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Wang Z, Lane C, Terza M, Khemani P, Lui S, McKinney WS, Mosconi MW. Upper and Lower Limb Movement Kinematics in Aging FMR1 Gene Premutation Carriers. Brain Sci 2020; 11:E13. [PMID: 33374331 PMCID: PMC7823457 DOI: 10.3390/brainsci11010013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder associated with a premutation cytosine-guanine-guanine (CGG) trinucleotide repeat expansion of the FMR1 gene. FXTAS is estimated to be the most common single-gene form of ataxia in the aging population. Gait ataxia and intention tremor are the primary behavioral symptoms of FXTAS, though clinical evaluation of these symptoms often is subjective, contributing to difficulties in reliably differentiating individuals with FXTAS and asymptomatic premutation carriers. This study aimed to clarify the extent to which quantitative measures of gait and upper limb kinematics may serve as biobehavioral markers of FXTAS degeneration. Nineteen premutation carriers (aged 46-77 years), including 9 with possible, probable, or definite FXTAS and 16 sex- and IQ-matched healthy controls, completed tests of non-constrained walking and reaching while both standing (static reaching) and walking (dynamic reaching) to quantify gait and upper limb control, respectively. For the non-constrained walking task, participants wore reflective markers and walked at their preferred speed on a walkway. During the static reaching task, participants reached and lifted boxes of different sizes while standing. During the dynamic reaching task, participants walked to reach and lift the boxes. Movement kinematics were examined in relation to clinical ratings of neuromotor impairments and CGG repeat length. During non-constrained walking, individuals with FXTAS showed decreased stride lengths and stride velocities, increased percentages of double support time, and increased variabilities of cadence and center of mass relative to both asymptomatic premutation carriers and controls. While individuals with FXTAS did not show any static reaching differences relative to the other two groups, they showed multiple differences during dynamic reaching trials, including reduced maximum reaching velocity, prolonged acceleration time, and jerkier movement of the shoulder, elbow, and hand. Gait differences during non-constrained walking were associated with more severe clinically rated posture and gait symptoms. Reduced maximum reaching velocity and increased jerkiness during dynamic reaching were each related to more severe clinically rated kinetic dysfunction and overall neuromotor symptoms in FMR1 premutation carriers. Our findings suggest kinematic alterations consistent with gait ataxia and upper limb bradykinesia are each selectively present in individuals with FXTAS, but not asymptomatic aging premutation carriers. Consistent with neuropathological and magnetic resonance imaging (MRI) studies of FXTAS, these findings implicate cerebellar and basal ganglia degeneration associated with neuromotor decline. Our results showing associations between quantitative kinematic differences in FXTAS and clinical ratings suggest that objective assessments of gait and reaching behaviors may serve as critical and reliable targets for detecting FXTAS risk and monitoring progression.
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Affiliation(s)
- Zheng Wang
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32611-0164, USA;
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
| | - Callie Lane
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Matthew Terza
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611-8205, USA;
| | - Pravin Khemani
- Department of Neurology, Swedish Neuroscience Institute, Seattle, WA 98121, USA;
| | - Su Lui
- Huaxi Magnetic Resonance Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China;
| | - Walker S. McKinney
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA
| | - Matthew W. Mosconi
- Kansas Center for Autism Research and Training (K−CART) and Life Span Institute, University of Kansas, Lawrence, KS 66045, USA
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA
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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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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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Hocking DR, Loesch DZ, Trost N, Bui MQ, Hammersley E, Francis D, Tassone F, Storey E. Total and Regional White Matter Lesions Are Correlated With Motor and Cognitive Impairments in Carriers of the FMR1 Premutation. Front Neurol 2019; 10:832. [PMID: 31456732 PMCID: PMC6700239 DOI: 10.3389/fneur.2019.00832] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/18/2019] [Indexed: 12/13/2022] Open
Abstract
This study explores the relationships between hemispheric and cerebellar white matter lesions and motor and cognitive impairments in male carriers of Fragile-X Mental Retardation 1 (FMR1) premutation alleles, and in a subgroup of these carriers affected with Fragile X-Associated Tremor/Ataxia syndrome (FXTAS). Regional and total white matter hyperintensities (wmhs) on MRI, assessed using semiquantitative scores, were correlated with three motor rating scales (ICARS, UPDRS, Tremor), and neuropsychological measures of non-verbal reasoning, working memory and processing speed, in a sample of 30 male premutation carriers aged 39–81 years, and separately in a subsample of 17 of these carriers affected with FXTAS. There were significant relationships between wmhs in the infratentorial region and all three motor scales, as well as several cognitive measures—Prorated IQ, Matrix Reasoning, Similarities, and the Symbol Digit Modalities Test (SDMT), in the total sample of carriers, as well as in the FXTAS group separately. This shows that whms within the infratentorial region correlates across the categories of clinical status with a range of motor and cognitive impairments. In the FXTAS group, there was a highly significant relationship between supratentorial (periventricular) lesions and parkinsonism, and between both periventricular and supratentorial deep white matter and ICARS ataxia score. These findings further support the relevance of white matter changes in different brain regions to the motor and cognitive deficits across the spectrum of premutation involvement. Future longitudinal studies using larger sample sizes will be necessary to examine the factors that lead to conversion to a greater extent of neurological involvement as seen in the progression across the FXTAS spectrum.
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Affiliation(s)
- Darren R Hocking
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Danuta Z Loesch
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Nicholas Trost
- Department of Radiology, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Minh Q Bui
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, University of Melbourne, Melbourne, VIC, Australia
| | - Eleanor Hammersley
- Developmental Neuromotor and Cognition Lab, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - David Francis
- VCGS Cytogenetics Laboratory, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, CA, United States.,School of Medicine, MIND Institute, University of California Davis Medical Center, Davis, CA, United States
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Central Clinical School, Monash University, Melbourne, VIC, Australia
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Loesch DZ, Trost N, Bui MQ, Hammersley E, Lay ST, Annesley SJ, Sanislav O, Allan CY, Tassone F, Chen ZP, Ngoei KRW, Kemp BE, Francis D, Fisher PR, Storey E. The Spectrum of Neurological and White Matter Changes and Premutation Status Categories of Older Male Carriers of the FMR1 Alleles Are Linked to Genetic (CGG and FMR1 mRNA) and Cellular Stress (AMPK) Markers. Front Genet 2018; 9:531. [PMID: 30483310 PMCID: PMC6241173 DOI: 10.3389/fgene.2018.00531] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 10/22/2018] [Indexed: 12/16/2022] Open
Abstract
The fragile X premutation (PM) allele contains a CGG expansion of 55-200 repeats in the FMR1 gene's promoter. Male PM carriers have an elevated risk of developing neurological and psychiatric changes, including an approximately 50% risk of the fragile X-associated tremor/ataxia syndrome (FXTAS). The aim of this study was to assess the relationships of regional white matter hyperintensities (wmhs) semi-quantitative scores, clinical status, motor (UPDRS, ICARS, Tremor) scales, and cognitive impairments, with FMR1-specific genetic changes, in a sample of 32 unselected male PM carriers aged 39-81 years. Half of these individuals were affected with FXTAS, while the non-FXTAS group comprised subcategories of non-affected individuals and individuals affected with non-syndromic changes. The dynamics of pathological processes at the cellular level relevant to the clinical status of PM carriers was investigated using the enzyme AMP-activated protein kinase (AMPK), which is a highly sensitive cellular stress-sensing alarm protein. This enzyme, as well as genetic markers - CGG repeat number and the levels of the FMR1 mRNA - were assessed in blood lymphoblasts. The results showed that the repeat distribution for FXTAS individuals peaked at 85-90 CGGs; non-FXTAS carriers were distributed within the lowest end of the PM repeat range, and non-syndromic carriers assumed an intermediate position. The size of the CGG expansion was significantly correlated, across all three categories, with infratentorial and total wmhs and with all motor scores, and the FMR1 mRNA levels with all the wmh scores, whilst AMPK activity showed considerable elevation in the non-FXTAS combined group, decreasing in the FXTAS group, proportionally to increasing severity of the wmhs and tremor/ataxia. We conclude that the size of the CGG expansion relates to the risk for FXTAS, to severity of infratentorial wmhs lesions, and to all three motor scale scores. FMR1 mRNA shows a strong association with the extent of wmhs, which is the most sensitive marker of the pathological process. However, the AMPK activity findings - suggestive of a role of this enzyme in the risk of FXTAS - need to be verified and expanded in future studies using larger samples and longitudinal assessment.
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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
| | - Nicholas Trost
- Medical Imaging Department, St Vincent’s Hospital, Melbourne, VIC, Australia
| | - Minh Q. Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eleanor Hammersley
- Department of Psychology and Counselling, School of Psychology and Public Health, College of Science Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Sui T. Lay
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Sarah J. Annesley
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Oana Sanislav
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Claire Y. Allan
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Flora Tassone
- UC Davis MIND Institute, Sacramento, CA, United States
| | - Zhi-Ping Chen
- St Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
| | - Kevin R. W. Ngoei
- St Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
| | - Bruce E. Kemp
- St Vincent’s Institute of Medical Research, Melbourne, VIC, Australia
| | - David Francis
- Cytomolecular Diagnostic Research, Victorian Clinical Genetics Services, Melbourne, VIC, Australia
| | - Paul R. Fisher
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Monash University, Melbourne, VIC, Australia
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Wang XH, Yang JC, Soohoo R, Cotter D, Yuan M, Xia J, Yaqub S, Doty J, Niu YQ, Tassone F, Hagerman R, Zhang L, Olichney J. Cognitive Deficits and Associated ERP N400 Abnormalities in FXTAS With Parkinsonism. Front Genet 2018; 9:327. [PMID: 30279697 PMCID: PMC6153313 DOI: 10.3389/fgene.2018.00327] [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: 01/10/2018] [Accepted: 07/31/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: To examine cognitive deficits and associated brain activity in fragile X-associated tremor/ataxia syndrome (FXTAS) patients with parkinsonism (FXTp+), in relation to FXTAS patients without parkinsonism (FXTp-), and normal elderly controls (NC). Methods: Retrospective reviews were performed in 65 FXTAS patients who participated in the event-related brain potential (ERP) study and also had either a videotaped neurological examination or a neurological examination for extrapyramidal signs. Parkinsonism was defined as having bradykinesia with at least one of the following: rest tremor, postural instability, hypermyotonia, or rigidity. Eleven FXTp+ patients were identified and compared to 11 matched FXTp- and 11 NC. Main ERP measures included the N400 congruity effect, N400 repetition effect, and the late positive component (LPC) repetition effect. Results: When compared with FXTp- and NC, the FXTp+ group showed more severe deficits in executive function, cued-recall, recognition memory, along with a significantly reduced N400 repetition effect (thought to index semantic processing and verbal learning/memory) which was correlated with poorer verbal memory. Across all patients, FMR1 mRNA levels were inversely correlated with delayed recall on the California Verbal Learning Test (CVLT). Interpretation: The findings of more prominent executive dysfunction and verbal learning/memory deficits in FXTp+ than FXTp- are consistent with findings in Parkinson’s disease (PD), and may indicate that concomitant and/or synergistic pathogenetic mechanisms associated with PD play a role in FXTAS. These results have implications not only for understanding the cognitive impairments associated with the parkinsonism subtype of FXTAS, but also for the development of new interventions for these patients.
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Affiliation(s)
- Xiao-Hong Wang
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China.,Department of Neurology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Jin-Chen Yang
- Department of Neurology, School of Medicine, University of California, Davis, Davis, CA, United States.,Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Robert Soohoo
- Department of Neurology, School of Medicine, University of California, Davis, Davis, CA, United States.,Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Devyn Cotter
- Department of Neurology, School of Medicine, University of California, Davis, Davis, CA, United States.,Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Mei Yuan
- Department of Neurology, School of Medicine, University of California, Davis, Davis, CA, United States.,Department of Neurology, The Second Affiliated Hospital, University of South China, Hengyang, China
| | - Jiangyi Xia
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Shuja Yaqub
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Jesse Doty
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
| | - Yu-Qiong Niu
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,MIND Institute, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Flora Tassone
- MIND Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, CA, United States
| | - Randi Hagerman
- MIND Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Department of Pediatrics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Lin Zhang
- Department of Neurology, School of Medicine, University of California, Davis, Davis, CA, United States
| | - John Olichney
- Department of Neurology, School of Medicine, University of California, Davis, Davis, CA, United States.,Center for Mind and Brain, University of California, Davis, Davis, CA, United States
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7
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Loesch DZ, Annesley SJ, Trost N, Bui MQ, Lay ST, Storey E, De Piazza SW, Sanislav O, Francione LM, Hammersley EM, Tassone F, Francis D, Fisher PR. Novel Blood Biomarkers Are Associated with White Matter Lesions in Fragile X- Associated Tremor/Ataxia Syndrome. NEURODEGENER DIS 2016; 17:22-30. [PMID: 27602566 PMCID: PMC10964908 DOI: 10.1159/000446803] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The need for accessible cellular biomarkers of neurodegeneration in carriers of the fragile X mental retardation 1 (FMR1) premutation (PM) alleles. OBJECTIVE To assess the mitochondrial status and respiration in blood lymphoblasts from PM carriers manifesting the fragile X-associated tremor/ataxia syndrome (FXTAS) and non-FXTAS carriers, and their relationship with the brain white matter lesions. METHODS Oxygen consumption rates (OCR) and ATP synthesis using a Seahorse XFe24 Extracellular Flux Analyser, and steady-state parameters of mitochondrial function were assessed in cultured lymphoblasts from 16 PM males (including 11 FXTAS patients) and 9 matched controls. The regional white matter hyperintensity (WMH) scores were obtained from MRI. RESULTS Mitochondrial respiratory activity was significantly elevated in lymphoblasts from PM carriers compared with controls, with a 2- to 3-fold increase in basal and maximum OCR attributable to complex I activity, and ATP synthesis, accompanied by unaltered mitochondrial mass and membrane potential. The changes, which were more advanced in FXTAS patients, were significantly associated with the WMH scores in the supratentorial regions. CONCLUSION The dramatic increase in mitochondrial activity in lymphoblasts from PM carriers may represent either the early stages of disease (specific alterations in short-lived blood cells) or an activation of the lymphocytes under pathological situations. These changes may provide early, convenient blood biomarkers of clinical involvements.
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Affiliation(s)
- Danuta Z. Loesch
- Department of Psychology and Counselling, School of Psychology and Public Health, Melbourne, Vic., Australia
| | - Sarah J. Annesley
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, Vic., Australia
| | - Nicholas Trost
- Medical Imaging Department, St Vincent's Hospital, Melbourne, Vic., Australia
| | - Minh Q. Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic., Australia
| | - Sui T. Lay
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, Vic., Australia
| | - Elsdon Storey
- Department of Medicine (Neuroscience), Monash University (Alfred Hospital Campus), Melbourne, Vic., Australia
| | - Shawn W. De Piazza
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, Vic., Australia
| | - Oana Sanislav
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, Vic., Australia
| | - Lisa M. Francione
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, Vic., Australia
| | - Eleanor M. Hammersley
- Department of Psychology and Counselling, School of Psychology and Public Health, Melbourne, Vic., Australia
| | | | - David Francis
- Cytomolecular Diagnostic Research, Victorian Clinical Genetic Services, Murdoch Institute, Royal Children's Hospital, Melbourne, Vic., Australia
| | - Paul R. Fisher
- Discipline of Microbiology, Department of Physiology Anatomy and Microbiology, School of Life Sciences, College of Science Health and Engineering, La Trobe University, Melbourne, Vic., Australia
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8
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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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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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