BMJ Case Reports 2009; doi:10.1136/bcr.05.2009.1889
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Nonsense mutation in pseudouridylate synthase 1 (PUS1) in two brothers affected by myopathy, lactic acidosis and sideroblastic anaemia (MLASA)

  1. Erika Fernandez-Vizarra1,
  2. Angela Berardinelli2,
  3. Lucia Valente1,
  4. Valeria Tiranti1,
  5. Massimo Zeviani1
  1. 1
    Division of Molecular Neurogenetics, Pierfranco and Luisa Mariani Center for the Study of Mitochondrial Disorders of Infancy and Childhood, National Institute of Neurology “C. Besta”, Milan, Italy
  2. 2
    Department of Child Neurology and Psychiatry, IRCCS “C. Mondino” Foundation, Pavia, Italy
  1. Massimo Zeviani, zeviani{at}
  • Published 9 June 2009


Myopathy, lactic acidosis and sideroblastic anaemia (MLASA) is a rare condition that combines early-onset myopathy with lactic acidosis and sideroblastic anaemia. MLASA has been associated with a missense mutation in pseudouridylate synthase 1 (PUS1), an enzyme located in both nucleus and mitochondria, which converts uridine into pseudouridine in several cytosolic and mitochondrial tRNA positions and increases the efficiency of protein synthesis in both compartments. We examined two Italian brothers with MLSA and sequenced the PUS1 gene. We found combined defects in mitochondrial respiratory chain complexes in muscle and fibroblast homogenates of both patients, and low levels of mtDNA translation products in fibroblast mitochondria. A novel, homozygous stop mutation was present in PUS1 (E220X). The stop mutation in PUS1 is likely to determine the loss of function of the protein, since it predicts the synthesis of a protein missing 208/427 amino acid residues on the C terminus, and was associated with low mtDNA translation.


  • Competing interests: none.

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