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Kadohisa M, Okamoto T, Yamamoto M, Uebayashi EY, Sonoda M, Ogawa E, Yokoyama A, Kawasaki H, Hiejima E, Ito S, Togawa T, Imagawa K, Murayama K, Okajima H, Hatano E. Living donor liver transplantation for myocerebrohepatopathy spectrum due to POLG mutations. Pediatr Transplant 2024; 28:e14659. [PMID: 38012111 DOI: 10.1111/petr.14659] [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: 06/06/2023] [Revised: 09/26/2023] [Accepted: 11/15/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND POLG is one of several nuclear genes associated with mitochondrial DNA maintenance defects and is a group of diseases caused by mitochondrial DNA deficiency that results in impaired adenosine triphosphate production and organ dysfunction. Myocerebrohepatopathy spectrum (MCHS) is the most severe and earliest presentation of POLG mutations, and liver transplantation (LT) for MCHS has never been reported. CASE PRESENTATION The patient was a 3-month-old boy with acute liver failure and no neurological manifestations (e.g., seizures). We performed a living donor LT using a left lateral segment graft from his father. The postoperative course was uneventful. Subsequently, a homozygous POLG mutation (c.2890C>T, p. R964C) was identified by multigene analysis of neonatal/infantile intrahepatic cholestasis. Moreover, respiratory chain complex I, II, and III enzyme activities and the ratio of mtDNA to nuclear DNA in the liver were reduced. Therefore, we considered that these clinical manifestations and examination findings met the definition for MCHS. During meticulous follow-up, the patient had shown satisfactory physical growth and mental development until the time of writing this report. CONCLUSION We presumed that the absence of remarkable neurologic manifestations prior to LT in patients with MCHS is a good indication for LT and contributes to a better prognosis in the present case.
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Affiliation(s)
- Masashi Kadohisa
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Tatsuya Okamoto
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Miki Yamamoto
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Elena Yukie Uebayashi
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Mari Sonoda
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Eri Ogawa
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Atsushi Yokoyama
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Kawasaki
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Eitaro Hiejima
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shogo Ito
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takao Togawa
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuo Imagawa
- Department of Child Health, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kei Murayama
- Department of Metabolism, Center for Medical Genetics, Chiba Children's Hospital, Chiba, Japan
| | - Hideaki Okajima
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pediatric Surgery, Kanazawa Medical University, Kanazawa, Japan
| | - Etsuro Hatano
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Pediatric Surgery, Kyoto University Hospital, Kyoto, Japan
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Hospital, Kyoto, Japan
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Li H, Wang W, Han X, Zhang Y, Dai L, Xu M, Deng J, Ding C, Wang X, Chen C, Yang X, Fang F. Clinical Attributes and Electroencephalogram Analysis of Patients With Varying Alpers' Syndrome Genotypes. Front Pharmacol 2021; 12:669516. [PMID: 34690748 PMCID: PMC8526534 DOI: 10.3389/fphar.2021.669516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Alpers' syndrome is an early inceptive neurodegenerative disorder with a poor prognosis, characterized by developmental regression, intractable epilepsy, and hepatic dysfunction. Candidate genes, such as POLG, PARS2, CARS2, FARS2, NARS2, and GABRB2 are distinguished and registered following research on large cohorts that portray the clinical phenotype in such patients using expanded access to whole-exome sequencing (WES). In this study, we aimed to better understand the electroencephalogram (EEG) characteristics and clinical phenotype of different genotypes of the Alpers' syndrome, which are currently insufficiently studied. We conducted a study on seven patients with Alpers' syndrome who received treatment in Beijing Children's Hospital and had a detailed clinical EEG. Furthermore, a substantial literature search of the Chinese Biomedical Literature Database, PubMed, and Cochrane Central Register of Controlled Trials EMBASE was also conducted, which revealed a total of 22 reported cases between January 2008 to January 2021. We analyzed 29 cases of Alpers' syndrome caused by different gene variants, of which 22 cases were related to POLG gene mutation and 7 cases were related to PARS2, CARS2, FARS2, NARS2, and GABRB2 gene mutation, and found that patients with distinctive pathogenic variants exhibited comparable phenotypes and similar EEG patterns. And we defined EEG characteristics found specifically in Alpers' syndrome. Rhythmic high-amplitude delta with superimposed (poly) spikes (RHADS) is a characteristic EEG finding in the early stages of Alpers' syndrome and is a kind of epileptic phenomenon, which can provide clues for the early diagnosis of the disease.
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Affiliation(s)
- Hua Li
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Wei Wang
- Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Xiaodi Han
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Yujia Zhang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Lifang Dai
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Manting Xu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Jie Deng
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Changhong Ding
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Xiaohui Wang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Chunhong Chen
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
| | - Xiaofeng Yang
- Bioland Laboratory Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center For Children's Health, Beijing, China
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3
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Gonçalves FG, Hill B, Guo Y, Muraresku CC, McCormick E, Alves CAPF, Teixeira SR, Martin-Saavedra JS, Zolkipli-Cunningham Z, Falk MJ, Vossough A, Goldstein A, Zuccoli G. The Perirolandic Sign: A Unique Imaging Finding Observed in Association with Polymerase γ-Related Disorders. AJNR Am J Neuroradiol 2020; 41:917-922. [PMID: 32381541 DOI: 10.3174/ajnr.a6514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/27/2020] [Indexed: 11/07/2022]
Abstract
Pathogenic variants in the polymerase γ gene (POLG) cause a diverse group of pathologies known as POLG-related disorders. In this report, we describe brain MR imaging findings and electroencephalogram correlates of 13 children with POLG-related disorders at diagnosis and follow-up. At diagnosis, all patients had seizures and 12 had abnormal MR imaging findings. The most common imaging findings were unilateral or bilateral perirolandic (54%) and unilateral or bilateral thalamic signal changes (77%). Association of epilepsia partialis continua with perirolandic and thalamic signal changes was present in 86% and 70% of the patients, respectively. The occipital lobe was affected in 2 patients. On follow-up, 92% of the patients had disease progression or fatal outcome. Rapid volume loss was seen in 77% of the patients. The occipital lobe (61%) and thalamus (61%) were the most affected brain regions. Perirolandic signal changes and seizures may represent a brain imaging biomarker of early-onset pediatric POLG-related disorders.
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Affiliation(s)
- F G Gonçalves
- From the Departments of Radiology and Division of Neuroradiology (F.G.G., B.H., C.A.P.F.A., S.R.T., J.S.M.-S., A.V., G.Z.)
| | - B Hill
- From the Departments of Radiology and Division of Neuroradiology (F.G.G., B.H., C.A.P.F.A., S.R.T., J.S.M.-S., A.V., G.Z.)
| | - Y Guo
- Departments of Pediatrics (Y.G., Z.Z.-C., M.J.F., A.G.)
| | - C C Muraresku
- Mitochondrial Medicine Frontier Program, Division of Human Genetics (C.C.M., E.M., Z.Z.-C., M.J.F., A.G.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - E McCormick
- Mitochondrial Medicine Frontier Program, Division of Human Genetics (C.C.M., E.M., Z.Z.-C., M.J.F., A.G.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - C A P F Alves
- From the Departments of Radiology and Division of Neuroradiology (F.G.G., B.H., C.A.P.F.A., S.R.T., J.S.M.-S., A.V., G.Z.)
| | - S R Teixeira
- From the Departments of Radiology and Division of Neuroradiology (F.G.G., B.H., C.A.P.F.A., S.R.T., J.S.M.-S., A.V., G.Z.)
| | - J S Martin-Saavedra
- From the Departments of Radiology and Division of Neuroradiology (F.G.G., B.H., C.A.P.F.A., S.R.T., J.S.M.-S., A.V., G.Z.)
| | - Z Zolkipli-Cunningham
- Mitochondrial Medicine Frontier Program, Division of Human Genetics (C.C.M., E.M., Z.Z.-C., M.J.F., A.G.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Departments of Pediatrics (Y.G., Z.Z.-C., M.J.F., A.G.)
| | - M J Falk
- Mitochondrial Medicine Frontier Program, Division of Human Genetics (C.C.M., E.M., Z.Z.-C., M.J.F., A.G.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Departments of Pediatrics (Y.G., Z.Z.-C., M.J.F., A.G.)
| | - A Vossough
- From the Departments of Radiology and Division of Neuroradiology (F.G.G., B.H., C.A.P.F.A., S.R.T., J.S.M.-S., A.V., G.Z.).,Radiology (A.V.), University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - A Goldstein
- Mitochondrial Medicine Frontier Program, Division of Human Genetics (C.C.M., E.M., Z.Z.-C., M.J.F., A.G.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Departments of Pediatrics (Y.G., Z.Z.-C., M.J.F., A.G.)
| | - G Zuccoli
- From the Departments of Radiology and Division of Neuroradiology (F.G.G., B.H., C.A.P.F.A., S.R.T., J.S.M.-S., A.V., G.Z.).,The Program for the Study of Neurodevelopment in Rare Disorders (NDRD) (G.Z.), Children's Hospital of Pittsburgh of UPMC
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Finsterer J. Valproate Is Contraindicated in POLG1 Mutations. Pediatr Gastroenterol Hepatol Nutr 2019; 22:105-106. [PMID: 30671381 PMCID: PMC6333585 DOI: 10.5223/pghn.2019.22.1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/28/2018] [Accepted: 04/06/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Josef Finsterer
- Neurological department, Krankenanstalt Rudolfstiftung, Vienna, Austria
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