Association of the mtDNA m.4171C>A/MT-ND1 mutation with both optic neuropathy and bilateral brainstem lesions

Background: An increasing number of mitochondrial DNA (mtDNA) mutations, mainly in complex I genes, have
been associated with variably overlapping phenotypes of Leber’s hereditary optic neuropathy (LHON),
mitochondrial encephalomyopathy with stroke-like episodes (MELAS) and Leigh syndrome (LS). We here describe
the first case in which the m.4171C>A/MT-ND1 mutation, previously reported only in association with LHON, leads
also to a Leigh-like phenotype.
Case presentation: A 16-year-old male suffered subacute visual loss and recurrent vomiting and vertigo associated
with bilateral brainstem lesions affecting the vestibular nuclei. His mother and one sister also presented subacute
visual loss compatible with LHON. Sequencing of the entire mtDNA revealed the homoplasmic m.4171C>A/MT-ND1
mutation, previously associated with pure LHON, on a haplogroup H background. Three additional non-synonymous
homoplasmic transitions affecting ND2 (m.4705T>C/MT-ND2 and m.5263C>T/MT-ND2) and ND6 (m.14180T>C/MT-ND6)
subunits, well recognized as polymorphisms in other mtDNA haplogroups but never found on the haplogroup H
background, were also present.
Conclusion: This case widens the phenotypic expression of the rare m.4171C>A/MT-ND1 LHON mutation, which
may also lead to Leigh-like brainstem lesions, and indicates that the co-occurrence of other ND non-synonymous
variants, found outside of their usual mtDNA backgrounds, may have increased the pathogenic potential of the
primary LHON mutation.