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Tomašić N, Kotarsky H, de Oliveira Figueiredo R, Hansson E, Mörgelin M, Tomašić I, Kallijärvi J, Elmér E, Jauhiainen M, Eklund EA, Fellman V. Fasting reveals largely intact systemic lipid mobilization mechanisms in respiratory chain complex III deficient mice. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165573. [PMID: 31672551 DOI: 10.1016/j.bbadis.2019.165573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 02/06/2023]
Abstract
Mice homozygous for the human GRACILE syndrome mutation (Bcs1lc.A232G) display decreased respiratory chain complex III activity, liver dysfunction, hypoglycemia, rapid loss of white adipose tissue and early death. To assess the underlying mechanism of the lipodystrophy in homozygous mice (Bcs1lp.S78G), these and wild-type control mice were subjected to a short 4-hour fast. The homozygotes had low baseline blood glucose values, but a similar decrease in response to fasting as in wild-type mice, resulting in hypoglycemia in the majority. Despite the already depleted glycogen and increased triacylglycerol content in the mutant livers, the mice responded to fasting by further depletion and increase, respectively. Increased plasma free fatty acids (FAs) upon fasting suggested normal capacity for mobilization of lipids from white adipose tissue into circulation. Strikingly, however, serum glycerol concentration was not increased concomitantly with free FAs, suggesting its rapid uptake into the liver and utilization for fuel or gluconeogenesis in the mutants. The mutant hepatocyte mitochondria were capable of responding to fasting by appropriate morphological changes, as analyzed by electron microscopy, and by increasing respiration. Mutants showed increased hepatic gene expression of major metabolic controllers typically associated with fasting response (Ppargc1a, Fgf21, Cd36) already in the fed state, suggesting a chronic starvation-like metabolic condition. Despite this, the mutant mice responded largely normally to fasting by increasing hepatic respiration and switching to FA utilization, indicating that the mechanisms driving these adaptations are not compromised by the CIII dysfunction. SUMMARY STATEMENT: Bcs1l mutant mice with severe CIII deficiency, energy deprivation and post-weaning lipolysis respond to fasting similarly to wild-type mice, suggesting largely normal systemic lipid mobilization and utilization mechanisms.
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Affiliation(s)
- Nikica Tomašić
- Lund University, Department of Clinical Sciences, Lund, Pediatrics, Lund, Sweden; Karolinska University Hospital, Department of Neonatology, Stockholm, Sweden; Faculty of Science, Department of Biology, University of Zagreb, Croatia.
| | - Heike Kotarsky
- Department of Pathology, Region Skåne, Lund University, Sweden
| | | | - Eva Hansson
- Lund University, Department of Clinical Sciences, Lund, Pediatrics, Lund, Sweden.
| | - Matthias Mörgelin
- Lund University, Department of Clinical Sciences, Lund, Lund, Sweden.
| | - Ivan Tomašić
- Mälardalen University, Division of Intelligent Future Technologies, Västerås, Sweden.
| | - Jukka Kallijärvi
- Folkhälsan Research Center, Helsinki, Finland; Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Eskil Elmér
- Department of Clinical Sciences, Lund, Mitochondrial Medicine, Lund University, Lund, Sweden.
| | - Matti Jauhiainen
- Minerva Foundation Institute for Medical Research, Biomedicum 2U, National Institute for Health and Welfare, Helsinki, Finland.
| | - Erik A Eklund
- Lund University, Department of Clinical Sciences, Lund, Pediatrics, Lund, Sweden.
| | - Vineta Fellman
- Lund University, Department of Clinical Sciences, Lund, Pediatrics, Lund, Sweden; Folkhälsan Research Center, Helsinki, Finland; Children's Hospital, University of Helsinki, Helsinki. Finland.
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Coughlin CR, Scharer GH, Friederich MW, Yu HC, Geiger EA, Creadon-Swindell G, Collins AE, Vanlander AV, Coster RV, Powell CA, Swanson MA, Minczuk M, Van Hove JLK, Shaikh TH. Mutations in the mitochondrial cysteinyl-tRNA synthase gene, CARS2, lead to a severe epileptic encephalopathy and complex movement disorder. J Med Genet 2015; 52:532-40. [PMID: 25787132 DOI: 10.1136/jmedgenet-2015-103049] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/26/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mitochondrial disease is often suspected in cases of severe epileptic encephalopathy especially when a complex movement disorder, liver involvement and progressive developmental regression are present. Although mutations in either mitochondrial DNA or POLG are often present, other nuclear defects in mitochondrial DNA replication and protein translation have been associated with a severe epileptic encephalopathy. METHODS AND RESULTS We identified a proband with an epileptic encephalopathy, complex movement disorder and a combined mitochondrial respiratory chain enzyme deficiency. The child presented with neurological regression, complex movement disorder and intractable seizures. A combined deficiency of mitochondrial complexes I, III and IV was noted in liver tissue, along with increased mitochondrial DNA content in skeletal muscle. Incomplete assembly of complex V, using blue native polyacrylamide gel electrophoretic analysis and complex I, using western blotting, suggested a disorder of mitochondrial transcription or translation. Exome sequencing identified compound heterozygous mutations in CARS2, a mitochondrial aminoacyl-tRNA synthetase. Both mutations affect highly conserved amino acids located within the functional ligase domain of the cysteinyl-tRNA synthase. A specific decrease in the amount of charged mt-tRNA(Cys) was detected in patient fibroblasts compared with controls. Retroviral transfection of the wild-type CARS2 into patient skin fibroblasts led to the correction of the incomplete assembly of complex V, providing functional evidence for the role of CARS2 mutations in disease aetiology. CONCLUSIONS Our findings indicate that mutations in CARS2 result in a mitochondrial translational defect as seen in individuals with mitochondrial epileptic encephalopathy.
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Affiliation(s)
- Curtis R Coughlin
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Gunter H Scharer
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA Intellectual and Developmental Disabilities Research Center, University of Colorado School of Medicine, Aurora, Colorado, USA Department of Pediatrics, Section of Clinical Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Marisa W Friederich
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hung-Chun Yu
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Elizabeth A Geiger
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Geralyn Creadon-Swindell
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Abigail E Collins
- Department of Pediatrics, Section of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Arnaud V Vanlander
- Department of Pediatrics, Division of Pediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | - Rudy Van Coster
- Department of Pediatrics, Division of Pediatric Neurology and Metabolism, Ghent University Hospital, Ghent, Belgium
| | | | - Michael A Swanson
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Johan L K Van Hove
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tamim H Shaikh
- Department of Pediatrics, Section of Genetics, University of Colorado School of Medicine, Aurora, Colorado, USA Intellectual and Developmental Disabilities Research Center, University of Colorado School of Medicine, Aurora, Colorado, USA
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Lee WS, Sokol RJ. Mitochondrial hepatopathies: advances in genetics, therapeutic approaches, and outcomes. J Pediatr 2013; 163:942-8. [PMID: 23810725 PMCID: PMC3934633 DOI: 10.1016/j.jpeds.2013.05.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/24/2013] [Accepted: 05/14/2013] [Indexed: 12/21/2022]
Affiliation(s)
- Way Seah Lee
- Department of Pediatrics, University of Malaya Medical Center, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
- Pediatrics and Child Health Research Group, University of Malaya, Kuala Lumpur, Malaysia, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Ronald J. Sokol
- Section of Pediatric Gastroenterology, Hepatology, and Nutrition and the Digestive Health Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
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Enkai S, Koinuma S, Ito R, Igaki J, Hasegawa Y, Murayama K, Ohtake A. Case of an infant with hepatic cirrhosis caused by mitochondrial respiratory chain disorder. Pediatr Int 2013; 55:e103-6. [PMID: 23910810 DOI: 10.1111/ped.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 01/17/2013] [Accepted: 02/19/2013] [Indexed: 11/27/2022]
Abstract
The patient had hepatomegaly with liver dysfunction at the age of 1 month. Magnetic resonance imaging performed at the age of 1 year showed multiple nodules of varying size in his liver. We were able to examine the mitochondrial respiratory chain function in the liver biopsy samples because all other differential diagnoses for hepatic cirrhosis had been ruled out. Complex I and IV activities were below the normal level (<30%) of the citrate synthase (CS) ratio. Liver blue native polyacrylamide gel electrophoresis showed an extremely weak complex I and IV band. Liver respiratory chain complexes I and IV were found to be deficient in this patient. The histologic findings were highly suggestive of mitochondrial respiratory chain disorder. Findings of progressive liver cirrhosis changes were observed in magnetic resonance imaging at the age of 5 years. An examination of the mitochondrial respiratory chain function should be performed along with a liver biopsy if mitochondrial respiratory chain disorder is suspected as a possible differential diagnosis of idiopathic hepatitis.
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Parikh S, Goldstein A, Koenig MK, Scaglia F, Enns GM, Saneto R, Anselm I, Collins A, Cohen BH, DeBrosse SD, Dimmock D, Falk MJ, Ganesh J, Greene C, Gropman AL, Haas R, Kahler SG, Kamholz J, Kendall F, Korson MS, Mattman A, Milone M, Niyazov D, Pearl PL, Reimschisel T, Salvarinova-Zivkovic R, Sims K, Tarnopolsky M, Tsao CY, van Hove J, Walsh L, Wolfe LA. Practice patterns of mitochondrial disease physicians in North America. Part 1: diagnostic and clinical challenges. Mitochondrion 2013; 14:26-33. [PMID: 23891656 DOI: 10.1016/j.mito.2013.07.116] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/10/2013] [Accepted: 07/18/2013] [Indexed: 11/24/2022]
Abstract
Mitochondrial medicine is a young subspecialty. Clinicians have a limited evidence base on which to formulate clinical decisions regarding diagnosis, treatment and patient management. Mitochondrial medicine specialists have cobbled together an informal set of rules and paradigms for preventive care and management based in part on anecdotal experience. The Mitochondrial Medicine Society (MMS) assessed the current state of clinical practice from diagnosis, to preventive care and treatment, as provided by various mitochondrial disease specialists in North America. We hope that by obtaining this information we can begin moving towards formulating a set of consensus criteria and establishing standards of care.
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Affiliation(s)
- Sumit Parikh
- Center for Child Neurology, Cleveland Clinic Children's Hospital, Cleveland, OH, United States.
| | - Amy Goldstein
- Division of Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Mary Kay Koenig
- Division of Child & Adolescent Neurology, University of Texas Medical School at Houston, Houston, TX, United States
| | - Fernando Scaglia
- Department of Molecular and Human Genetics, Baylor College of Medicine & Texas Children's Hospital, Houston, TX, United States
| | - Gregory M Enns
- Department of Pediatrics, Division of Medical Genetics, Stanford University Lucile Packard Children's Hospital, Palo Alto, CA, United States
| | - Russell Saneto
- Seattle Children's Hospital/University of Washington, Seattle, WA, United States
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Caietta E, Cano A, Halbert C, Hugonenq C, Mancini J, Milh M, Lépine A, Villeneuve N, Chaussenot A, Paquis-Flucklinger V, Chabrol B. [Epilepsy and mitochondrial diseases: retrospective study on 53 epileptic children]. Arch Pediatr 2012; 19:794-802. [PMID: 22789745 DOI: 10.1016/j.arcped.2012.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 04/06/2012] [Accepted: 05/22/2012] [Indexed: 11/28/2022]
Abstract
AIM Mitochondrial disease is a heterogeneous disorder entity induced by defects in the mitochondrial respiratory chain complex. Neurological symptoms, including epilepsy, are common in children. The aim of this study was to research the clinical signs indicating mitochondrial disease. METHODS We retrospectively studied epileptic children who underwent a muscle and/or hepatic biopsy between 1995 and 2010 searching for a mitochondrial disease. Patients were separated into 2 groups depending on the biopsy result: group 1 (presence of mitochondrial disease) and group 2 (absence of mitochondrial disease). Epileptic phenotypes were compared between these 2 groups. In group 1, we specified the clinical phenotype and characterized mitochondrial disease. RESULTS Fifty-three children were included: 29 in group 1 and 24 in group 2. The average age at onset of epilepsy was 39.6 months in group 1 versus 11.8 months in group 2. In the 1st group, epilepsy was less refractory and associated with other clinical symptoms. CONCLUSIONS In this study, epilepsy did not appear to be a unique sign of mitochondrial disease. It most often appeared during the 2nd year of life and is correlated with multiorgan involvement, notably ophthalmologic, such as oculomotor apraxia, optic atrophy, and retinitis pigmentosa, as well as auditory (deafness) and hepatic (hepatic failure, hepatomegaly). On the other hand, in children who did not have mitochondrial disease, epilepsy often began earlier (before 3 months of age), it was refractory, isolated without multiorgan involvement, and seems to be due to genetic anomalies in developmental genes, a finding that requires further research.
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Affiliation(s)
- E Caietta
- Service de neurologie pédiatrique et des maladies héréditaires du métabolisme, CHU La Timone, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France.
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Abstract
Mitochondrial disorders recognized in the neonatal period usually present as a metabolic crisis combined with one or several organ manifestations. Liver disorder in association with a respiratory chain deficiency may be overlooked since liver dysfunction is common in severely sick newborn infants. Lactacidosis, hypoglycemia, elevated serum transaminases and conjugated bilirubin are common signs of mitochondrial hepatopathy. Hepatosplenomegaly may occur in severe cases. A clinical picture with fetal growth restriction, postnatal lactacidosis, hypoglycemia, coagulopathy, and cholestasis, especially in combination with neurological symptoms or renal tubulopathy, should alert the neonatologist to direct investigations on mitochondrial disorder. A normal lactate level does not exclude respiratory chain defects. The most common liver manifestation caused by mutated mitochondrial DNA (deletion) is Pearson syndrome. Recently, mutations in several nuclear DNA genes have been identified that lead to mitochondrial hepatopathy, e.g. mitochondrial depletion syndrome caused by DGUOK, MPV17, SUCLG1, POLG1, or C10ORF2 mutations. A combination of lactacidosis, liver involvement, and Fanconi type renal tubulopathy is common when the complex III assembly factor BCS1L harbors mutations, the most severe disease with consistent genotype-phenotype correlation being the GRACILE syndrome. Mutations in nuclear translation factor genes (TRMU, EFG1, and EFTu) of the respiratory chain enzyme complexes have recently been identified. Diagnostic work-up of neonatal liver disorder should include assessment of function and structure of the complexes as well as mutation screening for known genes. So far, treatment is mainly symptomatic.
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Affiliation(s)
- Vineta Fellman
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden.
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Darwish AA, McKiernan P, Chardot C. Paediatric liver transplantation for metabolic disorders. Part 2: Metabolic disorders with liver lesions. Clin Res Hepatol Gastroenterol 2011; 35:271-80. [PMID: 21376696 DOI: 10.1016/j.clinre.2011.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Liver based metabolic disorders account for 10 to 15% of the indications for paediatric liver transplantation. In the last three decades, important progress has been made in the understanding of these diseases, and new therapies have emerged. Concomitantly, medical and surgical innovations have lead to improved results of paediatric liver transplantation, patient survival nowadays exceeding 80% 10 year after surgery with close to normal quality of life in most survivors. This review is a practical update on medical therapy, indications and results of liver transplantation, and potential future therapies, for the main liver based metabolic disorders in which paediatric liver transplantation may be considered. Part 1 focuses on metabolic based liver disorders without liver lesions, and part 2 on metabolic liver diseases with liver lesions.
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Affiliation(s)
- Ahmed A Darwish
- University of Geneva Children's hospital, Paediatric Surgery Unit, Geneva, Switzerland
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Rodenburg RJT. Biochemical diagnosis of mitochondrial disorders. J Inherit Metab Dis 2011; 34:283-92. [PMID: 20440652 PMCID: PMC3063578 DOI: 10.1007/s10545-010-9081-y] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/16/2010] [Accepted: 03/17/2010] [Indexed: 11/04/2022]
Abstract
Establishing a diagnosis in patients with a suspected mitochondrial disorder is often a challenge. Both knowledge of the clinical spectrum of mitochondrial disorders and the number of identified disease-causing molecular genetic defects are continuously expanding. The diagnostic examination of patients requires a multi-disciplinary clinical and laboratory evaluation in which the biochemical examination of the mitochondrial functional state often plays a central role. In most cases, a muscle biopsy provides the best opportunity to examine mitochondrial function. In addition to activity measurements of individual oxidative phosphorylation enzymes, analysis of mitochondrial respiration, substrate oxidation, and ATP production rates is performed to obtain a detailed picture of the mitochondrial energy-generating system. On the basis of the compilation of clinical, biochemical, and other laboratory test results, candidate genes are selected for molecular genetic testing. In patients in whom an unknown genetic variant is identified, a compatible biochemical phenotype is often required to firmly establish the diagnosis. In addition to the current role of the biochemical analysis in the diagnostic examination of patients with a suspected mitochondria disorder, this report gives a future perspective on the biochemical diagnosis in view of both the expanding genotypes of mitochondrial disorders and the possibilities for high throughput molecular genetic diagnosis.
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Affiliation(s)
- Richard J T Rodenburg
- Nijmegen Center for Mitochondrial Disorders (NCMD), 656 Department of Pediatrics, Department of Laboratory Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Mercier S, Josselin de Wasch M, Labarthe F, Jardel C, Lombès A, Munnich A, Toutain A, Nivet H, Saliba E, Chantepie A, Castelnau P. [Clinical variability and diagnosis steps in childhood mitochondrial disease]. Arch Pediatr 2009; 16:322-30. [PMID: 19233626 DOI: 10.1016/j.arcped.2008.12.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 12/03/2008] [Accepted: 12/26/2008] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Mitochondrial respiratory chain deficiencies are known for their high clinical variability. Difficult to diagnose, the prevalence of these diseases is probably underestimated. METHODS We report 18 children diagnosed with respiratory chain deficiency at the Tours University Hospital over the past 10 years. RESULTS Three clinical profiles can be distinguished depending on the age at onset of the first symptoms: the neonatal period (4 cases), between 1 month and 2 years of age (10 cases), and after 10 years (4 cases). However, no clinical feature appears specific of any age group. In contrast, respiratory chain analysis on liver biopsy was very informative for all our patients at any age and with any clinical presentation, even with predominant neurological symptoms. CONCLUSIONS These biochemical analyses support the diagnosis of mitochondrial disorders in view of molecular analysis, which nevertheless frequently remains inconclusive. These investigations should benefit from the new molecular screening technologies based on DNA chips that can identify the genomic mutations responsible for these severe and relatively frequent diseases.
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Affiliation(s)
- S Mercier
- Service de génétique, hôpital Bretonneau, CHU de Tours, université de Tours, 37000 Tours, France
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Haas RH, Parikh S, Falk MJ, Saneto RP, Wolf NI, Darin N, Wong LJ, Cohen BH, Naviaux RK. The in-depth evaluation of suspected mitochondrial disease. Mol Genet Metab 2008; 94:16-37. [PMID: 18243024 PMCID: PMC2810849 DOI: 10.1016/j.ymgme.2007.11.018] [Citation(s) in RCA: 252] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2007] [Revised: 11/21/2007] [Accepted: 11/21/2007] [Indexed: 12/12/2022]
Abstract
Mitochondrial disease confirmation and establishment of a specific molecular diagnosis requires extensive clinical and laboratory evaluation. Dual genome origins of mitochondrial disease, multi-organ system manifestations, and an ever increasing spectrum of recognized phenotypes represent the main diagnostic challenges. To overcome these obstacles, compiling information from a variety of diagnostic laboratory modalities can often provide sufficient evidence to establish an etiology. These include blood and tissue histochemical and analyte measurements, neuroimaging, provocative testing, enzymatic assays of tissue samples and cultured cells, as well as DNA analysis. As interpretation of results from these multifaceted investigations can become quite complex, the Diagnostic Committee of the Mitochondrial Medicine Society developed this review to provide an overview of currently available and emerging methodologies for the diagnosis of primary mitochondrial disease, with a focus on disorders characterized by impairment of oxidative phosphorylation. The aim of this work is to facilitate the diagnosis of mitochondrial disease by geneticists, neurologists, and other metabolic specialists who face the challenge of evaluating patients of all ages with suspected mitochondrial disease.
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Affiliation(s)
- Richard H. Haas
- Departments of Neurosciences & Pediatrics, University of California San Diego, La Jolla, CA and Rady Children's Hospital San Diego, San Diego, CA
- Corresponding Author: Richard H. Haas, MB, BChir, MRCP, Professor of Neurosciences and Pediatrics, University of California San Diego, T. 858-822-6700; F. 858-822-6707;
| | - Sumit Parikh
- Division of Neuroscience, The Cleveland Clinic, Cleveland, OH
| | - Marni J. Falk
- Division of Human Genetics, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA
| | - Russell P. Saneto
- Division of Pediatric Neurology, Children's Hospital and Regional Medical Center, University of Washington, Seattle, WA
| | - Nicole I. Wolf
- Department of Child Neurology, University Children's Hospital, Heidelberg, Germany
| | - Niklas Darin
- Division of Child Neurology, The Queen Silvia Children's Hospital, Göteborg, Sweden
| | - Lee-Jun Wong
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Bruce H. Cohen
- Division of Neuroscience, The Cleveland Clinic, Cleveland, OH
| | - Robert K. Naviaux
- Departments of Medicine and Pediatrics, Division of Medical and Biochemical Genetics, University of California San Diego, La Jolla, CA and Rady Children's Hospital San Diego, San Diego, CA
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