title: Association of the mtDNA m.4171C>A/MT-ND1 mutation with both optic neuropathy and bilateral brainstem lesions.
abstract: BACKGROUND
  An increasing number of mitochondrial DNA (mtDNA) mutations, mainly in complex I genes, have been associated with variably overlapping phenotypes of Leber's hereditary optic neuropathy (LHON), mitochondrial encephalomyopathy with stroke-like episodes (MELAS) and Leigh syndrome (LS). We here describe the first case in which the m.4171C>A/MT-ND1 mutation, previously reported only in association with LHON, leads also to a Leigh-like phenotype.
  
  
  METHODS
  A 16-year-old male suffered subacute visual loss and recurrent vomiting and vertigo associated with bilateral brainstem lesions affecting the vestibular nuclei. His mother and one sister also presented subacute visual loss compatible with LHON. Sequencing of the entire mtDNA revealed the homoplasmic m.4171C>A/MT-ND1 mutation, previously associated with pure LHON, on a haplogroup H background. Three additional non-synonymous homoplasmic transitions affecting ND2 (m.4705T>C/MT-ND2 and m.5263C>T/MT-ND2) and ND6 (m.14180T>C/MT-ND6) subunits, well recognized as polymorphisms in other mtDNA haplogroups but never found on the haplogroup H background, were also present.
  
  
  CONCLUSIONS
  This case widens the phenotypic expression of the rare m.4171C>A/MT-ND1 LHON mutation, which may also lead to Leigh-like brainstem lesions, and indicates that the co-occurrence of other ND non-synonymous variants, found outside of their usual mtDNA backgrounds, may have increased the pathogenic potential of the primary LHON mutation.
authors.affiliation: UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Bellaria, Bologna, Italy. chiaralamorgia@gmail.com.
authors.forename: Chiara
authors.initials: C
authors.lastname: La Morgia
authors.forename: Leonardo
authors.initials: L
authors.lastname: Caporali
authors.forename: Francesca
authors.initials: F
authors.lastname: Gandini
authors.forename: Anna
authors.initials: A
authors.lastname: Olivieri
authors.forename: Francesco
authors.initials: F
authors.lastname: Toni
authors.forename: Stefania
authors.initials: S
authors.lastname: Nassetti
authors.forename: Daniela
authors.initials: D
authors.lastname: Brunetto
authors.forename: Carlotta
authors.initials: C
authors.lastname: Stipa
authors.forename: Cristina
authors.initials: C
authors.lastname: Scaduto
authors.forename: Antonia
authors.initials: A
authors.lastname: Parmeggiani
authors.forename: Caterina
authors.initials: C
authors.lastname: Tonon
authors.forename: Raffaele
authors.initials: R
authors.lastname: Lodi
authors.forename: Antonio
authors.initials: A
authors.lastname: Torroni
authors.forename: Valerio
authors.initials: V
authors.lastname: Carelli
mesh_terms: D000293:Adolescent; D001927:Brain Diseases / Q000150:complications / Q000235:genetics*; D001933:Brain Stem; D004272:DNA, Mitochondrial / Q000235:genetics*; D006801:Humans; D008297:Male; D009154:Mutation / Q000235:genetics*; D029242:Optic Atrophy, Hereditary, Leber / Q000150:complications / Q000235:genetics*; D010375:Pedigree; D014726:Vestibular Nuclei / Q000473:pathology
chemical_list: D004272:DNA, Mitochondrial