease is relatively rare and there are limited data on this important patient subgroup. Case Presentation We present 3 particular presentations of LHON. Patient 1 was an 8-year-old boy admitted to the emergency department reporting a progressive bilateral visual loss and intermittent headaches. Neuro-ophthalmological examination revealed a bilateral pseudopapilledema. Lumbar puncture identified intracranial hypertension and the brain and orbits magnetic resonance imaging showed T2 hyperintensity in the posterior region of the left optic nerve and the optic chiasm. Patient 2 was a 12-year-old boy admitted to the emergency department reporting painless, progressive central vision loss in the right eye. Fundus examination revealed a hyperemic disc and vascular network papillary and peripapillary vascular microdilations. Three months later, the left eye presented visual loss. Patient 3 was a 6-year-old female child referred to the neuro-ophthalmology specialist due to painless central visual loss in both eyes. Her BCVA was 1/10 and counting fingers in right and left eye, respectively, and fundus examination revealed a pallor optic disc in the temporal sector. Discussion The phenotype of childhood-onset disease may present itself distinct from classical adult-onset LHON. The absence of classical clinical features could lead to initial misdiagnosis. There should exist a high index of suspicion in children presenting unexplained subnormal vision in order to avoid potential diagnostic delays.
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Affiliation(s)
- Ana Maria Cunha
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Ana Filipa Moleiro
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Olinda Faria
- Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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Piotrowska-Nowak A, Krawczyński MR, Kosior-Jarecka E, Ambroziak AM, Korwin M, Ołdak M, Tońska K, Bartnik E. Mitochondrial genome variation in male LHON patients with the m.11778G > A mutation. Metab Brain Dis 2020; 35:1317-1327. [PMID: 32740724 PMCID: PMC7584531 DOI: 10.1007/s11011-020-00605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Abstract
Leber hereditary optic neuropathy (LHON) is a mitochondrial disorder with symptoms limited to a single tissue, optic nerve, resulting in vision loss. In the majority of cases it is caused by one of three point mutations in mitochondrial DNA (mtDNA) but their presence is not sufficient for disease development, since ~50% of men and ~10% women who carry them are affected. Thus additional modifying factors must exist. In this study, we use next generation sequencing to investigate the role of whole mtDNA variation in male Polish patients with LHON and m.11778G > A, the most frequent LHON mutation. We present a possible association between mtDNA haplogroup K and variants in its background, a combination of m.3480A > G, m.9055G > A, m.11299 T > C and m.14167C > T, and LHON mutation. These variants may have a negative effect on m.11778G > A increasing its penetrance and the risk of LHON in the Polish population. Surprisingly, we did not observe associations previously reported for m.11778G > A and LHON in European populations, particularly for haplogroup J as a risk factor, implying that mtDNA variation is much more complex. Our results indicate possible contribution of novel combination of mtDNA genetic factors to the LHON phenotype.
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Affiliation(s)
- Agnieszka Piotrowska-Nowak
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 5a Pawińskiego Street, 02-106 Warsaw, Poland
| | - Maciej R. Krawczyński
- Department of Medical Genetics, Poznań University of Medical Sciences, 8 Rokietnicka Street, 60-806 Poznań, Poland
- Centers for Medical Genetics GENESIS, 4 Grudzieniec Street, 60-601 Poznań, Poland
| | - Ewa Kosior-Jarecka
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 1 Chmielna Street, 20-079 Lublin, Poland
| | - Anna M. Ambroziak
- Faculty of Physics, University of Warsaw, 5 Pasteur Street, 02-093 Warsaw, Poland
| | - Magdalena Korwin
- Department of Ophthalmology, Medical University of Warsaw, 13 Sierakowskiego Street, 03-709 Warsaw, Poland
| | - Monika Ołdak
- Department of Genetics, Institute of Physiology and Pathology of Hearing, 10 Mochnackiego Street, 02-042 Warsaw, Poland
- Department of Histology and Embryology, Center of Biostructure Research, Medical University of Warsaw, 5 Chałubińskiego Street, 02-004 Warsaw, Poland
| | - Katarzyna Tońska
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 5a Pawińskiego Street, 02-106 Warsaw, Poland
| | - Ewa Bartnik
- Institute of Genetics and Biotechnology, Faculty of Biology, University of Warsaw, 5a Pawińskiego Street, 02-106 Warsaw, Poland
- Institute of Biochemistry and Biophysics Polish Academy of Sciences, 5a Pawińskiego Street, 02-106 Warsaw, Poland
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Varricchio C, Beirne K, Aeschlimann P, Heard C, Rozanowska M, Votruba M, Brancale A. Discovery of Novel 2-Aniline-1,4-naphthoquinones as Potential New Drug Treatment for Leber's Hereditary Optic Neuropathy (LHON). J Med Chem 2020; 63:13638-13655. [PMID: 33180495 DOI: 10.1021/acs.jmedchem.0c00942] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Leber's hereditary optic neuropathy (LHON) is a rare genetic mitochondrial disease and the primary cause of chronic visual impairment for at least 1 in 10 000 individuals in the U.K. Treatment options remain limited, with only a few drug candidates and therapeutic approaches, either approved or in development. Recently, idebenone has been investigated as drug therapy in the treatment of LHON, although evidence for the efficacy of idebenone is limited in the literature. NAD(P)H:quinone oxidoreductase 1 (NQO1) and mitochondrial complex III were identified as the major enzymes involved in idebenone activity. Based on this mode of action, computer-aided techniques and structure-activity relationship (SAR) optimization studies led to the discovery of a series naphthoquinone-related small molecules, with comparable adenosine 5'-triphosphate (ATP) rescue activity to idebenone. Among these, three compounds showed activity in the nanomolar range and one, 2-((4-fluoro-3-(trifluoromethyl)phenyl)amino)-3-(methylthio)naphthalene-1,3-dione (1), demonstrated significantly higher potency ex vivo, and significantly lower cytotoxicity, than idebenone.
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Affiliation(s)
- Carmine Varricchio
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K.,School of Optometry and Vision Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K
| | - Kathy Beirne
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K
| | - Pascale Aeschlimann
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K.,School of Optometry and Vision Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K
| | - Charles Heard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K
| | - Malgorzata Rozanowska
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K
| | - Marcela Votruba
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K.,Cardiff Eye Unit, University Hospital of Wales, Heath Park, Cardiff CF24 4LU, Wales, U.K
| | - Andrea Brancale
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, Wales, U.K
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Park YJ, Lim HT. A Case of Leber Hereditary Optic Neuropathy Showing Optic Disc Hyperfluorescence. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2019. [DOI: 10.3341/jkos.2019.60.1.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yu Jeong Park
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ciron J, Baron C, Boissonnot M, Neau JP, Magdelaine C, Vallat JM, Mathis S. Peripheral nervous system involvement in Leber's hereditary optic neuropathy. J Neurol Sci 2018; 388:94-96. [DOI: 10.1016/j.jns.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/07/2018] [Accepted: 03/01/2018] [Indexed: 11/17/2022]
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Abstract
SIGNIFICANCE We identified a missense mutation, m.11778G>A (p.R340H), in the mitochondrially encoded NADH dehydrogenase 4 gene (ND4) in eight patients and three asymptomatic carriers, even though the incidence of this has been considered low in Chinese population. These results have implications for the families' genetic counseling and clinical management. PURPOSE Leber hereditary optic neuropathy (LHON OMIM 535000) is one of the most common inherited optic neuropathies. The aim of this study was to identify the genetic cause in two Han Chinese families with LHON. METHODS We used Sanger sequencing to identify the genetic cause of two Han Chinese families from Hunan, China, with LHON. RESULTS The patients in these two families presented with typical LHON, with male patients experiencing more severe phenotypes. A missense mutation, m.11778G>A (p.R340H), in the ND4 gene was identified in eight patients and three asymptomatic carriers, even though the incidence of this has been considered low in Chinese population. CONCLUSIONS Eight of 11 family members (72.7%) manifested some vision loss, which is far higher percentage than reported in other studies. The variant is predicted to be the disease-causing mutation and results in seriously abnormal function of complex I subunits of the mitochondrial respiratory chain. These results have implications for the families' genetic counseling and clinical management and help to develop new LHON target-gene therapy strategies.
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Mother's curse neutralizes natural selection against a human genetic disease over three centuries. Nat Ecol Evol 2017; 1:1400-1406. [PMID: 29046555 DOI: 10.1038/s41559-017-0276-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 06/06/2017] [Indexed: 12/30/2022]
Abstract
According to evolutionary theory, mitochondria could be poisoned gifts that mothers transmit to their sons. This is because mutations harmful to males are expected to accumulate in the mitochondrial genome, the so-called 'mother's curse'. However, the contribution of the mother's curse to the mutation load in nature remains largely unknown and hard to predict, because compensatory mechanisms could impede the spread of deleterious mitochondria. Here we provide evidence for the mother's curse in action over 290 years in a human population. We studied a mutation causing Leber's hereditary optical neuropathy, a disease with male-biased prevalence and which has long been suspected to be maintained in populations by the mother's curse. Male carriers showed a low fitness relative to non-carriers and to females, mostly explained by their high rate of infant mortality. Despite poor male fitness, selection analysis predicted a slight (albeit non-significant) increase in frequency, which sharply contrasts with the 35.5% per-generation decrease predicted if mitochondrial DNA transmission had been through males instead of females. Our results are therefore even suggestive of positive selection through the female line that may exacerbate effects of the mother's curse. This study supports a contribution of the mother's curse to the reduction of male lifespan, uncovering a large fitness effect associated with a single mitochondrial variant.
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Takayama K, Ito Y, Kaneko H, Kataoka K, Ra E, Terasaki H. Optical coherence tomography angiography in leber hereditary optic neuropathy. Acta Ophthalmol 2017; 95:e344-e345. [PMID: 27778481 DOI: 10.1111/aos.13244] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kei Takayama
- Department of Ophthalmology; Nagoya University Graduate School of Medicine; Nagoya City Japan
| | - Yasuki Ito
- Department of Ophthalmology; Nagoya University Graduate School of Medicine; Nagoya City Japan
| | - Hiroki Kaneko
- Department of Ophthalmology; Nagoya University Graduate School of Medicine; Nagoya City Japan
| | - Keiko Kataoka
- Department of Ophthalmology; Nagoya University Graduate School of Medicine; Nagoya City Japan
| | - Eimei Ra
- Department of Ophthalmology; Nagoya University Graduate School of Medicine; Nagoya City Japan
| | - Hiroko Terasaki
- Department of Ophthalmology; Nagoya University Graduate School of Medicine; Nagoya City Japan
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Genetic and Clinical Analyses of DOA and LHON in 304 Chinese Patients with Suspected Childhood-Onset Hereditary Optic Neuropathy. PLoS One 2017; 12:e0170090. [PMID: 28081242 PMCID: PMC5230780 DOI: 10.1371/journal.pone.0170090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/28/2016] [Indexed: 02/08/2023] Open
Abstract
Leber hereditary optic neuropathy (LHON) and dominant optic atrophy (DOA), the most common forms of hereditary optic neuropathy, are easily confused, and it is difficult to distinguish one from the other in the clinic, especially in young children. The present study was designed to survey the mutation spectrum of common pathogenic genes (OPA1, OPA3 and mtDNA genes) and to analyze the genotype-phenotype characteristics of Chinese patients with suspected childhood-onset hereditary optic neuropathy. Genomic DNA and clinical data were collected from 304 unrelated Chinese probands with suspected hereditary optic neuropathy with an age of onset below 14 years. Sanger sequencing was used to screen variants in the coding and adjacent regions of OPA1, OPA3 and the three primary LHON-related mutation sites in mitochondrial DNA (mtDNA) (m.3460G>A, m.11778G>A and m.14484T>C). All patients underwent a complete ophthalmic examination and were compared with age-matched controls. We identified 89/304 (29.3%) primary mtDNA mutations related to LHON in 304 probands, including 76 mutations at m.11778 (76/89, 85.4% of all mtDNA mutations), four at m.3460 (4/89, 4.5%) and nine at m.14484 (9/89, 10.1%). This result was similar to the mutation frequency among Chinese patients with LHON of any age. Screening of OPA1 revealed 23 pathogenic variants, including 11 novel and 12 known pathogenic mutations. This study expanded the OPA1 mutation spectrum, and our results showed that OPA1 mutation is another common cause of childhood-onset hereditary optic neuropathy in Chinese pediatric patients, especially those with disease onset during preschool age.
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Abstract
Leber hereditary optic neuropathy (LHON) was the first clinically characterized mitochondrial disorder. Since its first description in 1871, much has been discovered regarding the genetics and pathophysiology of the disease. This has enabled the development of in vitro cell and animal models that can be used to try to determine not only the effects of the genetic mutation upon the clinical phenotype but to also test potential novel therapies. Treatments for LHON have ranged from vitamins and minerals to immunosuppressants and, more recently, targeted gene therapy. This article reviews the pathophysiology and clinical features of LHON with a focus on translational research.
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Affiliation(s)
- Nailyn Rasool
- a Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , Massachusetts , USA
| | - Simmons Lessell
- a Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , Massachusetts , USA
| | - Dean M Cestari
- a Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston , Massachusetts , USA
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Mackey DA, Kearns LS, Hewitt AW. Gene-Based Therapies for Leber Hereditary Optic Neuropathy. Hype or Hope? Asia Pac J Ophthalmol (Phila) 2016; 5:253-5. [PMID: 27488066 DOI: 10.1097/apo.0000000000000220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Leber hereditary optic neuropathy has now joined Leber congenital amaurosis in the list of genetic eye diseases undergoing gene therapy clinical trials. Although a dramatic response to treatment would be welcome, a minor improvement in vision is a major challenge in efficacy assessment, given this may occur spontaneously as part of the natural history of minor recovery in some patients. Thus, we must await the outcome of adequately powered clinical trials to know if the treatment is effective, particularly given the likely high cost of such therapeutic interventions in the future. We need global cooperation to ensure that the most suitable patients are enrolled in these trials and that support is provided for participants who need to travel from the Asia-Pacific region to Europe or North America if there are no local arms of these trials.
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Affiliation(s)
- David A Mackey
- From the *Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth; †Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne; and ‡School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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