Milder clinical course of Type IV 3-methylglutaconic aciduria due to a novel mutation in TMEM70.
Mitochondrial disorders are a large and genetically heterogeneous group of disorders posing a significant diagnostic challenge. Only approximately 10-20% of patients have identifiable alterations in their mitochondrial DNA (mtDNA). The remaining ~80-90% of affected patients likely harbor mutations in nuclear genes, most of which are still poorly characterized, and therefore not amenable to efficient screening using currently available molecular methods. Here we present a patient, who has been followed since birth after presenting with neonatal hyperammonemia, lactic acidosis, Reye-like syndrome episodes, and ventricular tachyarrhythmia. Initial biochemical work-up revealed hyperalaninemia, normal plasma glutamine, mild orotic aciduria and significant amounts of urinary 3-methylglutaconic (3-MGC) and 3-methylglutaric (3-MGA) acids. Muscle biopsy demonstrated the presence of ragged-red fibers and non-specific structural abnormalities of mitochondria. The activities of respiratory chain enzymes (complexes I-IV) showed no deficiency. Mutational analysis of the entire mitochondrial genome did not reveal deleterious point mutations or large deletions. Long-term follow-up was significant for a later-onset hypertrophic cardiomyopathy, muscle weakness, and exercise intolerance. Although she had frequent episodes of Reye-like episodes in infancy and early childhood, mostly triggered by illnesses, these symptoms improved significantly with the onset of puberty. In the light of recent reports linking cases of type IV 3-methylglutaconic aciduria (3-MGCA) and hypertrophic cardiomyopathy to mutations in TMEM70, we proceeded with sequencing analysis of this gene. We identified one previously reported splice site mutation, c.317-2A>G and a novel mutation c.494G>A (p.G165D) in an evolutionarily conserved region predicted to be deleterious. This variant was not identified in 100 chromosomes of healthy control subjects and 200 chromosomes of patients with cardiomyopathies. Western blotting using a polyclonal antibody against ATP5J, subunit F6 of ATP synthase, on patient's skin fibroblasts showed undetectable amount of the ATP5J protein. In comparison to the previously reported cases, we note that our patient had normal growth parameters and cognitive development, absence of structural heart and urinary tract defects, no dysmorphic features, improvement of symptoms with age, and persistence of hypertrophic cardiomyopathy.
Shchelochkov
Oleg A
OA
Department of Molecular and Human Genetics, Baylor College of Medicine, Houston TX, United States.
Li
Fang-Yuan
FY
Wang
Jing
J
Zhan
Hongli
H
Towbin
Jeffrey A
JA
Jefferies
John Lynn
JL
Wong
Lee-Jun
LJ
Scaglia
Fernando
F
D000140:Acidosis, Lactic / Q000235:genetics; D000293:Adolescent; D002312:Cardiomyopathy, Hypertrophic / Q000235:genetics*; D002648:Child; D004579:Electron Transport / Q000235:genetics; D005260:Female; D005977:Glutarates / Q000652:urine*; D006801:Humans; D022124:Hyperammonemia / Q000235:genetics; D007231:Infant, Newborn; D008565:Membrane Proteins / Q000235:genetics*; D028361:Mitochondrial Diseases / Q000235:genetics*; D024101:Mitochondrial Proteins / Q000235:genetics*; D025261:Mitochondrial Proton-Translocating ATPases / Q000172:deficiency; D012202:Reye Syndrome / Q000235:genetics; D013577:Syndrome
D005977:Glutarates; D008565:Membrane Proteins; D024101:Mitochondrial Proteins; C533106:TMEM70 protein, human; C022034:3-methylglutaconic acid; C412204:ATP synthase subunit 6; D025261:Mitochondrial Proton-Translocating ATPases