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Mastrangelo M, Manti F, Ricciardi G, Cinnante EMC, Cameli N, Beatrice A, Tolve M, Pisani F. The diagnostic and prognostic role of cerebrospinal fluid biomarkers in glucose transporter 1 deficiency: a systematic review. Eur J Pediatr 2024; 183:3665-3678. [PMID: 38954008 PMCID: PMC11322378 DOI: 10.1007/s00431-024-05657-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
The purpose of this study is to investigate the diagnostic and prognostic role of cerebrospinal fluid (CSF) biomarkers in the diagnostic work-up of glucose transporter 1 (GLUT1) deficiency. Reported here is a systematic review according to PRISMA guidelines collecting clinical and biochemical data about all published patients who underwent CSF analysis. Clinical phenotypes were compared between groups defined by the levels of CSF glucose (≤ 2.2 mmol/L versus > 2.2 mmol/L), CSF/blood glucose ratio (≤ 0.45 versus > 0.45), and CSF lactate (≤ 1 mmol/L versus > 1 mmol/L). Five hundred sixty-two patients fulfilled the inclusion criteria with a mean age at the diagnosis of 8.6 ± 6.7 years. Patients with CSF glucose ≤ 2.2 mmol/L and CSF/blood glucose ratio ≤ 0.45 presented with an earlier onset of symptoms (16.4 ± 22.0 versus 54.4 ± 45.9 months, p < 0.01; 15.7 ± 23.8 versus 40.9 ± 38.0 months, p < 0.01) and received an earlier molecular genetic confirmation (92.1 ± 72.8 versus 157.1 ± 106.2 months, p < 0.01). CSF glucose ≤ 2.2 mmol/L was consistently associated with response to ketogenic diet (p = 0.018) and antiseizure medications (p = 0.025). CSF/blood glucose ratio ≤ 0.45 was significantly associated with absence seizures (p = 0.048), paroxysmal exercise-induced dyskinesia (p = 0.046), and intellectual disability (p = 0.016) while CSF lactate > 1 mmol/L was associated with a response to antiseizure medications (p = 0.026) but not to ketogenic diet.Conclusions:This systematic review supported the diagnostic usefulness of lumbar puncture for the early identification of patients with GLUT1 deficiency responsive to treatments especially if they present with co-occurring epilepsy, movement, and neurodevelopmental disorders. What is Known: • Phenotypes of GLUT1 deficiency syndrome range between early epileptic and developmental encephalopathy to paroxysmal movement disorders and developmental impairment What is New: • CSF blood/glucose ratio may predict better than CSF glucose the diagnosis in children presenting with early onset absences • CSF blood/glucose ratio may predict better than CSF glucose the diagnosis in children presenting with paroxysmal exercise induced dyskinesia and intellectual disability. • CSF glucose may predict better than CSF blood/glucose and lactate the response to ketogenic diet and antiseizure medications.
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Affiliation(s)
- Mario Mastrangelo
- Woman/Child Health and Urological Sciences Department, Sapienza University of Rome, Via dei Sabelli 108, 00185, Rome, Italy.
- Unit of Child Neurology and Psychiatry, Department of Neuroscience/Mental Health, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy.
| | - Filippo Manti
- Unit of Child Neurology and Psychiatry, Department of Neuroscience/Mental Health, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | | | - Noemi Cameli
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | - Manuela Tolve
- Clinical Pathology Unit, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy
| | - Francesco Pisani
- Unit of Child Neurology and Psychiatry, Department of Neuroscience/Mental Health, Azienda Ospedaliero Universitaria Policlinico Umberto, Rome, Italy
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
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2
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Monfrini E, Pesini A, Biella F, Sobreira CFR, Emmanuele V, Brescia G, Lopez LC, Tadesse S, Hirano M, Comi GP, Quinzii CM, Di Fonzo A. Whole-Exome Sequencing Study of Fibroblasts Derived From Patients With Cerebellar Ataxia Referred to Investigate CoQ10 Deficiency. NEUROLOGY GENETICS 2023; 9:e200058. [PMID: 37090936 PMCID: PMC10117701 DOI: 10.1212/nxg.0000000000200058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/04/2023] [Indexed: 03/17/2023]
Abstract
Background and ObjectivesCoenzyme Q10(CoQ10)–deficient cerebellar ataxia can be due to pathogenic variants in genes encoding for CoQ10biosynthetic proteins or associated with defects in protein unrelated to its biosynthesis. Diagnosis is crucial because patients may respond favorably to CoQ10supplementation. The aim of this study was to identify through whole-exome sequencing (WES) the pathogenic variants, and assess CoQ10levels, in fibroblasts from patients with undiagnosed cerebellar ataxia referred to investigate CoQ10deficiency.MethodsWES was performed on genomic DNA extracted from 16 patients. Sequencing data were filtered using a virtual panel of genes associated with CoQ10deficiency and/or cerebellar ataxia. CoQ10levels were measured by high-performance liquid chromatography in 14 patient-derived fibroblasts.ResultsA definite genetic etiology was identified in 8 samples of 16 (diagnostic yield = 50%). The identified genetic causes were pathogenic variants of the genesCOQ8A(ADCK3) (n = 3 samples),ATP1A3(n = 2),PLA2G6(n = 1),SPG7(n = 1), andMFSD8(n = 1). Five novel mutations were found (COQ8An = 3,PLA2G6n = 1, andMFSD8n = 1). CoQ10levels were significantly decreased in 3/14 fibroblast samples (21.4%), 1 carrying compound heterozygousCOQ8Apathogenic variants, 1 harboring a homozygous pathogenicSPG7variant, and 1 with an unknown molecular defect.DiscussionThis work confirms the importance ofCOQ8Agene mutations as a frequent genetic cause of cerebellar ataxia and CoQ10deficiency and suggestsSPG7mutations as a novel cause of secondary CoQ10deficiency.
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Affiliation(s)
- Edoardo Monfrini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Alba Pesini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Fabio Biella
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Claudia F R Sobreira
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Valentina Emmanuele
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Gloria Brescia
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Luis Carlos Lopez
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Saba Tadesse
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Michio Hirano
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Giacomo P Comi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Catarina Maria Quinzii
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
| | - Alessio Di Fonzo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico (E.M., G.B., A.D.F.), Neurology Unit, Milan, Italy; Dino Ferrari Center (E.M., F.B., G.P.C.), Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Italy; Department of Neurology (A.P., V.E., S.T., M.H., C.M.Q.), Columbia University Medical Center, New York; Universidade de São Paulo (C.F.R.S.), Ribeirão Preto Medical School, Department of Neurosciences, Brazil; Departamento de Fisiología (L.C.L.), Facultad de Medicina, Universidad de Granada, Spain; and Centro de Investigación Biomédica (L.C.L.), Instituto de Biotecnología, Universidad de Granada, Spain
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Navas P, Cascajo MV, Alcázar-Fabra M, Hernández-Camacho JD, Sánchez-Cuesta A, Rodríguez ABC, Ballesteros-Simarro M, Arroyo-Luque A, Rodríguez-Aguilera JC, Fernández-Ayala DJM, Brea-Calvo G, López-Lluch G, Santos-Ocaña C. Secondary CoQ 10 deficiency, bioenergetics unbalance in disease and aging. Biofactors 2021; 47:551-569. [PMID: 33878238 DOI: 10.1002/biof.1733] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022]
Abstract
Coenzyme Q10 (CoQ10 ) deficiency is a rare disease characterized by a decreased accumulation of CoQ10 in cell membranes. Considering that CoQ10 synthesis and most of its functions are carried out in mitochondria, CoQ10 deficiency cases are usually considered a mitochondrial disease. A relevant feature of CoQ10 deficiency is that it is the only mitochondrial disease with a successful therapy available, the CoQ10 supplementation. Defects in components of the synthesis machinery caused by mutations in COQ genes generate the primary deficiency of CoQ10 . Mutations in genes that are not directly related to the synthesis machinery cause secondary deficiency. Cases of CoQ10 deficiency without genetic origin are also considered a secondary deficiency. Both types of deficiency can lead to similar clinical manifestations, but the knowledge about primary deficiency is deeper than secondary. However, secondary deficiency cases may be underestimated since many of their clinical manifestations are shared with other pathologies. This review shows the current state of secondary CoQ10 deficiency, which could be even more relevant than primary deficiency for clinical activity. The analysis covers the fundamental features of CoQ10 deficiency, which are necessary to understand the biological and clinical differences between primary and secondary CoQ10 deficiencies. Further, a more in-depth analysis of CoQ10 secondary deficiency was undertaken to consider its origins, introduce a new way of classification, and include aging as a form of secondary deficiency.
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Affiliation(s)
- Plácido Navas
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - María V Cascajo
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - María Alcázar-Fabra
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan D Hernández-Camacho
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Sánchez-Cuesta
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Belén Cortés Rodríguez
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
- Laboratorio de Fisiopatología Celular y Bioenergética, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
| | - Manuel Ballesteros-Simarro
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Arroyo-Luque
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Rodríguez-Aguilera
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
- Laboratorio de Fisiopatología Celular y Bioenergética, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
| | - Daniel J M Fernández-Ayala
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Gloria Brea-Calvo
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Guillermo López-Lluch
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Santos-Ocaña
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
- CIBERER, Instituto de Salud Carlos III, Madrid, Spain
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Proctor EC, Turton N, Boan EJ, Bennett E, Philips S, Heaton RA, Hargreaves IP. The Effect of Methylmalonic Acid Treatment on Human Neuronal Cell Coenzyme Q 10 Status and Mitochondrial Function. Int J Mol Sci 2020; 21:E9137. [PMID: 33266298 PMCID: PMC7730949 DOI: 10.3390/ijms21239137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 12/26/2022] Open
Abstract
Methylmalonic acidemia is an inborn metabolic disease of propionate catabolism, biochemically characterized by accumulation of methylmalonic acid (MMA) to millimolar concentrations in tissues and body fluids. However, MMA's role in the pathophysiology of the disorder and its status as a "toxic intermediate" is unclear, despite evidence for its ability to compromise antioxidant defenses and induce mitochondrial dysfunction. Coenzyme Q10 (CoQ10) is a prominent electron carrier in the mitochondrial respiratory chain (MRC) and a lipid-soluble antioxidant which has been reported to be deficient in patient-derived fibroblasts and renal tissue from an animal model of the disease. However, at present, it is uncertain which factors are responsible for inducing this CoQ10 deficiency or the effect of this deficit in CoQ10 status on mitochondrial function. Therefore, in this study, we investigated the potential of MMA, the principal metabolite that accumulates in methylmalonic acidemia, to induce a cellular CoQ10 deficiency. In view of the severe neurological presentation of patients with this condition, human neuroblastoma SH-SY5Y cells were used as a neuronal cell model for this investigation. Following treatment with pathological concentrations of MMA (>0.5 mM), we found a significant (p = 0.0087) ~75% reduction in neuronal cell CoQ10 status together with a significant (p = 0.0099) decrease in MRC complex II-III activity at higher concentrations (>2 mM). The deficits in neuronal CoQ10 status and MRC complex II-III activity were associated with a loss of cell viability. However, no significant impairment of mitochondrial membrane potential (ΔΨm) was detectable. These findings indicate the potential of pathological concentrations of MMA to induce a neuronal cell CoQ10 deficiency with an associated loss of MRC complex II-III activity. However, in the absence of an impairment of ΔΨm, the contribution this potential deficit in cellular CoQ10 status makes towards the disease pathophysiology methylmalonic acidemia has yet to be fully elucidated.
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Affiliation(s)
- Emma C. Proctor
- Department of Biochemistry, University of Warwick, Coventry CV4 7AL, UK;
| | - Nadia Turton
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (N.T.); (E.J.B.); (E.B.); (R.A.H.)
| | - Elle Jo Boan
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (N.T.); (E.J.B.); (E.B.); (R.A.H.)
| | - Emily Bennett
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (N.T.); (E.J.B.); (E.B.); (R.A.H.)
| | - Suzannah Philips
- Department of Clinical Biochemistry, The Royal Liverpool University Hospital, Royal Liverpool and Broadgreen NHS Trust, Prescot Street, Liverpool L7 8XP, UK;
| | - Robert A. Heaton
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (N.T.); (E.J.B.); (E.B.); (R.A.H.)
| | - Iain P. Hargreaves
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (N.T.); (E.J.B.); (E.B.); (R.A.H.)
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Musumeci O, Ferlazzo E, Rodolico C, Gambardella A, Gagliardi M, Aguglia U, Toscano A. A Family With a Complex Phenotype Caused by Two Different Rare Metabolic Disorders: GLUT1 and Very-Long-Chain Fatty Acid Dehydrogenase (VLCAD) Deficiencies. Front Neurol 2020; 11:514. [PMID: 32655480 PMCID: PMC7324651 DOI: 10.3389/fneur.2020.00514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/11/2020] [Indexed: 01/04/2023] Open
Abstract
GLUT1 Deficiency Syndrome (GLUT1-DS) is a rare and potentially treatable neurometabolic condition, caused by a reduced glucose transport into the brain and clinically characterized by an epileptic encephalopathy with movement disorders. A wide inter-intrafamilial phenotypic variability has been reported. Very-long-chain acyl-CoA dehydrogenase (VLCAD) deficiency is an inherited metabolic disorder of mitochondrial long-chain fatty acid oxidation (FAO) with also a variable age of onset and clinical presentation including cardiomyopathy, hypoketotic hypoglycemia, and liver disease. Sometimes, VLCAD manifests later with a prevalent muscle involvement characterized by exercise intolerance and recurrent rhabdomyolysis. We report a 40-year-old man with mild mental retardation and sporadic choreo-athetoid movements, who complained of recurrent episodes of rhabdomyolysis triggered by exercise or fasting since his twenties. His 15-year-old son had a psychomotor developmental delay with episodes of drowsiness mainly at fasting and exercise-induced choreo-athetoid movements but no history of pigmenturia. Clinical and laboratory findings in the son suggested a diagnosis of GLUT1-DS confirmed by SCL2A1 genetic analysis that revealed a heterozygous mutation c.997C>T (p.R333W) that was also found in the proband. However, the presence in the latter of recurrent exercise-induced rhabdomyolysis, never reported in GLUT1-DS, implied a second metabolic disorder. Increased plasma C14:1-carnitine levels and the identification of two known heterozygous mutations c. 553G>A (p.G185S) and c.1153C>T (p.R385W) in ACADVL confirmed the additional diagnosis of VLCAD deficiency in the proband. Nowadays, there is an increasing evidence of "double trouble" cases of genetic origin. Consequently, when atypical features accompany a known phenotype, associated comorbidities should be considered.
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Affiliation(s)
- Olimpia Musumeci
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Edoardo Ferlazzo
- Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.,Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Carmelo Rodolico
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Gambardella
- Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Monica Gagliardi
- Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Umberto Aguglia
- Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.,Regional Epilepsy Centre, "Bianchi-Melacrino-Morelli" Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Antonio Toscano
- Unit of Neurology and Neuromuscular Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Abstract
The aging process includes impairment in mitochondrial function, a reduction in anti-oxidant activity, and an increase in oxidative stress, marked by an increase in reactive oxygen species (ROS) production. Oxidative damage to macromolecules including DNA and electron transport proteins likely increases ROS production resulting in further damage. This oxidative theory of cell aging is supported by the fact that diseases associated with the aging process are marked by increased oxidative stress. Coenzyme Q10 (CoQ10) levels fall with aging in the human but this is not seen in all species or all tissues. It is unknown whether lower CoQ10 levels have a part to play in aging and disease or whether it is an inconsequential cellular response to aging. Despite the current lay public interest in supplementing with CoQ10, there is currently not enough evidence to recommend CoQ10 supplementation as an anti-aging anti-oxidant therapy.
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Hernández-Camacho JD, Bernier M, López-Lluch G, Navas P. Coenzyme Q 10 Supplementation in Aging and Disease. Front Physiol 2018; 9:44. [PMID: 29459830 PMCID: PMC5807419 DOI: 10.3389/fphys.2018.00044] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 01/12/2018] [Indexed: 12/21/2022] Open
Abstract
Coenzyme Q (CoQ) is an essential component of the mitochondrial electron transport chain and an antioxidant in plasma membranes and lipoproteins. It is endogenously produced in all cells by a highly regulated pathway that involves a mitochondrial multiprotein complex. Defects in either the structural and/or regulatory components of CoQ complex or in non-CoQ biosynthetic mitochondrial proteins can result in a decrease in CoQ concentration and/or an increase in oxidative stress. Besides CoQ10 deficiency syndrome and aging, there are chronic diseases in which lower levels of CoQ10 are detected in tissues and organs providing the hypothesis that CoQ10 supplementation could alleviate aging symptoms and/or retard the onset of these diseases. Here, we review the current knowledge of CoQ10 biosynthesis and primary CoQ10 deficiency syndrome, and have collected published results from clinical trials based on CoQ10 supplementation. There is evidence that supplementation positively affects mitochondrial deficiency syndrome and the symptoms of aging based mainly on improvements in bioenergetics. Cardiovascular disease and inflammation are alleviated by the antioxidant effect of CoQ10. There is a need for further studies and clinical trials involving a greater number of participants undergoing longer treatments in order to assess the benefits of CoQ10 treatment in metabolic syndrome and diabetes, neurodegenerative disorders, kidney diseases, and human fertility.
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Affiliation(s)
- Juan D Hernández-Camacho
- Centro Andaluz de Biología del Desarrollo and CIBERER, Instituto de Salud Carlos III, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
| | - Michel Bernier
- Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, United States
| | - Guillermo López-Lluch
- Centro Andaluz de Biología del Desarrollo and CIBERER, Instituto de Salud Carlos III, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
| | - Plácido Navas
- Centro Andaluz de Biología del Desarrollo and CIBERER, Instituto de Salud Carlos III, Universidad Pablo de Olavide-CSIC-JA, Sevilla, Spain
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8
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Biochemical phenotyping unravels novel metabolic abnormalities and potential biomarkers associated with treatment of GLUT1 deficiency with ketogenic diet. PLoS One 2017; 12:e0184022. [PMID: 28961260 PMCID: PMC5621665 DOI: 10.1371/journal.pone.0184022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 07/30/2017] [Indexed: 11/19/2022] Open
Abstract
Global metabolomic profiling offers novel opportunities for the discovery of biomarkers and for the elucidation of pathogenic mechanisms that might lead to the development of novel therapies. GLUT1 deficiency syndrome (GLUT1-DS) is an inborn error of metabolism due to reduced function of glucose transporter type 1. Clinical presentation of GLUT1-DS is heterogeneous and the disorder mirrors patients with epilepsy, movement disorders, or any paroxysmal events or unexplained neurological manifestation triggered by exercise or fasting. The diagnostic biochemical hallmark of the disease is a reduced cerebrospinal fluid (CSF)/blood glucose ratio and the only available treatment is ketogenic diet. This study aimed at advancing our understanding of the biochemical perturbations in GLUT1-DS pathogenesis through biochemical phenotyping and the treatment of GLUT1-DS with a ketogenic diet. Metabolomic analysis of three CSF samples from GLUT1-DS patients not on ketogenic diet was feasible inasmuch as CSF sampling was used for diagnosis before to start with ketogenic diet. The analysis of plasma and urine samples obtained from GLUT1-DS patients treated with a ketogenic diet showed alterations in lipid and amino acid profiles. While subtle, these were consistent findings across the patients with GLUT1-DS on ketogenic diet, suggesting impacts on mitochondrial physiology. Moreover, low levels of free carnitine were present suggesting its consumption in GLUT1-DS on ketogenic diet. 3-hydroxybutyrate, 3-hydroxybutyrylcarnitine, 3-methyladipate, and N-acetylglycine were identified as potential biomarkers of GLUT1-DS on ketogenic diet. This is the first study to identify CSF, plasma, and urine metabolites associated with GLUT1-DS, as well as biochemical changes impacted by a ketogenic diet. Potential biomarkers and metabolic insights deserve further investigation.
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Abstract
ABSTRACTThis review aims at summarizing and discussing previous and recent findings concerning the cerebral manifestations of mitochondrial disorders (MIDs). MIDs frequently present as mitochondrial multiorgan disorder syndrome (MIMODS) either already at onset or later in the course. After the muscle, the brain is the organ second most frequently affected in MIMODS. Cerebral manifestations of MIDs are variable and may present with or without a lesion on imaging or functional studies, but there can be imaging/functional lesions without clinical manifestations. The most well-known cerebral manifestations of MIDs include stroke-like episodes, epilepsy, headache, ataxia, movement disorders, hypopituitarism, muscle weakness, psychiatric abnormalities, nystagmus, white and gray matter lesions, atrophy, basal ganglia calcification, and hypometabolism on 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron-emission tomography. For most MIDs, only symptomatic therapy is currently available. Symptomatic treatment should be supplemented by vitamins, cofactors, and antioxidants. In conclusion, cerebral manifestations of MIDs need to be recognized and appropriately managed because they strongly determine the outcome of MID patients.
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Yubero D, Montero R, Martín MA, Montoya J, Ribes A, Grazina M, Trevisson E, Rodriguez-Aguilera JC, Hargreaves IP, Salviati L, Navas P, Artuch R, Jou C, Jimenez-Mallebrera C, Nascimento A, Pérez-Dueñas B, Ortez C, Ramos F, Colomer J, O’Callaghan M, Pineda M, García-Cazorla A, Espinós C, Ruiz A, Macaya A, Marcé-Grau A, Garcia-Villoria J, Arias A, Emperador S, Ruiz-Pesini E, Lopez-Gallardo E, Neergheen V, Simões M, Diogo L, Blázquez A, González-Quintana A, Delmiro A, Domínguez-González C, Arenas J, García-Silva MT, Martín E, Quijada P, Hernández-Laín A, Morán M, Rivas Infante E, Ávila Polo R, Paradas Lópe C, Bautista Lorite J, Martínez Fernández EM, Cortés AB, Sánchez-Cuesta A, Cascajo MV, Alcázar M, Brea-Calvo G. Secondary coenzyme Q 10 deficiencies in oxidative phosphorylation (OXPHOS) and non-OXPHOS disorders. Mitochondrion 2016; 30:51-8. [DOI: 10.1016/j.mito.2016.06.007] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/06/2016] [Accepted: 06/29/2016] [Indexed: 11/30/2022]
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11
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Montero R, Yubero D, Villarroya J, Henares D, Jou C, Rodríguez MA, Ramos F, Nascimento A, Ortez CI, Campistol J, Perez-Dueñas B, O'Callaghan M, Pineda M, Garcia-Cazorla A, Oferil JC, Montoya J, Ruiz-Pesini E, Emperador S, Meznaric M, Campderros L, Kalko SG, Villarroya F, Artuch R, Jimenez-Mallebrera C. GDF-15 Is Elevated in Children with Mitochondrial Diseases and Is Induced by Mitochondrial Dysfunction. PLoS One 2016; 11:e0148709. [PMID: 26867126 PMCID: PMC4750949 DOI: 10.1371/journal.pone.0148709] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/20/2016] [Indexed: 02/04/2023] Open
Abstract
Background We previously described increased levels of growth and differentiation factor 15 (GDF-15) in skeletal muscle and serum of patients with mitochondrial diseases. Here we evaluated GDF-15 as a biomarker for mitochondrial diseases affecting children and compared it to fibroblast-growth factor 21 (FGF-21). To investigate the mechanism of GDF-15 induction in these pathologies we measured its expression and secretion in response to mitochondrial dysfunction. Methods We analysed 59 serum samples from 48 children with mitochondrial disease, 19 samples from children with other neuromuscular diseases and 33 samples from aged-matched healthy children. GDF-15 and FGF-21 circulating levels were determined by ELISA. Results Our results showed that in children with mitochondrial diseases GDF-15 levels were on average increased by 11-fold (mean 4046pg/ml, 1492 SEM) relative to healthy (350, 21) and myopathic (350, 32) controls. The area under the curve for the receiver-operating-characteristic curve for GDF-15 was 0.82 indicating that it has a good discriminatory power. The overall sensitivity and specificity of GDF-15 for a cut-off value of 550pg/mL was 67.8% (54.4%-79.4%) and 92.3% (81.5%-97.9%), respectively. We found that elevated levels of GDF-15 and or FGF-21 correctly identified a larger proportion of patients than elevated levels of GDF-15 or FGF-21 alone. GDF-15, as well as FGF-21, mRNA expression and protein secretion, were significantly induced after treatment of myotubes with oligomycin and that levels of expression of both factors significantly correlated. Conclusions Our data indicate that GDF-15 is a valuable serum quantitative biomarker for the diagnosis of mitochondrial diseases in children and that measurement of both GDF-15 and FGF-21 improves the disease detection ability of either factor separately. Finally, we demonstrate for the first time that GDF-15 is produced by skeletal muscle cells in response to mitochondrial dysfunction and that its levels correlate in vitro with FGF-21 levels.
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Affiliation(s)
- Raquel Montero
- Clinical Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
| | - Delia Yubero
- Clinical Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
| | - Joan Villarroya
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Biomedical Institute University of Barcelona (IBUB), Center for Biomedical Research on Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Desiree Henares
- Neuromuscular Unit, Neuropaediatrics Department, Hospital Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Cristina Jou
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Pathology Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Maria Angeles Rodríguez
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Neuromuscular Unit, Neuropaediatrics Department, Hospital Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Federico Ramos
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Andrés Nascimento
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Neuromuscular Unit, Neuropaediatrics Department, Hospital Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Carlos Ignacio Ortez
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Neuromuscular Unit, Neuropaediatrics Department, Hospital Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Jaume Campistol
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Belen Perez-Dueñas
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mar O'Callaghan
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mercedes Pineda
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
| | - Angeles Garcia-Cazorla
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Neuropaediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Jaume Colomer Oferil
- Neuromuscular Unit, Neuropaediatrics Department, Hospital Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Julio Montoya
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Biochemistry and Molecular Biology Department, University of Zaragoza, Zaragoza, Spain
| | - Eduardo Ruiz-Pesini
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Biochemistry and Molecular Biology Department, University of Zaragoza, Zaragoza, Spain
- Fundación ARAID, Universidad de Zaragoza, Zaragoza, Spain
| | - Sonia Emperador
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Biochemistry and Molecular Biology Department, University of Zaragoza, Zaragoza, Spain
| | - Marija Meznaric
- Institute of Anatomy, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Laura Campderros
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Biomedical Institute University of Barcelona (IBUB), Center for Biomedical Research on Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Susana G. Kalko
- Bioinformatics Core Facility, IDIBAPS, Hospital Clinic, Barcelona, Spain
| | - Francesc Villarroya
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Biochemistry and Molecular Biology Department, Biomedical Institute University of Barcelona (IBUB), Center for Biomedical Research on Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Rafael Artuch
- Clinical Biochemistry Department, Hospital Sant Joan de Déu, Barcelona, Spain
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
| | - Cecilia Jimenez-Mallebrera
- Center for Biomedical Research on Rare Diseases (CIBERER), Madrid, Spain, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Pediatric Research Sant Joan de Déu, Barcelona, Spain
- Neuromuscular Unit, Neuropaediatrics Department, Hospital Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- * E-mail:
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12
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CoQ 10 Deficiency Is Not a Common Finding in GLUT1 Deficiency Syndrome. JIMD Rep 2015; 29:47-52. [PMID: 26615598 DOI: 10.1007/8904_2015_493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/28/2015] [Accepted: 08/12/2015] [Indexed: 03/05/2023] Open
Abstract
CoQ10 deficiency has been recently described in tissues of a patient with GLUT1 deficiency syndrome. Here, we investigated patients and mice with GLUT1 deficiency in order to determine whether low CoQ is a recurrent biochemical feature of this disorder, to justify CoQ10 supplementation as therapeutic option.CoQ10 levels were investigated in plasma, white blood cells, and skin fibroblasts of 16 patients and healthy controls and in the brain, cerebellum, liver, kidney, muscle, and plasma of 4-month-old GLUT1 mutant and control mice.CoQ10 levels in plasma did not show any difference compared with controls. Since most of the patients studied were on a ketogenic diet, which can alter CoQ10 content in plasma, we also analyzed white blood cells and cultured skin fibroblasts. Again, we found no differences. In mice, we found slightly reduced CoQ in the cerebellum, likely an epiphenomenon, and activity of the mitochondrial respiratory chain enzymes was normal.Our data from GLUT1 deficiency patients and from GLUT1 model mice fail to support CoQ10 deficiency as a common finding in GLUT1 deficiency, suggesting that CoQ deficiency is not a direct biochemical consequence of defective glucose transport caused by molecular defects in the SLC2A1 gene.
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13
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Brea-Calvo G, Haack TB, Karall D, Ohtake A, Invernizzi F, Carrozzo R, Kremer L, Dusi S, Fauth C, Scholl-Bürgi S, Graf E, Ahting U, Resta N, Laforgia N, Verrigni D, Okazaki Y, Kohda M, Martinelli D, Freisinger P, Strom TM, Meitinger T, Lamperti C, Lacson A, Navas P, Mayr JA, Bertini E, Murayama K, Zeviani M, Prokisch H, Ghezzi D. COQ4 mutations cause a broad spectrum of mitochondrial disorders associated with CoQ10 deficiency. Am J Hum Genet 2015; 96:309-17. [PMID: 25658047 PMCID: PMC4320255 DOI: 10.1016/j.ajhg.2014.12.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 12/18/2014] [Indexed: 11/22/2022] Open
Abstract
Primary coenzyme Q10 (CoQ10) deficiencies are rare, clinically heterogeneous disorders caused by mutations in several genes encoding proteins involved in CoQ10 biosynthesis. CoQ10 is an essential component of the electron transport chain (ETC), where it shuttles electrons from complex I or II to complex III. By whole-exome sequencing, we identified five individuals carrying biallelic mutations in COQ4. The precise function of human COQ4 is not known, but it seems to play a structural role in stabilizing a multiheteromeric complex that contains most of the CoQ10 biosynthetic enzymes. The clinical phenotypes of the five subjects varied widely, but four had a prenatal or perinatal onset with early fatal outcome. Two unrelated individuals presented with severe hypotonia, bradycardia, respiratory insufficiency, and heart failure; two sisters showed antenatal cerebellar hypoplasia, neonatal respiratory-distress syndrome, and epileptic encephalopathy. The fifth subject had an early-onset but slowly progressive clinical course dominated by neurological deterioration with hardly any involvement of other organs. All available specimens from affected subjects showed reduced amounts of CoQ10 and often displayed a decrease in CoQ10-dependent ETC complex activities. The pathogenic role of all identified mutations was experimentally validated in a recombinant yeast model; oxidative growth, strongly impaired in strains lacking COQ4, was corrected by expression of human wild-type COQ4 cDNA but failed to be corrected by expression of COQ4 cDNAs with any of the mutations identified in affected subjects. COQ4 mutations are responsible for early-onset mitochondrial diseases with heterogeneous clinical presentations and associated with CoQ10 deficiency.
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Affiliation(s)
- Gloria Brea-Calvo
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide - Consejo Superior de Investigaciones Científicas - Junta de Andalucía and Centro de Investigación Biomédica en Red de Enfermedades Raras, 41013 Sevilla, Spain
| | - Tobias B Haack
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, 81675 Munich, Germany
| | - Daniela Karall
- Clinic for Pediatrics, Division of Inherited Metabolic Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Akira Ohtake
- Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama 350-0495, Japan
| | - Federica Invernizzi
- Unit of Molecular Neurogenetics, Foundation of the Carlo Besta Neurological Institute, Istituto di Ricovero e Cura a Carettere Scientifico, 20126 Milan, Italy
| | - Rosalba Carrozzo
- Unit for Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carettere Scientifico, 00165 Rome, Italy
| | - Laura Kremer
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, 81675 Munich, Germany
| | - Sabrina Dusi
- Unit of Molecular Neurogenetics, Foundation of the Carlo Besta Neurological Institute, Istituto di Ricovero e Cura a Carettere Scientifico, 20126 Milan, Italy
| | - Christine Fauth
- Division of Human Genetics, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Sabine Scholl-Bürgi
- Clinic for Pediatrics, Division of Inherited Metabolic Disorders, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Elisabeth Graf
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, 81675 Munich, Germany
| | - Uwe Ahting
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, 81675 Munich, Germany
| | - Nicoletta Resta
- Division of Medical Genetics, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Nicola Laforgia
- Neonatology and Neonatal Intensive Care Unit, Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Daniela Verrigni
- Unit for Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carettere Scientifico, 00165 Rome, Italy
| | - Yasushi Okazaki
- Division of Translational Research, Research Center for Genomic Medicine, Saitama Medical University, Saitama 350-1241, Japan; Division of Functional Genomics & Systems Medicine, Research Center for Genomic Medicine, Saitama Medical University, Saitama 350-1241, Japan
| | - Masakazu Kohda
- Division of Translational Research, Research Center for Genomic Medicine, Saitama Medical University, Saitama 350-1241, Japan
| | - Diego Martinelli
- Unit of Metabolism, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carettere Scientifico, 00165 Rome, Italy
| | - Peter Freisinger
- Department of Pediatrics, Klinikum Reutlingen, 72764 Reutlingen, Germany
| | - Tim M Strom
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, 81675 Munich, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, 81675 Munich, Germany
| | - Costanza Lamperti
- Unit of Molecular Neurogenetics, Foundation of the Carlo Besta Neurological Institute, Istituto di Ricovero e Cura a Carettere Scientifico, 20126 Milan, Italy
| | - Atilano Lacson
- Walter Mackenzie Health Sciences Centre, 8440 112 Street NW, Edmonton, AB T6G 2B7, Canada
| | - Placido Navas
- Centro Andaluz de Biología del Desarrollo, Universidad Pablo de Olavide - Consejo Superior de Investigaciones Científicas - Junta de Andalucía and Centro de Investigación Biomédica en Red de Enfermedades Raras, 41013 Sevilla, Spain
| | - Johannes A Mayr
- Department of Pediatrics, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
| | - Enrico Bertini
- Unit for Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carettere Scientifico, 00165 Rome, Italy
| | - Kei Murayama
- Department of Metabolism, Chiba Children's Hospital, Chiba 266-0007, Japan; Chiba Cancer Center Research Institute, Chiba 260-8717, Japan
| | - Massimo Zeviani
- Mitochondrial Biology Unit, Medical Research Council, Hills Road, Cambridge CB2 0XY, UK
| | - Holger Prokisch
- Institute of Human Genetics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Institute of Human Genetics, Technische Universität München, 81675 Munich, Germany.
| | - Daniele Ghezzi
- Unit of Molecular Neurogenetics, Foundation of the Carlo Besta Neurological Institute, Istituto di Ricovero e Cura a Carettere Scientifico, 20126 Milan, Italy.
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