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Mitochondrial neurogastrointestinal encephalomyopathy in three siblings

Clinical, genetic and neuroradiological features

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Abstract

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive disorder in which a nuclear mutation of the thymidine phosphorylase (TP) gene causes mitochondrial genomic dysfunction. Patients suffer from gastrointestinal dysmotility, cachexia, ptosis, external ophthalmoparesis, myopathy and polyneuropathy. Magnetic resonance imaging (MRI) shows leukoencephalopathy. We describe clinical, genetic and neuroradiological features of three brothers affected with MNGIE. Clinical examination, laboratory analyses, MRI and magnetic resonance spectroscopy (MRS) of the brain, and genetic analysis have been performed in all six members of the family with the three patients with MNGIE. Two of them are monozygous twins. They all suffered from gastrointestinal dysmotility, cachexia, ophthalmoplegia, muscular atrophies, and polyneuropathy. Urinary thymidine was elevated in the patients related to the severity of clinical disease, and urinary thymidine (normally not detectable) was also found in a heterozygous carrier. Brain MRI showed leukoencephalopathy in all patients; however, their cognitive functioning was normal. Brain MRS demonstrated reduced N-acetylaspartate and choline in severely affected areas. MRI of heterozygous carriers was normal. A new mutation (T92N) in the TP gene was identified. Urinary thymidine is for the first time reported to be detectable in a heterozygous carrier. MRS findings indicate loss of neurons, axons, and glial cells in patients with MNGIE, but not in heterozygous carriers.

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Acknowledgements

We thank Dr. M. Hirano, Columbia University, New York, for the assessment of the leucocyte TP activity in the index patient. We also thank Dr. P. Voore, Toronto, Canada, for critical reading of this manuscript, Dr. JM Nuoffer, University Hospital Berne, Switzerland, for clinical advice, and J. Slotboom, PhD, for the development and implementation of the MRS-quantification technique and his assistance in acquiring the MR spectra for this study. This work was supported by grant No 81BE-67704 of the Swiss National Science Foundation and the Swiss Parkinson’s Disease Association.

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Authors and Affiliations

  1. Dept. of Neurology, University Hospital – Inselspital, 3010, Bern, Switzerland

    W.M.M. Schüpbach MD, L. Kappeler MD, J.M. Burgunder MD &  H.P. Mattle

  2. National Neuroscience Institute, Singapore, Singapore

    K. Madhavi Vadday MSc & J.M. Burgunder MD

  3. Division of Human Genetics, Dept. of Paediatrics, University Children’s Hospital, University Hospital, Bern, Switzerland

    A. Schaller PhD & S. Gallati MD

  4. Dept. of Neuroradiology, University Hospital, Bern, Switzerland

    C. Brekenfeld MD

  5. Dept. of Gastroenterology, University Hospital, Bern, Switzerland

    F. Seibold MD

  6. Service de Biochimie-Hormonologie, Hôpital Robert Debré, Paris, France

    J.F. Benoist MD & C. Nguyen-Thi Xuan-Huong MD

  7. Centre d’Investigation Clinique, Fédération de Neurologie, National Institute of Health, Medical Research (INSERM), Unit 679, Hôpital de la Salpêtrière, Paris, France

    W.M.M. Schüpbach MD

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  1. W.M.M. Schüpbach MD
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Correspondence to H.P. Mattle.

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Received in revised form: 26 March 2006

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Schüpbach, W., Vadday, K.M., Schaller, A. et al. Mitochondrial neurogastrointestinal encephalomyopathy in three siblings. J Neurol 254, 146–153 (2007). https://doi.org/10.1007/s00415-006-0255-3

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  • DOI: https://doi.org/10.1007/s00415-006-0255-3

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