Infantile Cerebellar-Retinal Degeneration Associated with a Mutation in Mitochondrial Aconitase, ACO2

Department of Pediatrics A, Ha'Emek Medical Center, Afula, Israel.
The American Journal of Human Genetics (Impact Factor: 10.93). 03/2012; 90(3):518-23. DOI: 10.1016/j.ajhg.2012.01.009
Source: PubMed


Degeneration of the cerebrum, cerebellum, and retina in infancy is part of the clinical spectrum of lysosomal storage disorders, mitochondrial respiratory chain defects, carbohydrate glycosylation defects, and infantile neuroaxonal dystrophy. We studied eight individuals from two unrelated families who presented at 2-6 months of age with truncal hypotonia and athetosis, seizure disorder, and ophthalmologic abnormalities. Their course was characterized by failure to acquire developmental milestones and culminated in profound psychomotor retardation and progressive visual loss, including optic nerve and retinal atrophy. Despite their debilitating state, the disease was compatible with survival of up to 18 years. Laboratory investigations were normal, but the oxidation of glutamate by muscle mitochondria was slightly reduced. Serial brain MRI displayed progressive, prominent cerebellar atrophy accompanied by thinning of the corpus callosum, dysmyelination, and frontal and temporal cortical atrophy. Homozygosity mapping followed by whole-exome sequencing disclosed a Ser112Arg mutation in ACO2, encoding mitochondrial aconitase, a component of the Krebs cycle. Specific aconitase activity in the individuals' lymphoblasts was severely reduced. Under restrictive conditions, the mutant human ACO2 failed to complement a yeast ACO1 deletion strain, whereas the wild-type human ACO2 succeeded, indicating that this mutation is pathogenic. Thus, a defect in mitochondrial aconitase is associated with an infantile neurodegenerative disorder affecting mainly the cerebellum and retina. In the absence of noninvasive biomarkers, determination of the ACO2 sequence or of aconitase activity in lymphoblasts are warranted in similarly affected individuals, based on clinical and neuroradiologic grounds.

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    • "The five affected proteins which play an important role in ATP production: are succinyl-CoA ligase subunit beta (SUCLA2), aconitate hydratase (ACO2), aspartate aminotransferase (GOT2), fumarate hydratase (FH1), and succinyl-CoA:3-ketoacid-coenzyme A transferase 1 (SCOT). Low levels of these proteins are related to seizures, such as depletion of SUCLA2 [17], deficiency of FH1 [18] and mutations on genes that codes for ACO2 and SCOT [19] [20]. Furthermore , a low level of GOT2 was described in the hippocampus of TLE patients [21]. "
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