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Condition report · Metabolic

Mitochondrial Disease

A group of inherited disorders that impair the mitochondria, the energy-producing structures in cells, caused by variants in nuclear genes such as POLG or in mitochondrial DNA. Leigh syndrome and hereditary optic neuropathies are covered in their own reports.

A condition report looks for rare variants known to cause the conditions it covers.

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The 9 conditions we analyse

Mitochondrial Respiratory Chain Complex Deficiency

Isolated deficiencies of complex I, II, III, IV or V, caused by variants in nuclear or mitochondrial genes, which can affect the brain, muscles, heart, liver and other energy-demanding organs.

What a diagnosis changes

Knowing can end a diagnostic search and guide surveillance of affected organs and avoidance of drugs toxic to mitochondria.

Genes analysed

Also known as

isolated oxidative phosphorylation complex disorder; mitochondrial complex deficiency

Includes 93 related subtypes ↓
  • acyl-CoA dehydrogenase 9 deficiency
  • cardioencephalomyopathy, fatal infantile, due to cytochrome c oxidase deficiency 1
  • cardioencephalomyopathy, fatal infantile, due to cytochrome c oxidase deficiency 2
  • cardioencephalomyopathy, fatal infantile, due to cytochrome c oxidase deficiency 3
  • cardioencephalomyopathy, fatal infantile, due to cytochrome c oxidase deficiency 4
  • congenital lactic acidosis, Saguenay-Lac-Saint-Jean type
  • COX deficiency, benign infantile mitochondrial myopathy
  • Leber hereditary optic neuropathy, autosomal recessive
  • Leber-like hereditary optic neuropathy, autosomal recessive 1
  • Leber-like hereditary optic neuropathy, autosomal recessive 2
  • mitochondrial complex 1 deficiency, nuclear type 35
  • mitochondrial complex 4 deficiency, nuclear type 25
  • mitochondrial complex I deficiency
  • mitochondrial complex I deficiency, mitochondrial type
  • mitochondrial complex I deficiency, mitochondrial type 1
  • mitochondrial complex I deficiency, nuclear type
  • mitochondrial complex I deficiency, nuclear type 1
  • mitochondrial complex I deficiency, nuclear type 10
  • mitochondrial complex I deficiency, nuclear type 11
  • mitochondrial complex I deficiency, nuclear type 12
  • mitochondrial complex I deficiency, nuclear type 13
  • mitochondrial complex I deficiency, nuclear type 14
  • mitochondrial complex I deficiency, nuclear type 15
  • mitochondrial complex I deficiency, nuclear type 16
  • mitochondrial complex I deficiency, nuclear type 17
  • mitochondrial complex I deficiency, nuclear type 18
  • mitochondrial complex I deficiency, nuclear type 19
  • mitochondrial complex I deficiency, nuclear type 2
  • mitochondrial complex I deficiency, nuclear type 21
  • mitochondrial complex I deficiency, nuclear type 22
  • mitochondrial complex I deficiency, nuclear type 23
  • mitochondrial complex I deficiency, nuclear type 24
  • mitochondrial complex I deficiency, nuclear type 25
  • mitochondrial complex I deficiency, nuclear type 26
  • mitochondrial complex I deficiency, nuclear type 27
  • mitochondrial complex I deficiency, nuclear type 28
  • mitochondrial complex I deficiency, nuclear type 29
  • mitochondrial complex I deficiency, nuclear type 3
  • mitochondrial complex I deficiency, nuclear type 30
  • mitochondrial complex I deficiency, nuclear type 31
  • mitochondrial complex I deficiency, nuclear type 32
  • mitochondrial complex I deficiency, nuclear type 33
  • mitochondrial complex I deficiency, nuclear type 34
  • mitochondrial complex I deficiency, nuclear type 36
  • mitochondrial complex I deficiency, nuclear type 37
  • mitochondrial complex I deficiency, nuclear type 39
  • mitochondrial complex I deficiency, nuclear type 4
  • mitochondrial complex I deficiency, nuclear type 5
  • mitochondrial complex I deficiency, nuclear type 6
  • mitochondrial complex I deficiency, nuclear type 7
  • mitochondrial complex I deficiency, nuclear type 8
  • mitochondrial complex I deficiency, nuclear type 9
  • mitochondrial complex III deficiency
  • mitochondrial complex III deficiency nuclear type 1
  • mitochondrial complex III deficiency nuclear type 2
  • mitochondrial complex III deficiency nuclear type 3
  • mitochondrial complex III deficiency nuclear type 4
  • mitochondrial complex III deficiency nuclear type 5
  • mitochondrial complex III deficiency nuclear type 6
  • mitochondrial complex III deficiency nuclear type 7
  • mitochondrial complex III deficiency nuclear type 8
  • mitochondrial complex III deficiency nuclear type 9
  • mitochondrial complex III deficiency, nuclear type
  • mitochondrial complex III deficiency, nuclear type 10
  • mitochondrial complex III deficiency, nuclear type 11
  • mitochondrial complex IV deficiency, nuclear type 1
  • mitochondrial complex IV deficiency, nuclear type 10
  • mitochondrial complex IV deficiency, nuclear type 11
  • mitochondrial complex IV deficiency, nuclear type 12
  • mitochondrial complex IV deficiency, nuclear type 14
  • mitochondrial complex IV deficiency, nuclear type 15
  • mitochondrial complex IV deficiency, nuclear type 16
  • mitochondrial complex IV deficiency, nuclear type 17
  • mitochondrial complex IV deficiency, nuclear type 18
  • mitochondrial complex IV deficiency, nuclear type 19
  • mitochondrial complex IV deficiency, nuclear type 20
  • mitochondrial complex IV deficiency, nuclear type 21
  • mitochondrial complex IV deficiency, nuclear type 22
  • mitochondrial complex IV deficiency, nuclear type 23
  • mitochondrial complex IV deficiency, nuclear type 24
  • mitochondrial complex IV deficiency, nuclear type 3
  • mitochondrial complex IV deficiency, nuclear type 4
  • mitochondrial complex IV deficiency, nuclear type 7
  • mitochondrial complex IV deficiency, nuclear type 8
  • mitochondrial complex IV deficiency, nuclear-type
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 1
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 2
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 3
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 4B
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 5
  • pancreatic insufficiency-anemia-hyperostosis syndrome
  • renal tubulopathy-encephalopathy-liver failure syndrome
  • SDHC-related Mitochondrial Disease
MONDO:0000066Orphanet 254846MedGen 1843270

Combined Oxidative Phosphorylation Deficiency

Disorders, usually caused by nuclear genes involved in mitochondrial protein production, that reduce several respiratory chain complexes at once and often cause severe multisystem disease in childhood.

What a diagnosis changes

Knowing can end a diagnostic search and guide surveillance and supportive care.

Genes analysed

Includes 70 related subtypes ↓
  • combined oxidative phosphorylation defect type 11
  • combined oxidative phosphorylation defect type 13
  • combined oxidative phosphorylation defect type 14
  • combined oxidative phosphorylation defect type 15
  • combined oxidative phosphorylation defect type 17
  • combined oxidative phosphorylation defect type 2
  • combined oxidative phosphorylation defect type 20
  • combined oxidative phosphorylation defect type 21
  • combined oxidative phosphorylation defect type 23
  • combined oxidative phosphorylation defect type 24
  • combined oxidative phosphorylation defect type 25
  • combined oxidative phosphorylation defect type 26
  • combined oxidative phosphorylation defect type 27
  • combined oxidative phosphorylation defect type 30
  • combined oxidative phosphorylation defect type 4
  • combined oxidative phosphorylation defect type 7
  • combined oxidative phosphorylation defect type 8
  • combined oxidative phosphorylation defect type 9
  • combined oxidative phosphorylation deficiency 19
  • combined oxidative phosphorylation deficiency 22
  • combined oxidative phosphorylation deficiency 28
  • combined oxidative phosphorylation deficiency 29
  • combined oxidative phosphorylation deficiency 32
  • combined oxidative phosphorylation deficiency 33
  • combined oxidative phosphorylation deficiency 34
  • combined oxidative phosphorylation deficiency 35
  • combined oxidative phosphorylation deficiency 36
  • combined oxidative phosphorylation deficiency 37
  • combined oxidative phosphorylation deficiency 38
  • combined oxidative phosphorylation deficiency 39
  • combined oxidative phosphorylation deficiency 40
  • combined oxidative phosphorylation deficiency 41
  • combined oxidative phosphorylation deficiency 42
  • combined oxidative phosphorylation deficiency 43
  • combined oxidative phosphorylation deficiency 44
  • combined oxidative phosphorylation deficiency 45
  • combined oxidative phosphorylation deficiency 46
  • combined oxidative phosphorylation deficiency 47
  • combined oxidative phosphorylation deficiency 48
  • combined oxidative phosphorylation deficiency 49
  • combined oxidative phosphorylation deficiency 50
  • combined oxidative phosphorylation deficiency 51
  • combined oxidative phosphorylation deficiency 52
  • combined oxidative phosphorylation deficiency 53
  • combined oxidative phosphorylation deficiency 54
  • combined oxidative phosphorylation deficiency 55
  • combined oxidative phosphorylation deficiency 56
  • combined oxidative phosphorylation deficiency 57
  • combined oxidative phosphorylation deficiency 58
  • combined oxidative phosphorylation deficiency 59
  • combined oxidative phosphorylation deficiency 60
  • fatal mitochondrial disease due to combined oxidative phosphorylation defect type 3
  • growth and developmental delay-hypotonia-vision impairment-lactic acidosis syndrome
  • hepatoencephalopathy due to combined oxidative phosphorylation defect type 1
  • hypotonia with lactic acidemia and hyperammonemia
  • infantile hypertrophic cardiomyopathy due to MRPL44 deficiency
  • lethal left ventricular non-compaction-seizures-hypotonia-cataract-developmental delay syndrome
  • leukoencephalopathy-thalamus and brainstem anomalies-high lactate syndrome
  • mitochondrial complex 5 (ATP synthase) deficiency, mitochondrial type 1
  • mitochondrial complex 5 (ATP synthase) deficiency, nuclear type 6
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 1
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 2
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 3
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 4A
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 4B
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 5
  • mitochondrial complex V (ATP synthase) deficiency, nuclear type 7
  • mitochondrial hypertrophic cardiomyopathy with lactic acidosis due to MTO1 deficiency
  • mitochondrial proton-transporting ATP synthase complex deficiency
  • severe X-linked mitochondrial encephalomyopathy
MONDO:0000732MedGen 1626645

Mitochondrial DNA Depletion Syndrome

Caused by variants in nuclear genes such as POLG, TWNK, TK2, DGUOK, MPV17, RRM2B and SUCLA2, which reduce the amount of mitochondrial DNA and can cause muscle, liver or brain disease.

What a diagnosis changes

Knowing is directly actionable: valproate must be avoided in POLG disease because of the risk of fatal liver failure, and TK2 deficiency has a nucleoside therapy.

Genes analysed

Also known as

mtDNA depletion syndrome

Includes 32 related subtypes ↓
  • AFG3L2-related optic atrophy and/or spastic ataxia spectrum
  • mitochondrial DNA deletion syndrome with progressive myopathy
  • mitochondrial DNA depletion syndrome 1
  • mitochondrial DNA depletion syndrome 11
  • mitochondrial DNA depletion syndrome 12A (cardiomyopathic type), autosomal dominant
  • mitochondrial DNA depletion syndrome 12B (cardiomyopathic type), autosomal recessive
  • mitochondrial DNA depletion syndrome 13
  • mitochondrial dna depletion syndrome 14A (encephalomyopathic type)
  • mitochondrial DNA depletion syndrome 14B (cardioencephalomyopathic type)
  • mitochondrial DNA depletion syndrome 15 (hepatocerebral type)
  • mitochondrial DNA depletion syndrome 16 (hepatic type)
  • mitochondrial dna depletion syndrome 16B (neuroophthalmic type)
  • mitochondrial DNA depletion syndrome 17
  • mitochondrial DNA depletion syndrome 18
  • mitochondrial DNA depletion syndrome 19
  • mitochondrial DNA depletion syndrome 20 (mngie type)
  • mitochondrial dna depletion syndrome 21
  • mitochondrial DNA depletion syndrome 3 (hepatocerebral type)
  • mitochondrial DNA depletion syndrome 4a
  • mitochondrial DNA depletion syndrome 4b
  • mitochondrial DNA depletion syndrome 6 (hepatocerebral type)
  • mitochondrial DNA depletion syndrome 7 (hepatocerebral type)
  • mitochondrial DNA depletion syndrome 8a
  • mitochondrial DNA depletion syndrome 9
  • mitochondrial DNA depletion syndrome, encephalomyopathic form
  • mitochondrial DNA depletion syndrome, encephalomyopathic form with methylmalonic aciduria
  • mitochondrial DNA depletion syndrome, hepatocerebral form
  • mitochondrial DNA depletion syndrome, hepatocerebrorenal form
  • mitochondrial DNA depletion syndrome, myopathic form
  • optic atrophy 12
  • Sengers syndrome
  • spastic ataxia 5
MONDO:0018158Orphanet 35698MedGen 452449

Progressive External Ophthalmoplegia with Mitochondrial DNA Deletions

Caused by variants in nuclear genes such as POLG, TWNK, SLC25A4 and RRM2B that lead to multiple mitochondrial DNA deletions, causing drooping eyelids, weak eye movements and muscle weakness, usually in adulthood.

What a diagnosis changes

Knowing guides monitoring of eye, heart and swallowing function and avoidance of valproate in POLG disease.

Genes analysed

Also known as

progressive external ophthalmoplegia with mtDNA deletions

Includes 13 related subtypes ↓
  • autosomal dominant progressive external ophthalmoplegia
  • mitochondrial DNA deletion syndrome with progressive myopathy
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal dominant 1
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal dominant 2
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal dominant 3
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal dominant 4
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal dominant 5
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal recessive 1
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal recessive 2
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal recessive 3
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal recessive 4
  • progressive external ophthalmoplegia with mitochondrial DNA deletions, autosomal recessive 5
  • progressive external ophthalmoplegia with mitochondrial dna deletions, autosomal recessive 6
MONDO:0000090

Ataxia Neuropathy Spectrum

A POLG- or TWNK-related disorder causing problems with balance and coordination, sensory nerve damage, eye movement problems and sometimes seizures.

What a diagnosis changes

Knowing guides seizure management, including avoiding valproate.

Genes analysed

Includes 3 related subtypes ↓
  • recessive mitochondrial ataxia syndrome
  • sensory ataxic neuropathy, dysarthria, and ophthalmoparesis
  • spinocerebellar ataxia with epilepsy
MONDO:0016798Orphanet 254818MedGen 777176

Kearns-Sayre Syndrome

Usually caused by a single large deletion of mitochondrial DNA, which causes eye movement weakness, retinal changes and heart conduction problems, typically before age 20.

What a diagnosis changes

Knowing allows heart rhythm monitoring and timely pacemaker treatment, which can prevent sudden death.

Also known as

CPEO with ragged red fibers; CPEO with ragged red fibres; KSS; ophthalmoplegia plus syndrome; ophthalmoplegia, progressive external, with ragged red fibers; ophthalmoplegia, progressive external, with ragged red fibres

MONDO:0010787OMIM 530000Orphanet 480MedGen 9618

MELAS Syndrome

Mitochondrial

Usually caused by variants in mitochondrial DNA such as m.3243A>G, which can cause stroke-like episodes, seizures, muscle weakness, hearing loss and diabetes.

What a diagnosis changes

Knowing guides screening for diabetes, hearing and heart problems and specialist management of stroke-like episodes.

Also known as

MELAS; mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes; mitochondrial encephalomyopathy, lactic acidosis and stroke; mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes

Includes 10 related subtypes ↓
  • MELAS syndrome caused by mutation in MTND1
  • MELAS syndrome caused by mutation in MTND5
  • MELAS syndrome caused by mutation in MTND6
  • MELAS syndrome caused by mutation in MTTC
  • MELAS syndrome caused by mutation in MTTH
  • MELAS syndrome caused by mutation in MTTK
  • MELAS syndrome caused by mutation in MTTL1
  • MELAS syndrome caused by mutation in MTTQ
  • MELAS syndrome caused by mutation in MTTS1
  • MELAS syndrome caused by mutation in MTTS2
MONDO:0010789OMIM 540000Orphanet 550MedGen 56485

MERRF Syndrome

Mitochondrial

Usually caused by variants in mitochondrial DNA such as m.8344A>G, which can cause muscle jerks (myoclonus), seizures, balance problems and muscle weakness.

What a diagnosis changes

Knowing guides seizure treatment choices and monitoring of heart and hearing.

Genes analysed

Also known as

Fukuhara syndrome; MERRF; myoclonic epilepsy - ragged red fibres; myoclonic epilepsy associated with ragged red fibers; myoclonic epilepsy associated with ragged red fibres; myoclonic epilepsy with ragged red fibers; myoclonic epilepsy with ragged red fibres; myoclonus epilepsy and ragged red fibres; myoclonus epilepsy associated with ragged-red fibers; myoclonus epilepsy associated with ragged-red fibres; myoclonus with epilepsy and with ragged Red fibers (MERRF syndrome); myoclonus with epilepsy and with ragged Red fibres; myoclonus with epilepsy and with ragged Red fibres (MERRF syndrome); myoencephalopathy ragged-red fiber disease; myoencephalopathy ragged-red fibre disease

MONDO:0010790OMIM 545000Orphanet 551MedGen 56486

Coenzyme Q10 Deficiency

Autosomal recessive

Caused by variants in genes needed to make coenzyme Q10, such as COQ2, COQ8A and PDSS2, which can cause kidney disease, balance problems, muscle weakness or brain disease.

What a diagnosis changes

Knowing is actionable: primary coenzyme Q10 deficiency can respond to high-dose coenzyme Q10 supplements, especially when started early.

Genes analysed

Also known as

coenzyme Q10 deficiency disease; coenzyme Q10 deficiency, primary; CoQ10 deficiency; CoQ10 deficiency, primary

Includes 10 related subtypes ↓
  • autosomal recessive ataxia due to ubiquinone deficiency
  • coenzyme Q10 deficiency, primary, 1
  • coenzyme Q10 deficiency, primary, 3
  • coenzyme q10 deficiency, primary, 9
  • deafness-encephaloneuropathy-obesity-valvulopathy syndrome
  • encephalopathy-hypertrophic cardiomyopathy-renal tubular disease syndrome
  • familial steroid-resistant nephrotic syndrome with sensorineural deafness
  • neonatal encephalomyopathy-cardiomyopathy-respiratory distress syndrome
  • neuronopathy, distal hereditary motor, autosomal recessive 9
  • primary coenzyme Q10 deficiency 8
MONDO:0018151Orphanet 35656MedGen 334528

Limitations

  • Mitochondrial DNA variants are often present in only a fraction of cells (heteroplasmy), and low levels in blood may be missed even when other tissues such as muscle are affected. Nuclear copies of mitochondrial DNA (NUMTs) can cause false signals, and large mitochondrial DNA deletions require specialised analysis and may not be detected.

Other metabolic conditions

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