Abstract
OBJECTIVE--To verify the phenotype to genotype correlations of mitochondrial DNA (mtDNA) related disorders in an atypical maternally inherited encephalomyopathy. METHODS--Neuroradiological, morphological, biochemical, and molecular genetic analyses were performed on the affected members of a pedigree harbouring the heteroplasmic A to G transition at nucleotide 3243 of the mitochondrial tRNALeu(UUR), which is usually associated with the syndrome of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). RESULTS--The proband was affected by a fullblown syndrome of myoclonic epilepsy with ragged red fibres (MERRF), severe brain atrophy, and basal ganglia calcifications, without the MRI T2 hyperintense focal lesions which are pathognomonic of MELAS. Oligosymptomatic relatives were variably affected by lipomas, goitre, brain atrophy, and basal ganglia calcifications. Muscle biopsies in the proband and his mother showed a MELAS-like pattern with cytochrome c oxidase hyperreactive ragged red fibres and strongly succinate dehydrogenase reactive vessels. Quantification of the A3243G mutation disclosed 78% and 70% of mutated mtDNA in the muscle of the severely affected proband and of his oligosymptomatic mother respectively. Nucleotide sequencing of the mitochondrial tRNALeu(UUR) and tRNALys in the proband's muscle failed to show any additional nucleotide change which could account for the clinical oddity of this pedigree by modulating the expression of the primary pathogenic mutation. CONCLUSION--So far, MERRF has been associated with mutations of the mitochondrial tRNALys, and MELAS with mutations of the mitochondrial tRNALeu(UUR). Now MERRF may also be considered among the clinical syndromes associated with the A to G transition at nt 3243 of the tRNALeu(UUR).
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- Calabresi P. A., Silvestri G., DiMauro S., Griggs R. C. Ekbom's syndrome: lipomas, ataxia, and neuropathy with MERRF. Muscle Nerve. 1994 Aug;17(8):943–945. doi: 10.1002/mus.880170815. [DOI] [PubMed] [Google Scholar]
- Chen R. S., Huang C. C., Lee C. C., Wai Y. Y., Hsi M. S., Pang C. Y., Wei Y. H. Overlapping syndrome of MERRF and MELAS: molecular and neuroradiological studies. Acta Neurol Scand. 1993 Jun;87(6):494–498. doi: 10.1111/j.1600-0404.1993.tb04143.x. [DOI] [PubMed] [Google Scholar]
- Ciafaloni E., Ricci E., Shanske S., Moraes C. T., Silvestri G., Hirano M., Simonetti S., Angelini C., Donati M. A., Garcia C. MELAS: clinical features, biochemistry, and molecular genetics. Ann Neurol. 1992 Apr;31(4):391–398. doi: 10.1002/ana.410310408. [DOI] [PubMed] [Google Scholar]
- Folgerø T., Torbergsen T., Oian P. The 3243 MELAS mutation in a pedigree with MERRF. Eur Neurol. 1995;35(3):168–171. doi: 10.1159/000117115. [DOI] [PubMed] [Google Scholar]
- Fukuhara N., Tokiguchi S., Shirakawa K., Tsubaki T. Myoclonus epilepsy associated with ragged-red fibres (mitochondrial abnormalities ): disease entity or a syndrome? Light-and electron-microscopic studies of two cases and review of literature. J Neurol Sci. 1980 Jul;47(1):117–133. doi: 10.1016/0022-510x(80)90031-3. [DOI] [PubMed] [Google Scholar]
- Hammans S. R., Sweeney M. G., Hanna M. G., Brockington M., Morgan-Hughes J. A., Harding A. E. The mitochondrial DNA transfer RNALeu(UUR) A-->G(3243) mutation. A clinical and genetic study. Brain. 1995 Jun;118(Pt 3):721–734. doi: 10.1093/brain/118.3.721. [DOI] [PubMed] [Google Scholar]
- Hirano M., Ricci E., Koenigsberger M. R., Defendini R., Pavlakis S. G., DeVivo D. C., DiMauro S., Rowland L. P. Melas: an original case and clinical criteria for diagnosis. Neuromuscul Disord. 1992;2(2):125–135. doi: 10.1016/0960-8966(92)90045-8. [DOI] [PubMed] [Google Scholar]
- Manfredi G., Schon E. A., Moraes C. T., Bonilla E., Berry G. T., Sladky J. T., DiMauro S. A new mutation associated with MELAS is located in a mitochondrial DNA polypeptide-coding gene. Neuromuscul Disord. 1995 Sep;5(5):391–398. doi: 10.1016/0960-8966(94)00079-o. [DOI] [PubMed] [Google Scholar]
- Mariotti C., Savarese N., Suomalainen A., Rimoldi M., Comi G., Prelle A., Antozzi C., Servidei S., Jarre L., DiDonato S. Genotype to phenotype correlations in mitochondrial encephalomyopathies associated with the A3243G mutation of mitochondrial DNA. J Neurol. 1995 May;242(5):304–312. doi: 10.1007/BF00878873. [DOI] [PubMed] [Google Scholar]
- Matthews P. M., Tampieri D., Berkovic S. F., Andermann F., Silver K., Chityat D., Arnold D. L. Magnetic resonance imaging shows specific abnormalities in the MELAS syndrome. Neurology. 1991 Jul;41(7):1043–1046. doi: 10.1212/wnl.41.7.1043. [DOI] [PubMed] [Google Scholar]
- Moraes C. T., Ciacci F., Bonilla E., Jansen C., Hirano M., Rao N., Lovelace R. E., Rowland L. P., Schon E. A., DiMauro S. Two novel pathogenic mitochondrial DNA mutations affecting organelle number and protein synthesis. Is the tRNA(Leu(UUR)) gene an etiologic hot spot? J Clin Invest. 1993 Dec;92(6):2906–2915. doi: 10.1172/JCI116913. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moraes C. T., Ricci E., Bonilla E., DiMauro S., Schon E. A. The mitochondrial tRNA(Leu(UUR)) mutation in mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes (MELAS): genetic, biochemical, and morphological correlations in skeletal muscle. Am J Hum Genet. 1992 May;50(5):934–949. [PMC free article] [PubMed] [Google Scholar]
- Pavlakis S. G., Phillips P. C., DiMauro S., De Vivo D. C., Rowland L. P. Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes: a distinctive clinical syndrome. Ann Neurol. 1984 Oct;16(4):481–488. doi: 10.1002/ana.410160409. [DOI] [PubMed] [Google Scholar]
- Shoffner J. M., Lott M. T., Lezza A. M., Seibel P., Ballinger S. W., Wallace D. C. Myoclonic epilepsy and ragged-red fiber disease (MERRF) is associated with a mitochondrial DNA tRNA(Lys) mutation. Cell. 1990 Jun 15;61(6):931–937. doi: 10.1016/0092-8674(90)90059-n. [DOI] [PubMed] [Google Scholar]
- Silvestri G., Moraes C. T., Shanske S., Oh S. J., DiMauro S. A new mtDNA mutation in the tRNA(Lys) gene associated with myoclonic epilepsy and ragged-red fibers (MERRF). Am J Hum Genet. 1992 Dec;51(6):1213–1217. [PMC free article] [PubMed] [Google Scholar]