Schaefer, Patrick M.Scherer Alves, LeonardoLvova, MariaHuang, JessicaRathi, KomalJanssen, KevinButic, ArrienneYardeni, TalMorrow, RyanLott, MarieMurdock, DeborahSong, AngelaKeller, KierstinGarcia, Benjamin A.Francomano, Clair A.Wallace, Douglas C.2023-09-252023-09-252022Schaefer PM, Scherer Alves L, Lvova M, et al. Combination of common mtDNA variants results in mitochondrial dysfunction and a connective tissue dysregulation. Proc Natl Acad Sci U S A. 2022;119(45):e2212417119. doi:10.1073/pnas.2212417119https://hdl.handle.net/1805/35773Mitochondrial dysfunction can be associated with a range of clinical manifestations. Here, we report a family with a complex phenotype including combinations of connective tissue, neurological, and metabolic symptoms that were passed on to all surviving children. Analysis of the maternally inherited mtDNA revealed a novel genotype encompassing the haplogroup J - defining mitochondrial DNA (mtDNA) ND5 m.13708G>A (A458T) variant arising on the mtDNA haplogroup H7A background, an extremely rare combination. Analysis of transmitochondrial cybrids with the 13708A-H7 mtDNA revealed a lower mitochondrial respiration, increased reactive oxygen species production (mROS), and dysregulation of connective tissue gene expression. The mitochondrial dysfunction was exacerbated by histamine, explaining why all eight surviving children inherited the dysfunctional histidine decarboxylase allele (W327X) from the father. Thus, certain combinations of common mtDNA variants can cause mitochondrial dysfunction, mitochondrial dysfunction can affect extracellular matrix gene expression, and histamine-activated mROS production can augment the severity of mitochondrial dysfunction. Most important, we have identified a previously unreported genetic cause of mitochondrial disorder arising from the incompatibility of common, nonpathogenic mtDNA variants.en-USAttribution 4.0 InternationalmtDNA haplogroupsMitochondrial disorderConnective tissue disorderHistamine signalingArticle