Leber hereditary optic neuropathy (LHON) is an inherited form of vision loss. Although this condition usually begins in a person's teens or twenties, rare cases may appear in early childhood or later in adulthood. For unknown reasons, males are affected much more often than females.

Blurring and clouding of vision are usually the first symptoms of LHON. These vision problems may begin in one eye or simultaneously in both eyes; if vision loss starts in one eye, the other eye is usually affected within several weeks or months. Over time, vision in both eyes worsens with a severe loss of sharpness (visual acuity) and color vision. This condition mainly affects central vision, which is needed for detailed tasks such as reading, driving, and recognizing faces. Vision loss results from the death of cells in the nerve that relays visual information from the eyes to the brain (the optic nerve). Although central vision gradually improves in a small percentage of cases, in most cases the vision loss is profound and permanent.

Vision loss is typically the only symptom of LHON; however, some families with additional signs and symptoms have been reported. In these individuals, the condition is described as "LHON plus." In addition to vision loss, the features of LHON plus can include movement disorders, tremors, and abnormalities of the electrical signals that control the heartbeat (cardiac conduction defects). Some affected individuals develop features similar to multiple sclerosis, which is a chronic disorder characterized by muscle weakness, poor coordination, numbness, and a variety of other health problems.

Mutations in the MT-ND1, MT-ND4, MT-ND4L, or MT-ND6 gene can cause LHON. These genes are found in the DNA of cellular structures called mitochondria, which convert the energy from food into a form that cells can use. Although most DNA is packaged in chromosomes within the nucleus, mitochondria also have a small amount of their own DNA, known as mitochondrial DNA or mtDNA.

The genes associated with LHON each provide instructions for making a protein involved in normal mitochondrial function. These proteins are part of a large enzyme complex in mitochondria that helps convert oxygen, fats, and simple sugars to energy. Mutations in any of the genes disrupt this process. It remains unclear how these genetic changes cause the death of cells in the optic nerve and lead to the specific features of LHON.

A significant percentage of people with a mutation that causes LHON do not develop any features of the disorder. Specifically, more than 50 percent of males with a mutation and more than 85 percent of females with a mutation never experience vision loss or related health problems. Additional factors may determine whether a person develops the signs and symptoms of this disorder. Environmental factors such as smoking and alcohol use may be involved, although studies have produced conflicting results. Researchers are also investigating whether changes in additional genes contribute to the development of signs and symptoms.

Normal Function

The MT-ND1 gene provides instructions for making a protein called NADH dehydrogenase 1. This protein is part of a large enzyme complex known as complex I, which is active in mitochondria. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. These cellular structures produce energy through a process called oxidative phosphorylation, which uses oxygen and simple sugars to create adenosine triphosphate (ATP), the cell's main energy source.

Complex I is one of several enzyme complexes necessary for oxidative phosphorylation. Within mitochondria, these complexes are embedded in a tightly folded, specialized membrane called the inner mitochondrial membrane. During oxidative phosphorylation, mitochondrial enzyme complexes carry out chemical reactions that drive the production of ATP. Specifically, they create an unequal electrical charge on either side of the inner mitochondrial membrane through a step-by-step transfer of negatively charged particles called electrons. This difference in electrical charge provides the energy for ATP production.

Complex I is responsible for the first step in the electron transport process, the transfer of electrons from a molecule called NADH to another molecule called ubiquinone. Electrons are then passed from ubiquinone through several other enzyme complexes to provide energy for the generation of ATP.

Health Conditions Related to Genetic Changes

Leber hereditary optic neuropathy

Several mutations in the MT-ND1 gene are known to cause Leber hereditary optic neuropathy. Each of these mutations changes a single DNA building block (nucleotide) in the gene. One common MT-ND1 mutation is responsible for about 13 percent of all cases of Leber hereditary optic neuropathy. This mutation replaces the nucleotide guanine with the nucleotide adenine at gene position 3460 (written as G3460A). This change is associated with moderately severe cases of Leber hereditary optic neuropathy; however, 20 percent to 40 percent of people with vision loss due to this mutation experience some recovery of vision.

Researchers are investigating how mutations in the MT-ND1 gene lead to Leber hereditary optic neuropathy. These genetic changes appear to disrupt the normal activity of complex I in the mitochondrial inner membrane, which may affect the generation of ATP. MT-ND1 mutations also may increase the production within mitochondria of potentially harmful molecules called reactive oxygen species. It remains unclear, however, why the effects of these mutations are often limited to the nerve that relays visual information from the eye to the brain (the optic nerve). Additional genetic and environmental factors probably contribute to the vision loss and other medical problems associated with Leber hereditary optic neuropathy.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes

MT-ND1 mutations are a rare cause of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). Most cases of MELAS are caused by mutations in other mitochondrial genes, but a small number of cases resulting from mutations in the MT-ND1 gene have been reported. Fewer than five mutations, each of which alters a single DNA building block (nucleotide) in the gene, have been identified in affected individuals. These genetic changes reduce the activity of complex I, which disrupts energy production within mitochondria. Although these abnormalities have the greatest impact on tissues that require a lot of energy (such as the brain and muscles), researchers have not determined how changes in the MT-ND1 gene lead to the specific signs and symptoms of MELAS.

Leigh syndrome

MedlinePlus Genetics provides information about Leigh syndrome

Mitochondrial complex I deficiency

MedlinePlus Genetics provides information about Mitochondrial complex I deficiency

Other disorders

A mutation in the MT-ND1 gene has been reported in a few cases of adult-onset dystonia. Dystonia is a movement disorder that involves involuntary tensing of the muscles (muscle contractions), tremors, and other uncontrolled movements. The MT-ND1 mutation associated with these rare cases replaces the nucleotide adenine with the nucleotide guanine at gene position 3796 (written as A3796G). Further studies are needed to determine whether this genetic change combines with other genetic and environmental factors to increase the risk of developing adult-onset dystonia.

Other Names for This Gene

• mitochondrially encoded NADH dehydrogenase 1
• MTND1
• NADH dehydrogenase 1
• NADH dehydrogenase subunit 1
• NADH-ubiquinone oxidoreductase chain 1
• NADH-ubiquinone oxidoreductase, subunit ND1
• ND1
• NU1M_HUMAN

Genomic Location

Normal Function

The MT-ND4 gene provides instructions for making a protein called NADH dehydrogenase 4. This protein is part of a large enzyme complex known as complex I, which is active in mitochondria. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. These cellular structures produce energy through a process called oxidative phosphorylation, which uses oxygen and simple sugars to create adenosine triphosphate (ATP), the cell's main energy source.

Complex I is one of several enzyme complexes necessary for oxidative phosphorylation. Within mitochondria, these complexes are embedded in a tightly folded, specialized membrane called the inner mitochondrial membrane. During oxidative phosphorylation, mitochondrial enzyme complexes carry out chemical reactions that drive the production of ATP. Specifically, they create an unequal electrical charge on either side of the inner mitochondrial membrane through a step-by-step transfer of negatively charged particles called electrons. This difference in electrical charge provides the energy for ATP production.

Complex I is responsible for the first step in the electron transport process, the transfer of electrons from a molecule called NADH to another molecule called ubiquinone. Electrons are then passed from ubiquinone through several other enzyme complexes to provide energy for the generation of ATP.

Health Conditions Related to Genetic Changes

Leber hereditary optic neuropathy

Several variants (also called mutations) in the MT-ND4 gene are known to cause Leber hereditary optic neuropathy. This condition is an inherited form of vision loss. Each of these variants changes a single protein building block (amino acid) in the NADH dehydrogenase 4 protein.

One MT-ND4 gene variant is the most common cause of Leber hereditary optic neuropathy; it is responsible for about 70 percent of all cases worldwide. This variant, which can be written as G11778A or Arg340His, replaces the amino acid arginine with the amino acid histidine at protein position 340. This variant tends to cause severe vision loss, with little chance of recovery.

Researchers are investigating how variants in the MT-ND4 gene lead to Leber hereditary optic neuropathy. These genetic changes appear to prevent complex I from interacting normally with ubiquinone, which may affect the generation of ATP. MT-ND4 gene variants may also increase the production within mitochondria of potentially harmful molecules called reactive oxygen species. It remains unclear, however, why the effects of these variants are often limited to the nerve that relays visual information from the eye to the brain (the optic nerve). Additional genetic and environmental factors probably contribute to the vision loss and other medical problems associated with Leber hereditary optic neuropathy.

Leigh syndrome

A variant in the MT-ND4 gene also has been identified in a small number of people with Leigh syndrome, a progressive brain disorder that typically appears in infancy or early childhood. Affected children may experience vomiting, seizures, delayed development, muscle weakness, and problems with movement. Heart disease, kidney problems, and difficulty breathing can also occur in people with this disorder.

The MT-ND4 variant that can cause Leigh syndrome, written as C11777A or Arg340Ser, replaces the amino acid arginine with the amino acid serine at protein position 340. This genetic change appears to disrupt the normal function of complex I in mitochondria. It is not known, however, how this MT-ND4 gene variant is related to the specific features of Leigh syndrome.

Mitochondrial complex I deficiency

MedlinePlus Genetics provides information about Mitochondrial complex I deficiency

Other Names for This Gene

• mitochondrially encoded NADH dehydrogenase 4
• MTND4
• NADH dehydrogenase 4
• NADH dehydrogenase subunit 4
• NADH-ubiquinone oxidoreductase chain 4
• NADH-ubiquinone oxidoreductase, subunit ND4
• ND4
• NU4M_HUMAN

Genomic Location

Normal Function

The MT-ND4L gene provides instructions for making a protein called NADH dehydrogenase 4L. This protein is part of a large enzyme complex known as complex I, which is active in mitochondria. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. These cellular structures produce energy through a process called oxidative phosphorylation, which uses oxygen and simple sugars to create adenosine triphosphate (ATP), the cell's main energy source.

Complex I is one of several enzyme complexes necessary for oxidative phosphorylation. Within mitochondria, these complexes are embedded in a tightly folded, specialized membrane called the inner mitochondrial membrane. During oxidative phosphorylation, mitochondrial enzyme complexes carry out chemical reactions that drive the production of ATP. Specifically, they create an unequal electrical charge on either side of the inner mitochondrial membrane through a step-by-step transfer of negatively charged particles called electrons. This difference in electrical charge provides the energy for ATP production.

Complex I is responsible for the first step in the electron transport process, the transfer of electrons from a molecule called NADH to another molecule called ubiquinone. Electrons are then passed from ubiquinone through several other enzyme complexes to provide energy for the generation of ATP.

Health Conditions Related to Genetic Changes

Leber hereditary optic neuropathy

A mutation in the MT-ND4L gene has been identified in several families with Leber hereditary optic neuropathy. This mutation, which can be written as T10663C or Val65Ala, changes a single protein building block (amino acid) in the NADH dehydrogenase 4L protein. Specifically, it replaces the amino acid valine with the amino acid alanine at protein position 65.

Researchers have not determined how a mutation in the MT-ND4L gene can lead to the vision loss characteristic of Leber hereditary optic neuropathy. This genetic change appears to disrupt the normal activity of complex I in the mitochondrial inner membrane, which may affect the production of ATP. It remains unclear, however, why the effects of this mutation are limited to the nerve that relays visual information from the eye to the brain (the optic nerve). Additional genetic and environmental factors probably contribute to the features of Leber hereditary optic neuropathy.

Mitochondrial complex I deficiency

MedlinePlus Genetics provides information about Mitochondrial complex I deficiency

Other Names for This Gene

• Complex I, subunit ND4L
• mitochondrially encoded NADH 4L
• mitochondrially encoded NADH dehydrogenase 4L
• MTND4L
• NADH dehydrogenase 4L
• NADH dehydrogenase subunit 4L
• NADH-ubiquinone oxidoreductase chain 4L
• NADH-ubiquinone oxidoreductase, subunit ND4L
• NADH4L
• ND4L
• NU4LM_HUMAN

Genomic Location

Normal Function

The MT-ND6 gene provides instructions for making a protein called NADH dehydrogenase 6. This protein is part of a large enzyme complex known as complex I, which is active in mitochondria. Mitochondria are structures within cells that convert the energy from food into a form that cells can use. These cellular structures produce energy through a process called oxidative phosphorylation, which uses oxygen and simple sugars to create adenosine triphosphate (ATP), the cell's main energy source.

Complex I is one of several enzyme complexes necessary for oxidative phosphorylation. Within mitochondria, these complexes are embedded in a tightly folded, specialized membrane called the inner mitochondrial membrane. During oxidative phosphorylation, mitochondrial enzyme complexes carry out chemical reactions that drive the production of ATP. Specifically, they create an unequal electrical charge on either side of the inner mitochondrial membrane through a step-by-step transfer of negatively charged particles called electrons. This difference in electrical charge provides the energy for ATP production.

Complex I is responsible for the first step in the electron transport process, the transfer of electrons from a molecule called NADH to another molecule called ubiquinone. Electrons are then passed from ubiquinone through several other enzyme complexes to provide energy for the generation of ATP.

Health Conditions Related to Genetic Changes

Leber hereditary optic neuropathy

Several variants (also called mutations) in the MT-ND6 gene have been identified in people with Leber hereditary optic neuropathy. This condition is an inherited form of vision loss. Each of the MT-ND6 gene variants changes a single protein building block (amino acid) in the NADH dehydrogenase 6 protein. One common MT-ND6 gene variant is responsible for about 14 percent of all cases of Leber hereditary optic neuropathy, and it is the most common cause of this disorder among people of French Canadian descent. This genetic change, written as T14484C or Met64Val, replaces the amino acid methionine with the amino acid valine at protein position 64. The T14484C variant is associated with a good long-term prognosis; affected people with this genetic change have a 37 percent to 65 percent chance of some visual recovery.

Researchers are investigating how variants in the MT-ND6 gene lead to Leber hereditary optic neuropathy. These genetic changes appear to prevent complex I from interacting normally with ubiquinone, which may affect the generation of ATP.

Variants another gene called MT-ND4 may also increase the production within mitochondria of potentially harmful molecules called reactive oxygen species. It remains unclear, however, why the effects of these variants are often limited to the nerve that relays visual information from the eye to the brain (the optic nerve). Additional genetic and environmental factors probably contribute to the vision loss and other medical problems associated with Leber hereditary optic neuropathy.

Leigh syndrome

A variant in the MT-ND6 gene also has been identified in a small number of people with Leigh syndrome, a progressive brain disorder that typically appears in infancy or early childhood. Affected children may experience vomiting, seizures, delayed development, muscle weakness, and problems with movement. Heart disease, kidney problems, and difficulty breathing can also occur in people with Leigh syndrome.

The MT-ND6 gene variant that can cause Leigh syndrome, written as G14459A or Ala72Val, replaces the amino acid alanine with the amino acid valine at protein position 72. This genetic change also has been found in people with Leber hereditary optic neuropathy and a movement disorder called dystonia, which involves involuntary muscle contractions, tremors, and other uncontrolled movements. This variant appears to disrupt the normal assembly or activity of complex I in mitochondria. It is not known, however, how this MT-ND6 gene alteration is related to the specific features of Leigh syndrome, Leber hereditary optic neuropathy, or dystonia. It also remains unclear why a single variant can cause such varied signs and symptoms in different people.

Mitochondrial complex I deficiency

MedlinePlus Genetics provides information about Mitochondrial complex I deficiency

Other Names for This Gene

• mitochondrially encoded NADH dehydrogenase 6
• MTND6
• NADH dehydrogenase 6
• NADH dehydrogenase subunit 6
• NADH-ubiquinone oxidoreductase chain 6
• NADH-ubiquinone oxidoreductase, subunit ND6
• ND6
• NU6M_HUMAN

Genomic Location

LHON has a mitochondrial pattern of inheritance, which is also known as maternal inheritance. This pattern of inheritance applies to genes contained in mtDNA. Because egg cells, but not sperm cells, contribute mitochondria to the developing embryo, children can only inherit disorders resulting from mtDNA mutations from their mother. These disorders can appear in every generation of a family and can affect both males and females, but fathers do not pass traits associated with changes in mtDNA to their children.

Often, people who develop the features of LHON have no family history of the condition. Because a person may carry an mtDNA mutation without experiencing any signs or symptoms, it is hard to predict which members of a family who carry a mutation will eventually develop vision loss or other problems associated with LHON. It is important to note that all females with an mtDNA mutation, even those who do not have any signs or symptoms, will pass the genetic change to their children.

Leber hereditary optic neuropathy (LHON) is characterized by bilateral, painless, and almost sudden vision failure that develops in young adulthood (around 20 to 30 years of age). About 95% of affected people lose their vision before age 50. It is more common in males. Signs and symptoms include:

• Blurring and clouding of vision (usually the first symptoms) affecting the central visual field
• Severe loss of visual acuity (sharpness of vision) and color vision over time
• Loss of ability to complete visual tasks such as reading, driving, and recognizing faces
• A growing, dense central scotoma (blind spot) seen during visual field testing
• Development of optic atrophy

Most people with LHON eventually qualify for registration as legally blind.

In rare cases, additional symptoms may include heart arrhythmias; neurologic abnormalities (e.g., tremor, peripheral neuropathy, movement disorders); and features similar to those seen in multiple sclerosis.

A significant proportion of people with a mutation known to cause LHON do not develop any features. Specifically, more than 50% of males with a mutation and more than 85% of females with a mutation never experience vision loss or related medical problems.

The prevalence of LHON in most populations is unknown. It affects 1 in 30,000 to 50,000 people in northeast England and Finland.