Exp Clin Endocrinol Diabetes 2001; Vol. 109(3): 127-134
DOI: 10.1055/s-2001-14834
Review

© Johann Ambrosius Barth

Molecular and clinical aspects of mitochondrial diabetes mellitus

J. A. Maassen 1 , E. van Essen 2 , J. M. W. van den Ouweland 1 , H. H. J. P. Lemkes 2
  • 1 Department of Molecular Cell Biology, Leiden University Medical Centre, Leiden, The Netherlands
  • 2 Department of Endocrinology and Metabolic Diseases, Leiden University Medical Centre, Leiden, The Netherlands
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Summary:

This review provides a compact overview on the contribution of mutations in mtDNA to the pathogenesis of diabetes mellitus, with emphasis on the A3243G mutation in the tRNA(Leu,UUR) gene. This mutation associates in most individuals with maternally inherited diabetes and deafness (MIDD) whereas in some other carriers the MELAS syndrome or a progressive kidney failure is seen. Possible pathogenic mechanisms are discussed especially the question why particular mutations in mtDNA associate with distinct clinical entities. Mutations in mtDNA can affect the ATP production, thereby leading to particular clinical phenotypes such as muscle weakness. On the other hand mtDNA mutations may also alter the intracellular concentration of mitochondrial metabolites which can act as signalling molecules, such as Ca or glutamate. This situation may contribute to the development of particular phenotypes that are associated with distinct mtDNA mutations.

References

  • 1 Alcolado J C, Alcolado R. Importance of maternal history of non-insulin-dependent diabetes patients.  Br Med J. 302 1178-1180 1991; 
  • 2 Anderson S, Bankier A T, Barrell B G, Bruijn de M HL, Coulson A R, Drouin J, Eperon I C, Nierlich D P, Roe B A, Sanger F, Schreier P H, Smith A HJ, Staden R, Young I G. Sequence and organization of the human mitochondrial genome.  Nature. 290 457-465 1980; 
  • 3 Austin S A, Vriesendorp F J, Thandroyen F T, Hecht J T, Jones O T, Johns D R. Expanding the phenotype of the 8344 transfer RNAlysine mitochondrial DNA mutation.  Neurology. 51 1447-1450 1998; 
  • 4 Ballinger S W, Shoffner J M, Gebhard S, Koontz D A, Wallace D C. Mitochondrial diabetes revisited.  Nat Genet.. 7 458 1994; 
  • 5 Ballinger S W, Shoffner J M, Hedaya E V, Trounce I, Polak M A, Koontz D A, Wallace D C. Maternally transmitted diabetes and deafness associated with a 10.4 kb mitochondrial DNA deletion.  Nat Genet. 1 11-15 1992; 
  • 6 Brini M, Pinton P, King M P, Davidson M, Schon E A, Rizzuto R. A calcium signaling defect in the pathogenesis of a mitochondrial DNA inherited oxidative phosphorylation deficiency.  Nat Med. 5 951-954 1999; 
  • 7 Brown M D, Wallace D C. Molecular basis of mitochondrial DNA disease.  J Bioenerg Biomembr. 26 273-289 1994; 
  • 8 Buemi M, Allegra A, Rotig A, Gubler M C, Aloisi C, Corica F, Pettinato G, Frisina N, Niaudet P. Renal failure from mitochondrial cytopathies.  Nephron. 76 249-253 1997; 
  • 9 Chen Y, Liao W X, Roy A C, Loganath A, Ng S C. Mitochondrial gene mutations in gestational diabetes mellitus.  Diabetes Res Clin Pract. 48 29-35 2000; 
  • 10 Chinnery P F, Howell N, Lightowlers R N, Turnbull D M. Molecular pathology of MELAS and MERRF. The relationship between mutation load and clinical phenotypes.  Brain. 120 1713-1721 1997; 
  • 11 Chinnery P F, Zwijnenburg P J, Walker M, Howell N, Taylor R W, Lightowlers R N, Bindoff L, Turnbull D M. Nonrandom tissue distribution of mutant mtDNA.  Am J Med Genet. 85 498-501 1999; 
  • 12 Chomyn A, Enriquez J A, Micol V, Fernandez-Silva P, Attardi G. The MELAS syndrome-associated human mitochondrial tRNALeu(UUR) mutation causes aminoacylation deficiency and concomitant reduced association of mRNA with ribosomes.  J Biol Chem. 275 19198-19209 2000; 
  • 13 Damore M E, Speiser P W, Slonim A E, New M I, Shanske S, Xia W, Santorelli F M, DiMauro S. Early onset of diabetes mellitus associated with the mitochondrial DNA T14709C point mutation: patient report and literature review.  J Pediatr Endocrinol Metab. 12 207-213 1999; 
  • 14 Dörner G, Mohnike A, Steindel E. On possible genetic and epigenetic modes of diabetes transmission.  Endokrinologie. 66 225-227 1975; 
  • 15 Fukui M, Nakano K, Obayashi H, Kitagawa Y, Nakamura N, Mori H, Kajiyama S, Wada S, Fujii M, Yoshimori K, Kanaitsuka T, Shigeta H, Kondo M. High prevalence of mitochondrial diabetes mellitus in Japanese patients with major risk factors.  Metabolism. 46 793-795 1997; 
  • 16 Goto Y, Nonaka I, Horai S. A mutation in the tRNA(Leu)(UUR) gene associated with the MELAS subgroup of mitochondrial encephalomyopathies.  Nature. 348 651-653 1990; 
  • 17 Hagelberg E, Goldman N, Lio P, Whelan S, Schiefenhovel W, Clegg J B, Bowden D K. Evidence for mitochondrial DNA recombination in a human population of island Melanesia.  Proc. R. Soc Lond B Biol Sci. 266(1418) 485-492 1999; 
  • 18 Hao H, Moraes C . Functional and molecular mitochondrial abnormalities associated with a C → T transition at position 3256 of the human mitochondrial genome. The effects of a pathogenic mitochondrial tRNA point mutation in organelle translation and RNA processing.  J Biol Chem. 271 2347-2352 1996; 
  • 19 't Hart L M, Jansen J J, Lemkes H H, de Knijff P, Maassen J A. Heteroplasmy levels of a mitochondrial gene mutation associated with diabetes mellitus decrease in leucocyte DNA upon aging.  Hum Mutat. 7 93-97 1996; 
  • 20 't Hart L M, Lemkes H H, Heine R J, Stolk R P, Feskens E J, Jansen J J, van der Does F E, Grobbee D E, Kromhout D, van Den Ouweland J M. Prevalence of maternally inherited diabetes and deafness in diabetic populations in The Netherlands.  Diabetologia. 37 1169-1170 1994; 
  • 21 Hayakawa T, Noda M, Yasuda K, Yorifuji H, Taniguchi S, Miwa I, Sakura H, Terauchi Y, Hayashi J, Sharp G W, Kanazawa Y, Akanuma Y, Yazaki Y, Kadowaki T. Ethidium bromide-induced inhibition of mitochondrial gene transcription suppresses glucose-stimulated insulin release in the mouse pancreatic beta-cell line betaHC9.  J Biol Chem. 273 20300-20307 1998; 
  • 22 Hirai M, Suzuki S, Onoda M, Hinokio Y, Ai L, Hirai A, Ohtomo M, Komatsu K, Kasuga S, Satoh Y, Akai H, Toyota T. Mitochondrial DNA 3394 mutation in the NADH dehydrogenase subunit 1 associated with non-insulin-dependent diabetes mellitus.  Biochem Biophys Res Commun. 219 951-955 1996; 
  • 23 Hirai M, Suzuki S, Onoda M, Hinokio Y, Hirai A, Ohtomo M, Chiba M, Kasuga S, Hirai S, Satoh Y, Akai H, Miyabayashi S, Toyota T. Mitochondrial deoxyribonucleic acid 3256C-T mutation in a Japanese family with noninsulin-dependent diabetes mellitus.  J Clin Endocrinol Metab. 83 992-994 1998; 
  • 24 Iwanishi M, Obata T, Yamada S, Maegawa H, Tachikawa-Ide R, Ugi S, Hasegawa M, Kojima H, Oguni T, Toudo R. Clinical and laboratory characteristics in the families with diabetes and a mitochondrial tRNA(LEU(UUR)) gene mutation.  Diabetes Res Clin Pract. 29 75-82 1995; 
  • 25 Janssen G M, Maassen J A, van Den Ouweland J M. The diabetes-associated 3243 mutation in the mitochondrial tRNA(Leu(UUR)) gene causes severe mitochondrial dysfunction without a strong decrease in protein synthesis rate.  J Biol Chem. 274(42) 29744-29748 1999; 
  • 26 Jansen J J, Maassen J A, van der Woude F J, Lemmink H A, van Den Ouweland J M, t' Hart L M, Smeets H J, Bruijn J A, Lemkes H H. Mutation in mitochondrial tRNA(Leu(UUR)) gene associated with progressive kidney disease.  J Am Soc Nephrol. 8 1118-1124 1997; 
  • 27 Kadowaki T, Kadowaki H, Mori Y, Tobe K, Sakuta R, Suzuki Y, Tanabe Y, Sakura H, Awata T, Goto Y. A subtype of diabetes mellitus associated with a mutation of mitochondrial DNA.  N Engl J Med. 330 962-968 1994; 
  • 28 Kadowaki H, Tobe K, Mori Y, Sakura H, Sakuta R, Nonaka I, Hagura R, Yazaki Y, Akanuma Y, Kadowaki T. Mitochondrial gene mutation and insulin-deficient type of diabetes mellitus.  Lancet. 341(8849) 893-894 1993; 
  • 29 Kameoka K, Isotani H, Tanaka K, Kitaoka H, Ohsawa N. Impaired insulin secretion in Japanese diabetic subjects with an A-to-G mutation at nucleotide 8296 of the mitochondrial DNA in tRNA(Lys).  Diabetes Care. 21 2034-2205 1998; 
  • 30 Kanamori S, Tanaka K, Umezawa S, Matoba K, Fujita Y, Iizuka T, Yajima Y. Insulin resistance in mitochondrial gene mutation.  Diabetes Care. 17 778-779 1994; 
  • 31 Kawarai T, Kawakami H, Kozuka K, Izumi Y, Matsuyama Z, Watanabe C, Kohriyama T, Nakamura S. A new mitochondrial NA mutation associated with mitochondrial myopathy: tRNA(Leu)(UUR) 3254C-to-G.  Neurology. 49 598-600 1997; 
  • 32 King M P, Attardi G. Human cells lacking mtDNA: repopulation with exogenous mitochondria by complementation.  Science. 246 500-503 1989; 
  • 33 Kobayashi T, Oka Y, Katagiri H, Falorni A, Kasuga A, Takei I, Nakanishi K, Murase T, Kosaka K, Lernmark A. Association between HLA and islet cell antibodies in diabetic patients with a mitochondrial DNA mutation at base pair 3243.  Diabetologia. 39 1196-1200 1996; 
  • 34 Lehto M, Wipemo C, Ivarsson S A, Lindgren C, Lipsanen-Nyman M, Weng J, Wibell L, Widen E, Tuomi T, Groop L. High frequency of mutations in MODY and mitochondrial genes in Scandinavian patients with familial early-onset diabetes.  Diabetologia. 42 1131-1137 1999; 
  • 35 Lenaz G. Role of mitochondria in oxidative stress and ageing. Biochim. Biophys.  Acta. 1366 53-67 1998; 
  • 36 Lynn S, Wardell T, Johnson M A, Chinnery P F, Daly M E, Walker M, Turnbull D M. Mitochondrial diabetes: investigation and identification of a novel mutation.  Diabetes. 47 1800-1802 1998; 
  • 37 Maassen J A, Kadowaki T. Maternally inherited diabetes and deafness: a new diabetes subtype.  Diabetologia. 39 375-382 1996; 
  • 38 Maechler P, Wollheim C B. Mitochondrial glutamate acts as a messenger in glucose-induced insulin exocytosis.  Nature. 402 685-689 1999; 
  • 39 Majamaa K, Moilanen J S, Uimonen S, Remes A M, Salmela P I, Karppa M, Majamaa-Voltti K A, Rusanen H, Sorri M, Peuhkurinen K J, Hassinen I E. Epidemiology of A3243G, the mutation for mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes: prevalence of the mutation in an adult population.  Am J Hum Genet. 63 447-454 1998; 
  • 40 Marie S K, Goto Y, Passos-Bueno M R, Zatz M, Carvalho A A, Carvalho M, Levy J A, Palou V B, Campiotto S, Horai S. A Caucasian family with the 3271 mutation in mitochondrial DNA.  Biochem. Med. Metab Biol.. 52 136-139 1994; 
  • 41 Nakamura S, Yoshinari M, Doi Y, Yoshizumi H, Katafuchi R, Yokomizo Y, Nishiyama K, Wakisaka M, Fujishima M. Renal complications in patients with diabetes mellitus associated with an A to G mutation of mitochondrial DNA at the 3243 position of leucine tRNA.  Diabetes Res. Clin. Pract.. 44 183-189 1999; 
  • 42 Nakano S, Fukuda M, Hotta F, Ito T, Ishii T, Kitazawa M, Nishizawa M, Kigoshi T, Kakinuma H, Takahashi H, Uchida K. Mitochondrial DNA point mutation at nucleotide pair 3316 in a Japanese family with heterogeneous phenotypes of diabetes.  Endocr J. 45 625-630 1998; 
  • 43 Odawara M, Sasaki K, Yamashita K. A G-to-A substitution at nucleotide position 3316 in mitochondrial DNA is associated with Japanese non-insulin-dependent diabetes mellitus.  Biochem Biophys Res Commun. 227 147-151 1996; 
  • 44 Oka Y, Katagiri H, Yazaki Y, Murase T, Kobayashi T. Mitochondrial gene mutation in islet-cell-antibody-positive patients who were initially non-insulin-dependent diabetics.  Lancet. 342 527-528 1993; 
  • 45 Poulton J, Brown M S, Cooper A, Marchington D R, Phillips D I. A common mitochondrial DNA variant is associated with insulin resistance in adult life.  Diabetologia. 41 54-58 1998; 
  • 46 Poulton J, Deadman M E, Bindoff L, Morten K, Land J, Brown G. Families of mtDNA re-arrangements can be detected in patients with mtDNA deletions: duplications may be a transient intermediate form.  Hum Mol Genet. 2 23-30 1993; 
  • 47 Rötig A, Cormier V, Blanche S, Bonnefont J P, Ledeist F, Romero N, Schmitz J, Rustin P, Fischer A, Saudubray J M. Pearson's marrow-pancreas syndrome. A multisystem mitochondrial disorder in infancy.  J Clin Invest. 86 1601-1608 1990; 
  • 48 Sano M, Ozawa M, Shiota S, Momose Y, Uchigata M, Goto Y. The T-C(8356) mitochondrial DNA mutation in a Japanese family.  J Neurol. 243 441-444 1996; 
  • 49 Schoonjans K, Peinado-Onsurbe J, Lefebvre A M, Heyman R A, Briggs M, Deeb S, Staels B, Auwerx J. PPARalpha and PPARgamma activators direct a distinct tissue-specific transcriptional response via a PPRE in the lipoprotein lipase gene.  EMBO J. 15 5336-5348 1996; 
  • 50 Shoffner J M, Lott M T, Lezza A M, Seibel P, Ballinger S W, Wallace D C. Myoclonic epilepsy and ragged-red fiber disease (MERRF) is associated with a mitochondrial DNA tRNA(Lys) mutation.  Cell. 61 931-937 1990; 
  • 51 Soejima A, Inoue K, Takai D, Kaneko M, Ishihara H, Oka Y, Hayashi J I. Mitochondrial DNA is required for regulation of glucose-stimulated insulin secretion in a mouse pancreatic beta cell line, MIN6.  J. Biol. Chem.. 271 26194-26199 1996; 
  • 52 Suzuki S, Hinokio Y, Ohtomo M, Hirai M, Hirai A, Chiba M, Kasuga S, Satoh Y, Akai H, Toyota T. The effects of coenzyme Q10 treatment on maternally inherited diabetes mellitus and deafness, and mitochondrial DNA 3243 (A to G) mutation.  Diabetologia. 41 584-588 1998; 
  • 53 Suzuki Y, Iizuka T, Kobayashi T, Nishikawa T, Atsumi Y, Kadowaki T, Oka Y, Kadowaki H, Taniyama M, Hosokawa K, Asahina T, Matsuoka K. Diabetes mellitus associated with the 3243 mitochondrial tRNA(Leu)(UUR) mutation: insulin secretion and sensitivity.  Metabolism. 46 1019-1023 1997; 
  • 54 Tarnopolsky M A, Maguire J, Myint T, Applegarth D, Robinson B H. Clinical, physiological, and histological features in a kindred with the T3271C melas mutation.  Muscle Nerve. 21 25-33 1998; 
  • 55 Tawata M HJ, Hayashi J I, Isobe K, Ohkubo E, Ohtaka M, Chen J, Aida K, Onaya T. A new mitochondrial DNA mutation at 14577 T/C is probably a major pathogenic factor for maternally inherited type 2 diabetes.  Diabetes. 49 1269-1272 2000; 
  • 56 van de Corput M P, van Den Ouweland J M, Dirks R W, 't Hart L M, Bruining G J, Maassen J A, Raap A K. Detection of mitochondrial DNA deletions in human skin fibroblasts of patients with Pearson's syndrome by two-color fluorescence in situ hybridization.  J. Histochem. Cytochem.. 45 55-61 1997; 
  • 57 Van Essen E HR, Roep B O, 't Hart L M, Jansen J J, van Den Ouweland J MW, Lemkes H HPJ, Maassen J A. HLA-DQ polymorphism and heteroplasmy levels of the A3243G mitochondrial mutation in maternally inherited diabetes and dreafness.  Diabet Med. 17 842-847 2000; 
  • 58 van Den Ouweland J M, de Klerk J B, van de Corput M P, Dirks R W, Raap A K, Scholte H R, Huijmans J G, Hart L M, Bruining G J, Maassen J A. Characterization of a novel mitochondrial DNA deletion in a patient with a variant of the Pearson marrow-pancreas syndrome.  Eur. J. Hum. Genet.. 8 195-203 2000; 
  • 59 van Den Ouweland J M, Lemkes H H, Ruitenbeek W, Sandkuijl L A, de Vijlder M F, Struyvenberg P A, van de Kamp J J, Maassen J A. Mutation in mitochondrial tRNA(Leu)(UUR) gene in a large pedigree with maternally transmitted type II diabetes mellitus and deafness.  Nat Genet. 1 368-371 1992; 
  • 60 Velho G, Byrne M M, Clement K, Sturis J, Pueyo M E, Blanche H, Vionnet N, Fiet J, Passa P, Robert J J, Polonsky K S, Froguel P. Clinical phenotypes, insulin secretion, and insulin sensitivity in kindreds with maternally inherited diabetes and deafness due to mitochondrial tRNALeu(UUR) gene mutation.  Diabetes. 45 478-487 1996; 
  • 61 Verhoeven K, Ensink R J, Tiranti V, Huygen P L, Johnson D F, Schatteman I, Van Laer L, Verstreken M, Van de Heyning P, Fischel-Ghodsian N, Zeviani M, Cremers C W, Willems P J, Van Camp G. Hearing impairment and neurological dysfunction associated with a mutation in the mitochondrial tRNASer(UCN) gene.  Eur J Hum Genet. 7 45-51 1999; 
  • 62 Vialettes B H, Paquis-Flucklinger V, Pelissier J F, Bendahan D, Narbonne H, Silvestre-Aillaud P, Montfort M F, Righini-Chossegros M, Pouget J, Cozzone P J, Desnuelle C. Phenotypic expression of diabetes secondary to a T14709C mutation of mitochondrial DNA. Comparison with MIDD syndrome (A3243G mutation): a case report.  Diabetes Care. 20 1731-1737 1997; 
  • 63 Wallace D C. Mitochondrial DNA mutations in diseases of energy metabolism.  J. Bioenerg Biomembr. 26 241-250 1994; 
  • 64 Wallace D C. Mitochondrial diseases in man and mouse.  Science. 283 1482-1488 1999; 
  • 65 Wallace D C, Singh G, Lott M T, Hodge J A, Schurr T G, Lezza A M, Elsas L J, Nikoskelainen E K. Mitochondrial DNA mutation associated with Leber's hereditary optic neuropathy.  Science. 242 1427-1430 1988a; 
  • 66 Wallace D C, Zheng X X, Lott M T, Shoffner J M, Hodge J A, Kelley R I, Epstein C M, Hopkins L C. Familial mitochondrial encephalomyopathy (MERRF): genetic, pathophysiological, and biochemical characterization of a mitochondrial DNA disease.  Cell. 55 601-610 1988b; 
  • 67 Wollheim C B. Beta-cell mitochondria in the regulation of insulin secretion: a new culprit in type II diabetes.  Diabetologia. 43 265-277 2000; 
  • 68 Zeviani M, Servidei S, Gellera C, Bertini E, DiMauro S, DiDonato S. An autosomal dominant disorder with multiple deletions of mitochondrial DNA starting at the D-loop region.  Nature. 339 309-311 1989; 

Dr. J. A. Maassen

Dept of Molecular Cell Biology

Wassenaarseweg 72

2333 AL Leiden

The Netherlands

Phone: +31-71-527-6127

Fax: +31-71-527-6284

Email: j.a.maassen@lumc.nl

    >