Tryptophan-tRNA Ligase

色氨酸 - tRNA 连接酶
  • 文章类型: Journal Article
    L-色氨酸(Trp)转运系统对Trp具有高度选择性,亲和力在纳摩尔范围内。在人干扰素(IFN)-γ处理的和吲哚胺2,3-双加氧酶1(IDO1)表达的细胞中,这种运输系统得到了增强。上调Trp的细胞摄取导致细胞外Trp减少并引发免疫抑制。最近的研究表明,IDO1和色氨酸-tRNA合成酶(TrpRS),其表达水平由IFN-γ上调,在人细胞的高亲和力Trp摄取中起关键作用。此外,色氨酸2,3-双加氧酶(TDO2)的过表达对TrpRS介导的高亲和力Trp摄取具有与IDO1相似的作用。在这次审查中,我们总结了有关Trp摄取系统的最新发现,并提出了基于IDO1或TDO2诱导的Trp缺乏和TrpRS产生色氨酸-AMP的可能分子机制。
    The L-tryptophan (Trp) transport system is highly selective for Trp with affinity in the nanomolar range. This transport system is augmented in human interferon (IFN)-γ-treated and indoleamine 2,3-dioxygenase 1 (IDO1)-expressing cells. Up-regulated cellular uptake of Trp causes a reduction in extracellular Trp and initiates immune suppression. Recent studies demonstrate that both IDO1 and tryptophanyl-tRNA synthetase (TrpRS), whose expression levels are up-regulated by IFN-γ, play a pivotal role in high-affinity Trp uptake into human cells. Furthermore, overexpression of tryptophan 2,3-dioxygenase (TDO2) elicits a similar effect as IDO1 on TrpRS-mediated high-affinity Trp uptake. In this review, we summarize recent findings regarding this Trp uptake system and put forward a possible molecular mechanism based on Trp deficiency induced by IDO1 or TDO2 and tryptophanyl-AMP production by TrpRS.
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  • 文章类型: Journal Article
    伪狂犬病病毒(PRV)被认为是导致Aujeszky病的双螺旋DNA病毒,这导致了全球相当大的经济影响。色氨酸-tRNA合成酶2(WARS2),参与蛋白质合成的线粒体蛋白质,其广泛的表达和在翻译过程中的重要作用是公认的。我们的研究结果表明,在细胞培养和动物模型中,PRV感染后WARS2的mRNA和蛋白质水平均增加。通过RNA干扰抑制PK-15细胞中的WARS2表达导致PRV感染率降低,而增强WARS2表达导致感染率增加。此外,发现响应PRV的WARS2激活依赖于cGAS/STING/TBK1/IRF3信号通路和干扰素-α受体-1,突出了其通过I型干扰素信号通路的调节.进一步的分析表明,降低WARS2水平阻碍了PRV促进蛋白质和脂质合成的能力。我们的研究提供了新的证据,表明WARS2通过其蛋白质和脂质水平的管理促进PRV感染,为开发针对PRV感染的预防和治疗措施提供了新的途径。
    The pseudorabies virus (PRV) is identified as a double-helical DNA virus responsible for causing Aujeszky\'s disease, which results in considerable economic impacts globally. The enzyme tryptophanyl-tRNA synthetase 2 (WARS2), a mitochondrial protein involved in protein synthesis, is recognized for its broad expression and vital role in the translation process. The findings of our study showed an increase in both mRNA and protein levels of WARS2 following PRV infection in both cell cultures and animal models. Suppressing WARS2 expression via RNA interference in PK-15 ​cells led to a reduction in PRV infection rates, whereas enhancing WARS2 expression resulted in increased infection rates. Furthermore, the activation of WARS2 in response to PRV was found to be reliant on the cGAS/STING/TBK1/IRF3 signaling pathway and the interferon-alpha receptor-1, highlighting its regulation via the type I interferon signaling pathway. Further analysis revealed that reducing WARS2 levels hindered PRV\'s ability to promote protein and lipid synthesis. Our research provides novel evidence that WARS2 facilitates PRV infection through its management of protein and lipid levels, presenting new avenues for developing preventative and therapeutic measures against PRV infections.
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  • 文章类型: Journal Article
    结核病(TB)是由结核分枝杆菌引起的主要传染病,是仅次于COVID-19的第二大传染性杀手。耐药结核病的出现引起了对鉴定和开发具有新靶标的新抗结核药物的极大需求。吲哚丙酸(IPA),色氨酸(Trp)的结构类似物,在体外和体内对结核分枝杆菌具有活性。已经证实,IPA通过模拟Trp作为TrpE的变构抑制剂来发挥其抗菌作用,它是结核分枝杆菌Trp合成途径中的第一个酶。然而,其他Trp结构类似物,如吲哚霉素,还靶向色氨酸-tRNA合成酶(TrpRS),在细菌中具有两个功能:通过催化ATPTrp合成色氨酸-AMP,通过将Trp转移到tRNATrp来产生Trp-tRNATrp。所以,我们推测IPA也可能靶向TrpRS。在这项研究中,我们发现IPA可以对接到结核分枝杆菌TrpRS(TrpRSMtb)的Trp结合袋中,等温滴定量热法(ITC)进一步证实了这一点。生化分析表明,TrpRS可以催化IPA与ATP之间的反应生成焦磷酸盐(PPi),而无需Trp作为底物。野生型trpS在结核分枝杆菌中的过表达使IPA的MIC增加到32倍,在耻垢分枝杆菌中敲除trpS使其对IPA更加敏感。在培养基中补充Trp消除了IPA对结核分枝杆菌的抑制。我们证明了IPA可以通过模仿Trp来干扰TrpRS的功能,从而阻碍蛋白质合成并发挥其抗TB作用。
    Tuberculosis (TB) is the leading infectious disease caused by Mycobacterium tuberculosis and the second-most contagious killer after COVID-19. The emergence of drug-resistant TB has caused a great need to identify and develop new anti-TB drugs with novel targets. Indole propionic acid (IPA), a structural analog of tryptophan (Trp), is active against M. tuberculosis in vitro and in vivo. It has been verified that IPA exerts its antimicrobial effect by mimicking Trp as an allosteric inhibitor of TrpE, which is the first enzyme in the Trp synthesis pathway of M. tuberculosis. However, other Trp structural analogs, such as indolmycin, also target tryptophanyl-tRNA synthetase (TrpRS), which has two functions in bacteria: synthesis of tryptophanyl-AMP by catalyzing ATP + Trp and producing Trp-tRNATrp by transferring Trp to tRNATrp. So, we speculate that IPA may also target TrpRS. In this study, we found that IPA can dock into the Trp binding pocket of M. tuberculosis TrpRS (TrpRSMtb), which was further confirmed by isothermal titration calorimetry (ITC) assay. The biochemical analysis proved that TrpRS can catalyze the reaction between IPA and ATP to generate pyrophosphate (PPi) without Trp as a substrate. Overexpression of wild-type trpS in M. tuberculosis increased the MIC of IPA to 32-fold, and knock-down trpS in Mycolicibacterium smegmatis made it more sensitive to IPA. The supplementation of Trp in the medium abrogated the inhibition of M. tuberculosis by IPA. We demonstrated that IPA can interfere with the function of TrpRS by mimicking Trp, thereby impeding protein synthesis and exerting its anti-TB effect.
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  • 文章类型: Journal Article
    目的:色氨酸-tRNA合成酶1基因(WARS1),编码一种色氨酸-tRNA合成酶,参与色氨酸-tRNA的氨基酸化,据报道参与癌细胞生长,转移促进,以及多种癌症的耐药性。这项研究调查了WARS1表达作为生物标志物在接受根治性切除术的局部晚期胃癌(GC)患者胃癌组织中的临床意义。
    方法:采用定量聚合酶链反应(PCR)检测253例接受根治性切除的pStageII/III期GC患者GC组织和邻近正常胃粘膜中WARS1的表达。WARS1表达水平的关联,根据中位数表达水平分为高表达和低表达,评估了这些患者的临床病理因素和总生存期(OS).
    结果:低WARS1表达组浆膜浸润明显增高,淋巴结转移,淋巴侵入,静脉侵入,病理分期高于WARS1高表达组。低表达组的OS显著低于高表达组(5年生存率52.2%vs.75.9%;p=0.0001)。此外,在多变量分析中,低WARS1表达是OS差的独立预测因子(风险比=2.101;95%置信区间=1.328-3.322;p=0.002).
    结论:在局部晚期GC患者中,治愈性切除后,WARS1在GC组织中的表达可能是一个有用的预后标志物。
    OBJECTIVE: The tryptophanyl-tRNA synthetase 1 gene (WARS1), encodes a tryptophan-tRNA synthetase involved in the amino acidification of tryptophan-tRNA and has been reported to be involved in cancer cell growth, metastasis promotion, and drug resistance in a variety of cancers. This study investigated the clinical significance of WARS1 expression as a biomarker in gastric cancer tissues obtained from patients with locally advanced gastric cancer (GC) who underwent radical resection.
    METHODS: WARS1 expression in GC tissues and adjacent normal gastric mucosa of 253 patients with pStage II/III GC who underwent curative resection was determined using quantitative polymerase chain reaction (PCR). Association of WARS1 expression levels, categorized into high and low expression based on the median expression levels, with clinicopathological factors and overall survival (OS) of these patients was assessed.
    RESULTS: The low-WARS1 expression group had significantly higher serosal invasion, lymph node metastasis, lymphatic invasion, venous invasion, and pathological stage than did the high-WARS1 expression group. OS was significantly worse in the low- than in the high-WARS1 expression group (5-year survival 52.2% vs. 75.9%; p=0.0001). Furthermore, in multivariate analysis, low WARS1 expression was an independent predictor for poor OS (hazard ratio=2.101; 95% confidence interval=1.328-3.322; p=0.002).
    CONCLUSIONS: In patients with locally advanced GC, after curative resection, WARS1 expression in GC tissue may be a useful prognostic marker.
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  • 文章类型: Journal Article
    氨酰基-tRNA合成酶(aaRS)是负责将转移RNA(tRNA)与所有生命界中存在的同源氨基酸连接的必需酶。除了它们的氨酰tRNA合成酶活性,据描述,许多这些酶可以执行非规范的功能。它们被证明参与了重要的生物过程,如新陈代谢,豁免权,发展,血管生成和肿瘤发生。在目前的工作中,我们提供的证据表明,色氨酸-tRNA合成酶可能参与减轻某些干扰素-γ诱导基因表达的负反馈回路.挖掘可用的TCGA和Gtex数据,我们发现,与其他癌症相比,WARS在皮肤黑色素瘤(SKCM)中高表达,并且对于该特定癌症类型具有良好的预后.WARS表达与参与抗原加工和呈递的基因以及参与IFN-γ信号传导的转录因子(如STAT1)相关。此外,在用IFN-γ处理的A375细胞中发现WARS与STAT1的复合物。最后,我们发现,在IFN-γ刺激期间敲低WARS的表达进一步增加了GBP2,APOL1,ISG15,HLA-A和IDO1的表达。
    Aminoacyl-tRNA synthetases (aaRSs) are essential enzymes responsible for linking a transfer RNA (tRNA) with its cognate amino acid present in all the kingdoms of life. Besides their aminoacyl-tRNA synthetase activity, it was described that many of these enzymes can carry out non-canonical functions. They were shown to be involved in important biological processes such as metabolism, immunity, development, angiogenesis and tumorigenesis. In the present work, we provide evidence that tryptophanyl-tRNA synthetase might be involved in a negative feedback loop mitigating the expression of certain interferon-γ-induced genes. Mining the available TCGA and Gtex data, we found that WARS was highly expressed in cutaneous melanoma (SKCM) compared to other cancers and is of good prognosis for this particular cancer type. WARS expression correlates with genes involved in antigen processing and presentation but also transcription factors involved in IFN-γ signaling such as STAT1. In addition, WARS was found in complex with STAT1 in A375 cells treated with IFN-γ. Finally, we showed that knocking down WARS expression during IFN-γ stimulation further increases the expression of GBP2, APOL1, ISG15, HLA-A and IDO1.
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  • 文章类型: Journal Article
    尽管进行了大量的临床和科学努力,由于缺乏用于患者分层和治疗指导的精确生物标志物,脓毒症的死亡率仍然很高.分泌的人色氨酸-tRNA合成酶1(WARS1),Toll样受体(TLR)2和TLR4抗感染的内源性配体,激活表示高炎性败血症表型的基因。高血浆WARS1水平对脓毒症危重患者早期死亡分层,随着细胞因子水平的升高,趋化因子,和乳酸,以及绝对中性粒细胞和单核细胞数量的增加,和更高的序贯器官衰竭评估(SOFA)评分。这些症状在患有高细胞因子血症的严重脓毒症小鼠中得到了概括。Further,向轻度脓毒症小鼠注射WARS1会恶化发病率和死亡率。我们创建了一种抗人WARS1中和抗体,该抗体可抑制内毒素血症小鼠的促炎细胞因子表达。将这种抗体给予严重的败血症小鼠,减轻细胞因子风暴,器官衰竭,早期死亡。用抗生素,抗体几乎完全预防了死亡。这些数据表明,血液循环WARS1指导的抗WARS1治疗可能为危及生命的全身性高炎性败血症提供一种新的治疗策略。
    Despite intensive clinical and scientific efforts, the mortality rate of sepsis remains high due to the lack of precise biomarkers for patient stratification and therapeutic guidance. Secreted human tryptophanyl-tRNA synthetase 1 (WARS1), an endogenous ligand for Toll-like receptor (TLR) 2 and TLR4 against infection, activates the genes that signify the hyperinflammatory sepsis phenotype. High plasma WARS1 levels stratified the early death of critically ill patients with sepsis, along with elevated levels of cytokines, chemokines, and lactate, as well as increased numbers of absolute neutrophils and monocytes, and higher Sequential Organ Failure Assessment (SOFA) scores. These symptoms were recapitulated in severely ill septic mice with hypercytokinemia. Further, injection of WARS1 into mildly septic mice worsened morbidity and mortality. We created an anti-human WARS1-neutralizing antibody that suppresses proinflammatory cytokine expression in marmosets with endotoxemia. Administration of this antibody into severe septic mice attenuated cytokine storm, organ failure, and early mortality. With antibiotics, the antibody almost completely prevented fatalities. These data imply that blood-circulating WARS1-guided anti-WARS1 therapy may provide a novel theranostic strategy for life-threatening systemic hyperinflammatory sepsis.
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  • 文章类型: Journal Article
    我们先前的研究表明,L-色氨酸(Trp)耗尽的细胞在细胞外色氨酸-tRNA合成酶(TrpRS)的促进下显示出Trp摄取的显着增强。这里,我们表明,在Trp饥饿后,Trp对TrpRS过表达细胞的摄取也显着升高。这些发现表明Trp缺乏对Trp摄取至关重要,不仅进入已添加TrpRS蛋白的细胞,而且进入过表达TrpRS的细胞。我们还显示TrpRS突变体的过表达,不能合成色氨酰-AMP,不促进Trp摄取,色氨酸-AMP合成的抑制抑制了这种吸收。总的来说,这些数据表明,TrpRS产生色氨酸-AMP对于高亲和力Trp摄取至关重要。
    Our previous study demonstrated that L-tryptophan (Trp)-depleted cells display a marked enhancement in Trp uptake facilitated by extracellular tryptophanyl-tRNA synthetase (TrpRS). Here, we show that Trp uptake into TrpRS-overexpressing cells is also markedly elevated upon Trp starvation. These findings indicate that a Trp-deficient condition is critical for Trp uptake, not only into cells to which TrpRS protein has been added but also into TrpRS-overexpressing cells. We also show that overexpression of TrpRS mutants, which cannot synthesize tryptophanyl-AMP, does not promote Trp uptake, and that inhibition of tryptophanyl-AMP synthesis suppresses this uptake. Overall, these data suggest that tryptophanyl-AMP production by TrpRS is critical for high-affinity Trp uptake.
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  • 文章类型: Journal Article
    目的:本研究旨在测试色氨酸-tRNA合成酶1(WARS1)对脓毒症患者28天死亡率的预后价值是否受单核细胞减少的影响。
    方法:对74例脓毒症患者的回顾性样本进行前瞻性分析。WARS1,C反应蛋白(CRP),在入院时以及入院后24小时和72小时测量降钙素原。WARS1、CRP、使用重复测量方差分析(ANOVA)和受试者工作特征曲线下面积(AUROC)比较28天死亡率和降钙素原.所有分析均在有或没有单核细胞减少症的患者中进行,定义为绝对单核细胞计数小于0.1×109个细胞/L。
    结果:当评估所有患者和无单核细胞减少患者时,幸存者和非幸存者之间的WARS1水平存在显著差异(分别为p=0.008,p<0.001)。相比之下,单核细胞减少的幸存者和非幸存者的WARS1水平没有差异.无论是否患有单核细胞减少症,幸存者和非幸存者的CRP和降钙素原水平均无差异。WARS1在入院时和24小时死亡率的AUROC(0.830,0.818)明显高于单核细胞减少患者(0.232,0.196;p<0.001,两者)。当没有单核细胞减少症的患者进行分析时,WARS1对死亡率的AUROC分别为入院时和24小时时的0.830和0.818,分别,显著高于CRP(0.586,0.653)和降钙素原(0.456,0.453)(p分别为0.024和0.034)。
    结论:WARS1是无单核细胞减少的脓毒症患者预后的有用生物标志物。
    UNASSIGNED: Objective: This study aimed to test whether the prognostic value of tryptophanyl-tRNA synthetase 1 (WARS1) for 28-day mortality in patients with sepsis was affected by monocytopenia. Methods: A prospective analysis of retrospectively collected samples from 74 sepsis patients was performed. WARS1, C-reactive protein (CRP), and procalcitonin were measured at admission and 24 and 72 h after admission. The prognostic value of WARS1, CRP, and procalcitonin for 28-day mortality was compared using repeated measures analysis of variance and the area under the receiver operating characteristic curve (AUROC). All analyses were performed in patients with or without monocytopenia, defined as an absolute monocyte count less than 0.1 × 10 9 cells/L. Results: WARS1 levels differed significantly between survivors and nonsurvivors when all patients and patients without monocytopenia were assessed ( P = 0.008, P < 0.001, respectively). In contrast, the WARS1 level did not differ between survivors and nonsurvivors with monocytopenia. C-reactive protein and procalcitonin levels were not different between survivors and nonsurvivors regardless of whether they had monocytopenia. The AUROCs of WARS1 at admission and 24 h for mortality were significantly higher in patients without monocytopenia (0.830, 0.818) than in patients with monocytopenia (0.232, 0.196; P < 0.001, both). When patients without monocytopenia were analyzed, the AUROCs of WARS1 for mortality were 0.830 and 0.818 at admission and 24 h, respectively, which were significantly higher than those of CRP (0.586, 0.653) and procalcitonin (0.456, 0.453) at the same time points ( P = 0.024 and 0.034, respectively). Conclusion: WARS1 is a useful biomarker for prognosis in sepsis patients without monocytopenia.
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  • 文章类型: Journal Article
    色氨酸-tRNA合成酶(WRS)是参与蛋白质合成的关键酶,负责向tRNA加载必需氨基酸色氨酸。最近的研究强调了其在刺激针对细菌和病毒感染的先天免疫中的新作用。然而,WRS在严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染中的意义仍然难以捉摸。在这项研究中,我们的目的是调查WRS之间复杂的相互作用,炎症标志物,Toll样受体-4(TLR-4),冠状病毒病19例(COVID-19)患者的临床结局。一项病例对照调查包括127例COVID-19患者,入院时仔细分类为重度或中度,和112名健康个体作为比较组。在治疗开始前精心收集血液样本,WRS,白细胞介素-6(IL-6),和C-反应蛋白(CRP)浓度使用公认的商业ELISA试剂盒进行定量。从血液样品中分离外周血单核细胞(PBMC),提取RNA进行cDNA合成。采用半定量实时聚合酶链反应(PCR)评估TLR-4的相对表达。COVID-19患者表现出WRS水平升高,IL-6,CRP,和TLR-4表达与健康个体相比,重度组的水平明显高于中度组。值得注意的是,重症患者显示CRP大幅波动,IL-6和WRS水平随着时间的推移,在他们的温和同行中没有观察到的模式。尽管在WRS的动态变化中没有观察到明显的差异,IL-6,CRP,和TLR-4在死亡和存活患者之间的表达,出现了一种趋势,表明死亡患者的IL-6_1水平较高,而死于该疾病的重症患者的乳酸脱氢酶(LDH)水平升高。这项开创性的研究强调了COVID-19患者WRS的动态变化,为WRS之间的相关性提供有价值的见解,炎症标志物,以及该人群中疾病的严重程度。了解WRS在SARS-CoV-2感染中的作用可能会为针对先天免疫的治疗性干预措施开辟新的途径,以对抗COVID-19。
    Tryptophanyl-tRNA synthetase (WRS) is a critical enzyme involved in protein synthesis, responsible for charging tRNA with the essential amino acid tryptophan. Recent studies have highlighted its novel role in stimulating innate immunity against bacterial and viral infections. However, the significance of WRS in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains elusive. In this study, we aimed to investigate the complex interplay between WRS, inflammatory markers, Toll-like receptor-4 (TLR-4), and clinical outcomes in coronavirus disease 19 (COVID-19) patients. A case-control investigation comprised 127 COVID-19 patients, carefully classified as severe or moderate upon admission, and 112 healthy individuals as a comparative group. Blood samples were meticulously collected before treatment initiation, and WRS, interleukin-6 (IL-6), and C-reactive protein (CRP) concentrations were quantified using a well-established commercial ELISA kit. Peripheral blood mononuclear cells (PBMCs) were isolated from the blood samples, and RNA was extracted for cDNA synthesis. Semi-quantitative real-time polymerase chain reaction (PCR) was employed to assess the relative expression of TLR-4. COVID-19 patients exhibited elevated levels of WRS, IL-6, CRP, and TLR-4 expression compared to healthy individuals, with the severe group displaying significantly higher levels than the moderate group. Notably, severe patients demonstrated substantial fluctuations in CRP, IL-6, and WRS levels over time, a pattern not observed in their moderate counterparts. Although no significant distinctions were observed in the dynamic alterations of WRS, IL-6, CRP, and TLR-4 expression between deceased and surviving patients, a trend emerged indicating higher IL-6_1 levels in deceased patients and elevated lactate dehydrogenase (LDH) levels in severe patients who succumbed to the disease. This pioneering research highlights the dynamic alterations of WRS in COVID-19 patients, providing valuable insights into the correlation between WRS, inflammatory markers, and disease severity within this population. Understanding the role of WRS in SARS-CoV-2 infection may open new avenues for therapeutic interventions targeting innate immunity to combat COVID-19.
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  • 文章类型: Review
    色氨酸-tRNA合成酶(WARS2)线粒体形式的双等位基因变体可引起神经发育障碍,包括运动障碍,包括早发性震颤-帕金森病综合征。这里,我们描述了四个新病人,他们都在年轻时出现震颤-帕金森病综合征,对左旋多巴反应良好。所有患者都携带相同的复发性疾病,双态错义变体(NM_015836.4:c.37T>G;p.Trp13Gly)与先前描述的截断变体(NM_015836.4:c.797Cdel;p.Pro266ArgfsTer10)一起,一个新的截短变体(NM_015836.4:c.346C>T;p.Gln116Ter),一种新的典型剪接位点变体(NM_015836.4:c.349-1G>A),或一个新颖的错义变体(NM_015836.4:c.475A>C,p.Thr159Pro)。我们调查了患者的线粒体功能,发现线粒体编码的细胞色素C氧化酶II作为线粒体呼吸链的一部分的水平升高,线粒体完整性和分支降低。最后,我们进行了文献综述,并在此总结了已报道的WARS2相关疾病的广泛表型谱.总之,由于广泛的表型谱和相对常见的错义变化的疾病相关性,WARS2相关疾病在诊断上具有挑战性,通常在诊断环境中被过滤掉,因为它发生在约0.5%的普通欧洲人群中。
    Biallelic variants in the mitochondrial form of the tryptophanyl-tRNA synthetases (WARS2) can cause a neurodevelopmental disorder with movement disorders including early-onset tremor-parkinsonism syndrome. Here, we describe four new patients, who all presented at a young age with a tremor-parkinsonism syndrome and responded well to levodopa. All patients carry the same recurrent, hypomorphic missense variant (NM_015836.4: c.37T>G; p.Trp13Gly) either together with a previously described truncating variant (NM_015836.4: c.797Cdel; p.Pro266ArgfsTer10), a novel truncating variant (NM_015836.4: c.346C>T; p.Gln116Ter), a novel canonical splice site variant (NM_015836.4: c.349-1G>A), or a novel missense variant (NM_015836.4: c.475A>C, p.Thr159Pro). We investigated the mitochondrial function in patients and found increased levels of mitochondrially encoded cytochrome C Oxidase II as part of the mitochondrial respiratory chain as well as decreased mitochondrial integrity and branching. Finally, we conducted a literature review and here summarize the broad phenotypical spectrum of reported WARS2-related disorders. In conclusion, WARS2-related disorders are diagnostically challenging diseases due to the broad phenotypic spectrum and the disease relevance of a relatively common missense change that is often filtered out in a diagnostic setting since it occurs in ~0.5% of the general European population.
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