Alpers-Huttenlocher Syndrome
Alpers Huttenlocher

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Description from OMIM

Mitochondrial DNA depletion syndrome-4A, also known as Alpers syndrome, is an autosomal recessive disorder characterized by a clinical triad of psychomotor retardation, intractable epilepsy, and liver failure in infants and young children. Pathologic findings include neuronal loss in the cerebral gray matter with reactive astrocytosis and liver cirrhosis. The disorder is progressive and often leads to death from hepatic failure or status epilepticus before age 3 years (review by Milone and Massie, 2010). Some affected individuals may show mild intermittent 3-methylglutaconic aciduria and defects in mitochondrial oxidative phosphorylation (Wortmann et al., 2009). For a discussion of genetic heterogeneity of autosomal recessive mtDNA depletion syndromes, see MTDPS1 (603041). Neuropathologic changes characteristic of Alpers syndrome, namely laminar cortical necrosis, may also be seen in some patients with combined oxidative phosphorylation deficiency-14 (COXPD14; 614946), caused by mutation in the FARS2 gene (611592), and COXPD24 (616239), caused by mutation in the NARS2 gene (612803).



Prevalence of clinical parameters (%)







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List of symptoms



Symptom/sign Organ system Percent affected Pubmed id Added on(yyyy-mm-dd) Edit/add reference
Mental retardation nervous 100 % 16957900 2011-10-27
Failure to thrive multi 100 % 16957900 2011-10-27
Hypotonia nervous 100 % 16957900 2011-10-27
Lactate accumulation circulatory 100 % 20142534 2011-10-18
Seizures nervous 100 % 20142534 2011-10-05
Hepatopathy digestive 100 % 16957900 2011-10-27
Developmental delay multi 100 % 20142534 2011-10-11
Hepatopathy digestive 100 % 20142534 2011-10-12
Gastrointestinal dysmotility digestive 75 % 20142534 2011-10-10
Hypotonia nervous 50 % 20142534 2011-10-12
Cerebral atrophy nervous 33 % 16957900 2011-10-27
Short stature skeletal 25 % 20142534 2011-10-05
Cholestasis digestive 25 % 20142534 2011-10-05
Gastric ulcers digestive 25 % 20142534 2011-10-05
Optic atrophy nervous 25 % 20142534 2011-10-05
Ptosis nervous 25 % 20142534 2011-10-12
Hearing loss nervous 25 % 20142534 2011-10-12
Mental retardation nervous 25 % 20142534 2011-10-12



List of references:


Multiple oxidative phosphorylation deficiencies in severe childhood multi-system disorders due to polymerase gamma (POLG1) mutations.
Maaike C de Vries, Richard J Rodenburg, Eva Morava, Edwin P M van Kaauwen, Henk ter Laak, Reinier A Mullaart, Irina N Snoeck, Peter M van Hasselt, Peter Harding, Lambert P W van den Heuvel, Jan A M Smeitink,

Failure to thrive, feeding difficulties, variable forms of infantile epilepsy or psychomotor developmental delay and hypotonia were the most frequent clinical disease presentations in eight children with combined oxidative phosphorylation enzyme complex deficiencies carrying mutations in the polymerase gamma (POLG1) gene. Five out of eight patients developed severe liver dysfunction during the course of the disease. Three of these patients fulfilled the disease criteria for Alpers syndrome. Most children showed deficiencies of respiratory chain enzyme complexes I and III, in combination with complex II, complex IV and/or PDHc in muscle, whereas in fibroblasts normal enzyme activities were measured. All children carried homozygous or compound heterozygous mutations in the POLG1 gene, including two novel mutations in association with mtDNA depletion. Conclusion We suggest performing POLG1 mutation analysis in children with combined oxidative phosphorylation deficiencies in muscle, even if the clinical picture is not Alpers syndrome.

European journal of pediatrics - Mar 2007



A novel POLG gene mutation in 4 children with Alpers-like hepatocerebral syndromes.
Bulent Kurt, Jaak Jaeken, Johan Van Hove, Lieven Lagae, Ann Löfgren, David B Everman, Parul Jayakar, Ali Naini, Klaas J Wierenga, Gert Van Goethem, William C Copeland, Salvatore DiMauro,

To describe a novel POLG missense mutation (c.3218C>T; p.P1073L) that, in association with 2 previously described mutations, caused an Alpers-like hepatocerebral syndrome in 4 children.

Archives of neurology - Feb 2010