[Application of new techniques for locating the underlying molecular defects in patients with disorders of oxidative phosphorylation].

The oxidative phosphorylation (OXPHOS) is a system that generates ATP by the transfer of electrons through the complexes of the respiratory chain. Mitochondria are very abundant in organs with high energy demand, including skeletal muscle, heart muscle and brain. The incidence of OXPOS defects is estimated at 1/10,000. Most frequently, a myopathy, encephalopathy or encephalomyopathy is seen. Mutations in the patients with OXPHOS defects can be located in the nuclear genome as well as in the mitochondrial genome which makes the search for the underlying gene defect very difficult. A diagnostic strategy is developed to make the search for the molecular defect easier. Besides the classical spectrophotometric analysis also Blue Native Polyacrylamide Gel Electrophoresis (BN-PAGE) is used. The latter can be combined with activity staining in the gel, or with immunoblotting of the complexes, or with SDS electrophoresis (2-dimensional electrophoresis). Also immunocytological and immunohistochemical analyses are used, especially for detection of heteroplasmy. Skeletal muscle and cultured skin fibroblasts are the favorite tissues used for the application of BN-PAGE and immunological techniques. BN-PAGE followed by activity staining in the gel is especially suited for detection of a deficiency of complex I or of complex V With the spectrophotometric method is it difficult to detect these deficiencies in cultured skin fibroblasts. With BN-PAGE the presence of subcomplexes of complex V can be visualized, which is an indication of a decreased intramitochondrial translation. The immunological stainings on the other hand are well suited for detection of heteroplasmy. The combined use of all these techniques allows the identification of the underlying gene defect in a significant number of patients.