“…Since the discovery of aspartic tRNA synthase deficiency (DARS2) in leukodystrophies with brain stem and spinal cord involvement and lactate elevation (LBSL) in 2007 (9), there have been 14 reported pathogenic mutations that encode the mitochondrial aminoacyl-tRNA synthase gene in neurological diseases, such as mt-AlaRS (AARS2), mt-AsnRS (NARS2), mt-AspRS (DARS2), mt-ArgRS (RARS2), mt-CysRS (CARS2), mt-GluRS (EARS2), mt-HisRS (HARS2), mt-IleRS (IARS2), mt-LeuRS (LARS2), mt-MetRS (MARS2), mt-PheRS (FARS2), mt-ProRS (PARS2), mt-ThrRS (TARS2), and mt-ValRS (VARS2) (14). These mutations can induce multiple neurological disorders, such as epilepsy, autosomal recessive spastic ataxia with leukodystrophy (ARSAL), distal hereditary motor neuropathy (dHMN), hereditary motor neuropathy (HMN), LBSL, pontocerebellar hypoplasia (PCH), and leukodystrophy with thalamic and brainstem involvement and hyperlactatemia (14). However, the AARS2 mutation induces two different mutation-dependent diseases: ovarioleukodystropy (14,15) and lethal mitochondrial cardiomyopathy with lactacidosis (16).…”