Article Text

Download PDFPDF
Original article
Reversible infantile respiratory chain deficiency is a unique, genetically heterogenous mitochondrial disease
  1. J Uusimaa1,
  2. H Jungbluth2,3,
  3. C Fratter4,
  4. G Crisponi5,
  5. L Feng6,
  6. M Zeviani7,
  7. I Hughes8,
  8. E P Treacy9,
  9. J Birks10,
  10. G K Brown11,
  11. C A Sewry6,
  12. M McDermott12,
  13. F Muntoni6,
  14. J Poulton1
  1. 1Nuffield Department of Obstetrics and Gynaecology, University of Oxford, The Women's Centre, John Radcliffe Hospital, Oxford, UK
  2. 2Department of Clinical Neuroscience, King's College Hospital, London, UK
  3. 3Department of Paediatric Neurology – Neuromuscular Service, Evelina Children's Hospital, St Thomas' Hospital, London, UK
  4. 4Oxford Medical Genetics Lab, Churchill Hospital, Oxford, UK
  5. 5Servizio di Puericultura, Universita' di Cagliari, Cagliari, Italy
  6. 6Dubowitz Neuromuscular Centre, UCL Institute of Child Health, London, UK
  7. 7Unit of Molecular Neurogenetics, “C. Besta” Neurological Institute - IRCCS Foundation, Milan, Italy
  8. 8Department of Paediatric Neurology, Manchester Children's Hospital, Manchester, UK
  9. 9National Centre for Inherited Metabolic Disease, Children's University Hospital, Dublin, Republic of Ireland
  10. 10Centre for Statistics in Medicine, University of Oxford, Oxford, UK
  11. 11Department of Biochemistry, University of Oxford, Oxford, UK
  12. 12Our Lady's Hospital for Sick Children, Dublin, Ireland
  1. Correspondence to Professor Jo Poulton, Nuffield Department of Obstetrics and Gynaecology, The Women's Centre, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; joanna.poulton{at}


Objectives Homoplasmic maternally inherited, m.14674T>C or m. 14674T>G mt-tRNAGlu mutations have recently been identified in reversible infantile cytochrome c oxidase deficiency (or ‘benign COX deficiency’). This study sought other genetic defects that may give rise to similar presentations.

Patients Eight patients from seven families with clinicopathological features of infantile reversible cytochrome c oxidase deficiency were investigated.

Methods The study reviewed the diagnostic features and performed molecular genetic analyses of mitochondrial DNA and nuclear encoded candidate genes.

Results Patients presented with subacute onset of profound hypotonia, feeding difficulties and lactic acidosis within the first months of life. Although recovery was remarkable, a mild myopathy persisted into adulthood. Histopathological findings in muscle included increased lipid and/or glycogen content, ragged-red and COX negative fibres. Biochemical studies suggested more generalised abnormalities than pure COX deficiency. Clinical improvement was reflected by normalisation of lactic acidosis and histopathological abnormalities. The m.14674T>C mt-tRNAGlu mutation was identified in four families, but none had the m. 14674T>G mutation. Furthermore, in two families pathogenic mutations were also found in the nuclear TRMU gene which has not previously been associated with this phenotype. In one family, the genetic aetiology still remains unknown.

Conclusions Benign COX deficiency is better described as ‘reversible infantile respiratory chain deficiency’. It is genetically heterogeneous, and patients not carrying the m.14674T>C or T>G mt-tRNAGlu mutations may have mutations in the TRMU gene. Diagnosing this disorder at the molecular level is a significant advance for paediatric neurologists and intensive care paediatricians, enabling them to select children with an excellent prognosis for continuing respiratory support from those with severe mitochondrial presentation in infancy.

  • Neuromuscular diseases
  • Mitochondrial myopathies
  • respiratory chain
  • Diagnosis
  • Metabolic disorders
  • Liver disease
  • Neurology
  • Neuromuscular disease

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • JU and HJ contributed equally to this work.

  • Funding Wellcome Trust; Arvo and Lea Ylppo Foundation, Foundation for Paediatric Research (Finland), the Sigrid Juselius Foundation, the MRC (UK) and the Angus Memorial Mitochondrial Fund.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the W Berkshire REC.

  • Provenance and peer review Not commissioned; externally peer reviewed.