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Baltă G, Cristache G, Barac AD, Anton N, Barac IR. Leber's Hereditary Optic Neuropathy (LHON): Clinical Experience and Outcomes after Long-Term Idebenone Treatment. Life (Basel) 2023; 13:2000. [PMID: 37895381 PMCID: PMC10608457 DOI: 10.3390/life13102000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Leber's hereditary optic neuropathy (LHON) is a rare disease. Large studies are difficult to conduct; therefore, case reports provide valuable data. Since 2015, patients have been treated with Idebenone. The aim of this paper is to share our experience with diagnosing and managing patients in different stages of LHON. METHODS We designed a case series study, including four patients undergoing genetic testing and ophthalmologic examination. Criteria for Idebenone administration and follow-up were presented. RESULTS All patients had mutation 11778G>A in MT-ND4. The first patient, an 82-year-old man, with long history of vision loss, had no indication for Idebenone. Two additional cases emerged within the same family: a 40-year-old brother and a 31-year-old sister. Both received Idebenone, with good outcomes only for the female. After a one-year regimen, they were lost to follow-up. The fourth patient, a 46-year-old man, was diagnosed in the subacute stage. Idebenone administration was deferred, allowing progression of visual field defects. After 17 months of treatment, visual improvement appeared. The treatment was continued for 36 months, with short interruptions, resulting in good outcomes. CONCLUSIONS Our study demonstrated positive results with long-term Idebenone use. Contrary to medical literature, our female patient had a favorable evolution, despite the delayed diagnosis.
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Affiliation(s)
- George Baltă
- Doctoral School, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania;
| | - Georgiana Cristache
- Doctoral School, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania;
| | - Andreea Diana Barac
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania;
| | - Nicoleta Anton
- Department of Ophthalmology, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, 700115 Iasi, Romania;
| | - Ileana Ramona Barac
- Department of Ophthalmology, University of Medicine and Pharmacy “Carol Davila” Bucharest, 050474 Bucharest, Romania;
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Shamsnajafabadi H, MacLaren RE, Cehajic-Kapetanovic J. Current and Future Landscape in Genetic Therapies for Leber Hereditary Optic Neuropathy. Cells 2023; 12:2013. [PMID: 37566092 PMCID: PMC10416882 DOI: 10.3390/cells12152013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
Leber hereditary optic neuropathy (LHON) is the most common primary mitochondrial genetic disease that causes blindness in young adults. Over 50 inherited mitochondrial DNA (mtDNA) variations are associated with LHON; however, more than 95% of cases are caused by one of three missense variations (m.11778 G > A, m.3460 G > A, and m.14484 T > C) encoding for subunits ND4, ND1, and ND6 of the respiration complex I, respectively. These variants remain silent until further and currently poorly understood genetic and environmental factors precipitate the visual loss. The clinical course that ensues is variable, and a convincing treatment for LHON has yet to emerge. In 2015, an antioxidant idebenone (Raxone) received European marketing authorisation to treat visual impairment in patients with LHON, and since then it was introduced into clinical practice in several European countries. Alternative therapeutic strategies, including gene therapy and gene editing, antioxidant and neurotrophic agents, mitochondrial biogenesis, mitochondrial replacement, and stem cell therapies are being investigated in how effective they might be in altering the course of the disease. Allotopic gene therapies are in the most advanced stage of development (phase III clinical trials) whilst most other agents are in phase I or II trials or at pre-clinical stages. This manuscript discusses the phenotype and genotype of the LHON disease with complexities and peculiarities such as incomplete penetrance and gender bias, which have challenged the therapies in development emphasising the most recent use of gene therapy. Furthermore, we review the latest results of the three clinical trials based on adeno-associated viral (AAV) vector-mediated delivery of NADH dehydrogenase subunit 4 (ND4) with mitochondrial targeting sequence, highlighting the differences in the vector design and the rationale behind their use in the allotopic transfer.
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Affiliation(s)
- Hoda Shamsnajafabadi
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, Oxford University, Oxford OX3 9DU, UK
| | - Robert E. MacLaren
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, Oxford University, Oxford OX3 9DU, UK
- Oxford Eye Hospital, Oxford University NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Jasmina Cehajic-Kapetanovic
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, Oxford University, Oxford OX3 9DU, UK
- Oxford Eye Hospital, Oxford University NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Charif M, Bris C, Goudenège D, Desquiret-Dumas V, Colin E, Ziegler A, Procaccio V, Reynier P, Bonneau D, Lenaers G, Amati-Bonneau P. Use of Next-Generation Sequencing for the Molecular Diagnosis of 1,102 Patients With a Autosomal Optic Neuropathy. Front Neurol 2021; 12:602979. [PMID: 33841295 PMCID: PMC8027346 DOI: 10.3389/fneur.2021.602979] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
Advances in next-generation sequencing (NGS) facilitate the diagnosis of genetic disorders. To evaluate its use for the molecular diagnosis of inherited optic neuropathy (ION), a blinding disease caused by the degeneration of retinal ganglion cells, we performed genetic analysis using targeted NGS of 22 already known and candidate genes in a cohort of 1,102 affected individuals. The panel design, library preparation, and sequencing reactions were performed using the Ion AmpliSeq technology. Pathogenic variants were detected in 16 genes in 245 patients (22%), including 186 (17%) and 59 (5%) dominant and recessive cases, respectively. Results confirmed that OPA1 variants are responsible for the majority of dominant IONs, whereas ACO2 and WFS1 variants are also frequently involved in both dominant and recessive forms of ION. All pathogenic variants were found in genes encoding proteins involved in the mitochondrial function, highlighting the importance of mitochondria in the survival of retinal ganglion cells.
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Affiliation(s)
- Majida Charif
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Genetics and Immuno-Cell Therapy Team, Mohammed First University, Oujda, Morocco
| | - Céline Bris
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
| | - David Goudenège
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
| | - Valérie Desquiret-Dumas
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
| | - Estelle Colin
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
| | - Alban Ziegler
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
| | - Vincent Procaccio
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
| | - Pascal Reynier
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
| | - Dominique Bonneau
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
| | - Guy Lenaers
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France
| | - Patrizia Amati-Bonneau
- University Angers, MitoLab team, UMR CNRS 6015-INSERM U1083, Unité MitoVasc, SFR ICAT, Angers, France.,Departments of Biochemistry and Genetics, University Hospital Angers, Angers, France
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Zhang Y, Tian Z, Yuan J, Liu C, Liu HL, Ma SQ, Li B. The Progress of Gene Therapy for Leber's Optic Hereditary Neuropathy. Curr Gene Ther 2019; 17:320-326. [PMID: 29189152 PMCID: PMC5902861 DOI: 10.2174/1566523218666171129204926] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/16/2017] [Accepted: 11/20/2017] [Indexed: 11/26/2022]
Abstract
Introduction: Leber’s Optic Hereditary Neuropathy (LHON) is a common cause of teenaged blindness in both eyes for which there is currently no effective treatment. In 1871, the German ophthal-mologist Theodor Leber was the first to describe the clinical characteristics of his namesake disease, and through unremitting efforts over the past 100 years, researchers have continued to increase their under-standing of LHON. In recent years, using gene therapy, several groups have obtained breakthroughs in the treatment of the disease. Conclusion: In this article, we will review the challenging journey that researchers faced towards our current understanding of LHON, and describe the transition of gene therapy research for LHON from the bench to bedside.
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Affiliation(s)
- Yong Zhang
- Department of Ophthalmology Shiyan, Hubei University of Medicine - Taihe Hospital, Hubei. China
| | - Zhen Tian
- Department of Ophthalmology Shiyan, Hubei University of Medicine - Taihe Hospital, Hubei. China
| | - Jiajia Yuan
- Department of Ophthalmology, Tongji Medical College, Huazhong University of Science and Technology - Tongji Hospital, Wuhan Shi. China
| | - Chang Liu
- Department of Ophthalmology, Tongji Medical College, Huazhong University of Science and Technology - Tongji Hospital, Wuhan Shi. China
| | - Hong Li Liu
- Department of Ophthalmology, Tongji Medical College, Huazhong University of Science and Technology - Tongji Hospital, Wuhan Shi. China
| | - Si Qi Ma
- Department of Ophthalmology, Tongji Medical College, Huazhong University of Science and Technology - Tongji Hospital, Wuhan Shi. China
| | - Bin Li
- Department of Ophthalmology Shiyan, Hubei University of Medicine - Taihe Hospital, Hubei. China
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MRI of the Optic Nerves and Chiasm in Patients With Leber Hereditary Optic Neuropathy. J Neuroophthalmol 2018; 38:434-437. [DOI: 10.1097/wno.0000000000000621] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Finsterer J, Zarrouk-Mahjoub S. Leber's hereditary optic neuropathy is multiorgan not mono-organ. Clin Ophthalmol 2016; 10:2187-2190. [PMID: 27843288 PMCID: PMC5098596 DOI: 10.2147/opth.s120197] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Leber's hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disorder with bilateral loss of central vision primarily due to mitochondrial DNA (mtDNA) mutations in subunits of complex I in the respiratory chain (primary LHON mutations), while other mtDNA mutations can also be causative. Since the first description, it is known that LHON is not restricted to the eyes but is a multisystem disorder additionally involving the central nervous system, ears, endocrinological organs, heart, bone marrow, arteries, kidneys, or the peripheral nervous system. Multisystem involvement may start before or after the onset of visual impairment. Involvement of organs other than the eyes may be subclinical depending on age, ethnicity, and possibly the heteroplasmy rate of the responsible primary LHON mutation. Primary LHON mutations may rarely manifest without ocular compromise but with arterial hypertension, various neurodegenerative diseases, or Leigh syndrome. Patients with LHON need to be closely followed up to detect at which point organs other than the eyes become affected. Multiorgan disease in LHON often responds more favorably to symptomatic treatment than the ocular compromise.
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Santos-Bueso E, Asorey-García A, Porta-Etessam J, Vinuesa-Silva JM, García-Sánchez J. [Debut of Leber's hereditary optic neuropathy. Macular segmentation analysis using optical coherence tomography]. ACTA ACUST UNITED AC 2014; 90:233-6. [PMID: 25443199 DOI: 10.1016/j.oftal.2014.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/23/2014] [Accepted: 04/08/2014] [Indexed: 12/01/2022]
Abstract
CASE REPORT Two clinical cases are presented of two family relatives newly diagnosed with Leber hereditary optic neuropathy (LHON) and G11778A mutation analysis by optical coherence tomography (Cirrus HD-OCT, Carl Zeiss Meditec, Dublin, California, USA) layer peripapillary fibers retina (RNFL) and ganglion cell and internal plexiform layers (GCL/IPL) using macular segmentation. DISCUSSION The analysis of the macula by OCT segmentation (version 6.0 Cirrus OCT) allows the GCL/IPL to be evaluated without the interindividual variability of peripapillary RNFL distribution or the presence of edema of the optic disc. When an analysis of the peripapillary RNFL, it does not provide information on this neuronal damage, which itself is evidence in the study of GCL/IPL.
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Affiliation(s)
- E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España. RETICS, Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa, Patología ocular del envejecimiento, calidad visual y calidad de vida, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - A Asorey-García
- Unidad de Neurooftalmología, Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España. RETICS, Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa, Patología ocular del envejecimiento, calidad visual y calidad de vida, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J Porta-Etessam
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - J M Vinuesa-Silva
- Cátedra de Oftalmología, Universidad de Salamanca, Salamanca, España
| | - J García-Sánchez
- Unidad de Neurooftalmología, Servicio de Oftalmología, Hospital Clínico San Carlos, Madrid, España. RETICS, Instituto de Salud Carlos III, Red Temática de Investigación Cooperativa, Patología ocular del envejecimiento, calidad visual y calidad de vida, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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