BS - Mitochondrial Disorders - Week 3 Flashcards

1
Q

Name 6 pieces of evidence of the endosymbiosis theory.

A
  • Mitochondria and bacteria have simiar size and shape
  • Mitochondria have 2 membranes, the outer is eukaryotic, the inner is prokaryotic (chemically)
  • Mitochondria have circular DNA as do some bacteria (plasmids)
  • Mitochondria contain prokaryotic ribosomes
  • Mitochondria divide by binary fission, like bacteria
  • Complex DNA repair mechanisms are missing from mitochondria
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2
Q

What is the energy efficiency of mitochondria?

A

70%

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3
Q

Which complexes are responsible for pumping H+?

A

Complexes I, III, and IV.

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4
Q

Where is the H+ gradient set up, and what is it used for?

A

Set up high in the intermembrane space, and used by ATPase to make ATP.

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5
Q

How many of mitochondrial proteins are encoded by mtDNA? What can be said of this regarding mutations?

A

Of over 1000 proteins, only 13 are encoded by mtDNA.

Therefore mutations to mtDNA are severe.

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6
Q

In what manner is mtDNA inherited?

A

Maternal inheritance

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7
Q

Compare the expression of mtDNA in females vs males.

A

Males - variable

Females - almost identical

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8
Q

In what 5 structures of the eye are mitochonria found in high density?

A
RGC
NFL
Plexiform layers
Photoreceptors
Optic nerve
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9
Q

Where in myelinated nerves are mitochondria typically found?

A

Limited to regions of the nodes of ranvier.

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10
Q

What 5 structures of the eye are typically affected by mitochondrial disease?

A
EOM
Levator muscle
Lens
Retina
Optic nerve
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11
Q

What are the two categories of mitochondrial disease? Describe what both mean.

A

Primary - direct impairment of mitochondrial functions by mutations in mtDNA or nDNA
Secondary - mitochondrial dysfunction resulting from either genetic or environmental factors

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12
Q

Name 6 examples of ocular complications as a result of mtDNA mutations.

A
Optic atrophy
Optic neuropathy
Ptosis
Ophthalmoplegia
Retinopathy
Pigmentary retinopathy
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13
Q

Name the most common hereditary optic neuropathy, its prevalence, and whether it affects males or females more. Briefly describe what it is.

A

Dominant optic atrophy
1:12,000
Degenerative disorder, affecting RGCs and the NFL
Equally affects males and females

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14
Q

Name 3 clinical signs for dominant optic atrophy.

A

Saucerisation of the optic disc > 0.5 ratio
Peripapillary atrophy
Sectoral pallor of the optic nerve

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15
Q

The majority of dominant optic atrophy causes are due to what?

A

Mutations to nDNA encoded GTPase gene

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16
Q

What 3 complexes are affected in dominant optic atrophy?

A

Complex I, II, and III.

17
Q

Describe Lebers hereditary optic neuropathy, including prognosis, number of eyes it affects, pain, and time taken to develop blindness.

A

Acute, bilateral, painless central vision loss over days to months.

18
Q

What is the prevalence of lebers hereditary optic neuropathy, and does it affects males or females more?

A

1:25,000

Males 5x more affected than females

19
Q

What are majority of Lebers hereditary optic neuropathy caused by?

A

3 mtDNA point mutations

20
Q

What is the initial development lebers hereditary optic neuropathy?

A

Thickening of the RNF with disc pseudoedema and RGC loss

21
Q

What are 4 factors affecting the severity of lebers hereditary optic neuropathy?

A

Nuclear genes
mtDNA genes
Environmental factors (smoking/alcohol)
Sex

22
Q

Name 3 clinical signs of lebers hereditary optic neuropathy.

A

Disc hyperaemia
Telangi-ectatic (corkscrew) vessels
Relative opacity of the NFL

23
Q

Name 2 means of further diagnostics for a suspected case of lebers hereditary optic neuropathy.

A

Family history of the disease

Gene testing

24
Q

What is the onset of chronic progressive external ophthalmoplegia.

A

Childhood or up to 30s

25
Q

Name 5 symptoms and signs of chronic progressive external ophthalmoplegia.

A
Ptosis
Strabismus
Disjunctive eye movements
Ophthalmoplegia
Pigmentary retinopathy
26
Q

How does pigmentary retinopathy appear?

A

Salt and pepper-like

27
Q

Differentiate the signs and symptoms of chronic progressive external ophthalmoplegia with Kearns-Sayre-Daroff syndrome (5).

A
CPEO and KSD-syndrome have the same symptoms, except KSD-syndrome also has an additional 5:
Heart block
Mental retardation
Hearing loss
Endocrine disorder
Cerebellar ataxia
28
Q

Differentiate the signs and symptoms of chronic progressive external ophthalmoplegia with mitochondrial encephalopmyopathy lactic acidosis stroke (6).

A

CPEO and MELAS have the same symptoms, except MELAS also has an additional 6:
Onset in childhood
Hemianopia
Hemiparesis
Headaches
Convulsions
Short stature due to stroke-like episodes

29
Q

Define hemianopia.

A

Blindness over half the field of vision.

30
Q

Define hemiparesis.

A

Weakness of one’s entire side of the body.

31
Q

Consider CPEO. How does it affect EOM mobility, and does it result in diplopia? Does it cause a decrease in VA? How does it affect the eyelids?

A

Causes impaired EOM mobility in association with ptosis.
Rarely causes diplopia.
VA is spared.

32
Q

What is a common cause of CPEO?

A

A single mtDNA deletion

33
Q

Which complex is affected in CPEO?

A

Complex IV

34
Q

What is progression of CPEO characterised by?

A

Progressive ophthalmoparesis:

Weakening of the EOM and ptosis of the eyelids

35
Q

In what percentage of patient swith CPEO is pigment degeneration present?

A

2.5%

36
Q

What happens to electrons in the electron transport chain, and how does this change with mitochondrial dysfunction?

A

Electrons leak from the chain, even under ideal conditions.

Dysfunction increases the leakage.

37
Q

What is a consequence of leaking electrons? Relate this to mtDNA mutations.

A

Interacts with O2 to form superoxide radicals. The proximity of the radicals to mtDNA means theyre particularly susceptible to mutations.