1
|
Rioux AV, Bergeron NA, Riopel J, Marcoux N, Thériault C, Gould PV, Garneau AP, Isenring P. The ever wider clinical spectrum of RMND1-related disorders and limitedness of phenotype-based classifications. J Mol Med (Berl) 2023; 101:1229-1236. [PMID: 37584739 PMCID: PMC10560146 DOI: 10.1007/s00109-023-02356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/10/2023] [Accepted: 08/02/2023] [Indexed: 08/17/2023]
Abstract
RMND1 has been identified as a mitochondriopathy-associated gene less than 12 years ago. The most common phenotype related to this gene is an early onset, severe form of encephalomyopathy that leads to death in a medium time of three years after birth. However, milder and later onset presentations have been reported in some individuals, including two in whom the mitochondriopathy was identified at ~ 40 years of age, and the early onset presentations have been the object of no reports in those who survived beyond age 10. It is thus unclear how lethal RMND1-related conditions really are. We herein describe the oldest case to have been identified hitherto with this condition, i.e., that of a white female who was 61 at the time of diagnosis but was still active in her everyday life. The gene defect identified was nonetheless associated with many manifestations including ovarian insufficiency and sensorineural hearing loss (two features of what is currently designated as Perrault syndrome) as well as chronic renal failure, asymptomatic myopathy, leukopenia, and a few others. In our opinion, this case is of great translational interest for at least three reasons. First, it hints towards the possibility of near-normal life expectancies in some if not many individuals with RMND1 insufficiency. Second, it underlines the wide clinical spectrum associated with this gene. Third, it brings us to question the use of eponyms and syndromic features to identify the true etiology of multisystemic phenotypes. KEY MESSAGES: RMND1-related conditions typically manifest at an early age with a progressive and lethal form of encephalomyopathy. More benign presentations have been described with some being categorized as Perrault syndrome but none have been diagnosed after the age of 45. The clinical spectrum and presenting age of RMND1-related mitochondriopathies are probably much more varied than implied in the current literature. The case reported in this manuscript illustrates the limitedness of phenotype-based classifications of genetic disorders to identify the defect at cause.
Collapse
Affiliation(s)
- Alexis V Rioux
- CHU de Québec, Service of Nephrology, Faculty of Medicine, Université Laval, QC, G1R 2J6, Québec, Canada
| | - Nicolas Ad Bergeron
- CHU de Québec, Service of Nephrology, Faculty of Medicine, Université Laval, QC, G1R 2J6, Québec, Canada
| | - Julie Riopel
- CHU de Québec, Service of Pathology, Faculty of Medicine, Université Laval, Québec, QC, G1R 2J6, Canada
| | - Nicolas Marcoux
- CHU de Québec, Service of Hematology, Faculty of Medicine, Université Laval, Québec, QC, G1R 2J6, Canada
| | - Catherine Thériault
- CHU de Québec, Service of Pathology, Faculty of Medicine, Université Laval, Québec, QC, G1R 2J6, Canada
| | - Peter V Gould
- CHU de Québec, Service of Pathology, Faculty of Medicine, Université Laval, Québec, QC, G1R 2J6, Canada
| | - Alexandre P Garneau
- Service de Néphrologie-Transplantation Rénale Adultes, Hôpital Necker‑Enfants Malades, AP‑HP, Inserm U1151, Université Paris Cité, rue de Sèvres, Paris, France
| | - Paul Isenring
- CHU de Québec, Service of Nephrology, Faculty of Medicine, Université Laval, QC, G1R 2J6, Québec, Canada.
| |
Collapse
|
2
|
Yu S, Guo X, Li G, Yang H, Zheng L, Sun Y. Gender discrepancy in the predictive effect of aortic root diameter on incidence of cardiovascular events among rural Northeast Chinese. BMJ Open 2022; 12:e039207. [PMID: 36691125 PMCID: PMC9454021 DOI: 10.1136/bmjopen-2020-039207] [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: 04/07/2020] [Accepted: 12/28/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The possible predictive effect of echocardiographic aortic root diameter (ARD) on the incidence of cardiovascular events (CVEs) in a large, general population is limited. In addition, there is a lack of data about rural participants. We intend to figure out the possible relationship between ARD and the incidence of CVEs among the general population from rural China. DESIGN Population-based cohort study. SETTING Rural areas in Liaoning Province, Northeast China. PARTICIPANTS At baseline, 9810 participants (mean age 53±10, 49.1% male) were enrolled in the Northeast China Rural Cardiovascular Health Study between 2012 and 2017. MAIN OUTCOME MEASURES Cardiac ultrasonography, lifestyle, medical history, laboratory testing, blood pressure, weight and height. ARD measurement was conducted at the level of the sinuses of Valsalva. Furthermore, the ARD was indexed to height or body surface area. RESULTS During a median follow-up of 4.66 years, 550 non-fatal or fatal CVEs were recorded. Adjusting for blood pressure, age, total cholesterol, fasting blood glucose, estimated glomerular filtration rate, current smoking and drinking, previous cardiovascular diseases and antihypertensive treatment; ARD/height (HR per 1-unit increase=1.781, 95% CI: 1.160 to 2.736, p=0.008) was associated with an increased risk of CVEs in men only. The combination of left ventricular hypertrophy (LVH) and aortic dilation was an independent and powerful predictor for cardiovascular prognosis compared with aortic dilation alone in men but not in women. CONCLUSIONS Our study enrols a large sample of rural Chinese residents, and first confirms that ARD/height has a predictive effect on the incidence of CVEs among rural Chinese residents. The combination of LVH and aortic dilation is synergistic, which increases its predictive effect on CVEs in men only, suggesting that aortic dilatation predicts cardiovascular prognosis better than LVH does in men but not in women.
Collapse
Affiliation(s)
- Shasha Yu
- Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaofan Guo
- The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Guangxiao Li
- Clinical Epidemiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Hongmei Yang
- Cardiology, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Liqiang Zheng
- Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yingxian Sun
- The First Hospital of China Medical University, Shenyang, Liaoning, China
| |
Collapse
|
3
|
Abruzzo T, van den Berg R, Vadivelu S, Hetts SW, Dishop M, Cornejo P, Narayanan V, Ramsey KE, Coopwood C, Medici-van den Herik EG, Roosendaal SD, Lawton M, Bernes S. Arterioectatic Spinal Angiopathy of Childhood: Clinical, Imaging, Laboratory, Histologic, and Genetic Description of a Novel CNS Vascular Pathology. AJNR Am J Neuroradiol 2022; 43:1060-1067. [PMID: 35772802 PMCID: PMC9262071 DOI: 10.3174/ajnr.a7551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 04/18/2022] [Indexed: 11/07/2022]
Abstract
Pediatric patients with myelopathy expressing intradural spinal vascular ectasia without arteriovenous shunting were studied at four tertiary referral neuropediatric centers. Patients were identified by retrospective review of institutional records and excluded if spinal vascular pathology could be classified into a previously described category of spinal vascular malformation. Four patients meeting the study criteria were enrolled in the study. Clinical, magnetic resonance imaging, catheter-directed angiography, laboratory, histological and genetic data were analyzed to characterize the disease process and elucidate underlying pathomechanisms. Our study revealed a highly lethal, progressive multi-segmental myelopathy associated with a unique form of non-inflammatory spinal angiopathy featuring diffuse enlargement and tortuosity of spinal cord arteries, spinal cord hyperemia, and spinal cord edema (Arterioectatic Spinal Angiopathy of Childhood). The condition was shown to mimic venous congestive myelopathy associated with pediatric spinal cord arteriovenous shunts on MRI but to have distinct pathognomonic findings on catheter-directed angiography. Clinicopathological, genetic, and neuroimaging features, which are described in detail, closely overlap with those of mitochondrial disease.
Collapse
Affiliation(s)
- T Abruzzo
- Department of Radiology (T.A., P.C., S.B.)
- Department of Child Health (T.A., M.D., P.C., S.B.), College of Medicine, University of Arizona, Phoenix, Arizona
| | - R van den Berg
- Department of Radiology and Nuclear Medicine (R.v.d.B., S.D.R.), Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - S Vadivelu
- Department of Neurosurgery (S.V.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - S W Hetts
- Department of Radiology (S.W.H.), University of California, San Francisco, San Francisco, California
| | - M Dishop
- Department of Pathology and Laboratory Medicine (M.D.)
- Department of Child Health (T.A., M.D., P.C., S.B.), College of Medicine, University of Arizona, Phoenix, Arizona
| | - P Cornejo
- Department of Radiology (T.A., P.C., S.B.)
- Department of Child Health (T.A., M.D., P.C., S.B.), College of Medicine, University of Arizona, Phoenix, Arizona
| | - V Narayanan
- Translational Genomics Research Institute (V.N., K.E.R.), Phoenix, Arizona
| | - K E Ramsey
- Translational Genomics Research Institute (V.N., K.E.R.), Phoenix, Arizona
| | - C Coopwood
- College of Medicine (C.C.), University of Arizona, Tucson, Arizona
| | | | - S D Roosendaal
- Department of Radiology and Nuclear Medicine (R.v.d.B., S.D.R.), Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - S Bernes
- Department of Radiology (T.A., P.C., S.B.)
- Department of Neurology (S.B.)
- Department of Child Health (T.A., M.D., P.C., S.B.), College of Medicine, University of Arizona, Phoenix, Arizona
| |
Collapse
|
4
|
Abstract
Maternally mitochondrial dysfunction includes a heterogeneous group of genetic disorders which leads to the impairment of the final common pathway of energy metabolism. Coronary heart disease and coronary venous disease are two important clinical manifestations of mitochondrial dysfunction due to abnormality in the setting of underlying pathways. Mitochondrial dysfunction can lead to cardiomyopathy, which is involved in the onset of acute cardiac and pulmonary failure. Mitochondrial diseases present other cardiac manifestations such as left ventricular noncompaction and cardiac conduction disease. Different clinical findings from mitochondrial dysfunction originate from different mtDNA mutations, and this variety of clinical symptoms poses a diagnostic challenge for cardiologists. Heart transplantation may be a good treatment, but it is not always possible, and other complications of the disease, such as mitochondrial encephalopathy, lactic acidosis, and stroke-like syndrome, should be considered. To diagnose and treat most mitochondrial disorders, careful cardiac, neurological, and molecular studies are needed. In this study, we looked at molecular genetics of MIDs and cardiac manifestations in patients with mitochondrial dysfunction.
Collapse
|
5
|
Finsterer J. Aortic root ectasia as a phenotypic feature of a mitochondrial disorder. Clin Case Rep 2018; 6:1501-1503. [PMID: 30147891 PMCID: PMC6099020 DOI: 10.1002/ccr3.1652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 05/16/2018] [Accepted: 05/29/2018] [Indexed: 01/14/2023] Open
Abstract
Mitochondrial disorder (MID) can be suspected upon application of the mitochondrial multiorgan disorder syndrome score; aortic root ectasia (ARE) can be a phenotypic feature of MIDs; ARE in a MID may result from affection of vascular smooth muscle cells by the metabolic defect; ARE requires long-term follow-up not to miss the point at which ARE transforms to an aneurysm requiring vascular surgery.
Collapse
|
6
|
Comment on "Role of Mitochondrial Genome Mutations in Pathogenesis of Carotid Atherosclerosis". OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2018; 2018:4575821. [PMID: 29785245 PMCID: PMC5896220 DOI: 10.1155/2018/4575821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/02/2018] [Indexed: 01/27/2023]
|
7
|
Cardiovascular homeostasis dependence on MICU2, a regulatory subunit of the mitochondrial calcium uniporter. Proc Natl Acad Sci U S A 2017; 114:E9096-E9104. [PMID: 29073106 PMCID: PMC5664535 DOI: 10.1073/pnas.1711303114] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hypertension increases the risk for development of abdominal aortic aneurysms, a silent pathology that is prone to rupture and cause sudden cardiac death. Male gender, smoking, and hypertension appear to increase risk for development of abdominal aortic aneurysms by provoking oxidative stress responses in cardiovascular tissues. Here we uncovered unexpected linkages between the calcium-sensing regulatory subunit MICU2 of the mitochondrial calcium uniporter and stress responses. We show that naive Micu2−/− mice had abnormalities of cardiac relaxation but, with modest blood pressure elevation, developed abdominal aortic aneurysms with spontaneous rupture. These findings implicate mitochondrial calcium homeostasis as a critical pathway involved in protecting cardiovascular tissues from oxidative stress. Comparative analyses of transcriptional profiles from humans and mice with cardiovascular pathologies revealed consistently elevated expression of MICU2, a regulatory subunit of the mitochondrial calcium uniporter complex. To determine if MICU2 expression was cardioprotective, we produced and characterized Micu2−/− mice. Mutant mice had left atrial enlargement and Micu2−/− cardiomyocytes had delayed sarcomere relaxation and cytosolic calcium reuptake kinetics, indicating diastolic dysfunction. RNA sequencing (RNA-seq) of Micu2−/− ventricular tissues revealed markedly reduced transcripts encoding the apelin receptor (Micu2−/− vs. wild type, P = 7.8 × 10−40), which suppresses angiotensin II receptor signaling via allosteric transinhibition. We found that Micu2−/− and wild-type mice had comparable basal blood pressures and elevated responses to angiotensin II infusion, but that Micu2−/− mice exhibited systolic dysfunction and 30% lethality from abdominal aortic rupture. Aneurysms and rupture did not occur with norepinephrine-induced hypertension. Aortic tissue from Micu2−/− mice had increased expression of extracellular matrix remodeling genes, while single-cell RNA-seq analyses showed increased expression of genes related to reactive oxygen species, inflammation, and proliferation in fibroblast and smooth muscle cells. We concluded that Micu2−/− mice recapitulate features of diastolic heart disease and define previously unappreciated roles for Micu2 in regulating angiotensin II-mediated hypertensive responses that are critical in protecting the abdominal aorta from injury.
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Mitochondrial disorders are an increasingly recognized cause of heart dysfunction, with the primary manifestations being cardiomyopathy and conduction defects. This review focuses on the complex genetics of mitochondrial disease and recently discovered conditions that affect mitochondrial function. RECENT FINDINGS Next-generation sequencing techniques, especially whole-exome sequencing, have led to the discovery of a number of conditions that cause mitochondrial dysfunction and subsequent cardiac abnormalities. Nuclear DNA defects are the main cause of mitochondrial disease in children, with disease pathogenesis being related to either abnormalities in specific mitochondrial electron transport chain subunits or in proteins related to subunit or mitochondrial DNA maintenance, mitochondrial protein translation, lipid bilayer structure, or other aspects of mitochondrial function. SUMMARY Currently, symptomatic therapy using standard medications targeting relief of complications is the primary approach to treatment. There are no US Food and Drug Administration-approved therapies for the specific treatment of mitochondrial disease. However, on the basis of recent advances in understanding of the pathophysiology of these complex disorders, various novel approaches are either in clinical trials or in development.
Collapse
Affiliation(s)
- Gregory M Enns
- Department of Pediatrics, Stanford University, Stanford, California, USA
| |
Collapse
|
9
|
Finsterer J, Zarrouk-Mahjoub S. Macroangiopathy is a typical phenotypic manifestation of MELAS. Metab Brain Dis 2017; 32:977-979. [PMID: 28466388 DOI: 10.1007/s11011-017-0020-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 04/21/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Postfach 20, Vienna, Austria.
| | - Sinda Zarrouk-Mahjoub
- Pasteur Institute of Tunis, University of Tunis El Manar and Genomics Platform, Tunis, Tunisia
| |
Collapse
|
10
|
Zhu K, Li S, Chen H, Wang Y, Yu M, Wang H, Zhao W, Cao Y. Late onset MELAS with m.3243A > G mutation and its association with aneurysm formation. Metab Brain Dis 2017; 32:1069-1072. [PMID: 28321601 DOI: 10.1007/s11011-017-9989-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
Abstract
We reported a 53-year-old with late-onset mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) accompanied by aneurysm and large vessel dilations. Most studies have focused on microangiopathy causing stroke-like episodes. We report a case to describe large vessel involvement in clinical considerations, and possible mechanisms of aneurysm formation. We recommended regular angiographic examination for patients with MELAS.
Collapse
Affiliation(s)
- Kun Zhu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China
- The 96th Class, 7-Year Program, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, China
| | - Shuang Li
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China
| | - Huan Chen
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China
| | - Yao Wang
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China
| | - Miao Yu
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China
- The 97th Class, 7-Year Program, China Medical University, No.77 Puhe Road, Shenyang North New Area, Shenyang, Liaoning, 110122, China
| | - Hongyan Wang
- Department of Cadre, The Central Hospital of Jiamusi City, No. 256 Zhongshan Road, Xiangyang District, Jiamusi, Heilongjiang, 154002, China
| | - Weijie Zhao
- Department of Neurology, Capital Medical University Affiliated Beijing Friendship Hospital, No. 95 Yongan Road, Xicheng District, Beijing, 100050, China
| | - Yunpeng Cao
- Department of Neurology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China.
| |
Collapse
|
11
|
Exome Sequencing Identifies Candidate Genetic Modifiers of Syndromic and Familial Thoracic Aortic Aneurysm Severity. J Cardiovasc Transl Res 2017; 10:423-432. [PMID: 28550590 DOI: 10.1007/s12265-017-9753-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/16/2017] [Indexed: 01/09/2023]
Abstract
Thoracic aortic aneurysm (TAA) is a genetic disease predisposing to aortic dissection. It is important to identify the genetic modifiers controlling penetrance and expressivity to improve clinical prognostication. Exome sequencing was performed in 27 subjects with syndromic or familial TAA presenting with extreme phenotypes (15 with severe TAA; 12 with mild or absent TAA). Family-based analysis of a subset of the cohort identified variants, genes, and pathways segregating with TAA severity among three families. A rare missense variant in ADCK4 (p.Arg63Trp) segregated with mild TAA in each family. Genes and pathways identified in families were further investigated in the entire cohort using the optimal unified sequence kernel association test, finding significance for the gene COL15A1 (p = 0.025) and the retina homeostasis pathway (p = 0.035). Thus, we identified candidate genetic modifiers of TAA severity by exome-based study of extreme phenotypes, which may lead to improved risk stratification and development of new medical therapies.
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is responsible for more morbidity and mortality worldwide than any other ailment. Strategies for reducing CVD prevalence must involve identification of individuals at high risk for these diseases, and the prevention of its initial development. Such preventive efforts are currently limited by an incomplete understanding of the genetic determinants of CVD risk. In this review, evidence for the involvement of inherited mitochondrial mutations in development of CVD is examined. RECENT FINDINGS Several forms of CVD have been documented in the presence of pathogenic mitochondrial DNA (mtDNA) mutations, both in isolation and as part of larger syndromes. Other 'natural' mtDNA polymorphisms not overtly tied to any pathology have also been associated with alterations in mitochondrial function and individual risk for CVD, but until very recently these studies have been merely correlative. Fortunately, novel animal models are now allowing investigators to define a causal relationship between inherited 'natural' mtDNA polymorphisms, and cardiovascular function and pathology. SUMMARY Cardiovascular involvement is highly prevalent among patients with pathogenic mtDNA mutations. The relationship between CVD susceptibility and 'natural' mtDNA polymorphisms requires further investigation, but will be aided in the near future by several novel experimental models.
Collapse
Affiliation(s)
- Alexander W. Bray
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham
| | - Scott W. Ballinger
- Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at Birmingham
| |
Collapse
|
13
|
Finsterer J, Zarrouk-Mahjoub S. Mitochondrial multiorgan disorder syndrome score generated from definite mitochondrial disorders. Neuropsychiatr Dis Treat 2017; 13:2569-2579. [PMID: 29062232 PMCID: PMC5638572 DOI: 10.2147/ndt.s149067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Mitochondrial disorders (MIDs) frequently present as mitochondrial multiorgan disorder syndrome (MIMODS) at onset or evolve into MIMODS during the course. This study aimed to find which organs and/or tissues are most frequently affected by MIMODS, which are the most frequent abnormalities within an affected organ, whether there are typical MIMODS patterns, and to generate an MIMODS score to assess the diagnostic probability for an MID. METHODS This is a retrospective evaluation of clinical, biochemical, and genetic investigations of adult patients with definite MIDs. A total of 36 definite MID patients, 19 men and 17 women, aged 29-82 years were included in this study. The diagnosis was based on genetic testing (n=21), on biochemical investigations (n=17), or on both (n=2). RESULTS The number of organs most frequently affected was 4 ranging from 1 to 9. MIMODS was diagnosed in 97% of patients. The organs most frequently affected were the muscle (97%), central nervous system (CNS; 72%), endocrine glands (69%), heart (58%), intestines (55%), and peripheral nerves (50%). The most frequent CNS abnormalities were leukoencephalopathy, prolonged visually evoked potentials, and atrophy. The most frequent endocrine abnormalities included thyroid dysfunction, short stature, and diabetes. The most frequent cardiac abnormalities included arrhythmias, systolic dysfunction, and hypertrophic cardiomyopathy. The most frequent MIMODS patterns were encephalomyopathy, encephalo-myo-endocrinopathy, and encepalo-myo-endocrino-cardiopathy. The mean ± 2SD MIMODS score was 35.97±27.6 (range =11-71). An MIMODS score >10 was regarded as indicative of an MID. CONCLUSION Adult MIDs manifest as MIMODS in the vast majority of the cases. The organs most frequently affected in MIMODS are muscles, CNS, endocrine glands, and heart. An MIMODS score >10 suggests an MID.
Collapse
|
14
|
Finsterer J, Zarrouk-Mahjoub S. Mitochondrial vasculopathy. World J Cardiol 2016; 8:333-339. [PMID: 27231520 PMCID: PMC4877362 DOI: 10.4330/wjc.v8.i5.333] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 01/16/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023] Open
Abstract
Mitochondrial disorders (MIDs) are usually multisystem disorders (mitochondrial multiorgan disorder syndrome) either on from onset or starting at a point during the disease course. Most frequently affected tissues are those with a high oxygen demand such as the central nervous system, the muscle, endocrine glands, or the myocardium. Recently, it has been shown that rarely also the arteries may be affected (mitochondrial arteriopathy). This review focuses on the type, diagnosis, and treatment of mitochondrial vasculopathy in MID patients. A literature search using appropriate search terms was carried out. Mitochondrial vasculopathy manifests as either microangiopathy or macroangiopathy. Clinical manifestations of mitochondrial microangiopathy include leukoencephalopathy, migraine-like headache, stroke-like episodes, or peripheral retinopathy. Mitochondrial macroangiopathy manifests as atherosclerosis, ectasia of arteries, aneurysm formation, dissection, or spontaneous rupture of arteries. The diagnosis relies on the documentation and confirmation of the mitochondrial metabolic defect or the genetic cause after exclusion of non-MID causes. Treatment is not at variance compared to treatment of vasculopathy due to non-MID causes. Mitochondrial vasculopathy exists and manifests as micro- or macroangiopathy. Diagnosing mitochondrial vasculopathy is crucial since appropriate treatment may prevent from severe complications.
Collapse
|
15
|
Finsterer J, Stöllberger C. Heart Disease in Disorders of Muscle, Neuromuscular Transmission, and the Nerves. Korean Circ J 2016; 46:117-34. [PMID: 27014341 PMCID: PMC4805555 DOI: 10.4070/kcj.2016.46.2.117] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 10/30/2015] [Accepted: 11/24/2015] [Indexed: 12/31/2022] Open
Abstract
Little is known regarding cardiac involvement (CI) by neuromuscular disorders (NMDs). The purpose of this review is to summarise and discuss the major findings concerning the types, frequency, and severity of cardiac disorders in NMDs as well as their diagnosis, treatment, and overall outcome. CI in NMDs is characterized by pathologic involvement of the myocardium or cardiac conduction system. Less commonly, additional critical anatomic structures, such as the valves, coronary arteries, endocardium, pericardium, and even the aortic root may be involved. Involvement of the myocardium manifests most frequently as hypertrophic or dilated cardiomyopathy and less frequently as restrictive cardiomyopathy, non-compaction, arrhythmogenic right-ventricular dysplasia, or Takotsubo-syndrome. Cardiac conduction defects and supraventricular and ventricular arrhythmias are common cardiac manifestations of NMDs. Arrhythmias may evolve into life-threatening ventricular tachycardias, asystole, or even sudden cardiac death. CI is common and carries great prognostic significance on the outcome of dystrophinopathies, laminopathies, desminopathies, nemaline myopathy, myotonias, metabolic myopathies, Danon disease, and Barth-syndrome. The diagnosis and treatment of CI in NMDs follows established guidelines for the management of cardiac disease, but cardiotoxic medications should be avoided. CI in NMDs is relatively common and requires complete work-up following the establishment of a neurological diagnosis. Appropriate cardiac treatment significantly improves the overall long-term outcome of NMDs.
Collapse
Affiliation(s)
| | - Claudia Stöllberger
- 2 Medical Department with Cardiology and Intensive Care Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria
| |
Collapse
|
16
|
Finsterer J, Zarrouk-Mahjoub S. Management of juvenile stroke from noncompaction with muscular dystrophy. Int J Cardiol 2015; 184:371-372. [DOI: 10.1016/j.ijcard.2015.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 02/21/2015] [Indexed: 10/23/2022]
|
17
|
Smid B, van der Tol L, Cecchi F, Elliott P, Hughes D, Linthorst G, Timmermans J, Weidemann F, West M, Biegstraaten M, Lekanne Deprez R, Florquin S, Postema P, Tomberli B, van der Wal A, van den Bergh Weerman M, Hollak C. Uncertain diagnosis of Fabry disease: Consensus recommendation on diagnosis in adults with left ventricular hypertrophy and genetic variants of unknown significance. Int J Cardiol 2014; 177:400-8. [DOI: 10.1016/j.ijcard.2014.09.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/14/2014] [Indexed: 02/05/2023]
|
18
|
Finsterer J, Kothari S. Cardiac manifestations of primary mitochondrial disorders. Int J Cardiol 2014; 177:754-63. [PMID: 25465824 DOI: 10.1016/j.ijcard.2014.11.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/23/2014] [Accepted: 11/03/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES One of the most frequently affected organs in mitochondrial disorders (MIDs), defined as hereditary diseases due to affection of the mitochondrial energy metabolism, is the heart. Cardiac involvement (CI) in MIDs has therapeutic and prognostic implications. This review aims at summarizing and discussing the various cardiac manifestations in MIDs. METHODS Data for this review were identified by searches of MEDLINE, Current Contents, and PubMed using appropriate search terms. RESULTS CI in MIDs may be classified according to various different criteria. In the present review cardiac abnormalities in MIDs are discussed according to their frequency with which they occur. CI in MIDs includes cardiomyopathy, arrhythmias, heart failure, pulmonary hypertension, dilation of the aortic root, pericardial effusion, coronary heart disease, autonomous nervous system dysfunction, congenital heart defects, or sudden cardiac death. The most frequent among the cardiomyopathies is hypertrophic cardiomyopathy, followed by dilated cardiomyopathy, and noncompaction. CONCLUSIONS CI in MID is more variable and prevalent than previously thought. All tissues of the heart may be variably affected. The most frequently affected tissue is the myocardium. MIDs should be included in the differential diagnoses of cardiac disease.
Collapse
|
19
|
Abstract
Primary mitochondrial disorders are clinically and genetically heterogeneous, caused by an alteration(s) in either mitochondrial DNA or nuclear DNA, and affect the respiratory chain's ability to undergo oxidative phosphorylation, leading to decreased production of adenosine triphosphophate and subsequent energy failure. These disorders may present at any age, but children tend to have an acute onset of disease compared with subacute or slowly progressive presentation in adults. Varying organ involvement also contributes to the phenotypic spectrum seen in these disorders. The childhood presentation of primary mitochondrial disease is mainly due to nuclear DNA mutations, with mitochondrial DNA mutations being less frequent in childhood and more prominent in adulthood disease. The clinician should be aware of the pediatric presentation of mitochondrial disease and have an understanding of the myriad of nuclear genes responsible for these disorders. The nuclear genes can be best understood by utilizing a classification system of location and function within the mitochondria.
Collapse
Affiliation(s)
- Amy C Goldstein
- Division of Child Neurology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
| | | | | |
Collapse
|
20
|
Ryan TD, Ware SM, Lucky AW, Towbin JA, Jefferies JL, Hinton RB. Left ventricular noncompaction cardiomyopathy and aortopathy in a patient with recessive dystrophic epidermolysis bullosa. Circ Heart Fail 2012; 5:e81-2. [PMID: 22991407 DOI: 10.1161/circheartfailure.112.969675] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas D Ryan
- The Heart Institute, Divisions of Cardiology and Molecular Cardiovascular Biology, and Division of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | | | | | | | | | | |
Collapse
|
21
|
Finsterer J, Mahjoub SZ. Primary mitochondrial arteriopathy. Nutr Metab Cardiovasc Dis 2012; 22:393-399. [PMID: 22520486 DOI: 10.1016/j.numecd.2012.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/27/2011] [Accepted: 01/05/2012] [Indexed: 12/28/2022]
Abstract
AIM Whether arteries are affected in mitochondrial disorders (MIDs) was under debate for years but meanwhile there are strong indications that large and small arteries are primarily or secondarily affected in MIDs. DATA SYNTHESIS When reviewing the literature for appropriate studies it turned out that vascular involvement in MIDs includes primary or secondary micro- or macroangiopathy of the cerebral, cervical, and retinal arteries, the aorta, the iliac arteries, the brachial arteries, or the muscular arteries. Arteriopathy in MIDs manifests as atherosclerosis, stenosis, occlusion, dissection, ectasia, aneurysm formation, or arteriovenous malformation. Direct evidence for primary cerebral microangiopathy comes from histological studies and indirect evidence from imaging and perfusion studies of the brain. Microangiopathy of the retina is highly prevalent in Leber's hereditary optic neuropathy. Macroangiopathy of the carotid arteries may be complicated by stroke. Arteriopathy of the aorta may result in ectasia, aneurysm formation, or even rupture. Further evidence for arteriopathy in MIDs comes from the frequent association of migraine with MIDs and the occurrence of premature atherosclerosis in MID patients without classical risk factors. CONCLUSIONS Mitochondrial arteriopathy most frequently concerns the cerebral arteries and may result from the underlying metabolic defect or secondary from associated vascular risk factors. Vascular involvement in MIDs has a strong impact on the prognosis and outcome of these patients.
Collapse
Affiliation(s)
- J Finsterer
- Danube University Krems, Krems, Postfach 20, 1180 Vienna, Austria.
| | | |
Collapse
|