Neonatal-onset mitochondrial disease: clinical features, molecular diagnosis and prognosis
Open Access
- 7 October 2021
- journal article
- research article
- Published by BMJ in Archives of Disease in Childhood: Fetal & Neonatal
- Vol. 107 (3), 329-334
- https://doi.org/10.1136/archdischild-2021-321633
Abstract
Objective Neonatal-onset mitochondrial disease has not been fully characterised owing to its heterogeneity. We analysed neonatal-onset mitochondrial disease in Japan to clarify its clinical features, molecular diagnosis and prognosis. Design Retrospective observational study from January 2004 to March 2020. Setting Population based. Patients Patients (281) with neonatal-onset mitochondrial disease diagnosed by biochemical and genetic approaches. Interventions None. Main outcome measures Disease types, initial symptoms, biochemical findings, molecular diagnosis and prognosis. Results Of the 281 patients, multisystem mitochondrial disease was found in 194, Leigh syndrome in 26, cardiomyopathy in 38 and hepatopathy in 23 patients. Of the 321 initial symptoms, 236 occurred within 2 days of birth. Using biochemical approaches, 182 patients were diagnosed by mitochondrial respiratory chain enzyme activity rate and 89 by oxygen consumption rate. The remaining 10 patients were diagnosed using a genetic approach. Genetic analysis revealed 69 patients had nuclear DNA variants in 36 genes, 11 of 15 patients had mitochondrial DNA variants in five genes and four patients had single large deletion. The Cox proportional hazards regression analysis showed the effects of Leigh syndrome (HR=0.15, 95% CI 0.04 to 0.63, p=0.010) and molecular diagnosis (HR=1.87, 95% CI 1.18 to 2.96, p=0.008) on survival. Conclusions Neonatal-onset mitochondrial disease has a heterogenous aetiology. The number of diagnoses can be increased, and clarity regarding prognosis can be achieved by comprehensive biochemical and molecular analyses using appropriate tissue samples.Keywords
Funding Information
- Japan Agency for Medical Research and Development (JP20ek0109468, JP19ek0109273, JP21kk0305015)
This publication has 24 references indexed in Scilit:
- Investigation of the freely available easy-to-use software ‘EZR’ for medical statisticsBone Marrow Transplantation, 2012
- Microscale oxygraphy reveals OXPHOS impairment in MRC mutant cellsMitochondrion, 2012
- Neonatal onset of mitochondrial disorders in 129 patients: clinical and laboratory characteristics and a new approach to diagnosisJournal of Inherited Metabolic Disease, 2012
- Neonatal cardiomyopathies and metabolic crises due to oxidative phosphorylation defectsSeminars in Fetal and Neonatal Medicine, 2011
- Mitochondrial Oxidative Phosphorylation Disorders Presenting in Neonates: Clinical Manifestations and Enzymatic and Molecular DiagnosesPEDIATRICS, 2008
- Mitochondrial hepatopathies: Advances in genetics and pathogenesisJournal of Hepatology, 2007
- Biochemical Assays of Respiratory Chain Complex ActivityMethods in Cell Biology, 2007
- Long-term Outcome and Clinical Spectrum of 73 Pediatric Patients With Mitochondrial DiseasesPEDIATRICS, 2007
- Long-term Follow-up of Neonatal Mitochondrial Cytopathies: A Study of 57 PatientsPEDIATRICS, 2005
- Diagnostic criteria for respiratory chain disorders in adults and childrenNeurology, 2002