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Capacci E, Bagnoli S, Giacomucci G, Rapillo CM, Govoni A, Bessi V, Polito C, Giotti I, Brogi A, Pelo E, Sorbi S, Nacmias B, Ferrari C. The Frequency of Intermediate Alleles in Patients with Cerebellar Phenotypes. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1135-1145. [PMID: 37906407 PMCID: PMC11102406 DOI: 10.1007/s12311-023-01620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/02/2023]
Abstract
Cerebellar syndromes are clinically and etiologically heterogeneous and can be classified as hereditary, neurodegenerative non-hereditary, or acquired. Few data are available on the frequency of each form in the clinical setting. Growing interest is emerging regarding the genetic forms caused by triplet repeat expansions. Alleles with repeat expansion lower than the pathological threshold, termed intermediate alleles (IAs), have been found to be associated with disease manifestation. In order to assess the relevance of IAs as a cause of cerebellar syndromes, we enrolled 66 unrelated Italian ataxic patients and described the distribution of the different etiology of their syndromes and the frequency of IAs. Each patient underwent complete clinical, hematological, and neurophysiological assessments, neuroimaging evaluations, and genetic tests for autosomal dominant cerebellar ataxia (SCA) and fragile X-associated tremor/ataxia syndrome (FXTAS). We identified the following diagnostic categories: 28% sporadic adult-onset ataxia, 18% cerebellar variant of multiple system atrophy, 9% acquired forms, 9% genetic forms with full-range expansion, and 12% cases with intermediate-range expansion. The IAs were six in the FMR1 gene, two in the gene responsible for SCA8, and one in the ATXN2 gene. The clinical phenotype of patients carrying the IAs resembles, in most of the cases, the one associated with full-range expansion. Our study provides an exhaustive description of the causes of cerebellar ataxia, estimating for the first time the frequency of IAs in SCAs- and FXTAS-associated genes. The high percentage of cases with IAs supports further screening among patients with cerebellar syndromes.
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Affiliation(s)
- Elena Capacci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Silvia Bagnoli
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Giulia Giacomucci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Costanza Maria Rapillo
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Alessandra Govoni
- Neuromuscular-Skeletal and Sensory Organs Department, AOU Careggi, Florence, Italy
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | | | - Irene Giotti
- SODc Diagnostica Genetica, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alice Brogi
- SODc Diagnostica Genetica, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Elisabetta Pelo
- SODc Diagnostica Genetica, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Sandro Sorbi
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Camilla Ferrari
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy.
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Hong J, Dembo RS, DaWalt LS, Baker MW, Berry-Kravis E, Mailick MR. Mortality in Women across the FMR1 CGG Repeat Range: The Neuroprotective Effect of Higher Education. Cells 2023; 12:2137. [PMID: 37681869 PMCID: PMC10486613 DOI: 10.3390/cells12172137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
Higher education has been shown to have neuroprotective effects, reducing the risk of Alzheimer's and Parkinson's diseases, slowing the rate of age-related cognitive decline, and is associated with lower rates of early mortality. In the present study, the association between higher education, fragile X messenger ribonucleoprotein 1 (FMR1) cytosine-guanine-guanine (CGG) repeat number, and mortality before life expectancy was investigated in a population cohort of women born in 1939. The findings revealed a significant interaction between years of higher education and CGG repeat number. Counter to the study's hypothesis, the effects of higher education became more pronounced as the number of CGG repeats increased. There was no effect of years of higher education on early mortality for women who had 25 repeats, while each year of higher education decreased the hazard of early mortality by 8% for women who had 30 repeats. For women with 41 repeats, the hazard was decreased by 14% for each additional year of higher education. The interaction remained significant after controlling for IQ and family socioeconomic status (SES) measured during high school, as well as factors measured during adulthood (family, psychosocial, health, and financial factors). The results are interpreted in the context of differential sensitivity to the environment, a conceptualization that posits that some people are more reactive to both negative and positive environmental conditions. Expansions in CGG repeats have been shown in previous FMR1 research to manifest such a differential sensitivity pattern.
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Affiliation(s)
- Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.S.D.); (L.S.D.); (M.R.M.)
| | - Robert S. Dembo
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.S.D.); (L.S.D.); (M.R.M.)
- NORC at the University of Chicago, Chicago, IL 60603, USA
| | - Leann Smith DaWalt
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.S.D.); (L.S.D.); (M.R.M.)
| | - Mei Wang Baker
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA;
- Wisconsin State Laboratory of Hygiene, Madison, WI 53706, USA
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA;
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Marsha R. Mailick
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.S.D.); (L.S.D.); (M.R.M.)
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Maltman N, DaWalt LS, Hong J, Baker MW, Berry-Kravis EM, Brilliant MH, Mailick M. FMR1 CGG Repeats and Stress Influence Self-Reported Cognitive Functioning in Mothers. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2023; 128:1-20. [PMID: 36548377 PMCID: PMC10445796 DOI: 10.1352/1944-7558-128.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/25/2022] [Indexed: 06/17/2023]
Abstract
Variation in the FMR1 gene may affect aspects of cognition, such as executive function and memory. Environmental factors, such as stress, may also negatively impact cognitive functioning. Participants included 1,053 mothers of children with and without developmental disabilities. Participants completed self-report measures of executive function, memory, and stress (i.e., life events, parenting status), and provided DNA to determine CGG repeat length (ranging from 7 to 192 CGGs). Stress exposure significantly predicted greater self-reported difficulties in executive function and the likelihood of memory problems. Cubic CGG effects independently predicted executive function and memory difficulties, suggesting effects of both genetic variation and environmental stress exposure on cognitive functioning.
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Affiliation(s)
- Nell Maltman
- Nell Maltman, Leann Smith DaWalt, and Jinkuk Hong, University of Wisconsin-Madison
| | - Leann Smith DaWalt
- Nell Maltman, Leann Smith DaWalt, and Jinkuk Hong, University of Wisconsin-Madison
| | - Jinkuk Hong
- Nell Maltman, Leann Smith DaWalt, and Jinkuk Hong, University of Wisconsin-Madison
| | | | | | | | - Marsha Mailick
- Murray H. Brilliant and Marsha Mailick, University of Wisconsin-Madison
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Martins AAS, Paiva GM, Matosinho CGR, Coser EM, Fonseca PADS, Haase VG, Carvalho MRS. Working memory and arithmetic impairments in children with FMR1 premutation and gray zone alleles. Dement Neuropsychol 2022; 16:105-114. [PMID: 35719251 PMCID: PMC9170264 DOI: 10.1590/1980-5764-dn-2021-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/03/2021] [Indexed: 11/22/2022] Open
Abstract
Expansive mutations in familial mental retardation 1 (FMR1) gene have been associated with different phenotypes. Full mutations are associated with intellectual disability and autism spectrum disorder; premutations are associated with math learning difficulties and working memory impairments. In gray zone, neuropsychological development has not yet been described. Objectives This study aimed to describe the frequency of FMR1 premutation and gray zone alleles in a school population sample representing a broad spectrum of variation in math achievement and detail school achievement and cognitive performance in the children identified with FMR1 premutation or gray zone alleles. Methods We described a two-phase study. In the first phase, 2,195 school-age children were screened for math achievement. In the second phase, 378 children with normal intelligence were neuropsychologically assessed and genotyped for FMR1. Of these, 121 children (61 girls) performed below percentile 25 in mathematics (MD group) and 257 children (146 girls) performed above percentile 25 (control group). Results Four pupils presented expanded alleles, one premutation and three gray zone alleles. The girl with the premutation and one boy with a gray zone allele presented impairments in working memory and arithmetic performance below percentile 6, compatible with the diagnosis of developmental dyscalculia. These children's difficulties were not associated with inaccuracy of nonsymbolic number representations or literacy impairments. Dyscalculia in these children seems to be associated mainly with working memory impairments. Conclusions FMR1 expansions in the gray zone may contribute to dyscalculia in otherwise healthy and normally intelligent children.
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Affiliation(s)
- Aline Aparecida Silva Martins
- Universidade Federal de Minas Gerais, Intituto de Ciências Biológicas, Departamento de Genética, Ecologia e Evolução, Postgraduate Program em Genética, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Intituto de Ciências Biológicas, Departamento de Genética, Ecologia e Evolução, Belo Horizonte MG, Brazil
| | - Giulia Moreira Paiva
- Universidade Federal de Minas Gerais, Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil
| | - Carolina Guimarães Ramos Matosinho
- Universidade Federal de Minas Gerais, Intituto de Ciências Biológicas, Departamento de Genética, Ecologia e Evolução, Postgraduate Program em Genética, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Intituto de Ciências Biológicas, Departamento de Genética, Ecologia e Evolução, Belo Horizonte MG, Brazil
| | - Elisângela Monteiro Coser
- Fundação Oswaldo Cruz, Instituto René Rachou, Departamento de Informática de Biossistemas e Genômica, Belo Horizonte MG, Brazil
| | - Pablo Augusto de Souza Fonseca
- Universidade Federal de Minas Gerais, Intituto de Ciências Biológicas, Departamento de Genética, Ecologia e Evolução, Postgraduate Program em Genética, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Intituto de Ciências Biológicas, Departamento de Genética, Ecologia e Evolução, Belo Horizonte MG, Brazil
| | - Vitor Geraldi Haase
- Universidade Federal de Minas Gerais, Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Neurociências, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Medicina, Postgraduate Program em Saúde da Criança e do Adolescente Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Faculdade de Filosofia e Ciências Humanas, Departamento de Psicologia, Postgraduate Program em Psicologia, Belo Horizonte MG, Brazil.,Instituto Nacional de Ciência e Tecnologia em Cognição, Comportamento e Ensino, São Carlos SP, Brazil
| | - Maria Raquel Santos Carvalho
- Universidade Federal de Minas Gerais, Intituto de Ciências Biológicas, Departamento de Genética, Ecologia e Evolução, Postgraduate Program em Genética, Belo Horizonte MG, Brazil.,Universidade Federal de Minas Gerais, Intituto de Ciências Biológicas, Departamento de Genética, Ecologia e Evolução, Belo Horizonte MG, Brazil
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5
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Hnoonual A, Jankittunpaiboon C, Limprasert P. Screening for FMR1 CGG Repeat Expansion in Thai Patients with Autism Spectrum Disorder. BIOMED RESEARCH INTERNATIONAL 2021; 2021:4359308. [PMID: 34926684 PMCID: PMC8674057 DOI: 10.1155/2021/4359308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/07/2021] [Accepted: 11/26/2021] [Indexed: 11/30/2022]
Abstract
Autism spectrum disorder (ASD) is a complex disorder with a heterogeneous etiology. Fragile X syndrome (FXS) is recognized as the most common single gene mutation associated with ASD. FXS patients show some autistic behaviors and may be difficult to distinguish at a young age from autistic children. However, there have been no published reports on the prevalence of FXS in ASD patients in Thailand. In this study, we present a pilot study to analyze the CGG repeat sizes of the FMR1 gene in Thai autistic patients. We screened 202 unrelated Thai patients (168 males and 34 females) with nonsyndromic ASD and 212 normal controls using standard FXS molecular diagnosis techniques. The distributions of FMR1 CGG repeat sizes in the ASD and normal control groups were similar, with the two most common alleles having 29 and 30 CGG repeats, followed by an allele with 36 CGG repeats. No FMR1 full mutations or premutations were found in either ASD individuals or the normal controls. Interestingly, three ASD male patients with high normal CGG and intermediate CGG repeats (44, 46, and 53 CGG repeats) were identified, indicating that the prevalence of FMR1 intermediate alleles in Thai ASD patients was approximately 1% while these alleles were absent in the normal male controls. Our study indicates that CGG repeat expansions of the FMR1 gene may not be a common genetic cause of nonsyndromic ASD in Thai patients. However, further studies for mutations other than the CGG expansion in the FMR1 gene are required to get a better information on FXS prevalence in Thai ASD patients.
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Affiliation(s)
- Areerat Hnoonual
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | | | - Pornprot Limprasert
- Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Faculty of Medicine, Siam University, Bangkok 10160, Thailand
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'Essential Tremor' Phenotype in FMR1 Premutation/Gray Zone Sibling Series: Exploring Possible Genetic Modifiers. Twin Res Hum Genet 2021; 24:95-102. [PMID: 33757613 DOI: 10.1017/thg.2021.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) occurs in carriers of fragile X mental retardation 1 (FMR1) X-linked small CGG expansion (gray zone [GZ] and premutation [PM]) alleles, containing 41-200 repeats. Major features comprise kinetic tremor, gait ataxia, cognitive decline and cerebellar peduncular white matter lesions, but atypical/incomplete FXTAS may occur. We explored the possibility of polygenic effects modifying the FXTAS spectrum phenotypes. We used three motor scales and selected cognitive tests in a series of three males and three females from a single sibship carrying PM or GZ alleles (44 to 75 repeats). The molecular profiles from these siblings were determined by genomewide association study with single-nucleotide polymorphism (SNP) genotyping by Illumina Global Screening Array. Nonparametric linkage analysis was applied and Parkinson's disease (PD) polygenic risk scores (PRSs) were calculated for all the siblings, based on 107 known risk variants. All male and female siblings manifested similar kinetic tremor phenotypes. In contrast to FXTAS, they showed negligible gait ataxia, and few white matter lesions on MRI. Cognitive functioning was unaffected. Suggestive evidence of linkage to a broad region of the short arm of chromosome 10 was obtained, and median PD PRS for the sibship fell within the top 30% of a sample of over 500,000 UK and Australian controls. The genomewide study results are suggestive of modifying effects of genetic risk loci linked to PD, on the neurological phenotype of FMR1-CGG small expansion carriers, resulting in an oligosymptomatic kinetic tremor seen in FXTAS spectrum, but also consistent with essential tremor.
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The Role of Alpha-Synuclein and Other Parkinson's Genes in Neurodevelopmental and Neurodegenerative Disorders. Int J Mol Sci 2020; 21:ijms21165724. [PMID: 32785033 PMCID: PMC7460874 DOI: 10.3390/ijms21165724] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 12/13/2022] Open
Abstract
Neurodevelopmental and late-onset neurodegenerative disorders present as separate entities that are clinically and neuropathologically quite distinct. However, recent evidence has highlighted surprising commonalities and converging features at the clinical, genomic, and molecular level between these two disease spectra. This is particularly striking in the context of autism spectrum disorder (ASD) and Parkinson's disease (PD). Genetic causes and risk factors play a central role in disease pathophysiology and enable the identification of overlapping mechanisms and pathways. Here, we focus on clinico-genetic studies of causal variants and overlapping clinical and cellular features of ASD and PD. Several genes and genomic regions were selected for our review, including SNCA (alpha-synuclein), PARK2 (parkin RBR E3 ubiquitin protein ligase), chromosome 22q11 deletion/DiGeorge region, and FMR1 (fragile X mental retardation 1) repeat expansion, which influence the development of both ASD and PD, with converging features related to synaptic function and neurogenesis. Both PD and ASD display alterations and impairments at the synaptic level, representing early and key disease phenotypes, which support the hypothesis of converging mechanisms between the two types of diseases. Therefore, understanding the underlying molecular mechanisms might inform on common targets and therapeutic approaches. We propose to re-conceptualize how we understand these disorders and provide a new angle into disease targets and mechanisms linking neurodevelopmental disorders and neurodegeneration.
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Hall DA, Nag S, Ouyang B, Bennett DA, Liu Y, Ali A, Zhou L, Berry-Kravis E. Fragile X Gray Zone Alleles Are Associated With Signs of Parkinsonism and Earlier Death. Mov Disord 2020; 35:1448-1456. [PMID: 32463542 DOI: 10.1002/mds.28086] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Premutation size (55-199 CGG repeats) in the fragile X mental retardation 1 (FMR1) gene cause fragile X-associated tremor/ataxia syndrome, but it is unclear whether smaller "gray" zone expansions of 41-54 repeats are also associated with movement disorders. The objectives of this study were to determine the association between the FMR1 gene gray zone expansions, AGG interspersions, and the presence of parkinsonism and motor and cognitive function in an elderly community-based population. METHODS Automated FMR1 polymerase chain reaction was performed on existing samples from 2 longitudinal aging studies whose subjects agreed to brain donation. A detailed clinical evaluation including a modified Unified Parkinson's Disease Rating Scale score, a composite score of global motor function, 17 cognitive tests summarized as a global measure of cognition, and neuropathological examination were obtained for genotyped participants. RESULTS The average age of the population (n = 2362) was 85.9 ± 7.3 years, and average age at death was 88.6 ± 6.4 years (n = 1326), with 72% women. The prevalence of FMR1 gray zone alleles was 5.2% (122 of 2362). There was no difference between participants with gray zone expansions or those lacking AGG interspersions compared with normal participants in global cognition, global motor function, clinical diagnosis, or pathological changes. Gray zone alleles were associated with signs of parkinsonism in men (P = 0.01), and gray zone carrier men were more likely to die (hazard ratio, 2.34; 95% confidence interval, 1.31-4.16). CONCLUSIONS This is the largest study to investigate gray zone alleles in a community population. The key findings are that in men, the gray zone allele is associated with signs of parkinsonism and higher risk of death, but not with intranuclear neuronal inclusions. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Deborah A Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sukriti Nag
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA.,Rush Alzheimer's Disease Center, Chicago, Illinois, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - David A Bennett
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.,Rush Alzheimer's Disease Center, Chicago, Illinois, USA
| | - Yuanqing Liu
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Aisha Ali
- University of Illinois, Chicago, Illinois, USA
| | - Lili Zhou
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA.,Department of Pediatrics, Rush University Medical Center, Chicago, Illinois, USA
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9
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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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Salcedo‐Arellano MJ, Wolf‐Ochoa MW, Hong T, Amina S, Tassone F, Lechpammer M, Hagerman R, Martínez‐Cerdeño V. Parkinsonism Versus Concomitant Parkinson's Disease in Fragile X-Associated Tremor/Ataxia Syndrome. Mov Disord Clin Pract 2020; 7:413-418. [PMID: 32373658 PMCID: PMC7197312 DOI: 10.1002/mdc3.12942] [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: 01/06/2020] [Revised: 02/10/2020] [Accepted: 03/09/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder associated with premutation alleles (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene. FXTAS is characterized by the presence of ubiquitin-positive inclusions in neurons and astrocytes and by cerebellar tremor and ataxia. Parkinsonism has been reported in FXTAS, but most patients lack the characteristic rest tremor and severe rigidity seen in idiopathic Parkinson's disease (PD). OBJECTIVE To describe the frequency of concomitant PD in FXTAS. METHODS We reviewed the medical record of 40 deceased patients diagnosed with FXTAS and performed a pathology analysis to confirm both FXTAS and PD. RESULTS Clinical histories indicated that 5 FXTAS patients were diagnosed with idiopathic PD and 2 with atypical parkinsonian syndrome. After pathological examination, we found that 7 patients in the PD clinical diagnosis group had dopaminergic neuronal loss; however, only 2 of 7 presented Lewy bodies (LBs) in the substantia nigra. Therefore, a total of 5% of the 40 cohort patients met the pathologic criteria for the concomitant diagnosis of FXTAS and PD. In addition, 2 patients not clinically diagnosed with PD also had nigral neuronal loss with LBs in substantia nigra. In total 10% of these 40 patients had LBs. CONCLUSION This report expands our understanding of clinical symptoms and unusual presentations in patients with FXTAS and the concept that the parkinsonism found in FXTAS is sometimes indistinguishable from PD. We propose that FMR1 should be recognized as one of the exceptional genetic causes of parkinsonism with presynaptic dopaminergic loss and LBs.
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Affiliation(s)
- María Jimena Salcedo‐Arellano
- Department of PediatricsUniversity of CaliforniaDavis, School of Medicine, SacramentoCaliforniaUSA
- Medical Investigation of Neurodevelopmental Disorders Institute (MIND)University of CaliforniaDavis, SacramentoCaliforniaUSA
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Marisol Wendy Wolf‐Ochoa
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Tiffany Hong
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Sarwat Amina
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders Institute (MIND)University of CaliforniaDavis, SacramentoCaliforniaUSA
- Department of Biochemistry and Molecular MedicineUniversity of CaliforniaDavis, SacramentoCaliforniaUSA
| | - Mirna Lechpammer
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
| | - Randi Hagerman
- Department of PediatricsUniversity of CaliforniaDavis, School of Medicine, SacramentoCaliforniaUSA
- Medical Investigation of Neurodevelopmental Disorders Institute (MIND)University of CaliforniaDavis, SacramentoCaliforniaUSA
| | - Verónica Martínez‐Cerdeño
- Medical Investigation of Neurodevelopmental Disorders Institute (MIND)University of CaliforniaDavis, SacramentoCaliforniaUSA
- Institute for Pediatric Regenerative Medicine and Shriners Hospitals for Children Northern CaliforniaSacramentoCaliforniaUSA
- Department of Pathology and Laboratory MedicineUniversity of California, Davis, School of MedicineSacramentoCaliforniaUSA
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11
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Loesch DZ, Tassone F, Mellick GD, Horne M, Rubio JP, Bui MQ, Francis D, Storey E. Evidence for the role of FMR1 gray zone alleles as a risk factor for parkinsonism in females. Mov Disord 2019; 33:1178-1181. [PMID: 30153395 DOI: 10.1002/mds.27420] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/15/2018] [Accepted: 04/02/2018] [Indexed: 12/12/2022] Open
Abstract
Background and Objective There is convincing evidence that small CGG expansion (41-54 repeats): FMR1 "gray zone" alleles (GZ) contribute to the risk of parkinsonism in males, but there is insufficient corresponding data in females. This study intends to fill this gap. Methods We screened whole-blood-derived DNA from a cohort of 601 females diagnosed with idiopathic PD, and from dry Guthrie blood spots from a local sample of 1,005 female newborns (population controls), for the size of the FMR1 CGG repeat using a PCR technique. Results We found a significant excess (8.2%) of GZ carriers compared with 5.2% in the control sample, with a P value of 0.009 for the difference in proportions. Conclusion FMR1 gray zone alleles are a significant risk factor for parkinsonism in females. These population data and occasional reports of FXTAS-like or parkinsonian manifestations in carriers suggest possible mechanisms whereby the effects of these alleles synergize with the existing pathologies underpinning parkinsonism. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Danuta Z Loesch
- Department of Psychology and Counselling, School of Psychology and Public Health, College of Science Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Flora Tassone
- UC Davis MIND Institute, Sacramento, California, USA
| | - George D Mellick
- Griffith Institute for Drug Discovery, Griffith University, Brisbane, Queensland, Australia
| | - Malcolm Horne
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Justin P Rubio
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia.,Department of Pharmacology and Therapeutics, University of Melbourne, VIC, Australia
| | - Minh Q Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, VIC, Australia
| | - David Francis
- Victorian Clinical Genetic Services, Melbourne, VIC, Australia
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Monash University (Alfred Hospital Campus), Melbourne, VIC, Australia
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12
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Movaghar A, Page D, Brilliant M, Baker MW, Greenberg J, Hong J, DaWalt LS, Saha K, Kuusisto F, Stewart R, Berry-Kravis E, Mailick MR. Data-driven phenotype discovery of FMR1 premutation carriers in a population-based sample. SCIENCE ADVANCES 2019; 5:eaaw7195. [PMID: 31457090 PMCID: PMC6703870 DOI: 10.1126/sciadv.aaw7195] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/15/2019] [Indexed: 05/18/2023]
Abstract
The impact of the FMR1 premutation on human health is the subject of considerable controversy. A fundamental unanswered question is whether carrying the premutation allele is directly correlated with clinical phenotypes. A challenging problem in past genotype-phenotype studies of the FMR1 premutation is ascertainment bias, which could lead to invalid research conclusions and negatively affect clinical practice. Here, we created the first population-based FMR1-informed biobank to find the pattern of health characteristics in premutation carriers. Our extensive phenotyping shows that premutation carriers experience a clinical profile that is significantly different from controls and is evident throughout adulthood. Comprehensive understanding of the clinical risk associated with this genetic variant is critical for premutation carriers, their families, and clinicians and has important implications for public health.
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Affiliation(s)
- Arezoo Movaghar
- Waisman Center, University of Wisconsin–Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, USA
| | - David Page
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison, WI, USA
| | | | | | - Jan Greenberg
- Waisman Center, University of Wisconsin–Madison, Madison, WI, USA
| | - Jinkuk Hong
- Waisman Center, University of Wisconsin–Madison, Madison, WI, USA
| | | | - Krishanu Saha
- Waisman Center, University of Wisconsin–Madison, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, USA
| | | | - Ron Stewart
- Morgridge Institute for Research, Madison, WI, USA
| | | | - Marsha R. Mailick
- Waisman Center, University of Wisconsin–Madison, Madison, WI, USA
- Corresponding author.
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13
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Klusek J, Porter A, Abbeduto L, Adayev T, Tassone F, Mailick MR, Glicksman A, Tonnsen BL, Roberts JE. Curvilinear Association Between Language Disfluency and FMR1 CGG Repeat Size Across the Normal, Intermediate, and Premutation Range. Front Genet 2018; 9:344. [PMID: 30197656 PMCID: PMC6118037 DOI: 10.3389/fgene.2018.00344] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 08/09/2018] [Indexed: 12/18/2022] Open
Abstract
Historically, investigations of FMR1 have focused almost exclusively on the clinical effects of CGG expansion within the categories of the premutation (55-200 CGG repeats) and fragile X syndrome (>200 CGG repeats). However, emerging evidence suggests that CGG-dependent phenotypes may occur across allele sizes traditionally considered within the "normal" range. This study adopted an individual-differences approach to determine the association between language production ability and CGG repeat length across the full range of normal, intermediate, and premutation alleles. Participants included 61 adult women with CGG repeats within the premutation (n = 37), intermediate (i.e., 41-54 repeats; n = 2), or normal (i.e., 6-40 repeats; n = 22) ranges. All participants were the biological mothers of a child with a developmental disorder, to control for the potential effects of parenting stress. Language samples were collected and the frequency of language disfluencies (i.e., interruptions in the flow of speech) served as an index of language production skills. Verbal inhibition skills, measured with the Hayling Sentence Completion Test, were also measured and examined as a correlate of language disfluency, consistent with theoretical work linking language disfluency with inhibitory deficits (i.e., the Inhibition Deficit Hypothesis). Blood samples were collected to determine FMR1 CGG repeat size. A general linear model tested CGG repeat size of the larger allele (allele-2) as the primary predictor of language disfluency, covarying for education level, IQ, age, and CGG repeats on the other allele. A robust curvilinear association between CGG length and language disfluency was detected, where low-normal (∼ <25 repeats) and mid-premutation alleles (∼90-110 repeats) were linked with higher rates of disfluency. Disfluency was not associated with inhibition deficits, which challenges prior theoretical work and suggests that a primary language deficit could account for elevated language disfluency in FMR1-associated conditions. Findings suggest CGG-dependent variation in language production ability, which was evident across individuals with and without CGG expansions on FMR1.
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Affiliation(s)
- Jessica Klusek
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States
| | - Anna Porter
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Leonard Abbeduto
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- MIND Institute, University of California, Davis, Sacramento, CA, United States
| | - Tatyana Adayev
- Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
| | - Flora Tassone
- MIND Institute, University of California, Davis, Sacramento, CA, United States
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Sacramento, CA, United States
| | - Marsha R. Mailick
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Anne Glicksman
- Department of Human Genetics, New York State Institute for Basic Research in Developmental Disabilities, Staten Island, NY, United States
| | - Bridgette L. Tonnsen
- Department of Psychological Sciences, Purdue University, Lafayette, IN, United States
| | - Jane E. Roberts
- Department of Psychology, University of South Carolina, Columbia, SC, United States
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14
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Debrey SM, Leehey MA, Klepitskaya O, Filley CM, Shah RC, Kluger B, Berry-Kravis E, Spector E, Tassone F, Hall DA. Clinical Phenotype of Adult Fragile X Gray Zone Allele Carriers: a Case Series. THE CEREBELLUM 2017; 15:623-31. [PMID: 27372099 DOI: 10.1007/s12311-016-0809-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Considerable research has focused on patients with trinucleotide (CGG) repeat expansions in the fragile X mental retardation 1 (FMR1) gene that fall within either the full mutation (>200 repeats) or premutation range (55-200 repeats). Recent interest in individuals with gray zone expansions (41-54 CGG repeats) has grown due to reported phenotypes that are similar to those observed in premutation carriers, including neurological, molecular, and cognitive signs. The purpose of this manuscript is to describe a series of adults with FMR1 alleles in the gray zone presenting with movement disorders or memory loss. Gray zone carriers ascertained in large FMR1 screening studies were identified and their clinical phenotypes studied. Thirty-one gray zone allele carriers were included, with mean age of symptom onset of 53 years in patients with movement disorders and 57 years in those with memory loss. Four patients were chosen for illustrative case reports and had the following diagnoses: early-onset Parkinson disease (PD), atypical parkinsonism, dementia, and atypical essential tremor. Some gray zone carriers presenting with parkinsonism had typical features, including bradykinesia, rigidity, and a positive response to dopaminergic medication. These patients had a higher prevalence of peripheral neuropathy and psychiatric complaints than would be expected. The patients seen in memory clinics had standard presentations of cognitive impairment with no apparent differences. Further studies are necessary to determine the associations between FMR1 expansions in the gray zone and various phenotypes of neurological dysfunction.
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Affiliation(s)
- Sarah M Debrey
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Maureen A Leehey
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Olga Klepitskaya
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christopher M Filley
- Departments of Neurology and Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
- Denver Veterans Affairs Medical Center, Denver, CO, USA
| | - Raj C Shah
- Rush Alzheimer's Disease Center, Rush University, Chicago, IL, USA
| | - Benzi Kluger
- Departments of Neurology and Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics and Biochemistry, Rush University, Chicago, IL, USA
- Department of Neurological Sciences, Rush University, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA
| | - Elaine Spector
- Denver Genetics DNA Diagnostic Laboratory at Children's Hospital Colorado, Department of Pediatrics, University of Colorado-Denver, Aurora, CO, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California School of Medicine, Davis, CA, USA
- M.I.N.D. Institute, University of California-Davis Medical Center, Sacramento, CA, USA
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
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15
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Yang W, Fan C, Chen L, Cui Z, Bai Y, Lan F. Pathological Effects of the FMR1 CGG-Repeat Polymorphism (5-55 Repeat Numbers): Systematic Review and Meta-Analysis. TOHOKU J EXP MED 2017; 239:57-66. [PMID: 27193037 DOI: 10.1620/tjem.239.57] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The fragile X mental retardation 1 (FMR1) gene contains a highly polymorphic trinucleotide (CGG) repeat and consists of various allelic forms. Traditionally, 55-200 repeats and over 200 CGG repeats have been highlighted to be associated with ovarian dysfunction and neuro-psychiatric risks. However, previous studies had paid little attention to the allelic forms of 5-55 CGG repeats. Herein, we sought to evaluate the pathological features of FMR1 allelic category with a range of 5-55 CGG repeats. We further classified the spectrum of CGG sizes (5-55 repeats) into three sub-groups as low numbers of CGG repeat (< 26 repeats), normal CGG count (26-34 repeats), and small CGG expansion (35-54 repeats). Our systematic review documented that low numbers of CGG repeat (< 26 repeats) revealed a close relationship with premature ovarian failure. Correspondingly, the meta-analysis showed that small CGG expansion, involving allelic sizes with 35-54 (n = 8, OR = 1.22, 95% CI: 0.75-2.00, P > 0.05) and 41-54 (n = 7, OR = 1.62, 95% CI: 1.14-2.30, P < 0.05), was both linked to the risk of ovarian dysfunction. Additionally, small CGG expansion exerts significant influence on male Parkinsonism cohorts (OR = 2.17, 95% CI: 1.50-3.14, P < 0.05), mental retardation, and repeat instability. Our data provide evidence that the CGG-repeat numbers below 26 or above 34 of FMR1 gene are also associated with disease risks and thus should be regarded as pathological genotypes for a routine test.
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Affiliation(s)
- Wenjing Yang
- Department of Clinical Genetics and Experimental Medicine, Affiliated Dongfang Hospital of Xiamen University
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16
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Entezari A, Khaniani MS, Bahrami T, Derakhshan SM, Darvish H. Screening for intermediate CGG alleles of FMR1 gene in male Iranian patients with Parkinsonism. Neurol Sci 2016; 38:123-128. [DOI: 10.1007/s10072-016-2723-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 09/01/2016] [Indexed: 02/01/2023]
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17
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Robertson EE, Hall DA, McAsey AR, O'Keefe JA. Fragile X-associated tremor/ataxia syndrome: phenotypic comparisons with other movement disorders. Clin Neuropsychol 2016; 30:849-900. [PMID: 27414076 PMCID: PMC7336900 DOI: 10.1080/13854046.2016.1202239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/12/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this paper is to review the typical cognitive and motor impairments seen in fragile X-associated tremor/ataxia syndrome (FXTAS), essential tremor (ET), Parkinson disease (PD), spinocerebellar ataxias (SCAs), multiple system atrophy (MSA), and progressive supranuclear palsy (PSP) in order to enhance diagnosis of FXTAS patients. METHODS We compared the cognitive and motor phenotypes of FXTAS with each of these other movement disorders. Relevant neuropathological and neuroimaging findings are also reviewed. Finally, we describe the differences in age of onset, disease severity, progression rates, and average lifespan in FXTAS compared to ET, PD, SCAs, MSA, and PSP. We conclude with a flow chart algorithm to guide the clinician in the differential diagnosis of FXTAS. RESULTS By comparing the cognitive and motor phenotypes of FXTAS with the phenotypes of ET, PD, SCAs, MSA, and PSP we have clarified potential symptom overlap while elucidating factors that make these disorders unique from one another. In summary, the clinician should consider a FXTAS diagnosis and testing for the Fragile X mental retardation 1 (FMR1) gene premutation if a patient over the age of 50 (1) presents with cerebellar ataxia and/or intention tremor with mild parkinsonism, (2) has the middle cerebellar peduncle (MCP) sign, global cerebellar and cerebral atrophy, and/or subcortical white matter lesions on MRI, or (3) has a family history of fragile X related disorders, intellectual disability, autism, premature ovarian failure and has neurological signs consistent with FXTAS. Peripheral neuropathy, executive function deficits, anxiety, or depression are supportive of the diagnosis. CONCLUSIONS Distinct profiles in the cognitive and motor domains between these movement disorders may guide practitioners in the differential diagnosis process and ultimately lead to better medical management of FXTAS patients.
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Affiliation(s)
- Erin E Robertson
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Deborah A Hall
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
| | - Andrew R McAsey
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
| | - Joan A O'Keefe
- a Department of Anatomy and Cell Biology , Rush University , Chicago , IL , USA
- b Department of Neurological Sciences , Rush University , Chicago , IL , USA
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18
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Lozano R, Rosero CA, Hagerman RJ. Fragile X spectrum disorders. Intractable Rare Dis Res 2014; 3:134-46. [PMID: 25606363 PMCID: PMC4298643 DOI: 10.5582/irdr.2014.01022] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/28/2014] [Indexed: 12/13/2022] Open
Abstract
The fragile X mental retardation 1 gene (FMR1), which codes for the fragile X mental retardation 1 protein (FMRP), is located at Xp27.3. The normal allele of the FMR1 gene typically has 5 to 40 CGG repeats in the 5' untranslated region; abnormal alleles of dynamic mutations include the full mutation (> 200 CGG repeats), premutation (55-200 CGG repeats) and the gray zone mutation (45-54 CGG repeats). Premutation carriers are common in the general population with approximately 1 in 130-250 females and 1 in 250-810 males, whereas the full mutation and Fragile X syndrome (FXS) occur in approximately 1 in 4000 to 1 in 7000. FMR1 mutations account for a variety of phenotypes including the most common monogenetic cause of inherited intellectual disability (ID) and autism (FXS), the most common genetic form of ovarian failure, the fragile X-associated primary ovarian insufficiency (FXPOI, premutation); and fragile X-associated tremor/ataxia syndrome (FXTAS, premutation). The premutation can also cause developmental problems including ASD and ADHD especially in boys and psychopathology including anxiety and depression in children and adults. Some premutation carriers can have a deficit of FMRP and some unmethylated full mutation individuals can have elevated FMR1 mRNA that is considered a premutation problem. Therefore the term "Fragile X Spectrum Disorder" (FXSD) should be used to include the wide range of overlapping phenotypes observed in affected individuals with FMR1 mutations. In this review we focus on the phenotypes and genotypes of children with FXSD.
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Affiliation(s)
- Reymundo Lozano
- UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
- Address correspondence to: Dr. Reymundo Lozano, UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA. E-mail:
| | - Carolina Alba Rosero
- Instituto Colombiano del Sistema Nervioso, Clínica Montserrat, Bogotá D.C, Colombia
| | - Randi J Hagerman
- UC Davis MIND Institute and Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
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19
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Mailick MR, Hong J, Rathouz P, Baker MW, Greenberg JS, Smith L, Maenner M. Low-normal FMR1 CGG repeat length: phenotypic associations. Front Genet 2014; 5:309. [PMID: 25250047 PMCID: PMC4158814 DOI: 10.3389/fgene.2014.00309] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/19/2014] [Indexed: 11/13/2022] Open
Abstract
This population-based study investigates genotype-phenotype correlations of "low- normal" CGG repeats in the fragile X mental retardation 1 (FMR1) gene. FMR1 plays an important role in brain development and function, and encodes FMRP (fragile X mental retardation protein), an RNA-binding protein that regulates protein synthesis impacting activity-dependent synaptic development and plasticity. Most past research has focused on CGG premutation expansions (41-200 CGG repeats) and on fragile X syndrome (200+ CGG repeats), with considerably less attention on the other end of the spectrum of CGG repeats. Using existing data, older adults with 23 or fewer CGG repeats (2 SDs below the mean) were compared with age-peers who have normal numbers of CGGs (24-40) with respect to cognition, mental health, cancer, and having children with disabilities. Men (n = 341 with an allele in the low-normal range) and women (n = 46 with two low-normal alleles) had significantly more difficulty with their memory and ability to solve day to day problems. Women with both FMR1 alleles in the low-normal category had significantly elevated odds of feeling that they need to drink more to get the same effect as in the past. These women also had two and one-half times the odds of having had breast cancer and four times the odds of uterine cancer. Men and women with low-normal CGGs had higher odds of having a child with a disability, either a developmental disability or a mental health condition. These findings are in line with the hypothesis that there is a need for tight neuronal homeostatic control mechanisms for optimal cognitive and behavioral functioning, and more generally that low numbers as well as high numbers of CGG repeats may be problematic for health.
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Affiliation(s)
- Marsha R Mailick
- Waisman Center, University of Wisconsin-Madison Madison, WI, USA
| | - Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison Madison, WI, USA
| | - Paul Rathouz
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison Madison, WI, USA
| | - Mei W Baker
- Wisconsin State Laboratory of Hygiene Madison, WI, USA
| | - Jan S Greenberg
- Waisman Center, University of Wisconsin-Madison Madison, WI, USA ; School of Social Work, University of Wisconsin-Madison Madison, WI, USA
| | - Leann Smith
- Waisman Center, University of Wisconsin-Madison Madison, WI, USA
| | - Matthew Maenner
- Waisman Center, University of Wisconsin-Madison Madison, WI, USA
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20
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Usdin K, Hayward BE, Kumari D, Lokanga RA, Sciascia N, Zhao XN. Repeat-mediated genetic and epigenetic changes at the FMR1 locus in the Fragile X-related disorders. Front Genet 2014; 5:226. [PMID: 25101111 PMCID: PMC4101883 DOI: 10.3389/fgene.2014.00226] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 06/29/2014] [Indexed: 01/01/2023] Open
Abstract
The Fragile X-related disorders are a group of genetic conditions that include the neurodegenerative disorder, Fragile X-associated tremor/ataxia syndrome (FXTAS), the fertility disorder, Fragile X-associated primary ovarian insufficiency (FXPOI) and the intellectual disability, Fragile X syndrome (FXS). The pathology in all these diseases is related to the number of CGG/CCG-repeats in the 5′ UTR of the Fragile X mental retardation 1 (FMR1) gene. The repeats are prone to continuous expansion and the increase in repeat number has paradoxical effects on gene expression increasing transcription on mid-sized alleles and decreasing it on longer ones. In some cases the repeats can simultaneously both increase FMR1 mRNA production and decrease the levels of the FMR1 gene product, Fragile X mental retardation 1 protein (FMRP). Since FXTAS and FXPOI result from the deleterious consequences of the expression of elevated levels of FMR1 mRNA and FXS is caused by an FMRP deficiency, the clinical picture is turning out to be more complex than once appreciated. Added complications result from the fact that increasing repeat numbers make the alleles somatically unstable. Thus many individuals have a complex mixture of different sized alleles in different cells. Furthermore, it has become apparent that the eponymous fragile site, once thought to be no more than a useful diagnostic criterion, may have clinical consequences for females who inherit chromosomes that express this site. This review will cover what is currently known about the mechanisms responsible for repeat instability, for the repeat-mediated epigenetic changes that affect expression of the FMR1 gene, and for chromosome fragility. It will also touch on what current and future options are for ameliorating some of these effects.
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Affiliation(s)
- Karen Usdin
- Section on Gene Structure and Disease, Laboratory of Cell and Molecular Biology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD, USA
| | - Bruce E Hayward
- Section on Gene Structure and Disease, Laboratory of Cell and Molecular Biology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD, USA
| | - Daman Kumari
- Section on Gene Structure and Disease, Laboratory of Cell and Molecular Biology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD, USA
| | - Rachel A Lokanga
- Section on Gene Structure and Disease, Laboratory of Cell and Molecular Biology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD, USA
| | - Nicholas Sciascia
- Section on Gene Structure and Disease, Laboratory of Cell and Molecular Biology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD, USA
| | - Xiao-Nan Zhao
- Section on Gene Structure and Disease, Laboratory of Cell and Molecular Biology, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda MD, USA
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21
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Birch RC, Cornish KM, Hocking DR, Trollor JN. Understanding the neuropsychiatric phenotype of fragile X-associated tremor ataxia syndrome: a systematic review. Neuropsychol Rev 2014; 24:491-513. [PMID: 24828430 DOI: 10.1007/s11065-014-9262-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Abstract
Fragile X-associated tremor ataxia syndrome (FXTAS) is a recently identified X-linked neurodegenerative disorder affecting a proportion of premutation carriers of the Fragile X Mental Retardation 1 (FMR1) gene. Previous research suggests that cognitive and psychiatric features of FXTAS may include primary impairments in executive function and increased vulnerability to mood and anxiety disorders. A number of these reports, however, are based on overlapping cohorts or have produced inconsistent findings. A systematic review was therefore conducted to further elucidate the neuropsychiatric features characteristic of FXTAS. Fourteen papers met inclusion criteria for the review and were considered to represent nine independent FXTAS cohorts. Findings from the review suggest that the neuropsychiatric phenotype of FXTAS is characterised primarily by poorer performance on measures of executive function, working memory, information processing speed, and fine motor control when compared to matched comparison groups. Two studies were identified in which psychiatric symptoms in FXTAS were compared with controls, and these yielded mixed results. Overall the results of this review support previous reports that the neuropsychiatric profile of FXTAS is consistent with a dysexecutive fronto-subcortical syndrome. However, additional controlled studies are required to progress our understanding of FXTAS and how the neuropsychiatric profile relates to underlying pathological mechanisms.
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Affiliation(s)
- R C Birch
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
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22
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Kraan CM, Hocking DR, Georgiou-Karistianis N, Metcalfe SA, Archibald AD, Fielding J, Trollor J, Bradshaw JL, Cohen J, Cornish KM. Age and CGG-repeat length are associated with neuromotor impairments in at-risk females with the FMR1 premutation. Neurobiol Aging 2014; 35:2179.e7-13. [PMID: 24814676 DOI: 10.1016/j.neurobiolaging.2014.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 01/11/2023]
Abstract
Recent studies report a higher risk of dementia and motor symptoms in females with the fragile X mental retardation 1 premutation (PM-carriers) than has hitherto been appreciated. Here, we use dual-task gait paradigms to identify potential markers of cognitive and motor decline in female PM-carriers. Spatiotemporal gait characteristics and variability of gait were assessed during single- and dual-task conditions in 28 female PM-carriers (mean age 41.32 ± 8.03 years) and 31 female controls with normal fragile X mental retardation 1 alleles (mean age 41.61 ± 8.30 years). Despite comparable gait characteristics at baseline, gait performance was significantly poorer for PM-carriers when performing concurrent working memory tasks (counting backwards by 3's or 7's) when compared with controls. Correlational analyses showed that low working memory capacity was significantly associated with dual-task interference for the gait domains of pace (speed, step length) and variability (step time, swing time) in PM-carriers. Multiple regression analyses further showed that the interaction between age and CGG repeat length was strongly predictive of gait variability during dual-task performance. These findings indicate for the first time that vulnerability in specific domains of gait control may act as sensitive surrogate markers of future decline in female PM-carriers.
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Affiliation(s)
- Claudine M Kraan
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Darren R Hocking
- Olga Tennison Research Centre, School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia
| | - Nellie Georgiou-Karistianis
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Sylvia A Metcalfe
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Alison D Archibald
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia; Victorian Clinical Genetics Services, Parkville, Victoria, Australia
| | - Joanne Fielding
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Health Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - John L Bradshaw
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jonathan Cohen
- Genetics Education and Health Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Centre for Developmental Disability Health Victoria, Monash University, Clayton, Victoria, Australia; Fragile X Alliance Inc (Clinic and Resource Centre), North Caufield, Victoria, Australia
| | - Kim M Cornish
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia.
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Niu YQ, Yang JC, Hall DA, Leehey MA, Tassone F, Olichney JM, Hagerman RJ, Zhang L. Parkinsonism in fragile X-associated tremor/ataxia syndrome (FXTAS): revisited. Parkinsonism Relat Disord 2014; 20:456-9. [PMID: 24491663 DOI: 10.1016/j.parkreldis.2014.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 12/06/2013] [Accepted: 01/07/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Parkinsonian features have been used as a minor diagnostic criterion for fragile X-associated tremor/ataxia syndrome (FXTAS). However, prior studies have examined parkinsonism (defined as having bradykinesia with at least rest tremor or postural instability) mostly in premutation carriers without a diagnosis of FXTAS. The current study was intended to elaborate this important aspect of the FXTAS spectrum, and to quantify the relationships between parkinsonism, FXTAS clinical staging and genetic/molecular measures. METHODS Thirty eight (38) FXTAS patients and 10 age-matched normal controls underwent a detailed neurological examination that included all but one item (i.e. rigidity) of the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS). RESULTS The FXTAS patient group displayed substantially higher prevalence of parkinsonian features including body bradykinesia (57%) and rest tremor (26%), compared to the control group. Furthermore, parkinsonism was identified in 29% of FXTAS patients. Across all patients, body bradykinesia scores significantly correlated with FXTAS clinical stage, FMR1 mRNA level, and ataxic gait of cerebellar origin, while postural instability was associated with intention tremor. INTERPRETATION Parkinsonian features in FXTAS appear to be characterized as bradykinesia concurrent with cerebellar gait ataxia, postural instability accompanied by intention tremor, and frequent rest tremor, representing distinctive patterns that highlight the need for further clinical studies including genetic testing for the FMR1 premutation. The association between FMR1 mRNA level and bradykinesia implicates pathophysiological mechanisms which may link FMR1 mRNA toxicity, dopamine deficiency and parkinsonism in FXTAS.
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Affiliation(s)
- Yu-Qiong Niu
- Department of Neurology, University of California Davis, Sacramento, CA, USA; Center for Mind and Brain, University of California Davis, Davis, CA, USA.
| | - Jin-Chen Yang
- Department of Neurology, University of California Davis, Sacramento, CA, USA; Center for Mind and Brain, University of California Davis, Davis, CA, USA
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Maureen A Leehey
- Department of Neurology, University of Colorado, Denver, CO, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California Davis, Davis, CA, USA; Medical Investigations of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA, USA
| | - John M Olichney
- Department of Neurology, University of California Davis, Sacramento, CA, USA; Center for Mind and Brain, University of California Davis, Davis, CA, USA
| | - Randi J Hagerman
- Medical Investigations 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
| | - Lin Zhang
- Department of Neurology, University of California Davis, Sacramento, CA, USA.
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24
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Polussa J, Schneider A, Hagerman R. Molecular Advances Leading to Treatment Implications for Fragile X Premutation Carriers. BRAIN DISORDERS & THERAPY 2014; 3:1000119. [PMID: 25436181 PMCID: PMC4245015 DOI: 10.4172/2168-975x.1000119] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fragile X syndrome (FXS) is the most common single gene cause of intellectual disability and it is characterized by a CGG expansion of more than 200 repeats in the FMR1 gene, leading to methylation of the promoter and gene silencing. The fragile X premutation, characterized by a 55 to 200 CGG repeat expansion, causes health problems and developmental difficulties in some, but not all, carriers. The premutation causes primary ovarian insufficiency in approximately 20% of females, psychiatric problems (including depression and/or anxiety) in approximately 50% of carriers and a neurodegenerative disorder, the fragile X-associated tremor ataxia syndrome (FXTAS), in approximately 40% of males and 16% of females later in life. Recent clinical studies in premutation carriers have expanded the health problems that may be seen. Advances in the molecular pathogenesis of the premutation have shown significant mitochondrial dysfunction and oxidative stress in neurons which may be amenable to treatment. Here we review the clinical problems of carriers and treatment recommendations.
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Affiliation(s)
- Jonathan Polussa
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health System, Sacramento, California, USA
- Department of Pediatrics, University of California Davis Health System, Sacramento, California, USA
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25
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Tassone F, Choudhary NS, Tassone F, Durbin-Johnson B, Hansen R, Hertz-Picciotto I, Pessah I. Identification of expanded alleles of the FMR1 Gene in the CHildhood Autism Risks from Genes and Environment (CHARGE) study. J Autism Dev Disord 2013; 43:530-9. [PMID: 22767137 DOI: 10.1007/s10803-012-1580-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Fragile X syndrome (FXS) is a neuro-developmental disorder characterized by intellectual disabilities and autism spectrum disorders (ASD). Expansion of a CGG trinucleotide repeat (>200 repeats) in the 5'UTR of the fragile X mental retardation gene, is the single most prevalent cause of cognitive disabilities. Several screening studies for FXS, among individuals with ID from different ethnic populations, have indicated that the prevalence of the syndrome varies between 0.5 and 16 %. Because the high co-morbidity with autism, we have conducted a screening study of the cohort from CHARGE, a large-scale, population-based, case control study. We have identified six subjects carrying an expanded allele, which emphasize the importance of screening for FXS in a population with intellectual disabilities and ASD.
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Affiliation(s)
- Flora Tassone
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, 2700 Stockton Blvd, Suite 2102, Sacramento, CA 95817, USA.
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26
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Cognitive-motor interference during postural control indicates at-risk cerebellar profiles in females with the FMR1 premutation. Behav Brain Res 2013; 253:329-36. [PMID: 23896050 DOI: 10.1016/j.bbr.2013.07.033] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/16/2013] [Accepted: 07/20/2013] [Indexed: 11/22/2022]
Abstract
Recent investigations report a higher risk of motor symptoms in females with the FMR1 premutation (PM-carriers) than has hitherto been appreciated. Here we examined basic sensorimotor and postural control under different sensory and attentional dual-task demands. Physiological performance and postural sway measures from the Physiological Profile Assessment (Lord et al., 2003 [39]) were conducted in 28 female PM-carriers (mean age: 41.32±8.03) and 31 female controls with normal FMR1 alleles (mean age: 41.61±8.3). Multiple regression analyses were conducted to examine the moderating role of CGG-repeat length on the relation between age and postural sway under dual-task interference. In female PM-carriers, our results showed significantly poorer proprioceptive awareness, slower reaction time, and greater postural displacement when performing a concurrent verbal fluency task. Significantly, these findings showed age- and genetically-modulated changes in dual-task postural displacement in the medio-lateral direction in female PM-carriers. These findings highlight the sensitivity of postural control paradigms in identifying early cerebellar postural changes that may act as surrogate markers of future decline in female PM-carriers.
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27
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Maenner MJ, Baker MW, Broman KW, Tian J, Barnes JK, Atkins A, McPherson E, Hong J, Brilliant MH, Mailick MR. FMR1 CGG expansions: prevalence and sex ratios. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:466-73. [PMID: 23740716 PMCID: PMC3885228 DOI: 10.1002/ajmg.b.32176] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/13/2013] [Indexed: 11/12/2022]
Abstract
We have estimated the prevalence of FMR1 premutation and gray zone CGG repeat expansions in a population-based sample of 19,996 male and female adults in Wisconsin and compared the observed sex ratios of the prevalence of FMR1 CGG premutation and gray zone expansions to theoretical sex ratios. The female premutation prevalence was 1 in 148 and comparable to past research, but the male premutation prevalence of 1 in 290 is somewhat higher than most previous estimates. The female:male premutation prevalence ratio is in line with the theoretically predicted sex ratio. The prevalence of CGG repeats in the gray zone (45-54 repeats) was 1 in 33 females and 1 in 62 males. The prevalence of the "expanded" gray zone (defined here as 41-54 CGG repeats) was 1 in 14 females and 1 in 22 males, leading to a female:male ratio of 1.62 (95% confidence interval 1.39-1.90). This female:male ratio was significantly lower than the expected ratio of 2.0. We examined results from three previously published FMR1 prevalence studies and found similar female:male ratios for CGG repeats in this "expanded" gray zone range (pooled female:male ratio across all four studies 1.66, 95% confidence interval 1.51-1.82). Further research is needed to understand the apparent excess prevalence of males with CGG repeats in this range.
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Affiliation(s)
- Matthew J. Maenner
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin,Correspondence to: Matthew J. Maenner, 1500 Highland Avenue Rm 529A, Madison, WI 53705.
| | - Mei W. Baker
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin,Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Karl W. Broman
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jianan Tian
- Department of Statistics, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Anne Atkins
- Wisconsin State Laboratory of Hygiene, Madison, Wisconsin,Department of Pediatrics, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
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28
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Abstract
This article summarizes the clinical findings, genetics, pathophysiology, and treatment of fragile X-associated tremor ataxia syndrome. The disorder occurs from a CGG repeat (55-200) expansion in the fragile X mental retardation 1 gene. It manifests clinically in kinetic tremor, gait ataxia, and executive dysfunction, usually in older men who carry the genetic abnormality. The disorder has distinct radiographic and pathologic findings. Symptomatic treatment is beneficial in some patients. The inheritance is X-linked and family members may be at risk for other fragile X-associated disorders. This information is useful to neurologists, general practitioners, and geneticists.
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29
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Neurobehavioural evidence for the involvement of the FMR1 gene in female carriers of fragile X syndrome. Neurosci Biobehav Rev 2013; 37:522-47. [DOI: 10.1016/j.neubiorev.2013.01.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 12/11/2012] [Accepted: 01/06/2013] [Indexed: 12/19/2022]
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30
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Loesch DZ, Tassone F, Lo J, Slater HR, Hills LV, Bui MQ, Silburn PA, Mellick GD. New evidence for, and challenges in, linking small CGG repeat expansion FMR1 alleles with Parkinson's disease. Clin Genet 2012. [PMID: 23198693 DOI: 10.1111/cge.12070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We recently reported a significant increase in the frequency of carriers of grey zone (GZ) alleles of FMR1 gene in Australian males with Parkinson's disease (PD) from Victoria and Tasmania. Here, we report data comparing an independent sample of 817 PD patients from Queensland to 1078 consecutive Australian male newborns from Victoria. We confirmed the earlier finding by observing a significant excess of GZ alleles in PD (4.8%) compared to controls (1.5%). Although both studies provided evidence in support of an association between GZ-carrier status and increased risk for parkinsonism, the existing evidence in the literature from screening studies remains equivocal and we discuss the need for alternative approaches to resolve the issue.
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Affiliation(s)
- D Z Loesch
- School of Psychological Science, La Trobe University, Bundoora, Victoria, Australia
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31
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Tassone F, Iong KP, Tong TH, Lo J, Gane LW, Berry-Kravis E, Nguyen D, Mu LY, Laffin J, Bailey DB, Hagerman RJ. FMR1 CGG allele size and prevalence ascertained through newborn screening in the United States. Genome Med 2012; 4:100. [PMID: 23259642 PMCID: PMC4064316 DOI: 10.1186/gm401] [Citation(s) in RCA: 225] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/19/2012] [Accepted: 12/21/2012] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Population screening for FMR1 mutations has been a topic of considerable discussion since the FMR1 gene was identified in 1991. Advances in understanding the molecular basis of fragile X syndrome (FXS) and in genetic testing methods have led to new, less expensive methodology to use for large screening endeavors. A core criterion for newborn screening is an accurate understanding of the public health burden of a disease, considering both disease severity and prevalence rate. This article addresses this need by reporting prevalence rates observed in a pilot newborn screening study for FXS in the US. METHODS Blood spot screening of 14,207 newborns (7,312 males and 6,895 females) was conducted in three birthing hospitals across the United States beginning in November 2008, using a PCR-based approach. RESULTS The prevalence of gray zone alleles was 1:66 females and 1:112 males, while the prevalence of a premutation was 1:209 females and 1:430 males. Differences in prevalence rates were observed among the various ethnic groups; specifically higher frequency for gray zone alleles in males was observed in the White group compared to the Hispanic and African-American groups. One full mutation male was identified (>200 CGG repeats). CONCLUSIONS The presented pilot study shows that newborn screening in fragile X is technically feasible and provides overall prevalence of the premutation and gray zone alleles in the USA, suggesting that the prevalence of the premutation, particularly in males, is higher than has been previously reported.
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Affiliation(s)
- Flora Tassone
- Department of Biochemistry and Molecular Medicine, UC Davis, Sacramento, CA 95817, USA
- MIND Institute, UC Davis Medical Center, Sacramento, CA 95817, USA
| | - Ka Pou Iong
- Department of Biochemistry and Molecular Medicine, UC Davis, Sacramento, CA 95817, USA
| | - Tzu-Han Tong
- Department of Biochemistry and Molecular Medicine, UC Davis, Sacramento, CA 95817, USA
| | - Joyce Lo
- Department of Biochemistry and Molecular Medicine, UC Davis, Sacramento, CA 95817, USA
| | - Louise W Gane
- MIND Institute, UC Davis Medical Center, Sacramento, CA 95817, USA
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Neurological Sciences, and Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA
| | - Danh Nguyen
- Division of Biostatistics, UC Davis, Davis, CA 95616, USA
| | - Lisa Y Mu
- Division of Biostatistics, UC Davis, Davis, CA 95616, USA
| | - Jennifer Laffin
- Department of Pediatrics, University of Wisconsin, Madison, WI 53706, USA
| | - Don B Bailey
- RTI International, Research Triangle Park, NC 27709, USA
| | - Randi J Hagerman
- MIND Institute, UC Davis Medical Center, Sacramento, CA 95817, USA
- Department of Pediatrics, UC Davis, Sacramento, CA 95817, USA
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32
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Seltzer MM, Baker MW, Hong J, Maenner M, Greenberg J, Mandel D. Prevalence of CGG expansions of the FMR1 gene in a US population-based sample. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:589-97. [PMID: 22619118 PMCID: PMC3391968 DOI: 10.1002/ajmg.b.32065] [Citation(s) in RCA: 153] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 04/26/2012] [Indexed: 11/09/2022]
Abstract
The primary goal of this study was to calculate the prevalence of the premutation of the FMR1 gene and of the "gray zone" using a population-based sample of older adults in Wisconsin (n = 6,747 samples screened). Compared with past research, prevalence was relatively high (1 in 151 females and 1 in 468 males for the premutation and 1 in 35 females and 1 in 42 males for the gray zone as defined by 45-54 CGG repeats). A secondary study goal was to describe characteristics of individuals found to have the premutation (n = 30, 7 males and 23 females). We found that premutation carriers had a significantly higher rate of divorce than controls, as well as higher rates of symptoms that might be indicative of fragile X-associated tremor ataxia syndrome (FXTAS; numbness, dizziness/faintness) and fragile X primary ovarian insufficiency (FXPOI; age at last menstrual period). Although not statistically significant, premutation carriers were twice as likely to have a child with disability.
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Affiliation(s)
| | - Mei Wang Baker
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Matthew Maenner
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jan Greenberg
- Waisman Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Daniel Mandel
- Centers for Disease Control and Prevention, Atlanta, Georgia
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33
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Hagerman PJ. Current Gaps in Understanding the Molecular Basis of FXTAS. Tremor Other Hyperkinet Mov (N Y) 2012; 2:tre-02-63-375-2. [PMID: 23440729 PMCID: PMC3379894 DOI: 10.7916/d80c4th0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 12/01/2011] [Indexed: 01/26/2023] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder with defining clinical features that include kinetic tremor, gait ataxia, and parkinsonism, with associated features spanning medical, cognitive, and psychiatric clinical domains. The emerging model for the pathogenesis of FXTAS is that of RNA toxicity as a consequence of the sequestration of RNA binding proteins by the expanded CGG-repeat element within the FMR1 message, thus compromising the normal functions of those proteins. A principal challenge at this point is to determine precisely which proteins are involved in FXTAS pathogenesis and how to prevent or reverse this process. A second challenge is to determine why there is incomplete penetrance of FXTAS among premutation carriers with identical CGG-repeat lengths, and what the protective factors are in some carriers. Finally, the discovery in premutation mice of early neurodevelopmental abnormalities, some occurring even during late embryogenesis, raises the question of whether FXTAS is the end-stage of a life-long process of neuronal dysregulation. If an extended pre-clinical phase precedes the development of FXTAS, there is great potential for therapeutic intervention, years or even decades before its clinical features are manifest.
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Affiliation(s)
- Paul J. Hagerman
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Davis, California, United States of America
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34
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Hall DA, O'keefe JA. Fragile x-associated tremor ataxia syndrome: the expanding clinical picture, pathophysiology, epidemiology, and update on treatment. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2012; 2. [PMID: 23439567 PMCID: PMC3570061 DOI: 10.7916/d8hd7tds] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 11/21/2011] [Indexed: 12/12/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a progressive degenerative movement disorder characterized by kinetic tremor, cerebellar gait ataxia, parkinsonism, and cognitive decline. This disorder occurs in both males and females, frequently in families with children who have fragile X syndrome. The clinical features of this disorder, both classic and newly described, are summarized in this paper. In screening studies, fragile X mental retardation 1 (FMR1) gene premutation (55–200 CGG) expansions are most frequently seen in men with ataxia who have tested negative for spinocerebellar ataxias. Since the original description, the classic FXTAS phenotype has now been reported in females and in carriers of smaller (45–54 CGG) and larger (>200 CGG) expansions in FMR1. Premutation carriers may present with a Parkinson disease phenotype or hypotension, rather than with tremor and/or ataxia. Parkinsonism and gait ataxia may also be seen in individuals with gray zone (41–54 CGG) expansions. Studies regarding medication to treat the symptoms in FXTAS are few in number and suggest that medications targeted to specific symptoms, such as kinetic tremor or gait ataxia, may be most beneficial. Great progress has been made in regards to FXTAS research, likely given the readily available gene test and the screening of multiple family members, including parents and grandparents, of fragile X syndrome children. Expansion of genotypes and phenotypes in the disorder may suggest that a broader disease definition might be necessary in the future.
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Affiliation(s)
- Deborah A Hall
- Department of Neurological Sciences, Rush University, Chicago, Illinois, United States of America
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35
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Zhang X, Zhuang X, Gan S, Wu Z, Chen W, Hu Y, Wang N. Screening for FMR1 expanded alleles in patients with parkinsonism in mainland China. Neurosci Lett 2012; 514:16-21. [PMID: 22387066 DOI: 10.1016/j.neulet.2012.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 02/09/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
Abstract
Expanded alleles of the fragile X mental retardation 1 (FMR1) gene are generally divided into four classes based on the abundance of unstable CGG repeat expansions (CGGs) in its 5'-untranslated region. It has recently been reported that two of the four classes, premutation (55-200 CGGs) and gray zone (GZ, 40-54 CGGs) alleles, was potentially associated with parkinsonism. To investigate this association in patients in mainland China, a total of 360 Chinese patients with parkinsonism and 295 gender and age matched controls were recruited in this study. Indeed, no premutation or full mutation alleles (>200 CGGs) was detected among all the subjects. A total of 11 patients with parkinsonism were identified to have GZ alleles compared with only 1 carrier among the controls (P<0.05). Notably, 10 of the 11 GZ alleles carriers with parkinsonism were female, which was 6.8% of all 147 female patients compared with none in the control females (P<0.05). No significant difference was detected between the male groups of patients and controls. Therefore, our results indicate that FMR1 GZ allele is potentially associated with parkinsonism in mainland China, and the association is only present in the female patients, but not in the male.
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Affiliation(s)
- Xiong Zhang
- Department of Neurology and Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fujian Province 350005, China
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36
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Renoux AJ, Todd PK. Neurodegeneration the RNA way. Prog Neurobiol 2011; 97:173-89. [PMID: 22079416 DOI: 10.1016/j.pneurobio.2011.10.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 10/06/2011] [Accepted: 10/27/2011] [Indexed: 02/09/2023]
Abstract
The expression, processing, transport and activities of both coding and non-coding RNAs play critical roles in normal neuronal function and differentiation. Over the past decade, these same pathways have come under scrutiny as potential contributors to neurodegenerative disease. Here we focus broadly on the roles of RNA and RNA processing in neurodegeneration. We first discuss a set of "RNAopathies", where non-coding repeat expansions drive pathogenesis through a surprisingly diverse set of mechanisms. We next explore an emerging class of "RNA binding proteinopathies" where redistribution and aggregation of the RNA binding proteins TDP-43 or FUS contribute to a potentially broad range of neurodegenerative disorders. Lastly, we delve into the potential contributions of alterations in both short and long non-coding RNAs to neurodegenerative illness.
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Affiliation(s)
- Abigail J Renoux
- Department of Molecular and Integrative Physiology, University of Michigan, 4005 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI 48109, USA
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