Heteroplasmic pathogenic m.12315G>A variant in MT-TL2 presenting with MELAS syndrome and depletion of nitric oxide donors.

The MT-TL2 m.12315G>A pathogenic variant has previously been reported in five individuals with mild clinical phenotypes. Herein we report the case of a 5-year-old child with heteroplasmy for this variant who developed neurological regression and stroke-like episodes similar to those observed in mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). Biochemical evaluation revealed depletion of arginine on plasma amino acid analysis and low z-scores for citrulline on untargeted plasma metabolomics analysis. These findings suggested that decreased availability of nitric oxide may have contributed to the stroke-like episodes. The use of intravenous arginine during stroke-like episodes and daily enteral L-citrulline supplementation normalized her biochemical values of arginine and citrulline. Untargeted plasma metabolomics showed the absence of nicotinamide and 1-methylnicotinamide, and plasma total glutathione levels were low; thus, nicotinamide riboside and N-acetylcysteine therapies were initiated. This report expands the phenotype associated with the rare mitochondrial variant MT-TL2 m.12315G>A to include neurological regression and a MELAS-like phenotype. Individuals with this variant should undergo in-depth biochemical analysis to include untargeted plasma metabolomics, plasma amino acids, and glutathione levels to help guide a targeted approach to treatment.

Clinical genome sequencing: Three years' experience at a tertiary children's hospital.

PURPOSE: Genome sequencing (GS) may shorten the diagnostic odyssey for patients, but clinical experience with this assay in nonresearch settings remains limited. Texas Children's Hospital began offering GS as a clinical test to admitted patients in 2020, providing an opportunity to study GS utilization, possibilities for test optimization, and testing outcomes. METHODS: We retrospectively reviewed GS orders for admitted patients for a nearly 3-year period from March 2020 through December 2022. We gathered anonymized clinical data from the electronic health record to answer the study questions. RESULTS: The diagnostic yield over 97 admitted patients was 35%. The majority of GS clinical indications were neurologic or metabolic (61%) and most patients were in intensive care (58%). Tests were often characterized as candidates for intervention/improvement (56%), frequently because of redundancy with prior testing. Patients receiving GS without prior exome sequencing (ES) had higher diagnostic rates (45%) than the cohort as a whole. In 2 cases, GS revealed a molecular diagnosis that is unlikely to be detected by ES. CONCLUSION: The performance of GS in clinical settings likely justifies its use as a first-line diagnostic test, but the incremental benefit for patients with prior ES may be limited.

Natural organic matter and sunlight accelerate the degradation of 17ss-estradiol in water.

Nanomolar concentrations of steroid hormones such as 17beta-estradiol can influence the reproductive development and sex ratios of invertebrate and vertebrate populations. Thus their release into surface and ground waters from wastewater facilities and agricultural applications of animal waste is of environmental concern. Many of these compounds are chromophoric and susceptible to photolytic degradation. High intensity UV-C radiation has been demonstrated to degrade some of these compounds in engineered systems. However, the degradation efficacy of natural solar radiation in shallow fresh waters is less understood. Here photolytic experiments with 17beta-estradiol demonstrated modest photodegradation (~26%) when exposed to simulated sunlight between 290 and 720 nm. Photodegradation significantly increased (~40-50%) in the presence of 2.0-15.0 mg/l of dissolved organic carbon (DOC) derived from humic acids of the Suwannee River, GA. However, rates of photodegradation reached a threshold at approximately 5.0 mg/l DOC. Observed suppression of photolysis in the presence of a radical inhibitor (i.e. 2-propanol) indicated that a significant proportion of the degradation was due to radicals formed from the photolysis of DOC. Although photodegradation was greatest in full sunlight containing UV-B (290-320 nm), degradation was also detected with UV-A (320-400 nm) and visible light (400-720 nm) alone.