MELAS syndrome with m.4450 G > A mutation in mitochondrial tRNAMet gene.

Abstract:

:Mutations in the mitochondrial tRNAMet gene have been reported in only five patients to date, all of whom presented with muscle weakness and exercise intolerance as signs of myopathy. We herein report the case of a 12-year-old girl with focal epilepsy since the age of eight years. At age 11, the patient developed sudden visual disturbances and headaches accompanied by recurrent, stroke-like episodes with lactic acidosis (pH 7.279, lactic acid 11.6 mmol/L). The patient frequently developed a delirious state, exhibited regression of intellectual ability. Brain magnetic resonance imaging revealed high-intensity signals on T2-weighted images of the left occipital lobe. Mitochondrial gene analysis revealed a heteroplasmic m.4450G > A mutation in the mitochondrial tRNAMet. The heteroplasmic rate of the m.4450G > A mutation in blood, skin, urinary sediment, hair, saliva, and nail samples were 20, 38, 59, 41, 27, and 35%, respectively. The patient's fibroblast showed an approximately 53% reduction in the oxygen consumption rate, compared to a control, and decreased complex I and IV activities. Stroke-like episodes, lactic acidosis, encephalopathy with brain magnetic resonance imaging findings, and declined mitochondrial function were consistent with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. To our knowledge, the findings associated with this first patient with MELAS syndrome harboring the m.4450G > A mutation in mitochondrial tRNAMet expand the phenotypic spectrum of tRNAMet gene.

journal_name

Brain Dev

journal_title

Brain & development

authors

Kuwajima M,Goto M,Kurane K,Shimbo H,Omika N,Jimbo EF,Muramatsu K,Tajika M,Shimura M,Murayama K,Kurosawa K,Yamagata T,Osaka H

doi

10.1016/j.braindev.2019.01.006

subject

Has Abstract

pub_date

2019-05-01 00:00:00

pages

465-469

issue

5

eissn

0387-7604

issn

1872-7131

pii

S0387-7604(18)30597-7

journal_volume

41

pub_type

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