Leber's hereditary optic neuropathy: clinical and molecular genetic results in a patient with a point mutation at np T11253C (isoleucine to threonine) in the ND4 gene and spontaneous recovery.

Background: Mitochondrial DNA mutations at nucleotide position (np) 3460 in the ND1 gene, np 11778 in the ND4 gene, and np 14484 in the ND6 gene are commonly considered to be associated with the clinical features of LHON and account for the majority of LHON cases. Here we report the clinical and molecular genetic findings of a LHON patient with a new mitochondrial DNA mutation at np 11253 in the ND4 gene and spontaneous recovery.

Methods: The clinical examination consisted of visual acuity measurements, visual field testing, and ophthalmoscopy over a period of 14 years. Total lymphocyte DNA was analyzed for all common LHON mutations. Because the LHON patient did not harbor any of the common or recently described rare LHON mutations, we performed a sequence analysis of the whole mitochondrial genome.

Results: The patient exhibited typical clinical features of LHON. Molecular genetic analysis did not reveal any of the common LHON mutations. Sequence analysis of the mtDNA of the patient and his unaffected sister and niece was performed and showed a T to C missense mutation at np 11253 in the ND4 gene, leading to a replacement of an evolutionary highly conserved isoleucine by a threonine residue. This mutation introduces a polar group into a hydrophobic domain of the protein and induces a significant change in hydrophobicity of the peptide sequence. The mutation was not found among 100 controls.

Conclusion: The fact that the new mutation at np 11253 is found within a highly conserved region and was not present in any controls implies that this mutation is responsible for LHON in this patient. Interestingly, this point mutation has formerly been reported in the mitochondria of the substantia nigra in an unrelated patient with proven Parkinson's disease.