MITOCHONDRIAL NEUROGASTROINTESTINAL ENCEPHALOPATHY: CLINICAL, BIOCHEMICAL AND MOLECULAR STUDY IN THREE EGYPTIAN PATIENTS

Mitochondrial neurogastrointestinal encephalopathy: clinical, biochemical and molecular study in three Egyptian patients:Background: Mitochondrial Neurogastrointestinal Encephalopathy syndrome is a rare autosomal recessive disorder. The disease is caused by mutations in the thymidine phosphorylase gene. This article reports the clinical, biochemical and molecular findings in three Egyptian patients with Mitochondrial Neurogastrointestinal Encephalopathy syndrome from two different pedigrees.Subjects and Methods: The three patients were subjected to thorough neurologic examination, Brain Magnetic Resonance Imaging. Histochemical and biochemical assay of the mitochondrial respiratory chain complexes in muscle homogenate was performed (1/3). Thymidine Phosphorylase enzyme activity was performed in 2/3 patients and Thymidine Phosphorylase gene sequencing was done (2/3) to confirm the diagnosis.Results: All patients presented with symptoms of severe gastrointestinal dysmotility with progressive cachexia, neuropathy, sensory neural hearing loss, asymptomatic leukoencephalopathy. Histochemical analysis of the muscle biopsy revealed deficient Cytochrome C oxidase and mitochondrial respiratory chain enzyme assay revealed isolated complex I deficiency (1/3). Thymidine Phosphorylase enzyme activity revealed complete absence of enzyme activity in 2/3 patients. Direct sequencing of Thymidine Phosphorylase gene revealed c.3371A>C homozygous mutation. Molecular screening of both families revealed heterozygous mutation in both parents and 4 siblings.Conclusions: Mitochondrial Neurogastrointestinal Encephalopathy syndrome is a rare mitochondrial disorder with an important diagnostic delay. In case of pathogenic mutations in Thymidine Phosphorylase gene in the family, carrier testing and prenatal diagnosis of at risk members is recommended for early detection. The possibility of new therapeutic options makes it necessary to diagnose the disease in an early state.