[Leigh syndrome resulting from a de novo mitochondrial DNA mutation (T8993G)]. / Síndrome de Leigh producido por una mutación de novo T8993G en el ADN mitocondrial.

INTRODUCTION: Several degenerative neurological diseases are caused by mutations in the mitochondrial gene coding for subunit 6 of the ATPase. Thus, NARP (neurogenic weakness, ataxia, and retinitis pigmentosa) and Leigh syndromes are associated to a T8993G mutation when the percentage of mutant mitochondrial DNA is low (60 90%) or high (>90%), respectively. Leigh syndrome is also caused by a second mutation in the same position T8993C. CASE REPORT: The patient, a boy that died at 6 months, had generalized hypotonia, psychomotor delay, hepatomegaly, choreic movements and hyporreflexia. MRI showed hypodensities in the basal ganglia and brain stem as well as hyperlactacidemia. Molecular genetic analysis of the mitochondrial DNA showed that the patient had the T8993G mutation in a percentage higher than 95%. No mutated DNA was detected in blood of the proband s mother, maternal aunt and grandmother. CONCLUSIONS: The point mutation T8993G may occur de novo, at high levels, causing neurodegenerative diseases.

Síndrome de Leigh producido por una mutación de novo T8993G en el ADN mitocondrial / Leigh syndrome resulting from a de novo mitochondrial DNA mutation (T8993G)

Introducción. Varias enfermedades neurológicas degenerativas están causadas por mutaciones en el gen de la subunidad 6 de la ATP sintetasa codificada por el ADN mitocondrial (ADNmt). Así, los síndromes de NARP (debilidad neurogénica, ataxia y retinitis pigmentosa) y el de Leigh están causados por una misma mutación, la T8993G, cuando está presente en proporciones bajas (60-90 por ciento) y altas (>90 por ciento). Una segunda mutación en la misma posición, la T8993C, produce también síndrome de Leigh, aunque con manifestaciones más moderadas. Caso clínico. El paciente, un niño que falleció a los seis meses de vida, presentaba una marcada hipotonía generalizada, retraso psicomotor, hepatomegalia, movimientos coreoatetósicos e hiporreflexia. Asimismo, presentaba hiperlactacidemia y alteraciones en la señal de los núcleos de la base y de la zona troncoencefálica. El análisis geneticomolecular del ADNmt mostró la presencia de una mutación T8993G en una proporción superior al 95 por ciento, sin que se encontrara en las muestras de sangre de su madre, su tía y su abuela materna. Conclusiones. La mutación puntual T8993G puede aparecer, de novo, en proporciones muy elevadas, con posibilidades que origine enfermedades degenerativas (AU)

[Genetic diseases of the mitochondrial DNA in humans]. / Enfermedades genéticas del ADN mitocondrial humano.

Mitochondrial diseases are a group of disorders produced by defects in the oxidative phosphorylation system (Oxphos system), the final pathway of the mitochondrial energetic metabolism, resulting in a deficiency of the biosynthesis of ATP. Part of the polypeptide subunits involved in the Oxphos system are codified by the mitochondrial DNA. In the last years, mutations in this genetic system have been described and associated to well defined clinical syndromes. The clinical features of these disorders are very heterogeneous affecting, in most cases, to different organs and tissues and their correct diagnosis require precise clinical, morphological, biochemical and genetic data. The peculiar genetic characteristics of the mitochondrial DNA (maternal inheritance, polyplasmia and mitotic segregation) give to these disorders very distinctive properties. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

[Mitochondrial encephalomyelitis, lactic acidosis and cerebrovascular accidents (MELAS) in pediatric age with the A3243G mutation in the tRNALeu(UUR) gene of mitochondrial DNA]. / Encefalomiopatía mitocondrial, acidosis láctica y accidentes cerebrovasculares (MELAS) en edad pediátrica con la mutación A3243G en el gen del ARNtLeu(UUR) del ADN mitocondrial.

OBJECTIVES: To evaluate three patients with the mitochondrial encephalopathy, lactic acidosis and cerebrovascular accident syndrome (MELAS) diagnosed in childhood, with particular reference to the initial symptoms and clinical evolution during the first stage at a pediatric age, and to compare them with other studies on the subject. PATIENTS AND METHODS: Two boys and a girl of 10, 11 and 13 years had tests on lactate, pyruvate and aminoacids in biological fluids under basal conditions and also functional tests and enzyme activity assay of the mitochondrial respiratory chain of a muscle biopsy. We also analysed the particular DNA mutations related to MELAS in different tissues from these patients and in lymphocytes from members of the mothers' families who could be tested. RESULTS: The patients fulfilled the clinical criteria for the MELAS syndrome. Neuroimaging showed cerebrovascular accidents. Neurophysiological studies showed myopathy in one patient and neuroaxonal neuropathy in another. In two cases ophthalmological study showed retinitis pigmentaria and during cerebrovascular accidents transient phenomena of homonymous hemianopsia and cortical blindness were seen. In all patients muscle biopsy showed ragged red fibres and the biochemical study showed an enzyme deficit in the respiratory mitochondrial chain. On molecular genetic study of the mitochondrial DNA (mtDNA) there was a particular mutation A3243G on the tRNA(Leu) in all patients and some members of the mothers' families. CONCLUSIONS: In children with frequent episodes of migraine headaches, vomiting, refractory epilepsy and fatigue the presence of a mitochondrial disease should be suspected. On detection of mtDNA mutations MELAS may be diagnosed even without all the clinical criteria which characterise this syndrome.

Oxygen consumption measurement in lymphocytes for the diagnosis of pediatric patients with oxidative phosphorylation diseases.

OBJECTIVES: To evaluate the results of oxygen consumption measurement in lymphocytes for the diagnosis and treatment monitoring of pediatric patients with oxidative phosphorylation diseases. DESIGN AND METHODS: Twenty-four children with an oxidative phosphorylation disease were studied. Results were compared with those of 87 healthy children. Oxygen consumption measurements in digitonine-permeabilized lymphocytes incubated with pyruvate plus malate and succinate were performed in a Clark-type oxygen electrode. RESULTS: A total of 58% of patients showed a decreased oxygen consumption in lymphocytes incubated with pyruvate. In 4 patients, this analysis was the unique initial biochemical test, which revealed an impaired mitochondrial energy metabolism. Significant differences were observed in lymphocytes incubated with pyruvate between patients and reference values (p<0.00005), and in lymphocytes incubated with pyruvate before and after treatment (p<0.05). CONCLUSIONS: This test is useful for diagnosing oxidative phosphorylation diseases in patients who did not have other biochemical alterations, although false-negative results can be found. It is not useful for treatment monitoring.

Uncoupling protein-1 mRNA expression in lipomas from patients bearing pathogenic mitochondrial DNA mutations.

Multiple symmetric lipomatosis (MSL) is a rare disorder characterised by large subcutaneous fat masses in some parts of the trunk. Mitochondrial disfunction is common in MSL, but the identity of the adipose cells developing in multiple lipomas is not well known. We determined that brown adipose tissue-specific uncoupling protein-1 (UCP-1) mRNA is expressed in the lipoma of a multiple symmetric lipomatosis patient bearing the 8344 mutation in the tRNALys gene of mitochondrial DNA. UCP1 mRNA was not detected in normal subcutaneous fat from the same patient or in the lipoma of another patient bearing a different mutation in the same tRNALys gene. These findings implicate brown adipose cells as the origin of lipomas in a subset of patients bearing tRNALys mutations in mitochondrial DNA.

Encefalomiopatía mitocondrial, acidosis lácticay accidentes cerebrovasculares (MELAS) en edad pediátricacon la mutación A3243G en el gen del ARNtLeu(UUR)del ADN mitocondrial / Mitochondrial encephalomyopathy, lactic acidosis and cerebrovascular accidents (MELAS) in children with the A3243G mutation of the tRNA(Leu)(UUR) gene of DNA mitochondria

Objetivos. Evaluar tres pacientes afectos de síndrome de encefalopatía mitocondrial, acidosis láctica y accidentes cerebrovasculares (MELAS) con diagnóstico en la infancia; en especial, los síntomas iniciales y la evolución clínica durante los primeros estadios en edad pediátrica, y compararlos con los descritos en otros estudios publicados sobre el tema. Pacientes y métodos. Dos varones y una mujer de 10, 11 y 13 años, a quienes se realizaron determinaciones de lactato, piruvato y aminoácidos en fluidos biológicos en condiciones basales, así como, tras pruebas funcionales y de las actividades enzimáticas de la cadena respiratoria mitocondrial, en biopsia muscular. Se analizaron también las mutaciones puntuales del ADN relacionadas con MELAS en diferentes tejidos de los pacientes y en linfocitos de sus familiares de línea materna disponibles. Resultados. Los enfermos cumplían los criterios clínicos de síndrome de MELAS. La neuroimagen demostró los accidentes cerebrovasculares. Los estudios neurofisiológicos mostraron en un paciente una miopatía y en otro una neuropatía neuroaxonal. En dos casos, el estudio oftalmológico reveló una retinitis pigmentaria y, en el transcurso de los accidentes cerebrovasculares, se observaron fenómenos transitorios de hemianopsia homónima y ceguera cortical. La biopsia muscular mostró en todos los enfermos fibras rojo rasgadas y el estudio bioquímico, un déficit enzimático de la cadena respiratoria mitocondrial. El estudio genético molecular del ADN mitocondrial (ADNmt) detectó la presencia de la mutación puntual A3243G del gen del ARNtLeu en todos los pacientes y en algunos familiares de línea materna. Conclusiones. En niños con episodios frecuentes de cefalea migrañosa, vómitos, epilepsia rebelde y fatiga debemos sospechar una enfermedad mitocondrial. Con la detección de mutaciones de ADNmt, el diagnóstico de MELAS puede realizarse sin que hayan aparecido aún todos los criterios clínicos que caracterizan este síndrome (AU)

A MELAS phenotype and a paternal inherited inversion of chromosome 10 in a female patient.

A MELAS phenotype and a paternal inherited inversion of chromosome 10 in a female patient: We describe a patient suffering from encephalomyopathy with overlapping symptoms, including MELAS and Kearn-Sayre syndrome features. Mutations in tRNA LEU (UUR) were not found in mtDNA of blood cells, suggesting a different genetic defect. Cytogenetic studies revealed a paternal inherited pericentric inversion of chromosome 10 (p13;q22) pat. Although the presence of the same inversion in the father and in the apparently asymptomatic sister does rather suggest that the concurrence of the mitochondrial disease in the patient was due to chance, some alternative explanations to associate both events might be proposed.

[Diseases of mitochondrial DNA]. / Enfermedades del ADN mitocondrial.

INTRODUCTION: Human diseases caused by disorders of the mitochondrial metabolism have been described more than 30 years ago. Some of these are associated to defects in the oxidative phosphorylation system (OXPHOS system), the final pathway of the mitochondrial energetic metabolism, that leads to the synthesis of ATP. DEVELOPMENT: Part of the polypeptide subunits involved in the OXPHOS system are codified by the mitochondrial DNA (mtDNA). In the last 12 years, mutations (point mutations or deletions) in the mtDNA have been described and associated to well defined clinical syndromes caused by defects in the OXPHOS system. The clinical features of these diseases are very heterogeneous affecting in most cases to a great variety of organs and tissues. CONCLUSIONS: The correct diagnosis of these mitochondrial disorders require precise clinical, morphological, biochemical, and genetic data. The rapid advances in genetic analysis allow the rapid detection of mutations, even before the obtention of other type of analysis.

Enfermedades del ADN mitocondrial / Diseases of the mitochondrial DNA

Introducción. Desde hace más de 30 años se conocen diversas anomalías del metabolismo mitocondrial que producen enfermedades humanas. Entre ellas se encuentran los defectos en el sistema de fosforilación oxidativa (sistema OXPHOS), la ruta final del metabolismo energético mitocondrial que conduce a la síntesis de ATP. Desarrollo. Este sistema presenta la particularidad de que una parte de las subunidades proteicas que lo componen están codificadas en el ADN mitocondrial. En los últimos 12 años se han descrito una serie de mutaciones (puntuales o deleciones) en el ADN mitocondrial que se han asociado con síndromes clínicos bien definidos originados por defectos en el sistema OXPHOS. Los caracteres clínicos de estas enfermedades son muy heterogéneos y, excepto en algún caso, afectan a gran variedad de órganos y tejidos. Conclusiones. El diagnóstico preciso de este grupo de trastornos requiere la obtención de datos clínicos, morfológicos, bioquímicos y genéticos. La utilización de técnicas sencillas de genética molecular permite la detección rápida de mutaciones, incluso antes de que puedan realizarse otros tipos de análisis (AU)

[Recent advances in genetics of epilepsy. Genetic of mitochondrial epilepsy]. / Avances recientes en genética de las epilepsias. Genética de las epilepsias mitocondriales.

INTRODUCTION: Recently the molecular basis of a series of clinical disorders associated with defects in the oxidative phosphorylation system (OXPHOS system) leading to ATP synthesis, the final pathway of mitochondrial energy metabolism, has been established. The polypeptide components of the OXPHOS system are codified in both nuclear and mitochondrial DNA. Therefore these mitochondrial diseases may be originated by mutations of genes found in both genetic systems. DEVELOPMENT: In recent years, several such neuromuscular diseases have been defined and associated with mitochondrial DNA mutations. One of the most striking of these is the syndrome of myoclonic epilepsy with ragged red fibres (MERRF), characterized by myoclonic epilepsy of maternal inheritance. This disorder is caused by a specific mutation on the mitochondrial tRNA(Lys) (position 8344), which gives rise to a reduction in the level of lysil-tRNA(Lys) and thus to premature termination of the translation of proteins codified in the mitochondrial DNA.

Genética de las epilepsias mitocondriales / The genetics of mitochondrial epilepsy

Introducción. Recientemente se ha establecido la base molecular de una serie de trastornos clínicos asociados a defectos en el sistema de fosforilación oxidativa (sistema OXPHOS) que conduce a la síntesis de ATP, la ruta final del metabolismo energético mitocondrial. Los polipéptidos componentes del sistema OXPHOS están codificados tanto en el ADN nuclear como en el mitocondrial, por lo que estas enfermedades mitocondriales pueden estar originadas por mutaciones en genes localizados en ambos sistemas genéticos. Desarrollo. En los últimos años se han definido y asociado varias de estas enfermedades neuromusculares con mutaciones en el ADN mitocondrial. Entre ellas, una de las que más ha llamado la atención es el síndrome de epilepsia mioclónica con fibras rojo-rasgadas (MERRF), caracterizado por epilepsias mioclónicas y por presentar un tipo de herencia materna. Esta enfermedad está causada por una mutación puntual en el ARNtLys mitocondrial (posición 8344), que origina una disminución de los niveles de lisil-ARNtLys y, por consiguiente, una terminación prematura de la traducción de las proteínas codificadas en el ADN mitocondrial (AU)

Multiple endocrine involvement in two pediatric patients with Kearns-Sayre syndrome.

We present 2 cases of progressively severe Kearns-Sayre syndrome (KSS) with multisystemic affectation and atypical endocrine and cutaneous features, a 16-year-old patient (case 1) and a 5-year-old patient (case 2). Endocrine studies showed high glucose and glycohemoglobin concentrations with normal pancreatic reserve and low values of ACTH, cortisol, LH and FSH in case 1. Normal ACTH values with low concentrations of cortisol and PTH were observed in case 2. Southern blot analysis and PCR amplification revealed the presence of a deletion of approximately 6.7 kb in the mitochondrial DNA of both patients. Endocrinological studies suggest that adrenal insufficiency may be an additional feature of KSS that worsens the clinical evolution of the patients. In spite of a normal pancreatic reserve, insulin therapy should be considered in patients with diabetes mellitus of mitochondrial origin.

Familial multiple symmetric lipomatosis associated with the A8344G mutation of mitochondrial DNA.

We describe familial multiple symmetric lipomatosis in a pedigree harboring the 8344 mutation in the tRNA(Lys) gene of mitochondrial DNA (mtDNA). The proband showed neuromuscular involvement but lacked the typical manifestations of myoclonic epilepsy and ragged-red fibers disease. The distribution of the mutation was unusual because the proportion of mutated genomes was higher in blood and lipomas than in muscle tissue.

[Acute presentation of leukodystrophy due to mitochondrial cytopathology and multiple deletions of mitochondrial DNA]. / Leucodistrofia de presentación aguda por citopatía mitocondrial y deleciones múltiples del ADN mitocondrial.

INTRODUCTION: Deletions of mitochondrial DNA (mtDNA) are a known cause of various mitochondrial cytopathies, which are sporadic and usually not due to maternal transmission. The multiple deletions are usually transmitted on a Mendelian pattern, and are frequently of autosomal dominant character. Leukodystrophy may be part of the picture, or even the form of presentation, of some mitochondrial cytopathies. Thus, in a case of leukoencephaly of unknown origin, mitochondrial cytopathy should be considered in the differential diagnosis. CLINICAL CASE: We present the case of a boy with no previous clinical abnormalities who, at the age of 13, suddenly fell to the floor with an encephalopathy which required aggressive treatment, needing mechanical ventilation and prolonged sedation. Following partial recovery spastic-dystonic quadriplegia remained. Neuroimaging showed advanced leukodystrophy with small hemorrhages in the white matter, which later disappeared. After rejecting other aetiologies, mitochondrial cytopathies in muscle were studied. A partial defect of the I and IV complexes of the respiratory chain and two deletions of mtDNA were shown. CONCLUSIONS: This case is another example of the variable clinical presentation of mitochondrial cytopathies and yet another argument for their inclusion in the diagnosis of leukodystrophy of unknown origin.