1
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Grigalionienė K, Burnytė B, Ambrozaitytė L, Utkus A. Wide diagnostic and genotypic spectrum in patients with suspected mitochondrial disease. Orphanet J Rare Dis 2023; 18:307. [PMID: 37784170 PMCID: PMC10544509 DOI: 10.1186/s13023-023-02921-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Mitochondrial Diseases (MDs) are a diverse group of neurometabolic disorders characterized by impaired mitochondrial oxidative phosphorylation and caused by pathogenic variants in more than 400 genes. The implementation of next-generation sequencing (NGS) technologies helps to increase the understanding of molecular basis and diagnostic yield of these conditions. The purpose of the study was to investigate diagnostic and genotypic spectrum in patients with suspected MD. The comprehensive analysis of mtDNA variants using Sanger sequencing was performed in the group of 83 unrelated individuals with clinically suspected mitochondrial disease. Additionally, targeted next generation sequencing or whole exome sequencing (WES) was performed for 30 patients of the study group. RESULTS The overall diagnostic rate was 21.7% for the patients with suspected MD, increasing to 36.7% in the group of patients where NGS methods were applied. Mitochondrial disease was confirmed in 11 patients (13.3%), including few classical mitochondrial syndromes (MELAS, MERRF, Leigh and Kearns-Sayre syndrome) caused by pathogenic mtDNA variants (8.4%) and MDs caused by pathogenic variants in five nDNA genes. Other neuromuscular diseases caused by pathogenic variants in seven nDNA genes, were confirmed in seven patients (23.3%). CONCLUSION The wide spectrum of identified rare mitochondrial or neurodevelopmental diseases proves that MD suspected patients would mostly benefit from an extensive genetic profiling allowing rapid diagnostics and improving the care of these patients.
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Affiliation(s)
- Kristina Grigalionienė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariškių Str. 2, Vilnius, LT-08661, Lithuania.
| | - Birutė Burnytė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariškių Str. 2, Vilnius, LT-08661, Lithuania
| | - Laima Ambrozaitytė
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariškių Str. 2, Vilnius, LT-08661, Lithuania
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Santariškių Str. 2, Vilnius, LT-08661, Lithuania
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2
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Paredes-Fuentes AJ, Oliva C, Urreizti R, Yubero D, Artuch R. Laboratory testing for mitochondrial diseases: biomarkers for diagnosis and follow-up. Crit Rev Clin Lab Sci 2023; 60:270-289. [PMID: 36694353 DOI: 10.1080/10408363.2023.2166013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The currently available biomarkers generally lack the specificity and sensitivity needed for the diagnosis and follow-up of patients with mitochondrial diseases (MDs). In this group of rare genetic disorders (mutations in approximately 350 genes associated with MDs), all clinical presentations, ages of disease onset and inheritance types are possible. Blood, urine, and cerebrospinal fluid surrogates are well-established biomarkers that are used in clinical practice to assess MD. One of the main challenges is validating specific and sensitive biomarkers for the diagnosis of disease and prediction of disease progression. Profiling of lactate, amino acids, organic acids, and acylcarnitine species is routinely conducted to assess MD patients. New biomarkers, including some proteins and circulating cell-free mitochondrial DNA, with increased diagnostic specificity have been identified in the last decade and have been proposed as potentially useful in the assessment of clinical outcomes. Despite these advances, even these new biomarkers are not sufficiently specific and sensitive to assess MD progression, and new biomarkers that indicate MD progression are urgently needed to monitor the success of novel therapeutic strategies. In this report, we review the mitochondrial biomarkers that are currently analyzed in clinical laboratories, new biomarkers, an overview of the most common laboratory diagnostic techniques, and future directions regarding targeted versus untargeted metabolomic and genomic approaches in the clinical laboratory setting. Brief descriptions of the current methodologies are also provided.
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Affiliation(s)
- Abraham J Paredes-Fuentes
- Division of Inborn Errors of Metabolism-IBC, Biochemistry and Molecular Genetics Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Clara Oliva
- Clinical Biochemistry Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Roser Urreizti
- Clinical Biochemistry Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Delia Yubero
- Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain.,Department of Genetic and Molecular Medicine-IPER, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Rafael Artuch
- Clinical Biochemistry Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain.,Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
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3
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Bansept C, Gaignard P, Lebigot E, Eyer D, Delplancq G, Hoebeke C, Mazodier K, Ledoyen A, Rouzier C, Fragaki K, Ait-El-Mkadem Saadi S, Philippe C, Bruel AL, Faivre L, Feillet F, Abi Warde MT. UQCRC2-related mitochondrial complex III deficiency, about 7 patients. Mitochondrion 2023; 68:138-144. [PMID: 36509339 DOI: 10.1016/j.mito.2022.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/09/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Isolated complex III defect is a relatively rare cause of mitochondrial disorder. New genes involved were identified in the last two decades, with only a few cases described for each deficiency. UQCRC2, which encodes ubiquinol-cytochrome c reductase core protein 2, is one of the eleven structural subunits of complex III. We report seven French patients with UQCRC2 deficiency to complete the phenotype reported so far. We highlight the similarities with neoglucogenesis defect during decompensations - hypoglycaemias, liver failure and lactic acidosis - and point out the rapid improvement with glucose fluid infusion, which is a remarkable feature for a mitochondrial disorder. Finally, we discuss the relevance of coenzyme Q10 supplementation in this defect.
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Affiliation(s)
- Claire Bansept
- Service de Pédiatrie, GHRMSA, 69 avenue du Dr Léon Mangeney, 68100 Mulhouse, France.
| | - Pauline Gaignard
- Laboratoire de Biochimie, AP-HP, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Elise Lebigot
- Laboratoire de Biochimie, AP-HP, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France.
| | - Didier Eyer
- Service de Pédiatrie, Hôpital de Haguenau, 64 avenue du Professeur René Leriche, 67500 Haguenau, France.
| | - Geoffroy Delplancq
- Service de Neuropédiatrie, CHRU Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France; Oncobiologie Génétique Bioinformatique, PCBio, CHRU Besançon, 3 boulevard Alexandre Fleming, 25030 Besançon, France.
| | - Célia Hoebeke
- Service de Neurométabolisme Pédiatrique, AP-HM, CHU Timone, 264 Rue Saint-Pierre, 13005 Marseille, France.
| | - Karin Mazodier
- Service de Médecine Interne, AP-HM, CHU Conception, 147 boulevard Baille, 13005 Marseille, France.
| | - Anaïs Ledoyen
- Service de Pédiatrie, Centre hospitalier d'Ajaccio, 27 avenue de l'Impératrice Eugénie, 20000 Ajaccio, France.
| | - Cécile Rouzier
- Centre de référence des Maladies Mitochondriales, Service de Génétique Médicale, CHU de Nice, 151 route de Saint-Antoine, 06200 Nice, France; Université Côte d'Azur, CNRS, INSERM, IRCAN, 28 avenue de Valombrose, 06107 Nice Cedex 02, France.
| | - Konstantina Fragaki
- Centre de référence des Maladies Mitochondriales, Service de Génétique Médicale, CHU de Nice, 151 route de Saint-Antoine, 06200 Nice, France; Université Côte d'Azur, CNRS, INSERM, IRCAN, 28 avenue de Valombrose, 06107 Nice Cedex 02, France.
| | - Samira Ait-El-Mkadem Saadi
- Centre de référence des Maladies Mitochondriales, Service de Génétique Médicale, CHU de Nice, 151 route de Saint-Antoine, 06200 Nice, France; Université Côte d'Azur, CNRS, INSERM, IRCAN, 28 avenue de Valombrose, 06107 Nice Cedex 02, France.
| | - Christophe Philippe
- Unité Fonctionnelle Innovation en Diagnostic Génomique des maladies rares, CHU Dijon Bourgogne, FHU TRANSLAD, 14 Rue Paul Gaffarel, 21000 Dijon, France; INSERM UMR1231 GAD, F-21000, Dijon, France.
| | - Ange-Line Bruel
- Unité Fonctionnelle Innovation en Diagnostic Génomique des maladies rares, CHU Dijon Bourgogne, FHU TRANSLAD, 14 Rue Paul Gaffarel, 21000 Dijon, France; INSERM UMR1231 GAD, F-21000, Dijon, France.
| | - Laurence Faivre
- INSERM UMR1231 GAD, F-21000, Dijon, France; Centre de Référence Maladies Rares "Anomalies du développement et syndromes malformatifs", Centre de Génétique, FHU TRANSLAD et Institut GIMI, CHU Dijon Bourgogne, 14 Rue Paul Gaffarel, 21000 Dijon, France.
| | - François Feillet
- Centre de Référence des Maladies Métaboliques, Inserm U1256 NGERE, Service de Médecine Infantile, CHRU Brabois Enfants, Rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
| | - Marie-Thérèse Abi Warde
- Service de Neuropédiatrie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 avenue Molière, 67200 Strasbourg, France.
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4
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Zanfardino P, Doccini S, Santorelli FM, Petruzzella V. Tackling Dysfunction of Mitochondrial Bioenergetics in the Brain. Int J Mol Sci 2021; 22:8325. [PMID: 34361091 PMCID: PMC8348117 DOI: 10.3390/ijms22158325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Oxidative phosphorylation (OxPhos) is the basic function of mitochondria, although the landscape of mitochondrial functions is continuously growing to include more aspects of cellular homeostasis. Thanks to the application of -omics technologies to the study of the OxPhos system, novel features emerge from the cataloging of novel proteins as mitochondrial thus adding details to the mitochondrial proteome and defining novel metabolic cellular interrelations, especially in the human brain. We focussed on the diversity of bioenergetics demand and different aspects of mitochondrial structure, functions, and dysfunction in the brain. Definition such as 'mitoexome', 'mitoproteome' and 'mitointeractome' have entered the field of 'mitochondrial medicine'. In this context, we reviewed several genetic defects that hamper the last step of aerobic metabolism, mostly involving the nervous tissue as one of the most prominent energy-dependent tissues and, as consequence, as a primary target of mitochondrial dysfunction. The dual genetic origin of the OxPhos complexes is one of the reasons for the complexity of the genotype-phenotype correlation when facing human diseases associated with mitochondrial defects. Such complexity clinically manifests with extremely heterogeneous symptoms, ranging from organ-specific to multisystemic dysfunction with different clinical courses. Finally, we briefly discuss the future directions of the multi-omics study of human brain disorders.
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Affiliation(s)
- Paola Zanfardino
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy;
| | - Stefano Doccini
- IRCCS Fondazione Stella Maris, Calambrone, 56128 Pisa, Italy;
| | | | - Vittoria Petruzzella
- Department of Medical Basic Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, 70124 Bari, Italy;
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5
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Allouche S, Schaeffer S, Chapon F. [Mitochondrial diseases in adults: An update]. Rev Med Interne 2021; 42:541-557. [PMID: 33455836 DOI: 10.1016/j.revmed.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022]
Abstract
Mitochondrial diseases, characterized by a respiratory chain deficiency, are considered as rare genetic diseases but are the most frequent among inherited metabolic disorders. The complexity of their diagnosis is due to the dual control by the mitochondrial (mtDNA) and the nuclear DNA (nDNA), and to the heterogeneous clinical presentations; illegitimate association of symptoms should prompt the clinician to evoke a mitochondrial disorder. The goals of this review are to provide clinicians a better understanding of mitochondrial diseases in adults. After a brief overview on the mitochondrial origin and functions, especially their role in the energy metabolism, we will describe the genetic bases for mitochondrial diseases, then we will describe the various clinical presentations with the different affected tissues as well as the main symptoms encountered. Even if the new sequencing approaches have profoundly changed the diagnostic process, the brain imaging, the biological, the biochemical, and the histological explorations are still important highlighting the need for a multidisciplinary approach. While for most of the patients with a mitochondrial disease, only supportive and symptomatic therapies are available, recent advances in the understanding of the pathophysiological mechanisms have been made and new therapies are being developed and are evaluated in human clinical trials.
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Affiliation(s)
- S Allouche
- Laboratoire de biochimie, Centre Hospitalier et Universitaire, avenue côte de nacre, 14033 Caen cedex, France.
| | - S Schaeffer
- Centre de compétence des maladies neuromusculaires, Centre Hospitalier et Universitaire, avenue côte de nacre, 14033 Caen cedex, France
| | - F Chapon
- Centre de compétence des maladies neuromusculaires, Centre Hospitalier et Universitaire, avenue côte de nacre, 14033 Caen cedex, France
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6
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Ahmad R, Hasan MY. Next-generation sequencing technology in the diagnosis of mitochondrial disorders. Int J Health Sci (Qassim) 2021; 15:1-2. [PMID: 33456435 PMCID: PMC7786442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rizwan Ahmad
- Vice Deanship of Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, KSA,
Address for correspondence: Dr. Rizwan Ahmad, Vice Deanship of Quality and Development, College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, 34221, Saudi Arabia. Cell: +966-567810999. E-mail: ;
| | - Mohammad Yusuf Hasan
- Department of Biomedical Sciences, School of Biomedical Sciences, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom
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7
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Martinez N, Rosales J, Medina N, Perez-Maturo J, Salinas V, Zavala L, Vega P, Rodríguez-Quiroga S, Morón DG, Kauffman MA. Molecular Diagnosis in an Argentinean Mitochondrial Disorders Cohort. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2021. [DOI: 10.1590/2326-4594-jiems-2020-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nerina Martinez
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina; Universidad Austral, Argentina
| | - Julieta Rosales
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina
| | - Nancy Medina
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina
| | - Josefina Perez-Maturo
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina; Universidad Austral, Argentina
| | - Valeria Salinas
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina; Universidad Austral, Argentina
| | - Lucia Zavala
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina
| | - Patricia Vega
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina
| | - Sergio Rodríguez-Quiroga
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina; Centro Universitario de Neurologia “Jose Maria Ramos Mejia”, Argentina
| | | | - Marcelo A. Kauffman
- Centro Universitario de Neurología “José María Ramos Mejía”, Argentina; Universidad Austral, Argentina
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8
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Levy MA, Kerkhof J, Belmonte FR, Kaufman BA, Bhai P, Brady L, Bursztyn LLCD, Tarnopolsky M, Rupar T, Sadikovic B. Validation and clinical performance of a combined nuclear-mitochondrial next-generation sequencing and copy number variant analysis panel in a Canadian population. Am J Med Genet A 2020; 185:486-499. [PMID: 33300680 DOI: 10.1002/ajmg.a.61998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/17/2022]
Abstract
Diagnosing mitochondrial disorders is a challenge due to the heterogeneous clinical presentation and large number of associated genes. A custom next generation sequencing (NGS) panel was developed incorporating the full mitochondrial genome (mtDNA) plus 19 nuclear genes involved in structural mitochondrial defects and mtDNA maintenance. This assay is capable of simultaneously detecting small gene sequence variations and larger copy number variants (CNVs) in both the nuclear and mitochondrial components along with heteroplasmy detection down to 5%. We describe technical validations of this panel and its implementation for clinical testing in a Canadian reference laboratory, and report its clinical performance in the initial 950 patients tested. Using this assay, we demonstrate a diagnostic yield of 18.1% of patients with known pathogenic variants. In addition to the common 5 kb mtDNA deletion, we describe significant contribution of pathogenic CNVs in both the mitochondrial genome and nuclear genes in this patient population.
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Affiliation(s)
- Michael A Levy
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, Ontario, Canada
| | - Jennifer Kerkhof
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, Ontario, Canada
| | - Frances R Belmonte
- Division of Cardiology, Center for Metabolism and Mitochondrial Medicine and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Brett A Kaufman
- Division of Cardiology, Center for Metabolism and Mitochondrial Medicine and Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Pratibha Bhai
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, Ontario, Canada
| | - Lauren Brady
- Division of Neuromuscular and Neurometabolic Disease, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Mark Tarnopolsky
- Division of Neuromuscular and Neurometabolic Disease, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Tony Rupar
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Departments of Biochemistry and Paediatrics, Schulich School of Medicine & Dentistry, Western University, and Biochemical Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, Ontario, Canada
| | - Bekim Sadikovic
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.,Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, Ontario, Canada
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9
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Labory J, Fierville M, Ait-El-Mkadem S, Bannwarth S, Paquis-Flucklinger V, Bottini S. Multi-Omics Approaches to Improve Mitochondrial Disease Diagnosis: Challenges, Advances, and Perspectives. Front Mol Biosci 2020; 7:590842. [PMID: 33240932 PMCID: PMC7667268 DOI: 10.3389/fmolb.2020.590842] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/14/2020] [Indexed: 01/06/2023] Open
Abstract
Mitochondrial diseases (MD) are rare disorders caused by deficiency of the mitochondrial respiratory chain, which provides energy in each cell. They are characterized by a high clinical and genetic heterogeneity and in most patients, the responsible gene is unknown. Diagnosis is based on the identification of the causative gene that allows genetic counseling, prenatal diagnosis, understanding of pathological mechanisms, and personalized therapeutic approaches. Despite the emergence of Next Generation Sequencing (NGS), to date, more than one out of two patients has no diagnosis in the absence of identification of the responsible gene. Technologies currently used for detecting causal variants (genetic alterations) is far from complete, leading many variants of unknown significance (VUS) and mainly based on the use of whole exome sequencing thus neglecting the identification of non-coding variants. The complexity of human genome and its regulation at multiple levels has led biologists to develop several assays to interrogate the different aspects of biological processes. While one-dimension single omics investigation offers a peek of this complex system, the combination of different omics data allows the discovery of coherent signatures. The community of computational biologists and bioinformaticians, in order to integrate data from different omics, has developed several approaches and tools. However, it is difficult to understand which suits the best to predict diverse phenotypic outcome. First attempts to use multi-omics approaches showed an improvement of the diagnostic power. However, we are far from a complete understanding of MD and their diagnosis. After reviewing multi-omics algorithms developed in the latest years, we are proposing here a novel data-driven classification and we will discuss how multi-omics will change and improve the diagnosis of MD. Due to the growing use of multi-omics approaches in MD, we foresee that this work will contribute to set up good practices to perform multi-omics data integration to improve the prediction of phenotypic outcomes and the diagnostic power of MD.
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Affiliation(s)
- Justine Labory
- Université Côte d’Azur, Center of Modeling, Simulation and Interactions, Nice, France
| | - Morgane Fierville
- Université Côte d’Azur, Center of Modeling, Simulation and Interactions, Nice, France
| | - Samira Ait-El-Mkadem
- Université Côte d’Azur, Inserm U1081, CNRS UMR 7284, Institute for Research on Cancer and Aging, Nice (IRCAN), Centre hospitalier universitaire (CHU) de Nice, Nice, France
| | - Sylvie Bannwarth
- Université Côte d’Azur, Inserm U1081, CNRS UMR 7284, Institute for Research on Cancer and Aging, Nice (IRCAN), Centre hospitalier universitaire (CHU) de Nice, Nice, France
| | - Véronique Paquis-Flucklinger
- Université Côte d’Azur, Center of Modeling, Simulation and Interactions, Nice, France
- Université Côte d’Azur, Inserm U1081, CNRS UMR 7284, Institute for Research on Cancer and Aging, Nice (IRCAN), Centre hospitalier universitaire (CHU) de Nice, Nice, France
| | - Silvia Bottini
- Université Côte d’Azur, Center of Modeling, Simulation and Interactions, Nice, France
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10
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Identification of a novel homozygous nonsense variant in a Chinese patient with ethylmalonic encephalopathy and a genotype-phenotype spectrum review. Clin Chim Acta 2020; 509:8-17. [DOI: 10.1016/j.cca.2020.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022]
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11
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Kerr M, Hume S, Omar F, Koo D, Barnes H, Khan M, Aman S, Wei XC, Alfuhaid H, McDonald R, McDonald L, Newell C, Sparkes R, Hittel D, Khan A. MITO-FIND: A study in 390 patients to determine a diagnostic strategy for mitochondrial disease. Mol Genet Metab 2020; 131:66-82. [PMID: 32980267 DOI: 10.1016/j.ymgme.2020.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/29/2020] [Accepted: 08/30/2020] [Indexed: 12/14/2022]
Abstract
Mitochondrial diseases, due to nuclear or mitochondrial genome mutations causing mitochondrial dysfunction, have a wide range of clinical features involving neurologic, muscular, cardiac, hepatic, visual, and auditory symptoms. Making a diagnosis of a mitochondrial disease is often challenging since there is no gold standard and traditional testing methods have required tissue biopsy which presents technical challenges and most patients prefer a non-invasive approach. Since a diagnosis invariably involves finding a disease-causing DNA variant, new approaches such as next generation sequencing (NGS) have the potential to make it easier to make a diagnosis. We evaluated the ability of our traditional diagnostic pathway (metabolite analysis, tissue neuropathology and respiratory chain enzyme activity) in 390 patients. The traditional diagnostic pathway provided a diagnosis of mitochondrial disease in 115 patients (29.50%). Analysis of mtDNA, tissue neuropathology, skin electron microscopy, respiratory chain enzyme analysis using inhibitor assays, blue native polyacrylamide gel electrophoresis were all statistically significant in distinguishing patients between a mitochondrial and non-mitochondrial diagnosis. From these 390 patients who underwent traditional analysis, we recruited 116 patients for the NGS part of the study (36 patients who had a mitochondrial diagnosis (MITO) and 80 patients who had no diagnosis (No-Dx)). In the group of 36 MITO patients, nuclear whole exome sequencing (nWES) provided a second diagnosis in 2 cases who already had a pathogenic variant in mtDNA, and a revised diagnosis (GLUL) in one case that had abnormal pathology but no pathogenic mtDNA variant. In the 80 NO-Dx patients, nWES found non-mitochondrial diagnosis in 26 patients and a mitochondrial diagnosis in 1 patient. A genetic diagnosis was obtained in 53/116 (45.70%) cases that were recruited for NGS, but not in 11/116 (9.48%) of cases with abnormal mitochondrial neuropathology. Our results show that a non-invasive, bigenomic sequencing (BGS) approach (using both a nWES and optimized mtDNA analysis to include large deletions) should be the first step in investigating for mitochondrial diseases. There may still be a role for tissue biopsy in unsolved cases or when the diagnosis is still not clear after NGS studies.
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Affiliation(s)
- Marina Kerr
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Stacey Hume
- Department of Medical Genetics, University of Alberta, Edmonton, Canada
| | - Fadya Omar
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Desmond Koo
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Heather Barnes
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Maida Khan
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Suhaib Aman
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Xing-Chang Wei
- Department of Radiology, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hanen Alfuhaid
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Roman McDonald
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Liam McDonald
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Christopher Newell
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Rebecca Sparkes
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Dustin Hittel
- Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Aneal Khan
- Departments of Medical Genetics and Pediatrics, University of Calgary Cumming School of Medicine, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
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12
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Zereg E, Chaussenot A, Morel G, Bannwarth S, Sacconi S, Soriani MH, Attarian S, Cano A, Pouget J, Bellance R, Tranchant C, Lannes B, de Paula AM, Saadi Ait-El-Mkadem S, Chafino B, Berthet M, Fragaki K, Paquis-Flucklinger V, Rouzier C. Single-fiber studies for assigning pathogenicity of eight mitochondrial DNA variants associated with mitochondrial diseases. Hum Mutat 2020; 41:1394-1406. [PMID: 32419253 DOI: 10.1002/humu.24037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/29/2020] [Accepted: 04/19/2020] [Indexed: 12/21/2022]
Abstract
Whole mitochondrial DNA (mtDNA) sequencing is now systematically used in clinical laboratories to screen patients with a phenotype suggestive of mitochondrial disease. Next Generation Sequencing (NGS) has significantly increased the number of identified pathogenic mtDNA variants. Simultaneously, the number of variants of unknown significance (VUS) has increased even more, thus challenging their interpretation. Correct classification of the variants' pathogenicity is essential for optimal patient management, including treatment and genetic counseling. Here, we used single muscle fiber studies to characterize eight heteroplasmic mtDNA variants, among which were three novel variants. By applying the pathogenicity scoring system, we classified four variants as "definitely pathogenic" (m.590A>G, m.9166T>C, m.12293G>A, and m.15958A>T). Two variants remain "possibly pathogenic" (m.4327T>C and m.5672T>C) but should these be reported in a different family, they would be reclassified as "definitely pathogenic." We also illustrate the contribution of single-fiber studies to the diagnostic approach in patients harboring pathogenic variants with low level heteroplasmy.
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Affiliation(s)
- Elamine Zereg
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France
| | - Annabelle Chaussenot
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France.,Inserm U1081, CNRS UMR7284, IRCAN, Université Côte d'Azur, Nice, France
| | - Godelieve Morel
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France
| | - Sylvie Bannwarth
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France.,Inserm U1081, CNRS UMR7284, IRCAN, Université Côte d'Azur, Nice, France
| | - Sabrina Sacconi
- Department of Clinical Neurosciences, Neuromuscular Diseases Centre, Nice Teaching Hospital, Nice, France
| | - Marie-Hélène Soriani
- Department of Clinical Neurosciences, Neuromuscular Diseases Centre, Nice Teaching Hospital, Nice, France
| | - Shahram Attarian
- Neurology Department, Referral Center for ALS and Neuromuscular Diseases, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Aline Cano
- Pediatric Neurology Department, Reference Center for Inherited Metabolic Diseases, Timone Hospital, Marseille, France
| | - Jean Pouget
- Neurology Department, Referral Center for ALS and Neuromuscular Diseases, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Rémi Bellance
- Neuromyology Department, Neuromuscular Reference Center, Fort-de-France Teaching Hospital, Fort-de-France, France
| | - Christine Tranchant
- Department of Movement Pathology, Strasbourg Teaching Hospital, Strasbourg, France
| | - Béatrice Lannes
- Pathology Department, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
| | - André Maues de Paula
- Pathology Department, Timone University Hospital, Aix-Marseille University, Marseille, France
| | - Samira Saadi Ait-El-Mkadem
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France.,Inserm U1081, CNRS UMR7284, IRCAN, Université Côte d'Azur, Nice, France
| | - Bernadette Chafino
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France
| | - Mathieu Berthet
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France
| | - Konstantina Fragaki
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France.,Inserm U1081, CNRS UMR7284, IRCAN, Université Côte d'Azur, Nice, France
| | - Véronique Paquis-Flucklinger
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France.,Inserm U1081, CNRS UMR7284, IRCAN, Université Côte d'Azur, Nice, France
| | - Cécile Rouzier
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France.,Inserm U1081, CNRS UMR7284, IRCAN, Université Côte d'Azur, Nice, France
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13
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Fragaki K, Chaussenot A, Serre V, Acquaviva C, Bannwarth S, Rouzier C, Chabrol B, Paquis-Flucklinger V. A novel variant m.8561C>T in the overlapping region of MT-ATP6 and MT-ATP8 in a child with early-onset severe neurological signs. Mol Genet Metab Rep 2019; 21:100543. [PMID: 31788426 PMCID: PMC6879992 DOI: 10.1016/j.ymgmr.2019.100543] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/29/2022] Open
Abstract
Among mitochondrial diseases, isolated complex V (CV) deficiency represents a rare cause of respiratory chain (RC) dysfunction. In mammalian mitochondrial DNA (mtDNA), MT-ATP6 partly overlaps with MT-ATP8 making double mutations possible, yet extremely rarely reported principally in patients with cardiomyopathy. Here, we report a novel m.8561 C>T substitution in the overlapping region of MT-ATP6 and MT-ATP8 in a child with early-onset ataxia, psychomotor delay and microcephaly, enlarging the clinical manifestations spectrum associated with CV deficiency.
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Key Words
- ADP, adenosine triphosphate
- ATP synthase
- ATP, adenosine triphosphate
- Ataxia
- BN-PAGE, Blue Native-PolyAcrylamide Gel Electrophoresis
- CV, complex V
- MRI, Magnetic resonance imaging
- Microcephaly
- Mitochondrial disorders
- NARP, Neuropathy, Ataxia, Retinitis Pigmentosa
- NGS, Next-generation sequencing
- OXPHOS, oxidative phosphorylation
- PCR, polymerase chain reaction
- PVDF, PolyVinyliDene Fluoride
- Psychomotor delay
- RC, respiratory chain
- RFLP, Restriction Fragment Length Polymorphism
- WT, wild-type
- mtDNA, mitochondrial DNA
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Affiliation(s)
| | | | - Valerie Serre
- UMR7592 CNRS, Institut Jacques Monod, Université Paris Diderot, Nice, France
| | - Cecile Acquaviva
- Department of Inborn Errors of Metabolism and Neonatal Screening, Center of Biology and Pathology Est CHU, Lyon Bron, France
| | | | - Cecile Rouzier
- Université Côte d'Azur, CHU, Inserm, CNRS, IRCAN, France
| | - Brigitte Chabrol
- Department of Neuropediatrics, Timone Hospital, CHU, Marseille, France
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14
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Rouzier C, Chaussenot A, Fragaki K, Serre V, Ait-El-Mkadem S, Richelme C, Paquis-Flucklinger V, Bannwarth S. NDUFS6 related Leigh syndrome: a case report and review of the literature. J Hum Genet 2019; 64:637-645. [DOI: 10.1038/s10038-019-0594-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/27/2019] [Accepted: 03/03/2019] [Indexed: 12/14/2022]
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15
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Schoonen M, Smuts I, Louw R, Elson JL, van Dyk E, Jonck LM, Rodenburg RJT, van der Westhuizen FH. Panel-Based Nuclear and Mitochondrial Next-Generation Sequencing Outcomes of an Ethnically Diverse Pediatric Patient Cohort with Mitochondrial Disease. J Mol Diagn 2019; 21:503-513. [PMID: 30872186 DOI: 10.1016/j.jmoldx.2019.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/08/2019] [Accepted: 02/06/2019] [Indexed: 12/31/2022] Open
Abstract
Mitochondrial disease (MD) is a group of rare inherited disorders with clinical heterogeneous phenotypes. Recent advances in next-generation sequencing (NGS) allow for rapid genetic diagnostics in patients who experience MD, resulting in significant strides in determining its etiology. This, however, has not been the case in many patient populations. We report on a molecular diagnostic study using mitochondrial DNA and targeted nuclear DNA (nDNA) NGS of an extensive cohort of predominantly sub-Saharan African pediatric patients with clinical and biochemically defined MD. Patients in this novel cohort presented mostly with muscle involvement (73%). Of the original 212 patients, a muscle respiratory chain deficiency was identified in 127 cases. Genetic analyses were conducted for these 127 cases based on biochemical deficiencies, for both mitochondrial (n = 123) and nDNA using panel-based NGS (n = 86). As a pilot investigation, whole-exome sequencing was performed in a subset of African patients (n = 8). These analyses resulted in the identification of a previously reported pathogenic mitochondrial DNA variant and seven pathogenic or likely pathogenic nDNA variants (ETFDH, SURF1, COQ6, RYR1, STAC3, ALAS2, and TRIOBP), most of which were identified via whole-exome sequencing. This study contributes to knowledge of MD etiology in an understudied, ethnically diverse population; highlights inconsistencies in genotype-phenotype correlations; and proposes future directions for diagnostic approaches in such patient populations.
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Affiliation(s)
- Maryke Schoonen
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Izelle Smuts
- Department of Paediatrics and Child Health, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Roan Louw
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Joanna L Elson
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa; Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Etresia van Dyk
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Lindi-Maryn Jonck
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa
| | - Richard J T Rodenburg
- Department of Pediatrics, Radboudumc Amalia Childrens Hospital, Radboud Center for Mitochondrial Medicine, Nijmegen, the Netherlands
| | - Francois H van der Westhuizen
- Human Metabolomics, Faculty of Natural and Agricultural Sciences, North-West University, Potchefstroom, South Africa.
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16
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Muscle Involvement in a Large Cohort of Pediatric Patients with Genetic Diagnosis of Mitochondrial Disease. J Clin Med 2019; 8:jcm8010068. [PMID: 30634555 PMCID: PMC6352184 DOI: 10.3390/jcm8010068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/17/2018] [Accepted: 01/07/2019] [Indexed: 12/22/2022] Open
Abstract
Mitochondrial diseases (MD) are a group of genetic and acquired disorders which present significant diagnostic challenges. Here we report the disease characteristics of a large cohort of pediatric MD patients (n = 95) with a definitive genetic diagnosis, giving special emphasis on clinical muscle involvement, biochemical and histopathological features. Of the whole cohort, 51 patients harbored mutations in nuclear DNA (nDNA) genes and 44 patients had mutations in mitochondrial DNA (mtDNA) genes. The nDNA patients were more likely to have a reduction in muscle fiber succinate dehydrogenase (SDH) stains and in SDH-positive blood vessels, while a higher frequency of mtDNA patients had ragged red (RRF) and blue fibers. The presence of positive histopathological features was associated with ophthalmoplegia, myopathic facies, weakness and exercise intolerance. In 17 patients younger than two years of age, RRF and blue fibers were observed only in one case, six cases presented cytochrome c oxidase (COX) reduction/COX-fibers, SDH reduction was observed in five and all except one presented SDH-positive blood vessels. In conclusion, muscle involvement was a frequent finding in our series of MD patients, especially in those harboring mutations in mtDNA genes.
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