Clinical spectrum, morbidity, and mortality in 113 pediatric patients with mitochondrial disease.
OBJECTIVE
The aim of this study was to elucidate the frequency of major clinical manifestations in children with mitochondrial disease and establish their clinical course, prognosis, and rates of survival depending on their clinical features.


METHODS
We performed a retrospective review of the medical records of 400 patients who were referred for evaluation of mitochondrial disease. By use of the modified Walker criteria, only patients who were assigned a definite diagnosis were included in the study.


RESULTS
A total of 113 pediatric patients with mitochondrial disease were identified. A total of 102 (90%) patients underwent a muscle biopsy as part of the diagnostic workup. A significant respiratory chain (RC) defect, according to the diagnostic criteria, was found in 71% of the patients who were evaluated. In this cohort, complex I deficiency (32%) and combined complex I, III, and IV deficiencies (26%) were the most common causes of RC defects, followed by complex IV (19%), complex III (16%), and complex II deficiencies (7%). Pathogenic mitochondrial DNA abnormalities were found in 11.5% of the patients. A substantial fraction (40%) of patients with mitochondrial disorders exhibited cardiac disease, diagnosed by Doppler echocardiography; however, the majority (60%) of patients had predominant neuromuscular manifestations. No correlation between the type of RC defect and the clinical presentation was observed. Overall, the mean age at presentation was 40 months. However, the mean age at presentation was 33 months in the cardiac group and 44 months in the noncardiac group. Twenty-six (58%) patients in the cardiac group exhibited hypertrophic cardiomyopathy, 29% had dilated cardiomyopathy, and the remainder (13%) had left ventricular noncompaction. Patients with cardiomyopathy had an 18% survival rate at 16 years of age. Patients with neuromuscular features but no cardiomyopathy had a 95% survival at the same age.


CONCLUSIONS
This study gives strong support to the view that in patients with RC defects, cardiomyopathy is more common than previously thought and tends to follow a different and more severe clinical course. Although with a greater frequency than previously reported, mitochondrial DNA mutations were found in a minority of patients, emphasizing that most mitochondrial disorders of childhood follow a Mendelian pattern of inheritance.
Department of Molecular and Human Genetics, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. fscaglia@bcm.tmc.edu
Fernando
F
Scaglia
Jeffrey A
JA
Towbin
William J
WJ
Craigen
John W
JW
Belmont
E O'Brian
EO
Smith
Stephen R
SR
Neish
Stephanie M
SM
Ware
Jill V
JV
Hunter
Susan D
SD
Fernbach
Georgirene D
GD
Vladutiu
Lee-Jun C
LJ
Wong
Hannes
H
Vogel
D000293:Adolescent; D017668:Age of Onset; D009202:Cardiomyopathies / Q000209:etiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004272:DNA, Mitochondrial; D004579:Electron Transport; D045222:Electron Transport Chain Complex Proteins / Q000172:deficiency*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D028361:Mitochondrial Diseases / Q000150:complications* / Q000235:genetics / Q000401:mortality; D009154:Mutation; D009468:Neuromuscular Diseases / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis
D004272:DNA, Mitochondrial; D045222:Electron Transport Chain Complex Proteins