Pathogenic GFM1 variants have been linked to neurological phenotypes with or without liver involvement, but only a few cases have been reported in the literature.Here, we report clinical, biochemical, and neuroimaging findings from nine unrelated children carrying GFM1 variants, 10 of which were not previously reported. All patients presented with neurological involvement-mainly axial hypotonia and dystonia during the neonatal period-with five diagnosed with West syndrome; two children had liver involvement with cytolysis episodes or hepatic failure. While two patients died in infancy, six exhibited a stable clinical course. Brain magnetic resonance imaging showed the involvement of basal ganglia, brainstem, and periventricular white matter. Mutant EFG1 and OXPHOS proteins were decreased in patientʼs fibroblasts consistent with impaired mitochondrial translation. Thus, we expand the genetic spectrum of GFM1linked disease and provide detailed clinical profiles of the patients that will improve the diagnostic success for other patients carrying GFM1 mutations. K E Y W O R D S EFG1, GFM1, mitochondrial diseases, mitochondrial translation, OXPHOS *Metodi D. Metodiev and Benedetta Ruzzenente contributed equally to this study.study did not include brain biopsies, the neurological phenotype that has now emerged as the predominant clinical presentation of GFM1 mutations remains to be explained. Future studies will include more comprehensive biochemical and molecular analyses of patient biopsies as well as animal models expressing GFM1 disease-causing variants to understand their tissue-specific clinical presentations.
ACKNOWLEDGMENTSWe would like to thank the families for their participation in this study. This work was supported in part by grants from the French association against myopathies (AFM-Telethon) to M.D.M. (nrs. 19876 and 22529) and to B.R. (nr. 22251); and grant GENOMITANR-15-RAR3-0012-07 to A.R.
CONFLICT OF INTERESTSThe authors declare that there are no conflict of interests.
ORCID
Manuel Schiffhttp://orcid.org/0000-0001-8272-232XMetodi D. Metodiev