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David R Thorburn - One of the best experts on this subject based on the ideXlab platform.
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recent advances in the genetics of Mitochondrial encephalopathies
Current Neurology and Neuroscience Reports, 2010Co-Authors: Elena J Tucker, Alison G Compton, David R ThorburnAbstract:Mitochondrial Encephalopathy, the most common neurometabolic disorder, may be caused by mutations in approximately 100 different genes and may present with various symptoms, such as seizures, ataxia, myopathy, cognitive impairment, blindness, and stroke. Fewer than 50% of patients with Mitochondrial Encephalopathy receive a molecular diagnosis, primarily because of the large degree of clinical and genetic heterogeneity among patients and the limited knowledge of the genes involved in Mitochondrial function. Here we review the most recent discoveries of genes associated with Mitochondrial disease with variable neuropathology. All these genes have been identified via homozygosity mapping or linkage analysis; however, advances in sequencing technology indicate that the future of genetic diagnosis and disease gene discovery likely lies in high-throughput sequencing.
Robert W Taylor - One of the best experts on this subject based on the ideXlab platform.
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A patient with typical clinical features of Mitochondrial Encephalopathy, lactic acidosis and stroke-like episodes (MELAS) but without an obvious genetic cause: a case report.
Journal of medical case reports, 2009Co-Authors: Khaled K Abu-amero, Saeed Bohlega, Ali Hellani, Hesham M. Aldhalaan, Robert W TaylorAbstract:There are currently 23 missense point mutations and one 4 basepair deletion spanning different Mitochondrial genes associated with Mitochondrial Encephalopathy, lactic acidosis and stroke-like episodes (MELAS). The spectrum of Mitochondrial DNA mutations in Arab patients with MELAS is largely unknown. A standard clinical examination was carried out on a 34-year-old Saudi woman showing clinical features of MELAS. Fresh frozen muscle tissue was subjected to enzyme histochemical analysis. DNA was extracted from her leukocytes and muscle tissue, and the full Mitochondrial genome was screened for base substitution mutations and deletions. Additionally, we screened the polymerase gamma-1 nuclear gene for mutations. The patient was negative for the most common m.3243 A>G MELAS mutation. Sequencing the full Mitochondrial genome did not reveal any known or potentially pathogenic sequence changes. The polymerase gamma-1 gene was also free from mutations. The clinical picture described here typically fits that observed in patients with MELAS or Mitochondrial stroke-like events, but mutations in recognized genes (Mitochondrial DNA and polymerase gamma-1 gene) were absent. We report the case of a patient with typical clinical features of MELAS, but without an obvious genetic cause.
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A patient with typical clinical features of Mitochondrial Encephalopathy, lactic acidosis and stroke-like episodes (MELAS) but without an obvious genetic cause: a case report
Journal of Medical Case Reports, 2009Co-Authors: Khaled K Abu-amero, Hesham Al-dhalaan, Saeed Bohlega, Ali Hellani, Robert W TaylorAbstract:Introduction There are currently 23 missense point mutations and one 4 basepair deletion spanning different Mitochondrial genes associated with Mitochondrial Encephalopathy, lactic acidosis and stroke-like episodes (MELAS). The spectrum of Mitochondrial DNA mutations in Arab patients with MELAS is largely unknown. Case presentation A standard clinical examination was carried out on a 34-year-old Saudi woman showing clinical features of MELAS. Fresh frozen muscle tissue was subjected to enzyme histochemical analysis. DNA was extracted from her leukocytes and muscle tissue, and the full Mitochondrial genome was screened for base substitution mutations and deletions. Additionally, we screened the polymerase gamma-1 nuclear gene for mutations. The patient was negative for the most common m.3243 A>G MELAS mutation. Sequencing the full Mitochondrial genome did not reveal any known or potentially pathogenic sequence changes. The polymerase gamma-1 gene was also free from mutations. Conclusion The clinical picture described here typically fits that observed in patients with MELAS or Mitochondrial stroke-like events, but mutations in recognized genes (Mitochondrial DNA and polymerase gamma-1 gene) were absent. We report the case of a patient with typical clinical features of MELAS, but without an obvious genetic cause.
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guanidinoacetate methyltransferase deficiency masquerading as a Mitochondrial Encephalopathy
Journal of Inherited Metabolic Disease, 2007Co-Authors: A A M Morris, Richard Appleton, B Power, D M Isherwood, L J Abernethy, Robert W Taylor, D M Turnbull, N M Verhoeven, Gajja S Salomons, C JakobsAbstract:Guanidinoacetate methyltransferase (GAMT) deficiency is a rare disorder of creatine synthesis. We report a patient who presented at 10 months of age with hypotonia and global developmental delay. Subsequently, she developed seizures and choreoathetosis. Magnetic resonance imaging showed high signal bilaterally in the globus pallidus on T2-weighted images. Mitochondrial respiratory chain studies revealed low complex I activity (in muscle 0.052 nmol NADH oxidized per min per unit citrate synthase, controls 0.166 ± 0.047; in fibroblasts 0.080 nmol NADH oxidized per min per unit citrate synthase, controls 0.197 ± 0.034). The true diagnosis was suspected at 21 months of age because of persistent low plasma and urine creatinine concentrations. GAMT activity was undetectable in fibroblasts and compound heterozygous mutations were found in the GAMT gene (c.327G>A and c.522G>A). The patient was treated with creatine, dietary arginine restriction and ornithine supplements. Her movement disorder and seizures resolved but she still has severe cognitive impairment and no expressive language. The occurrence of secondary respiratory chain abnormalities in GAMT deficiency may lead to misdiagnosis, particularly as the clinical and radiological features resemble those seen in Mitochondrial encephalopathies. It is important to establish the correct diagnosis because specific treatment is available.
Elena J Tucker - One of the best experts on this subject based on the ideXlab platform.
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recent advances in the genetics of Mitochondrial encephalopathies
Current Neurology and Neuroscience Reports, 2010Co-Authors: Elena J Tucker, Alison G Compton, David R ThorburnAbstract:Mitochondrial Encephalopathy, the most common neurometabolic disorder, may be caused by mutations in approximately 100 different genes and may present with various symptoms, such as seizures, ataxia, myopathy, cognitive impairment, blindness, and stroke. Fewer than 50% of patients with Mitochondrial Encephalopathy receive a molecular diagnosis, primarily because of the large degree of clinical and genetic heterogeneity among patients and the limited knowledge of the genes involved in Mitochondrial function. Here we review the most recent discoveries of genes associated with Mitochondrial disease with variable neuropathology. All these genes have been identified via homozygosity mapping or linkage analysis; however, advances in sequencing technology indicate that the future of genetic diagnosis and disease gene discovery likely lies in high-throughput sequencing.
Josef Finsterer - One of the best experts on this subject based on the ideXlab platform.
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Stroke in Mitochondrial Encephalopathy, lactic acidosis, and stroke-like episodes is a vasogenic edema and not ischemic
International Journal of Biology and Medicine, 2019Co-Authors: Josef Finsterer, Sinda Zarrouk-mahjoubAbstract:Introduction: there is no common sense how to diagnose and treat stroke-like episodes in Mitochondrial Encephalopathy, lactic acidosis, and stroke-like episodes Aims: to discuss some shortcomings of a previously published paper about a 48yo female with MELAS. Methods: commentary Conclusion: the report could be more meaningful if the diagnosis would have been confirmed genetically, if NO-precursors would have been administered for the SLE, if possible, triggers of the SLE would have been discussed, and if the patient would have been prospectively investigated for subclinical or mildly manifesting abnormalities. Keywords: Mitochondrial; Stroke-like episode; Stroke-like lesion; NO-precursors
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Does 3D pASP truly reflect hyperperfusion in stroke-like lesions?
2018Co-Authors: Josef Finsterer, Sinda Zarrouk-mahjoubAbstract:In a recent article, Li et al. reported about the application of3D pseudocontinuous arterial spin labelling (3D pCASL) to9 patients with Mitochondrial Encephalopathy, lactacidosis,and stroke-like episodes (MELAS) syndrome within onemonth after onset of a stroke-like episode (SLE)1 . 3DpCASL revealed hyperperfusion during the acute andsubacute stage of a SLE in all 9 MELAS patients1 . We havethe following comments and concerns.
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Noncompaction in Mitochondrial Disorders
Circulation research, 2017Co-Authors: Josef FinstererAbstract:With interest, we read the article by Towbin and Jefferies about left ventricular noncompaction (LVNC) in patients with inborn errors of metabolism (Mitochondrial disorders [MIDs], and storage diseases).1 We have the following comments and concerns. The authors describe noncompaction in MIDs, such as Mitochondrial Encephalopathy, lactic acidosis, and stroke-like episodes, myoclonic epilepsy with ragged-red fibers, Kearns–Sayre syndrome, Leigh syndrome, Sengers syndrome, Barth syndrome, and in patients carrying DNAJC19 or TMEM70 mutations.1 However, the number of MIDs presenting with LVNC is larger than presented in this review.2 LVNC has been also described in Leber hereditary optic …
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Sea food consumption for improving cardiac and cerebral manifestations of Mitochondrial Encephalopathy, lactic acidosis, and stroke-like episodes
Annals of translational medicine, 2017Co-Authors: Fulvio A. Scorza, Josef FinstererAbstract:Since the initial description >30 y ago, therapeutic options for Mitochondrial Encephalopathy, lactic acidosis, and stroke- like episodes (MELAS) syndrome, the most well-known of the Mitochondrial disorders (MIDs), remain limited due to the complexity of its genetic background and its clinical manifestations (1,2).
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Phenotype and genotype heterogeneity of Mitochondrial Encephalopathy with lactic acidosis and stroke-like episodes
International Journal of Clinical and Experimental Pathology, 2016Co-Authors: Josef Finsterer, Sinda Zarrouk-mahjoubAbstract:With interest we read the article by Zhang et al. about a study of 524 pediatric patients with a Mitochondrial Encephalopathy with lactic acidosis and stroke-like episodes (MELAS)-like phenotype of whom 40 were positive for the mutation m.3243A > G [1]. From 44 of these patients, 36 carrying the mutation and 8 without the mutation, the clinical presentation was provided in more detail in table 2 of Zhang’s paper [1]. We have the following comments and concerns
Laurence A Bindoff - One of the best experts on this subject based on the ideXlab platform.
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acute Mitochondrial Encephalopathy reflects neuronal energy failure irrespective of which genome the genetic defect affects
Brain, 2012Co-Authors: Charalampos Tzoulis, Laurence A BindoffAbstract:Mitochondrial dysfunction and disease may arise as a result of mutations in either the Mitochondrial genome itself or nuclear encoded genes involved in Mitochondrial homeostasis and function. Irrespective of which genome is affected, Mitochondrial encephalopathies share clinical and biochemical features suggesting common pathophysiological pathways. Two common paradigms of Mitochondrial Encephalopathy are Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes caused by maternally transmitted mutations of Mitochondrial DNA and Mitochondrial spinocerebellar ataxia and epilepsy caused by recessively inherited mutations of the nuclear-encoded DNA polymerase gamma, which replicates and repairs the Mitochondrial genome. We studied and compared the disease mechanisms involved in these two syndromes. Despite having different genetic origins, their pathophysiological pathways converge on one critical event, damage to the respiratory chain leading to insufficient energy to maintain cellular homeostasis. In the central nervous system, this appears to cause selective neuronal damage leading to the development of lesions that mimic ischaemic damage, but which lack evidence of decreased tissue perfusion. Although these stroke-like lesions may expand or regress dynamically, the critical factor that dictates prognosis is the presence of epilepsy. Epileptic seizures increase the energy requirements of the metabolically already compromised neurons establishing a vicious cycle resulting in worsening energy failure and neuronal death. We believe that it is this cycle of events that determines outcome and which provides us with a mechanistic structure to understand the pathophysiology of acute Mitochondrial encephalopathies and plan future treatments.