Leigh Syndrome with Nephropathy and CoQ10 Deficiency Due to decaprenyl diphosphate synthase subunit 2 (PDSS2) Mutations  Luis Carlos López, Markus Schuelke,

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Leigh Syndrome with Nephropathy and CoQ10 Deficiency Due to decaprenyl diphosphate synthase subunit 2 (PDSS2) Mutations  Luis Carlos López, Markus Schuelke, Catarina M. Quinzii, Tomotake Kanki, Richard J.T. Rodenburg, Ali Naini, Salvatore DiMauro, Michio Hirano  The American Journal of Human Genetics  Volume 79, Issue 6, Pages 1125-1129 (December 2006) DOI: 10.1086/510023 Copyright © 2006 The American Society of Human Genetics Terms and Conditions

Figure 1 CoQ10 biosynthetic pathway. Isopentenyl diphosphates derived from the mevalonate pathway generate geranylgeranyl diphosphate. Additional isopentenyl diphosphates are added by decaprenyl diphosphate synthase, which, in humans is a heterotetramer composed of two prenyl diphosphate synthase subunit 1 and two prenyl diphosphate synthase subunit 2 molecules. PHB is derived from the amino acids tyrosine or phenylalanine. After PHB and decaprenyl diphosphate are produced, at least seven enzymes catalyze condensation, methylation, decarboxylation, and hydroxylation reactions to synthesize CoQ10.1,2 The American Journal of Human Genetics 2006 79, 1125-1129DOI: (10.1086/510023) Copyright © 2006 The American Society of Human Genetics Terms and Conditions

Figure 2 A, At age 5 mo, the child was severely hypotonic. B, T2-weighted MR image of the brain at age 3 mo, showing bilateral increased signal intensities at the putamen and globus pallidus, as well as increased white matter signal in the parieto-occipital regions and atrophy in the occipital lobe and peri-insular region. C, EEG during right-sided focal status epilepticus, showing continuous high-voltage 2-hz sharp waves over the entire right hemisphere. D, Gomori trichrome stain, demonstrating several muscle fibers with abnormal subsarcolemmal mitochondrial aggregates (500×). E, COX stain, showing a similar pattern of increased subsarcolemmal stain (400×). The American Journal of Human Genetics 2006 79, 1125-1129DOI: (10.1086/510023) Copyright © 2006 The American Society of Human Genetics Terms and Conditions