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White matter involvement in mitochondrial diseases
Tally Lerman-Sagie1, Esther Leshinsky-Silver, Nathan Watemberg
1The Mitochondrial Disease Clinic, Metabolic-Neurogenetic Service, Wolfson Medical Center, Pediatric Neurology Unit, Holon, Israel. asagie@post.tau.ac.il
Abstract:
White matter involvement is recently being realized as a common finding in mitochondrial disorders. It is considered an inherent part of the classical mitochondrial syndromes which are usually associated with alterations in the mitochondrial DNA such as: Leigh disease, Kearns-Sayre syndrome, mitochondrial encephalomyopathy lactic acidosis, and stroke like episodes, mitochondrial neuro-gastro-intestinal encephalomyopathy and Leber's hereditary optic neuropathy. White matter involvement is also described in mitochondrial disorders due to mutations in the nuclear DNA which are transmitted in an autosomal pattern. MRI findings suggestive of a mitochondrial disease are: small cyst-like lesions in abnormal white matter, involvement of both cerebral and cerebellar white matter, and a combination of a leukoencephalopathy with bilateral basal ganglia lesions. The clinical manifestations may be disproportionate to the extent of white matter involvement. Other organs may frequently be involved. The onset is often in infancy with a neurodegenerative course. The finding of a leukoencephalopathy in a patient with a complex neurologic picture and multisystem involvement should prompt a thorough mitochondrial evaluation.
Insights
White matter abnormalities are common in mitochondrial disorders, affecting both brain and cerebellum. Prompt mitochondrial evaluation is crucial for complex neurological cases with multisystem involvement.
Area of Science:
- Neurology
- Genetics
- Radiology
Background:
- White matter involvement is increasingly recognized in mitochondrial disorders.
- It is a key feature of classical mitochondrial syndromes linked to mitochondrial DNA alterations.
- Autosomal disorders involving nuclear DNA mutations also manifest white matter changes.
Purpose of the Study:
- To highlight the significance of white matter involvement in mitochondrial diseases.
- To outline characteristic MRI findings suggestive of mitochondrial disorders.
- To emphasize the need for mitochondrial evaluation in specific clinical contexts.
Main Methods:
- Review of literature on white matter involvement in mitochondrial disorders.
- Analysis of characteristic Magnetic Resonance Imaging (MRI) findings.
- Correlation of clinical presentation with neuroimaging findings.
Main Results:
- Common MRI findings include leukoencephalopathy, cyst-like lesions, and basal ganglia involvement.
- White matter lesions can be disproportionate to clinical symptoms.
- Multisystem involvement and early-onset neurodegeneration are frequent.
Conclusions:
- White matter abnormalities are a hallmark of many mitochondrial diseases.
- Specific MRI patterns can suggest a mitochondrial etiology.
- Leukoencephalopathy with complex neurological and systemic symptoms warrants comprehensive mitochondrial investigation.
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