RESUMO
Respiratory infections cause significant morbidity and mortality, yet it is unclear why some individuals succumb to severe disease. In patients hospitalized with avian A(H7N9) influenza, we investigated early drivers underpinning fatal disease. Transcriptomics strongly linked oleoyl-acyl-carrier-protein (ACP) hydrolase (OLAH), an enzyme mediating fatty acid production, with fatal A(H7N9) early after hospital admission, persisting until death. Recovered patients had low OLAH expression throughout hospitalization. High OLAH levels were also detected in patients hospitalized with life-threatening seasonal influenza, COVID-19, respiratory syncytial virus (RSV), and multisystem inflammatory syndrome in children (MIS-C) but not during mild disease. In olah-/- mice, lethal influenza infection led to survival and mild disease as well as reduced lung viral loads, tissue damage, infection-driven pulmonary cell infiltration, and inflammation. This was underpinned by differential lipid droplet dynamics as well as reduced viral replication and virus-induced inflammation in macrophages. Supplementation of oleic acid, the main product of OLAH, increased influenza replication in macrophages and their inflammatory potential. Our findings define how the expression of OLAH drives life-threatening viral disease.
RESUMO
BACKGROUND: Most patients suffering from Leber hereditary optic neuropathy carry one of the three classic pathologic mutations, but not all individuals with these genetic alterations develop the disease. There are different risk factors that modify the penetrance of these mutations. The remaining patients carry one of a set of very rare genetic variants and, it appears that, some of the risk factors that modify the penetrance of the classical pathologic mutations may also affect the phenotype of these other rare mutations. RESULTS: We describe a large family including 95 maternally related individuals, showing 30 patients with Leber hereditary optic neuropathy. The mutation responsible for the phenotype is a novel transition, m.3734A > G, in the mitochondrial gene encoding the ND1 subunit of respiratory complex I. Molecular-genetic, biochemical and cellular studies corroborate the pathogenicity of this genetic change. CONCLUSIONS: With the study of this family, we confirm that, also for this very rare mutation, sex and age are important factors modifying penetrance. Moreover, this pedigree offers an excellent opportunity to search for other genetic or environmental factors that additionally contribute to modify penetrance.
Assuntos
DNA Mitocondrial , Atrofia Óptica Hereditária de Leber , Humanos , DNA Mitocondrial/genética , Atrofia Óptica Hereditária de Leber/genética , Linhagem , Mutação/genética , FenótipoRESUMO
Influenza A virus (IAV) is one of the major global public health concerns but the emerging resistance of IAV to currently available antivirals requires the need to identify potential alternatives. Polyphenol rich sugarcane extract (PRSE) is an extract prepared from the sugarcane plant Saccharum Officinarum. Herein we aimed to determine if PRSE had antiviral activity against IAV. We showed that treatment of IAV-infected cells with PRSE results in a dose-dependent inhibition of virus infection at concentrations that were non-cytotoxic. PRSE treatment limited the early stages of infection, reducing viral genome replication, mRNA transcription and viral protein expression. PRSE did not affect the ability of IAV to bind sialic acid or change the morphology of viral particles. Additionally, PRSE treatment attenuated the replication of multiple IAV strains of the H3N2 and H1N1 subtype. In conclusion, we show that PRSE displays antiviral activity against a broad range of IAV strains, in vitro.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Vírus da Influenza A , Influenza Humana , Saccharum , Humanos , Polifenóis/farmacologia , Vírus da Influenza A Subtipo H1N1/fisiologia , Vírus da Influenza A Subtipo H3N2 , Replicação Viral , Extratos Vegetais/farmacologia , Antivirais/farmacologiaRESUMO
Resumen Objetivo: Analizar la complejidad de la expresión génica en tejido adiposo de genes asociados con obesidad, mediante simulación computacional con diferentes herramientas bioinformáticas. Métodos: Después de una búsqueda bibliográfica en PubMed, se seleccionaron 37 genes asociados con obesidad con fold change mayor a 1,5. A partir del cálculo de valores de los z-score obtenidos de experimentos de micromatrices de ADN de muestras de tejido adiposo de personas obesas y de control, se construyó una red de interacción con el programa Cytoscape 3.2. La información detallada sobre las características genómicas de estos genes se extrajo de las bases de datos Genome Browser de la UCSC y del NCBI. Utilizando herramientas de análisis de multivariado, se hizo un análisis de componentes principales y uno de agrupación. Resultados: La red construida mostró que los genes con mayor número de interacciones fueron: 1) el factor nuclear respiratorio (NRF1), 2) el canal activado de potasio activado por calcio alfa 1 (KCNMA1) y 3) la sintasa de ácidos grasos (FASN). Los que tuvieron mayores valores de expresión fueron: 1) el factor de crecimiento endotelial vascular A (VEGFA), 2) la dioxigenasa dependiente de alfa-cetoglutarato (FTO) y 3) el regulador de crecimiento neuronal 1 (NEGR1). Las proteínas IL6, BDNF y HLC tuvieron los mayores valores de interacción con IL6R, NRF1 y ACACB, respetivamente. Las categorías ontológicas más importantes se relacionaron con procesos metabólicos de lipoproteínas, el ciclo de los ácidos tricarboxílicos, la activación de las MAP-quinasas y la cascada JNK. Conclusiones: En su conjunto los resultados obtenidos de sobreexpresión diferencial de genes asociados con el metabolismo de lípidos en el tejido adiposo de personas obesas podría ser un criterio para discriminar a nivel de diagnóstico esta patología.
Summary Objective: To analyze the complexity of gene expression in the adipose tissue of genes associated with obesity, by computer simulation with different bioinformatics tools. Methods: After conducting a PubMed literature search, 37 genes associated with obesity with a fold change greater than 1.5 were selected. An interaction network was cons tructed using the Cytoscape 3.2 program from the calculation of z-score values obtained from DNA microarray experiments of adipose tissue samples collected from obese and control people. Detailed information on the genomic characteristics of these genes was extracted from the UCSC and NCBI Genome Browser databases. Using multivariate analysis tools, a principal component analysis and a cluster analysis were carried out. Results: The constructed network showed that the genes with the greatest number of interactions were: 1) the nuclear respiratory factor (NRF1), 2) the activated channel of potassium activate by calcium alpha 1 (KCNMA1), and 3) the fatty acid synthase (FASN). Those with the higher expression values were: 1) vascular endothelial growth factor A (VEGFA), 2) alpha-ketoglutarate-dependent dioxygenase (FTO), and 3) neuronal growth regulator 1 (NEGR1). The IL6, BDNF and HLC proteins had the highest interaction values with IL6R, NRF1 and ACACB, respectively. The most important ontological categories were related to lipoprotein metabolic processes, the tricarboxylic acid cycle, the activation of the MAP kinases, and the JNK cascade. Conclusions: As a whole, the results obtained from differential overexpression of genes associated with lipid metabolism in the adipose tissue of obese people could be a criterion to discriminate this pathology at a diagnostic level.
Resumo Objetivo: Analisar a complexidade da expressão gênica no tecido adiposo de genes associados com obesidade, por meio de simulação por computador com diferentes ferramentas bioinformáticas. Métodos: Após uma busca bibliográfica em PubMed, foram selecionados 37 genes associados com obesidade com fold change superior a 1,5. A partir do cálculo de valores dos z-score obtidos de experimentos de micro matrizes de ADN de amostras de tecido adiposo de pessoas obesas e de controle, construiu-se uma rede de interação com o programa Cytoscape 3.2. A informação detalhada sobre as características genômicas destes genes foi obtida das bases de dados Genome Browser da UCSC e do NCBI. Utilizando ferramentas de análise de multivariado, fez-se uma análise de componentes principais e um de agrupação. Resultados: A rede construída mostrou que os genes com maior número de interações foram: 1) o fator nuclear respiratório (NRF1), 2) o canal ativado de potássio ativado por cálcio alfa 1 (KCNMA1) e 3) ácido graxo sintase (FASN). Os que tiveram maiores valores de expressão foram: 1) o fator de crescimento endo-telial vascular A (VEGFA), 2) a dioxigenase dependente de alfa-cetoglutarato (FTO) e 3) o regulador de crescimento neuronal 1 (NEGR1). As proteínas IL6, BDNF e HLC tiveram os maiores valores de interação com IL6R, NRF1 e ACACB, respectivamente. As categorias ontológicas mais importantes se relacionaram com processos metabólicos de lipoproteínas, o ciclo dos ácidos tri carboxílicos, a ativação das MAP-quinases e a cascata JNK. Conclusões: Em seu conjunto, os resultados obtidos de superexpressão diferencial de genes associados com o metabolismo de lipídios no tecido adiposo de pessoas obesas poderia ser um critério para discriminar a nível de diagnóstico esta patologia.
Assuntos
Humanos , Obesidade , Expressão Gênica , Tecido Adiposo , Biologia ComputacionalRESUMO
Introducción: La preeclampsia continúa siendo la primera causa de morbimortalidad perinatal. El conocimiento sobre su etiología molecular se ha incrementado en los últimos años debido al avance en la aplicación de las ciencias "ómicas". Ello ha llevado a identificar genes candidatos que participarían en su patogénesis. Objetivo: Identificar y caracterizar estructural y funcionalmente genes expresados en placenta que se asocian con preeclampsia. Métodos: A partir de una revisión de literatura de los últimos diez años, se identificaron 16 genes cuya expresión en placenta estaba asociada con la patología. Se realizó la minería de datos incluyendo las siguientes variables: número de genes, tamaño de los genes, número de exones codificantes, islas CpG y las familias de los diferentes elementos repetidos en una ventana de 100Kbp. Mediante un análisis bioinformático, usando los diferentes recursos del NCBI (www.ncbi.nlm.nih.gov) y del Genome Browser de UCSC (http://genome.ucsc.edu/). Adicionalmente se usó el portal BioGPS (http://biogps.gnf.org/#goto=welcome) se determinaron los niveles de expresión de cada gen por tejidos. Resultados: Se registraron diferencias en la cromatina que contiene las familias de elementos no codificantes de los genes asociados en comparación con los controles (Prueba de Kruskall-Wallis, P= 0.0341824). Los genes LEP, EBI3, PROCR, FSTL3, HEXB, INHBA y ENG fueron los que registraron el mayor puntaje z en placentas preeclámpsicas. Conclusión:La aplicación de las herramientas bioinformáticas se convierte en un instrumento potente para el análisis integrado de la expresión de genes y su papel en la patogénesis de la PE. Esto conllevaría a la identificación temprana de mujeres afectadas.
Introduction: Preeclampsia still is the main cause of perinatal morbi-mortality; due to the advance in the application of the omics sciences the knowledge about its molecular etiology has increased in the last years, this has led to the identification of candidate genes, which would be involved in its pathogenesis. Objective: To identify those genes, expressed in placenta that are associated with preeclampsia and compare their structural and functional characteristics. Methods: From a literature review, 16 genes were found, whose expression in placenta was associated to the pathology. Data mining was performed including the following genomic variables: number of genes, genomic size, coding exon count, CpG islands and repeat elements in a 100Kbp window. For the Bioinformatics analysis, we used different resources of the NCBI (www.ncbi.nlm.nih.gov) and the UCSC Genome Browser (http://genome.ucsc.edu/). Furthermore, the portal BioGPS (http://biogps.gnf.org/#goto=welcome) Was used to determine the expression levels of each gene per tissue. Results: Significant differences were found for the non-coding elements of the chromatin in that associated genes, in comparison with controls (Kruskall-Wallis test, P= 0.0341824). The genes LEP, EBI3, PROCR, FSTL3, HEXB, INHBA and ENG were the ones with the highest z- score values in preeclampsic placenta. Conclusion: The application of computational tools has become a powerful instrument for the integrated analysis of gene expression and its role in the pathogenesis of PE. This would lead to an early detection of affected women.
Introdução: A pré-eclâmpsia ainda é a principal causa perinatal Morbi-mortalidade; devido ao avanço na aplicação das ciências "ómicas" o conhecimento sobre sua etiologia molecular tem aumentado nos últimos anos, Isto levou à identificação de genes candidatos, que estariam envolvidos na sua Patogênese. Objetivo: Para identificar esses genes, Expresso em placenta que está associada à pré-eclâmpsia e comparar as suas características estruturais e funcionais. Métodos: A partir de uma revisão da literatura, foram encontrados 16 genes, cuja expressão na placenta foi asociada à patología. Extração de dados Foi realizada incluindo as seguintes variáveis genómicas: Número de genes, tamanho genômico, exon contagem de codificação, CpG ilhas e repetir elementos em uma janela de 100Kbp. Para a análise bioinformática, Utilizamos diferentes recursos do NCBI (www.ncbi.nlm.nih.gov) e do UCSC Genome Browser (http://genome.ucsc.edu/). Além disso, o portal BioGPS (http://biogps.gnf.org/#goto=welcome) foi utilizado para determinar os níveis de expressão de cada gene por tecido. Resultados: Se encontrou diferenças significativas para os elementos não codificantes da cromatina nos genes associados, Em comparação com os controlos (teste de Kruskall-Wallis, P = 0,0341824). Os genes LEP, EBI3, PROCR, FSTL3, HEXB, INHBA e ENG foram os que apresentaram os maiores valores de z-score na placenta pré-eclâmpsica. Conclusão: A aplicação de ferramentas computacionais tornou-se um poderoso instrumento para a análise integrada da expressão gênica e seu papel na patogênese da PE. Isso levaria a uma detecção precoce das mulheres afetadas.
Assuntos
Pré-Eclâmpsia , Expressão Gênica , Bioengenharia , Mineração de DadosRESUMO
Background: The information of gene expression obtained from databases, have made possible the extraction and analysis of data related with several molecular processes involving not only in brain homeostasis but its disruption in some neuropathologies; principally in Down syndrome and the Alzheimer disease. Objective: To correlate the levels of transcription of 19 genes located in the Down Syndrome Critical Region (DSCR) with their expression in several substructures of normal human brain. Methods: There were obtained expression profiles of 19 DSCR genes in 42 brain substructures, from gene expression values available at the database of the human brain of the Brain Atlas of the Allen Institute for Brain Sciences", (http://human.brain-map.org/). The co-expression patterns of DSCR genes in brain were calculated by using multivariate statistical methods. Results: Highest levels of gene expression were registered at caudate nucleus, nucleus accumbens and putamen among central areas of cerebral cortex. Increased expression levels of RCAN1 that encode by a protein involved in signal transduction process of the CNS were recorded for PCP4 that participates in the binding to calmodulin and TTC3; a protein that is associated with differentiation of neurons. That previously identified brain structures play a crucial role in the learning process, in different class of memory and in motor skills. Conclusion: The precise regulation of DSCR gene expression is crucial to maintain the brain homeostasis, especially in those areas with high levels of gene expression associated with a remarkable process of learning and cognition.
Introducción: La información de la expresión de genes consignada en bases de datos, ha permitido extraer y analizar información acerca procesos moleculares implicados tanto en la homeostasis cerebral y su alteración en algunas neuropatologías. Objetivos: Correlacionar los niveles de transcripción de 19 genes localizados en la región crítica del cromosoma 21, asociada a Síndrome de Down (DSCR), con la localización cerebral y su coexpresión en diferentes subestructuras del cerebro humano. Métodos: A partir de valores de expresión génica disponibles en la base de datos del proyecto cerebro humano del Atlas del Cerebro del "Allen Institute for Brain Sciences" (http://human.brain-map.org/), se construyeron perfiles de expresión de 19 genes DSCR en 42 subestructuras cerebrales. Además, utilizando métodos estadísticos multivariados se analizaron los patrones de coexpresión de genes DSCR en el cerebro normal. Resultados: En el núcleo caudado, el núcleo accumbens y el putamen además de las Áreas centrales 2, 3 y 4, se determinaron los valores de expresión más elevados para los genes incluidos RCAN1, que codifica para una proteína involucrada en el proceso de transducción de señales de SNC; PCP4 cuya proteína interviene en la unión a la calmodulina y TTC3 una proteína que interviene en la diferenciación de neuronas. Las subestructuras identificadas con una elevada expresión de estos genes, están asociadas con procesos de aprendizaje, en diferentes tipos de memoria y habilidades motoras. Conclusiones: La regulación de la expresión de los genes DSCR es clave para mantener la homeostasis cerebral, especialmente en aquellas áreas de mayor expresión, las cuales están asociadas con procesos sumamente importantes.
Assuntos
Humanos , Encéfalo/fisiologia , Síndrome de Down/genética , Expressão Gênica , Encéfalo/fisiopatologia , Diferenciação Celular , Bases de Dados Factuais , Homeostase , Análise Multivariada , Neurônios/metabolismoRESUMO
Entre las etiologías de anemias en la infancia, las citopatías mitocondriales son poco frecuentes. El síndrome de Pearson se diagnostica principalmente durante etapas iniciales de la vida y es caracterizado por anemia sideroblástica refractaria con vacuolización de células progenitoras en la médula ósea, disfunción del páncreas exocrino y variables alteraciones neurológicas, hepáticas, renales y endocrinas. En el siguiente informe reportamos un nuevo caso de lactante mayor femenino de 14 meses de edad, evaluada de forma multicéntrica con diagnostico clínico y molecular de síndrome de Pearson, con la deleción común de 4.977 pares de bases del ADN mitocondrial. Esta entidad ha sido asociada a diversos fenotipos dentro del amplio espectro clínico de las enfermedades mitocondriales.
Among the etiologies of anemia in the infancy, the mitochondrial cytopathies are infrequent. Pearson syndrome is diagnosed principally during the initial stages of life and it is characterized by refractory sideroblastic anemia with vacuolization of marrow progenitor cells, exocrine pancreatic dysfunction and variable neurologic, hepatic, renal and endocrine failures. We report the case of a 14 month-old girl evaluated by a multicentric study, with clinic and molecular diagnosis of Pearson syndrome, with the 4,977-base pair common deletion of mitochondrial DNA. This entity has been associated to diverse phenotypes within the broad clinical spectrum of mitochondrial disease.
Assuntos
Feminino , Humanos , Lactente , Anemia Sideroblástica , Doenças Mitocondriais , Anemia Sideroblástica/sangue , Anemia Sideroblástica/diagnóstico , Anemia Sideroblástica/genética , DNA Mitocondrial/genética , Diarreia Infantil/etiologia , Insuficiência Pancreática Exócrina/etiologia , Insuficiência Pancreática Exócrina/genética , Evolução Fatal , Hipopotassemia/etiologia , Doenças Mitocondriais/sangue , Doenças Mitocondriais/diagnóstico , Doenças Mitocondriais/genética , Fenótipo , Encaminhamento e Consulta , Análise de Sequência de DNA , Deleção de SequênciaRESUMO
Introduction: Previous reports have identified a region of chromosome 21 known as Down syndrome critical region (DSCR) in which the expression of some genes would modulate the main clinical characteristics of this pathology. In this sense, there is currently limited information on the architecture of the DSCR associated. Objective: To obtain in silico a detailed vision of the chromatin structure associated with the evaluation of genomic covariables contained in public data bases. Methods: Taking as reference the information consigned in the National Center for Biotechnology Information, the Genome Browser from the University of California at Santa Cruz and from the HapMap project, a chromosome walk along 21 Mb of the distal portion of chromosome 21q arm was performed. In this distal portion, the number of single nucleotide polymorphisms (SNP), number of CpG islands, repetitive elements, recombination frequencies, and topographical state of that chromatin were recorded. Results: The frequency of CpG islands and Ref genes increased in the more distal 1.2 Mb DSCR that contrast with those localized near to the centromere. The highest level of recombination calculated for women was registered in the 21q22.12 to 22.3 bands. DSCR 6 and 9 genes showed a high percentage of methylation in CpG islands in DNA from normal and trisomic fibroblasts. The DSCR2 gene exhibited high levels of open chromatin and also methylation in some lysine residues of the histone H3 as relevant characteristics. Conclusion: The existence of a genomic environment characterized by high values of recombination frequencies and CpG methylation in DSCR 6 and 9 and also DSCR2 genes led us to postulate that in non-disjunction detected in Down syndrome, complex genomic, epigenetic and environmental relationships regulate some processes of meiosis.
Introducción: Análisis previos han identificado una región del cromosoma 21, conocida como región crítica del síndrome de Down (DSCR) en donde se localizan algunos genes cuya expresión modularía las principales características clínicas de este síndrome. En este sentido, existe poca información detallada sobre la arquitectura de la cromatina asociada con la DSCR. Objetivo: Obtener in silico, a partir de la evaluación de covariables genómicas contenidas en bases de datos públicas, una visión detallada de la estructura cromatina asociada con la DSCR. Métodos: Tomando como referencia la información consignada en el National Center for Biotechnology Information, el Genome Browser de la Universidad de California en Santa Clara y el proyecto internacional HapMap, se efectuó un paseo cromosómico a lo largo de 21Mb de la porción distal del brazo q del cromosoma 21, para registrar el número de polimorfismos de nucleótido único, el de islas CpG, de secuencias repetidas, las tasas de recombinación y el estado topológico de la cromatina asociada. Resultados: La frecuencia de islas CpG y de genes referenciados se incrementó en los últimos 1,2 Mb de la región distal en contraste con su distribución pericentromérica. La mayor tasa de recombinación calculada en este estudio para mujeres se registró en las bandas 21q22.13 y 21q22.3. Los genes DSCR 6 y 9 presentaron un elevado grado de metilación en islas CpG tanto en fibroblastos normales como en trisómicos. En el gen DSCR2 se observó un alto grado de descondensación cromatínica, además de metilación de diferentes residuos de lisina de la histona H3. Conclusiones: La existencia de un ambiente genómico caracterizado por tener elevadas tasas de recombinación y de metilación de genes DSCR 6 y 9, permite postular que en la no disyunción asociada con el SD, operarían complejas interacciones genómicas, epigenéticas y ambientales que actuarían en algunos procesos meióticos.
Assuntos
Humanos , Síndrome de Down , Genômica , Não Disjunção GenéticaRESUMO
Autism is the prototype of generalized developmental disorders or what today are called autism spectrum disorders. In most cases it is impossible to detect a specific etiology. It is estimated that a causative diagnosis may be shown in approximately 10-37 percent of the cases, including, congenital rubella, tuberous sclerosis, chromosome abnormalities such as fragile X syndrome and 22q13.3 deletion syndrome, Angelman, Williams, Smith-Magenis, Sotos, Cornelia de Lange, Mõbius, Joubert and Goldenhar syndromes, Itos hypomelanosis, as well as certain cerebral malformations and several inherited metabolic disorders. The case of a 3-year old girl is described, who was considered as autistic according to the criteria established by the DSM-IV manual for psychiatric disorders. She showed a delay in psychomotor development since she was 18 months old; she pronounces very few words (10), points to some objects, does not look up and it is hard to establish eye contact with her. She has paradoxical deafness and therefore, does not respond when called or when she is given orders, she is beginning to walk. She has not convulsions. Laboratory tests showed an anion gap of 31.6 mEq/L, lactate: 2.55: mmol/L, pyruvate: 0.06 mmol/L, and elevated lactate to/pyruvate ratio: 42.5. Under optical microscopy a muscular biopsy showed a reduction of the diameter of muscular fibers. The study of energy metabolism showed a partial deficiency of complexes III and IV of the respiratory chain, which allowed us to conclude that this was a mitochondrial dysfunction with an autistic clinical spectrum.
El autismo es el prototipo de los trastornos generalizados del desarrollo o de lo que hoy se denominan trastornos del espectro autista. En la mayoría de los casos no es posible detectar una etiología específica. Se estima que aproximadamente entre el 10 y el 37 por ciento de los casos se puede demostrar una causa específica,como la rubéola congénita, la esclerosis tuberosa, anomalías cromosómicas como el sindrome del cromasoma X frágil y la microdelección 22q13.3, los sindromes de Angelman, Williams, Smith-Magenis, Sotos, Cornelia de Lange, Mõebius, Joubert y Goldenhar, la hipomelanosis de Ito, así como algunas malformaciones cerebrales y varios trastornos metabólicos. Se describe un preescolar de 3 años de edad, de sexo femenino,catalogada como autista de acuerdo a los criterios establecidos por el manual DSM-IV para trastornos psiquiátricos. Presentaba un retraso en la adquisición de su desarrollo psicomotor desde los 18 meses, pronunciaba pocas palabras (10), señalaba algunos objetos, no utilizaba la mirada y era dificil establecer contacto ocular con ella, mostraba sordera paradójica, por lo que no respondia cuando se le llamaba ni cuando se le daban órdenes. Empezaba a caminar y no había presentado convulsiones. Los exámenes de laboratorio mostraban anión gap: 31,6 mEq/L, lactato: 2,55 mmol/L, piruvato: 0,06 mmol/L y una relación lactato/piruvato elevada de: 42,50 mmol/L. La biopsia muscular practicada reportó en la microscopía óptica disminución del diámetro de las fibras musculares y el estudio del metabolismo energético demostró una deficiencia parcial en los complejos III y IV de la cadena respiratoria, el cual nos permitió concluir que se trataba de una disfunción mitocondrial con espectro autista.