No description available.

Abstract This study describes clinical and biochemical consequences of the 3243A→G mutation in the tRNALeu(UUR) gene of the mitochondrial DNA. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS syndrome) is usually caused by this mutation. Demyelinating polyneuropathy was observed as a novel feature in a patient with the mutation. Based on electrodiagnostic examination the polyneuropathy was defined as being of the demyelinating, mixed (motor more than sensory) type. In a 1 year follow-up an approximately 7% reduction in both the motor and sensory nerve conduction velocities were observed. The effect and mechanism of action of nicotinamide treatment in a MELAS patient with the 3243A→G was studied. The blood NAD concentration increased linearly, being 24-fold elevated at 6 weeks of treatment. Blood lactate and pyruvate concentration decreased by 50% within three days and 24 h urine lactate content within 2 weeks. A clinical improvement together with a decrease in the lesion volume in magnetic resonance imaging within the first month were observed. Alleviation of the lactate accumulation during the nicotinamide treatment suggested that an increase in the cellular NAD+NADH concentration led to enhancement of the oxidation of reducing equivalents, suggesting that complex I of respiratory chain operates at non-saturating substrate concentration. Myoblasts cultured from patients carrying the 3243A→G mutation and from controls were used to measure ATP, ADP, catalase and superoxide dismutase activity, population growth, apoptotic cell death and the morphology of cytoskeletal components. ATP and ADP concentrations were decreased, suggesting a decrease in the adenylate pool. The superoxide dismutase and catalase activities were higher than in control cells, suggesting an increased production of reactive oxygen species due to respiratory chain dysfunction. No increase in apoptotic cell death was observed in proliferating myoblasts, but randomization of vimentin filament direction and length was observed and decreased population growth was associated with the mutation. The results show that the 3243A→G mutation leads to numerous secondary pathophysiological events. Based on the literature and the results of this study, similarities were found between the pathophysiology of 3243A→G mutation and other neurodegenerative diseases and aging.

INTRODUÇÃO: A forma clássica de encefalomiopatia mitocondrial associada à mutação do DNA mitocondrial m.3243A>G é a Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like episodes (síndrome de MELAS). Entretanto, o espectro de manifestações clínicas dos indivíduos que apresentam essa mutação é bastante amplo. OBJETIVO: Descrever o espectro clínico, laboratorial e de imagem de pacientes com doença mitocondrial decorrente da mutação m.3243A>G. MÉTODOS: Estudo descritivo retrospectivo de uma série de casos de pacientes com a mutação m.3243A>G em seguimento no ANEM/HCFMRP-USP. Os dados clínicos e informações sobre exames complementares foram coletados através de revisão sistemática dos prontuários médicos dos pacientes selecionados. Os exames de neuroimagem foram revisados juntamente com neurorradiologista experiente para descrição das lesões encontradas. RESULTADOS: No período compreendido entre maio de 2000 e maio de 2015, a mutação m.3243A>G foi pesquisada em um total de 817 pacientes, em DNA extraído de células do sangue periférico (n= 441), de fragmentos de biópsia de músculo esquelético (n= 293), de ambos (n= 82) e mais raramente de células do sedimento urinário (n=1). Dentre esses, 16 indivíduos de 12 famílias apresentaram a referida mutação, resultando em uma taxa de detecção da mutação de 1,96% nessa população. Foram incluídos no estudo 12 indivíduos de 9 famílias que estavam em seguimento no nosso serviço. Os achados mais comuns nesta série foram em ordem de frequência: sinais de miopatia, transtornos neurocomportamentais, epilepsia, endocrinopatias, ataxia cerebelar, migrânea, episódios semelhantes a AVC, vômitos recorrentes, distúrbios de condução cardíaca, neuropatia periférica e sinais de disautonomia, mioclonias, surdez neurossensorial, cegueira cortical, comprometimento ocular, e proteinúria. Em nossa série, identificamos que cinco pacientes foram classificados com a forma clássica de MELAS, dois apresentaram CPEO associada a outros sintomas como transtornos psiquiátricos e diabetes mellitus. Os demais pacientes apresentavam características clínicas que não configuravam uma síndrome clinica definida. Além das lesões semelhantes a AVC, as lesões reveladas por neuroimagem mais frequentes nessa população foram alteração de sinal dos núcleos da base, atrofia encefálica e alteração de sinal da substância branca, sendo igualmente prevalentes entre os pacientes com a síndrome clássica de MELAS e os pacientes que não apresentaram lesões semelhantes a AVC. Dos pacientes com MELAS, 100% apresentaram pico anômalo de lactado e 60% redução do NAA à espectroscopia de prótons; enquanto que entre os pacientes sem lesões semelhantes a AVC essas alterações foram encontradas em dois e em um paciente Caracterização clínica, laboratorial e de neuroimagem de pacientes com doença mitocondrial associada à mutação m.3243A>G 8 respectivamente. Nós identificamos o achado inédito de azoospermia associada à mutação m.3243A>G. Essa é a maior série de casos de pacientes brasileiros com a mutação m.3243A>G até o momento. CONCLUSÃO: O amplo espectro de apresentação clínica e de neuroimagem é uma característica notável entre os pacientes com a mutação m.3243A>G do DNAmt. Essa desordem deve ser considerada em pacientes com evidência de sinais e sintomas que sugiram acometimento multissistêmico. / INTRODUCTION: The classic form of mitochondrial encephalomyopathy associated with m.3243A>G mutation is the Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like episodes (MELAS syndrome). However, the spectrum of clinical manifestations of patients with this mutation is quite wide. OBJECTIVE: To describe the clinical, laboratory and imaging spectrum of patients with mitochondrial disease due to m.3243A>G mutation METHODS: A retrospective descriptive study of a series of cases of patients with the m.3243A>G mutation in follow-up in ANEM/HCFMRP-USP. Clinical data and information about additional tests were collected through systematic review of medical records of selected patients. Neuroimaging studies were reviewed with supervision of experienced neuroradiologist and the lesions were described. RESULTS: Between May 2000 and May 2015, the mutation m.3243A>G was evaluated in a total of 817 patients, on DNA extracted from peripheral blood (n = 441), skeletal muscle biopsy samples (n = 293), both (n = 82) and more rarely urinary sediment cells (n = 1). We founded 16 individuals 12 families with the mutation, resulting in a mutation detection rate of 1.96 % that population. 12 individuals from nine families, who were following at our service, were included in this study. The most common findings in this series were in order of frequency: myopathy signs, neurobehavioral disorders, epilepsy, endocrine disorders, cerebellar ataxia, migraine, stroke-like episodes, recurrent vomiting, cardiac conduction disorders, peripheral neuropathy and signs of dysautonomia, myoclonus, sensorineural deafness, cortical blindness, uveitis, and proteinuria. In our series, we found that five of the patients were classified with the classical MELAS syndrome, two patients had CPEO associated with other symptoms such as psychiatric disorders and diabetes mellitus. The remaining patients had other features of mitochondrial disease not consistent with another recognised syndrome. In addition to stroke-like lesions, the more frequent lesions revealed in neuroimaging studies were deep gray matter changes, brain atrophy and white matter changes. These changes had similar prevalences between the patients with the classic syndrome of MELAS and patients who did not have stroke-like lesions. All patients with classical MELAS have lactate peak and 60% of them have reduction of NAA at spectroscpopy; while these changes were found in two and one patient respectively, in the group of patients without stroke-like lesions. We identified azoospermia in one paciente with classic MELAS, a finding not previously associated with m.3243A>G. At moment, this is the largest Brazilian case series of patients with the m.3243A>G mutation. Clinical, laboratory and neuroimaging features of patients with mitochondrial disease associated with mutation m.3243A > G 10 CONCLUSION: The wide spectrum of clinical presentation and neuroimaging is a notable feature among patients with the mutation m.3243A> G mtDNA. This disorder should be considered in patients with evidence of signs and symptoms suggestive of multisystem involvement.

INTRODUÇÃO: A forma clássica de encefalomiopatia mitocondrial associada à mutação do DNA mitocondrial m.3243A>G é a Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like episodes (síndrome de MELAS). Entretanto, o espectro de manifestações clínicas dos indivíduos que apresentam essa mutação é bastante amplo. OBJETIVO: Descrever o espectro clínico, laboratorial e de imagem de pacientes com doença mitocondrial decorrente da mutação m.3243A>G. MÉTODOS: Estudo descritivo retrospectivo de uma série de casos de pacientes com a mutação m.3243A>G em seguimento no ANEM/HCFMRP-USP. Os dados clínicos e informações sobre exames complementares foram coletados através de revisão sistemática dos prontuários médicos dos pacientes selecionados. Os exames de neuroimagem foram revisados juntamente com neurorradiologista experiente para descrição das lesões encontradas. RESULTADOS: No período compreendido entre maio de 2000 e maio de 2015, a mutação m.3243A>G foi pesquisada em um total de 817 pacientes, em DNA extraído de células do sangue periférico (n= 441), de fragmentos de biópsia de músculo esquelético (n= 293), de ambos (n= 82) e mais raramente de células do sedimento urinário (n=1). Dentre esses, 16 indivíduos de 12 famílias apresentaram a referida mutação, resultando em uma taxa de detecção da mutação de 1,96% nessa população. Foram incluídos no estudo 12 indivíduos de 9 famílias que estavam em seguimento no nosso serviço. Os achados mais comuns nesta série foram em ordem de frequência: sinais de miopatia, transtornos neurocomportamentais, epilepsia, endocrinopatias, ataxia cerebelar, migrânea, episódios semelhantes a AVC, vômitos recorrentes, distúrbios de condução cardíaca, neuropatia periférica e sinais de disautonomia, mioclonias, surdez neurossensorial, cegueira cortical, comprometimento ocular, e proteinúria. Em nossa série, identificamos que cinco pacientes foram classificados com a forma clássica de MELAS, dois apresentaram CPEO associada a outros sintomas como transtornos psiquiátricos e diabetes mellitus. Os demais pacientes apresentavam características clínicas que não configuravam uma síndrome clinica definida. Além das lesões semelhantes a AVC, as lesões reveladas por neuroimagem mais frequentes nessa população foram alteração de sinal dos núcleos da base, atrofia encefálica e alteração de sinal da substância branca, sendo igualmente prevalentes entre os pacientes com a síndrome clássica de MELAS e os pacientes que não apresentaram lesões semelhantes a AVC. Dos pacientes com MELAS, 100% apresentaram pico anômalo de lactado e 60% redução do NAA à espectroscopia de prótons; enquanto que entre os pacientes sem lesões semelhantes a AVC essas alterações foram encontradas em dois e em um paciente Caracterização clínica, laboratorial e de neuroimagem de pacientes com doença mitocondrial associada à mutação m.3243A>G 8 respectivamente. Nós identificamos o achado inédito de azoospermia associada à mutação m.3243A>G. Essa é a maior série de casos de pacientes brasileiros com a mutação m.3243A>G até o momento. CONCLUSÃO: O amplo espectro de apresentação clínica e de neuroimagem é uma característica notável entre os pacientes com a mutação m.3243A>G do DNAmt. Essa desordem deve ser considerada em pacientes com evidência de sinais e sintomas que sugiram acometimento multissistêmico. / INTRODUCTION: The classic form of mitochondrial encephalomyopathy associated with m.3243A>G mutation is the Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like episodes (MELAS syndrome). However, the spectrum of clinical manifestations of patients with this mutation is quite wide. OBJECTIVE: To describe the clinical, laboratory and imaging spectrum of patients with mitochondrial disease due to m.3243A>G mutation METHODS: A retrospective descriptive study of a series of cases of patients with the m.3243A>G mutation in follow-up in ANEM/HCFMRP-USP. Clinical data and information about additional tests were collected through systematic review of medical records of selected patients. Neuroimaging studies were reviewed with supervision of experienced neuroradiologist and the lesions were described. RESULTS: Between May 2000 and May 2015, the mutation m.3243A>G was evaluated in a total of 817 patients, on DNA extracted from peripheral blood (n = 441), skeletal muscle biopsy samples (n = 293), both (n = 82) and more rarely urinary sediment cells (n = 1). We founded 16 individuals 12 families with the mutation, resulting in a mutation detection rate of 1.96 % that population. 12 individuals from nine families, who were following at our service, were included in this study. The most common findings in this series were in order of frequency: myopathy signs, neurobehavioral disorders, epilepsy, endocrine disorders, cerebellar ataxia, migraine, stroke-like episodes, recurrent vomiting, cardiac conduction disorders, peripheral neuropathy and signs of dysautonomia, myoclonus, sensorineural deafness, cortical blindness, uveitis, and proteinuria. In our series, we found that five of the patients were classified with the classical MELAS syndrome, two patients had CPEO associated with other symptoms such as psychiatric disorders and diabetes mellitus. The remaining patients had other features of mitochondrial disease not consistent with another recognised syndrome. In addition to stroke-like lesions, the more frequent lesions revealed in neuroimaging studies were deep gray matter changes, brain atrophy and white matter changes. These changes had similar prevalences between the patients with the classic syndrome of MELAS and patients who did not have stroke-like lesions. All patients with classical MELAS have lactate peak and 60% of them have reduction of NAA at spectroscpopy; while these changes were found in two and one patient respectively, in the group of patients without stroke-like lesions. We identified azoospermia in one paciente with classic MELAS, a finding not previously associated with m.3243A>G. At moment, this is the largest Brazilian case series of patients with the m.3243A>G mutation. Clinical, laboratory and neuroimaging features of patients with mitochondrial disease associated with mutation m.3243A > G 10 CONCLUSION: The wide spectrum of clinical presentation and neuroimaging is a notable feature among patients with the mutation m.3243A> G mtDNA. This disorder should be considered in patients with evidence of signs and symptoms suggestive of multisystem involvement.

Eight carriers of the A3243G mutation of mitochondrial DNA without stroke-like episodes were monitored for up to 7 years in clinical and metabolic studies, by magnetic resonance imaging (MRI) and positron emission tomography (PET). None developed mitochondrial encephalopathy (MELAS), but 2 developed diabetes mellitus, 1 terminal kidney failure and 2 cardiomyopathy. One patient improved markedly under ubiquinone. Electroencephalography showed progressive slowing in 2 cases, but electrophysiological tests and MRI were otherwise noncontributary. PET showed widespread cortical and basal ganglion metabolic deficits in 6 cases. We conclude that internal medical complications are more common than MELAS in adult carriers of the mutation. PET findings, firstly reported in such patients, suggest that chronic subclinical encephalopathy is very frequent, and PET may play a role in monitoring in the future. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Eight carriers of the A3243G mutation of mitochondrial DNA without stroke-like episodes were monitored for up to 7 years in clinical and metabolic studies, by magnetic resonance imaging (MRI) and positron emission tomography (PET). None developed mitochondrial encephalopathy (MELAS), but 2 developed diabetes mellitus, 1 terminal kidney failure and 2 cardiomyopathy. One patient improved markedly under ubiquinone. Electroencephalography showed progressive slowing in 2 cases, but electrophysiological tests and MRI were otherwise noncontributary. PET showed widespread cortical and basal ganglion metabolic deficits in 6 cases. We conclude that internal medical complications are more common than MELAS in adult carriers of the mutation. PET findings, firstly reported in such patients, suggest that chronic subclinical encephalopathy is very frequent, and PET may play a role in monitoring in the future. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

No description available.

<p>Med musiken till hands – Funktionsinriktad musikterapi med två ungdomar, en med Cerebral Pares och en med mitokondriell sjukdom.</p><p> </p><p>Funktionsinriktad musikterapi, FMT-metoden, är en neuromuskulär behandlingsmodell för barn och vuxna med olika funktionsnedsättningar. Jag har valt att i detta examensarbete för-klara vad metoden går ut på samt beskriva arbetet med två av mina elever, en med diagnosen Cerebral Pares och en med mitokondriell sjukdom. Jag har förklarat hur deras helhetsutveckling, främst arm-/handfunktionen, har påverkats. Båda ungdomarna har fått en utökad förmåga att greppa om olika föremål och sträcka ut för att nå ting som står långt ifrån dem.</p>

Med musiken till hands – Funktionsinriktad musikterapi med två ungdomar, en med Cerebral Pares och en med mitokondriell sjukdom.   Funktionsinriktad musikterapi, FMT-metoden, är en neuromuskulär behandlingsmodell för barn och vuxna med olika funktionsnedsättningar. Jag har valt att i detta examensarbete för-klara vad metoden går ut på samt beskriva arbetet med två av mina elever, en med diagnosen Cerebral Pares och en med mitokondriell sjukdom. Jag har förklarat hur deras helhetsutveckling, främst arm-/handfunktionen, har påverkats. Båda ungdomarna har fått en utökad förmåga att greppa om olika föremål och sträcka ut för att nå ting som står långt ifrån dem.

Abstract The mitochondrial oxidative phosphorylation system (OXPHOS) generates energy but also deleterious reactive oxygen species (ROS). Changes in the cytoskeleton, composed mainly of microfilaments, microtubules and intermediate filaments, have been observed in OXPHOS deficiency. The 3243A>G point mutation in mitochondrial DNA (mtDNA) leads to mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS), which is the most common mitochondrial disease. Interestingly, mitochondrial aberrations have been demonstrated in patients with a mutation in NOTCH3, the genetic cause of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Randomization of vimentin intermediate filament direction and length together with slower population growth was observed in myoblasts with 3243A>G, with no difference in the amount of apoptotic cell death. Upon complex IV inhibition (with or without the microtubule-depolymerizing compound nocodazole) or a lack of mtDNA (ρ0) in osteosarcoma cells the vimentin network collapsed perinuclearly, forming thick bundles, whereas complex I inhibition led to thinner vimentin network bundles. Furthermore, the amount of vimentin was increased in ρ0 cells. Mitochondria accumulated around the nucleus upon complex IV inhibition and in ρ0 cells. Analysis of the total proteome revealed that specific OXPHOS deficiencies led to changes in the expression of cytoskeletal proteins and proteins involved in apoptosis, OXPHOS, glycolysis and oxidative stress response. Muscle histochemical and genetic analysis showed ragged red fibres and cytochrome c oxidase-negative fibres to be associated with 5650G>A in a patient with R133C in NOTCH3 and 5650G>A in MTTA. Immunolabelling of cells with R133C and 5650G>A revealed a sparse tubulin network with asters and less abundant mitochondria by comparison with control cell lines. Comparison of nucleotide diversity between CADASIL pedigrees and controls showed increased mtDNA sequence variation in the CADASIL patients. Also maternal relatives in two CADASIL pedigrees differed from each other in their mtDNA. These findings suggest that defects in OXPHOS lead to selective changes in the vimentin network, which may have a role in the pathophysiology of mitochondrial diseases. They also suggest a relationship between NOTCH3 and mtDNA, and establish the pathogenicity of 5650G>A. The overall results emphasize that a deficiency in the energy converting system together with oxidative stress can lead to cytoskeletal changes.