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Parikh S, Karaa A, Goldstein A, Ng YS, Gorman G, Feigenbaum A, Christodoulou J, Haas R, Tarnopolsky M, Cohen BK, Dimmock D, Feyma T, Koenig MK, Mundy H, Niyazov D, Saneto RP, Wainwright MS, Wusthoff C, McFarland R, Scaglia F. Solid organ transplantation in primary mitochondrial disease: Proceed with caution. Mol Genet Metab 2016; 118:178-184. [PMID: 27312126 DOI: 10.1016/j.ymgme.2016.04.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 01/02/2023]
Abstract
Solid organ transplants are rarely performed in both adult and pediatric patients with primary mitochondrial disease. Poor outcomes have been described in case reports and small case series. It is unclear whether the underlying genetic disease has a significant impact on post-transplant morbidity and mortality. Data were obtained for 35 patients from 17 Mitochondrial Disease Centers across North America, the United Kingdom and Australia. Patient outcomes were noted after liver, kidney or heart transplantation. Excluding patients with POLG-related disease, post-transplant survival approached or met outcomes seen in non-mitochondrial disease transplant patients. The majority of mitochondrial disease patients did not have worsening of their mitochondrial disease within 90-days post-transplant. Post-transplant complications, including organ rejection, were not a common occurrence and were generally treatable. Many patients did not have a mitochondrial disease considered or diagnosed prior to transplantation. In conclusion, patients with mitochondrial disease in this cohort generally tolerated solid-organ transplantation. Such patients may not need to be excluded from transplant solely for their mitochondrial diagnosis; additional caution may be needed for patients with POLG-related disease. Transplant teams should be aware of mitochondrial disease as an etiology for organ-failure and consider appropriate consultation in patients without a known cause of their symptoms.
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Affiliation(s)
- Sumit Parikh
- Neurogenetics & Mitochondrial Disease, Center for Pediatric Neurology, Cleveland Clinic, Cleveland, OH, United States.
| | - Amel Karaa
- Department of Medical Genetics, Massachusetts General Hospital, Boston, MA, United States
| | - Amy Goldstein
- Center for Pediatric Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Yi S Ng
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Grainne Gorman
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Annette Feigenbaum
- Department of Medical Genetics, Rady Children's Hospital, San Diego, CA, United States
| | - John Christodoulou
- Western Sydney Genetics Program, Children's Hospital at Westmead, Sydney and Disciplines of Paediatrics and Child Health and Genetic Medicine, University of Sydney, Sydney, Australia
| | - Richard Haas
- Department of Pediatric Neurology, Rady Children's Hospital, San Diego, CA, United States
| | - Mark Tarnopolsky
- Department of Pediatrics, Division of Neuromuscular and Neurometabolic Disease, McMaster University, Hamilton, ON, Canada
| | - Bruce K Cohen
- Department of Pediatric Neurology, Akron Children's Hospital, Akron, OH, United States
| | - David Dimmock
- Department of Medical Genetics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Tim Feyma
- Department of Pediatric Neurology, Gillette Children's Specialty Healthcare, St. Paul, MN, United States
| | - Mary K Koenig
- Department of Pediatrics, Division of Child & Adolescent Neurology, The University of Texas Medical School at Houston, Houston, TX, United States
| | - Helen Mundy
- Pediatric Metabolism, Evelina London Children's Healthcare, London, UK
| | - Dmitriy Niyazov
- Division of Medical Genetics, Department of Pediatrics, Ochsner Clinic Foundation, New Orleans, LA, United States
| | - Russell P Saneto
- Department of Pediatric Neurology, Seattle Children's Hospital, Seattle, WA, United States
| | - Mark S Wainwright
- Department of Pediatrics, Division of Neurology, Lurie Children's Hospital, Chicago, IL, United States
| | - Courtney Wusthoff
- Department of Pediatric Neurology, Lucile Packard Children's Hospital, Palo Alto, CA, United States
| | - Robert McFarland
- Wellcome Trust Centre for Mitochondrial Research, Newcastle University, Newcastle upon Tyne, UK
| | - Fernando Scaglia
- Department of Molecular and Human Genetics, Baylor College of Medicine, Baylor, TX, United States
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Vattemi G, Marini M, Di Chio M, Colpani M, Guglielmi V, Tomelleri G. Polymyositis in solid organ transplant recipients receiving tacrolimus. J Neurol Sci 2014; 345:239-43. [PMID: 25130930 DOI: 10.1016/j.jns.2014.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 06/17/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
Abstract
Tacrolimus, also known as FK506, is an immunosuppressive agent widely used for the prevention of acute allograft rejection in organ transplantation and for the treatment of immunological diseases. This study reports two male patients who underwent solid organ transplantation (liver and kidney). After transplant, the patients received continuous immunosuppressive therapy with oral tacrolimus and later presented clinical manifestations and laboratory signs of myopathy. Muscle biopsies of both patients clearly documented an inflammatory myopathy with the histological features of polymyositis including CD8+ T cells which invaded healthy muscle fibers and expressed granzyme B and perforin, many CD68+ macrophages and MHC class I antigen upregulation on the surface of most fibers. Because of the temporal association while receiving tacrolimus and since other possible causes for myopathy were excluded, the most likely cause of polymyositis in our patients was tacrolimus toxicity. We suggest that patients on tacrolimus should be carefully monitored for serum CK levels and clinical signs of muscle disease.
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Affiliation(s)
- Gaetano Vattemi
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy
| | - Matteo Marini
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy
| | - Marzia Di Chio
- Department of Medicine and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Maria Colpani
- Department of Gastroenterology, Liver Transplantation Unit, "Ospedali Riuniti", Bergamo, Italy
| | - Valeria Guglielmi
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy
| | - Giuliano Tomelleri
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy.
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Golden AS, Law YM, Shurtleff H, Warner M, Saneto RP. Mitochondrial electron transport chain deficiency, cardiomyopathy, and long-term cardiac transplant outcome. Pediatr Transplant 2012; 16:265-8. [PMID: 22248292 DOI: 10.1111/j.1399-3046.2011.01635.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Organ transplantation in multisystemic mitochondrial cytopathies is usually not performed because of perceived untoward complications. We report three patients with demonstrated oxidative phosphorylation defects and dilated cardiomyopathy who underwent cardiac transplant. All three patients tolerated immunosuppression medications and have had an excellent long-term outcome. Our results suggest that with proper patient selection in this population, cardiac transplantation is feasible and can have good outcomes.
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Affiliation(s)
- Alana S Golden
- Division of Pediatric Neurology, Seattle Children's Hospital and University of Washington, Seattle, WA 98105, USA
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Grönberg A, Zettergren L, Bergh K, Ståhle M, Heilborn J, Angeby K, Small PL, Akuffo H, Britton S. Antioxidants protect keratinocytes against M. ulcerans mycolactone cytotoxicity. PLoS One 2010; 5:e13839. [PMID: 21079804 PMCID: PMC2973957 DOI: 10.1371/journal.pone.0013839] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 10/05/2010] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mycobacterium ulcerans is the causative agent of necrotizing skin ulcerations in distinctive geographical areas. M. ulcerans produces a macrolide toxin, mycolactone, which has been identified as an important virulence factor in ulcer formation. Mycolactone is cytotoxic to fibroblasts and adipocytes in vitro and has modulating activity on immune cell functions. The effect of mycolactone on keratinocytes has not been reported previously and the mechanism of mycolactone toxicity is presently unknown. Many other macrolide substances have cytotoxic and immunosuppressive activities and mediate some of their effects via production of reactive oxygen species (ROS). We have studied the effect of mycolactone in vitro on human keratinocytes--key cells in wound healing--and tested the hypothesis that the cytotoxic effect of mycolactone is mediated by ROS. METHODOLOGY/PRINCIPAL FINDINGS The effect of mycolactone on primary skin keratinocyte growth and cell numbers was investigated in serum free growth medium in the presence of different antioxidants. A concentration and time dependent reduction in keratinocyte cell numbers was observed after exposure to mycolactone. Several different antioxidants inhibited this effect partly. The ROS inhibiting substance deferoxamine, which acts via chelation of Fe(2+), completely prevented mycolactone mediated cytotoxicity. CONCLUSIONS/SIGNIFICANCE This study demonstrates that mycolactone mediated cytotoxicity can be inhibited by deferoxamine, suggesting a role of iron and ROS in mycolactone induced cytotoxicity of keratinocytes. The data provide a basis for the understanding of Buruli ulcer pathology and the development of improved therapies for this disease.
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Affiliation(s)
- Alvar Grönberg
- Molecular Dermatology, Department of Medicine, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden.
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Halter J, Schüpbach W, Casali C, Elhasid R, Fay K, Hammans S, Illa I, Kappeler L, Krähenbühl S, Lehmann T, Mandel H, Marti R, Mattle H, Orchard K, Savage D, Sue CM, Valcarcel D, Gratwohl A, Hirano M. Allogeneic hematopoietic SCT as treatment option for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE): a consensus conference proposal for a standardized approach. Bone Marrow Transplant 2010; 46:330-337. [PMID: 20436523 PMCID: PMC4578692 DOI: 10.1038/bmt.2010.100] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic hematopoietic SCT (HSCT) has been proposed as a treatment for patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE). HSCT has been performed in nine patients using different protocols with varying success. Based on this preliminary experience, participants of the first consensus conference propose a common approach to allogeneic HSCT in MNGIE. Standardization of the transplant protocol and the clinical and biochemical assessments will allow evaluation of the safety and efficacy of HSCT as well as optimization of therapy for patients with MNGIE.
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Affiliation(s)
- J Halter
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Wmm Schüpbach
- Centre d'Investigation Clinique, Fédération des Maladies du Système Nerveux & INSERM UMR 679, Pitié-Salpxêtrière Group, Paris, France.,Department of Neurology, University Hospital-Inselspital Bern, Bern, Switzerland
| | - C Casali
- Neurology, La Sapienza University, University Hospital, Rome, Italy
| | - R Elhasid
- Pediatric-Oncology, Rambam Medical Centre, Haifa, Israel
| | - K Fay
- Department of Hematology, St Vincent's Hospital, Darlinghurst, Sydney, Australia
| | - S Hammans
- Wessex Neurological Centre, Southampton University Hospital Trust, Southampton, UK
| | - I Illa
- Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L Kappeler
- Department of Neurology, University Hospital-Inselspital Bern, Bern, Switzerland
| | - S Krähenbühl
- Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland
| | - T Lehmann
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - H Mandel
- Pediatrics, Rambam Medical Centre, Haifa, Israel
| | - R Marti
- Institut de Recerca, University Hospital Vall d'Hebron and CIBERER, Barcelona, Spain
| | - H Mattle
- Centre d'Investigation Clinique, Fédération des Maladies du Système Nerveux & INSERM UMR 679, Pitié-Salpxêtrière Group, Paris, France.,Department of Neurology, University Hospital-Inselspital Bern, Bern, Switzerland
| | - K Orchard
- Department of Haematology, University of Southampton, Southampton, UK
| | - D Savage
- Department of Haematology, Columbia University Medical Centre, New York, NY, USA
| | - C M Sue
- Department of Neurogenetics, University of Sydney Kolling Institute for Medical Research, Kolling Institute for Medical Research, Royal North Shore Hospital and University of Sydney, Sydney, Australia
| | - D Valcarcel
- Department of Hematology, Santa Creu i San Pau Hospital, Barcelona, Spain
| | - A Gratwohl
- Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - M Hirano
- Department of Neurology, Columbia University Medical Centre, New York, NY, USA
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Moriya K, Miyoshi H, Tsutsumi T, Shinzawa S, Fujie H, Shintani Y, Yotsuyanagi H, Moriishi K, Matsuura Y, Suzuki T, Miyamura T, Koike K. Tacrolimus ameliorates metabolic disturbance and oxidative stress caused by hepatitis C virus core protein: analysis using mouse model and cultured cells. THE AMERICAN JOURNAL OF PATHOLOGY 2009; 175:1515-24. [PMID: 19729476 DOI: 10.2353/ajpath.2009.090102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hepatic steatosis and insulin resistance are factors that aggravate the progression of liver disease caused by hepatitis C virus (HCV) infection. In the pathogenesis of liver disease and metabolic disorders in HCV infection, oxidative stress due to mitochondrial respiratory chain dysfunction plays a pivotal role. Tacrolimus (FK506) is supposed to protect mitochondrial respiratory function. We studied whether tacrolimus affects the development of HCV-associated liver disease using HCV core gene transgenic mice, which develop hepatic steatosis, insulin resistance, and hepatocellular carcinoma. Administration of tacrolimus to HCV core gene transgenic mice three times per week for 3 months led to a significant reduction in the amounts of lipid in the liver as well as in serum insulin. Tacrolimus treatment also ameliorated oxidative stress and DNA damage in the liver of the core gene transgenic mice. Tacrolimus administration reproduced these effects in a dose-dependent manner in HepG2 cells expressing the core protein. The intrahepatic level of tumor necrosis factor-alpha, which may be a key molecule for the pathogenesis in HCV infection, was significantly decreased in tacrolimus-treated core gene transgenic mice. Tacrolimus thus reversed the effect of the core protein in the pathogenesis of HCV-associated liver disease. These results may provide new therapeutic tools for chronic hepatitis C, in which oxidative stress and abnormalities in lipid and glucose metabolism contribute to liver pathogenesis.
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Affiliation(s)
- Kyoji Moriya
- Department of Internal Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
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Mun KC, Lee KT, Choi HJ, Jin KB, Han SY, Park SB, Kim HC, Ha EY, Kim YH. Effects of cyclosporine on the production of the reactive oxygen species in the glial cells. Transplant Proc 2008; 40:2742-3. [PMID: 18929851 DOI: 10.1016/j.transproceed.2008.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES After organ transplantation, some patients suffer mild neurological symptoms such as tremor to severe complications including seizures and encephalopathy. Among the immunosuppressants, cyclosporine (CsA) can induce neurological side effects. However, the mechanisms of encephalopathy by CsA are not fully understood. We measured the production of reactive oxygen species (ROS) in the glioma cells after CsA treatment. METHODS CsA (2.5 mmol/L) added to glioma cells was incubated for 60 minutes at 37 degrees C. ROS production was evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2',7'-dichlorofluorescin using VICTOR3 multilabel counter. RESULTS CsA resulted in ROS production by glioma cells. The ROS production increased with the time of exposure to CsA. CONCLUSIONS These findings indicated that CsA may contribute to neurological side effects via ROS production.
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Affiliation(s)
- K C Mun
- Dongsan Kidney Institute and Chronic Disease Research Center, Keimyung University, Daegu, Korea.
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Jin K, Hwang E, Han S, Park S, Kim H, Ha E, Suh S, Mun K. Effects of Tacrolimus on Antioxidant Status and Oxidative Stress in Glioma Cells. Transplant Proc 2008; 40:2740-1. [DOI: 10.1016/j.transproceed.2008.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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