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Features include always present findings: Visual loss, Inner ear hearing loss (sensorineural hearing impairment), Dyschromatopsia, and Damage to the optic nerve (optic atrophy) and others; and common findings: Reduced visual acuity.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Eyes | 2 | Damage to the optic nerve (optic atrophy), Temporal optic disc pallor |
MECR encodes mitochondrial trans-2-enoyl-CoA reductase (373 aa). Catalyzes the NADPH-dependent reduction of trans-2-enoyl thioesters in mitochondrial fatty acid synthesis (fatty acid synthesis type II). Highest expression in Cells Cultured fibroblasts (16.3 TPM) and Nerve Tibial (15.9 TPM).
Optic atrophy 16 is associated with mutations in the MECR gene on chromosome 1.
MECR is classified as a druggable target (Druggable Genome and Enzyme categories) with score 0.0.
To date no formal diagnostic criteria have been published for MECR-related neurologic disorder.
MECR-related neurologic disorder should be suspected in individuals with the following clinical findings, neuroimaging findings, and ethnicity.
Clinical findings
Childhood-onset dystonia, chorea, and other movement disorders: ages 1-6.5 years
No approved treatments are currently available for optic atrophy 16. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with MECR-related neurologic disorder, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 3. Recommended Evaluations Following Initial Diagnosis
The following are recommended:
Yearly eye examination to determine need for additional visual aids
Yearly neurologic assessment to determine need for additional interventions, including speech therapy
Source: GeneReviews — "MECR-Related Neurologic Disorder"
No clinical trials have been registered for optic atrophy 16.
132 publications have been identified in PubMed for optic atrophy 16. Research spans Case Report / Case Series (28%), Basic Science / Preclinical (25%), and Diagnostic / Biomarker (16%).
Research Type | Count | % of Total |
|---|---|---|
Patient case studies | 36 | 28% |
Data assembled from 6 of 12 sources · Last updated Sep 18, 2026, 6:09 PM UTC
Online Mendelian Inheritance in Man
Ears |
1 |
Inner ear hearing loss (sensorineural hearing impairment) |
Muscles | 1 | Damage to the optic nerve (optic atrophy) |
Brain and nerves | 1 | Headache |
To date, the authors know of 13 individuals with MECR-related neurologic disorder: seven (5 probands and 2 family members) described by , and six ascertained more recently by the authors (1 individual and 2 sets of sibs). The common clinical phenotype in these 13 individuals is characterized by childhood-onset movement disorder followed by optic atrophy, and often – but not always – preserved intellect. Similar to other metabolic disorders, symptoms may fluctuate temporally with febrile illnesses. In one instance, the young child never fully regained motor skills lost after fever.
Source: GeneReviews — "MECR-Related Neurologic Disorder"
No clear genotype-phenotype correlations have been observed. Of the 13 currently known affected individuals, 12 are compound heterozygotes with various combinations of a missense variant and nonsense variant, and one is a homozygote for a missense variant [ and personal communication]. These findings suggest that the combination of two nonsense variants could either be incompatible with life or give rise to a more severe phenotype.
Source: GeneReviews — "MECR-Related Neurologic Disorder"
Childhood-onset optic atrophy: typically ages 4-12 years. Note that optic atrophy is not necessary to consider the diagnosis of MECR-related neurologic disorder in a young child as it may appear several years after the onset of the movement disorder.
Source: GeneReviews — "MECR-Related Neurologic Disorder"
The differential diagnosis of MECR-related neurologic disorder includes disorders that combine the clinical features of childhood-onset movement disorder (mainly dystonia [see Hereditary Dystonia Overview] but also ataxia and chorea) and the MRI findings of signal abnormality in the basal ganglia present when the movement disorder appears. Table 2. Disorders with Dystonia and MRI Signal Abnormality in the Basal Ganglia to Consider in the Differential Diagnosis of MECR-Related Neurologic Disorder
Differential Disorder | Gene(s) | MOI | Clinical Features of Differential Disorder |
|---|---|---|---|
Overlapping w/MECR-related neurologic disorder1 | Distinguishing from MECR-related neurologic disorder Leigh syndrome(See Nuclear Gene-Encoded Leigh Syndrome Overview Mitochondrial DNA-Associated Leigh Syndrome and NARP.) | See footnote 2. | AR, XL, Mit |
Leber hereditary optic neuropathy | See footnote 3. | Mit | Optic atrophy is the main manifestation. |
GCDH | AR | Cognition may be preserved.; Symptoms may worsen following febrile illness. | Typically seen:; Macrocephaly widening of Sylvian fissures on MRI; Episodes of acute encephalopathy w/dystonic crises; urine glutaric acid 3-OH-glutaric acid D-2-hydroxyglutaric aciduria(OMIM 609186) |
D2HGDH | AR | Symptoms may worsen following febrile illness. | Typically seen:; Seizures, cardiomyopathy, cognitive regression; urine D-2-hydroxyglutaric acid May be seen:; Subependymal cysts on MRI; blood/CNS lactate Biotin-thiamine-responsive basal ganglia disease |
SLC19A3 | AR | Dysarthria eye mvmt abnormality are common. | Typically seen:; Encephalopathy; Good response to high doses of biotin thiamine May be seen:; Signal abnormality in the brain stem on MRI |
Huntington disease | HTT4 | AD | Ataxia chorea may also be present. |
VPS13A | AR | Dysarthria is common. | Typically seen:; Onset after 3rd decade (although childhood onset has been reported); Cognitive behavioral changes; Caudate atrophy on MRI (characteristic feature); creatine kinase acanthocytes; Seizures (in almost half of affected persons) DRPLA5 |
ATN1 | AD | Ataxia chorea may also be present. | Typically seen:; Myoclonic epilepsy, behavioral changes, dementia; Atrophic changes in cerebellum brain stem on MRI Wilson disease |
ATP7B | AR | Chorea dysarthria are common. | — |
Source: GeneReviews — "MECR-Related Neurologic Disorder"
Genetic testing for MECR is available. Testing is considered confirmatory for diagnosis.
Biomarker and diagnostic research for optic atrophy 16 has been reported in the published literature.
System/Concern |
|---|
Evaluation |
|---|
Comment |
|---|
Eyes | Ophthalmologic eval | To assess for optic atrophy visual acuity Gastrointestinal/ |
Feeding | Gastroenterology/ nutrition/ feeding team eval | Incl eval of aspiration risk nutritional status; Consider eval for gastric tube placement in patients w/dysphagia /or aspiration risk. |
Musculoskeletal | OT PT assessments | To assess effect of mvmt disorder on activities of daily living |
Neurologic | Brain MRI | Medication management for dystonia; Rehab w/therapies equipment needs assessment for dystonia, chorea, /or ataxia |
Development | Developmental assessment | Incl eval of motor, speech/language, general cognitive, vocational skills; Speech therapy augmentative communication consultation for dysarthria |
Neuropsychological | Assessment of cognitive function | Miscellaneous/ |
Other | Consultation w/clinical geneticist /or genetic counselor | Incl genetic counseling OT = occupational therapy; PT = physical therapy Treatment of Manifestations The following are appropriate:; Visual aids can be used in cases of decreased visual acuity due to optic atrophy. |
Source: GeneReviews — "MECR-Related Neurologic Disorder"
Disease progression is presumed to be exacerbated by stress or febrile illness; therefore, prevention of these – to the extent possible – is recommended. One patient reported onset of significant new, long-term motor symptoms following extended anesthesia with propofol. As with other mitochondrial disorders, anesthetic considerations should be discussed with a patient's medical team prior to any surgical procedure . In one of the sisters (Family G), a test dose of dopamine worsened her chorea significantly.
Source: GeneReviews — "MECR-Related Neurologic Disorder"
The pathomechanism of MECR-related neurologic disorder suggests the possible therapeutic effect of supplementation with lipoic acid (LA) and octanoic acid (C8). One individual showed remarkable improvement after receiving LA and a nutritional supplement high in C8 within three months of symptom onset . The authors are currently offering their patients treatment with a Mito Cocktail of coenzyme Q10, riboflavin, thiamine, and alpha lipoic acid with the addition of octanoic acid, vitamin E, and vitamin C (see also ). Of note, the efficacy of this regimen for treatment of MECR-related neurologic disorder has yet to be proven in an evidence-based manner. Search ClinicalTrials.
Source: GeneReviews — "MECR-Related Neurologic Disorder"
View trials for optic atrophy 16
Phenotype severity distribution: 7 always present features, 1 common feature.
32 |
25% |
Testing and diagnosis research | 20 | 16% |
Disease patterns and progression | 18 | 14% |
Research summaries | 11 | 9% |
Clinical study results | 7 | 6% |
New treatment approaches | 2 | 2% |
Other research | 1 | 1% |
Roberti G (2026). [PMID: 41528649](https://pubmed.ncbi.nlm.nih.gov/41528649/). *Doc Ophthalmol*. [Case Report / Case Series]
Krasniakova M (2026). [PMID: 41888298](https://pubmed.ncbi.nlm.nih.gov/41888298/). *Sci Rep*. [Clinical Trial Publication]
Margoni M (2026). [PMID: 41627519](https://pubmed.ncbi.nlm.nih.gov/41627519/). *J Neurol*. [Case Report / Case Series]
Liu Q (2026). [PMID: 42116779](https://pubmed.ncbi.nlm.nih.gov/42116779/). *Zhongguo Zhen Jiu*. [Basic Science / Preclinical]
Rohayem J (2026). [PMID: 40297921](https://pubmed.ncbi.nlm.nih.gov/40297921/). *Andrology*. [Epidemiology / Natural History]
Yan K (2026). [PMID: 41726794](https://pubmed.ncbi.nlm.nih.gov/41726794/). *Neurol Clin Pract*. [Diagnostic / Biomarker]
St Clair Tracy H (2026). [PMID: 42180515](https://pubmed.ncbi.nlm.nih.gov/42180515/). *Front Genet*. [Case Report / Case Series]
Palacio JE (2026). [PMID: 41998697](https://pubmed.ncbi.nlm.nih.gov/41998697/). *Orphanet J Rare Dis*. [Epidemiology / Natural History]
Jaggers TN (2026). [PMID: 41984835](https://pubmed.ncbi.nlm.nih.gov/41984835/). *Proc Natl Acad Sci U S A*. [Basic Science / Preclinical]
Schrittwieser J (2026). [PMID: 41944540](https://pubmed.ncbi.nlm.nih.gov/41944540/). *Invest Ophthalmol Vis Sci*. [Epidemiology / Natural History]