Succinyl-CoA ligase deficiency: a mitochondrial hepatoencephalomyopathy.
This patient presented on the first day of life with pronounced lactic acidosis with an elevated lactate/pyruvate ratio. Urine organic acids showed Krebs cycle metabolites and mildly elevated methylmalonate and methylcitrate. The acylcarnitine profile showed elevated propionylcarnitine and succinylcarnitine. Amino acids showed elevated glutamic acid, glutamine, proline, and alanine. From the age 2 of mo on, she had elevated transaminases and intermittent episodes of liver failure. Liver biopsy showed steatosis and a decrease of mitochondrial DNA to 50% of control. She had bilateral sensorineural hearing loss. Over the course of the first 2 y of life, she developed a progressively severe myopathy with pronounced muscle weakness eventually leading to respiratory failure, Leigh disease, and recurrent hepatic failure. The hepatic symptoms and the metabolic parameters temporarily improved on treatment with aspartate, but neither muscle symptoms nor brain lesions improved. Laboratory testing revealed a deficiency of succinyl-CoA ligase enzyme activity and protein in fibroblasts because of a novel homozygous mutation in the SUCLG1 gene: c.40A>T (p.M14L). Functional analysis suggests that this methionine is more likely to function as the translation initiator methionine, explaining the pathogenic nature of the mutation. Succinyl-CoA ligase deficiency due to an SUCLG1 mutation is a new cause for mitochondrial hepatoencephalomyopathy.
Van Hove
Johan L K
JL
Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045, USA. Vanhove.Johan@tchden.org
Saenz
Margarita S
MS
Thomas
Janet A
JA
Gallagher
Renata C
RC
Lovell
Mark A
MA
Fenton
Laura Z
LZ
Shanske
Sarah
S
Myers
Sommer M
SM
Wanders
Ronald J A
RJ
Ruiter
Jos
J
Turkenburg
Marjolein
M
Waterham
Hans R
HR
D000595:Amino Acid Sequence; D001483:Base Sequence; D001921:Brain / Q000378:metabolism / Q000473:pathology; D001928:Brain Diseases, Metabolic / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D004252:DNA Mutational Analysis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007888:Leigh Disease / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D008107:Liver Diseases / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D008279:Magnetic Resonance Imaging; D028361:Mitochondrial Diseases / Q000201:enzymology / Q000235:genetics / Q000473:pathology; D008969:Molecular Sequence Data; D009154:Mutation; D013389:Succinate-CoA Ligases / Q000172:deficiency* / Q000235:genetics
D013389:Succinate-CoA Ligases
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