Mutations to MT-ATP8 and other genes affecting
oxidative phosphorylation in the mitochondria have been associated with a variety of
neurodegenerative and
cardiovascular disorders, including mitochondrial complex V deficiency,
Leber's hereditary optic neuropathy (LHON), mitochondrial encephalomyopathy with stroke-like episodes (
MELAS),
Leigh syndrome, and
NARP syndrome. Most of the body's cells contain thousands of mitochondria, each with one or more copies of
mitochondrial DNA. The severity of some
mitochondrial disorders is associated with the percentage of mitochondria in each cell that has a particular genetic change. People with
Leigh syndrome due to a MT-ATP6 gene mutation tend to have a very high percentage of mitochondria with the mutation (from more than 90 percent to 95 percent). The less-severe features of
NARP result from a lower percentage of mitochondria with the mutation, typically 70 percent to 90 percent. Because these two conditions result from the same genetic changes and can occur in different members of a single family, researchers believe that they may represent a spectrum of overlapping features instead of two distinct syndromes. Mitochondrial complex V deficiency is a shortage (deficiency) or loss of function in
complex V of the
electron transport chain that can cause a wide variety of
signs and symptoms affecting many organs and systems of the body, particularly the
nervous system and the
heart. The disorder can be life-threatening in infancy or early childhood. Affected individuals may have feeding problems, slow growth, low muscle tone (
hypotonia), extreme fatigue (
lethargy), and
developmental delay. They tend to develop elevated levels of
lactic acid in the blood (
lactic acidosis), which can cause nausea, vomiting, weakness, and rapid breathing. High levels of
ammonia in the blood (
hyperammonemia) can also occur in affected individuals, and in some cases result in abnormal brain function (
encephalopathy) and damage to other organs.
Ataxia,
microcephaly, developmental delay and intellectual disability have been observed in patients with a frameshift mutation in MT-ATP6. This causes a C insertion at position 8612 that results in a truncated protein only 36 amino acids long, and two T > C
single-nucleotide polymorphisms at positions 8610 and 8614 that result in a homopolymeric
cytosine stretch.
Hypertrophic cardiomyopathy, a common feature of mitochondrial complex V deficiency, is characterized by thickening (
hypertrophy) of the
cardiac muscle that can lead to
heart failure. Individuals with mitochondrial complex V deficiency may also have a characteristic pattern of facial features, including a high forehead, curved eyebrows, outside corners of the eyes that point downward (downslanting
palpebral fissures), a prominent bridge of the nose, low-set ears, thin lips, and a small chin (
micrognathia). Infantile hypertrophic cardiomyopathy (CMHI) is also caused by mutations affecting distinct
genetic loci, including
MT-ATP6 and MT-ATP8. An infantile form of
hypertrophic cardiomyopathy, a heart disorder characterized by
ventricular hypertrophy, which is usually asymmetric and often involves the
interventricular septum. The symptoms include
dyspnea,
syncope, collapse,
palpitations, and
chest pain. They can be readily provoked by exercise. The disorder has inter- and intrafamilial variability ranging from benign to malignant forms with high risk of
cardiac failure and
sudden cardiac death. == References ==