Abstract
The small, maternally inherited mtDNA has turned out to be a Pandora's box of pathogenic mutations: 12 years into the era of “mitochondrial medicine,” about 100 pathogenic point mutations and innumerable rearrangements have been associated with a bewildering variety of multisystemic as well as tissue‐specific human diseases. After reviewing the principles of mitochondrial genetics, we compare and contrast the clinical and pathological features of disorders due to mutations in genes affecting mitochondrial protein synthesis with those of mutations in protein‐coding genes.
In contrast to the striking progress in our understanding of etiology, pathogenesis is only partially explained by the rules of mitochondrial genetics and remains largely terra incognita. We review recent progress in prenatal diagnosis and epidemiology. Therapy is still woefully inadequate, but a number of promising approaches are being developed.
Full Text
The Full Text of this article is available as a PDF (117.4 KB).
References
- 1. Andreu AL, Bruno C, Dunne TC, Tanji K, Shanske S, Sue CM, Krishna S, Hadjigeorgiou GM, Shtilbans A, Bonilla E, DiMauro S (1999) A nonsense mutation (G15059A) in the cytochrome b gene in a patient with exercise intolerance and myoglobinuria. Ann Neurol 45:127–130. [DOI] [PubMed] [Google Scholar]
- 2. Andreu AL, Bruno C, Shanske S, Shtilbans A, Hirano M, Krishna S, Hayward L, Systrom DS, Brown RH, DiMauro S (1998) Missense mutation in the mtDNA cytochrome b gene in a patient with myopathy. Neurology 51:1444–1447. [DOI] [PubMed] [Google Scholar]
- 3. Andreu AL, Checcarelli N, Iwata S, Shanske S, DiMauro S (2000) A missense mutation in the mitochondrial cytochrome b gene in a revisited case with histiocytoid cardiomyopathy. Pediatr Res (in Press). [DOI] [PubMed] [Google Scholar]
- 4. Andreu AL, Hanna M G, Reichmann H, Bruno C, Penn A S, Tanji K, Pallotti F, Iwata S, Bonilla E, Lach B, Morgan‐Hughes JA, DiMauro S (1999) Exercise intolerance due to mutations in the cytochrome b gene of mitochondrial DNA. New Engl J Med 341: 1037–1044. [DOI] [PubMed] [Google Scholar]
- 5. Andreu AL, Tanji K, Bruno C, Hadjigeorgiou GM, Sue C M, Jay C, Ohnishi T, Shanske S, Bonilla E, DiMauro S (1999) Exercise intolerance due to a nonsense mutation in the mtDNA ND4 gene. Ann Neurol 45: 820–823. [DOI] [PubMed] [Google Scholar]
- 6. Bet L, Bresolin N, Moggio M, Meola G, Prelle A, Schapira AH, Binzoni T, Chomyn A, Fortunato F, Cerretelli P, Scarlato G (1990) A case of mitochondrial myopathy, lactic acidosis and complex I deficiency. J Neurol 237: 399–404. [DOI] [PubMed] [Google Scholar]
- 7. Bindoff LA, Howell N, Poulton J, McCullogh DA, Morten KJ, Lightowlers RN, Turnbull DM, Webert K (1993) Abnormal RNA processing associated with a novel tRNA mutation in mitochondrial DNA. J Biol Chem 268: 19559–19564. [PubMed] [Google Scholar]
- 8. Bruno C, Martinuzzi A, Tang Y, Andreu AL, Pallotti F, Bonilla E, Shanske S, Fu J, Sue CM, Angelini C, DiMauro S, Manfredi G (1999) A stop‐codon mutation in the human mtDNA cytochrome c oxidase I gene disrupts the functional structure of complex IV. Am J Hum Genet 65: 611–620. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Campos Y, Martin M A, Rubio JC, Gutierrez del Olmo M, Cabello A, Arenas J (1997) Bilateral striatal necrosis and MELAS associated with a new T3308C mutation in the mitochondrial ND1 gene. Biochem Biophys Res Comm in press: [DOI] [PubMed] [Google Scholar]
- 10. Chinnery PF, Taylor DJ, Brown DT, Manners D, Styles P, Lodi R (2000) Very low levels of the mtDNA A3243G mutation associated with mitochondrial dysfunction in vivo. Ann Neurol 47: 381–384. [PubMed] [Google Scholar]
- 11. Chinnery PF, Wardell TM, Singh‐Kler R, Hayes C, Johnson MA, Taylor RW, Bindoff LA, Turnbull DM (2000) The epidemiology of pathogenic mitochondrial DNA mutations. Ann Neurol (in Press). [PubMed] [Google Scholar]
- 12. Clark KM, Taylor RW, Johnson MA, Chinnery PF, Chrzanowska‐Lightowlers Z, Andrews RM, Nelson IP, Wood NW, Lamont PJ, Hanna MG, Lightowlers RN, Turnbull DM (1999) A mtDNA mutation in the initiation codon of the cytochrome c oxidase subunit II results in lower levels of the protein and a mitochondrial encephalomyopathy. Am J Hum Genet 64: 1330–1339. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13. Comi GP, Bordoni A, Salani S, Franceschina L, Sciacco M, Prelle A, Fortunato F, Zeviani M, Napoli L, Bresolin N, Moggio M, Ausenda CD, Taanman J‐W, Scarlato G (1998) Cytochrome c oxidase subunit I microdeletion in a patient with motor neuron disease. Ann Neurol 43: 110–116. [DOI] [PubMed] [Google Scholar]
- 14. De Coo IFM, Renier WO, Ruitenbeek W, Ter Laak HJ, Bakker M, Schagger H, Van Oost BA, Smeets HJM (1999) A 4‐base pair deletion in the mitochondrial cytochrome b gene associated with Parkinsonism/MELAS overlap syndrome. Ann Neurol 45: 130–133. [DOI] [PubMed] [Google Scholar]
- 15. De Meirleir L, Seneca S, Lissens W, Schoentjes E, Desprechins B (1995) Bilateral striatal necrosis with a novel point mutation in the mitochondrial ATPase 6 gene. Pediatr Neurol 13: 242–246. [DOI] [PubMed] [Google Scholar]
- 16. De Vries DD, van EB , Gabreels F, Ruitenbeek W, Van Oost BA (1993) A second missense mutation in the mitochondrial ATPase 6 gene in Leigh's syndrome. Ann Neurol 34: 410–412. [DOI] [PubMed] [Google Scholar]
- 17. DiMauro S, Bonilla E. (1997). Mitochondrial encephalomy‐opathies. In: The Molecular and Genetic Basis of Neurological Disease, Rosenberg R. N., Prusiner S. B., DiMauro S. and Barchi R. L. (eds), 2nd. pp 201–235, Butterworth‐Heinemann, Boston . [Google Scholar]
- 18. DiMauro S, Hirano M (1998) Mitochondria and heart disease. Curr Opin Cardiol 13:190–197. [PubMed] [Google Scholar]
- 19. DiMauro S, Schon E A (1998) Mitochondrial DNA and diseases of the nervous system: The spectrum. The Neuroscientist 4: 53–63. [Google Scholar]
- 20. Dubeau F, De Stefano N, Zifkin BG, Arnold DL, Shoubridge EA (2000) Oxidative phosphorylation defect in the brains of carriers of the tRNAleu (UUR) A3243G mutation in a MELAS pedigree. Ann Neurol 47: 179–185. [PubMed] [Google Scholar]
- 21. Dumoulin R, Sagnol I, Ferlin T, Bozon D, Stepien G, Mousson B (1996) A novel gly290asp mitochondrial cytochrome b mutation linked to a complex III deficiency in progressive exercise intolerance. Mol Cell Probes 10: 389–391. [DOI] [PubMed] [Google Scholar]
- 22. Engel AG, Cunnigham CG (1963) Rapid examination of muscle tissue: An improved trichome stain method for fresh‐frozen biopsy sections. Neurology 13: 919–923. [DOI] [PubMed] [Google Scholar]
- 23. Gattermann N, Retzlaff S, Wang YL, Hofhaus G, Heinisch J, Aul C, Schneider W (1997) Heteroplasmic point mutations of mitochondrial DNA subunit I of cytochrome c oxidase in two patients with acquired idiopathic sideroblastic anemia. Blood 90: 4961–4972. [PubMed] [Google Scholar]
- 24. Goto Y, Tojo M, Tohyama J, Horai S, Nonaka I (1992) A novel point mutation in the mitochondrial tRNALeu(UUR) gene in a family with mitochondrial myopathy. Ann Neurol 31: 672–675. [DOI] [PubMed] [Google Scholar]
- 25. Hadjigeorgiou GM, Kim SH, Fischbeck KH, Andreu AL, Berry GT, Bingham P, Shanske S, Bonilla E, DiMauro S (1999) A new mitochondrial DNA mutation (A3288G) in the tRNALeu(UUR) gene associated with familial myopathy. J Neurol Sci 164: 153–157. [DOI] [PubMed] [Google Scholar]
- 26. Hanna MG, Nelson IP, Rahman S, Lane RJM, Land J, Heales S, Cooper MJ, Schapira AHV, Morgan‐Hughes JA, Wood NW (1998) Cytochrome c oxidase deficiency associated with the first stop‐codon point mutation in human mtDNA. Am J Hum Genet 63: 29–36. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27. Holt IJ, Harding AE, Morgan Hughes JA (1988) Deletions of muscle mitochondrial DNA in patients with mitochondrial myopathies. Nature 331: 717–719. [DOI] [PubMed] [Google Scholar]
- 28. Holt IJ, Harding AE, Petty RK, Morgan Hughes JA (1990) A new mitochondrial disease associated with mitochondrial DNA heteroplasmy. Am J Hum Genet 46: 428–433. [PMC free article] [PubMed] [Google Scholar]
- 29. Huoponen K, Vilkki J, Aula P, Nikoskelainen EK, Savontaus ML (1991) A new mtDNA mutation associated with Leber hereditary optic neuroretinopathy. Am J Hum Genet 48:1147–1153. [PMC free article] [PubMed] [Google Scholar]
- 30. Ivanov PL, Wadhams MJ, Roby RK, Holland MM, Weedn VW, Parsons TJ (1996) Mitochondrial DNA sequence heteroplasmy in the Grand Duke of Russia Georgij Romanov establishes the authenticity of the remains of Tsar Nicholas II. Nature Genet 12: 417–420. [DOI] [PubMed] [Google Scholar]
- 31. Johns DR, Neufeld MJ, Park RD (1992) An ND‐6 mitochondrial DNA mutation associated with Leber hereditary optic neuropathy. Biochem Biophys Res Comm 187: 1551–1557. [DOI] [PubMed] [Google Scholar]
- 32. Jun AS, Brown MD, Wallace DC (1994) A mitochondrial DNA mutation at nucleotide pair 14459 of the NADH dehydrogenase subunit 6 gene associated with maternally inherited Leber hereditary optic neuropathy and dysto‐nia. Proc Nat Acad Sci USA 91: 6206–6210. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33. Karadimas CL, Greenstein P, Sue CM, Joseph JT, Tanji K, Haller RG, Taivassalo T, Davidson MM, Shanske S, Bonilla E, DiMauro S (2000) Recurrent myoglobinuria due to a nonsense mutation in the COX I gene of mtDNA. Neurology (in press). [DOI] [PubMed] [Google Scholar]
- 34. Keightley JA, Hoffbuhr KC, Burton MD, Salas V, Johnston WSW, Penn AMW, Buist NRM, Kennaway NG (1996) A microdeletion in cytochrome c oxidase (COX) subunit III associated with COX deficiency and recurrent myoglobinuria. Nature Genet 12: 410–415. [DOI] [PubMed] [Google Scholar]
- 35. Kennaway NG, Keightley JA, Burton MD, Quan F, Libby B D, Buist NRM (1998) Mitochondrial encephalomyopathy associated with a nonsense mutation in cytochrome b. Mol Genet Metab 63: 49. [Google Scholar]
- 36. King MP, Attardi G (1989) Human cells lacking mtDNA: repopulation with exogenous mitochondria by complementation. Science 246: 500–503. [DOI] [PubMed] [Google Scholar]
- 37. Kleinle S, Schneider V, Moosmann P, Brandner S, Krahenbuhl S, Liechti‐Gallati S (1998) A novel mitochondrial tRNAPhe mutation inhibiting anticodon stem formation associated with a muscle disease. Biochem Biophys Res Comm 247: 112–115. [DOI] [PubMed] [Google Scholar]
- 38. Kruse B, Narasimhan N, Attardi G (1989) Termination of transcription in human mitochondria: identification and purification of a DNA binding protein factor that promotes termination. Cell 58: 391–397. [DOI] [PubMed] [Google Scholar]
- 39. Majamaa K, Moilanen JS, Uimonen S, Remes AM, Salmela PI, Karppa M, Majamaa‐Voltti KAM, Rusanen H, Sorri M, Peuhkurinen KJ, Hassinen IE (1998) Epidemiology of A3243G, the mutation for mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes: Prevalence of the mutation in an adult population. Am J Hum Genet 63: 447–454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40. Manfredi G, Gupta N, Vazquez‐Memije ME, Sadlock JE, Spinazzola A, De Vivo DC, Schon EA (1999) Oligomycin induces a decrease in the cellular content of a pathogenic mutation in the human mitochondrial ATPase 6 gene. J Biol Chem 274: 9386–9391. [DOI] [PubMed] [Google Scholar]
- 41. Manfredi G, Schon EA, Moraes CT, Bonilla E, Berry GT, Sladky JT, DiMauro S (1995) A new mutation associated with MELAS is located in a mitochondrial DNA polypeptide‐coding gene. Neuromusc Disord 5: 391–398. [DOI] [PubMed] [Google Scholar]
- 42. Moraes CT, Ciacci F, Bonilla E, Ionasescu V, Schon EA, DiMauro S (1993) A mitochondrial tRNA anticodon swap associated with a muscle disease. Nature Genet 4: 284–288. [DOI] [PubMed] [Google Scholar]
- 43. Moraes CT, DiMauro S, Zeviani M, Lombes A, Shanske S, Miranda AF, Nakase H, Bonilla E, Werneck LC, Servidei S, Nonaka I, Koga Y, Spiro A J, Brownnel A, Schmidt B, Schotland DL, Zupanc M, DeVivo DC, Schon EA, Rowland LP (1989) Mitochondrial DNA deletions in progressive external ophthalmoplegia and Kearns‐Sayre syndrome. N Engl J Med 320: 1293–1299. [DOI] [PubMed] [Google Scholar]
- 44. Moraes CT, Schon EA (1996) Detection and analysis of mitochondrial DNA and RNA in muscle by in situ hybridization and single‐fiber PCR. Meth Enzymol 264: 522–540. [DOI] [PubMed] [Google Scholar]
- 45. Musumeci O, Andreu AL, Shanske S, Bresolin N, Comi G P, Rothstein R, Schon EA, DiMauro S (2000) Intragenic inversion of mtDNA: A new type of pathogenic mutation in a patient with mitochondrial myopathy. Am J Hum Genet 66:1900–1904. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46. Nass S, Nass M (1963) Intramitochondrial fibers with DNA characteristics. J Cell Biol 19: 593–629. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 47. Ogle RF, Christodoulou J, Fagan E, Blok RB, Kirby DM, Seller KL, Dahl H‐HM, Thorburn DR (1997) Mitochondrial myopathy with tRNALeu(UUR) mutation complex I deficiency responsive to riboflavin. J Pediatr 130: 138–145. [DOI] [PubMed] [Google Scholar]
- 48. Papadimitriou A, Neustein HB, DiMauro S, Stanton R, Bresolin N (1984) Histiocytoid cardiomyopathy of infancy: deficiency of reducible cytochrome b in heart mitochondria. Pediatr Res 18: 1023–1028. [DOI] [PubMed] [Google Scholar]
- 49. Petruzzella V, Moraes CT, Sano MC, Bonilla E, DiMauro S, Schon EA (1994) Extremely high levels of mutant mtDNAs co‐localize with cytochrome c oxidase‐negative ragged‐red fibers in patients harboring a point mutation at nt 3243. Hum Mol Genet 3: 449–454. [DOI] [PubMed] [Google Scholar]
- 50. Rahman S, Taanman J‐W, Cooper M, Nelson I, Hargreaves I, Meunier B, Hanna M G, Garcia JJ, Capaldi RA, Lake BD, Leonard JV, Schapira AHV (1999) A missense mutation of cytochrome oxidase subunit II causes defective assembly and myopathy. Am J Hum Genet 65: 1030–1039. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51. Santorelli FM, Tanji K, Kulikova R, Shanske S, Vilarinho L, Hays AP, DiMauro S (1997) Identification of a novel mutation in the mtDNA ND5 gene associated with MELAS. Biochem Biophys Res Comm 238: 326–328. [DOI] [PubMed] [Google Scholar]
- 52. Schon EA, Bonilla E, DiMauro S (1997) Mitochondrial DNA mutations and pathogenesis. J Bioenerg Biomembr 29:131–149. [DOI] [PubMed] [Google Scholar]
- 53. Silvestri G, Rana M, DiMuzio A, Uncini A, Tonali P, Servidei S (1998) A late‐onset mitochondrial myopathy is associated with a novel mitochondrial DNA (mtDNA) point mutation in the tRNATrp gene. Neuromusc Disord 8: 291–295. [DOI] [PubMed] [Google Scholar]
- 54. Taivassalo T, Fu K, Johns T, Arnold D, Karpati G, Shoubridge EA (1999) Gene shifting: a novel therapy for mitochondrial myopathy. Hum Mol Genet 8: 1047–1052. [DOI] [PubMed] [Google Scholar]
- 55. Tatuch Y, Christodoulou J, Feigenbaum A, Clarke J, Wherret J, Smith C, Rudd N, Petrova‐Benedict R, Robinson BH (1992) Heteroplasmic mtDNA mutation (T→G) at 8993 can cause Leigh disease when the percentage of abnormal mtDNA is high. Am J Hum Genet 50: 852–858. [PMC free article] [PubMed] [Google Scholar]
- 56. Taylor RF, Chinnery PF, Lightowlers RN, Turnbull DN (1997) Gene therapy for mitochondrial DNA disease. Neurology 48: A248. [Google Scholar]
- 57. Thyagarajan D, Shanske S, Vazquez‐Memije M, De Vivo DC, DiMauro S (1995) A novel mitochondrial ATPase 6 point mutation in familial bilateral striatal necrosis. Ann Neurol 38: 468–472. [DOI] [PubMed] [Google Scholar]
- 58. Valnot I, Kassis J, Chretien D, De Lonlay P, Parfait B, Munnich A, Kachaner J, Rustin P, Rotig A (1999) A mitochondrial cytochrome b mutation but no mutations of nuclearly encoded subunits in ubiquinol cytochrome c reductase (complex III) deficiency. Hum Genet 104: 460–466. [DOI] [PubMed] [Google Scholar]
- 59. Vissing J, Salamon M B, Arlien‐Soborg P, Norby S, Manta P, DiMauro S, Schmalbruch H (1998) A new mitochondrial tRNAMet gene mutation in a patient with dystrophic muscle and exercise intolerance. Neurology 50: 1875–1878. [DOI] [PubMed] [Google Scholar]
- 60. Wallace DC, Brown MD, Lott MT (1999) Mitochondrial DNA variation in human evolution and disease. Gene 238: 211–230. [DOI] [PubMed] [Google Scholar]
- 61. Wallace DC, Singh G, Lott MT, Hodge JA, Schurr TG, Lezza A, Elsas LJ, Nikoskelainen EK (1988) Mitochondrial DNA mutation associated with Leber's hereditary optic neuropathy. Science 242: 1427–1430. [DOI] [PubMed] [Google Scholar]
- 62. Weber K, Wilson JN, Taylor L, Brierly E, Johnson MA, Turnbull DM, Bindoff LA (1997) A new mtDNA mutation showing accumulation with time and restriction to skeletal muscle. Am J Hum Genet 60: 373–380. [PMC free article] [PubMed] [Google Scholar]
- 63. White SL, Shanske S, Biros I, Warwick L, Dahl HM, Thorburn DR, DiMauro S (1999) Two cases of prenatal analysis for the pathogenic T to G substitution at nucleotide 8993 in mitochondrial DNA. Prenatal Diagnosis 19: 1165–1168. [PubMed] [Google Scholar]
- 64. White SL, Shanske S, McGill JJ, Mountain H, Geraghty M T, DiMauro S, Dahl H‐HM, Thorburn DR (1999) Mitochondrial DNA mutations at nucleotide 8993 show a lack of tissue‐or age‐related variation. J Inher Metab Dis 22: 899–914. [DOI] [PubMed] [Google Scholar]
- 65. Zeviani M, Moraes CT, DiMauro S (1988) Deletions of mitochondrial DNA in Kearns‐Sayre syndrome. Neurology 38: 1339–1346. [DOI] [PubMed] [Google Scholar]
