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Johnson K, Stanfield AC, Scerif G, McKechanie A, Clarke A, Herring J, Smith K, Crawford H. A holistic approach to fragile X syndrome integrated guidance for person-centred care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13214. [PMID: 38383947 DOI: 10.1111/jar.13214] [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: 04/28/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The Fragile X community has expressed a desire for centralised, national guidelines in the form of integrated guidance for Fragile X Syndrome (FXS). METHODS This article draws on existing literature reviews, primary research and clinical trials on FXS, a Fragile X Society conference workshop and first-hand experience of clinicians who have worked with those living with FXS over many years. RESULTS The article scopes proposed integrated guidance over the life course, including appendices of symptoms, comorbidities and referral options for FXS and Fragile X Premutation Associated Conditions. CONCLUSION Integrated guidance would provide an authoritative source for doctors, health professionals, therapists, care workers, social workers, educators, employers, families and those living with FXS, so that a holistic, person-centred approach can be taken across the United Kingdom to garner the best outcomes for those with FXS.
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Affiliation(s)
- Kirsten Johnson
- The Fragile X Society, Great Dunmow, Essex, UK
- Fragile X International, Brussels, Belgium
| | - Andrew C Stanfield
- The Fragile X Society, Great Dunmow, Essex, UK
- The Patrick Wild Centre, The University of Edinburgh, Edinburgh, UK
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Angus Clarke
- The Fragile X Society, Great Dunmow, Essex, UK
- Institute of Cancer & Genetics, Cardiff University, Cardiff, UK
| | - Jonathan Herring
- The Fragile X Society, Great Dunmow, Essex, UK
- Law Faculty, University of Oxford, Oxford, UK
| | - Kayla Smith
- Mental Health and Wellbeing Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hayley Crawford
- The Fragile X Society, Great Dunmow, Essex, UK
- Mental Health and Wellbeing Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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2
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Quilichini J, Perol S, Cuisset L, Grotto S, Fouveaut C, Barbot JC, Verebi C, Jordan P, Héron D, Molina-Gomes D, Pipiras E, Grynberg M, Catteau-Jonard S, Touraine P, Christin-Maître S, Plu-Bureau G, El Khattabi L, Bienvenu T. Stratification of the risk of ovarian dysfunction by studying the complexity of intermediate and premutation alleles of the FMR1 gene. Am J Med Genet A 2024; 194:e63479. [PMID: 37987117 DOI: 10.1002/ajmg.a.63479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023]
Abstract
FMR1 premutation female carriers are at risk of developing premature/primary ovarian insufficiency (POI) with an incomplete penetrance. In this study, we determined the CGG repeat size among 1095 women with diminished ovarian reserve (DOR) / POI and characterized the CGG/AGG substructure in 44 women carrying an abnormal FMR1 repeat expansion number, compared to a group of 25 pregnant women carrying an abnormal FMR1 CGG repeat size. Allelic complexity scores of the FMR1 gene were calculated and compared between the two groups. In the DOR/POI cohort, 2.1% of women presented with an intermediate repeat size and 1.9% with a premutation. Our results suggest that the risk of POI is highest in the mid-range of CGG repeats. We observed that the allelic score is significantly higher in POI women compared to the pregnant women group (p-value = 0.02). We suggest that a high allelic score due to more than 2 AGG interspersions in the context of an intermediate number of repetitions could favor POI. Larger studies are still needed to evaluate the relevance of this new tool for the determination of the individual risk of developing POI in women with abnormal number of CGG repeats.
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Affiliation(s)
- Juliette Quilichini
- Service de Médecine Génomique des maladies de système et d'organe, APHP. Centre Université Paris Cité, Paris, France
| | - Sandrine Perol
- Unité de gynécologie médicale, APHP. Centre Université Paris Cité, Hôpital Cochin Port-Royal, Paris, France
| | - Laurence Cuisset
- Service de Médecine Génomique des maladies de système et d'organe, APHP. Centre Université Paris Cité, Paris, France
| | - Sarah Grotto
- Maternité Port-Royal, APHP. Centre Université Paris Cité, Hôpital Cochin, Paris, France
| | - Corinne Fouveaut
- Service de Médecine Génomique des maladies de système et d'organe, APHP. Centre Université Paris Cité, Paris, France
| | - Jean Claude Barbot
- Service de Médecine Génomique des maladies de système et d'organe, APHP. Centre Université Paris Cité, Paris, France
| | - Camille Verebi
- Service de Médecine Génomique des maladies de système et d'organe, APHP. Centre Université Paris Cité, Paris, France
| | - Pénélope Jordan
- Service de Médecine Génomique des maladies de système et d'organe, APHP. Centre Université Paris Cité, Paris, France
| | - Delphine Héron
- Département de Génétique, APHP. Sorbonne Université, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Denise Molina-Gomes
- Service de Biologie de la reproduction, Cytogénétique et Génétique Médicale, CHI Poissy-Saint Germain, Poissy, France
| | - Eva Pipiras
- Unité fonctionnelle de Médecine génomique et génétique clinique, APHP. Université Sorbonne Paris Nord, Hôpital Jean Verdier, Bondy, France
| | - Michael Grynberg
- Gynécologie médicale et médecine de la reproduction, Hôpital Jean Verdier, Bondy, France
| | | | - Philippe Touraine
- Département d'Endocrinologie et médecine de la reproduction, APHP. Sorbonne Université, Pitié-Salpêtrière Hospital, Center for Rare Endocrine and Gynecological Disorders, Paris, France
| | - Sophie Christin-Maître
- Service d'endocrinologie, diabétologie et médecine de la reproduction, APHP. Sorbonne Université, Paris, France
| | - Geneviève Plu-Bureau
- Unité de gynécologie médicale, APHP. Centre Université Paris Cité, Hôpital Cochin Port-Royal, Paris, France
| | - Laila El Khattabi
- Service de Médecine Génomique des maladies de système et d'organe, APHP. Centre Université Paris Cité, Paris, France
- Institut Cochin, INSERM U1016, team « From gametes to birth », Paris, France
| | - Thierry Bienvenu
- Service de Médecine Génomique des maladies de système et d'organe, APHP. Centre Université Paris Cité, Paris, France
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3
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Trevino CE, Rounds JC, Charen K, Shubeck L, Hipp HS, Spencer JB, Johnston HR, Cutler DJ, Zwick ME, Epstein MP, Murray A, Macpherson JN, Mila M, Rodriguez-Revenga L, Berry-Kravis E, Hall DA, Leehey MA, Liu Y, Welt C, Warren ST, Sherman SL, Jin P, Allen EG. Identifying susceptibility genes for primary ovarian insufficiency on the high-risk genetic background of a fragile X premutation. Fertil Steril 2021; 116:843-854. [PMID: 34016428 PMCID: PMC8494118 DOI: 10.1016/j.fertnstert.2021.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/21/2021] [Accepted: 04/21/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To identify modifying genes that explains the risk of fragile X-associated primary ovarian insufficiency (FXPOI). DESIGN Gene-based, case/control association study, followed by a functional screen of highly ranked genes using a Drosophila model. SETTING Participants were recruited from academic and clinical settings. PATIENT(S) Women with a premutation (PM) who experienced FXPOI at the age of 35 years or younger (n = 63) and women with a PM who experienced menopause at the age of 50 years or older (n = 51) provided clinical information and a deoxyribonucleic acid sample for whole genome sequencing. The functional screen was on the basis of Drosophila TRiP lines. INTERVENTION(S) Clinical information and a DNA sample were collected for whole genome sequencing. MAIN OUTCOME MEASURES A polygenic risk score derived from common variants associated with natural age at menopause was calculated and associated with the risk of FXPOI. Genes associated with the risk of FXPOI were identified on the basis of the P-value from gene-based association test and an altered level of fecundity when knocked down in the Drosophila PM model. RESULTS The polygenic risk score on the basis of common variants associated with natural age at menopause explained approximately 8% of the variance in the risk of FXPOI. Further, SUMO1 and KRR1 were identified as possible modifying genes associated with the risk of FXPOI on the basis of an untargeted gene analysis of rare variants. CONCLUSIONS In addition to the large genetic effect of a PM on ovarian function, the additive effects of common variants associated with natural age at menopause and the effect of rare modifying variants appear to play a role in FXPOI risk.
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Affiliation(s)
| | | | - Krista Charen
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Lisa Shubeck
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Heather S Hipp
- Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | - Jessica B Spencer
- Department of Gynecology and Obstetrics, Emory University, Atlanta, Georgia
| | | | - Dave J Cutler
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Michael E Zwick
- Department of Human Genetics, Emory University, Atlanta, Georgia; Department of Pediatrics, Emory University, Atlanta, Georgia
| | | | - Anna Murray
- University of Exeter Medical School, University of Exeter, Exeter, United Kingdom
| | - James N Macpherson
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, United Kingdom
| | - Montserrat Mila
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laia Rodriguez-Revenga
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III, Spain
| | - Elizabeth Berry-Kravis
- Departments of Pediatrics, Neurological Sciences, Biochemistry, Rush University Medical Center, Chicago, Illinois
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University, Chicago, Illinois
| | - Maureen A Leehey
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ying Liu
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Corrine Welt
- Division of Endocrinology, Metabolism and Diabetes, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stephen T Warren
- Department of Human Genetics, Emory University, Atlanta, Georgia; Department of Pediatrics, Emory University, Atlanta, Georgia; Department of Biochemistry, Emory University, Atlanta, Georgia
| | - Stephanie L Sherman
- Department of Human Genetics, Emory University, Atlanta, Georgia; Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Peng Jin
- Department of Human Genetics, Emory University, Atlanta, Georgia
| | - Emily G Allen
- Department of Human Genetics, Emory University, Atlanta, Georgia.
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Cabal-Herrera AM, Saldarriaga-Gil W, Salcedo-Arellano MJ, Hagerman RJ. Fragile X associated neuropsychiatric disorders in a male without FXTAS. Intractable Rare Dis Res 2020; 9:113-118. [PMID: 32494560 PMCID: PMC7263992 DOI: 10.5582/irdr.2020.01028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 11/05/2022] Open
Abstract
Fragile X syndrome (FXS) is the most common inherited cause of intellectual disability and autism spectrum disorder. In most cases, it is due to an expansion of the CGG triplet to more than 200 repeats within the promoter region of the FMR1 gene. In the premutation (PM) the trinucleotide is expanded to 55-200 repeats. PM carriers can present with disorders associated with the PM including fragile X-associated tremor/ataxia syndrome (FXTAS) and fragile X-associated ovarian insufficiency (FXPOI). Recently fragile X-associated neuropsychiatric disorders (FXAND) was proposed as an umbrella term to include the neuropsychiatric disorders that are more prevalent in PM carriers compared to the general population such as anxiety, depression, chronic fatigue, alcohol abuse, and psychosis, among others. The patient in our study was evaluated by a team of clinicians from the University del Valle in Cali who traveled to Ricaurte, a Colombian town known for being a genetic geographic cluster of FXS. A detailed medical history was collected and complete physical, neurological and psychiatric evaluations were performed in addition to molecular and neuroradiological studies. We report the case of a 78-year-old man, PM carrier, without FXTAS whose main clinical presentation consists of behavioral changes and psychosis. Brain imaging revealed white matter lesions in the periventricular region and mild cerebral atrophy. Although anxiety and depression are the most common neuropsychiatric manifestations in PM carriers, it is important to perform a complete psychiatric evaluation since some patients may present with behavioral changes and psychosis.
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Affiliation(s)
- Ana María Cabal-Herrera
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- School of Medicine, Universidad del Valle, Cali, Colombia
| | | | - Maria Jimena Salcedo-Arellano
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
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5
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Friedman-Gohas M, Kirshenbaum M, Michaeli A, Domniz N, Elizur S, Raanani H, Orvieto R, Cohen Y. Does the presence of AGG interruptions within the CGG repeat tract have a protective effect on the fertility phenotype of female FMR1 premutation carriers? J Assist Reprod Genet 2020; 37:849-854. [PMID: 32096109 DOI: 10.1007/s10815-020-01701-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/12/2019] [Indexed: 10/24/2022] Open
Abstract
PURPOSE While FMR1 premutation carriers (CGG 55-200) were shown to have reduced success with IVF treatment (lower oocyte yield), studies reporting on the association between the number of CGG repeats and patients' response to controlled ovarian hyperstimulation (COH) are inconsistent. In the present study, we aim to explore whether the number of CGG repeats in women with premutation in FMR1 gene, undergoing COH for IVF, correlates with COH variables and whether the number of AGG interruptions may function as a "protective factor" by improving the ovarian response to COH. METHODS Retrospective study, in an academic IVF-PGD unit. Fifty-seven consecutive FMR1 premutation carriers who underwent 285 IVF treatment cycles were included. The numbers of CGG repeats and AGG interruptions were retrieved and correlated to the demographics and COH variables. RESULTS There were no significant association between the numbers of CGG or the AGG interruptions and the number of oocyte retrieved or the peak estradiol levels. The lack of association was also observed when including all the IVF treatment cycles or only the first or last IVF treatment cycle. Moreover, no associations were found between the number of CGG repeats or AGG interruptions and other COH variables, i.e., duration of stimulation, the total dose of gonadotropin used, or the number of top-quality embryos. CONCLUSIONS No associations were observed between the number of CGG repeats or AGG interruptions and any of the COH variables. Further studies are required to identify early biomarkers of POI to empower FMR1 premutation carriers with risk assessment tools to consider procedures such as fertility preservation.
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Affiliation(s)
- M Friedman-Gohas
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - M Kirshenbaum
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - A Michaeli
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - N Domniz
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel
| | - S Elizur
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - H Raanani
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - R Orvieto
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Y Cohen
- Department of Obstetrics and Gynecology, Infertility and IVF Unit, Chaim Sheba Medical Center (Tel-Hashomer), Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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6
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Johnson K, Herring J, Richstein J. Fragile X Premutation Associated Conditions (FXPAC). Front Pediatr 2020; 8:266. [PMID: 32537445 PMCID: PMC7267017 DOI: 10.3389/fped.2020.00266] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/28/2020] [Indexed: 11/13/2022] Open
Abstract
The European Fragile X Network (EFXN) proposes that Fragile X Premutation Associated Conditions (FXPAC) be adopted as a universal term covering any condition linked to the Fragile X premutation. To date, there has not been an umbrella term assigned to issues associated with the FMR1 premutation, though several defined conditions which affect some premutation carriers, namely Fragile X-associated Primary Ovarian Insufficiency (FXPOI) and Fragile X-associated Tremor/Ataxia Syndrome (FXTAS), are now commonly accepted. An overarching term covering all FX premutation conditions will help doctors in determining how the premutation might be affecting their patient; and encourage researchers to explore the interrelationships of the various conditions affecting premutation carriers. Further, there are ongoing discoveries about physical and psychological issues faced by premutation carriers, and a new term helps encompass all of these burgeoning developments.
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Fink DA, Nelson LM, Pyeritz R, Johnson J, Sherman SL, Cohen Y, Elizur SE. Fragile X Associated Primary Ovarian Insufficiency (FXPOI): Case Report and Literature Review. Front Genet 2018; 9:529. [PMID: 30542367 PMCID: PMC6278244 DOI: 10.3389/fgene.2018.00529] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/22/2018] [Indexed: 11/29/2022] Open
Abstract
Abnormalities in the X-linked FMR1 gene are associated with a constellation of disorders, which have broad and profound implications for the person first diagnosed, and extended family members of all ages. The rare and pleiotropic nature of the associated disorders, both common and not, place great burdens on (1) the affected families, (2) their care providers and clinicians, and (3) investigators striving to conduct research on the conditions. Fragile X syndrome, occurring more severely in males, is the leading genetic cause of intellectual disability. Fragile X associated tremor and ataxia syndrome (FXTAS) is a neurodegenerative disorder seen more often in older men. Fragile X associated primary ovarian insufficiency (FXPOI) is a chronic disorder characterized by oligo/amenorrhea and hypergonadotropic hypogonadism before age 40 years. There may be significant morbidity due to: (1) depression and anxiety related to the loss of reproductive hormones and infertility; (2) reduced bone mineral density; and (3) increased risk of cardiovascular disease related to estrogen deficiency. Here we report the case of a young woman who never established regular menses and yet experienced a 5-year diagnostic odyssey before establishing a diagnosis of FXPOI despite a known family history of fragile X syndrome and early menopause. Also, despite having clearly documented FXPOI the woman conceived spontaneously and delivered two healthy children. We review the pathophysiology and management of FXPOI. As a rare disease, the diagnosis of FXPOI presents special challenges. Connecting patients and community health providers with investigators who have the requisite knowledge and expertise about the FMR1 gene and FXPOI would facilitate both patient care and research. There is a need for an international natural history study on FXPOI. The effort should be coordinated by a global virtual center, which takes full advantage of mobile device communication systems.
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Affiliation(s)
- Dorothy A Fink
- Hospital for Special Surgery, New York, NY, United States
| | | | - Reed Pyeritz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Josh Johnson
- University of Colorado, Denver, CO, United States
| | | | - Yoram Cohen
- Sheba Medical Center, Tel Hashomer and Tel Aviv University, Tel Aviv, Israel
| | - Shai E Elizur
- Sheba Medical Center, Tel Hashomer and Tel Aviv University, Tel Aviv, Israel
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