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Namani S, Kavetsky K, Lin CY, Maharjan S, Gamper HB, Li NS, Piccirilli JA, Hou YM, Drndic M. Unraveling RNA Conformation Dynamics in Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like Episode Syndrome with Solid-State Nanopores. ACS NANO 2024; 18:17240-17250. [PMID: 38906834 DOI: 10.1021/acsnano.4c04625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
This study investigates transfer ribonucleic acid (tRNA) conformational dynamics in the context of MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) using solid-state silicon nitride (SiN) nanopore technology. SiN nanopores in thin membranes with specific dimensions exhibit high signal resolution, enabling real-time and single-molecule electronic detection of tRNA conformational changes. We focus on human mitochondrial tRNALeu(UAA) (mt-Leu(UAA)) that decodes Leu codons UUA/UUG (UUR) during protein synthesis on the mt-ribosome. The single A14G substitution in mt-Leu(UAA) is the major cause of MELAS disease. Measurements of current blockades and dwell times reveal distinct conformational dynamics of the wild-type (WT) and the A14G variant of mt-Leu(UAA) in response to the conserved post-transcriptional m1G9 methylation. While the m1G9-modified WT transcript adopts a more stable structure relative to the unmodified transcript, the m1G9-modified MELAS transcript adopts a less stable structure relative to the unmodified transcript. Notably, these differential features were observed at 0.4 M KCl, but not at 3 M KCl, highlighting the importance of experimental settings that are closer to physiological conditions. This work demonstrates the feasibility of the nanopore platform to discern tRNA molecules that differ by a single-nucleotide substitution or by a single methylation event, providing an important step forward to explore changes in the conformational dynamics of other RNA molecules in human diseases.
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Affiliation(s)
- Srilahari Namani
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Kyril Kavetsky
- Department of Materials Science and Engineering, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Chih-Yuan Lin
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
| | - Sunita Maharjan
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, United States
| | - Howard B Gamper
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, United States
| | - Nan-Sheng Li
- Department of Biochemistry and Molecular Biology, University of Chicago, Chicago, Illinois 60637, United States
| | - Joseph A Piccirilli
- Department of Biochemistry and Molecular Biology, and Department of Chemistry, University of Chicago, Chicago, Illinois 60637, United States
| | - Ya-Ming Hou
- Department of Biochemistry and Molecular Biology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, United States
| | - Marija Drndic
- Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, Pennsylvania 19104, United States
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Khasminsky V, Auriel E, Luckman J, Eliahou R, Inbar E, Pardo K, Landau Y, Barnea R, Mermelstein M, Shelly S, Naftali J, Peretz S. Clinicoradiologic Criteria for the Diagnosis of Stroke-like Episodes in MELAS. Neurol Genet 2023; 9:e200082. [PMID: 37426458 PMCID: PMC10323819 DOI: 10.1212/nxg.0000000000200082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/16/2023] [Indexed: 07/11/2023]
Abstract
Background and Objectives Stroke-like episodes (SLEs) in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome are often misdiagnosed as acute ischemic stroke (AIS). We aimed to determine unique clinical and neuroimaging features for SLEs and formulate diagnostic criteria. Methods We retrospectively identified patients with MELAS admitted for SLEs between January 2012 and December 2021. Clinical features and imaging findings were compared with a cohort of patients who presented with AIS and similar lesion topography. A set of criteria was formulated and then tested by a blinded rater to evaluate diagnostic performance. Results Eleven MELAS patients with 17 SLE and 21 AISs were included. Patients with SLEs were younger (median 45 [37-60] vs 77 [68-82] years, p < 0.01) and had a lower body mass index (18 ± 2.6 vs 29 ± 4, p < 0.01), more commonly reported hearing loss (91% vs 5%, p < 0.01), and more commonly presented with headache and/or seizures (41% vs 0%, p < 0.01). The earliest neuroimaging test performed at presentation was uniformly a noncontrast CT. Two main patterns of lesion topography with a stereotypical spatiotemporal evolution were identified-an anterior pattern (7/21, 41%) starting at the temporal operculum and spreading to the peripheral frontal cortex and a posterior pattern (10/21, 59%) starting at the cuneus/precuneus and spreading to the lateral occipital and parietal cortex. Other distinguishing features for SLEs vs AIS were cerebellar atrophy (91% vs 19%, p < 0.01), previous cortical lesions with typical SLE distribution (46% vs 9%, p = 0.03), acute lesion tissue hyperemia and venous engorgement on CT angiography (CTA) (45% vs 0%, p < 0.01), and no large vessel occlusion on CTA (0% vs 100%, p < 0.01). Based on these clinicoradiologic features, a set of diagnostic criteria were constructed for possible SLE (sensitivity 100%, specificity 81%, AUC 0.905) and probable SLE (sensitivity 88%, specificity 95%, AUC 0.917). Discussion Clinicoradiologic criteria based on simple anamnesis and a CT scan at presentation can accurately diagnose SLE and lead to early administration of appropriate therapy. Classification of Evidence This study provides Class III evidence that an algorithm using clinical and imaging features can differentiate stroke-like episodes due to MELAS from acute ischemic strokes.
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Affiliation(s)
- Vadim Khasminsky
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Eitan Auriel
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Judith Luckman
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Ruth Eliahou
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Edna Inbar
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Keshet Pardo
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Yuval Landau
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Rani Barnea
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Maor Mermelstein
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Shahar Shelly
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Jonathan Naftali
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
| | - Shlomi Peretz
- From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN
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Naftali J, Mermelstein M, Landau YE, Barnea R, Shelly S, Auriel E, Peretz S. Clinical score for early diagnosis and treatment of stroke-like episodes in MELAS syndrome. Acta Neurol Belg 2023:10.1007/s13760-023-02196-z. [PMID: 36792807 DOI: 10.1007/s13760-023-02196-z] [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: 08/24/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Stroke-like episodes (SLEs) in patients with MELAS syndrome are often initially misdiagnosed as acute ischemic stroke (AIS), resulting in treatment delay. We aimed to determine clinical features that may distinguish SLEs from AISs and explore the benefit of early L-arginine treatment on patient outcomes. METHODS We looked retrospectively for MELAS patients admitted between January 2005 and January 2022 and compared them to an AIS cohort with similar lesion topography. MELAS patients who received L-arginine within 40 days of their first SLE were defined as the early treatment group and the remaining as late or no treatment group. RESULTS Twenty-three SLEs in 10 MELAS patients and 21 AISs were included. SLE patients had significantly different features: they were younger, more commonly reported hearing loss, lower body mass index, had more commonly a combination of headache and/or seizures at presentation, serum lactate was higher, and hemiparesis was less common. An SLE Early Clinical Score (SLEECS) was constructed by designating one point to each above features. SLEECS ≥ 4 had 80% sensitivity and 100% specificity for SLE diagnosis. Compared to late or no treatment, early treatment group patients (n = 5) had less recurrent SLEs (total 2 vs. 11), less seizures (14% vs. 25%, p = 0.048), lower degree of disability at first and last follow-up (modified ranking scale, mRS 2 ± 0.7 vs. 4.2 ± 1, p = 0.005; 2 ± 0.7 vs. 5.8 ± 0.5, p < 0.001, respectively), and a lower mortality (0% vs. 80% p = 0.048). CONCLUSIONS The SLEECS model may aid in the early diagnosis and treatment of SLEs and lead to improved clinical outcomes.
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Affiliation(s)
- Jonathan Naftali
- Department of Neurology, Rabin Medical Center, Zeev Jabotinsky St 39, 49100, Petah Tikva, Israel
| | - Maor Mermelstein
- Department of Neurology, Rabin Medical Center, Zeev Jabotinsky St 39, 49100, Petah Tikva, Israel
| | - Yuval E Landau
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Metabolic Diseases Clinic, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Rani Barnea
- Department of Neurology, Rabin Medical Center, Zeev Jabotinsky St 39, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shahar Shelly
- Department of Neurology, Sheba Medical Center, Tel Aviv, Israel.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eitan Auriel
- Department of Neurology, Rabin Medical Center, Zeev Jabotinsky St 39, 49100, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomi Peretz
- Department of Neurology, Rabin Medical Center, Zeev Jabotinsky St 39, 49100, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Tanaka M, Szabó Á, Spekker E, Polyák H, Tóth F, Vécsei L. Mitochondrial Impairment: A Common Motif in Neuropsychiatric Presentation? The Link to the Tryptophan-Kynurenine Metabolic System. Cells 2022; 11:cells11162607. [PMID: 36010683 PMCID: PMC9406499 DOI: 10.3390/cells11162607] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/14/2022] [Accepted: 08/19/2022] [Indexed: 02/07/2023] Open
Abstract
Nearly half a century has passed since the discovery of cytoplasmic inheritance of human chloramphenicol resistance. The inheritance was then revealed to take place maternally by mitochondrial DNA (mtDNA). Later, a number of mutations in mtDNA were identified as a cause of severe inheritable metabolic diseases with neurological manifestation, and the impairment of mitochondrial functions has been probed in the pathogenesis of a wide range of illnesses including neurodegenerative diseases. Recently, a growing number of preclinical studies have revealed that animal behaviors are influenced by the impairment of mitochondrial functions and possibly by the loss of mitochondrial stress resilience. Indeed, as high as 54% of patients with one of the most common primary mitochondrial diseases, mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome, present psychiatric symptoms including cognitive impairment, mood disorder, anxiety, and psychosis. Mitochondria are multifunctional organelles which produce cellular energy and play a major role in other cellular functions including homeostasis, cellular signaling, and gene expression, among others. Mitochondrial functions are observed to be compromised and to become less resilient under continuous stress. Meanwhile, stress and inflammation have been linked to the activation of the tryptophan (Trp)-kynurenine (KYN) metabolic system, which observably contributes to the development of pathological conditions including neurological and psychiatric disorders. This review discusses the functions of mitochondria and the Trp-KYN system, the interaction of the Trp-KYN system with mitochondria, and the current understanding of the involvement of mitochondria and the Trp-KYN system in preclinical and clinical studies of major neurological and psychiatric diseases.
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Affiliation(s)
- Masaru Tanaka
- ELKH-SZTE Neuroscience Research Group, Danube Neuroscience Research Laboratory, Eötvös Loránd Research Network, University of Szeged (ELKH-SZTE), Tisza Lajos krt. 113, H-6725 Szeged, Hungary
| | - Ágnes Szabó
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Korányi fasor 6, H-6720 Szeged, Hungary
| | - Eleonóra Spekker
- ELKH-SZTE Neuroscience Research Group, Danube Neuroscience Research Laboratory, Eötvös Loránd Research Network, University of Szeged (ELKH-SZTE), Tisza Lajos krt. 113, H-6725 Szeged, Hungary
| | - Helga Polyák
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Doctoral School of Clinical Medicine, University of Szeged, Korányi fasor 6, H-6720 Szeged, Hungary
| | - Fanni Tóth
- ELKH-SZTE Neuroscience Research Group, Danube Neuroscience Research Laboratory, Eötvös Loránd Research Network, University of Szeged (ELKH-SZTE), Tisza Lajos krt. 113, H-6725 Szeged, Hungary
| | - László Vécsei
- ELKH-SZTE Neuroscience Research Group, Danube Neuroscience Research Laboratory, Eötvös Loránd Research Network, University of Szeged (ELKH-SZTE), Tisza Lajos krt. 113, H-6725 Szeged, Hungary
- Department of Neurology, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis u. 6, H-6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-62-545-351
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