Going Beyond the Diagnosis in Rare Childhood Disorders: Development of Personalized Treatment Methods for Mitochondrial Disease in Patients with a Nonsynonymous MTFMT Mutation

abstract: A single splice site mutation in the mitochondrial methionyl-tRNA formyltransferase (MTFMT) gene is described in three patients with mitochondrial disease from two unrelated families. Nuclear-encoded MTFMT localized to the mitochondria is responsible for the formylation of Met-tRNAMet necessary for the initiation of translation in the mitochondria. This mutation has been associated with mitochondrial disease (oxidative phosphorylation deficiencies due to a decreased expression of MTFMT), Leigh syndrome, and developmental delay. However, there is significant phenotypic variation between patients, which is not uncommon in mitochondrial disease. Though the variation was not clearly elucidated through analysis of gene expression, this data supported two potential gene modifiers as well as proposed an alternative energy producing pathway in the cell—glutamine metabolism. This nonsynonymous mutation at site c.626C>T generates a splicing suppressor in the coding region on exon 4 resulting exon skipping in almost all transcripts in homozygotes during splicing. It is hypothesized that antisense oligotherapy will be effective in rescuing this mutation by inhibiting the splice silencer and promoting exon inclusion as well as an increased expression of MTFMT protein in affected patients. Patient fibroblast cells were treated with MTFMT Oligo 3, which was shown to be promising in previous experiments. Real-Time qPCR was used to measure mRNA expression showing a significant up-regulation of wild-type MTFMT with treatment. In order to test whether this therapy increases mitochondrial function as well, three mitochondrial functional assays measuring superoxide species in the mitochondria, the mitochondrial membrane potential, and calcium uptake in the mitochondria were tested for optimization of results. Success has been shown in the measurement of superoxide species and mitochondrial membrane potential in patient cells without treatment. Oligotherapy will hopefully be considered as a viable therapeutic option in the future as further testing is conducted and perfected