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Gaier ED, Jaimes C, Gise RA, Armstrong-Javors AE, Kadzielski SM. Case 25-2024: A 12-Year-Old Boy with Autism and Decreased Vision. N Engl J Med 2024; 391:641-650. [PMID: 39141857 DOI: 10.1056/nejmcpc2309726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Affiliation(s)
- Eric D Gaier
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
| | - Camilo Jaimes
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
| | - Ryan A Gise
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
| | - Amy E Armstrong-Javors
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
| | - Sarah M Kadzielski
- From the Departments of Ophthalmology (E.D.G., R.A.G.), Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Harvard Medical School, the Department of Ophthalmology, Boston Children's Hospital (E.D.G., R.A.G.), the Department of Ophthalmology, Massachusetts Eye and Ear (E.D.G., R.A.G.), and the Departments of Radiology (C.J.), Pediatrics (A.E.A.-J., S.M.K.), and Neurology (A.E.A.-J.), Massachusetts General Hospital - all in Boston
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Chia AZ, Ann LS, Sim B, Davis C. Xeropthalmia and optic neuropathy secondary to ARFID: a case report. J Eat Disord 2024; 12:90. [PMID: 38956602 PMCID: PMC11218449 DOI: 10.1186/s40337-024-01042-8] [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: 11/02/2023] [Accepted: 06/09/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Patients with avoidant/restrictive food intake disorder (ARFID) commonly present with loss of weight or faltering growth in the setting of poor nutrition. However, patients with ARFID can present with micronutrient deficiencies without weight loss. In patients with ARFID, clinicians should be vigilant for micronutrient deficiencies and their presentations. CASE PRESENTATION We report a unique case of ARFID in a twelve-year-old girl, who developed micronutrient deficiencies and presented with acute visual loss with a preceding history of impaired night vision. Ophthalmic examination revealed xerophthalmia and bilateral optic neuropathy. Investigations showed severe Vitamin A and folate deficiencies which accounted for her clinical findings. In addition, she was also found to have low Vitamin B12, copper, and Vitamin D levels. She had a history of selective eating from a young age with a diet consisting largely of carbohydrates, with no regular intake of meat, dairy, fruit and vegetables. This was not driven by weight or body image concerns. The patient's symptoms improved significantly with appropriate vitamin replacement and continued multidisciplinary care. CONCLUSIONS This report describes a patient with ARFID presenting with visual complaints. In this case, the selective eating behaviours resulted in xeropthalmia and optic neuropathy. Micronutrient deficiencies are uncommon in developed countries. When these deficiencies are suspected, eating disorders, such as ARFID, should be considered. Similarly, clinicians caring for patients with restrictive eating disorders including ARFID should be familiar with the clinical presentations of various micronutrient deficiencies and consider evaluation and treatment for micronutrient deficiencies when clinically indicated.
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Affiliation(s)
- Aletheia Zh Chia
- Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
- SingHealth Duke-NUS Paediatric Academic Clinical Programme, Singapore, Singapore.
| | - Lim Su Ann
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bryan Sim
- Myopia Service, Singapore National Eye Centre, Singapore, Singapore
| | - Courtney Davis
- SingHealth Duke-NUS Paediatric Academic Clinical Programme, Singapore, Singapore
- Adolescent Medicine Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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Ayoubi M, Khodeiry MM, Jiang H, Lee RK. Toxic Optic Neuropathy Due to Chronic Arsenic Exposure. J Neuroophthalmol 2024:00041327-990000000-00669. [PMID: 38913978 DOI: 10.1097/wno.0000000000002198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Affiliation(s)
- Mohammad Ayoubi
- Bascom Palmer Eye Institute (MA, MMK, HJ, RKL), University of Miami Miller School of Medicine, Miami, Florida; and Department of Ophthalmology and Visual Sciences (MMK), University of Kentucky College of Medicine, Lexington, Kentucky
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Othman I, Tai E, Kuganasan S, Abu N. Vision Loss as a Presenting Symptom of Vitamin B12 Deficiency. Cureus 2024; 16:e60113. [PMID: 38864050 PMCID: PMC11164691 DOI: 10.7759/cureus.60113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 06/13/2024] Open
Abstract
Nutritional optic neuropathy is a rare and often overlooked factor leading to bilateral, symmetrical, and gradual visual impairment. This condition falls within the category of metabolic neuropathies. We documented a case involving bilateral nutritional optic neuropathy attributed to pancytopenia associated with vitamin B12 deficiency. A healthy 65-year-old Indian woman reported a bilateral, progressive, painless decline in vision over the past six months. She had a history of reduced oral intake for the preceding year and denied experiencing any gastrointestinal or constitutional symptoms. Bilateral visual acuity was 1/60. Examination revealed pale optic discs with attenuated vessels in both eyes and a cup-disc ratio of 0.3. The blood analysis showed low indices and a deficiency in serum vitamin B12. Despite undergoing treatment, her vision remained impaired due to the chronic nature of the condition. This case highlights the importance of identifying visual symptoms in an elderly woman experiencing malnutrition caused by inadequate dietary habits, which leads to bilateral nutritional optic neuropathy.
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Affiliation(s)
- Izzati Othman
- Department of Ophthalmology, Hospital Tuanku Jaafar Seremban, Negeri Sembilan, MYS
- Department of Ophthalmology and Visual Science, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Evelyn Tai
- Department of Ophthalmology and Visual Science, Hospital Universiti Sains Malaysia, Kubang Kerian, MYS
| | - Sangeeta Kuganasan
- Department of Ophthalmology, Hospital Tuanku Jaafar Seremban, Negeri Sembilan, MYS
| | - Norlelawati Abu
- Department of Ophthalmology, Hospital Tuanku Jaafar Seremban, Negeri Sembilan, MYS
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5
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Wu M, Li M, Liu W, Yan M, Li L, Ding W, Nian X, Dai W, Sun D, Zhu Y, Huang Q, Lu X, Cai Z, Hong F, Li X, Zhang L, Liu Z, Mo W, Zhang X, Zhang L. Nucleoporin Seh1 maintains Schwann cell homeostasis by regulating genome stability and necroptosis. Cell Rep 2023; 42:112802. [PMID: 37453065 DOI: 10.1016/j.celrep.2023.112802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Schwann cells play critical roles in peripheral neuropathies; however, the regulatory mechanisms of their homeostasis remain largely unknown. Here, we show that nucleoporin Seh1, a component of nuclear pore complex, is important for Schwann cell homeostasis. Expression of Seh1 decreases as mice age. Loss of Seh1 leads to activated immune responses and cell necroptosis. Mice with depletion of Seh1 in Schwann cell lineage develop progressive reduction of Schwann cells in sciatic nerves, predominantly non-myelinating Schwann cells, followed by neural fiber degeneration and malfunction of the sensory and motor system. Mechanistically, Seh1 safeguards genome stability by mediating the interaction between SETDB1 and KAP1. The disrupted interaction after ablation of Seh1 derepresses endogenous retroviruses, which triggers ZBP1-dependent necroptosis in Schwann cells. Collectively, our results demonstrate that Seh1 is required for Schwann cell homeostasis by maintaining genome integrity and suggest that decrease of nucleoporins may participate in the pathogenesis of periphery neuropathies.
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Affiliation(s)
- Mei Wu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Man Li
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Wei Liu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Minbiao Yan
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Li Li
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Weichao Ding
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Ximing Nian
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Wenxiu Dai
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Di Sun
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Yanqin Zhu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Qiuying Huang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Xiaoyun Lu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Zhiyu Cai
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Fan Hong
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Xuewen Li
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Ling Zhang
- Department of Clinic Laboratory, the affiliated Chenggong Hospital, School of Medicine, Xiamen University, Xiamen, Fujian 361102, China
| | - Zhixiong Liu
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Wei Mo
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Xueqin Zhang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China
| | - Liang Zhang
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Department of Gynaecology and Obstetrics, Women and Children's Hospital Affiliated to Xiamen University, Faculty of Medicine and Life Sciences, Xiamen University, Xiamen, Fujian 361102, China.
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Oxidative Stress in Antibiotic Toxic Optic Neuropathy Mimicking Acute LHON in a Patient with Exacerbation of Cystic Fibrosis. STRESSES 2023. [DOI: 10.3390/stresses3010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
The striking similarity of disc edema without leakage on fluorescein angiography, which is pathognomonic of Leber hereditary optic neuropathy (LHON), was present in a patient with cystic fibrosis with antibiotic toxic optic neuropathy. This similarity suggested the common effect of oxidative stress on retinal ganglion cells in inherited mitochondrial and antibiotic optic neuropathies. We present the case of a patient with advanced cystic fibrosis on chronic antibiotic treatment who experienced a rapid painless bilateral visual decline over a course of a few weeks. At examination, his corrected visual acuity was reduced to 0.3 in both eyes, with dyschromatopsia and central scotoma. The appearance of the fundus resembled the typical clinical features of acute LHON with hyperemic optic discs and tortuous vessels with no dye leakage from the optic discs on fluorescein angiography. Ganglion cell layer loss was seen on optic coherence tomography, with all findings pointing to LHON. Genetic testing did not reveal any LHON-specific mutations. After extended genetic testing, a heterozygous variant c.209C>T in the OPA3 gene on chromosome 19, g.46032648G>A, classified as a variant of unknown significance, was also found. After discontinuing antibiotics and general improvements in his health, surprisingly, his visual function completely improved. Later, he also received a bilateral lung transplant that further improved his general condition, and his vision remained normal. Excluding LHON, the transient optic neuropathy in our patient could be mainly due to antibiotic toxicity of linezolid and ciprofloxacin, which have been linked to mitochondrial dysfunction and advanced cystic fibrosis with hypoxic status. We suggest the possibility that patients with cystic fibrosis may be more prone to developing mitochondrial optic neuropathy, especially with additional risk factors such as chronic antibiotic therapy, which affect mitochondrial function, and can perhaps serve as a model for LHON.
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Koca S, Bozkurt E, Dogan M, Yavasoglu F, Erogul Ö, Bulut AK. Effects of B12 Deficiency Anemia on Radial Peripapillary and Macular Vessel Density: An Optical Coherence Tomography Angiography (OCTA) Study. Klin Monbl Augenheilkd 2023; 240:92-98. [PMID: 35320869 DOI: 10.1055/a-1738-9941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND To evaluate the macular and optic disc vascular changes in vitamin B12 deficiency anemia. METHODS A total of 24 patients with vitamin B12 deficiency anemia and 24 healthy controls were involved in this study. All participants were evaluated for central macular thickness (CMT), peripapillary retina nerve fiber layer (RNFL) thickness, foveal avascular zone (FAZ) area, macular vessel density (VD) in superficial capillary plexus (SCP) and deep capillary plexus (DCP), choriocapillaris flow area, and optic disc radial peripapillary capillary (RPC) VD using optic coherence tomography (OCT) and optic coherence tomography angiography (OCTA). Metabolic parameters were also noted. RESULTS Temporal RNFL thickness significantly decreased in the B12 deficiency anemia group (p = 0.04). Choriocapillaris flow area (p = 0.045) and macular vessel density in both SCP (p = 0.022) and DCP (p = 0.018) markedly declined in the study group. Optic disc RPC VD in the B12 deficiency anemia group was lower in all regions compared to that of the control group, but the difference was not statistically significant (p > 0.05). There were significant positive correlations between choriocapillaris flow area, macular VD, vitamin B12, and hemoglobin. CONCLUSION Retinal vascular alterations were observed in B12 deficiency anemia, and OCTA may be beneficial in the diagnosis and follow-up of ocular complications in these cases.
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Affiliation(s)
- Semra Koca
- Department of Ophthalmology, Kayseri City Education and Research Hospital, Kocasinan/Kayseri, Turkey
| | - Erhan Bozkurt
- Department of Internal Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Mustafa Dogan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Filiz Yavasoglu
- Department of Hematology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Özgür Erogul
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Bhartiya S. Niacinamide and Neuroprotection: The Glaucoma Holy Grail. J Curr Glaucoma Pract 2022; 16:141-143. [PMID: 36793265 PMCID: PMC9905873 DOI: 10.5005/jp-journals-10078-1390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
How to cite this article: Bhartiya S. Niacinamide and Neuroprotection: The Glaucoma Holy Grail. J Curr Glaucoma Pract 2022;16(3):141-143.
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Affiliation(s)
- Shibal Bhartiya
- Department of Ophthalmology, Fortis Memorial Research Institute (FMRI) Gurgaon, Haryana, India
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Zibold J, von Livonius B, Kolarova H, Rudolph G, Priglinger CS, Klopstock T, Catarino CB. Vitamin B12 in Leber hereditary optic neuropathy mutation carriers: a prospective cohort study. Orphanet J Rare Dis 2022; 17:310. [PMID: 35945620 PMCID: PMC9361590 DOI: 10.1186/s13023-022-02453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Leber hereditary optic neuropathy (LHON) is the most common mitochondrial disorder, frequently resulting in acute or subacute severe bilateral central vision loss. Vitamin B12 deficiency is also a known cause of optic neuropathy through mitochondrial dysfunction. Here we evaluated the prevalence and clinical significance of vitamin B12 deficiency in a large cohort of LHON patients and asymptomatic mutation carriers from a tertiary referral center. Methods From the Munich LHON prospective cohort study, participants included all LHON patients and asymptomatic LHON mutation carriers, who were recruited between February 2014 and March 2020 and consented to participate. Neurological, general, and ophthalmological examinations were regularly performed, as were laboratory tests. Vitamin B12 deficiency was diagnosed if serum vitamin B12 was below 201 pg/mL, or if 201–339 pg/mL plus low serum holotranscobalamin or elevated serum methylmalonic acid or elevated total plasma homocysteine. Results We analyzed 244 subjects, including 147 symptomatic LHON patients (74% males) and 97 asymptomatic mutation carriers (31% males). Median age at study baseline was 34 years (range 5–82 years). The prevalence of vitamin B12 deficiency was higher for LHON mutation carriers than for the general population in all age categories. This was statistically significant for the LHON mutation carriers under 65 years (21% vs. 5–7%, p = 0.002). While vitamin B12 deficiency prevalence was not statistically different between LHON patients and asymptomatic mutation carriers, its clinical correlates, e.g., macrocytosis and polyneuropathy, were more frequent in the subgroup of LHON patients. Excessive alcohol consumption was a significant predictor of vitamin B12 deficiency (p < 0.05). Conclusions The high prevalence of vitamin B12 deficiency in LHON mutation carriers, both asymptomatic mutation carriers and LHON patients, highlights the need for regular vitamin B12 screening in this population, in order to ensure early treatment, aiming for better outcomes. Our study is not conclusive regarding vitamin B12 deficiency as determinant for disease conversion in LHON, and further research is warranted to disentangle the role of vitamin B12 in the pathophysiology and prognosis of LHON.
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Affiliation(s)
- Julia Zibold
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig-Maximilian University (LMU) Munich, Ziemssenstr. 1a, 80336, Munich, Germany
| | - Bettina von Livonius
- Department of Ophthalmology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Hana Kolarova
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig-Maximilian University (LMU) Munich, Ziemssenstr. 1a, 80336, Munich, Germany.,Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Günter Rudolph
- Department of Ophthalmology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Claudia S Priglinger
- Department of Ophthalmology, University Hospital, Ludwig-Maximilian University (LMU) Munich, Munich, Germany
| | - Thomas Klopstock
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig-Maximilian University (LMU) Munich, Ziemssenstr. 1a, 80336, Munich, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Claudia B Catarino
- Department of Neurology, Friedrich-Baur Institute, University Hospital, Ludwig-Maximilian University (LMU) Munich, Ziemssenstr. 1a, 80336, Munich, Germany.
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Stramkauskaitė A, Povilaityte I, Glebauskiene B, Liutkeviciene R. Clinical Overview of Leber Hereditary Optic Neuropathy. Acta Med Litu 2022; 29:9-18. [PMID: 36061944 PMCID: PMC9428633 DOI: 10.15388/amed.2022.29.1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
Leber hereditary ptic neuropathy (LHON) is a disease of young adults with bilateral, painless, subacute visual loss. The peak age of onset of LHON is in the second and third decades of life. Men are 4 times more likely to be affected than women. In about 25-50% of cases, both eyes are affected simultaneously. In unilateral cases, the other eye is usually affected 2 to 3 months later. Visual acuity deteriorates to counting fingers or worse with a dense central or centrocecal scotoma. In the subacute phase, the optic disc may appear hyperemic with swelling of the peripapillary retinal nerve fibre layer, peripapillary telangiectasias, and increased vascular tortuosity. Ocular coherence tomography of the macula shows marked thinning of the ganglion cell complex even at this stage. The diagnosis of LHON is made in a subject with a consistent clinical history and/or one of three common pathogenic mitochondrial DNA (mtDNA) variants identified by molecular genetic testing. Idebenone was approved by the European Medicines Agency under exceptional circumstances for the treatment of LHON. Current evidence suggests some benefit to vision in a subset of affected individuals treated with idebenone, particularly when treated within the first year of onset of vision loss. In this article, we discuss aetiology, clinical features, diagnosis, differential dignosis, prognosis and treatment.
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Sen S, Mandal S, Banerjee M, Gk R, Saxena A, Aalok SP, Saxena R. Ethambutol-induced optic neuropathy: Functional and structural changes in the retina and optic nerve. Semin Ophthalmol 2022; 37:730-739. [PMID: 35699333 DOI: 10.1080/08820538.2022.2085517] [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] [Indexed: 10/18/2022]
Abstract
BACKGROUD Ethambutol hydrochloride (EMB) is used in the treatment of tuberculosis and is used as first line modality in combination with other medications. Ethambutol optic neuropathy (EON) is a rare but well-recognised adverse ocular event in patients who receive ethambutol for the treatment of mycobacterial infections and may be potentially devastating with reversible to irreversible changes in visual acuity. KEY FINDINGS Optical coherence tomography has been used to evaluate the thickness of retinal nerve fibre and ganglion cell layers to look for degenerative changes and early markers. Electrophysiological tests like multifocal electroretinogram, visual evoked potentials and visual fields have been used to understand the functional changes associated with established EON and also whether these can be used to detect subclinical EON and correlate them with the structural changes. In this review, we have summarised evidence published till December 2021 related to evaluation of structural and functional changes in the retina and optic nerve in eyes with EON.
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Affiliation(s)
- Sagnik Sen
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Sohini Mandal
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Mousumi Banerjee
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | - Ranjitha Gk
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
| | | | | | - Rohit Saxena
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India
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Food Aversion Leading to Nutritional Optic Neuropathy in a Child With Severe Vitamin A Deficiency. J Neuroophthalmol 2021; 41:e718-e719. [PMID: 33136685 DOI: 10.1097/wno.0000000000001142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Clinicopathological Correlates: Chronic Arsenic Toxicity Causing Bilateral Symmetric Progressive Optic Neuropathy. J Neuroophthalmol 2021; 40:423-427. [PMID: 32441902 DOI: 10.1097/wno.0000000000000961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 70 year-old man presented with insidiously progressing central visual acuity loss in both eyes over several years. Objectively the only abnormality identified on the exam was questionable granularity in the fovea in each eye. Extensive work up which included neuro-imaging, screening blood work for toxic and nutritional causes of optic neuropathy as well as electroretinogram and fluorescein angiography to rule out subtle maculopathy was all unrevealing. When vision continued to deteriorate over the next several years investigations were repeated and again did not yield any positive results. Levels of heavy metals were then obtained after further progression of visual loss, revealing very high levels of arsenic. Subsequent investigations revealed that patient has been spending almost every weekend for the past 28 years alone at a remote country cottage where the sole supply of water was from the local well. He also recalled that 1.5 months after purchasing the cottage he developed hemorrhagic colitis requiring partial colectomy. The specimen from colectomy was located and total reflection x-ray fluorescence testing performed in a specialized lab revealed greatly increased level of arsenic particle in the colonic biopsy from 28 years ago. This case is a reminder that heavy metal toxicity should be considered in a differential diagnosis of patients with bilateral symmetric optic neuropathy.
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Sato H, Kyan R, Kamada C, Kaku M, Sato S, Tawara T, Sakawaki E, Sakawaki S, Takeyama Y. Transient total blindness associated with alcoholic ketoacidosis. Acute Med Surg 2021; 8:e660. [PMID: 34012551 PMCID: PMC8112226 DOI: 10.1002/ams2.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
Background Methanol poisoning is often suspected in patients with high anion gap metabolic acidosis and visual deficits. Although alcoholic ketoacidosis can cause high anion gap metabolic acidosis, reports on vision loss are limited. We report the case of a patient with alcoholic ketoacidosis with transient total blindness. Case Presentation A 56‐year‐old man complaining of total blindness was transferred to our hospital. Physical examination revealed a clear consciousness and mydriasis with an absence of pupillary light reflex. Blood analysis revealed high anion gap metabolic acidosis with a high ketone body concentration. Alcoholic ketoacidosis was diagnosed because the patient had a chronic alcohol abuse history and denied methanol intake. As acidemia improved because of fluid infusion and glucose and vitamin B1 supplementation, his visual acuity recovered. He was discharged after 44 days without visual deficits. Conclusion Patients with alcoholic ketoacidosis may present with acute vision loss, which recovers along with treatment.
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Affiliation(s)
- Hiroki Sato
- Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan
| | - Ryoko Kyan
- Clinical Toxicology Center Saitama Medical University Hospital Saitama Japan
| | - Chinami Kamada
- Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan
| | - Mitsunori Kaku
- Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan
| | - Shota Sato
- Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan
| | - Toshihiro Tawara
- Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan
| | - Eiji Sakawaki
- Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan
| | - Sonoko Sakawaki
- Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan
| | - Yoshihiro Takeyama
- Department of Emergency Medicine Hakodate Municipal Hospital Hakodate Japan
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15
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Amore G, Romagnoli M, Carbonelli M, Barboni P, Carelli V, La Morgia C. Therapeutic Options in Hereditary Optic Neuropathies. Drugs 2021; 81:57-86. [PMID: 33159657 PMCID: PMC7843467 DOI: 10.1007/s40265-020-01428-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Options for the effective treatment of hereditary optic neuropathies have been a long time coming. The successful launch of the antioxidant idebenone for Leber's Hereditary Optic Neuropathy (LHON), followed by its introduction into clinical practice across Europe, was an important step forward. Nevertheless, other options, especially for a variety of mitochondrial optic neuropathies such as dominant optic atrophy (DOA), are needed, and a number of pharmaceutical agents, acting on different molecular pathways, are currently under development. These include gene therapy, which has reached Phase III development for LHON, but is expected to be developed also for DOA, whilst most of the other agents (other antioxidants, anti-apoptotic drugs, activators of mitobiogenesis, etc.) are almost all at Phase II or at preclinical stage of research. Here, we review proposed target mechanisms, preclinical evidence, available clinical trials with primary endpoints and results, of a wide range of tested molecules, to give an overview of the field, also providing the landscape of future scenarios, including gene therapy, gene editing, and reproductive options to prevent transmission of mitochondrial DNA mutations.
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Affiliation(s)
- Giulia Amore
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Martina Romagnoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Michele Carbonelli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Via Altura 3, 40139, Bologna, Italy
| | | | - Valerio Carelli
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Chiara La Morgia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Via Altura 3, 40139, Bologna, Italy.
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16
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Gokoffski KK, Patel VR. A case of reversible toxic optic neuropathy from tacrolimus (FK506). Am J Ophthalmol Case Rep 2020; 20:100932. [PMID: 33005819 PMCID: PMC7509794 DOI: 10.1016/j.ajoc.2020.100932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/25/2020] [Accepted: 09/13/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kimberly K. Gokoffski
- Roski Eye Institute, University of Southern California, Los Angeles, CA, 90033, USA
- Corresponding author.
| | - Vivek R. Patel
- Roski Eye Institute, University of Southern California, Los Angeles, CA, 90033, USA
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17
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Roda M, di Geronimo N, Pellegrini M, Schiavi C. Nutritional Optic Neuropathies: State of the Art and Emerging Evidences. Nutrients 2020; 12:E2653. [PMID: 32878163 PMCID: PMC7551088 DOI: 10.3390/nu12092653] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 12/19/2022] Open
Abstract
Nutritional optic neuropathy is a cause of bilateral, symmetrical, and progressive visual impairment with loss of central visual acuity and contrast sensitivity, dyschromatopsia, and a central or centrocecal scotoma. The clinical features are not pathognomonic, since hereditary and toxic forms share similar signs and symptoms. It is becoming increasingly common due to the widespread of bariatric surgery and strict vegetarian or vegan diets, so even the scientific interest has recently increased. In particular, recent studies have focused on possible pathogenetic mechanisms, and on novel diagnostic and therapeutic strategies in order to prevent the onset, make a prompt diagnosis and an accurate nutritional supplementation, and to avoid irreversible optic nerve atrophy. Nowadays, there is clear evidence of the role of cobalamin, folic acid, thiamine, and copper, whereas further studies are needed to define the role of niacin, riboflavin, and pyridoxine. This review aims to summarize the etiology, diagnosis, and treatment of nutritional optic neuropathy, and it is addressed not only to ophthalmologists, but to all physicians who could come in contact with a patient with a possible nutritional optic neuropathy, being a fundamental multidisciplinary approach.
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Affiliation(s)
- Matilde Roda
- Ophthalmology Unit, S. Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (N.d.G.); (M.P.); (C.S.)
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18
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Affiliation(s)
- Denize Atan
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Eye Hospital, University Hospitals NHS Foundation Trust, Bristol, UK
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19
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Sethi HS, Naik M, Gandhi A. Megaloblastic anemia and bilateral disc edema: An enigma… Have we figured it out yet? Taiwan J Ophthalmol 2020; 10:71-75. [PMID: 32309129 PMCID: PMC7158926 DOI: 10.4103/tjo.tjo_27_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022] Open
Abstract
A 28-year-old male presented with insidious-onset, painless, progressive diminution of vision in both eyes. He denied any other ocular symptoms. On examination, visual acuity in both eyes was 6/60. Color vision and contrast sensitivity were maintained in both eyes. Direct ophthalmoscopy revealed that the optic discs were bilaterally hyperemic and congested, with blurring of all the disc margins and loss of spontaneous venous pulsations. Besides this bilateral disc edema, rest of the clinical examination was normal. Primary intensive search for any intracranial space-occupying lesions returned negative on computed tomography scan imaging. Blood investigations revealed a hemoglobin level of 9.2 g/dl, leukocyte count of 7000 cells/mm3, and serum Vitamin B12 level of 155 pg/ml (200–835 pg/ml). Serum homocysteine and methylmalonic acid levels were done and were found to be elevated. After 4 weeks, visual acuity improved to 6/6 in both the eyes, and laboratory investigations showed no signs of Vitamin B12 deficiency. Nonsurgical causes for papilledema should be considered in the differential diagnosis. Early diagnosis and prompt treatment is the key to a good prognosis in Vitamin B12-deficient optic neuropathy, which has shown to have a good prognosis if treatment is initiated in the first few months after the onset of symptoms.
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Affiliation(s)
| | - Mayuresh Naik
- Department of Ophthalmology, V.M.M.C and Safdarjung Hospital, New Delhi, India
| | - Aastha Gandhi
- Department of Ophthalmology, V.M.M.C and Safdarjung Hospital, New Delhi, India
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20
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Gospe SM, Travis AM, Kolesnikov AV, Klingeborn M, Wang L, Kefalov VJ, Arshavsky VY. Photoreceptors in a mouse model of Leigh syndrome are capable of normal light-evoked signaling. J Biol Chem 2019; 294:12432-12443. [PMID: 31248988 DOI: 10.1074/jbc.ra119.007945] [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: 02/27/2019] [Revised: 06/12/2019] [Indexed: 11/06/2022] Open
Abstract
Mitochondrial dysfunction is an important cause of heritable vision loss. Mutations affecting mitochondrial bioenergetics may lead to isolated vision loss or life-threatening systemic disease, depending on a mutation's severity. Primary optic nerve atrophy resulting from death of retinal ganglion cells is the most prominent ocular manifestation of mitochondrial disease. However, dysfunction of other retinal cell types has also been described, sometimes leading to a loss of photoreceptors and retinal pigment epithelium that manifests clinically as pigmentary retinopathy. A popular mouse model of mitochondrial disease that lacks NADH:ubiquinone oxidoreductase subunit S4 (NDUFS4), a subunit of mitochondrial complex I, phenocopies many traits of the human disease Leigh syndrome, including the development of optic atrophy. It has also been reported that ndufs4 -/- mice display diminished light responses at the level of photoreceptors or bipolar cells. By conducting electroretinography (ERG) recordings in live ndufs4 -/- mice, we now demonstrate that this defect occurs at the level of retinal photoreceptors. We found that this deficit does not arise from retinal developmental anomalies, photoreceptor degeneration, or impaired regeneration of visual pigment. Strikingly, the impairment of ndufs4 -/- photoreceptor function was not observed in ex vivo ERG recordings from isolated retinas, indicating that photoreceptors with complex I deficiency are intrinsically capable of normal signaling. The difference in electrophysiological phenotypes in vivo and ex vivo suggests that the energy deprivation associated with severe mitochondrial impairment in the outer retina renders ndufs4 -/- photoreceptors unable to maintain the homeostatic conditions required to operate at their normal capacity.
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Affiliation(s)
- Sidney M Gospe
- Department of Ophthalmology, Duke University, Durham, North Carolina 27710.
| | - Amanda M Travis
- Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina 27710
| | - Alexander V Kolesnikov
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, Missouri 63110
| | - Mikael Klingeborn
- Department of Ophthalmology, Duke University, Durham, North Carolina 27710
| | - Luyu Wang
- Department of Ophthalmology, Duke University, Durham, North Carolina 27710
| | - Vladimir J Kefalov
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, Saint Louis, Missouri 63110
| | - Vadim Y Arshavsky
- Department of Ophthalmology, Duke University, Durham, North Carolina 27710; Department of Pharmacology and Cancer Biology, Duke University, Durham, North Carolina 27710
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21
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Ustaoglu M, Onder F, Karapapak M, Taslidere H, Guven D. Ophthalmic, systemic, and genetic characteristics of patients with Wolfram syndrome. Eur J Ophthalmol 2019; 30:1099-1105. [DOI: 10.1177/1120672119842489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To evaluate the ophthalmic, systemic, and genetic characteristics of patients with Wolfram syndrome. Methods: In total, 13 patients with suspected or clinically diagnosed Wolfram syndrome underwent ophthalmic and systemic examinations and genetic analyses for Wolfram syndrome between August and October 2018. Results: The mean age of the subjects was 24.2 ± 7.1 years, of which 5 (38.5%) subjects were male and 8 (61.5%) were female. The mean best-corrected visual acuity ranged from counting fingers to 20/40, with a mean of 20/250 (1.10 ± 0.69 logarithm of the minimum angle of resolution). Dyschromatopsia was present in all patients (100%). There was a severe decrease in the average peripapillary retinal nerve fiber layer and macular ganglion cell–inner plexiform layer thicknesses (54.7 ± 6.5 and 51.9 ± 4.8 µm, respectively). Optical coherence tomography angiography showed significantly lower whole-image, inside disk, and peripapillary vessel densities in the patients with Wolfram syndrome than in the healthy controls (p < 0.001 for all). All patients who underwent genetic analyses had mutations in the WFS1 gene. Moreover, two novel mutations, p.Met623Trpfs*2 (c.1867delA) and p.Arg611Profs*9 (c.1832_11847del16) at exon 8, were detected. The frequency of systemic findings was as follows: optic atrophy (100%), diabetes mellitus (92.3%), central diabetes insipidus (38.5%), sensorineural hearing loss (38.5%), and presence of urological (30.8%), psychiatric (30.8%), and neurological (23.1%) diseases. Conclusion: Wolfram syndrome is a rare genetic disorder that can be associated with severe ophthalmic and systemic abnormalities. All patients who present with unexplained optic atrophy should be evaluated for Wolfram syndrome, even if they do not have diabetes mellitus because optic atrophy can sometimes manifest before diabetes mellitus.
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Affiliation(s)
- Melih Ustaoglu
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA, USA
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Feyza Onder
- Department of Ophthalmology, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Karapapak
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hasan Taslidere
- Department of Medical Genetics, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Dilek Guven
- Department of Ophthalmology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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22
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Abstract
PURPOSE OF REVIEW Nutritional optic neuropathy is a potential cause of severe visual loss; however, appropriate and timely management can result in excellent visual outcomes. The purpose of this review is to outline our current understanding of the treatment and outcomes for nutritional optic neuropathy. RECENT FINDINGS Current understanding of nutritional optic neuropathy has been greatly aided by some well-reported and investigated epidemics of the condition, most notably the Cuban epidemic optic neuropathy of the early 1990s. More recently, there is an emerging literature surrounding nutritional deficiencies that can occur in patients who have undergone bariatric surgery. There also continues to be a stream of case reports in the literature that add to our understanding. Nutritional optic neuropathy has a great deal of overlap with toxic optic neuropathies and hereditary optic neuropathies and should not be thought of in isolation from these conditions. The mainstay of treatment for nutritional optic neuropathy involves identifying and replacing deficient nutrients as well as identifying and eliminating contributory toxins. It is also important to identify contributory genetic factors and to consider the broader social, economic and societal factors which may contribute.
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Affiliation(s)
- Joanna M Jefferis
- Department of Ophthalmology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
| | - Simon J Hickman
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
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23
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Goglin SE, Manesh R, Graf JD. A 56-Year-Old Man With Visual Changes and Arthralgias. Arthritis Care Res (Hoboken) 2019; 70:153-156. [PMID: 29088577 DOI: 10.1002/acr.23458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/24/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Sarah E Goglin
- University of California, San Francisco, and Zuckerberg San Francisco General Hospital, San Francisco, California
| | - Reza Manesh
- Johns Hopkins University, Baltimore, Maryland
| | - Jonathan D Graf
- University of California, San Francisco, and Zuckerberg San Francisco General Hospital, San Francisco, California
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24
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Williams PA, Harder JM, John SWM. Glaucoma as a Metabolic Optic Neuropathy: Making the Case for Nicotinamide Treatment in Glaucoma. J Glaucoma 2017; 26:1161-1168. [PMID: 28858158 PMCID: PMC5854489 DOI: 10.1097/ijg.0000000000000767] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mitochondrial dysfunction may be an important, if not essential, component of human glaucoma. Using transcriptomics followed by molecular and neurobiological techniques, we have recently demonstrated that mitochondrial dysfunction within retinal ganglion cells is an early feature in the DBA/2J mouse model of inherited glaucoma. Guided by these findings, we discovered that the retinal level of nicotinamide adenine dinucleotide (NAD, a key molecule for mitochondrial health) declines in an age-dependent manner. We hypothesized that this decline in NAD renders retinal ganglion cells susceptible to damage during periods of elevated intraocular pressure. To replete NAD levels in this glaucoma, we administered nicotinamide (the amide of vitamin B3). At the lowest dose tested, nicotinamide robustly protected from glaucoma (~70% of eyes had no detectable glaucomatous neurodegeneration). At this dose, nicotinamide had no influence on intraocular pressure and so its effect was neuroprotective. At the highest dose tested, 93% of eyes had no detectable glaucoma. This represents a ~10-fold decrease in the risk of developing glaucoma. At this dose, intraocular pressure still became elevated but there was a reduction in the degree of elevation showing an additional benefit. Thus, nicotinamide is unexpectedly potent at preventing this glaucoma and is an attractive option for glaucoma therapeutics. Our findings demonstrate the promise for both preventing and treating glaucoma by interventions that bolster metabolism during increasing age and during periods of elevated intraocular pressure. Nicotinamide prevents age-related declines in NAD (a decline that occurs in different genetic contexts and species). NAD precursors are reported to protect from a variety of neurodegenerative conditions. Thus, nicotinamide may provide a much needed neuroprotective treatment against human glaucoma. This manuscript summarizes human data implicating mitochondria in glaucoma, and argues for studies to further assess the safety and efficacy of nicotinamide in human glaucoma care.
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Affiliation(s)
- Pete A Williams
- The Howard Hughes Medical Institute, The Jackson Laboratory, Bar Harbor, ME, USA
| | - Jeffrey M Harder
- The Howard Hughes Medical Institute, The Jackson Laboratory, Bar Harbor, ME, USA
| | - Simon W M John
- The Howard Hughes Medical Institute, The Jackson Laboratory, Bar Harbor, ME, USA
- Department of Ophthalmology, Tufts University of Medicine, Boston, MA, USA
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25
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Pilz YL, Bass SJ, Sherman J. A Review of Mitochondrial Optic Neuropathies: From Inherited to Acquired Forms. JOURNAL OF OPTOMETRY 2017; 10:205-214. [PMID: 28040497 PMCID: PMC5595256 DOI: 10.1016/j.optom.2016.09.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/02/2016] [Accepted: 09/22/2016] [Indexed: 05/28/2023]
Abstract
In recent years, the term mitochondrial optic neuropathy (MON) has increasingly been used within the literature to describe a group of optic neuropathies that exhibit mitochondrial dysfunction in retinal ganglion cells (RGCs). Interestingly, MONs include genetic aetiologies, such as Leber hereditary optic neuropathy (LHON) and dominant optic atrophy (DOA), as well as acquired aetiologies resulting from drugs, nutritional deficiencies, and mixed aetiologies. Regardless of an inherited or acquired cause, patients exhibit the same clinical manifestations with selective loss of the RGCs due to mitochondrial dysfunction. Various novel therapies are being explored to reverse or limit damage to the RGCs. Here we review the pathophysiology, clinical manifestations, differential diagnosis, current treatment, and promising therapeutic targets of MON.
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MESH Headings
- DNA, Mitochondrial
- Diagnosis, Differential
- Humans
- Mitochondrial Diseases/diagnosis
- Mitochondrial Diseases/genetics
- Mitochondrial Diseases/physiopathology
- Mitochondrial Diseases/therapy
- Optic Atrophy, Autosomal Dominant/diagnosis
- Optic Atrophy, Autosomal Dominant/genetics
- Optic Atrophy, Autosomal Dominant/physiopathology
- Optic Atrophy, Autosomal Dominant/therapy
- Optic Atrophy, Hereditary, Leber/diagnosis
- Optic Atrophy, Hereditary, Leber/genetics
- Optic Atrophy, Hereditary, Leber/physiopathology
- Optic Atrophy, Hereditary, Leber/therapy
- Optic Nerve Diseases/diagnosis
- Optic Nerve Diseases/genetics
- Optic Nerve Diseases/physiopathology
- Optic Nerve Diseases/therapy
- Retinal Ganglion Cells/pathology
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Affiliation(s)
- Yasmine L Pilz
- State University New York, College of Optometry, New York, USA.
| | - Sherry J Bass
- State University New York, College of Optometry, New York, USA
| | - Jerome Sherman
- State University New York, College of Optometry, New York, USA
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26
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Kang JH, Willett WC, Rosner BA, Buys E, Wiggs JL, Pasquale LR. Association of Dietary Nitrate Intake With Primary Open-Angle Glaucoma: A Prospective Analysis From the Nurses' Health Study and Health Professionals Follow-up Study. JAMA Ophthalmol 2016; 134:294-303. [PMID: 26767881 DOI: 10.1001/jamaophthalmol.2015.5601] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Nitric oxide signaling alterations in outflow facility and retinal blood flow autoregulation are implicated in primary open-angle glaucoma (POAG). Nitric oxide donation has emerged as a POAG therapeutic target. An exogenous source of nitric oxide is dietary nitrates. OBJECTIVE To evaluate the association between dietary nitrate intake, derived mainly from green leafy vegetables, and POAG. DESIGN, SETTING, AND PARTICIPANTS We followed up participants biennially in the prospective cohorts of the Nurses' Health Study (63 893 women; 1984-2012) and the Health Professionals Follow-up Study (41 094 men; 1986-2012) at each 2-year risk period. Eligible participants were 40 years or older, were free of POAG, and reported eye examinations. EXPOSURES The primary exposure was dietary nitrate intake. Information on diet and potential confounders was updated with validated questionnaires. MAIN OUTCOMES AND MEASURES The main outcome was the incidence of POAG and POAG subtypes; 1483 cases were confirmed with medical records and classified into subtypes defined by intraocular pressure (IOP) (≥22 or <22 mm Hg) or by visual field (VF) loss pattern at diagnosis (peripheral loss only or early paracentral loss). Cohort-specific and pooled multivariable rate ratios (MVRRs) and 95% CIs were estimated. RESULTS During 1 678 713 person-years of follow-up, 1483 incident cases of POAG were identified. The mean (SD) age for the 1483 cases was 66.8 (8.3). Compared with the lowest quintile of dietary nitrate intake (quintile 1: approximately 80 mg/d), the pooled MVRR for the highest quintile (quintile 5: approximately 240 mg/d) was 0.79 (95% CI, 0.66-0.93; P for trend = .02). The dose response was stronger (P for heterogeneity = .01) for POAG with early paracentral VF loss (433 cases; quintile 5 vs quintile 1 MVRR = 0.56; 95% CI, 0.40-0.79; P for trend < .001) than for POAG with peripheral VF loss only (835 cases; quintile 5 vs quintile 1 MVRR = 0.85; 95% CI, 0.68-1.06; P for trend = .50). The association did not differ (P for heterogeneity = .75) by POAG subtypes defined by IOP (997 case patients with IOP ≥22 mm Hg: quintile 5 vs quintile 1 MVRR = 0.82; 95% CI, 0.67-1.01; P for trend = .11; 486 case patients with IOP <22 mm Hg: quintile 5 vs quintile 1 MVRR = 0.71; 95% CI, 0.53-0.96; P for trend = .12). Green leafy vegetables accounted for 56.7% of nitrate intake variation. Compared with consuming 0.31 servings per day, the MVRR for consuming 1.45 or more servings per day was 0.82 for all POAG (95% CI, 0.69-0.97; P for trend = .02) and 0.52 for POAG with paracentral VF loss (95% CI, 0.29-0.96; P for trend < .001). CONCLUSIONS AND RELEVANCE Higher dietary nitrate and green leafy vegetable intake was associated with a lower POAG risk, particularly POAG with early paracentral VF loss at diagnosis.
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Affiliation(s)
- Jae H Kang
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Walter C Willett
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts2Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts3Department of Epidemiology, Harvard
| | - Bernard A Rosner
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts4Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
| | - Emmanuel Buys
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital Research Institute, Boston
| | - Janey L Wiggs
- Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston
| | - Louis R Pasquale
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts6Glaucoma Service, Massachusetts Eye and Ear Infirmary, Boston
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27
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Zeboulon P, Vignal-Clermont C, Baudouin C, Labbé A. Une cause rare de neuropathie optique : le manioc. J Fr Ophtalmol 2016; 39:506-14. [DOI: 10.1016/j.jfo.2016.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 02/16/2016] [Indexed: 12/01/2022]
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28
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Abstract
The purpose of this review is to update clinicians on available literature on the ocular toxicity of ethambutol and the type of eye care to be provided to patients treated with these medications. Ethambutol is a commonly used first-line anti-tuberculosis drug. Since its first use in the 1960s, ocular toxicity is described as related to dose and duration, and it is reversible on therapy discontinuation. However, the reversibility of the toxic optic neuropathy remains controversial. The mechanism of ocular toxicity owing to ethambutol is still under investigation. Other than discontinuing the drug, no specific treatment is available for the optic neuropathy caused by ethambutol. Doctors prescribing ethambutol should be aware of the ocular toxicity, and the drug should be used with proper patient education and ophthalmic monitoring.
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Bilateral optic neuropathy associated with the tumor necrosis factor-alpha inhibitor golimumab. J Neuroophthalmol 2014; 34:336-9. [PMID: 25259862 DOI: 10.1097/wno.0000000000000137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 62-year-old man developed bilateral blurred vision associated with bilateral optic disc swelling shortly after receiving his third dose of the tumor necrosis factor-alpha (TNF-α) inhibitor golimumab, that he took for psoriatic arthritis. An extensive assessment including magnetic resonance imaging, lumbar puncture, and serologies was negative. He was treated with systemic corticosteroids and the golimumab was stopped, after which his vision improved and his disc swelling resolved. We postulate that the bilateral, simultaneous anterior optic neuropathies in this patient were due to golimumab, representing a rare but well-documented serious adverse event associated with TNF-α inhibitors.
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Sultana J, Farooqi A, Ali U. Arsenic concentration variability, health risk assessment, and source identification using multivariate analysis in selected villages of public water system, Lahore, Pakistan. ENVIRONMENTAL MONITORING AND ASSESSMENT 2014; 186:1241-1251. [PMID: 24197557 DOI: 10.1007/s10661-013-3453-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/14/2013] [Indexed: 06/02/2023]
Abstract
This paper reports high levels and variability in arsenic (As) levels at locations identified as one of the highest As-contaminated locations in Pakistan. Groundwater pollution related to arsenic has been reported since many years in the areas lying in outskirts of District Lahore, Pakistan. A comparative study is done to determine temporal variations of As from three villages, i.e., Kalalanwala (KLW), Manga Mandi (MM), and Shamki Bhattian (SKB). Seventy-three percent of the 30 investigated samples ranging in depth from 20 to 200 m, show an increasing trend in variations of As concentration over a time span of 4 years and 87% of samples exceeded the WHO standard of 10 μg/L for As while 77% of samples have As concentration >50 μg/L (national standard). Further results indicate that high levels of As is accompanied with increase pH (r = 0.8) favoring desorption of As from minerals at higher pH under oxidizing conditions. For health risk assessment of arsenic, the average daily dose, hazard quotient (HQ), and cancer risk were calculated. The residents of the studied areas had toxic risk index in the order of SKB>KLW>MM, with 87% of samples exceeding the typical toxic risk index 1.00 (ranging from 2.3-48.6) which was 83% (ranging from 0.3-41) 4 years before. The results of the present study therefore indicate that arsenic concentrations are increasing in the area, which needs an immediate attention to provide alternate sources of water to save people at risk.
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Affiliation(s)
- Jawairia Sultana
- Department of Environmental Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad, 45320, Pakistan,
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31
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Kim JY, Heo DW, Lee HJ, Lee YH. A Case of Thiamine (Vitamin B1)-Deficient Optic Neuropathy Associated with Wernicke's Encephalopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.12.1954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dong Won Heo
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Haeng Jin Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yeon Hee Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
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Abstract
About three-fourths of the total world population live in the tropics but consume only 6% of worldwide food production and contribute 15% of the world's net revenue explaining the short life expectancy, high infantile mortality, and poor daily caloric intake; moreover, lack of clean drinking water and deficient sanitation promote water-borne infections, diarrhea, and risk of malabsorption that contribute to the prevalence of malnutrition in the tropics. One-third of the world's population consumes insufficient iodine increasing the risk for mental retardation and deafness due to maternal hypothyroidism. The main nutritional syndromes comprise protein-energy malnutrition (marasmus and kwashiorkor); nutritional neuropathies, myelopathies and neuromyelopathies, as well as specific deficiencies of vitamins and micronutrients including iodine, iron, zinc, and selenium.
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Affiliation(s)
- Gustavo C Román
- Department of Neurology, Weill Cornell Medical College and Nantz National Alzheimer Center, Methodist Neurological Institute, Houston, TX, USA.
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Visual field characteristics in normal-tension glaucoma patients with autonomic dysfunction and abnormal peripheral microcirculation. Am J Ophthalmol 2012; 154:466-475.e1. [PMID: 22704139 DOI: 10.1016/j.ajo.2012.03.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 03/20/2012] [Accepted: 03/21/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE To elucidate the visual field (VF) characteristics of normal-tension glaucoma (NTG) patients with either autonomic dysfunction or abnormal peripheral microcirculation. DESIGN Prospective, observational study. METHODS participants: Sixty NTG patients. procedures: All subjects underwent a complete ophthalmic examination and were then referred to a rheumatology department, where they were subjected to heart rate variability (HRV) assessment and nailfold capillaroscopy. Subjects with VF defect clusters confined to the central 10 degrees or outside the central 10 degrees (defined as peripheral) in 1 hemifield were selected (n = 60). The central and peripheral regions were divided further into superior and inferior sectors. Patients were classified into low, middle, and high HRV groups using HRV assessment or normal and abnormal capillaroscopy groups using nailfold capillaroscopy findings. The VF characteristics of the groups were compared. main outcome measures: Location of the VF defect, depth of the VF defect, mean deviation, and the pattern standard deviation of the VF. RESULTS The VF defect was more frequent and deepest in the superior central sector in both the low HRV and abnormal capillaroscopy groups. The mean deviation was similar between groups, but the pattern standard deviation was significantly higher in eyes with central defects than in eyes with peripheral defects among those in the low HRV group or abnormal capillaroscopy group. Logistic regression analysis revealed that the group classified by the HRV assessment and the presence of abnormalities in the capillaroscopy were related to the location of the VF defect. CONCLUSIONS NTG patients with low heart rate variability or abnormal nail capillaroscopy may present as central VF defects. Therefore, vascular risk factors need to be considered when NTG patients have central VF defects.
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Pandey PK, Zankyani H, Deshmukh R, Pandey M. Arsenic contamination in central-east India: new lessons for environmental health. ACTA ACUST UNITED AC 2012. [DOI: 10.1080/00207233.2012.626928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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35
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Abstract
The eye allows living functioning blood vessels to be observed and is thus ideal for the study of haematological disease. Disorders of the blood have significant ocular manifestations and pose a real threat to vision, making knowledge of the subject essential to ophthalmologists, haematologists, oncologists and general physicians.
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Axonal degeneration in peripheral nerves in a case of Leber hereditary optic neuropathy. J Neuroophthalmol 2011; 31:6-11. [PMID: 21139512 DOI: 10.1097/wno.0b013e3181fab1b4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Leber hereditary optic neuropathy (LHON) is a mitochondrial DNA (mtDNA) genetic disorder characterized by profound bilateral loss of central vision due to selective loss of retinal ganglion cells. Most patients with LHON do not have complaints related to the peripheral nervous system. We investigated possible qualitative and quantitative histological changes in the peripheral nerve of a patient with LHON as compared to normal controls. METHODS Brachial plexus specimens were obtained at necropsy from a patient with LHON carrying the 3460/ND1 mtDNA mutation and age-matched controls without known history of neurological disease. The nerves were evaluated by light microscope coupled to a digital camera-based morphometric analysis and electron microscopy. RESULTS Extensive axonal degeneration of the large heavily myelinated fibers was found in the brachial plexus from the patient with LHON. In LHON nerve fascicles, we counted over 10 times as many degenerated profiles as found in the control nerve fascicles. CONCLUSIONS Microscopic examination of the brachial plexus in the patient with LHON clearly demonstrated a significant pattern of neurodegeneration. Our study suggests that peripheral neuropathy may be a subclinical feature associated with LHON.
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Viader A, Golden JP, Baloh RH, Schmidt RE, Hunter DA, Milbrandt J. Schwann cell mitochondrial metabolism supports long-term axonal survival and peripheral nerve function. J Neurosci 2011; 31:10128-40. [PMID: 21752989 PMCID: PMC3147283 DOI: 10.1523/jneurosci.0884-11.2011] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/25/2011] [Accepted: 05/04/2011] [Indexed: 11/21/2022] Open
Abstract
Mitochondrial dysfunction is a common cause of peripheral neuropathies. While the role of neuron and axonal mitochondria in peripheral nerve disease is well appreciated, whether Schwann cell (SC) mitochondrial deficits contribute to peripheral neuropathies is unclear. Here, we examine how SC mitochondrial dysfunction affects axonal survival and contributes to the decline of peripheral nerve function by generating mice with SC-specific mitochondrial deficits. These mice (Tfam-SCKOs) were produced through the tissue-specific deletion of the mitochondrial transcription factor A gene (Tfam), which is essential for mitochondrial DNA (mtDNA) transcription and maintenance. Tfam-SCKOs were viable, but as they aged, they developed a progressive peripheral neuropathy characterized by nerve conduction abnormalities as well as extensive muscle denervation. Morphological examination of Tfam-SCKO nerves revealed early preferential loss of small unmyelinated fibers followed by prominent demyelination and degeneration of larger-caliber axons. Tfam-SCKOs displayed sensory and motor deficits consistent with this pathology. Remarkably, the severe mtDNA depletion and respiratory chain abnormalities in Tfam-SCKO mice did not affect SC proliferation or survival. Mitochondrial function in SCs is therefore essential for maintenance of axonal survival and normal peripheral nerve function, suggesting that SC mitochondrial dysfunction contributes to human peripheral neuropathies.
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Affiliation(s)
| | | | - Robert H. Baloh
- Department of Neurology
- Hope Center for Neurological Disorders, and
| | | | - Daniel A. Hunter
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri 63110
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Abstract
The optic disc represents the anterior end of the optic nerve, the most forward extension of the central nervous system (CNS). The optic disc gives a rare glimpse into the CNS. Hence, diseases of the CNS are often manifested on fundus examination. Abnormalities of the optic disc may reflect eye disease (such as glaucoma), problems in development (as in various syndromes), or CNS disease (such as increased intracranial pressure). Each optic nerve is composed of about 1.2 million axons deriving from the retinal ganglion cells of one eye. Optic atrophy is a morphological sequela reflecting the loss of many or all of these axons. Myriad diseases such as hereditary, metabolic, tumor, and increased intracranial pressure can lead to optic atrophy. Some diseases, such as optic disc drusen, intracranial masses, orbital tumors, ischemic optic neuropathies, inflammations, and infiltrations, can produce optic disc edema before leading to optic atrophy. A number of new imaging modalities, such as optical coherence tomography (OCT), quantitate the thickness of the peripapillary retinal nerve fiber layer as an indirect measure of axonal loss or swelling. OCT can therefore be used to quantitate pathology or the response to therapy in various generalized CNS conditions, such as multiple sclerosis.
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Affiliation(s)
- Alfredo A Sadun
- Departments of Ophthalmology and Neurosurgery, Doheny Eye Institute, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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39
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Theeler BJ, Wilson DJ, Crawford CM, Grazko M. Optic neuropathy and a reversible splenial lesion after gastric bypass: A shared pathophysiology? J Neurol Sci 2010; 291:92-4. [DOI: 10.1016/j.jns.2010.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 01/15/2010] [Accepted: 01/15/2010] [Indexed: 10/19/2022]
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40
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Seo JH, Hwang JM, Park SS. Antituberculosis medication as a possible epigenetic factor of Leber's hereditary optic neuropathy. Clin Exp Ophthalmol 2010; 38:363-6. [DOI: 10.1111/j.1442-9071.2010.02240.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Linezolid-associated optic neuropathy in a patient with ocular sarcoidosis. Jpn J Ophthalmol 2009; 53:420-4. [PMID: 19763761 DOI: 10.1007/s10384-009-0678-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We describe a case of bilateral linezolid-associated optic neuropathy in a patient with ocular sarcoidosis. CASE A 70-year-old woman with sarcoidosis noted foggy vision in both eyes. Best-corrected visual acuity was 0.5 in the right eye and 0.9 in the left. No abnormality other than slight optic disc hyperemia was visible in either eye. A central scotoma in both eyes and enlargement of the blind spot in the right eye were detected by Goldmann perimetry examination, and magnetic resonance imaging demonstrated an edematous optic nerve in the right eye. Therefore, retrobulbar optic neuritis resulting from sarcoidosis was initially suspected. Sub-Tenon's capsule injection of triamcinolone acetonide along with steroid pulse therapy was given; however, best-corrected visual acuity worsened to 0.06 in the right eye and 0.08 in the left. Pulse therapy was discontinued on day 1, and the possibility of linezolid-associated optic neuropathy was speculated because linezolid had been given for methicillin-resistant Staphylococcus aureus osteomyelitis 2 years before by an orthopedist. After discontinuation of linezolid, best-corrected visual acuity improved to 0.8 in the right eye and 0.9 in the left, and the optic disc hyperemia in both eyes disappeared. CONCLUSION Our findings demonstrate that it is important for ophthalmologists as well as physicians and orthopedists to consider the possibility of optic neuropathy caused by long-term use of linezolid.
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42
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Aggarwal D, Carelli V, Sadun AA. Genotype–phenotype correlations in mitochondrial optic neuropathies. EXPERT REVIEW OF OPHTHALMOLOGY 2009. [DOI: 10.1586/eop.09.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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43
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Characterizing ethambutol-induced optic neuropathy with a 3D computer-automated threshold Amsler grid test. Clin Exp Ophthalmol 2008; 36:484-8. [DOI: 10.1111/j.1442-9071.2008.01807.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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44
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Abstract
Nutritional deficiency may be the cause of a genuine optic neuropathy, sometimes associated with involvement of the peripheral nervous system. Nutritional optic neuropathies are usually bilateral, painless, chronic, insidious and slowly progressive. Most often, they present as a non-specific retrobulbar optic neuropathy. The differential diagnosis with other causes of optic nerve involvement, in particular of toxic origin, may be particularly difficult. Nutritional deficits are often associated with toxic effects from alcohol and tobacco; therefore, the separation of the nutritional and toxic components is often illusory and artificial. The pathophysiological mechanisms involved in nutritional -- and toxic -- optic neuropathies affect biochemical pathways involved in cell energetic production, correction of oxidative stress and quenching of free radicals. The recognition of these mechanisms could provide future therapeutic alternatives. Currently, the treatment is limited to the intensive use of vitamins with variable results in individual cases, and to the implementation of preventive measures, when feasible.
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Affiliation(s)
- C Orssaud
- Department of Ophthalmology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, 20, Rue Leblanc, 75015, Paris, France.
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45
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Kee C, Hwang JM. Authors’ reply: ‘Optical coherence tomography in a patient with tobacco-alcohol amblyopia’. Eye (Lond) 2007. [DOI: 10.1038/sj.eye.6702951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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46
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Spinazzi M, De Lazzari F, Tavolato B, Angelini C, Manara R, Armani M. Myelo-optico-neuropathy in copper deficiency occurring after partial gastrectomy. Do small bowel bacterial overgrowth syndrome and occult zinc ingestion tip the balance? J Neurol 2007; 254:1012-7. [PMID: 17415508 DOI: 10.1007/s00415-006-0479-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Revised: 09/25/2006] [Accepted: 10/09/2006] [Indexed: 11/30/2022]
Abstract
Acquired copper deficiency has recently been recognized as a cause of myeloneuropathy mimicking subacute combined degeneration due to vitamin B-12 deficiency. A remote history of gastric surgery is frequently associated with this syndrome. However, the very limited prevalence of severe copper deficiency in patients with a history of gastric surgery suggests that additional contributing factors are likely to be involved. We describe a patient with copper deficiency and a previous Billroth II partial gastrectomy for gastric carcinoma, presenting with severe myelo-optico-neuropathy, demyelinating lesions of the brain, and subjective hyposmia. An abnormal glucose breath test also revealed small bowel bacterial overgrowth syndrome. Copper replacement therapy associated with antibiotic therapy was effective in preventing further neurological damage and in obtaining mild improvement. We propose that copper status should be evaluated in all patients presenting with unexplained noninflammatory myeloneuropathy. Small bowel bacterial overgrowth syndrome should be investigated as a cause of generalized malabsorption and a possible contributing factor to copper deficiency after gastric surgery, as should occult zinc ingestion.
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Affiliation(s)
- Marco Spinazzi
- Second Neurological Unit, Dept. of Neurosciences, University of Padova Ospedale S Antonio, Via Facciolati 71, 35100, Padova, Italy.
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47
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Javaheri M, Khurana RN, O'hearn TM, Lai MM, Sadun AA. Linezolid-induced optic neuropathy: a mitochondrial disorder? Br J Ophthalmol 2007; 91:111-5. [PMID: 17179125 PMCID: PMC1857552 DOI: 10.1136/bjo.2006.102541] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We report a case of bilateral mitochondrial optic neuropathies secondary to long-term linezolid treatment, show the nature of recovery, review the findings in the literature and propose a potential mitochondrial mechanism for linezolid-induced mitochondrial optic neuropathy. This is an observational case report and literature review with presentation of the clinical course of linezolid mitochondrial optic neuropathies through clinical and psychophysical documentation. Main outcome measures included: visual acuity, funduscopical examinations and peripapillary retinal nerve fibre layer (PRNFL) optical coherence tomography (OCT). A 6-year-old boy presented with bilateral optic neuropathies secondary to 1 year of linezolid treatment for osteomyelitis of the mandible. On presentation, visual acuities were 20/400 in both eyes, with considerable optic disc oedema, hyperaemia and PRNFL swelling confirmed by OCT. 2 weeks after the discontinuation of linezolid, visual acuities returned to 20/25 in both eyes, with reduction in the optic disc oedema, hyperaemia and PRNFL swelling. 3 months after the discontinuation of linezolid treatment, visual acuities were stable at 20/20 in both eyes, with a marked decrease in PRNFL swelling confirmed by OCT, and the development of mild temporal optic disc pallor in both eyes. Doctors should be aware of impairments of vision among patients on long-term linezolid treatment and promptly discontinue treatment to prevent irreversible vision loss. The development and resolution of bilateral optic neuropathies with considerable PRNFL swelling in this patient provide insight into the more general rubric of mitochondrial optic neuropathies.
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Affiliation(s)
- M Javaheri
- Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine, University of Southern California, 1450 San Pablo Street DEI 5802, Los Angeles, CA 90033, USA
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48
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Abstract
This article reviews several retrospective case series and reported adverse events regarding common ocular adverse effects related to systemic therapy. It is not intended as a comprehensive summary of these well described adverse drug reactions, nor is it intended to cover the complete spectrum of all ocular adverse effects of systemic therapy. Many systemic drugs may produce ocular toxicity, including bisphosphonates, topiramate, vigabatrin, isotretinoin and other retinoids, amiodarone, ethambutol, chloroquine and hydroxychloroquine, tamoxifen, quetiapine, cyclo-oxygenase (COX)-2 inhibitors, erectile dysfunction agents and some herbal medications. For this review, the certainty of the adverse effect profile of each medication was evaluated according to the WHO Causality Assessment Guide.A certain relationship has been established for pamidronate and alendronate as causes of scleritis, uveitis, conjunctivitis and blurred vision. Topiramate has been established as adversely causing symptoms consistent with acute angle-closure glaucoma, typically bilateral. Vigabatrin has been shown to cause bilateral irreversible visual field defects attributed to underlying medication-induced retinal pathology. Isotretinoin should be considered in the differential diagnosis of any patient with pseudotumour cerebri. Patients taking amiodarone and hydroxychloroquine should be monitored and screened regularly for development of optic neuropathy and maculopathy, respectively. Sildenafil has been reported to cause several changes in visual perception and is a possible, not yet certain, cause of anterior ischaemic optic neuropathy. Patients taking tamoxifen should also be monitored for development of dose-dependent maculopathy and decreased colour vision. COX-2 inhibitors should be included in the differential diagnosis of reversible conjunctivitis. Several herbal medications including canthaxanthine, chamomile, datura, Echinacea purpurea, Ginkgo biloba and liquorice have also been associated with several ocular adverse effects. It is the role of all healthcare professionals to detect, treat and educate the public about adverse reactions to medications as they are an important health problem.
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Affiliation(s)
- Ricardo M Santaella
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97201, USA
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49
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Abstract
Ethambutol optic neuropathy is a well-recognised adverse ocular event in patients who receive ethambutol for the treatment of mycobacterial infections. Much has been published on this condition; however, understanding of patient outcomes and the mechanism by which ethambutol optic neuropathy occurs, as well as data published in textbooks and reference books, tend to lag behind what is currently known. The purpose of this article is to update the clinician on what is currently accepted in regards to the clinical presentation of ethambutol optic neuropathy and what type of eye care should be provided to patients treated with this medication. In addition, new treatment recommendations are suggested to assist clinicians in complying with currently accepted standards of care.
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Affiliation(s)
- Frederick W Fraunfelder
- Casey Eye Institute, Oregon Health & Science University, 3375 S.W. Terwilliger Boulevard, Portland, OR 97239-4197, USA.
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50
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Billaut-Laden I, Rat E, Allorge D, Crunelle-Thibaut A, Cauffiez C, Chevalier D, Lo-Guidice JM, Broly F. Evidence for a functional genetic polymorphism of the human mercaptopyruvate sulfurtransferase (MPST), a cyanide detoxification enzyme. Toxicol Lett 2006; 165:101-11. [PMID: 16545926 DOI: 10.1016/j.toxlet.2006.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Revised: 02/05/2006] [Accepted: 02/08/2006] [Indexed: 10/24/2022]
Abstract
Mercaptopyruvate sulfurtransferase (MPST) plays a central role in both cysteine degradation and cyanide detoxification. Moreover, deficiency in MPST activity has been suggested to be responsible for a rare inheritable disorder known as mercaptolactate-cysteine disulfiduria (MCDU). To date, no mutation of the human MPST gene has been reported. We developed a screening strategy to search for mutations in the MPST gene of 50 unrelated French individuals. Two intronic polymorphisms (IVS1-110C>G and IVS2+39C>T) and a nonsense mutation (Tyr(85)Stop) were identified and their functional consequences were assessed in vivo by measurement of erythrocyte MPST activity and/or in vitro using heterologous expression or transient transfection assay. The nonsense mutation likely leads to the synthesis of a severely truncated protein without enzymatic activity, as supported by our in vitro data. This work constitutes the first report of the existence of a functional genetic polymorphism affecting MPST and should be of great help to investigate certain disorders such as MCDU.
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Affiliation(s)
- Ingrid Billaut-Laden
- Equipe d'accueil EA2679, Faculté de Médecine, Pôle Recherche, 1 place de Verdun, 59045 Lille Cedex, France
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