Article

Novel POLG splice site mutation and optic atrophy

Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Archives of neurology (Impact Factor: 7.01). 06/2011; 68(6):806-11. DOI: 10.1001/archneurol.2011.124
Source: PubMed

ABSTRACT To investigate the molecular etiology of 2 unrelated patients with a multisystem mitochondrial disorder accompanied by optic atrophy in one of them.
Clinical examination and neurophysiological, radiological, morphological, and molecular analyses.
Tertiary care neuromuscular clinic and molecular genetics laboratory.
A 65-year-old man (patient 1) with dyschromatopsia and vision loss since childhood developed progressive external ophthalmoplegia, ptosis, and myopathy in the seventh decade of life and was found to have optic atrophy. A 63-year-old man (patient 2) with a similar phenotype, without visual symptoms, experienced also hearing loss and parkinsonism.
Description of the clinical and molecular findings.
A muscle biopsy specimen showed ragged-red, ragged-blue, and cytochrome c oxidase-negative fibers in both patients. Because optic atrophy in patient 1 suggested an autosomal dominant OPA1-related disorder, the OPA1 gene was first sequenced, the results of which did not detect any mutations. Southern blot and polymerase chain reaction analyses of muscle mitochondrial DNA revealed multiple deletions. Sequencing of POLG detected a novel variant, c.3104 + 3A>T, in both patients. Patient 1 was compound heterozygous for a known p.F749S mutation; patient 2 had p.G848S as the second mutation. Analysis of POLG complementary DNA showed that c.3104 + 3A>T results in skipping of exon 18.
Early-onset dyschromatopsia and optic atrophy can occur not only in OPA1-related but also in POLG-related disorders with significant impact on genetic counseling.

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    • "The most important observation in these patients was that they all had a mitochondrial myopathy with accumulation of multiple mtDNA deletions, thus implicating the OPA1 gene function in mtDNA maintenance. Interestingly, a single report recently presented a similar phenotype associated with compound heterozygote mutations in the polymerase gamma (POLG1) gene, demonstrating a genetic heterogeneity of optic atrophy associated with mitochondrial myopathy and mtDNA multiple deletions (Milone et al., 2011). Over recent years, other phenotypes have been described within the frame of the OPA1-related DOA " plus " syndrome with mtDNA multiple deletions, including MS-like features, Behr-like spastic paraparesis and cases with absent or subclinical ocular involvement, thus defining an increasingly large spectrum of " OPAopathies " (Yu-Wai-Man et al., 2010; Milone et al., 2009; Marelli et al., 2011; Pretegiani et al., 2011; Schaaf et al., 2011). "
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