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1.
Food Chem Toxicol ; 186: 114537, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38417538

ABSTRACT

Increases in botanical use, encompassing herbal medicines and dietary supplements, have underlined a critical need for an advancement in safety assessment methodologies. However, botanicals present unique challenges for safety assessment due to their complex and variable composition arising from diverse growing conditions, processing methods, and plant varieties. Historically, botanicals have been largely evaluated based on their history of use information, based primarily on traditional use or dietary history. However, this presumption lacks comprehensive toxicological evaluation, demanding innovative and consistent assessment strategies. To address these challenges, the Botanical Safety Consortium (BSC) was formed as an international, cross-sector forum of experts to identify fit-for purpose assays that can be used to evaluate botanical safety. This global effort aims to assess botanical safety assessment methodologies, merging traditional knowledge with modern in vitro and in silico assays. The ultimate goal is to champion the development of toxicity tools for botanicals. This manuscript highlights: 1) BSC's strategy for botanical selection, sourcing, and preparation of extracts to be used in in vitro assays, and 2) the approach utilized to characterize botanical extracts, using green tea and Asian ginseng as examples, to build confidence for use in biological assays.


Subject(s)
Plants, Medicinal , Dietary Supplements , Tea
2.
Hum Mol Genet ; 33(5): 465-474, 2024 Feb 18.
Article in English | MEDLINE | ID: mdl-37988592

ABSTRACT

Whole genome sequencing (WGS) from large clinically unselected cohorts provides a unique opportunity to assess the penetrance and expressivity of rare and/or known pathogenic mitochondrial variants in population. Using WGS from 179 862 clinically unselected individuals from the UK Biobank, we performed extensive single and rare variant aggregation association analyses of 15 881 mtDNA variants and 73 known pathogenic variants with 15 mitochondrial disease-relevant phenotypes. We identified 12 homoplasmic and one heteroplasmic variant (m.3243A>G) with genome-wide significant associations in our clinically unselected cohort. Heteroplasmic m.3243A>G (MAF = 0.0002, a known pathogenic variant) was associated with diabetes, deafness and heart failure and 12 homoplasmic variants increased aspartate aminotransferase levels including three low-frequency variants (MAF ~0.002 and beta~0.3 SD). Most pathogenic mitochondrial disease variants (n = 66/74) were rare in the population (<1:9000). Aggregated or single variant analysis of pathogenic variants showed low penetrance in unselected settings for the relevant phenotypes, except m.3243A>G. Multi-system disease risk and penetrance of diabetes, deafness and heart failure greatly increased with m.3243A>G level ≥ 10%. The odds ratio of these traits increased from 5.61, 12.3 and 10.1 to 25.1, 55.0 and 39.5, respectively. Diabetes risk with m.3243A>G was further influenced by type 2 diabetes genetic risk. Our study of mitochondrial variation in a large-unselected population identified novel associations and demonstrated that pathogenic mitochondrial variants have lower penetrance in clinically unselected settings. m.3243A>G was an exception at higher heteroplasmy showing a significant impact on health making it a good candidate for incidental reporting.


Subject(s)
Deafness , Diabetes Mellitus, Type 2 , Heart Failure , Mitochondrial Diseases , Humans , Penetrance , Diabetes Mellitus, Type 2/genetics , DNA, Mitochondrial/genetics , Mitochondrial Diseases/genetics , Deafness/genetics , Mutation
3.
Life Sci Alliance ; 6(11)2023 11.
Article in English | MEDLINE | ID: mdl-37652671

ABSTRACT

Pathogenic mitochondrial DNA (mtDNA) single-nucleotide variants are a common cause of adult mitochondrial disease. Levels of some variants decrease with age in blood. Given differing division rates, longevity, and energetic requirements within haematopoietic lineages, we hypothesised that cell-type-specific metabolic requirements drive this decline. We coupled cell-sorting with mtDNA sequencing to investigate mtDNA variant levels within progenitor, myeloid, and lymphoid lineages from 26 individuals harbouring one of two pathogenic mtDNA variants (m.3243A>G and m.8344A>G). For both variants, cells of the T cell lineage show an enhanced decline. High-throughput single-cell analysis revealed that decline is driven by increasing proportions of cells that have cleared the variant, following a hierarchy that follows the current orthodoxy of T cell differentiation and maturation. Furthermore, patients with pathogenic mtDNA variants have a lower proportion of T cells than controls, indicating a key role for mitochondrial function in T cell homeostasis. This work identifies the ability of T cell subtypes to selectively purify their mitochondrial genomes, and identifies pathogenic mtDNA variants as a new means to track blood cell differentiation status.


Subject(s)
DNA, Mitochondrial , Mitochondria , Adult , Humans , DNA, Mitochondrial/genetics , Cell Differentiation/genetics , Mitochondria/genetics , Lymphocyte Activation , Cell Lineage
5.
Nat Commun ; 14(1): 3146, 2023 05 30.
Article in English | MEDLINE | ID: mdl-37253732

ABSTRACT

Neuroticism is a heritable trait composed of separate facets, each conferring different levels of protection or risk, to health. By examining mitochondrial DNA in 269,506 individuals, we show mitochondrial haplogroups explain 0.07-0.01% of variance in neuroticism and identify five haplogroup and 15 mitochondria-marker associations across a general factor of neuroticism, and two special factors of anxiety/tension, and worry/vulnerability with effect sizes of the same magnitude as autosomal variants. Within-haplogroup genome-wide association studies identified H-haplogroup-specific autosomal effects explaining 1.4% variance of worry/vulnerability. These H-haplogroup-specific autosomal effects show a pleiotropic relationship with cognitive, physical and mental health that differs from that found when assessing autosomal effects across haplogroups. We identify interactions between chromosome 9 regions and mitochondrial haplogroups at P < 5 × 10-8, revealing associations between general neuroticism and anxiety/tension with brain-specific gene co-expression networks. These results indicate that the mitochondrial genome contributes toward neuroticism and the autosomal links between neuroticism and health.


Subject(s)
Genome-Wide Association Study , Mitochondria , Neuroticism , Humans , DNA, Mitochondrial/genetics , Genetic Variation , Haplotypes , Mitochondria/genetics
6.
CBE Life Sci Educ ; 22(1): es1, 2023 03.
Article in English | MEDLINE | ID: mdl-36563055

ABSTRACT

Could co-teaching be a mechanism to support the adoption of evidence-based teaching strategies? Co-teaching has been proposed as a lever for fostering pedagogical change and has key attributes of a successful change strategy, but does research indicate co-teaching effectively shifts instructional practices? Based on our review of the emerging evidence, we wrote this essay for multiple audiences, including science, technology, engineering, and mathematics (STEM) instructors, education development professionals, leaders who oversee teaching, and researchers. We define co-teaching in the context of STEM higher education and summarize what is known about the pedagogical changes that co-teaching could support and the potential mechanisms behind these changes. We share recommendations based on the available evidence for those who need productive ideas right now. We also lay out a variety of future directions for research about co-teaching as a lever for pedagogical change. Achieving widespread and impactful pedagogical change is a monumental undertaking facing STEM higher education, and multiple approaches will be needed to meet this challenge. Co-teaching has potential to shift ways of thinking and pedagogical practices among undergraduate STEM faculty, but how co-teaching is enacted is likely crucial to its impact, as is the context in which it occurs.


Subject(s)
Students , Technology , Humans , Technology/education , Faculty , Engineering/education , Mathematics , Teaching
7.
Hum Mol Genet ; 31(23): 4075-4086, 2022 11 28.
Article in English | MEDLINE | ID: mdl-35849052

ABSTRACT

The A-to-G point mutation at position 3243 in the human mitochondrial genome (m.3243A > G) is the most common pathogenic mtDNA variant responsible for disease in humans. It is widely accepted that m.3243A > G levels decrease in blood with age, and an age correction representing ~ 2% annual decline is often applied to account for this change in mutation level. Here we report that recent data indicate that the dynamics of m.3243A > G are more complex and depend on the mutation level in blood in a bi-phasic way. Consequently, the traditional 2% correction, which is adequate 'on average', creates opposite predictive biases at high and low mutation levels. Unbiased age correction is needed to circumvent these drawbacks of the standard model. We propose to eliminate both biases by using an approach where age correction depends on mutation level in a biphasic way to account for the dynamics of m.3243A > G in blood. The utility of this approach was further tested in estimating germline selection of m.3243A > G. The biphasic approach permitted us to uncover patterns consistent with the possibility of positive selection for m.3243A > G. Germline selection of m.3243A > G shows an 'arching' profile by which selection is positive at intermediate mutant fractions and declines at high and low mutant fractions. We conclude that use of this biphasic approach will greatly improve the accuracy of modelling changes in mtDNA mutation frequencies in the germline and in somatic cells during aging.


Subject(s)
DNA, Mitochondrial , Mitochondrial Diseases , Humans , DNA, Mitochondrial/genetics , Mitochondria/genetics , Mutation , Point Mutation , Germ Cells , Mitochondrial Diseases/genetics
8.
J Microbiol Biol Educ ; 23(1)2022 Apr.
Article in English | MEDLINE | ID: mdl-35496704

ABSTRACT

Students possess informal, intuitive ways of reasoning about the world, including biological phenomena. Although useful in some cases, intuitive reasoning can also lead to the development of scientifically inaccurate ideas that conflict with central concepts taught in formal biology education settings, including evolution. Using antibiotic resistance as an example of evolution, we developed a set of reading interventions and an assessment tool to examine the extent to which differences in instructional language affect undergraduate student misconceptions and intuitive reasoning. We find that readings that confront intuitive misconceptions can be more effective in reducing those misconceptions than factual explanations of antibiotic resistance that fail to confront misconceptions. Overall, our findings build upon investigations of intuitive reasoning in biology, examine possible instructional interventions, and raise questions about effective implementation of reading interventions in addressing persistent misconceptions about biology.

9.
Cell Rep ; 38(12): 110556, 2022 03 22.
Article in English | MEDLINE | ID: mdl-35320722

ABSTRACT

Many neurodegenerative diseases, such as amyotrophic lateral sclerosis (ALS), lead to the selective degeneration of discrete cell types in the CNS despite the ubiquitous expression of many genes linked to disease. Therapeutic advancement depends on understanding the unique cellular adaptations that underlie pathology of vulnerable cells in the context of disease-causing mutations. Here, we employ bacTRAP molecular profiling to elucidate cell type-specific molecular responses of cortical upper motor neurons in a preclinical ALS model. Using two bacTRAP mouse lines that label distinct vulnerable or resilient projection neuron populations in motor cortex, we show that the regulation of oxidative phosphorylation (Oxphos) pathways is a common response in both cell types. However, differences in the baseline expression of genes involved in Stem and the handling of reactive oxygen species likely lead to the selective degeneration of the vulnerable cells. These results provide a framework to identify cell-type-specific processes in neurodegenerative disease.


Subject(s)
Amyotrophic Lateral Sclerosis , Motor Cortex , Neurodegenerative Diseases , Amyotrophic Lateral Sclerosis/metabolism , Animals , Disease Models, Animal , Mice , Mice, Transgenic , Motor Cortex/metabolism , Motor Neurons/metabolism , Neurodegenerative Diseases/metabolism , Superoxide Dismutase/metabolism , Superoxide Dismutase-1/genetics , Superoxide Dismutase-1/metabolism
10.
Mitochondrion ; 63: 85-88, 2022 03.
Article in English | MEDLINE | ID: mdl-35167983

ABSTRACT

Interactions between the products of the nuclear and mitochondrial genomes are critical for the function of most eukaryotic cells. Recently the introduction of mitochondrial replacement therapy has raised the question of incompatibilities between mitochondrial and nuclear variants, and their potential influence on the genetic makeup of human populations. Such interactions could also contribute to the variability of the penetrance of pathogenic DNA variants. This led us to investigate the frequencies of combinations of nuclear and mitochondrial SNP alleles (mitonuclear combinations) in healthy individuals (n = 5375) and in a cohort of patients with Parkinson's disease (PD, n = 2210). In the unaffected population, we were not able to find associations between nuclear and mitochondrial variants with a false discovery rate below 0.05 after accounting for multiple testing (i.e., the number of combinations examined). However, in the PD cohort, five combinations surpassed this threshold. Next, after combining both cohorts, we investigated whether these associations were modulated by disease status. All five combinations were significant (p < 10-3 for all tests). These combinations also showed significant evidence for an effect of the interaction between the mitochondrial and nuclear variants on disease risk. Their nuclear components mapped to TBCA, NIBAN3, and GLT25D1 and an uncharacterised intergenic region. In summary, starting from a single cohort design we identified combinations of nuclear and mitochondrial variants affecting PD disease risk.


Subject(s)
Parkinson Disease , Polymorphism, Single Nucleotide , Cell Nucleus/genetics , DNA, Mitochondrial/genetics , Humans , Mitochondria/genetics , Parkinson Disease/genetics
11.
Hum Mol Genet ; 30(R2): R245-R253, 2021 10 01.
Article in English | MEDLINE | ID: mdl-34169319

ABSTRACT

Mitochondrial DNA (mtDNA) disorders are recognized as one of the most common causes of inherited metabolic disorders. The mitochondrial genome occurs in multiple copies resulting in both homoplasmic and heteroplasmic pathogenic mtDNA variants. A biochemical defect arises when the pathogenic variant level reaches a threshold, which differs between variants. Moreover, variants can segregate, clonally expand, or be lost from cellular populations resulting in a dynamic and tissue-specific mosaic pattern of oxidative deficiency. MtDNA is maternally inherited but transmission patterns of heteroplasmic pathogenic variants are complex. During oogenesis, a mitochondrial bottleneck results in offspring with widely differing variant levels to their mother, whilst highly deleterious variants, such as deletions, are not transmitted. Complemented by a complex interplay between mitochondrial and nuclear genomes, these peculiar genetics produce marked phenotypic variation, posing challenges to the diagnosis and clinical management of patients. Novel therapeutic compounds and several genetic therapies are currently under investigation, but proven disease-modifying therapies remain elusive. Women who carry pathogenic mtDNA variants require bespoke genetic counselling to determine their reproductive options. Recent advances in in vitro fertilization techniques, have greatly improved reproductive choices, but are not without their challenges. Since the first pathogenic mtDNA variants were identified over 30 years ago, there has been remarkable progress in our understanding of these diseases. However, many questions remain unanswered and future studies are required to investigate the mechanisms of disease progression and to identify new disease-specific therapeutic targets.


Subject(s)
DNA, Mitochondrial , Genetic Association Studies , Genetic Predisposition to Disease , Genetic Variation , Mitochondrial Diseases/genetics , Disease Management , Extrachromosomal Inheritance , Humans , Mitochondrial Diseases/diagnosis , Mitochondrial Diseases/therapy
12.
NPJ Parkinsons Dis ; 7(1): 39, 2021 May 12.
Article in English | MEDLINE | ID: mdl-33980828

ABSTRACT

Here we report the application of a mass spectrometry-based technology, imaging mass cytometry, to perform in-depth proteomic profiling of mitochondrial complexes in single neurons, using metal-conjugated antibodies to label post-mortem human midbrain sections. Mitochondrial dysfunction, particularly deficiency in complex I has previously been associated with the degeneration of dopaminergic neurons in Parkinson's disease. To further our understanding of the nature of this dysfunction, and to identify Parkinson's disease specific changes, we validated a panel of antibodies targeting subunits of all five mitochondrial oxidative phosphorylation complexes in dopaminergic neurons from Parkinson's disease, mitochondrial disease, and control cases. Detailed analysis of the expression profile of these proteins, highlighted heterogeneity between individuals. There is a widespread decrease in expression of all complexes in Parkinson's neurons, although more severe in mitochondrial disease neurons, however, the combination of affected complexes varies between the two groups. We also provide evidence of a potential neuronal response to mitochondrial dysfunction through a compensatory increase in mitochondrial mass. This study highlights the use of imaging mass cytometry in the assessment and analysis of expression of oxidative phosphorylation proteins, revealing the complexity of deficiencies of these proteins within individual neurons which may contribute to and drive neurodegeneration in Parkinson's disease.

13.
FEBS Lett ; 595(8): 1003-1024, 2021 04.
Article in English | MEDLINE | ID: mdl-33513266

ABSTRACT

Mitochondrial diseases are clinically and genetically heterogeneous disorders, caused by pathogenic variants in either the nuclear or mitochondrial genome. This heterogeneity is particularly striking for disease caused by variants in mitochondrial DNA-encoded tRNA (mt-tRNA) genes, posing challenges for both the treatment of patients and understanding the molecular pathology. In this review, we consider disease caused by the two most common pathogenic mt-tRNA variants: m.3243A>G (within MT-TL1, encoding mt-tRNALeu(UUR) ) and m.8344A>G (within MT-TK, encoding mt-tRNALys ), which together account for the vast majority of all mt-tRNA-related disease. We compare and contrast the clinical disease they are associated with, as well as their molecular pathologies, and consider what is known about the likely molecular mechanisms of disease. Finally, we discuss the role of mitochondrial-nuclear crosstalk in the manifestation of mt-tRNA-associated disease and how research in this area not only has the potential to uncover molecular mechanisms responsible for the vast clinical heterogeneity associated with these variants but also pave the way to develop treatment options for these devastating diseases.


Subject(s)
DNA, Mitochondrial , Genetic Variation , Mitochondria , Mitochondrial Diseases , RNA, Mitochondrial , RNA, Transfer, Leu , DNA, Mitochondrial/genetics , DNA, Mitochondrial/metabolism , Humans , Mitochondria/genetics , Mitochondria/metabolism , Mitochondria/pathology , Mitochondrial Diseases/genetics , Mitochondrial Diseases/metabolism , Mitochondrial Diseases/pathology , RNA, Mitochondrial/genetics , RNA, Mitochondrial/metabolism , RNA, Transfer, Leu/genetics , RNA, Transfer, Leu/metabolism
14.
Article in English | MEDLINE | ID: mdl-32528607

ABSTRACT

Over the past decade, growing evidence has shown that there are many benefits to undergraduate students engaging in scientific research, including increased persistence in pursuing STEM careers and successful outcomes in graduate study. With these benefits in mind, there has been a significant push toward providing research opportunities for students in STEM majors. To address this need, an increasing number of undergraduate courses have been developed to provide students with research experiences in a class setting, also known as course-based undergraduate research experiences, or CUREs. Despite the growing success of these courses, a number of barriers remain that deter faculty from developing and implementing CUREs. Here, we will review the perceived challenges of developing a CURE and provide practical strategies to overcome these challenges.

15.
Proc Natl Acad Sci U S A ; 117(12): 6476-6483, 2020 03 24.
Article in English | MEDLINE | ID: mdl-32152114

ABSTRACT

We tested the hypothesis that underrepresented students in active-learning classrooms experience narrower achievement gaps than underrepresented students in traditional lecturing classrooms, averaged across all science, technology, engineering, and mathematics (STEM) fields and courses. We conducted a comprehensive search for both published and unpublished studies that compared the performance of underrepresented students to their overrepresented classmates in active-learning and traditional-lecturing treatments. This search resulted in data on student examination scores from 15 studies (9,238 total students) and data on student failure rates from 26 studies (44,606 total students). Bayesian regression analyses showed that on average, active learning reduced achievement gaps in examination scores by 33% and narrowed gaps in passing rates by 45%. The reported proportion of time that students spend on in-class activities was important, as only classes that implemented high-intensity active learning narrowed achievement gaps. Sensitivity analyses showed that the conclusions are robust to sampling bias and other issues. To explain the extensive variation in efficacy observed among studies, we propose the heads-and-hearts hypothesis, which holds that meaningful reductions in achievement gaps only occur when course designs combine deliberate practice with inclusive teaching. Our results support calls to replace traditional lecturing with evidence-based, active-learning course designs across the STEM disciplines and suggest that innovations in instructional strategies can increase equity in higher education.


Subject(s)
Achievement , Minority Groups/education , Problem-Based Learning , Educational Measurement , Engineering/education , Humans , Mathematics/education , Science/education , Students , Technology/education , United States , Universities
16.
Mol Genet Metab ; 128(1-2): 19-29, 2019.
Article in English | MEDLINE | ID: mdl-31648942

ABSTRACT

Mitochondrial diseases, caused by mutations in either the nuclear or mitochondrial genomes (mtDNA), are the most common form of inherited neurometabolic disorders. They are remarkably heterogeneous, both in their clinical presentation and genetic etiology, presenting challenges for diagnosis, clinical management and elucidation of molecular mechanism. The multifaceted nature of these diseases, compounded by the unique characteristics of mitochondrial genetics, cement their space in the field of complex disease. In this review we examine the m.3243A>G variant, one of the most prevalent mitochondrial DNA mutations, using it as an exemplar to demonstrate the challenges presented by these complex disorders. Disease caused by m.3243A>G is one of the most phenotypically diverse of all mitochondrial diseases; we outline known causes of this heterogeneity including mtDNA heteroplasmy, mtDNA copy number and nuclear genetic factors. We consider the impact that this has in the clinic, discussing the personalized management of common manifestations attributed to this pathogenic mtDNA variant, including hearing impairment, diabetes mellitus, myopathy, cardiac disease, stroke-like episodes and gastrointestinal disturbances. Future research into this complex disorder must account for this heterogeneity, benefitting from the use of large patient cohorts to build upon current clinical expertise. Through multi-disciplinary collaboration, the complexities of this mitochondrial disease can be addressed with the variety of diagnostic, prognostic, and treatment approaches that are moulded to best fit the needs of each individual patient.


Subject(s)
Mitochondria/genetics , Mitochondrial Diseases/genetics , Mutation , Precision Medicine , DNA, Mitochondrial/genetics , Genetic Variation , Humans , Mitochondrial Diseases/diagnosis , Phenotype
18.
J Assoc Res Otolaryngol ; 20(1): 1-19, 2019 02.
Article in English | MEDLINE | ID: mdl-30635804

ABSTRACT

Although perhaps best known for their use in developmental studies, over the last couple of decades, zebrafish have become increasingly popular model organisms for investigating auditory system function and disease. Like mammals, zebrafish possess inner ear mechanosensory hair cells required for hearing, as well as superficial hair cells of the lateral line sensory system, which mediate detection of directional water flow. Complementing mammalian studies, zebrafish have been used to gain significant insights into many facets of hair cell biology, including mechanotransduction and synaptic physiology as well as mechanisms of both hereditary and acquired hair cell dysfunction. Here, we provide an overview of this literature, highlighting some of the particular advantages of using zebrafish to investigate hearing and hearing loss.


Subject(s)
Hair Cells, Auditory/physiology , Zebrafish/physiology , Animals , Cell Death , Cell Polarity , Eye Proteins/physiology , Glutaredoxins/genetics , Hearing Loss/genetics , Mechanotransduction, Cellular/physiology , Models, Animal , Myosin VIIa/genetics , Sound , Water , Zebrafish Proteins/genetics , Zebrafish Proteins/physiology
19.
J Clin Endocrinol Metab ; 104(6): 2057-2066, 2019 06 01.
Article in English | MEDLINE | ID: mdl-30423112

ABSTRACT

CONTEXT: Abnormal growth and short stature are observed in patients with mitochondrial disease, but it is unclear whether there is a relationship between final adult height and disease severity. OBJECTIVE: To determine whether patients with genetically confirmed mitochondrial disease are shorter than their peers and whether stature is related to disease severity. DESIGN: Analysis of final adult height in relation to disease severity as determined by the Newcastle Mitochondrial Disease Adult Scale (NMDAS). SETTING: UK Mitochondrial Disease Patient Cohort (Mito Cohort). PATIENTS: 575 patients were identified with recorded height, weight, and molecular genetic diagnosis of mitochondrial disease within the Mito Cohort. MAIN OUTCOME MEASURES: Adult height, body mass index (BMI), and their association with genetic subgroup and disease severity. RESULTS: Adults with mitochondrial disease were short, with a mean height of -0.49 SD (95% CI, -0.58 to -0.39; n = 575) compared with UK reference data. Patients were overweight, with a BMI SD of 0.52 (95% CI, 0.37 to 0.67; n = 472). The most common genetic subgroup (m.3243A>G mutation) had a height SD of -0.70 (95% CI, -0.85 to -0.54; n = 234) and a BMI SD of 0.12 (95% CI, -0.10 to 0.34; n = 212). NMDAS scores were negatively correlated with height SD (r = -0.25; 95% CI, -0.33 to -0.17; P < 0.001, n = 533). Rate of disease progression also correlated negatively with adult height (P < 0.001). CONCLUSION: Final height in mitochondrial disease reflects disease severity and rate of disease progression. Mitochondrial dysfunction and associated subclinical comorbidities affect growth plate physiology.


Subject(s)
Body Height/genetics , Growth Disorders/genetics , Mitochondrial Diseases/diagnosis , Severity of Illness Index , Adolescent , Adult , Aged , Aged, 80 and over , Body Mass Index , Disease Progression , Female , Growth Disorders/diagnosis , Humans , Male , Middle Aged , Mitochondrial Diseases/complications , Mitochondrial Diseases/genetics , Retrospective Studies , United Kingdom , Young Adult
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