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American Journal of Human Genetics logoLink to American Journal of Human Genetics
. 1999 Aug;65(2):474–482. doi: 10.1086/302488

Genetic counseling and prenatal diagnosis for the mitochondrial DNA mutations at nucleotide 8993.

S L White 1, V R Collins 1, R Wolfe 1, M A Cleary 1, S Shanske 1, S DiMauro 1, H H Dahl 1, D R Thorburn 1
PMCID: PMC1377946  PMID: 10417290

Abstract

Mitochondrial genetics is complicated by heteroplasmy, or mutant load, which may be from 1%-99%, and thus may produce a gene dosage-type effect. Limited data are available for genotype/phenotype correlations in disorders caused by mtDNA mutations; therefore, prenatal diagnosis for mtDNA mutations has been hindered by an inability to predict accurately the clinical severity expected from a mutant load measured in fetal tissue. After reviewing 44 published and 12 unpublished pedigrees, we considered the possibility of prenatal diagnosis for two common mtDNA mutations at nucleotide 8993. We related the severity of symptoms to the mutant load and predicted the clinical outcome of a given mutant load. We also used the available data to generate empirical recurrence risks for genetic counseling, which may be used in conjunction with prenatal diagnosis.

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Selected References

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  1. Blok R. B., Gook D. A., Thorburn D. R., Dahl H. H. Skewed segregation of the mtDNA nt 8993 (T-->G) mutation in human oocytes. Am J Hum Genet. 1997 Jun;60(6):1495–1501. doi: 10.1086/515453. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Boulet L., Karpati G., Shoubridge E. A. Distribution and threshold expression of the tRNA(Lys) mutation in skeletal muscle of patients with myoclonic epilepsy and ragged-red fibers (MERRF). Am J Hum Genet. 1992 Dec;51(6):1187–1200. [PMC free article] [PubMed] [Google Scholar]
  3. Chinnery P. F., Howell N., Lightowlers R. N., Turnbull D. M. Molecular pathology of MELAS and MERRF. The relationship between mutation load and clinical phenotypes. Brain. 1997 Oct;120(Pt 10):1713–1721. doi: 10.1093/brain/120.10.1713. [DOI] [PubMed] [Google Scholar]
  4. Ciafaloni E., Santorelli F. M., Shanske S., Deonna T., Roulet E., Janzer C., Pescia G., DiMauro S. Maternally inherited Leigh syndrome. J Pediatr. 1993 Mar;122(3):419–422. doi: 10.1016/s0022-3476(05)83431-6. [DOI] [PubMed] [Google Scholar]
  5. Degoul F., Diry M., Rodriguez D., Robain O., Francois D., Ponsot G., Marsac C., Desguerre I. Clinical, biochemical, and molecular analysis of a maternally inherited case of Leigh syndrome (MILS) associated with the mtDNA T8993G point mutation. J Inherit Metab Dis. 1995;18(6):682–688. doi: 10.1007/BF02436757. [DOI] [PubMed] [Google Scholar]
  6. Degoul F., François D., Diry M., Ponsot G., Desguerre I., Héron B., Marsac C., Moutard M. L. A near homoplasmic T8993G mtDNA mutation in a patient with atypic Leigh syndrome not present in the mother's tissues. J Inherit Metab Dis. 1997 Mar;20(1):49–53. doi: 10.1023/a:1005357506614. [DOI] [PubMed] [Google Scholar]
  7. Ferlin T., Landrieu P., Rambaud C., Fernandez H., Dumoulin R., Rustin P., Mousson B. Segregation of the G8993 mutant mitochondrial DNA through generations and embryonic tissues in a family at risk of Leigh syndrome. J Pediatr. 1997 Sep;131(3):447–449. doi: 10.1016/s0022-3476(97)80074-1. [DOI] [PubMed] [Google Scholar]
  8. Fryer A., Appleton R., Sweeney M. G., Rosenbloom L., Harding A. E. Mitochondrial DNA 8993 (NARP) mutation presenting with a heterogeneous phenotype including 'cerebral palsy'. Arch Dis Child. 1994 Nov;71(5):419–422. doi: 10.1136/adc.71.5.419. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Harding A. E., Holt I. J., Sweeney M. G., Brockington M., Davis M. B. Prenatal diagnosis of mitochondrial DNA8993 T----G disease. Am J Hum Genet. 1992 Mar;50(3):629–633. [PMC free article] [PubMed] [Google Scholar]
  10. Hauswirth W. W., Laipis P. J. Mitochondrial DNA polymorphism in a maternal lineage of Holstein cows. Proc Natl Acad Sci U S A. 1982 Aug;79(15):4686–4690. doi: 10.1073/pnas.79.15.4686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Holt I. J., Harding A. E., Petty R. K., Morgan-Hughes J. A. A new mitochondrial disease associated with mitochondrial DNA heteroplasmy. Am J Hum Genet. 1990 Mar;46(3):428–433. [PMC free article] [PubMed] [Google Scholar]
  12. Houstek J., Klement P., Hermanská J., Houstková H., Hansíková H., Van den Bogert C., Zeman J. Altered properties of mitochondrial ATP-synthase in patients with a T-->G mutation in the ATPase 6 (subunit a) gene at position 8993 of mtDNA. Biochim Biophys Acta. 1995 Jun 9;1271(2-3):349–357. doi: 10.1016/0925-4439(95)00063-a. [DOI] [PubMed] [Google Scholar]
  13. Howell N. Origin, cellular expression, and cybrid transmission of mitochondrial CAP-R, PYR-IND, and OLI-R mutant phenotypes. Somatic Cell Genet. 1983 Jan;9(1):1–24. doi: 10.1007/BF01544045. [DOI] [PubMed] [Google Scholar]
  14. Klement P., Zeman J., Hansikova H., Houstkova H., Baudysova M., Houstek J. Different restriction fragment pattern of mtDNA indicative of generalized 8993 point mutations in a boy with lactic acidosis. J Inherit Metab Dis. 1994;17(2):249–250. doi: 10.1007/BF00711630. [DOI] [PubMed] [Google Scholar]
  15. Lodi R., Montagna P., Iotti S., Zaniol P., Barboni P., Puddu P., Barbiroli B. Brain and muscle energy metabolism studied in vivo by 31P-magnetic resonance spectroscopy in NARP syndrome. J Neurol Neurosurg Psychiatry. 1994 Dec;57(12):1492–1496. doi: 10.1136/jnnp.57.12.1492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Mak S. C., Chi C. S., Liu C. Y., Pang C. Y., Wei Y. H. Leigh syndrome associated with mitochondrial DNA 8993 T-->G mutation and ragged-red fibers. Pediatr Neurol. 1996 Jul;15(1):72–75. doi: 10.1016/0887-8994(96)00126-9. [DOI] [PubMed] [Google Scholar]
  17. Mäkelä-Bengs P., Suomalainen A., Majander A., Rapola J., Kalimo H., Nuutila A., Pihko H. Correlation between the clinical symptoms and the proportion of mitochondrial DNA carrying the 8993 point mutation in the NARP syndrome. Pediatr Res. 1995 May;37(5):634–639. doi: 10.1203/00006450-199505000-00014. [DOI] [PubMed] [Google Scholar]
  18. Ortiz R. G., Newman N. J., Shoffner J. M., Kaufman A. E., Koontz D. A., Wallace D. C. Variable retinal and neurologic manifestations in patients harboring the mitochondrial DNA 8993 mutation. Arch Ophthalmol. 1993 Nov;111(11):1525–1530. doi: 10.1001/archopht.1993.01090110091031. [DOI] [PubMed] [Google Scholar]
  19. Pastores G. M., Santorelli F. M., Shanske S., Gelb B. D., Fyfe B., Wolfe D., Willner J. P. Leigh syndrome and hypertrophic cardiomyopathy in an infant with a mitochondrial DNA point mutation (T8993G). Am J Med Genet. 1994 Apr 15;50(3):265–271. doi: 10.1002/ajmg.1320500310. [DOI] [PubMed] [Google Scholar]
  20. Poulton J., Macaulay V., Marchington D. R. Mitochondrial genetics '98 is the bottleneck cracked? Am J Hum Genet. 1998 Apr;62(4):752–757. doi: 10.1086/301811. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Poulton J., Morten K. Noninvasive diagnosis of the MELAS syndrome from blood DNA. Ann Neurol. 1993 Jul;34(1):116–116. doi: 10.1002/ana.410340124. [DOI] [PubMed] [Google Scholar]
  22. Puddu P., Barboni P., Mantovani V., Montagna P., Cerullo A., Bragliani M., Molinotti C., Caramazza R. Retinitis pigmentosa, ataxia, and mental retardation associated with mitochondrial DNA mutation in an Italian family. Br J Ophthalmol. 1993 Feb;77(2):84–88. doi: 10.1136/bjo.77.2.84. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Rahman S., Blok R. B., Dahl H. H., Danks D. M., Kirby D. M., Chow C. W., Christodoulou J., Thorburn D. R. Leigh syndrome: clinical features and biochemical and DNA abnormalities. Ann Neurol. 1996 Mar;39(3):343–351. doi: 10.1002/ana.410390311. [DOI] [PubMed] [Google Scholar]
  24. Santorelli F. M., Mak S. C., El-Schahawi M., Casali C., Shanske S., Baram T. Z., Madrid R. E., DiMauro S. Maternally inherited cardiomyopathy and hearing loss associated with a novel mutation in the mitochondrial tRNA(Lys) gene (G8363A). Am J Hum Genet. 1996 May;58(5):933–939. [PMC free article] [PubMed] [Google Scholar]
  25. Santorelli F. M., Shanske S., Jain K. D., Tick D., Schon E. A., DiMauro S. A T-->C mutation at nt 8993 of mitochondrial DNA in a child with Leigh syndrome. Neurology. 1994 May;44(5):972–974. doi: 10.1212/wnl.44.5.972. [DOI] [PubMed] [Google Scholar]
  26. Santorelli F. M., Shanske S., Macaya A., DeVivo D. C., DiMauro S. The mutation at nt 8993 of mitochondrial DNA is a common cause of Leigh's syndrome. Ann Neurol. 1993 Dec;34(6):827–834. doi: 10.1002/ana.410340612. [DOI] [PubMed] [Google Scholar]
  27. Santorelli F. M., Tanji K., Shanske S., DiMauro S. Heterogeneous clinical presentation of the mtDNA NARP/T8993G mutation. Neurology. 1997 Jul;49(1):270–273. doi: 10.1212/wnl.49.1.270. [DOI] [PubMed] [Google Scholar]
  28. Seller A., Kennedy C. R., Temple I. K., Brown G. K. Leigh syndrome resulting from de novo mutation at position 8993 of mitochondrial DNA. J Inherit Metab Dis. 1997 Mar;20(1):102–103. doi: 10.1023/a:1005378011157. [DOI] [PubMed] [Google Scholar]
  29. Shoffner J. M., Fernhoff P. M., Krawiecki N. S., Caplan D. B., Holt P. J., Koontz D. A., Takei Y., Newman N. J., Ortiz R. G., Polak M. Subacute necrotizing encephalopathy: oxidative phosphorylation defects and the ATPase 6 point mutation. Neurology. 1992 Nov;42(11):2168–2174. doi: 10.1212/wnl.42.11.2168. [DOI] [PubMed] [Google Scholar]
  30. Tatuch Y., Christodoulou J., Feigenbaum A., Clarke J. T., Wherret J., Smith C., Rudd N., Petrova-Benedict R., Robinson B. H. Heteroplasmic mtDNA mutation (T----G) at 8993 can cause Leigh disease when the percentage of abnormal mtDNA is high. Am J Hum Genet. 1992 Apr;50(4):852–858. [PMC free article] [PubMed] [Google Scholar]
  31. Tatuch Y., Robinson B. H. The mitochondrial DNA mutation at 8993 associated with NARP slows the rate of ATP synthesis in isolated lymphoblast mitochondria. Biochem Biophys Res Commun. 1993 Apr 15;192(1):124–128. doi: 10.1006/bbrc.1993.1390. [DOI] [PubMed] [Google Scholar]
  32. Tulinius M. H., Houshmand M., Larsson N. G., Holme E., Oldfors A., Holmberg E., Wahlström J. De novo mutation in the mitochondrial ATP synthase subunit 6 gene (T8993G) with rapid segregation resulting in Leigh syndrome in the offspring. Hum Genet. 1995 Sep;96(3):290–294. doi: 10.1007/BF00210409. [DOI] [PubMed] [Google Scholar]
  33. Uziel G., Moroni I., Lamantea E., Fratta G. M., Ciceri E., Carrara F., Zeviani M. Mitochondrial disease associated with the T8993G mutation of the mitochondrial ATPase 6 gene: a clinical, biochemical, and molecular study in six families. J Neurol Neurosurg Psychiatry. 1997 Jul;63(1):16–22. doi: 10.1136/jnnp.63.1.16. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Vazquez-Memije M. E., Shanske S., Santorelli F. M., Kranz-Eble P., Davidson E., DeVivo D. C., DiMauro S. Comparative biochemical studies in fibroblasts from patients with different forms of Leigh syndrome. J Inherit Metab Dis. 1996;19(1):43–50. doi: 10.1007/BF01799347. [DOI] [PubMed] [Google Scholar]
  35. Yoneda M., Miyatake T., Attardi G. Heteroplasmic mitochondrial tRNA(Lys) mutation and its complementation in MERRF patient-derived mitochondrial transformants. Muscle Nerve Suppl. 1995;3:S95–101. doi: 10.1002/mus.880181420. [DOI] [PubMed] [Google Scholar]
  36. Yoshinaga H., Ogino T., Ohtahara S., Sakuta R., Nonaka I., Horai S. A T-to-G mutation at nucleotide pair 8993 in mitochondrial DNA in a patient with Leigh's syndrome. J Child Neurol. 1993 Apr;8(2):129–133. doi: 10.1177/088307389300800204. [DOI] [PubMed] [Google Scholar]
  37. de Coo I. F., Smeets H. J., Gabreëls F. J., Arts N., van Oost B. A. Isolated case of mental retardation and ataxia due to a de novo mitochondrial T8993G mutation. Am J Hum Genet. 1996 Mar;58(3):636–638. [PMC free article] [PubMed] [Google Scholar]
  38. de Vries D. D., van Engelen B. G., Gabreëls F. J., Ruitenbeek W., van Oost B. A. A second missense mutation in the mitochondrial ATPase 6 gene in Leigh's syndrome. Ann Neurol. 1993 Sep;34(3):410–412. doi: 10.1002/ana.410340319. [DOI] [PubMed] [Google Scholar]
  39. van Erven P. M., Gabreëls F. J., Ruitenbeek W., Renier W. O., Lamers K. J., Sloof J. L. Familial Leigh's syndrome: association with a defect in oxidative metabolism probably restricted to brain. J Neurol. 1987 May;234(4):215–219. doi: 10.1007/BF00618253. [DOI] [PubMed] [Google Scholar]

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