ELAC2 Mutations Cause a Mitochondrial RNA Processing Defect Associated with Hypertrophic Cardiomyopathy  Tobias B. Haack, Robert Kopajtich, Peter Freisinger,

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ELAC2 Mutations Cause a Mitochondrial RNA Processing Defect Associated with Hypertrophic Cardiomyopathy  Tobias B. Haack, Robert Kopajtich, Peter Freisinger, Thomas Wieland, Joanna Rorbach, Thomas J. Nicholls, Enrico Baruffini, Anett Walther, Katharina Danhauser, Franz A. Zimmermann, Ralf A. Husain, Jessica Schum, Helen Mundy, Ileana Ferrero, Tim M. Strom, Thomas Meitinger, Robert W. Taylor, Michal Minczuk, Johannes A. Mayr, Holger Prokisch  The American Journal of Human Genetics  Volume 93, Issue 2, Pages 211-223 (August 2013) DOI: 10.1016/j.ajhg.2013.06.006 Copyright © 2013 The Authors Terms and Conditions

Figure 1 ELAC2 Mutation Status and Gene Structure (A) Pedigrees of three families with mutations in ELAC2. Individual #57415 (F1: II-3) from unrelated parents was found to have a compound heterozygous mutation. Individuals #61982 (F2: II-5) and #65937 (F3: II-2) born to consanguineous parents (first-degree cousins) carry homozygous missense mutations in ELAC2. (B) Gene structure of ELAC2 with known protein domains of the gene product and localization and conservation of amino acid residues affected by mutations. Intronic regions are not drawn to scale. The American Journal of Human Genetics 2013 93, 211-223DOI: (10.1016/j.ajhg.2013.06.006) Copyright © 2013 The Authors Terms and Conditions

Figure 2 Quantification and Rescue of the Mitochondrial mRNA Processing Defect by qPCR (A) Map of the mitochondrial genome with the annotation of rRNA, tRNA, and mRNA genes among the heavy and light strand. Numbering 1–10 indicates the RNA cleavage sites located 5′ terminal of rRNAs or mRNAs. As an example for the primer design, a scheme of the tRNAArg-ND4L junction is given. (B and C) Quantification of the ten unprocessed mitochondrial tRNA-rRNA or tRNA-mRNA junctions analyzed by qPCR in (C) muscle and (D) fibroblasts before (−) and after (+) transduction with a wild-type ELAC2 expression construct. Values are given as fold change to the average of three different controls. Error bars indicate ±1 standard deviation (SD) from the mean of at least three technical (B) or biological (C) replicates. The American Journal of Human Genetics 2013 93, 211-223DOI: (10.1016/j.ajhg.2013.06.006) Copyright © 2013 The Authors Terms and Conditions

Figure 3 Steady-State Levels Mitochondrial RNAs and RNA-Seq in Mutant Fibroblasts (A and B) Quantification of steady-state levels of (A) 14 mt-tRNAs and (B) 3 mt-mRNAs and 16S mt-rRNA in control and affected individual’s (#57415) fibroblasts by RNA blot analysis. 18S rRNA was used as loading control. (C) Mitochondrial transcriptome analysis by next-generation sequencing (RNA-seq) of fibroblasts RNA from ELAC2 individuals and three controls. Relative sequencing coverage is plotted against the mitochondrial genome (numbering according to RefSeq accession number J01415). Colored lines represent individuals #57415 (blue), #61982 (red), and #65937 (green). The black dotted line indicates the average of three controls. The ten RNase Z cleavage sites analyzed by qPCR (Figure 2) are shown with higher magnification. (D) RNA blot analysis decorated with tRNALeu(UUR)- and tRNAVal-specific probes to detect unprocessed mt-tRNA-mRNA intermediates. The American Journal of Human Genetics 2013 93, 211-223DOI: (10.1016/j.ajhg.2013.06.006) Copyright © 2013 The Authors Terms and Conditions

Figure 4 Mitochondrial Translation and Steady-State Levels of Respiratory Chain Complexes in Mutant Fibroblasts (A and B) Analysis of mitochondrial translation products in fibroblasts from individual #57415 by [35S]methionine pulse labeling (A) and quantification of three experiments (B). Error bars indicate ±1 SD from the mean of three replicates. mtDNA-encoded structural subunits of complex I (ND1, ND2, ND3, ND4, ND4L, ND5, ND6), complex III (cytb), complex IV (MT-COI, MT-COII, MT-COIII), and complex V (ATP6, ATP8) are shown. (C and D) Immunoblot analysis of respiratory chain complex subunits in crude mitochondrial extractions from individual #57415 and control (C) fibroblasts as well as (D) muscle. Porin antibody was used as a loading control in muscle. The American Journal of Human Genetics 2013 93, 211-223DOI: (10.1016/j.ajhg.2013.06.006) Copyright © 2013 The Authors Terms and Conditions

Figure 5 Model of Potential ELAC2 Pathomechanism Suggested model of normal and impaired ELAC2 activity. Under normal conditions minor amounts of unprocessed ELAC2 substrates can be degraded by the RNA surveillance machinery. Reduced ELAC2 activity results in an accumulation of mitochondrial precursor mRNAs, which impair mitochondrial translation. The American Journal of Human Genetics 2013 93, 211-223DOI: (10.1016/j.ajhg.2013.06.006) Copyright © 2013 The Authors Terms and Conditions