Mol Genet Metab Rep. 2022 Dec;33 100932
Rachel Wolfe,
Paige Heiman,
Olivia D'Annibale,
Anuradha Karunanidhi,
Alyssa Powers,
Marianne Mcguire,
Bianca Seminotti,
Steven F Dobrowolski,
Miguel Reyes-Múgica,
Kathryn S Torok,
Al-Walid Mohsen,
Jerry Vockley,
Lina Ghaloul-Gonzalez.
Autoimmune Disease, Multisystem, with Facial Dysmorphism (ADMFD) is an autosomal recessive disorder due to pathogenic variants in the ITCH gene. It is characterized by failure to thrive, dysmorphic facial features, developmental delay, and systemic autoimmunity that can manifest variably with autoimmune hepatitis, thyroiditis, and enteropathy, among other organ manifestations. It was originally described in 10 consanguineous Old Order Amish patients, and more recently in two patients of White British and Black German ethnicities. While the role of ITCH protein in apoptosis and inflammation has previously been characterized, a defect in cellular bioenergetics has not yet been reported in ITCH deficiency. Here we present a Caucasian female originally evaluated for possible mitochondrial respiratory chain deficiency, who ultimately was found to have two novel variants in ITCH with absence of ITCH protein in patient derived fibroblasts. Clinical studies of patient muscle showed mitochondrial DNA copy number of 57% compared to controls. Functional studies in skin fibroblasts revealed decreased activity of mitochondrial fatty acid oxidation and oxidative phosphorylation, and decreased overall ATP production. Our findings confirm mitochondrial energy dysfunction in a patient with ITCH deficiency offering the opportunity to assess alternative therapeutic options.
Keywords: Apoptosis; Autoimmune disease; DMEM, Dulbecco's Modified Eagle Medium; E3 ligase; ETC, Mitochondrial electron transport chain; FAO, Fatty acid oxidation; FOXP3, Forkhead box P3 protein; HECT, Homologous to the E6-Associated Protein C-Terminus; IBD, Inflammatory Bowel Disease; IF, Immunofluorescence analysis; ITCH; MAVS, Mitochondrial antiviral signaling protein; Mitochondrial dysfunction; NOTCH1, Notch receptor 1 protein; OCR, Oxygen consumption rate; OXPHOS, Oxidative Phosphorylation; TAX1BP1, TAX1-binding protein 1; TFP, Trifunctional protein; TXNIP, Thioredoxin Interacting Protein; Tregs, T regulatory cells; UPS, Ubiquitin proteasome system; Ubiquitination; VLCAD, Very long-chain acyl-CoA dehydrogenase protein