17. Mitochondrial inheritance Flashcards
What is the role of the mitochondria?
Produce cellular energy in form of ATP via oxidative phosphorylation (OXPHOS)
Also important for regulation of cellular metabolism, haemoglobin synthesis, apoptosis
Describe the mitochondrial genome
- Circular dsDNA enconding 37 genes
- No introns
- Multiple copies of mtDNA per mitochondria, multiple mitochondria per cell
- Termination codons created post-transcriptionally by polyadenylation
Why is a high mutation rate seen in mtDNA?
Inefficient DNA repair + localised oxidative environment
Define homoplasmy & heteroplasmy
Homoplasmy - all copies of mtDNA identical
Heteroplasmy - mixture of 2 or more genotypes
What is the ‘threshold level’
The level of heteroplasmy which is clinically relevant
Why does the level of heteroplasmy differ between family members
Bottleneck effect
During production of primary oocytes, each oocyte has a different number of mtDNA molecules
These are then rapidly replicated
Describe the general profile of mitochondrial disorders
- Involve multiple organ systems, tissues with high metabolic demand (nervous, skeletal muscle, heart)
- Varying age of onset
Why is it important to test affected tissue where possible?
Mutation levels change of over time and within tissue types
E.g. increase in muscle, decrease in blood
What is MELAS and what causes it?
Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes
Seizures, muscle weakness, exercise intolerance
Most commonly m.3243A>G (heteroplasmic) in MT-TL1 - encodes tRNA
How is MERFF characterised and what causes it?
Myoclonic epilepsy with ragged red fibers
Epilepsy, myopathy, ataxia
Most commonly heteroplasmic m.8344A>G
How is NARP characterised & what causes it?
Sensory neuropathy, ataxia, retinitis pigmentosa
Forms a continuum with Leigh syndrome
Various heteroplasmic variants, m.8993T>G most common
How is LHON characterised?
Leber hereditary optic neuropathy
Visual failure and optic atrophy
Mostly homoplasmic
What do mtDNA deletions cause?
Pearson syndrome, Kearns-Sayre syndrome, CPEO
Heteroplasmic
What is the phenotype of Kearns-Sayre syndrome?
Pigmentary retinopathy, CPEO, and cardiac conduction abnormality
What is the phenotype of Pearson syndrome?
Pancytopenia, pancreatic dysfunction, poor weight gain