Abstract
BackgroundThe c.2447G>A (p.R722H) mutation in the gene POLG1 of the catalytic subunit of human mitochondrial polymerase gamma has been previously found in a few occasions but its pathogenicity has remained uncertain. We set out to ascertain its contribution to neuromuscular disease.MethodsProbands from two families with probable mitochondrial disease were examined clinically, muscle and buccal epithelial DNA were analyzed for mtDNA deletions, and the POLG1, POLG2, ANT1 and Twinkle genes were sequenced.ResultsAn adult proband presented with progressive external ophthalmoplegia, sensorineural hearing impairment, diabetes mellitus, dysphagia, a limb myopathy and dementia. Brain MRI showed central and cortical atrophy, and 18F-deoxyglucose PET revealed reduced glucose uptake. Histochemical analysis of muscle disclosed ragged red fibers and cytochrome c oxidase-negative fibers. Electron microscopy showed subsarcolemmal aggregates of morphologically normal mitochondria. Multiple mtDNA deletions were found in the muscle, and sequencing of the POLG1 gene revealed a homozygous c.2447G>A (p.R722H) mutation. His two siblings were also homozygous with respect to the p.R722H mutation and presented with dementia and sensorineural hearing impairment. In another family the p.R722H mutation was found as compound heterozygosity with the common p.W748S mutation in two siblings with mental retardation, ptosis, epilepsy and psychiatric symptoms. The estimated carrier frequency of the p.R722H mutation was 1:135 in the Finnish population. No mutations in POLG2, ANT1 and Twinkle genes were found. Analysis of the POLG1 sequence by homology modeling supported the notion that the p.R722H mutation is pathogenic.ConclusionsThe recessive c.2447G>A (p.R722H) mutation in the linker region of the POLG1 gene is pathogenic for multiple mtDNA deletions in muscle and is associated with a late-onset neurological phenotype as a homozygous state. The onset of the disease can be earlier in compound heterozygotes.
Highlights
The c.2447G>A (p.R722H) mutation in the gene POLG1 of the catalytic subunit of human mitochondrial polymerase gamma has been previously found in a few occasions but its pathogenicity has remained uncertain
We found a pathogenic mutation p.R722H in POLG1 in three siblings, who were homozygous for the mutation and presented with a clinical phenotype suggesting a mitochondrial disease
The children had mental retardation, ptosis and epilepsy resembling the clinical phenotype that has been described in subjects with compound heterozygosity for p.W748S and another POLG1 mutation
Summary
The c.2447G>A (p.R722H) mutation in the gene POLG1 of the catalytic subunit of human mitochondrial polymerase gamma has been previously found in a few occasions but its pathogenicity has remained uncertain. The human mitochondrial DNA polymerase is a 195 kDa heterotrimer consisting of a 140 kDa catalytic subunit (pol γA) and two identical 55 kDa accessory subunits (pol γB) [3]. The C-terminus of the catalytic subunit PolγA is the pol domain, which is responsible for the polymerase function, while the N-terminus is responsible for exonuclease activity and proofreading of the mitochondrial DNA (mtDNA). Other conditions associated with POLG1 mutations include male subfertility, premature. POLG1 mutations can cause deletions or depletion in mtDNA [16,21,22,23]
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