Clinical mitochondrial genetics

The last decade has been an age of enlightenment as far as mitochondrial pathology is concerned. Well established nuclear genetic diseases, such as Friedreich's ataxia,¹² Wilson disease,³ and autosomal recessive hereditary spastic paraplegia,⁴ have been shown to have a mitochondrial basis, and we are just starting to unravel the complex nuclear genetic disorders which directly cause mitochondrial dysfunction (table 1). However, in addition to the 3 billion base pair nuclear genome, each human cell typically contains thousands of copies of a small, 16.5 kb circular molecule of double stranded DNA (fig 1). Mitochondrial DNA (mtDNA) accounts for only 1% of the total cellular nucleic acid content. It encodes for 13 polypeptides which are essential for aerobic metabolism and defects of the mitochondrial genome are an important cause of human disease.⁹²⁹³ Since the characterisation of the first pathogenic mtDNA defects in 1988,⁵¹³ over 50 point mutations and well over 100 rearrangements of the mitochondrial genome have been associated with human disease⁹⁴⁹⁵ (http://www.gen.emory.edu/mitomap.html). These disorders form the focus of this article.


Keywords: mitochondrial DNA; mitochondrial disease; heteroplasmy; genetic counselling     

线粒体肌病患者线粒体DNA的突变分析

目的分析线粒体肌病患者线粒体DNA的突变情况，为疾病诊断提供依据。方法用常规HE、酶组化染色和电镜检查等病理形态学方法对3例线粒体肌病疑似患者进行诊断，并用聚合酶链反应-单链构象多态和DNA测序等方法对患者线粒体DNA中全部22个tRNA基因进行突变筛查。结果3例患者均被确诊为线粒体肌病，其中例1tRNA—VaI基因发生A1627G纯合突变，例2tRNA—Val基因发生A1627G／A杂合突变，例3tRNA—Trp基因发生T5554C突变、tRNA—Arg基因发生A10412C／A杂合突变。结论线粒体DNA中的tRNA基因突变是线粒体肌病的重要病因之一。     

家族性乳腺癌线粒体基因组控制区突变研究

目的研究家族性乳腺癌线粒体基因组控制区(D-loop区)突变的情况。方法用PCR技术,对来自21个家系的23例家族性乳腺癌患者和18名正常对照者线粒体DNA(mitochondrial DNA,mtDNA)的D-loop区进行扩增并基因测序,分析突变。结果在23例乳腺癌患者mtDNA的D-loop区共发现126个突变位点,4个为新发现的突变;37个突变分别发生在所有23例患者D-loop区的突变热点D310区;在所有突变中,第310位点的T→C,311～312位点的TC插入,522～523位点的CA缺失和527位点的C→G是高发突变位点;同一家系中乳腺癌患者D310区的突变与正常对照不同。结论家族性乳腺癌患者D310区的突变可能提高了其对乳腺癌的易感性。     

Nonrandom tissue distribution of mutant mtDNA

Heteroplasmic mitochondrial DNA (mtDNA) defects are an important cause of inherited human disease. On a cellular level, the percentage of mutant mtDNA is the principal factor behind the expression of the genetic defect. Marked variation in the level of mutant mtDNA among tissues is thought to be responsible for the diverse clinical phenotypes associated with the same pathogenic mtDNA mutation. This study was designed to determine whether the percentage level of a pathogenic mtDNA molecule is determined by a purely random process. The tissue distribution of the A3243G MELAS point mutation was analyzed in five individuals who were members of a family with maternally inherited diabetes and deafness. The level of mutant mtDNA was measured in four tissues in three individuals and three tissues in two individuals. The highest level of mutant mtDNA occurred in skeletal muscle, followed by hair follicles, and then buccal mucosa, with the lowest levels in blood (leucocyte/platelet fraction). The probability of observing any strict hierarchy in family is 4.82 × 10⁻⁵. These results indicate that the distribution of the A3243G mutation is not solely determined by random processes. Am. J. Med. Genet. 85:498–501, 1999. © 1999 Wiley-Liss, Inc.     

MT‐ND5 Mutation Causing Exercise Intolerance Displays Intercellular Heteroplasmy and Rapid Shifts Between Generations

We studied the inheritance and cellular segregation of a maternally inherited, heteroplasmic MT‐ND5 mutation, m.13271T>C, previously shown to cause only exercise intolerance despite being present in multiple tissues. The mutation was present at low levels in early passage, bulk muscle culture, but on subcloning, only homoplasmic clones were found. Studies of transmission showed that the mutation expanded from very low levels in the patient's mother to higher levels in the patient, particularly skeletal muscle, but was not found in the placenta and umbilical cord blood of her child. Our study suggests that the m.13271T>C is either already strictly segregated (intercellular heteroplasmy), or moves rapidly to this state in cultured cells. Transmission studies suggest that intercellular heteroplasmy may also be present in the patient's germline. Although rapid shifts in heteroplasmic mitochondrial DNA mutations reflect a bottleneck in the female germline, complete segregation will accentuate the effects of this and further complicate genetic counseling.     

2型糖尿病患者mtDNA变异筛查研究

目的探讨线粒体基因突变与2型糖尿病的关系。方法随机筛查222例散发2型糖尿病患者和191名正常对照，以聚合酶链反应、限制性内切酶片段长度多态性及T-A克隆测序和变性高效液相色谱分析技术验证等方法检测线粒体基因突变。结果糖尿病组线粒体基因（3153—3551nt）突变总的发生率（24．32％）明显高于正常组（7．33％）（P〈0．05）；发现3个尚未见报道的新突变位点：A3209T、T3253G和A3467C，而C3497T则在糖尿病中是首次报道；起病年龄、体重指数、空腹血糖、糖化血红蛋白、高密度脂蛋白和糖尿病肾病等指标是线粒体基因突变的相关因素（P〈0．05）。结论温州地区糖尿病患者存在多种线粒体基因点突变，其在糖尿病的发生发展中起重要作用。     

Mitochondrial genetic analysis in a Chinese family suffering from both mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes and diabetes

To investigate the mitochondrial mutations in patients suffering from both mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) and maternally inherited diabetes. MELAS was confirmed by muscle biopsy performed from the biceps muscle of the proband. Mitochondrial DNA (mtDNA) was isolated from peripheral blood mononuclear cells. The significant mtDNA loci of other 14 family members were further detected according to the sequencing results of the proband. Direct sequencing of PCR products was used to identify the mitochondrial mutations. The proband (III 1) and her brother (III 3) both harbored the tRNALeu (UUR) A3243G mutation, with heteroplasmic levels of 50% and 33% respectively. Moreover, another two mitochondrial variants, A8860G and A15326G, were also detected in the samples of all the family members. MELAS and diabetes can coexist in one patient, and the main cause for these diseases is the tRNALeu (UUR) A3243G mutation. However, other gene variants may contribute to its pathogenesis. This case also supports the concept that both syndromes can be regarded as two phenotypes of the same disease.     

Prevalence of mitochondrial DNA mutations in childhood/congenital onset non-syndromal sensorineural hearing impairment

Genetic factors are the major causes of childhood hearing impairment. Whereas autosomal recessive mutations account for the majority of prelingual non-syndromic sensorineural hearing impairment (NSSHI), the relative contribution of mitochondrial DNA (mtDNA) mutations to childhood onset NSSHI has not been established.
We screened 202 subjects with congenital/childhood onset NSSHI, consisting of 110 sporadic cases, 75 sib pairs, and 17 families with affected subjects in more than one generation, in order to determine the prevalence of mtDNA mutations associated with NSSHI.
mtDNA mutations were found in three of 10 families (30%) in whom the affected members were related through the maternal lineage. One sporadic case (0.9%) was also found to have a known mtDNA mutation but none was found in the sib pairs.
Although the prevalence of mtDNA mutations was low in the group as a whole (2%), we suggest that screening should be considered in cases of childhood hearing impairment when it is progressive and particularly in families where transmission is compatible with maternal inheritance.


Keywords: mitochondrial DNA; point mutation; hearing impairment     

遗传性共济失调一家系中发现的线粒体DNA突变

目的探索遗传性共济失调（hereditary ataxia，HA）家系中的线粒体DNA突变。方法采用聚合酶链反应扩增两个HA家系及35名健康对照者外周血白细胞的线粒体DNA，并对PCR产物进行单链构象多态性分析，对出现异常条带者进行线粒体DNA片段测序。结果其中一家系中的2例患者及1例无临床症状亲属检测到线粒体DNA11893（A→G）点突变。结论遗传性共济失调的发生、发展可能与线粒体DNA11893（A→G）点突变有关。     

脊髓小脑性共济失调3型线粒体DNA突变的研究

目的 探索脊髓小脑性共济失调3型(spinocerebellar ataxia type 3,SCA3)与线粒体DNA(mitochondrial DNA,mtDNA)突变的关系.方法 采用测序方法对临床诊断为脊髓小脑性共济失调的患者及家系成员行MJD1基因CAG重复拷贝数检测,以基因水平确诊SCA3患者及症状前患者.然后采用聚合酶链反应、单链构象多态性分析、测序方法对基因确诊的43例SCA3患者及症状前患者和30名对照组的mtDNA片段进行分析.结果 发现SCA3组4名成员存在mtDNA位点8282.8290区域9个碱基缺失.结论 在SCA3患者及症状前患者中发现mtDNA缺失突变的现象.     

Somatic mitochondrial DNA mutations in Chinese patients with osteosarcoma

Somatic mutations in mitochondrial DNA (mtDNA) have been long proposed to drive the pathogenesis and progression of human malignancies. Previous investigations have revealed a high frequency of somatic mutations in the D‐loop control region of mtDNA in osteosarcoma. However, little is known with regard to whether or not somatic mutations also occur in the coding regions of mtDNA in osteosarcoma. To test this possibility, in the present study we screened somatic mutations over the full‐length mitochondrial genome of 31 osteosarcoma tumour tissue samples, and corresponding peripheral blood samples from the same cohort of patients. We detected a sum of 11 somatic mutations in the mtDNA coding regions in our series. Nine of them were missense or frameshift mutations that have the potential to hamper mitochondrial respiratory function. In combination with our earlier observations on the D‐loop fragment, 71.0% (22/31) of patients with osteosarcoma carried at least one somatic mtDNA mutation, and a total of 40 somatic mutations were identified. Amongst them, 29 (72.5%) were located in the D‐loop region, two (5%) were in the sequences of the tRNA genes, two (5%) were in the mitochondrial ATP synthase subunit 6 gene and seven (17.5%) occurred in genes encoding components of the mitochondrial respiratory complexes. In addition, somatic mtDNA mutation was not closely associated with the clinicopathological characteristics of osteosarcoma. Together, these findings suggest that somatic mutations are highly prevalent events in both coding and non‐coding regions of mtDNA in osteosarcoma. Some missense and frameshift mutations are putatively harmful to proper mitochondrial activity and might play vital roles in osteosarcoma carcinogenesis.     

Heteroplasmic Segregation Associated with Trisomy-9 in Cultured Human Cells

In cybrid cells carrying the mitochondrial A3243G MELAS mutation, which were also heteroplasmic for the G12300A suppressor mutation, we observed a transient episode of heteroplasmic instability, resulting in a wide diversification in G12300A heteroplasmy levels and a shift in the average heteroplasmy level from 11 to 29%. These cells were found to be trisomic for chromosome 9, whereas a minority of cells that retained disomy-9 showed no instability. Coculture experiments implied that trisomy-9 cells exhibited a significant growth advantage, but neither heteroplasmy levels, respiratory phenotype nor trisomy-9 itself had direct selective value under standard culture conditions. Mitochondrial nucleoid number was the same (50–100) in cells that had or had not experienced transient heteroplasmic instability, but 1–2 orders of magnitude less than the segregation number in such cells. These findings support the idea that mtDNA partition is under nuclear genetic control, and implicate a locus on chromosome 9 in this regulation.     

Mitochondrial transfer between oocytes: potential applications of mitochondrial donation and the issue of heteroplasmy

The developmental competence of mouse and human early embryosappears to be directly related to the metabolic capacity ofa finite complement of maternally inherited mitochondria thatappear to begin to replicate after implantation. Mitochondrialdysfunctions resulting from a variety of intrinsic and extrinsicinfluences, including genetic abnormalities, hypoxia and oxidativestress, can profoundly influence the level of ATP generationin oocytes and early embryos, which in turn may result in aberrantchromosomal segregation or developmental arrest. Deletions andmutations in oocyte mitochondrial DNA may subtend metabolicdeficiencies or replication disorders in some infertile womenand in women of increased reproductive age. Here, we describemethods for (i) the compartmentalization of mouse and humanoocyte mitochondria into unique cytoplasts enriched for theseorganelles, and (ii) their transfer by microinjection into intactrecipient oocytes. Metabolically active mitochondria in donorand recipient metaphase II stage oocytes were labelled withmitochondria-specific fluorescent probes, and the fate and locationof donated mitochondria in recipient oocytes were followed byconventional epifluorescence and scanning laser confocal fluorescencemicroscopy. The net ATP content of undisturbed and recipientoocytes from the same cohort(s) was measured quantitativelyat timed intervals after mitochondrial injection. The resultsdemonstrate the feasibility of isolating and transferring mitochondriabetween oocytes, an apparent increase in net ATP productionin the recipients, and the persistence of activity in the transferredmitochondria. The findings are discussed with respect to mitochondrialfunction and dysfunction in mammalian oocytes and embryos, andto the potential clinical applications of mitochondrial donationas they relate to the creation of heteroplasmic embryos.     

Yield of mtDNA mutation analysis in 2,000 patients

The multiplex polymerase chain reaction–allele specific oligonucleotides (PCR/ASO) dot blot hybridization method was used to detect 44 mitochondrial DNA point mutations in 2,000 patients suspected as having mitochondrial DNA disorders. These point mutations are classified into four categories. Category I consists of primary disease-causing, heteroplasmic point mutations. Homoplasmic nucleotide substitutions that have been reported to be possibly disease associated are in Category II. Homoplasmic nucleotide substitutions that are thought to be benign polymorphism are included in category III. The novel nucleotide substitutions recently discovered in our laboratory by single strand conformation polymorphism analysis are in category IV. Frequencies of these 44 nucleotide substitutions in 2,000 patients and 262 control individuals were studied. The results indicated that analysis of 12 recurrent disease-causing point mutations in category I identified 5.4 % of the patients suspected as having mitochondrial DNA disorders. Since the mitochondrial disorders are a group of complex, heterogeneous, and multisystemic diseases, it is often difficult to confirm clinical diagnosis without molecular studies. Thus, the multiplex PCR/ASO method is an effective approach for initial screening of mtDNA mutations in patients suspected as having mitochondrial DNA disorders. Am. J. Med. Genet. 77:395–400, 1998. © 1998 Wiley-Liss, Inc.     

山西地区线粒体DNA11778突变所致Leber遗传性视神经病变外显率分析

目的　分析山西地区线粒体 DNA11778位点突变者外显率。方法　应用等位基因特异性PCR检测视神经病变者线粒体DNA11778位点 ,对突变者及其母系成员进行分析。结果　在 30个家系中 17个家系仅先证者患病 ,另 13个家系除先证者外母系亲属有 72人携带该位点突变 ,其中 4 0人出现临床症状。结论　山西地区线粒体 DNA11778位点突变者外显率达 5 5 .6 %。     

Mitogenomic differences between the normal and tumor cells of colorectal cancer patients

So far, a reliable spectrum of mitochondrial DNA mutations in colorectal cancer cells is still unknown, and neither is their significance in carcinogenesis. Indeed, it remains debatable whether mtDNA mutations are “drivers” or “passengers” of colorectal carcinogenesis. Thus, we analyzed 200 mitogenomes from normal and cancer tissues of 100 colorectal cancer patients. Minority variant mutations were detected at the 1% level. We showed that somatic mutations frequently occur in colorectal cancer cells (75%) and are randomly distributed across the mitochondrial genome. Mutational signatures of somatic mitogenome mutations suggest that they might arise through nucleotide deamination due to oxidative stress. The majority of somatic mutations localized within the coding region (in positions not known from the human phylogeny) and was potentially pathogenic to cell metabolism. Further analysis suggested that the relaxation of negative selection in the mitogenomes of colorectal cancer cells may allow accumulation of somatic mutations. Thus, a shift in glucose metabolism from oxidative phosphorylation to glycolysis may create advantageous conditions for accumulation of mtDNA mutations. Considering the fact that the presence of somatic mtDNA mutations was not associated with any clinicopathological features, we suggested that mtDNA somatic mutations are “passengers” rather than the cause of colorectal carcinogenesis.     

线粒体tRNAThr A15951G可能是与Leber遗传性视神经病变相关的基因突变

目的 进一步分析中国汉族Leber遗传性视神经病变(Leber's hereditary optic neuropathy,LHON)家系的临床和分子遗传学特征,阐明LHON的分子致病机制.方法 对2例具有典型LHON临床特征的先证者和家系其他成员进行眼科学及其临床检查.对这2个家系先证者使用24对有部分重叠的引物进行线粒体DNA(mitochondrial DNA,mtDNA)全序列扩增分析.结果 检查发现这些家系成员中视力损害的外显率分别为5.3％(1/19)、18.2％(4/22).经mtDNA测序分析,并没有发现mtDNA G11778A、G3460A和T14484C 3个常见的突变,在tRNAThr上发现了A15951G同质性突变位点.线粒体DNA全序列分析显示2个家系呈现mtDNA多态性,都属于东亚单倍型D4b1.A15951G突变位于线粒体tRNAThr高度保守区(通用位点为71位),可能导致tRNA空间结构和稳定性发生改变,线粒体蛋白合成功能受损,最终发生视力损害.结论 线粒体tRNAThr A15951G可能是与Leber遗传性视神经病变相关的致病性线粒体基因突变.     

线粒体DNA11778突变所致Leber遗传性视神经病变外显率分析

目的 分析携带线粒体DNA（mitochondrialDNA,mtDNA)11778突变者视神经病变的外显率。方法 对经基因诊断确定为mtDNA11778突变的Leber遗传性视神经病变（Leber hereditary optic neuropathy,LHON)家系进行分析。确定mtDNA11778突变携带者及患者。结果 16个家系中mtDNA11778突变携带者130人,其中男65人,女65人,130人突变携带者中43人患病,外显率33.1%。男性患者34人,男性外显率52.3%,女性患者9人,女性外显率13.8%,男女患病比率3.8:1,患者中男性占79%。结论 携带纯合性mtDNA11778位点突变的中国人,LHON外显率近1/3。     

Respiratory chain complex I deficiency caused by mitochondrial DNA mutations

Defects of the mitochondrial respiratory chain are associated with a diverse spectrum of clinical phenotypes, and may be caused by mutations in either the nuclear or the mitochondrial genome (mitochondrial DNA (mtDNA)). Isolated complex I deficiency is the most common enzyme defect in mitochondrial disorders, particularly in children in whom family history is often consistent with sporadic or autosomal recessive inheritance, implicating a nuclear genetic cause. In contrast, although a number of recurrent, pathogenic mtDNA mutations have been described, historically, these have been perceived as rare causes of paediatric complex I deficiency. We reviewed the clinical and genetic findings in a large cohort of 109 paediatric patients with isolated complex I deficiency from 101 families. Pathogenic mtDNA mutations were found in 29 of 101 probands (29%), 21 in MTND subunit genes and 8 in mtDNA tRNA genes. Nuclear gene defects were inferred in 38 of 101 (38%) probands based on cell hybrid studies, mtDNA sequencing or mutation analysis (nuclear gene mutations were identified in 22 probands). Leigh or Leigh-like disease was the most common clinical presentation in both mtDNA and nuclear genetic defects. The median age at onset was higher in mtDNA patients (12 months) than in patients with a nuclear gene defect (3 months). However, considerable overlap existed, with onset varying from 0 to >60 months in both groups. Our findings confirm that pathogenic mtDNA mutations are a significant cause of complex I deficiency in children. In the absence of parental consanguinity, we recommend whole mitochondrial genome sequencing as a key approach to elucidate the underlying molecular genetic abnormality.