title: POLG1 p.R722H mutation associated with multiple mtDNA deletions and a neurological phenotype.
abstract: BACKGROUND
  The c.2447G>A (p.R722H) mutation in the gene POLG1 of the catalytic subunit of human mitochondrial polymerase gamma has been previously found in a few occasions but its pathogenicity has remained uncertain. We set out to ascertain its contribution to neuromuscular disease.
  
  
  METHODS
  Probands from two families with probable mitochondrial disease were examined clinically, muscle and buccal epithelial DNA were analyzed for mtDNA deletions, and the POLG1, POLG2, ANT1 and Twinkle genes were sequenced.
  
  
  RESULTS
  An adult proband presented with progressive external ophthalmoplegia, sensorineural hearing impairment, diabetes mellitus, dysphagia, a limb myopathy and dementia. Brain MRI showed central and cortical atrophy, and 18F-deoxyglucose PET revealed reduced glucose uptake. Histochemical analysis of muscle disclosed ragged red fibers and cytochrome c oxidase-negative fibers. Electron microscopy showed subsarcolemmal aggregates of morphologically normal mitochondria. Multiple mtDNA deletions were found in the muscle, and sequencing of the POLG1 gene revealed a homozygous c.2447G>A (p.R722H) mutation. His two siblings were also homozygous with respect to the p.R722H mutation and presented with dementia and sensorineural hearing impairment. In another family the p.R722H mutation was found as compound heterozygosity with the common p.W748S mutation in two siblings with mental retardation, ptosis, epilepsy and psychiatric symptoms. The estimated carrier frequency of the p.R722H mutation was 1:135 in the Finnish population. No mutations in POLG2, ANT1 and Twinkle genes were found. Analysis of the POLG1 sequence by homology modeling supported the notion that the p.R722H mutation is pathogenic.
  
  
  CONCLUSIONS
  The recessive c.2447G>A (p.R722H) mutation in the linker region of the POLG1 gene is pathogenic for multiple mtDNA deletions in muscle and is associated with a late-onset neurological phenotype as a homozygous state. The onset of the disease can be earlier in compound heterozygotes.
authors.affiliation: Department of Pediatrics, University of Oulu, Box 5000, FIN-90014, University of Oulu, Oulu, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Komulainen
authors.forename: Reetta
authors.initials: R
authors.lastname: Hinttala
authors.forename: Mikko
authors.initials: M
authors.lastname: Kärppä
authors.forename: Leila
authors.initials: L
authors.lastname: Pajunen
authors.forename: Saara
authors.initials: S
authors.lastname: Finnilä
authors.forename: Hannu
authors.initials: H
authors.lastname: Tuominen
authors.forename: Heikki
authors.initials: H
authors.lastname: Rantala
authors.forename: Ilmo
authors.initials: I
authors.lastname: Hassinen
authors.forename: Kari
authors.initials: K
authors.lastname: Majamaa
authors.forename: Johanna
authors.initials: J
authors.lastname: Uusimaa
mesh_terms: D000369:Aged, 80 and over; D001120:Arginine / Q000235:genetics*; D001921:Brain / Q000473:pathology; D000074002:DNA Polymerase gamma; D004272:DNA, Mitochondrial / Q000235:genetics*; D004259:DNA-Directed DNA Polymerase / Q000235:genetics*; D003680:Deglutition Disorders / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D018450:Disease Progression; D006639:Histidine / Q000235:genetics; D006801:Humans; D008297:Male; D028361:Mitochondrial Diseases / Q000150:complications / Q000235:genetics*; D009154:Mutation / Q000235:genetics*; D009886:Ophthalmoplegia / Q000150:complications; D010641:Phenotype
chemical_list: D004272:DNA, Mitochondrial; D006639:Histidine; D001120:Arginine; D000074002:DNA Polymerase gamma; D004259:DNA-Directed DNA Polymerase; C413027:POLG protein, human