Diagnosis and treatment of childhood mitochondrial diseases.
Mitochondrial cytopathies are caused by genetic alterations of nuclear- or mitochondrial-encoded genes involved in the synthesis of subunits of the electron transport chain. Mutations of mitochondrial DNA are associated with a wide range of clinical presentations [1-4]. The ubiquitous nature of mitochondria and the role of the mitochondria in cellular metabolism result in the potential for any tissue in the body to be affected [5-7,8..,9]. Although some children with mitochondrial disease present with life-threatening lactic acidosis in the newborn period, the majority of children come to clinical attention for nonspecific problems, including failure to thrive, developmental delay, seizures, hypotonia, and loss of developmental milestones. The diagnosis of these disorders is made through careful clinical evaluation, coupled with biochemical, morphologic, and molecular biologic techniques. Genetic counseling is difficult due to unique aspects of mitochondrial genetics. Despite advances in our understanding of mitochondrial biochemistry and genetics, treatment options remain limited.
Gropman
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National Human Genome Research Institute, Neurogenetics Branch, National Institutes of Neurologic Disorders and Stroke, National Institutes of Health, 10 Center Drive, Building 10, Room 3B04, Bethesda, MD 20892, USA. gropman@ninds.nih.gov
D015415:Biomarkers; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D030401:Cytochrome-c Oxidase Deficiency; D004247:DNA / Q000235:genetics; D004252:DNA Mutational Analysis; D004261:DNA Replication; D004272:DNA, Mitochondrial / Q000235:genetics; D004569:Electroencephalography; D004579:Electron Transport / Q000235:genetics; D003576:Electron Transport Complex IV / Q000235:genetics; D004734:Energy Metabolism / Q000235:genetics; D005817:Genetic Counseling; D006801:Humans; D007223:Infant; D007888:Leigh Disease / Q000201:enzymology / Q000235:genetics; D017241:MELAS Syndrome / Q000235:genetics; D008279:Magnetic Resonance Imaging; D028361:Mitochondrial Diseases / Q000145:classification / Q000175:diagnosis* / Q000178:diet therapy / Q000235:genetics / Q000378:metabolism; D018482:Muscle, Skeletal / Q000473:pathology; D029242:Optic Atrophy, Hereditary, Leber / Q000235:genetics; D010085:Oxidative Phosphorylation; D017354:Point Mutation; D014176:Protein Biosynthesis; D017384:Sequence Deletion; D013577:Syndrome
D015415:Biomarkers; D004272:DNA, Mitochondrial; D004247:DNA; D003576:Electron Transport Complex IV