5.1. MtDNA Mutations
As already stated in the introduction, the majority of mutations associated with combined OXPHOS deficiencies and a mitochondrial translation defect are located in the mitochondrial genome. Approximately 150 mutations, of which a large percentage awaits proper determination of their pathological significance (see [
210] for a scoring system), have been reported in mitochondrial tRNA genes and a few in rRNA genes [
12]. It is beyond the scope of this review to discuss these mutations in detail; overviews of mitochondrial tRNA mutations and their molecular and clinical consequences have been published before [
210–
212].
The tRNA
Leu(UUR) gene forms a hotspot for pathogenic mutations with nearly 30 different mutations, but in all tRNA genes, mutations have been detected now. A pathogenic tRNA gene mutation is expected to lead to a combined OXPHOS defect through a decreased rate of mitochondrial protein synthesis. The exact complexes that show a deficiency differ for each mutation, partly depending on which tRNA is affected and the percentages of the corresponding amino acid in the different OXPHOS subunits. The pathogenic mechanisms involved in the translation defect due to a tRNA mutation are numerous and frequently multiple events are involved; potential effects are: impaired transcription termination, impaired tRNA maturation, defective posttranscriptional modification of the tRNA, effect on tRNA structure (e.g., global structural weakness or conformational alteration), decreased tRNA stability (found for all mutations investigated), reduced aminoacylation, decreased binding to translation factor mtEFTu or the mitoribosome, and disturbed codon reading [
211]. However, cases are known where mitochondrial translation was not or only slightly affected despite clear impairment of the OXPHOS system (e.g., [
220,
221]). Possibly, this is due to toxic effects of premature translation products generated by the absence of the correctly functioning tRNA [
222]. These peptides could interfere with the assembly of the OXPHOS complexes or exert their toxic effect through interactions with other (non)mitochondrial components, while a quantitative deficit in mitochondrial protein synthesis cannot be detected.
The best-studied mitochondrial tRNA mutations are 3243A>G in tRNA
Leu(UUR) (
MT-TL1) and 8344A>G in tRNA
Lys (
MT-TK). The 3243A>G mutation is one of the most common mutations and causes a range of clinical phenotypes, of which MELAS is the most prevalent [
223]. There is controversy over the pathogenic mechanism of the 3243A>G mutation: both loss-of-function (due to poor aminoacylation, reduced stability or lack of wobble-base U hypermodification) and gain-of-function (due to lack of the hypermodification) of the mutant tRNA have been proposed [
224]. The post-transcriptional taurine modification at the anticodon wobble position is needed to restrict decoding to leucine UUR codons. Loss of this modification leads to varying degrees of mitochondrial translation malfunctioning in different cellular backgrounds through a combination of a decoding defect of UUG (and UUA) codons (loss-of-function) and amino acid misincorporation (gain-of-function) [
126,
225]. Additionally, the 3243A>G mutation was shown to diminish 16S rRNA transcription termination and alter processing of the primary transcript [
61,
226], but these effects are likely to contribute less to the disease etiology than the previously mentioned mechanisms. The 8344A>G mutation is associated with MERRF (myoclonic epilepsy with ragged-red fibers). It has also been reported to affect aminoacylation and taurine modification of the wobble-base U, the latter which abolishes codon-anticodon pairing on the mitoribosomes for both tRNA
Lys codons [
225,
227]. This generates a marked decrease in mitochondrial protein synthesis that is most pronounced in proteins with a high lysine content and is believed to result from premature translation termination.
Most rRNA mutations have been reported in the 12S rRNA gene (
MT-RNR1) and all of these are associated with nonsyndromic sensorineural hearing loss or aminoglycoside-induced deafness, with the 1555A>G mutation forming one of the most common causes [
12,
228]. This mutation is located in the decoding site of the mitoribosomal SSU and results in a secondary rRNA structure that more closely resembles the corresponding region of the bacterial 16S rRNA, impairing mitochondrial protein synthesis and facilitating interaction with aminoglycoside antibiotics, which again exacerbates the translation defect. The mutation alone does not lead to disease, only in combination with modulators such as the aminoglycosides, mitochondrial haplotypes and nuclear modifier genes (e.g., TFB1M, as already mentioned in
Section 3.3). In the 16S rRNA gene (
MT-RNR2) merely 3 mutations have been found: 2835C>T, 3093C>G, and 3196G>A [
12]. These mutations are thought to be associated with Rett syndrome, MELAS, and Alzheimer and Parkinson disease, respectively, [
229–
231]. Nevertheless, further investigations are necessary to determine their pathogenicity.
5.2. nDNA Mutations
Up till now, mutations in nine nuclear genes implicated in mitochondrial protein synthesis have been associated with mitochondrial disorders. The first report was a homozygous missense mutation in the tRNA modifying gene
PUS1 [
14], and shortly thereafter homozygous mutations were detected in the genes for elongation factor mtEFG1 [
15] and mitoribosomal protein MRPS16 [
18]. Subsequently, four compound heterozygous mutations in
GFM1 (coding for mtEFG1) [
22,
25] and homozygous mutations in
TUFM (encoding mtEFTu) [
22],
TSFM (coding for mtEFTs) [
21],
MRPS22 [
19],
PUS1 again [
17], and in the arginine tRNA synthetase gene (
RARS2) [
16] were found, bringing the total number of mutations on 12. Additionally, several compound heterozygous mutations have been reported in the gene for mitochondrial aspartyl-tRNA synthetase (
DARS2) [
20,
23]. Recently, 9 mutations were identified in the gene for another tRNA modifying gene,
TRMU [
24]. All patients harboring these mutations show combined OXPHOS deficiencies, with (near) normal complex II activities, and a clear defect in mitochondrial translation (the latter was not tested for the
MRPS22,
RARS2, and
DARS2 mutations). The one exception is
DARS2: surprisingly, Blue-native PAGE as well as spectrophotometric measurements revealed normal OXPHOS enzyme activities [
20]. The clinical features differ substantially between all patients and even between patients that carry the same mutation, but generally the mutations result in severe and early-fatal diseases.
As already mentioned in
Section 2.3, defects in the tRNA-modifying enzymes PUS1 and TRMU can result in mitochondrial disease. PUS1 converts uridine into pseudouridine at several cytoplasmic and mitochondrial tRNA positions and thereby improves translation efficiency in the cytosol as well as the mitochondrion [
17]. Thus it is not part of the translation machinery, but it is required for protein synthesis due to its function in post-transcriptional modification of tRNAs. Pseudouridylation is the most frequently found modification in tRNAs [
232], however, the exact function is not entirely clear. The marked variability in the severity of the MLASA syndrome, despite the presence of an identical
PUS1 mutation, could partly be explained by the dual localization of PUS1 [
17]. A defect in PUS1 therefore impairs both cytosolic and mitochondrial translation, resulting in corresponding clinical symptoms that can vary due to individual differences in compensation mechanisms in both cell compartments. Bykhovskaya et al. suggested that compensatory changes in transcript levels of ribosomal proteins can overcome the lack of pseudouridylation of tRNAs and that pleiotropic effects of PUS1 on non-tRNA substrates involved in transcription and iron metabolism are a major cause of the disease phenotype [
233]. Notably, complex II can be affected slightly in addition to the other OXPHOS complexes that all contain mtDNA-encoded subunits [
17]. This could be a primary effect of the decrease in cytosolic translation or it could be a secondary effect of the mitochondrial translation deficit, leading to disruption of the mtDNA-dependent complexes, which can subsequently cause destabilization of the entire OXPHOS system. TRMU (tRNA 5-methylaminomethyl-2-thiouridylate methyltransferase) is responsible for the 2-thio modification of the wobble-base of the mitochondrial tRNA
Lys, tRNA
Gln and tRNA
Glu. Defects in this enzyme result in reduced steady-state levels of these three tRNAs and consequently impaired mitochondrial protein synthesis [
24,
62]. The 2-thiouridylation is reported to be critical for effective codon-anticodon interaction and ribosome binding [
234,
235].
Concerning the mitochondrial translation factors, defects have only been found in proteins involved in the elongation phase, in all elongation factors except for mtEFG2, which appears to function in termination instead elongation. In
GFM1, mutations have been reported in nearly all protein domains, leading to severe hepato(encephalo)pathy [
15,
22,
25]. All mutations result in a marked global translation defect, with the strongest deficit in the three complex IV subunits and the two complex I subunits ND5 and ND6. Both subunits of complex V (ATP6 and ATP8) show normal or even increased synthesis rates, possibly caused by more efficient protein synthesis of bicistronic compared to monocistronic mRNAs, which would then also explain the near normal mitochondrial translation levels of ND4 and ND4L. This variable pattern in translation impairment was also found for a mutation in
TSFM [
21], which will be described below. Surprisingly, tissues are selectively affected by
GFM1 mutations, in spite of its ubiquitous expression, with liver being most severely affected and heart hardly showing a defect [
25]. This tissue specificity appears to result from differences among tissues in the relative ratios of the elongation factors and in adaptive changes herein in response to dysfunction. For example, transcription of
TUFM was upregulated in cardiac tissue in patients with a
GFM1 mutation and overexpression of either
TUFM or
TSFM in control and patient fibroblasts impaired mitochondrial translation. Overexpression of
GFM2, on the contrary, did not have a clear effect on protein synthesis in either control or patient cells [
15,
25]. Remarkably, mtEFTu or mtEFG2, but not mtEFTs or mtEFG1, can partially suppress the combined OXPHOS system defect caused by the 3243A>G mutation in tRNA
Leu(UUR) [
126]. These observations evidence that efficient mitochondrial translation partly depends on appropriate ratios of the elongation factors. A homozygous mutation in
TUFM was shown to be responsible for rapidly progressive encephalopathy [
22]. The mutation, located in the tRNA-binding region of mtEFTu, hampers the formation of the ternary complex with GTP and an aminoacylated tRNA, resulting in a severe decrease in mitochondrial protein synthesis [
22,
236]. Notably, a homozygous mutation in
TSFM led to encephalomyopathy in one patient and hypertrophic cardiomyopathy in another [
21]. This could be due to individual differences in relative abundance of the translation factors and compensatory mechanisms in the various tissues. Alternatively, as yet unknown genetic modifiers of the mitochondrial translation machinery could be involved. Steady-state levels of not only mtEFTs but also mtEFTu were reduced, and overexpression of either factor rescued the OXPHOS deficiency and translation defect. The most likely explanation for these findings is that the mutation, situated in a subdomain of mtEFTs that interacts with mtEFTu, destabilizes the mtEFTu
·mtEFTs complex and promotes turnover of its components. Additional mtEFTu or mtEFTs would then stabilize the complex.
Of all 81 human MRPs, mutations have been found in merely two of them: MRPS16 and MRPS22 [
18,
19]. Both defects resulted in a marked decrease in the 12S rRNA transcript level, probably caused by impaired assembly of the mitoribosomal small subunit, generating unincorporated and instable 12S rRNA. MRPS16 is evolutionary highly conserved, however, MRPS22 is only present in metazoa [
107]. Recently, both proteins were shown to be important for assembly of the SSU [
123]. In fibroblasts from patients with a
MRPS16 or
MRPS22 mutation, the level of MRPS11 was significantly reduced, whereas considerable amounts of MRPS2 were present. Furthermore, MRPS16 was barely detectable in the
MRPS22-mutated patient. The presence of MRPS22 was not determined in these patients. On the other hand, near normal levels of MRPL13, MRPL15 [
123] as well as 16S rRNA [
18,
19] were found. These observations indicate that both MRPS16 and MRPS22 are essential for assembly and stability of the SSU. A lack of these MRPs results in the failure to assemble part of the mitoribosome, containing at least MRPS11, MRPS16, MRPS22, and 12S rRNA, and subsequent degradation of its components. Both a macromolecular complex containing MRPS2 and the mitoribosomal large subunit can still be formed in the absence of a functional SSU, suggesting that the assembly of the mitoribosome is a process consisting of relatively independent subassembly steps.
Mutations in the mitochondrial arginyl- and aspartyl-tRNA synthetases (
RARS2 and
DARS2) are associated with severe encephalopathy with pontocerebellar hypoplasia and LBSL (leukoencephalopathy with brain stem and spinal cord involvement and lactate elevation), respectively [
16,
20,
23]. In both genes, intronic mutations that affect splicing were detected. The absence of extracerebral symptoms might be explained by a potential difference in abundance of splicing factors between brain and the unaffected tissues, enabling synthesis of small amounts of wild-type transcript of the synthetases in most tissues. Alternatively, the vulnerability of the brain for aminoacyl-tRNA synthetase defects could be due to the high expression of mitochondrial tRNAs in this tissue [
237]. The tRNA
Arg transcript is scarcely present, but almost fully acylated, in patient fibroblasts harboring a
RARS2 mutation. Presumably, the little available wild-type RARS2 can aminoacylate a small portion of the tRNA
Arg molecules and the uncharged transcripts then become unstable. This will impair mitochondrial protein synthesis, which has only been confirmed in yeast [
238]. In contrast,
DARS2 mutations do not seem to affect mitochondrial translation and likewise do not result in defects of the OXPHOS complexes, notwithstanding a clear reduction in aminoacylation activity [
20]. The reason for this is currently not understood.
Besides these nine gene products, numerous proteins are indirectly involved in mitochondrial translation, as should be evident from the current review, and defects in these proteins could undoubtedly also interfere with the translation process. For example, lack of the protease paraplegin (see
Section 3.3 for information on its function) results in impaired mitochondrial translation in yeast and in a hereditary spastic paraplegia (HSP) mouse model [
143]. Nonetheless, HSP patients with mutations in paraplegin (
HSP7) do not show consistent OXPHOS enzyme deficiencies [
239–
241]; often only or mainly complex I is affected, while a combined defect would be expected. The selective involvement of certain neurons could in this case be rationalized by tissue-specific differences in the expression of m-AAA protease subunits and their assembly into proteolytic complexes, which vary in their subunit composition depending on subunit availability [
242]. This is analogous to the importance of elongation factor ratios for efficient mitochondrial translation and tissue-specific variability herein.