Defects of the mitochondrial energy production cab be expressed in many tissues and may lead to various types of diseases. Since defects can occur on many sites of the oxidative phosphorylation system, molecular diagnosis can be difficult. In typical mitochondrial syndromes, like MELAS- or MERRF-syndrome, diagnosis can be suspected already on clinical grounds. Lactate measured in various body fluids is still the best selective screening parameter. Loading tests, respectively ergometry is only necessary in the milder clinical forms of diseases or possibly in older children. The in vivo lactate determination e.g. In the CNS by 1H NMR spectroscopy can be helpful in evaluating prognosis. The diagnosis of a mitochondriopathy is usually confirmed enzymatically by tissue biopsies; skeletal muscle is still the tissue of the first choice because some enzyme deficiencies are not sufficiently expressed in cultured fibroblasts. If possible, intact mitochondria should be investigated polarografically along with histology and histochemistry. Finally several parts of the respiratory chain and pyruvate dehydrogenase complex are analyzed by single enzyme measurement. Also combined deficiencies have been described. Polypeptide subunits of respiratory chain complexes can be investigated by means of immunoblotting. The investigations of the mitochondrial DNA from the end of the diagnostic scale. The application of various new therapeutic agents, such as antioxidants, radical scavangers and cofactors have not come to any persuasive clinical result. But there is a number of reports about some successful treatment with coenzyme Q10, vitamin K3, vitamin C, riboflavin, thiamine, dichloroacetate and in PDHC -deficiency with ketogenic diet. Mitochondrial gene therapy appears only theoretical and speculative. Because of the enormous heterogeneity even on the DNA-level genetic counselling is reserved for some cases with exact molecular diagnosis.
"In plasma amino acid assays, special attention was paid to the secondary hyperalaninemia derived from lactic acidemia. The mitochondrial fatty acid disorder was analyzed through the evaluation of plasma acylcarnitine profile screen15, 16). "
[Show abstract][Hide abstract] ABSTRACT: Mitochondrial dysfunction can present with various symptoms depending on the organ it has affected. This research tried to analyze the ophthalmologic symptoms and ophthalmologic examination (OE) results in patients with mitochondrial disease (MD).
Seventy-four patients diagnosed with mitochondrial respiratory chain complex defect with biochemical enzyme assay were included in the study. They were divided into 2 groups based on the OE results by funduscopy and were analyzed on the basis of their clinical features, biochemical test results, morphological analysis, and neuroimaging findings.
Thirty-seven (50%) of the 74 MD patients developed ophthalmologic symptoms. Abnormal findings were observed in 36 (48.6%) patients during an OE, and 16 (21.6%) of them had no ocular symptoms. Significantly higher rates of prematurity, clinical history of epilepsy or frequent apnea events, abnormal light microscopic findings in muscle pathology, diffuse cerebral atrophy in magnetic resonance imaging, and brainstem hyperintensity and lactate peaks in magnetic resonance spectroscopy were noted in the group with abnormal OE results.
Although the ophthalmologic symptoms are not very remarkable in MD patients, an OE is required. When the risk factors mentioned above are observed, a more active approach should be taken in the OE because a higher frequency of ocular involvement can be expected.
Korean Journal of Pediatrics 12/2010; 53(12):994-9. DOI:10.3345/kjp.2010.53.12.994
"Polarography determines respiratory chain efficiency, OXPHOS activity , integrity of the mitochondrial membranes, and the efficiency of the substrate transport (Gillis and Kaye 2002). Immunoblot measures amount and molecular weight of various mitochondrial proteins in skeletal muscle (Sperl 1997; Gillis and Kaye 2002; The Mitochondrial Disease Foundation 2003), using antibodies generated against the individual subunits of specific proteins. Combined immunohistochemical and immunoblot analysis can be useful to assess intrafibral distribution and/or quantity of the different peptide subunits, either mtDNA or nDNA encoded, of the respiratory chain enzymatic complexes. "
[Show abstract][Hide abstract] ABSTRACT: Mitochondrial diseases (MD) with respiratory chain defects are caused by genetic mutations that determine an impairment of the electron transport chain functioning. Diagnosis often requires a complex approach with measurements of serum lactate, magnetic resonance spectroscopy (MRS), muscle histology and ultrastructure, enzymology, genetic analysis, and exercise testing. The ubiquitous distribution of the mitochondria in the human body explains the multiple organ involvement. Exercise intolerance is a common symptom of MD, due to increased dependence of skeletal muscle on anaerobic metabolism, with an excess lactate generation, phosphocreatine depletion, enhanced free radical production, reduced oxygen extraction and electron flux through the respiratory chain. MD treatment has included antioxidants (vitamin E, alpha lipoic acid), coenzyme Q10, riboflavin, creatine monohydrate, dichloroacetate and exercise training. Exercise is a particularly important tool in diagnosis as well as in the management of these diseases.
"The high-fat, very low-carbohydrate, bclassicQ ketogenic diet ameliorates several disorders affecting brain metabolism and function, including intractable epilepsy , glucose transporter defects , and mitochondriopathies . The ketogenic diet raises plasma ketone bodies (acetoacetate , b-hydroxybutyrate [b-HBA], and acetone) because genes controlling enzymes of ketogenesis, particularly 3- hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) synthase [4,5] and HMG-CoA lyase , are activated when plasma insulin is suppressed by low carbohydrate intake. "
[Show abstract][Hide abstract] ABSTRACT: In contrast to humans, rats on a high-fat ketogenic diet seem incapable of maintaining plasma beta-hydroxybutyrate above 1 mmol/L for more than a week. Our goal was to determine whether fatty acid metabolism in rats changes despite the absence of sustained ketosis induced by the ketogenic diet. Fatty acid metabolism was assessed as changes in tissue fatty acid profiles and change in 13C-alpha-linolenic acid incorporation into plasma, liver, adipose tissue, and brain lipids. Despite loss of ketosis, the ketogenic diet reduced some polyunsaturated fatty acids in adipose tissue (up to 44%) and plasma (up to 90%) but raised polyunsaturates in liver triglycerides by up to 25-fold and raised arachidonic and docosahexaenoic acids in the brain by 15%. Lower tissue incorporation of 13C-alpha-linolenic acid but higher unlabeled and 13C-labeled docosahexaenoic acid in brain supports the view that the principal changes in fatty acid composition resulted from enhanced mobilization of polyunsaturates from adipose tissue to liver and brain. In the absence of sustained ketosis, changes in fatty acid metabolism resulting in an increase in brain polyunsaturates, particularly docosahexaenoic acid may, nevertheless, contribute to the seizure protection by the ketogenic diet.
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