Human Molecular Genetics Advance Access originally published online on August 19, 2003
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Human Molecular Genetics, 2003, Vol. 12, No. 20 2693-2702
DOI: 10.1093/hmg/ddg284
© 2003 Oxford University Press
Mutations in COX10 result in a defect in mitochondrial heme A biosynthesis and account for multiple, early-onset clinical phenotypes associated with isolated COX deficiency


1Montreal Neurological Institute and 2Department of Human Genetics, McGill University, Montreal H3A 2B4, Canada, 3Department of Pediatrics and 4Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, OR 97201, USA and 5Metabolic Disease Centre Munich-Schwabing and Institute of Clinical Chemistry, Molecular Diagnostics and Mitochondrial Genetics, 80804 Munich, Germany
Received June 20, 2003; Accepted August 1, 2003
Deficiencies in the activity of cytochrome c oxidase (COX) are an important cause of autosomal recessive respiratory chain disorders. Patients with isolated COX deficiency are clinically and genetically heterogeneous, and mutations in several different assembly factors have been found to cause specific clinical phenotypes. Two of the most common clinical presentations, Leigh Syndrome and hypertrophic cardiomyopathy, have so far only been associated with mutations in SURF1 or SCO2 and COX15, respectively. Here we show that expression of COX10 from a retroviral vector complements the COX deficiency in a patient with anemia and Leigh Syndrome, and in a patient with anemia, sensorineural deafness and fatal infantile hypertrophic cardiomyopathy. A partial rescue was also obtained following microcell-mediated transfer of mouse chromosomes into patient fibroblasts. COX10 functions in the first step of the mitochondrial heme A biosynthetic pathway, catalyzing the conversion of protoheme (heme B) to heme O via the farnesylation of a vinyl group at position C2. Heme A content was reduced in mitochondria from patient muscle and fibroblasts in proportion to the reduction in COX enzyme activity and the amount of fully assembled enzyme. Mutation analysis of COX10 identified four different missense alleles, predicting amino acid substitutions at evolutionarily conserved residues. A topological model places these residues in regions of the protein shown to have important catalytic functions by mutation analysis of a prokaryotic ortholog. Mutations in COX10 have previously been reported in a single family with tubulopathy and leukodystrophy. This study shows that mutations in this gene can cause nearly the full range of clinical phenotypes associated with early onset isolated COX deficiency.
* To whom correspondence should be addressed at: Montreal Neurological Institute, 3801 University Street, Montreal, Quebec, Canada H3A 2B4. Tel: +1 5143988523; Fax: +1 5143981509; Email: eric{at}ericpc.mni.mcgill.ca
The authors wish it to be known that, in their opinion, the first two authors should be regarded as joint First Authors.
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