Brain Advance Access originally published online on February 2, 2005
Brain 2005 128(4):723-731; doi:10.1093/brain/awh410
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Infantile hepatocerebral syndromes associated with mutations in the mitochondrial DNA polymerase-
A
1 Unit of Molecular Neurogenetics, Pierfranco and Luisa Mariani Center for the Study of Children's Mitochondrial Disorders, National Institute of Neurology, Milano, 2 Unit of Child Neurology, ‘Meyer’ Children's Hospital (Florence), 3 Institute of Neurology, University of Verona, Verona, 4 Unit of Pediatrics, Pierfranco and Luisa Mariani Center for the Study of Children's Metabolic Disorders, University Hospital, Monza, Italy and 5 University Children's Hospital, Hamburg, Germany
Correspondence to: Massimo Zeviani, MD, PhD, Unit of Molecular Neurogenetics, National Neurological Institute ‘Carlo Besta’, via Temolo 4, 20126 Milan, Italy E-mail: zeviani{at}istituto-besta.it
We studied nine infant patients with a combination of progressive neurological and hepatic failure. Eight children, including two sibling pairs and four singletons, were affected by Alpers' hepatopathic poliodystrophy. A ninth baby patient suffered of a severe floppy infant syndrome associated with liver failure. Analysis of POLG1, the gene encoding the catalytic subunit of mitochondrial DNA polymerase, revealed that all the patients carried different allelic mutations in this gene. POLG1 is a major disease gene in mitochondrial disorders. Mutations in this gene can be associated with multiple deletions, depletion or point mutations of mitochondrial DNA (mtDNA). In turn, these different molecular phenotypes dictate an extremely heterogeneous spectrum of clinical outcomes, ranging from adult-onset progressive ophthalmoplegia to juvenile ataxic syndromes with epilepsy, to rapidly fatal hepatocerebral presentations, including Alpers' syndrome.
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