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Tassone F, Protic D, Allen EG, Archibald AD, Baud A, Brown TW, Budimirovic DB, Cohen J, Dufour B, Eiges R, Elvassore N, Gabis LV, Grudzien SJ, Hall DA, Hessl D, Hogan A, Hunter JE, Jin P, Jiraanont P, Klusek J, Kooy RF, Kraan CM, Laterza C, Lee A, Lipworth K, Losh M, Loesch D, Lozano R, Mailick MR, Manolopoulos A, Martinez-Cerdeno V, McLennan Y, Miller RM, Montanaro FAM, Mosconi MW, Potter SN, Raspa M, Rivera SM, Shelly K, Todd PK, Tutak K, Wang JY, Wheeler A, Winarni TI, Zafarullah M, Hagerman RJ. Insight and Recommendations for Fragile X-Premutation-Associated Conditions from the Fifth International Conference on FMR1 Premutation. Cells 2023; 12:2330. [PMID: 37759552 PMCID: PMC10529056 DOI: 10.3390/cells12182330] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The premutation of the fragile X messenger ribonucleoprotein 1 (FMR1) gene is characterized by an expansion of the CGG trinucleotide repeats (55 to 200 CGGs) in the 5' untranslated region and increased levels of FMR1 mRNA. Molecular mechanisms leading to fragile X-premutation-associated conditions (FXPAC) include cotranscriptional R-loop formations, FMR1 mRNA toxicity through both RNA gelation into nuclear foci and sequestration of various CGG-repeat-binding proteins, and the repeat-associated non-AUG (RAN)-initiated translation of potentially toxic proteins. Such molecular mechanisms contribute to subsequent consequences, including mitochondrial dysfunction and neuronal death. Clinically, premutation carriers may exhibit a wide range of symptoms and phenotypes. Any of the problems associated with the premutation can appropriately be called FXPAC. Fragile X-associated tremor/ataxia syndrome (FXTAS), fragile X-associated primary ovarian insufficiency (FXPOI), and fragile X-associated neuropsychiatric disorders (FXAND) can fall under FXPAC. Understanding the molecular and clinical aspects of the premutation of the FMR1 gene is crucial for the accurate diagnosis, genetic counseling, and appropriate management of affected individuals and families. This paper summarizes all the known problems associated with the premutation and documents the presentations and discussions that occurred at the International Premutation Conference, which took place in New Zealand in 2023.
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Affiliation(s)
- Flora Tassone
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA 95817, USA;
- MIND Institute, University of California Davis, Davis, CA 95817, USA; (B.D.); (D.H.); (V.M.-C.)
| | - Dragana Protic
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Belgrade, 11129 Belgrade, Serbia;
- Fragile X Clinic, Special Hospital for Cerebral Palsy and Developmental Neurology, 11040 Belgrade, Serbia
| | - Emily Graves Allen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA; (E.G.A.); (P.J.); (K.S.)
| | - Alison D. Archibald
- Victorian Clinical Genetics Services, Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia;
- Genomics in Society Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, VIC 3052, Australia
| | - Anna Baud
- Department of Gene Expression, Institute of Molecular Biology and Biotechnology, Adam Mickiewicz University, Uniwersytetu Poznańskiego 6, 61-614 Poznan, Poland; (A.B.); (K.T.)
| | - Ted W. Brown
- Central Clinical School, University of Sydney, Sydney, NSW 2006, Australia;
- Fragile X Association of Australia, Brookvale, NSW 2100, Australia;
- NYS Institute for Basic Research in Developmental Disabilities, New York, NY 10314, USA
| | - Dejan B. Budimirovic
- Department of Psychiatry, Fragile X Clinic, Kennedy Krieger Institute, Baltimore, MD 21205, USA;
- Department of Psychiatry & Behavioral Sciences-Child Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Jonathan Cohen
- Fragile X Alliance Clinic, Melbourne, VIC 3161, Australia;
| | - Brett Dufour
- MIND Institute, University of California Davis, Davis, CA 95817, USA; (B.D.); (D.H.); (V.M.-C.)
- Department of Pathology and Laboratory Medicine, Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children of Northern California, School of Medicine, University of California Davis, Sacramento, CA 95817, USA;
| | - Rachel Eiges
- Stem Cell Research Laboratory, Medical Genetics Institute, Shaare Zedek Medical Center Affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel;
| | - Nicola Elvassore
- Veneto Institute of Molecular Medicine (VIMM), 35129 Padova, Italy; (N.E.); (C.L.)
- Department of Industrial Engineering, University of Padova, 35131 Padova, Italy
| | - Lidia V. Gabis
- Keshet Autism Center Maccabi Wolfson, Holon 5822012, Israel;
- Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel
| | - Samantha J. Grudzien
- Department of Neurology, University of Michigan, 4148 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA; (S.J.G.); (P.K.T.)
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Deborah A. Hall
- Department of Neurological Sciences, Rush University, Chicago, IL 60612, USA;
| | - David Hessl
- MIND Institute, University of California Davis, Davis, CA 95817, USA; (B.D.); (D.H.); (V.M.-C.)
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Abigail Hogan
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.H.); (J.K.)
| | - Jessica Ezzell Hunter
- RTI International, Research Triangle Park, NC 27709, USA; (J.E.H.); (S.N.P.); (M.R.); (A.W.)
| | - Peng Jin
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA; (E.G.A.); (P.J.); (K.S.)
| | - Poonnada Jiraanont
- Faculty of Medicine, King Mongkut’s Institute of Technology Ladkrabang, Bangkok 10520, Thailand;
| | - Jessica Klusek
- Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (A.H.); (J.K.)
| | - R. Frank Kooy
- Department of Medical Genetics, University of Antwerp, 2000 Antwerp, Belgium;
| | - Claudine M. Kraan
- Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC 3052, Australia;
- Diagnosis and Development, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Cecilia Laterza
- Veneto Institute of Molecular Medicine (VIMM), 35129 Padova, Italy; (N.E.); (C.L.)
- Department of Industrial Engineering, University of Padova, 35131 Padova, Italy
| | - Andrea Lee
- Fragile X New Zealand, Nelson 7040, New Zealand;
| | - Karen Lipworth
- Fragile X Association of Australia, Brookvale, NSW 2100, Australia;
| | - Molly Losh
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL 60201, USA;
| | - Danuta Loesch
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia;
| | - Reymundo Lozano
- Departments of Genetics and Genomic Sciences and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
| | - Marsha R. Mailick
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Apostolos Manolopoulos
- Intramural Research Program, Laboratory of Clinical Investigation, National Institute on Aging, Baltimore, MD 21224, USA;
| | - Veronica Martinez-Cerdeno
- MIND Institute, University of California Davis, Davis, CA 95817, USA; (B.D.); (D.H.); (V.M.-C.)
- Department of Pathology and Laboratory Medicine, Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children of Northern California, School of Medicine, University of California Davis, Sacramento, CA 95817, USA;
| | - Yingratana McLennan
- Department of Pathology and Laboratory Medicine, Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children of Northern California, School of Medicine, University of California Davis, Sacramento, CA 95817, USA;
| | | | - Federica Alice Maria Montanaro
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Matthew W. Mosconi
- Schiefelbusch Institute for Life Span Studies, University of Kansas, Lawrence, KS 66045, USA;
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA
- Kansas Center for Autism Research and Training (K-CART), University of Kansas, Lawrence, KS 66045, USA
| | - Sarah Nelson Potter
- RTI International, Research Triangle Park, NC 27709, USA; (J.E.H.); (S.N.P.); (M.R.); (A.W.)
| | - Melissa Raspa
- RTI International, Research Triangle Park, NC 27709, USA; (J.E.H.); (S.N.P.); (M.R.); (A.W.)
| | - Susan M. Rivera
- Department of Psychology, University of Maryland, College Park, MD 20742, USA;
| | - Katharine Shelly
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA; (E.G.A.); (P.J.); (K.S.)
| | - Peter K. Todd
- Department of Neurology, University of Michigan, 4148 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA; (S.J.G.); (P.K.T.)
- Ann Arbor Veterans Administration Healthcare, Ann Arbor, MI 48105, USA
| | - Katarzyna Tutak
- Department of Gene Expression, Institute of Molecular Biology and Biotechnology, Adam Mickiewicz University, Uniwersytetu Poznańskiego 6, 61-614 Poznan, Poland; (A.B.); (K.T.)
| | - Jun Yi Wang
- Center for Mind and Brain, University of California Davis, Davis, CA 95618, USA;
| | - Anne Wheeler
- RTI International, Research Triangle Park, NC 27709, USA; (J.E.H.); (S.N.P.); (M.R.); (A.W.)
| | - Tri Indah Winarni
- Center for Biomedical Research (CEBIOR), Faculty of Medicine, Universitas Diponegoro, Semarang 502754, Central Java, Indonesia;
| | - Marwa Zafarullah
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA 95817, USA;
| | - Randi J. Hagerman
- MIND Institute, University of California Davis, Davis, CA 95817, USA; (B.D.); (D.H.); (V.M.-C.)
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA 95817, USA
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Hong J, Dembo RS, DaWalt LS, Brilliant M, Berry-Kravis EM, Mailick M. The effect of college degree attainment on neurodegenerative symptoms in genetically at-risk women. SSM Popul Health 2022; 19:101262. [PMID: 36238818 PMCID: PMC9550653 DOI: 10.1016/j.ssmph.2022.101262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/28/2022] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
Using longitudinal data, the present study examined the association between college degree attainment and the manifestation of neurodegenerative symptoms among women (n = 93) at elevated genetic risk. The neurodegenerative symptoms investigated in this study are due to FXTAS (Fragile X-associated Tremor/Ataxia Syndrome), a condition with onset after age 50. Those at risk for FXTAS have a mutation of a single gene found on the X chromosome. FXTAS is characterized by intention tremor, gait ataxia, executive function deficits, memory issues, and neuropathy. College degree attainment has been shown to provide neuroprotective effects in the general population, delaying the development of neurodegenerative conditions such as Alzheimer's disease. For this reason, college degree attainment is a potentially salient resource for those at risk of FXTAS. The results of the present research indicated significantly more severe FXTAS symptoms in women who did not attain a college degree as compared with those who were college graduates, although the two groups were similar in age, genetic risk, household income, health behaviors, and general health problems. Furthermore, symptoms in those who did not attain a college degree worsened over the 9-year study period at a significantly faster rate than the college graduates. The association between college degree attainment and FXTAS symptoms was significantly mediated by depression, which was lower among the graduates than those who did not attain a college degree. Thus, the present research is an example of how a sociodemographic factor can mitigate neurodegenerative conditions in genetically at-risk adults.
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Affiliation(s)
- Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, USA,Corresponding author. Waisman Center, 1500 Highland Ave. Room 555, Madison, WI, 53706, USA.
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Sodhi DK, Hagerman R. Fragile X Premutation: Medications, Therapy and Lifestyle Advice. Pharmgenomics Pers Med 2022; 14:1689-1699. [PMID: 35002287 PMCID: PMC8721286 DOI: 10.2147/pgpm.s338846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
The fragile X premutation is characterized by 55–200 CGG repeats in the 5ʹ untranslated region of FMR1, whereas full fragile X mutation has greater than 200 repeats and full methylation, which manifests as fragile X syndrome (FXS). The premutation spectrum of clinical involvement includes fragile X-associated tremor/ataxia syndrome (FXTAS), fragile X-associated primary ovarian insufficiency (FXPOI), and fragile X-associated neuropsychiatric disorders (FXAND). In addition, premutation carriers also suffer from various other health problems such as endocrine abnormalities and autoimmune problems. In this paper, we have discussed different health issues faced by the carriers and interventions including medications, therapy and lifestyle changes that could improve their health.
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Affiliation(s)
- Deepika Kour Sodhi
- The MIND Institute, University of California Davis Health, Sacramento, CA, USA
| | - Randi Hagerman
- The MIND Institute, University of California Davis Health, Sacramento, CA, USA.,Department of Pediatrics, University of California Davis Health, Sacramento, CA, USA
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Frequency of FMR1 Premutation Alleles in Patients with Undiagnosed Cerebellar Ataxia and Multiple System Atrophy in the Japanese Population. CEREBELLUM (LONDON, ENGLAND) 2021; 21:954-962. [PMID: 34845661 DOI: 10.1007/s12311-021-01329-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is an adult-onset neurodegenerative disorder caused by FMR1 premutation expansion of CGG repeats. FXTAS can be misdiagnosed with many neurodegenerative disorders manifesting with cerebellar ataxias owing to their overlapping clinical and radiological features. The frequency of the FMR1 premutation allele in Japan has not been fully determined. Herein, we aimed to determine the frequency of FMR1 premutation alleles in Japanese patients with undiagnosed cerebellar ataxia and multiple system atrophy, using repeat-primed PCR in 186 patients with adult onset of undiagnosed cerebellar ataxia and 668 patients with multiple system atrophy, to identify expanded CGG repeats as well as to detect AGG interruptions within the expanded alleles. The size of expansions was estimated using fragment length analysis of PCR products obtained by conventional PCR employing a pair of unique primers flanking the repeat sequence. We identified FMR1 premutation alleles in three male patients. One patient revealed 84 repeat units with one AGG interruption and another patient showed 103 repeat units. Both had presented with sporadic cerebellar ataxia, giving an estimated frequency of 3.7% among Japanese male patients with sporadic cerebellar ataxia with age at onset above 50 years. One patient with the clinical diagnosis of multiple system atrophy harbored 60 repeat units with four AGG interruptions. FMR1 intermediate alleles were observed in two males and one female among the multiple system atrophy patients. We found that genetic tests for FMR1 premutation should be considered in Japanese male patients with cerebellar ataxia with the age at onset above 50 years.
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Salcedo-Arellano MJ, Sanchez D, Wang JY, McLennan YA, Clark CJ, Juarez P, Schneider A, Tassone F, Hagerman RJ, Martínez-Cerdeño V. Case Report: Coexistence of Alzheimer-Type Neuropathology in Fragile X-Associated Tremor Ataxia Syndrome. Front Neurosci 2021; 15:720253. [PMID: 34602969 PMCID: PMC8485779 DOI: 10.3389/fnins.2021.720253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
This case documents the co-occurrence of the fragile X-associated tremor ataxia syndrome (FXTAS) and Alzheimer-type neuropathology in a 71-year-old premutation carrier with 85 CGG repeats in the fragile X mental retardation 1 (FMR1) gene, in addition to an apolipoprotein E (APOE) ε4 allele. FXTAS and Alzheimer's Disease (AD) are late-onset neurodegenerative diseases that share overlapping cognitive deficits including processing speed, working memory and executive function. The prevalence of coexistent FXTAS-AD pathology remains unknown. The clinical picture in this case was marked with rapid cognitive decline between age 67 and 71 years in addition to remarkable MRI changes. Over the 16 months between the two clinical evaluations, the brain atrophied 4.12% while the lateral ventricles increased 26.4% and white matter hyperintensities (WMH) volume increased 15.6%. Other regions atrophied substantially faster than the whole brain included the thalamus (-6.28%), globus pallidus (-10.95%), hippocampus (-6.95%), and amygdala (-7.58%). A detailed postmortem assessment included an MRI with confluent WMH and evidence of cerebral microbleeds (CMB). The histopathological study demonstrated FXTAS inclusions in neurons and astrocytes, a widespread presence of phosphorylated tau protein and, amyloid β plaques in cortical areas and the hippocampus. CMBs were noticed in the precentral gyrus, middle temporal gyrus, visual cortex, and brainstem. There were high amounts of iron deposits in the globus pallidus and the putamen consistent with MRI findings. We hypothesize that coexistent FXTAS-AD neuropathology contributed to the steep decline in cognitive abilities.
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Affiliation(s)
- Maria Jimena Salcedo-Arellano
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Desiree Sanchez
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Jun Yi Wang
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Yingratana A. McLennan
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
| | - Courtney Jessica Clark
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
| | - Pablo Juarez
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Andrea Schneider
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Sacramento, CA, United States
| | - Randi J. Hagerman
- Department of Pediatrics, University of California, Davis, Sacramento, CA, United States
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
| | - Verónica Martínez-Cerdeño
- Department of Pathology and Laboratory Medicine, University of California, Davis, Sacramento, CA, United States
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern California, Sacramento, CA, United States
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Schneider A, Summers S, Tassone F, Seritan A, Hessl D, Hagerman P, Hagerman R. Women with Fragile X-associated Tremor/Ataxia Syndrome. Mov Disord Clin Pract 2020; 7:910-919. [PMID: 33163562 PMCID: PMC7604678 DOI: 10.1002/mdc3.13084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Fragile X-associated tremor and ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder linked to the FMR1 premutation. OBJECTIVES FXTAS in women is far less common than in men, and this study represents the largest sample reported to date. METHODS A total of 53 female premutation carriers with FXTAS (meanage, 66.83 years; FXTAS stages 2-5) and 55 age-matched and demographic background-matched control participants (meanage, 61.94 years) underwent a comprehensive molecular, physiological, neuropsychological, and psychiatric assessment. RESULTS The large sample of female premutation carriers showed a wide range of variability of clinical signs and symptom progression. The imaging results showed a middle cerebellar peduncles sign in only 6 patients; another symptom included high-signal intensity in the splenium of the corpus callosum, and diffuse cerebral deep white matter changes (e.g., in the pons) are more common. The rate of psychiatric disorders, especially depression, is higher than in the general population. There is a clear impairment in executive functioning and fine motor skills in connection with a higher FXTAS stage. CONCLUSIONS The manifestation of FXTAS symptoms in female carriers can be diverse with a milder phenotype and a lower penetrance than those observed in male premutation carriers. The middle cerebellar peduncles sign is present in only a small percentage of the sample, and we propose that the imaging criteria for FXTAS in women need to be expanded.
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Affiliation(s)
- Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders InstituteSacramentoCaliforniaUSA
- Department of Pediatrics, School of MedicineUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Scott Summers
- Department of Psychiatry and Behavioral SciencesUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Flora Tassone
- Department of BiochemistryUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Andreea Seritan
- Department of Psychiatry, UCSF Weill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - David Hessl
- Medical Investigation of Neurodevelopmental Disorders InstituteSacramentoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Paul Hagerman
- Department of BiochemistryUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders InstituteSacramentoCaliforniaUSA
- Department of Pediatrics, School of MedicineUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
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Krasteva M, Koycheva Y, Racheva R, Taseva T, Raycheva T, Simeonova S, Andreev B. Decreased FMR1 mRNA levels found in men with substance use disorders. Heliyon 2020; 6:e05270. [PMID: 33102869 PMCID: PMC7575801 DOI: 10.1016/j.heliyon.2020.e05270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/31/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022] Open
Abstract
FMR1 gene (fragile X mental retardation 1) represents a genetic and epigenetic factor in a number of human diseases. Though the role of FMR1 gene in substance use disorders (SUDs) is not well studied, a number of investigations indicate that SUDs and FMR1-accociated disorders may share common underlying mechanisms. We examined the relative FMR1 mRNA levels and their sex-distribution in leukocytes from patients with alcohol and drug dependence compared to healthy controls. The study included 44 participants, 16 with alcohol dependence (mean age 43, 10 males and 6 females), 17 with drug dependence (mean age 41, 12 males and 5 females) and 11 healthy controls (mean age 47, 5 males and 6 females). Participants donated 5–6 ml of blood and completed a specialized questionnaire. Total RNA was isolated and cDNA was synthesized and used as a template for qRT-PCR analysis. The studied persons with alcohol and drug dependence share common socio-demographic and substance-use related characteristics. Significant FMR1 down-regulation was observed in the alcohol dependent group (25 % decrease; p = 0.005). Sex-associated analysis revealed that FMR1 down-regulation was primarily in alcohol-dependent men (40% decrease; p = 0.001) and did not reach significance in women. A similar sex-dependent pattern was observed among drug-dependent individuals. Drug-dependent men had significantly lower FMR1 mRNA levels (24% decrease; p = 0.015) compared with controls, while no significant difference was observed in drug-dependent females. These data indicate FMR1 mRNA down-regulation in persons with alcohol- and drug-dependence, relative to controls, is sex-dependent. This implies a role for FMR1 in substance use disorders. These findings require confirmation by including protein measures and the recruitment of larger cohorts.
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Affiliation(s)
- Maria Krasteva
- Institute of Plant Physiology and Genetics, Laboratory of Genome Dynamics and Stability, Bulgarian Academy of Sciences, Acad. Georgi Bonchev Street, Bldg. 21, 1113 Sofia, Bulgaria
| | - Yana Koycheva
- Institute of Plant Physiology and Genetics, Laboratory of Genome Dynamics and Stability, Bulgarian Academy of Sciences, Acad. Georgi Bonchev Street, Bldg. 21, 1113 Sofia, Bulgaria
| | - Rositsa Racheva
- Institute for Population and Human Studies, Department of Psychology, Bulgarian Academy of Sciences, Acad. Georgi Bonchev Street, Bldg. 6, 1113 Sofia, Bulgaria
| | - Teodora Taseva
- Institute of Plant Physiology and Genetics, Laboratory of Genome Dynamics and Stability, Bulgarian Academy of Sciences, Acad. Georgi Bonchev Street, Bldg. 21, 1113 Sofia, Bulgaria
| | - Tsveta Raycheva
- National Center for Public Health and Analyses, Department of Addictions, Acad. Ivan Ev. Geshov Street 15, 1431 Sofia, Bulgaria
| | - Stiliana Simeonova
- Institute of Plant Physiology and Genetics, Laboratory of Genome Dynamics and Stability, Bulgarian Academy of Sciences, Acad. Georgi Bonchev Street, Bldg. 21, 1113 Sofia, Bulgaria
| | - Boryan Andreev
- Institute for Population and Human Studies, Department of Psychology, Bulgarian Academy of Sciences, Acad. Georgi Bonchev Street, Bldg. 6, 1113 Sofia, Bulgaria
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Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): Pathophysiology and Clinical Implications. Int J Mol Sci 2020; 21:ijms21124391. [PMID: 32575683 PMCID: PMC7352421 DOI: 10.3390/ijms21124391] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023] Open
Abstract
The fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder seen in older premutation (55-200 CGG repeats) carriers of FMR1. The premutation has excessive levels of FMR1 mRNA that lead to toxicity and mitochondrial dysfunction. The clinical features usually begin in the 60 s with an action or intention tremor followed by cerebellar ataxia, although 20% have only ataxia. MRI features include brain atrophy and white matter disease, especially in the middle cerebellar peduncles, periventricular areas, and splenium of the corpus callosum. Neurocognitive problems include memory and executive function deficits, although 50% of males can develop dementia. Females can be less affected by FXTAS because of a second X chromosome that does not carry the premutation. Approximately 40% of males and 16% of female carriers develop FXTAS. Since the premutation can occur in less than 1 in 200 women and 1 in 400 men, the FXTAS diagnosis should be considered in patients that present with tremor, ataxia, parkinsonian symptoms, neuropathy, and psychiatric problems. If a family history of a fragile X mutation is known, then FMR1 DNA testing is essential in patients with these symptoms.
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Cabal-Herrera AM, Saldarriaga-Gil W, Salcedo-Arellano MJ, Hagerman RJ. Fragile X associated neuropsychiatric disorders in a male without FXTAS. Intractable Rare Dis Res 2020; 9:113-118. [PMID: 32494560 PMCID: PMC7263992 DOI: 10.5582/irdr.2020.01028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 11/05/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability and autism spectrum disorder. In most cases, it is due to an expansion of the CGG triplet to more than 200 repeats within the promoter region of the FMR1 gene. In the premutation (PM) the trinucleotide is expanded to 55-200 repeats. PM carriers can present with disorders associated with the PM including fragile X-associated tremor/ataxia syndrome (FXTAS) and fragile X-associated ovarian insufficiency (FXPOI). Recently fragile X-associated neuropsychiatric disorders (FXAND) was proposed as an umbrella term to include the neuropsychiatric disorders that are more prevalent in PM carriers compared to the general population such as anxiety, depression, chronic fatigue, alcohol abuse, and psychosis, among others. The patient in our study was evaluated by a team of clinicians from the University del Valle in Cali who traveled to Ricaurte, a Colombian town known for being a genetic geographic cluster of FXS. A detailed medical history was collected and complete physical, neurological and psychiatric evaluations were performed in addition to molecular and neuroradiological studies. We report the case of a 78-year-old man, PM carrier, without FXTAS whose main clinical presentation consists of behavioral changes and psychosis. Brain imaging revealed white matter lesions in the periventricular region and mild cerebral atrophy. Although anxiety and depression are the most common neuropsychiatric manifestations in PM carriers, it is important to perform a complete psychiatric evaluation since some patients may present with behavioral changes and psychosis.
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Affiliation(s)
- Ana María Cabal-Herrera
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- School of Medicine, Universidad del Valle, Cali, Colombia
| | | | - Maria Jimena Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
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Ligsay A, El-Deeb M, Salcedo-Arellano MJ, Schloemerkemper N, Grayson JS, Hagerman R. General Anesthetic Use in Fragile X Spectrum Disorders. J Neurosurg Anesthesiol 2019; 31:285-290. [PMID: 29734272 PMCID: PMC6215737 DOI: 10.1097/ana.0000000000000508] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The fragile X premutation is characterized by a repeat expansion mutation (between 55 to 200 CGG repeats) in the fragile X mental retardation 1 (FMR1) gene, which leads to RNA toxicity at the cellular level. This may cause patients with the premutation to be particularly susceptible to environmental toxins, which could manifest clinically as new or worsening ataxia and memory loss. Multiple published case reports have also suggested general anesthetics as a potential toxin leading to negative side effects when used in patients with fragile X-associated disorders. However, at this time, there have been no formal research studies regarding cellular changes or long-term clinical manifestations after general anesthetic use in this population. This review aims to highlight previous case reports regarding sequelae related to general anesthetic use in fragile X-associated disorders. New case reports related to this phenomenon are also included.
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Affiliation(s)
- Andrew Ligsay
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Marwa El-Deeb
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA
- Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Maria J Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA
- Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Nina Schloemerkemper
- Department of Anesthesiology and Pain Medicine, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Jeremy S. Grayson
- Department of Anesthesia, Rutgers University Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA
- Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA, USA
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Salcedo-Arellano MJ, Hagerman RJ, Martínez-Cerdeño V. [Fragile X associated tremor/ataxia syndrome: its clinical presentation, pathology, and treatment]. Rev Neurol 2019; 68:199-206. [PMID: 30805918 PMCID: PMC7001878 DOI: 10.33588/rn.6805.2018457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The fragile X associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disease associated with the repetition of CGG triplets (55-200 CGG repetitions) in the FMR1 gene. The premutation of the FMR1 gene, contrasting with the full mutation (more than 200 CGG repetitions), presents an increased production of messenger and a similar or slightly decreased production of FMRP protein. FXTAS affects 40% of men and 16% of women carriers of the premutation. It presents with a wide constellation of neurological signs such as intention tremor, cerebellar ataxia, parkinsonism, executive function deficits, peripheral neuropathy and cognitive decline leading to dementia among others. In this review, we present what is currently known about the molecular mechanism, the radiological findings and the pathology, as well as the complexity of the diagnosis and management of FXTAS.
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Affiliation(s)
- María Jimena Salcedo-Arellano
- Department of Pediatrics, University of California Davis
School of Medicine, Sacramento, CA, USA
- Medical Investigation of Neurodevelopmental Disorders
(MIND) Institute, University of California Davis, Sacramento, CA, USA
| | - Randi J Hagerman
- Department of Pediatrics, University of California Davis
School of Medicine, Sacramento, CA, USA
- Medical Investigation of Neurodevelopmental Disorders
(MIND) Institute, University of California Davis, Sacramento, CA, USA
| | - Verónica Martínez-Cerdeño
- Medical Investigation of Neurodevelopmental Disorders
(MIND) Institute, University of California Davis, Sacramento, CA, USA
- Institute for Pediatric Regenerative Medicine and Shriners
Hospitals for Children Northern California, Sacramento, CA, USA
- Department of Pathology and Laboratory Medicine, UC Davis
School of Medicine, Sacramento, CA, USA
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Saldarriaga W, Salcedo-Arellano MJ, Rodriguez-Guerrero T, Ríos M, Fandiño-Losada A, Ramirez-Cheyne J, Lein PJ, Tassone F, Hagerman RJ. Increased severity of fragile X spectrum disorders in the agricultural community of Ricaurte, Colombia. Int J Dev Neurosci 2019; 72:1-5. [PMID: 30385191 PMCID: PMC6354926 DOI: 10.1016/j.ijdevneu.2018.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/30/2018] [Accepted: 10/25/2018] [Indexed: 12/26/2022] Open
Abstract
Premutation carriers of the FMR1 gene (CGG repeats between 55 and 200) usually have normal intellectual abilities but approximately 20% are diagnosed with developmental problems or autism spectrum disorder. Additionally, close to 50% have psychiatric problems such as anxiety, ADHD and/or depression. The spectrum of fragile X disorders also includes Fragile-X-associated primary ovarian insufficiency (FXPOI) in female carriers and Fragile-X-associated tremor/ataxia syndrome (FXTAS) in older male and female carriers. We evaluated 25 premutation carriers in the rural community of Ricaurte Colombia and documented all behavioral problems, social deficits and clinical signs of FXPOI and FXTAS as well as reviewed the medical and obstetric history. We found an increased frequency and severity of symptoms of fragile X spectrum disorders, which might be related to the vulnerability of FMR1 premutation carriers to higher exposure to neurotoxic pesticides in this rural community.
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Affiliation(s)
- Wilmar Saldarriaga
- School of Medicine, Universidad del Valle, Cali, Colombia; Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia; Department of Morphology, Universidad del Valle, Cali, Colombia
| | - María J Salcedo-Arellano
- School of Medicine, Universidad del Valle, Cali, Colombia; Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia; Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA, USA.
| | | | - Marcela Ríos
- School of Medicine, Universidad del Valle, Cali, Colombia
| | - Andrés Fandiño-Losada
- School of Medicine, Universidad del Valle, Cali, Colombia; CISALVA Institute, School of Public Health, Faculty of Health, Universidad del Valle, Cali, Colombia
| | - Julian Ramirez-Cheyne
- School of Medicine, Universidad del Valle, Cali, Colombia; Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia; Department of Morphology, Universidad del Valle, Cali, Colombia
| | - Pamela J Lein
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA, USA; Department of Molecular Biosciences, University of California Davis School of Veterinary Medicine, Davis, CA, USA
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA, USA; Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA, USA; Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA.
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Hagerman RJ, Protic D, Rajaratnam A, Salcedo-Arellano MJ, Aydin EY, Schneider A. Fragile X-Associated Neuropsychiatric Disorders (FXAND). Front Psychiatry 2018; 9:564. [PMID: 30483160 PMCID: PMC6243096 DOI: 10.3389/fpsyt.2018.00564] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/18/2018] [Indexed: 12/12/2022] Open
Abstract
Fragile X syndrome (FXS) is caused by the full mutation (>200 CGG repeats) in the Fragile X Mental Retardation 1 (FMR1) gene. It is the most common inherited cause of intellectual disability (ID) and autism. This review focuses on neuropsychiatric disorders frequently experienced by premutation carriers with 55 to 200 CGG repeats and the pathophysiology involves elevated FMR1 mRNA levels, which is different from the absence or deficiency of fragile X mental retardation protein (FMRP) seen in FXS. Neuropsychiatric disorders are the most common problems associated with the premutation, and they affect approximately 50% of individuals with 55 to 200 CGG repeats in the FMR1 gene. Neuropsychiatric disorders in children with the premutation include anxiety, ADHD, social deficits, or autism spectrum disorders (ASD). In adults with the premutation, anxiety and depression are the most common problems, although obsessive compulsive disorder, ADHD, and substance abuse are also common. These problems are often exacerbated by chronic fatigue, chronic pain, fibromyalgia, autoimmune disorders and sleep problems, which are also associated with the premutation. Here we review the clinical studies, neuropathology and molecular underpinnings of RNA toxicity associated with the premutation. We also propose the name Fragile X-associated Neuropsychiatric Disorders (FXAND) in an effort to promote research and the use of fragile X DNA testing to enhance recognition and treatment for these disorders.
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Affiliation(s)
- Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Dragana Protic
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pharmacology, Clinical Pharmacology and Toxicology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Akash Rajaratnam
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Maria J. Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Elber Yuksel Aydin
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis, Sacramento, CA, United States
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
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Famula JL, McKenzie F, McLennan YA, Grigsby J, Tassone F, Hessl D, Rivera SM, Martinez-Cerdeno V, Hagerman RJ. Presence of Middle Cerebellar Peduncle Sign in FMR1 Premutation Carriers Without Tremor and Ataxia. Front Neurol 2018; 9:695. [PMID: 30186228 PMCID: PMC6113389 DOI: 10.3389/fneur.2018.00695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/31/2018] [Indexed: 11/23/2022] Open
Abstract
Here we report five cases of male FMR1 premutation carriers who present without clinical symptoms of the fragile X-associated tremor/ataxia syndrome (FXTAS), but who on MRI demonstrate white matter hyperintensities in the middle cerebellar peduncles (MCP sign) and other brain regions, a rare finding. MCP sign is the major radiological feature of FXTAS; it is therefore remarkable to identify five cases in which this MRI finding is present in the absence of tremor and ataxia, the major clinical features of FXTAS. Subjects underwent a detailed neurological evaluation, neuropsychological testing, molecular testing, and MRI evaluation utilizing T2 imaging described here. Additional white matter disease was present in the corpus callosum in four of the five cases. However, all cases were asymptomatic for motor signs of FXTAS.
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Affiliation(s)
- Jessica L Famula
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Forrest McKenzie
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Yingratana A McLennan
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
| | - James Grigsby
- School of Medicine, University of Colorado, Denver, CO, United States
| | - Flora Tassone
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine, Sacramento, CA, United States
| | - David Hessl
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Susan M Rivera
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Psychology, University of California Davis, Davis, CA, United States
| | - Veronica Martinez-Cerdeno
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Pathology and Laboratory Medicine, Sacramento, CA, United States.,Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern California, Sacramento, CA, United States
| | - Randi J Hagerman
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States
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Albizua I, Rambo-Martin BL, Allen EG, He W, Amin AS, Sherman SL. Women who carry a fragile X premutation are biologically older than noncarriers as measured by telomere length. Am J Med Genet A 2017; 173:2985-2994. [PMID: 28941155 DOI: 10.1002/ajmg.a.38476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/12/2017] [Accepted: 08/21/2017] [Indexed: 01/25/2023]
Abstract
Women who carry a fragile X premutation, defined as having 55-200 unmethylated CGG repeats in the 5' UTR of the X-linked FMR1 gene, have a 20-fold increased risk for primary ovarian insufficiency (FXPOI). We tested the hypothesis that women with a premutation + FXPOI have shorter telomeres than those without FXPOI because they are "biologically older." Using linear regression, we found that women carrying a premutation (n = 172) have shorter telomeres and hence, are "biologically older" than women carrying the normal size allele (n = 81). Strikingly, despite having shorter telomeres, age was not statistically associated with their telomere length, in contrast to non-carrier controls. Further, telomere length within premutation carriers was not associated with repeat length but was associated with a diagnosis of FXPOI, although the latter finding may depend on FXPOI age of onset.
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Affiliation(s)
- Igor Albizua
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Emily G Allen
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Weiya He
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Ashima S Amin
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
| | - Stephanie L Sherman
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia
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Lozano R, Martinez-Cerdeno V, Hagerman RJ. Advances in the Understanding of the Gabaergic Neurobiology of FMR1 Expanded Alleles Leading to Targeted Treatments for Fragile X Spectrum Disorder. Curr Pharm Des 2016; 21:4972-4979. [PMID: 26365141 DOI: 10.2174/1381612821666150914121038] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/11/2015] [Indexed: 12/15/2022]
Abstract
Fragile X spectrum disorder (FXSD) includes: fragile X syndrome (FXS), fragile X-associated tremor ataxia syndrome (FXTAS) and fragile X-associated primary ovarian insufficiency (FXPOI), as well as other medical, psychiatric and neurobehavioral problems associated with the premutation and gray zone alleles. FXS is the most common monogenetic cause of autism (ASD) and intellectual disability (ID). The understanding of the neurobiology of FXS has led to many targeted treatment trials in FXS. The first wave of phase II clinical trials in FXS were designed to target the mGluR5 pathway; however the results did not show significant efficacy and the trials were terminated. The advances in the understanding of the GABA system in FXS have shifted the focus of treatment trials to GABA agonists, and a new wave of promising clinical trials is under way. Ganaxolone and allopregnanolone (GABA agonists) have been studied in individuals with FXSD and are currently in phase II trials. Both allopregnanolone and ganaxolone may be efficacious in treatment of FXS and FXTAS, respectively. Allopregnanolone, ganaxolone, riluzole, gaboxadol, tiagabine, and vigabatrin are potential GABAergic treatments. The lessons learned from the initial trials have not only shifted the targeted system, but also have refined the design of clinical trials. The results of these new trials will likely impact further clinical trials for FXS and other genetic disorders associated with ASD.
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Affiliation(s)
- Reymundo Lozano
- Icahn School of Medicine at Mount Sinai, New York, NY USA; Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA; Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Veronica Martinez-Cerdeno
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, UC Davis, CA, USA; Institute for Pediatric Regenerative Medicine and Shriners Hospital for Children of Northern California, Sacramento, CA, USA; Department of Pathology and Laboratory Medicine, UC Davis, Sacramento, USA
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, UC Davis, CA, USA; Department of Pediatrics, UC Davis, Sacramento, CA, USA
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Abstract
Many physicians are unaware of the many phenotypes associated with the fragile X premutation, an expansion in the 5' untranslated region of the fragile X mental retardation 1 (FMR1) gene that consists of 55-200 CGG repeats. The most severe of these phenotypes is fragile X-associated tremor/ataxia syndrome (FXTAS), which occurs in the majority of ageing male premutation carriers but in fewer than 20% of ageing women with the premutation. The prevalence of the premutation is 1 in 150-300 females, and 1 in 400-850 males, so physicians are likely to see people affected by FXTAS. Fragile X DNA testing is broadly available in the Western world. The clinical phenotype of FXTAS at presentation can vary and includes intention tremor, cerebellar ataxia, neuropathic pain, memory and/or executive function deficits, parkinsonian features, and psychological disorders, such as depression, anxiety and/or apathy. FXTAS causes brain atrophy and white matter disease, usually in the middle cerebellar peduncles, the periventricular area, and the splenium and/or genu of the corpus callosum. Here, we review the complexities involved in the clinical management of FXTAS and consider how targeted treatment for these clinical features of FXTAS will result from advances in our understanding of the molecular mechanisms that underlie this neurodegenerative disorder. Such targeted approaches should also be more broadly applicable to earlier forms of clinical involvement among premutation carriers.
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Ariza J, Rogers H, Monterrubio A, Reyes-Miranda A, Hagerman PJ, Martínez-Cerdeño V. A Majority of FXTAS Cases Present with Intranuclear Inclusions Within Purkinje Cells. THE CEREBELLUM 2016; 15:546-51. [DOI: 10.1007/s12311-016-0776-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Saldarriaga W, Lein P, González Teshima LY, Isaza C, Rosa L, Polyak A, Hagerman R, Girirajan S, Silva M, Tassone F. Phenobarbital use and neurological problems in FMR1 premutation carriers. Neurotoxicology 2016; 53:141-147. [PMID: 26802682 DOI: 10.1016/j.neuro.2016.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 01/08/2016] [Accepted: 01/18/2016] [Indexed: 12/23/2022]
Abstract
Fragile X Syndrome (FXS) is a neurodevelopmental disorder caused by a CGG expansion in the FMR1 gene located at Xq27.3. Patients with the premutation in FMR1 present specific clinical problems associated with the number of CGG repeats (55-200 CGG repeats). Premutation carriers have elevated FMR1 mRNA expression levels, which have been associated with neurotoxicity potentially causing neurodevelopmental problems or neurological problems associated with aging. However, cognitive impairments or neurological problems may also be related to increased vulnerability of premutation carriers to neurotoxicants, including phenobarbital. Here we present a study of three sisters with the premutation who were exposed differentially to phenobarbital therapy throughout their lives, allowing us to compare the neurological effects of this drug in these patients.
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Affiliation(s)
- Wilmar Saldarriaga
- Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS),Universidad del Valle, Cali, Colombia; Departments of Morphology and Obstetrics & Gynecology, Universidad del Valle, Hospital Universitario Del Valle, Cali, Colombia.
| | - Pamela Lein
- Department of Molecular Biosciences, University of California, Davis School of Veterinary Medicine, Davis, CA, USA; MIND Institute, University of California, Davis School of Medicine, Sacramento, CA, USA
| | | | - Carolina Isaza
- Department of Morphology, Universidad del Valle, Cali, Colombia
| | - Lina Rosa
- La Misericordia International Clinic, Barranquilla, Colombia; Instituto Superior de Estudios Psicológicos, Barcelona, Spain; Autonomous University of Barcelona-Sant Joan de Déu Hospital, Barcelona, Spain
| | - Andrew Polyak
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Randi Hagerman
- Department of Pediatrics and the MIND Institute, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Santhosh Girirajan
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Marisol Silva
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Davis, CA, USA
| | - Flora Tassone
- MIND Institute, University of California, Davis School of Medicine, Sacramento, CA, USA; Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Davis, CA, USA
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Martínez-Cerdeño V, Lechpammer M, Lott A, Schneider A, Hagerman R. Fragile X-Associated Tremor/Ataxia Syndrome in a Man in His 30s. JAMA Neurol 2015; 72:1070-3. [PMID: 26368352 DOI: 10.1001/jamaneurol.2015.1138] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Verónica Martínez-Cerdeño
- Department of Pathology and Laboratory Medicine, University of California-Davis2Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children-Northern California, Sacramento3MIND Institute, University of California-Davis Medical Center
| | - Mirna Lechpammer
- Department of Pathology and Laboratory Medicine, University of California-Davis
| | - Aisha Lott
- MIND Institute, University of California-Davis Medical Center
| | - Andrea Schneider
- MIND Institute, University of California-Davis Medical Center4Department of Pediatrics, University of California-Davis Medical Center
| | - Randi Hagerman
- MIND Institute, University of California-Davis Medical Center4Department of Pediatrics, University of California-Davis Medical Center
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