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The unfolding clinical spectrum of POLG mutations
  1. M J Blok (rien.blok{at}gen.unimaas.nl)
  1. Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
    1. B J Van den Bosch (bianca.vandenbosch{at}gen.unimaas.nl)
    1. Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
      1. E Jongen (eveline.jongen{at}gen.unimaas.nl)
      1. Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
        1. A Hendrickx (alexandra.hendrickx{at}gen.unimaas.nl)
        1. Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
          1. C E de Die-Smulders (christine.dedie{at}gen.unimaas.nl)
          1. Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
            1. J E Hoogendijk (j.hoogendijk{at}umcutrecht.nl)
            1. Department of Neurology, University Medical Center Utrecht, Rudolf Magnus Institute of Neuroscience, Netherlands
              1. E Brusse (e.brusse.1{at}erasmusmc.nl)
              1. Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
                1. M de Visser (m.devisser{at}amc.uva.nl)
                1. Department of Neurology, Academic Medical Centre, University of Amsterdam, Netherlands
                  1. B T Poll-The (b.t.pollthe{at}amc.uva.nl)
                  1. Department of Pediatrics, Emma's Children Hospital, University of Amsterdam, Amsterdam, Netherlands
                    1. J Bierau (jorgen.bierau{at}gen.unimaas.nl)
                    1. Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
                      1. I F de Coo (i.decoo{at}erasmusmc.nl)
                      1. Department of Neurology, Erasmus MC University Medical Center, Rotterdam, Netherlands
                        1. H J Smeets (bert.smeets{at}gen.unimaas.nl)
                        1. Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, Netherlands

                          Abstract

                          Background: Mutations in the DNA polymerase-gamma (POLG) gene are a major cause of clinically heterogeneous mitochondrial diseases, associated with mtDNA depletion and multiple deletions.

                          Objective: To determine the spectrum of POLG mutations in our Dutch patient cohort, to evaluate the pathogenicity of novel mutations and to establish genotype-phenotype correlations.

                          Results: We identified 64 predominantly recessive mutations in 37 patients from a total of 232 patients, consisting of 23 different mutations. The substitution p.A467T was most frequently observed (n=23), but was as frequent in childhood cases as in adult cases. Five new pathogenic recessive mutations, p.Lys925ArgfsX42, p.R275X, p.G426S, p.A804T and p.R869Q were identified. The known dominant CPEO mutation p.R943H was for the first time associated with premature ovarian failure as well. In 19 patients we identified only a single recessive mutation, or a sequence variant with unclear clinical significance. Our data substantiate earlier observations that in POLG patients a fatal status epilepticus and liver failure can be triggered by sodium valproate. It is therefore important to exclude POLG mutations before administering this treatment.

                          Conclusion: We conclude that the clinical features of the patient are the most important features to select putative POLG-mutation carriers and not the presence of mtDNA deletions or OXPHOS activity. We conclude that POLG mutations are an important cause of heterogeneous mitochondrial pathology and that more accurate genotype-phenotype correlations allow a more rapid genetic diagnosis and improved prognosis for mutation carriers.

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