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Elias-Mas A, Wang JY, Rodríguez-Revenga L, Kim K, Tassone F, Hessl D, Rivera SM, Hagerman R. Enlarged perivascular spaces and their association with motor, cognition, MRI markers and cerebrovascular risk factors in male fragile X premutation carriers. J Neurol Sci 2024; 461:123056. [PMID: 38772058 DOI: 10.1016/j.jns.2024.123056] [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: 10/11/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/23/2024]
Abstract
FMR1 premutation carriers (55-200 CGG repeats) are at risk of developing fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disorder associated with motor and cognitive impairment. Bilateral hyperintensities of the middle cerebellar peduncles (MCP sign) are the major radiological hallmarks of FXTAS. In the general population, enlarged perivascular spaces (PVS) are biomarkers of small vessel disease and glymphatic dysfunction and are associated with cognitive decline. Our aim was to determine if premutation carriers show higher ratings of PVS than controls and whether enlarged PVS are associated with motor and cognitive impairment, MRI features of neurodegeneration, cerebrovascular risk factors and CGG repeat length. We evaluated 655 MRIs (1-10 visits/participant) from 229 carriers (164 with FXTAS and 65 without FXTAS) and 133 controls. PVS in the basal ganglia (BG-EPVS), centrum semiovale, and midbrain were evaluated with a semiquantitative scale. Mixed-effects models were used for statistical analysis adjusting for age. In carriers with FXTAS, we revealed that (1) BG-PVS ratings were higher than those of controls and carriers without FXTAS; (2) BG-PVS severity was associated with brain atrophy, white matter hyperintensities, enlarged ventricles, FXTAS stage and abnormal gait; (3) age-related increase in BG-PVS was associated with cognitive dysfunction; and (4) PVS ratings of all three regions showed robust associations with CGG repeat length and were higher in carriers with the MCP sign than carriers without the sign. This study demonstrates clinical relevance of PVS in FXTAS especially in the basal ganglia region and suggests microangiopathy and dysfunctional cerebrospinal fluid circulation in FXTAS physiopathology.
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Affiliation(s)
- Andrea Elias-Mas
- Radiology Department, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain; Institute for Research and Innovation Parc Taulí (I3PT), Sabadell, Spain; Genetics Doctorate Program, Universitat de Barcelona (UB), Barcelona, Spain.
| | - Jun Yi Wang
- Center for Mind and Brain, University of California Davis, CA, United States.
| | - Laia Rodríguez-Revenga
- Biochemistry and Molecular Genetics Department, Hospital Clinic of Barcelona, Barcelona, Spain; CIBER of Rare Diseases (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain; Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Kyoungmi Kim
- Department of Public Health Sciences, University of California Davis School of Medicine, Sacramento, CA, United States.
| | - Flora Tassone
- MIND Institute, University of California Davis, Sacramento, CA, United States; Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine, Sacramento, CA, United States.
| | - David Hessl
- MIND Institute, University of California Davis, Sacramento, CA, United States; Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, United States.
| | - Susan M Rivera
- Center for Mind and Brain, University of California Davis, CA, United States; MIND Institute, University of California Davis, Sacramento, CA, United States; Department of Psychology, University of Maryland, College Park, MD, United States.
| | - Randi Hagerman
- MIND Institute, University of California Davis, Sacramento, CA, United States; Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, United States.
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Hessl D, Mandujano Rojas K, Ferrer E, Espinal G, Famula J, Schneider A, Hagerman R, Tassone F, Rivera SM. FMR1 Carriers Report Executive Function Changes Prior to Fragile X-Associated Tremor/Ataxia Syndrome: A Longitudinal Study. Mov Disord 2024; 39:519-525. [PMID: 38124331 DOI: 10.1002/mds.29695] [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: 09/08/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Men with fragile X-associated tremor/ataxia syndrome (FXTAS) often develop executive dysfunction, characterized by disinhibition, frontal dyscontrol of movement, and working memory and attention changes. Although cross-sectional studies have suggested that earlier executive function changes may precede FXTAS, the lack of longitudinal studies has made it difficult to address this hypothesis. OBJECTIVE To determine whether executive function deterioration experienced by premutation carriers (PC) in daily life precedes and predicts FXTAS. METHODS This study included 66 FMR1 PC ranging from 40 to 78 years (mean, 59.5) and 31 well-matched healthy controls (HC) ages 40 to 75 (mean, 57.7) at baseline. Eighty-four participants returned for 2 to 5 follow up visits over a duration of 1 to 9 years (mean, 4.6); 28 of the PC developed FXTAS. The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) was completed by participants and their spouses/partners at each visit. RESULTS Longitudinal mixed model regression analyses showed a greater decline with age in PC compared to HC on the Metacognition Index (MI; self-initiation, working memory, organization, task monitoring). Conversion to FXTAS was associated with worsening MI and Behavioral Regulation Index (BRI; inhibition, flexibility, emotion modulation). For spouse/partner report, FXTAS conversion was associated with worsening MI. Finally, increased self-report executive function problems at baseline significantly predicted later development of FXTAS. CONCLUSIONS Executive function changes experienced by male PC represent a prodrome of the later movement disorder. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- David Hessl
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Karina Mandujano Rojas
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Center for Mind and Brain, University of California Davis, Davis, California, USA
| | - Emilio Ferrer
- Department of Psychology, University of California Davis, Davis, California, USA
| | - Glenda Espinal
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
| | - Jessica Famula
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, California, USA
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
| | - Andrea Schneider
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Randi Hagerman
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, California, USA
| | - Flora Tassone
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine, Davis, California, USA
| | - Susan M Rivera
- MIND Institute, University of California Davis Health, Sacramento, California, USA
- Center for Mind and Brain, University of California Davis, Davis, California, USA
- Department of Psychology, University of California Davis, Davis, California, USA
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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Santos E, Clark C, Biag HMB, Tang SJ, Kim K, Ponzini MD, Schneider A, Giulivi C, Montanaro FAM, Gipe JTE, Dayton J, Randol JL, Yao PJ, Manolopoulos A, Kapogiannis D, Hwang YH, Hagerman P, Hagerman R, Tassone F. Open-Label Sulforaphane Trial in FMR1 Premutation Carriers with Fragile-X-Associated Tremor and Ataxia Syndrome (FXTAS). Cells 2023; 12:2773. [PMID: 38132093 PMCID: PMC10741398 DOI: 10.3390/cells12242773] [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: 09/11/2023] [Revised: 11/03/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Fragile X (FMR1) premutation is a common mutation that affects about 1 in 200 females and 1 in 450 males and can lead to the development of fragile-X-associated tremor/ataxia syndrome (FXTAS). Although there is no targeted, proven treatment for FXTAS, research suggests that sulforaphane, an antioxidant present in cruciferous vegetables, can enhance mitochondrial function and maintain redox balance in the dermal fibroblasts of individuals with FXTAS, potentially leading to improved cognitive function. In a 24-week open-label trial involving 15 adults aged 60-88 with FXTAS, 11 participants successfully completed the study, demonstrating the safety and tolerability of sulforaphane. Clinical outcomes and biomarkers were measured to elucidate the effects of sulforaphane. While there were nominal improvements in multiple clinical measures, they were not significantly different after correction for multiple comparisons. PBMC energetic measures showed that the level of citrate synthase was higher after sulforaphane treatment, resulting in lower ATP production. The ratio of complex I to complex II showed positive correlations with the MoCA and BDS scores. Several mitochondrial biomarkers showed increased activity and quantity and were correlated with clinical improvements.
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Affiliation(s)
- Ellery Santos
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Department of Pediatrics, School of Medicine, University of California, Davis, CA 95817, USA
| | - Courtney Clark
- Department of Pediatrics, School of Medicine, University of California, Davis, CA 95817, USA
| | - Hazel Maridith B. Biag
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Department of Pediatrics, School of Medicine, University of California, Davis, CA 95817, USA
| | - Si Jie Tang
- Department of Pediatrics, School of Medicine, University of California, Davis, CA 95817, USA
| | - Kyoungmi Kim
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Matthew D. Ponzini
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA 95616, USA
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Department of Pediatrics, School of Medicine, University of California, Davis, CA 95817, USA
| | - Cecilia Giulivi
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Federica Alice Maria Montanaro
- Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Jesse Tran-Emilia Gipe
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Jacquelyn Dayton
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Jamie L. Randol
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, CA 95616, USA
| | - Pamela J. Yao
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 212241, USA (A.M.); (D.K.)
| | - Apostolos Manolopoulos
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 212241, USA (A.M.); (D.K.)
| | - Dimitrios Kapogiannis
- Laboratory of Clinical Investigation, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD 212241, USA (A.M.); (D.K.)
| | - Ye Hyun Hwang
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, CA 95616, USA
| | - Paul Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, CA 95616, USA
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Department of Pediatrics, School of Medicine, University of California, Davis, CA 95817, USA
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis Health, Sacramento, CA 95817, USA (A.S.); (R.H.)
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, CA 95616, USA
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Seritan AL. Advances in the Diagnosis and Management of Psychotic Symptoms in Neurodegenerative Diseases: A Narrative Review. J Geriatr Psychiatry Neurol 2023; 36:435-460. [PMID: 36941085 PMCID: PMC10578041 DOI: 10.1177/08919887231164357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background: Approximately 15% of older adults may experience psychotic phenomena. Primary psychiatric disorders that manifest with psychosis (delusions, hallucinations, and disorganized thought or behavior) account for less than half. Up to 60% of late-life psychotic symptoms are due to systemic medical or neurological conditions, particularly neurodegenerative diseases. A thorough medical workup including laboratory tests, additional procedures if indicated, and neuroimaging studies is recommended. This narrative review summarizes current evidence regarding the epidemiology and phenomenology of psychotic symptoms encountered as part of the neurodegenerative disease continuum (including prodromal and manifest stages). Results: Prodromes are constellations of symptoms that precede the onset of overt neurodegenerative syndromes. Prodromal psychotic features, particularly delusions, have been associated with an increased likelihood of receiving a neurodegenerative disease diagnosis within several years. Prompt prodrome recognition is crucial for early intervention. The management of psychosis associated with neurodegenerative diseases includes behavioral and somatic strategies, although evidence is scarce and mostly limited to case reports, case series, or expert consensus guidelines, with few randomized controlled trials. Conclusion: The complexity of psychotic manifestations warrants management by interprofessional teams that provide coordinated, integrated care.
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Affiliation(s)
- Andreea L. Seritan
- University of California, San Francisco Department of Psychiatry and UCSF Weill Institute for Neurosciences, CA, USA
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Hessl D, Rojas KM, Ferrer E, Espinal G, Famula J, Schneider A, Elagerman R, Tassone F, Rivera SM. A Longitudinal Study of Executive Function in Daily Life in Male Fragile X Premutation Carriers and Association with FXTAS Conversion. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.31.23294855. [PMID: 37693384 PMCID: PMC10491369 DOI: 10.1101/2023.08.31.23294855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Men with fragile X-associated tremor/ataxia syndrome (FXTAS) often develop executive dysfunction, characterized by disinhibition, frontal dyscontrol of movement, and working memory and attention changes. Although cross-sectional studies have suggested that earlier executive function changes may precede FXTAS, the lack of longitudinal studies have made it difficult to address this hypothesis. Methods This study included 66 FMR1 premutation carriers (PC) ranging from 40-78 years (Mean=59.5) and 31 well-matched healthy controls (HC) ages 40-75 (Mean 57.7) at baseline. Eighty-four participants returned for 2-5 follow up visits over a duration of 1 to 9 years (Mean=4.6); 28 of the PC developed FXTAS. The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) was completed by participants and their spouses/partners at each visit. Results Longitudinal mixed model regression analyses showed a greater decline with age in PC compared to HC on the Metacognition Index (MI; self-initiation, working memory, organization, task monitoring). Conversion to FXTAS was associated with worsening MI and Behavioral Regulation Index (BRI; inhibition, flexibility, emotion modulation). For spouse/partner report, FXTAS conversion was associated with worsening MI. Finally, BRIEF-A executive function problems at baseline significantly predicted later development of FXTAS. Conclusions These findings suggest that executive function changes represent a prodrome of the later movement disorder.
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Affiliation(s)
- David Hessl
- MIND Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Karina Mandujano Rojas
- MIND Institute, University of California Davis Health, Sacramento, CA, USA
- Center for Mind and Brain, University of California Davis, Davis, California, USA
| | - Emilio Ferrer
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - Glenda Espinal
- MIND Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Jessica Famula
- MIND Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
- Family Caregiving Institute, Betty Irene Moore School of Nursing, University of California Davis, Sacramento, California, USA
| | - Andrea Schneider
- MIND Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Randi Elagerman
- MIND Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Flora Tassone
- MIND Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine, Davis, California, USA
| | - Susan M. Rivera
- MIND Institute, University of California Davis Health, Sacramento, CA, USA
- Department of Psychology, University of California Davis, Davis, CA, USA
- Center for Mind and Brain, University of California Davis, Davis, California, USA
- Department of Psychology, University of Maryland, College Park, Maryland, USA
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Zafarullah M, Li J, Salemi MR, Phinney BS, Durbin-Johnson BP, Hagerman R, Hessl D, Rivera SM, Tassone F. Blood Proteome Profiling Reveals Biomarkers and Pathway Alterations in Fragile X PM at Risk for Developing FXTAS. Int J Mol Sci 2023; 24:13477. [PMID: 37686279 PMCID: PMC10488017 DOI: 10.3390/ijms241713477] [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: 07/15/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Fragile X-associated Tremor/Ataxia Syndrome (FXTAS) is a neurodegenerative disorder associated with the FMR1 premutation. Currently, it is not possible to determine when and if individual premutation carriers will develop FXTAS. Thus, with the aim to identify biomarkers for early diagnosis, development, and progression of FXTAS, along with associated dysregulated pathways, we performed blood proteomic profiling of premutation carriers (PM) who, as part of an ongoing longitudinal study, emerged into two distinct groups: those who developed symptoms of FXTAS (converters, CON) over time (at subsequent visits) and those who did not (non-converters, NCON). We compared these groups to age-matched healthy controls (HC). We assessed CGG repeat allele size by Southern blot and PCR analysis. The proteomic profile was obtained by liquid chromatography mass spectrometry (LC-MS/MS). We identified several significantly differentiated proteins between HC and the PM groups at Visit 1 (V1), Visit 2 (V2), and between the visits. We further reported the dysregulated protein pathways, including sphingolipid and amino acid metabolism. Our findings are in agreement with previous studies showing that pathways involved in mitochondrial bioenergetics, as observed in other neurodegenerative disorders, are significantly altered and appear to contribute to the development of FXTAS. Lastly, we compared the blood proteome of the PM who developed FXTAS over time with the CSF proteome of the FXTAS patients recently reported and found eight significantly differentially expressed proteins in common. To our knowledge, this is the first report of longitudinal proteomic profiling and the identification of unique biomarkers and dysregulated protein pathways in FXTAS.
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Affiliation(s)
- Marwa Zafarullah
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA 95817, USA;
| | - Jie Li
- Genome Center, Bioinformatics Core, University of California Davis, Davis, CA 95616, USA;
| | - Michelle R. Salemi
- Genome Center, Proteomics Core, Genome and Biomedical Sciences Facility, University of California Davis, Davis, CA 95616, USA; (M.R.S.); (B.S.P.)
| | - Brett S. Phinney
- Genome Center, Proteomics Core, Genome and Biomedical Sciences Facility, University of California Davis, Davis, CA 95616, USA; (M.R.S.); (B.S.P.)
| | - Blythe P. Durbin-Johnson
- Division of Biostatistics, School of Medicine, University of California Davis, Davis, CA 95616, USA;
| | - Randi Hagerman
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (R.H.); (D.H.); (S.M.R.)
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA 95817, USA
| | - David Hessl
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (R.H.); (D.H.); (S.M.R.)
- Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, Sacramento, CA 95817, USA
| | - Susan M. Rivera
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (R.H.); (D.H.); (S.M.R.)
- Department of Psychology, University of California Davis, Davis, CA 95616, USA
- Department of Psychology, University of Maryland, College Park, MD 20742, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA 95817, USA;
- MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (R.H.); (D.H.); (S.M.R.)
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7
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Salcedo-Arellano MJ, Johnson MD, McLennan YA, Hwang YH, Juarez P, McBride EL, Pantoja AP, Durbin-Johnson B, Tassone F, Hagerman RJ, Martínez-Cerdeño V. Brain Metabolomics in Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS). Cells 2023; 12:2132. [PMID: 37681866 PMCID: PMC10487256 DOI: 10.3390/cells12172132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/09/2023] Open
Abstract
The course of pathophysiological mechanisms involved in fragile X-associated tremor/ataxia syndrome (FXTAS) remains largely unknown. Previous proteomics and metabolomics studies conducted in blood samples collected from FMR1 premutation carriers with FXTAS reported abnormalities in energy metabolism, and precursors of gluconeogenesis showed significant changes in plasma expression levels in FMR1 premutation carriers who developed FXTAS. We conducted an analysis of postmortem human brain tissues from 44 donors, 25 brains with FXTAS, and 19 matched controls. We quantified the metabolite relative abundance in the inferior temporal gyrus and the cerebellum using untargeted mass spectrometry (MS)-based metabolomics. We investigated how the metabolite type and abundance relate to the number of cytosine-guanine-guanine (CGG) repeats, to markers of neurodegeneration, and to the symptoms of FXTAS. A metabolomic analysis identified 191 primary metabolites, the data were log-transformed and normalized prior to the analysis, and the relative abundance was compared between the groups. The changes in the relative abundance of a set of metabolites were region-specific with some overlapping results; 22 metabolites showed alterations in the inferior temporal gyrus, while 21 showed differences in the cerebellum. The relative abundance of cytidine was decreased in the inferior temporal gyrus, and a lower abundance was found in the cases with larger CGG expansions; oleamide was significantly decreased in the cerebellum. The abundance of 11 metabolites was influenced by changes in the CGG repeat number. A histological evaluation found an association between the presence of microhemorrhages in the inferior temporal gyrus and a lower abundance of 2,5-dihydroxypyrazine. Our study identified alterations in the metabolites involved in the oxidative-stress response and bioenergetics in the brains of individuals with FXTAS. Significant changes in the abundance of cytidine and oleamide suggest their potential as biomarkers and therapeutic targets for FXTAS.
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Affiliation(s)
- Maria Jimena Salcedo-Arellano
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA 95616, USA; (M.J.S.-A.); (F.T.); (R.J.H.); (V.M.-C.)
- Institute for Pediatric Regenerative Medicine at Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
| | - Michael D. Johnson
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
- Institute for Pediatric Regenerative Medicine at Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
| | - Yingratana A. McLennan
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
- Institute for Pediatric Regenerative Medicine at Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
| | - Ye Hyun Hwang
- Department of Biochemistry and Molecular Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (Y.H.H.); (F.T.)
| | - Pablo Juarez
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
- Institute for Pediatric Regenerative Medicine at Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
| | - Erin Lucille McBride
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
- Institute for Pediatric Regenerative Medicine at Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
| | - Adriana P. Pantoja
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
- Institute for Pediatric Regenerative Medicine at Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
| | - Blythe Durbin-Johnson
- Division of Biostatistics, Department of Public Health Sciences, UC Davis School of Medicine, Sacramento, CA 95817, USA;
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA 95616, USA; (M.J.S.-A.); (F.T.); (R.J.H.); (V.M.-C.)
- Department of Biochemistry and Molecular Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (Y.H.H.); (F.T.)
| | - Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA 95616, USA; (M.J.S.-A.); (F.T.); (R.J.H.); (V.M.-C.)
- Department of Pediatrics, UC Davis School of Medicine, Sacramento, CA 95817, USA;
| | - Verónica Martínez-Cerdeño
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, Sacramento, CA 95616, USA; (M.J.S.-A.); (F.T.); (R.J.H.); (V.M.-C.)
- Institute for Pediatric Regenerative Medicine at Shriners Hospitals for Children Northern California, Sacramento, CA 95817, USA; (M.J.S.-A.); (M.D.J.); (Y.A.M.); (P.J.); (E.L.M.); (A.P.P.); (V.M.-C.)
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8
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Giulivi C, Wang JY, Hagerman RJ. Artificial neural network applied to fragile X-associated tremor/ataxia syndrome stage diagnosis based on peripheral mitochondrial bioenergetics and brain imaging outcomes. Sci Rep 2022; 12:21382. [PMID: 36496525 PMCID: PMC9741636 DOI: 10.1038/s41598-022-25615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
No proven prognosis is available for the neurodegenerative disorder fragile X-associated tremor/ataxia syndrome (FXTAS). Artificial neural network analyses (ANN) were used to predict FXTAS progression using data from 127 adults (noncarriers and FMR1 premutation carriers with and without FXTAS) with five outcomes from brain MRI imaging and 22 peripheral bioenergetic outcomes from two cell types. Diagnosis accuracy by ANN predictions ranged from 41.7 to 86.3% (depending on the algorithm used), and those misclassified usually presented a higher FXTAS stage. ANN prediction of FXTAS stages was based on a combination of two imaging findings (white matter hyperintensity and whole-brain volumes adjusted for intracranial volume) and four bioenergetic outcomes. Those at Stage 3 vs. 0-2 showed lower mitochondrial mass, higher oxidative stress, and an altered electron transfer consistent with mitochondrial unfolded protein response activation. Those at Stages 4-5 vs. 3 had higher oxidative stress and glycerol-3-phosphate-linked ATP production, suggesting that targeting mGPDH activity may prevent a worse prognosis. This was confirmed by the bioenergetic improvement of inhibiting mGPDH with metformin in affected fibroblasts. ANN supports the prospect of an unbiased molecular definition in diagnosing FXTAS stages while identifying potential targets for personalized medicine.
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Affiliation(s)
- Cecilia Giulivi
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA.
- MIND Institute, University of California at Davis Medical Center, Sacramento, CA, USA.
| | - Jun Yi Wang
- MIND Institute, University of California at Davis Medical Center, Sacramento, CA, USA
- Center for Mind and Brain, University of California Davis, Davis, CA, USA
| | - Randi J Hagerman
- MIND Institute, University of California at Davis Medical Center, Sacramento, CA, USA
- Department of Pediatrics, University of California at Davis Medical Center, Sacramento, CA, USA
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9
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Flavell J, Franklin C, Nestor PJ. A Systematic Review of Fragile X-Associated Neuropsychiatric Disorders. J Neuropsychiatry Clin Neurosci 2022; 35:110-120. [PMID: 36172690 DOI: 10.1176/appi.neuropsych.21110282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Fragile X premutation carriers are reported to have increased neuropsychiatric problems, and thus the term fragile X-associated neuropsychiatric disorders (FXAND) has been proposed. Unfortunately, published prevalence estimates of these phenomena are inconsistent. This systematic review clarified this issue by reviewing both fragile X premutation prevalence in patients with neurodevelopmental disorders and psychiatric disorder prevalence in premutation carriers without fragile X-associated tremor/ataxia syndrome (FXTAS). Average prevalence was derived from studies that used semistructured clinical interviews, diagnostic criteria, and validated rating scales. METHODS Forty-six studies were reviewed. The rate of fragile X premutation in neurodevelopmental disorders was assessed from five studies. Probands with neurodevelopmental disorders were more likely than those in the general population to be premutation carriers. The rate of psychiatric disorders in premutation carriers was assessed from five studies for neurodevelopmental, 13 studies for mood, 12 studies for anxiety, and two studies for psychotic disorders. The phenotype and sex distribution among premutation carriers were similar to those with fragile X syndrome. RESULTS Compared to control group and general population estimates, the most prevalent psychiatric disorders were neurodevelopmental disorders, anxiety disorders, and bipolar II disorder. Psychiatric disorders were also more common in males. Most studies relied only on past medical history to define the prevalence of psychiatric disorders, yielding variability in results. CONCLUSIONS Future studies are needed to avoid bias by identifying cohorts from population-based sampling, to describe cohort demographic characteristics to elucidate differences in age and sex, and to prioritize the use of validated psychiatric assessment methods.
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Affiliation(s)
- Joshua Flavell
- Mater Intellectual Disability and Autism Service (Flavell, Franklin) and Mater Centre for Neurosciences (Flavell, Nestor), Mater Hospital, Brisbane, Australia; Metro North Hospital and Health Service, Brisbane (Flavell); Queensland Brain Institute (Flavell, Nestor) and Mater Research Institute (Franklin), University of Queensland, Brisbane
| | - Catherine Franklin
- Mater Intellectual Disability and Autism Service (Flavell, Franklin) and Mater Centre for Neurosciences (Flavell, Nestor), Mater Hospital, Brisbane, Australia; Metro North Hospital and Health Service, Brisbane (Flavell); Queensland Brain Institute (Flavell, Nestor) and Mater Research Institute (Franklin), University of Queensland, Brisbane
| | - Peter J Nestor
- Mater Intellectual Disability and Autism Service (Flavell, Franklin) and Mater Centre for Neurosciences (Flavell, Nestor), Mater Hospital, Brisbane, Australia; Metro North Hospital and Health Service, Brisbane (Flavell); Queensland Brain Institute (Flavell, Nestor) and Mater Research Institute (Franklin), University of Queensland, Brisbane
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10
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McLennan YA, Mosconi MW, McKenzie FJ, Famula J, Krawchuk B, Kim K, Clark CJ, Hessl D, Rivera SM, Simon TJ, Tassone F, Hagerman RJ. Prosaccade and Antisaccade Behavior in Fragile X-Associated Tremor/Ataxia Syndrome Progression. Mov Disord Clin Pract 2022; 9:473-478. [PMID: 35586536 PMCID: PMC9092736 DOI: 10.1002/mdc3.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
Background Quantitative measurement of eye movements can reveal subtle progression in neurodegenerative diseases. Objective To determine if quantitative measurements of eye movements may reveal subtle progression of fragile X-associated tremor and ataxia (FXTAS). Methods Prosaccade (PS) and antisaccade (AS) behavior was analyzed in 25 controls, 57 non-FXTAS carriers, and 46 carriers with FXTAS. Results Symptomatic individuals with FXTAS had longer AS latencies, increased rates of AS errors, and increased AS dysmetria relative to non-FXTAS carriers and controls. These deficits, along with PS latency and velocity, were greater in advanced FXTAS stages. Conclusion AS deficits differentiated FXTAS from non-FXTAS premutation carriers implicating top-down control and frontostriatal deterioration. However, the absence of group differences between non-FXTAS carriers and controls in AS and PS markers suggests saccade performance may not be a sensitive enough measure for detecting conversion to FXTAS, but instead more helpful as translational biomarkers of FXTAS progression.
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Affiliation(s)
- Yingratana A. McLennan
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of PediatricsUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - Matthew W. Mosconi
- Life Span Institute, Kansas Center for Autism Research and Training, and Clinical Child Psychology ProgramUniversity of KansasLawrenceKansasUSA
| | | | - Jessica Famula
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - Bennet Krawchuk
- University of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Kyoungmi Kim
- Department of PsychologyUniversity of CaliforniaDavisCaliforniaUSA
| | - Courtney J. Clark
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of PediatricsUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
| | - David Hessl
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- University of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Susan M. Rivera
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of PsychologyUniversity of CaliforniaDavisCaliforniaUSA
| | - Tony J. Simon
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- University of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Flora Tassone
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of Biochemistry and Molecular MedicineUniversity of California Davis School of MedicineSacramentoCaliforniaUSA
| | - Randi J. Hagerman
- The MIND InstituteUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
- Department of PediatricsUniversity of California Davis Medical CenterSacramentoCaliforniaUSA
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11
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Famula J, Ferrer E, Hagerman RJ, Tassone F, Schneider A, Rivera SM, Hessl D. Neuropsychological changes in FMR1 premutation carriers and onset of fragile X-associated tremor/ataxia syndrome. J Neurodev Disord 2022; 14:23. [PMID: 35321639 PMCID: PMC8942145 DOI: 10.1186/s11689-022-09436-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Carriers of the FMR1 premutation are at increased risk of developing a late-onset progressive neurodegenerative disease, fragile X-associated tremor/ataxia syndrome (FXTAS), characterized by intention tremor, gait ataxia, and cognitive decline. Cross-sectional studies to date have provided evidence that neuropsychological changes, such as executive function alterations, or subtle motor changes, may precede the onset of formal FXTAS, perhaps characterizing a prodromal state. However, the lack of longitudinal data has prevented the field from forming a clear picture of progression over time within individuals, and we lack consensus regarding early markers of risk and measures that may be used to track response to intervention. Methods This was a longitudinal study of 64 male FMR1 premutation carriers (Pm) without FXTAS at study entry and 30 normal controls (Nc), aged 40 to 80 years (Pm M = 60.0 years; Nc M = 57.4 years). Fifty of the Pm and 22 of the Nc were re-assessed after an average of 2.33 years, and 37 Pm and 20 Nc were re-assessed a third time after an average of another 2.15 years. Eighteen of 64 carriers (28%) converted to FXTAS during the study to date. Neuropsychological assessments at each time point, including components of the Cambridge Neuropsychological Test Automated Battery (CANTAB), tapped domains of episodic and working memory, inhibitory control, visual attention, planning, executive control of movement, and manual speed and dexterity. Age-based mixed models were used to examine group differences in change over time on the outcomes in the full sample, and differences were further evaluated in 15 trios (n = 45; 15 Pm “converters,” 15 Pm “nonconverters,” 15 Nc) that were one-one matched on age, education, and socioeconomic status. Results Compared to Nc, Pm showed significantly greater rates of change over time in visual working memory, motor dexterity, inhibitory control, and manual movement speed. After multiple comparison correction, significant effects remained for motor dexterity. Worsening inhibitory control and slower manual movements were related to progression in FXTAS stage, but these effects became statistically non-significant after correcting for multiple comparisons. Higher FMR1 mRNA correlated with worsening manual reaction time but did not survive multiple comparisons and no other molecular measures correlated with neuropsychological changes. Finally, trio comparisons revealed greater rate of decline in planning and manual movement speed in Pm converters compared to Pm nonconverters. Conclusions Accelerated decline in executive function and subtle motor changes, likely mediated by frontocerebellar circuits, may precede, and then track with the emergence of formal FXTAS symptoms. Further research to develop and harmonize clinical assessment of FMR1 carriers across centers is needed to prepare for future prophylactic and treatment trials for this disorder.
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Affiliation(s)
- Jessica Famula
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Emilio Ferrer
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - Randi J Hagerman
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Flora Tassone
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine, Davis, CA, USA
| | - Andrea Schneider
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Susan M Rivera
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA, 95817, USA.,Department of Psychology, University of California Davis, Davis, CA, USA.,Center for Mind and Brain, University of California Davis, Davis, CA, USA
| | - David Hessl
- MIND Institute, University of California Davis Health, 2825 50th Street, Sacramento, CA, 95817, USA. .,Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine, Sacramento, CA, USA.
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12
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Wang J, Napoli E, Kim K, McLennan YA, Hagerman RJ, Giulivi C. Brain Atrophy and White Matter Damage Linked to Peripheral Bioenergetic Deficits in the Neurodegenerative Disease FXTAS. Int J Mol Sci 2021; 22:9171. [PMID: 34502080 PMCID: PMC8431233 DOI: 10.3390/ijms22179171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a neurodegenerative disorder affecting subjects (premutation carriers) with a 55-200 CGG-trinucleotide expansion in the 5'UTR of the fragile X mental retardation 1 gene (FMR1) typically after age 50. As both the presence of white matter hyperintensities (WMHs) and atrophied gray matter on magnetic resonance imaging (MRI) are linked to age-dependent decline in cognition, here we tested whether MRI outcomes (WMH volume (WMHV) and brain volume) were correlated with mitochondrial bioenergetics from peripheral blood monocytic cells in 87 carriers with and without FXTAS. As a parameter assessing cumulative damage, WMHV was correlated to both FXTAS stages and age, and brain volume discriminated between carriers and non-carriers. Similarly, mitochondrial mass and ATP production showed an age-dependent decline across all participants, but in contrast to WMHV, only FADH2-linked ATP production was significantly reduced in carriers vs. non-carriers. In carriers, WMHV negatively correlated with ATP production sustained by glucose-glutamine and FADH2-linked substrates, whereas brain volume was positively associated with the latter and mitochondrial mass. The observed correlations between peripheral mitochondrial bioenergetics and MRI findings-and the lack of correlations with FXTAS diagnosis/stages-may stem from early brain bioenergetic deficits even before overt FXTAS symptoms and/or imaging findings.
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Affiliation(s)
- Junyi Wang
- Center for Mind and Brain, University of California Davis, Davis, CA 95618, USA;
| | - Eleonora Napoli
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA;
| | - Kyoungmi Kim
- The MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (K.K.); (Y.A.M.)
- Department of Public Health Sciences, School of Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Yingratana A. McLennan
- The MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (K.K.); (Y.A.M.)
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA 95817, USA
| | - Randi J. Hagerman
- The MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (K.K.); (Y.A.M.)
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA 95817, USA
| | - Cecilia Giulivi
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA 95616, USA;
- The MIND Institute, University of California Davis Medical Center, Sacramento, CA 95817, USA; (K.K.); (Y.A.M.)
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13
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review the prevalence, pathophysiology, and management of fragile X-associated tremor/ataxia syndrome (FXTAS). RECENT FINDINGS The pathophysiology of FXTAS involves ribonucleic acid (RNA) toxicity due to elevated levels of the premutation-expanded CGG (eoxycytidylate-deoxyguanylate-deoxyguanylate)-repeat FMR1 mRNA, which can sequester a variety of proteins important for neuronal function. A recent analysis of the inclusions in FXTAS demonstrates elevated levels of several proteins, including small ubiquitin-related modifiers 1/2 (SUMO1/2), that target molecules for the proteasome, suggesting that some aspect(s) of proteasomal function may be altered in FXTAS. Recent neuropathological studies show that Parkinson disease and Alzheimer disease can sometimes co-occur with FXTAS. Lewy bodies can be found in 10% of the brains of patients with FXTAS. Microbleeds and iron deposition are also common in the neuropathology, in addition to white matter disease (WMD) and atrophy. SUMMARY The premutation occurs in 1:200 females and 1:400 males. Penetrance for FXTAS increases with age, though lower in females (16%) compared to over 60% of males by age 70. To diagnose FXTAS, an MRI is essential to document the presence of WMD, a primary component of the diagnostic criteria. Pain can be a significant feature of FXTAS and is seen in approximately 50% of patients.
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14
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Cocozza S, Pontillo G, De Michele G, Di Stasi M, Guerriero E, Perillo T, Pane C, De Rosa A, Ugga L, Brunetti A. Conventional MRI findings in hereditary degenerative ataxias: a pictorial review. Neuroradiology 2021; 63:983-999. [PMID: 33733696 PMCID: PMC8213578 DOI: 10.1007/s00234-021-02682-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 02/25/2021] [Indexed: 12/15/2022]
Abstract
Purpose Cerebellar ataxias are a large and heterogeneous group of disorders. The evaluation of brain parenchyma via MRI plays a central role in the diagnostic assessment of these conditions, being mandatory to exclude the presence of other underlying causes in determining the clinical phenotype. Once these possible causes are ruled out, the diagnosis is usually researched in the wide range of hereditary or sporadic ataxias. Methods We here propose a review of the main clinical and conventional imaging findings of the most common hereditary degenerative ataxias, to help neuroradiologists in the evaluation of these patients. Results Hereditary degenerative ataxias are all usually characterized from a neuroimaging standpoint by the presence, in almost all cases, of cerebellar atrophy. Nevertheless, a proper assessment of imaging data, extending beyond the mere evaluation of cerebellar atrophy, evaluating also the pattern of volume loss as well as concomitant MRI signs, is crucial to achieve a proper diagnosis. Conclusion The integration of typical neuroradiological characteristics, along with patient’s clinical history and laboratory data, could allow the neuroradiologist to identify some conditions and exclude others, addressing the neurologist to the more appropriate genetic testing.
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Affiliation(s)
- Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.,Department of Electrical Engineering and Information Technology, University of Naples "Federico II", Naples, Italy
| | - Giovanna De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Martina Di Stasi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Elvira Guerriero
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Teresa Perillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Chiara Pane
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Anna De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy
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15
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Pešić M, Dragašević Mišković N, Marjanović A, Dobričić V, Maksimović N, Svetel M, Perović D, Novaković I, Cirković S, Stanković I, Kostić V. Premutations in the FMR1 gene in Serbian patients with undetermined tremor, ataxia and parkinsonism. Neurol Res 2021; 43:321-326. [PMID: 33403926 DOI: 10.1080/01616412.2020.1863697] [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: 02/05/2023]
Abstract
Introduction: Although one of the most common monogenic late-onset neurodegenerative disorders, fragile-X-associated tremor/ataxia syndrome (FXTAS) is still underdiagnosed. The aim of the present study was to estimate the frequency of premutation carriers in patients with unexplained degenerative ataxias, action tremor or parkinsonism, and action tremor with or without associated cognitive impairment.Methods: The study comprised 100 consecutive patients with the disease onset >49 years who had any form of unexplained action tremor, cerebellar ataxia, followed by parkinsonism with or without incipient dementia, and in whom the FMR1 repeats size was determined.Results: Premutation in the FMR1 was identified in two patients (2%): the first, male patient had 83 CGG repeats and the second, female patient had 32 and 58 CGG repeats.Discussion/Conclusion: FXTAS was relatively rare among older patients with unexplained ataxia and action tremor, with or without parkinsonism and/or cognitive impairment. Tremor and ataxia were major clinical features in our two patients, although parkinsonism, autonomic dysfunction and psychiatric problems might be an important part of the spectrum. Probable FXTAS should be considered in the differential diagnosis of patients with unexplained action tremor and ataxia, and undetermined parkinsonism, especially when there was a positive family history for involuntary movement disorders in other family members and/or autism spectrum disorders in younger cousins.
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Affiliation(s)
- Milica Pešić
- Faculty of Medicine, Institute of Human Genetics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nataša Dragašević Mišković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Ana Marjanović
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Valerija Dobričić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nela Maksimović
- Faculty of Medicine, Institute of Human Genetics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marina Svetel
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Dijana Perović
- Faculty of Medicine, Institute of Human Genetics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Novaković
- Faculty of Medicine, Institute of Human Genetics, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Cirković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Iva Stanković
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Vladimir Kostić
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Faculty of Medicine, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
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16
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Zafarullah M, Durbin-Johnson B, Fourie ES, Hessl DR, Rivera SM, Tassone F. Metabolomic Biomarkers Are Associated With Area of the Pons in Fragile X Premutation Carriers at Risk for Developing FXTAS. Front Psychiatry 2021; 12:691717. [PMID: 34483988 PMCID: PMC8415564 DOI: 10.3389/fpsyt.2021.691717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/21/2021] [Indexed: 11/22/2022] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late adult-onset neurodegenerative disorder that affects movement and cognition in male and female carriers of a premutation allele (55-200 CGG repeats; PM) in the fragile X mental retardation (FMR1) gene. It is currently unknown how the observed brain changes are associated with metabolic signatures in individuals who develop the disorder over time. The primary objective of this study was to investigate the correlation between longitudinal changes in the brain (area of the pons, midbrain, and MCP width) and the changes in the expression level of metabolic biomarkers of early diagnosis and progression of FXTAS in PM who, as part of an ongoing longitudinal study, emerged into two distinct categories. These included those who developed symptoms of FXTAS (converters, CON) at subsequent visits and those who did not meet the criteria of diagnosis (non-converters, NCON) and were compared to age-matched healthy controls (HC). We assessed CGG repeat allele size by Southern Blot and PCR analysis. Magnetic Resonance Imaging (MRIs) acquisition was obtained on a 3T Siemens Trio scanner and metabolomic profile was obtained by ultra-performance liquid chromatography, accurate mass spectrometer, and an Orbitrap mass analyzer. Our findings indicate that differential metabolite levels are linked with the area of the pons between healthy control and premutation groups. More specifically, we observed a significant association of ceramides and mannonate metabolites with a decreased area of the pons, both at visit 1 (V1) and visit 2 (V2) only in the CON as compared to the NCON group suggesting their potential role in the development of the disorder. In addition, we found a significant correlation of these metabolic signatures with the FXTAS stage at V2 indicating their contribution to the progression and pathogenesis of FXTAS. Interestingly, these metabolites, as part of lipid and sphingolipid lipids pathways, provide evidence of the role that their dysregulation plays in the development of FXTAS and inform us as potential targets for personalized therapeutic development.
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Affiliation(s)
- Marwa Zafarullah
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Sacramento, CA, United States
| | - Blythe Durbin-Johnson
- Division of Biostatistics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Emily S Fourie
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,Department of Psychology, University of California, Davis, Davis, CA, United States
| | - David R Hessl
- MIND Institute, University of California, Davis Medical Center, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Susan M Rivera
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,Department of Psychology, University of California, Davis, Davis, CA, United States.,MIND Institute, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Sacramento, CA, United States.,MIND Institute, University of California, Davis Medical Center, Sacramento, CA, United States
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17
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Johnson D, Santos E, Kim K, Ponzini MD, McLennan YA, Schneider A, Tassone F, Hagerman RJ. Increased Pain Symptomatology Among Females vs. Males With Fragile X-Associated Tremor/Ataxia Syndrome. Front Psychiatry 2021; 12:762915. [PMID: 35126193 PMCID: PMC8811376 DOI: 10.3389/fpsyt.2021.762915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/27/2021] [Indexed: 12/12/2022] Open
Abstract
Individuals with the fragile X premutation report symptoms of chronic pain from multiple systems, have increased incidence of comorbid conditions where pain is a prominent feature, and pathophysiology that supports disrupted pain regulation, inflammation, and energy imbalance. Less is known about how pain manifests for the subpopulation of carriers that develop the motor and cognitive changes of fragile X-associated tremor and ataxia syndrome (FXTAS), and how pain may differ between men and women. We gathered data collected from 104 males and females with FXTAS related to chronic pain, comorbid conditions related to pain, and medications used for pain control to further explore the types of pain experienced and to better characterize how individuals with the fragile X premutation experience pain sensation across genders. We found that women experience significantly more pain symptoms than men, particularly allodynia (20 vs. 2.0%, p = 0.008), peripheral neuropathy pain (43.9 vs. 25.4%, p = 0.0488), migraine (43.9 vs. 14.5%, p = 0.0008), fibromyalgia (26.8 vs. 0%, p = 0.0071) and back pain (48.5 vs. 23.4%, p = 0.008). We found onset of peripheral neuropathy predicts the onset of ataxia (β = 0.63 ± 0.25, p = 0.019) and tremor (β = 0.56 ± 0.17, p = 0.004) across gender. Women also report significantly more anxiety (82.9 vs. 39.7%, p < 0.001), which has implications for ideal pain treatment. These pain symptoms need to be recognized in the medical history and treated appropriately, with consideration for overlapping comorbidities.
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Affiliation(s)
- Devon Johnson
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Ellery Santos
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Kyoungmi Kim
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Division of Biostatistics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Matthew D Ponzini
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Division of Biostatistics, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Yingratana A McLennan
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders 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
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders Institute, School of Medicine, University of California, Davis, Davis, CA, United States.,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Davis, CA, United States
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders 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
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18
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Zafarullah M, Palczewski G, Rivera SM, Hessl DR, Tassone F. Metabolic profiling reveals dysregulated lipid metabolism and potential biomarkers associated with the development and progression of Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS). FASEB J 2020; 34:16676-16692. [PMID: 33131090 PMCID: PMC7756608 DOI: 10.1096/fj.202001880r] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/27/2020] [Accepted: 10/13/2020] [Indexed: 12/28/2022]
Abstract
Fragile X-associated Tremor/Ataxia Syndrome (FXTAS) is a neurodegenerative disorder associated with the FMR1 premutation. It is currently unknown when, and if, individual premutation carriers will develop FXTAS. Thus, with the aim of identifying biomarkers for early diagnosis, development, and progression of FXTAS, we performed global metabolomic profiling of premutation carriers (PM) who, as part of an ongoing longitudinal study, emerged into two distinct categories: those who developed symptoms of FXTAS (converters, CON) at subsequent visits and those who did not (non-converters, NCON) and we compared to age-matched healthy controls (HC). We assessed CGG repeat allele size by Southern Blot and PCR analysis. Metabolomic profile was obtained by ultra-performance liquid chromatography, accurate mass spectrometer, and an Orbitrap mass analyzer. In this study we found 47 metabolites were significantly dysregulated between HC and the premutation groups (PM). Importantly, we identified 24 metabolites that showed significant changes in expression in the CON as compared to the NCON both at V1 and V2, and 70 metabolites in CON as compared to NCON but only at V2. These findings suggest the potential role of the identified metabolites as biomarkers for early diagnosis and for FXTAS disease progression, respectively. Interestingly, the majority of the identified metabolites were lipids, followed by amino acids. To our knowledge, this the first report of longitudinal metabolic profiling and identification of unique biomarkers of FXTAS. The lipid metabolism and specifically the sub pathways involved in mitochondrial bioenergetics, as observed in other neurodegenerative disorders, are significantly altered in FXTAS.
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Affiliation(s)
- Marwa Zafarullah
- Department of Biochemistry and Molecular MedicineUniversity of California Davis, School of MedicineSacramentoCAUSA
| | | | - Susan M. Rivera
- Center for Mind and BrainUniversity of California DavisDavisCAUSA
- Department of PsychologyUniversity of California DavisDavisCAUSA
- MIND Institute, University of California Davis Medical CenterSacramentoCAUSA
| | - David R. Hessl
- MIND Institute, University of California Davis Medical CenterSacramentoCAUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California Davis Medical CenterSacramentoCAUSA
| | - Flora Tassone
- Department of Biochemistry and Molecular MedicineUniversity of California Davis, School of MedicineSacramentoCAUSA
- MIND Institute, University of California Davis Medical CenterSacramentoCAUSA
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19
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Schneider A, Summers S, Tassone F, Seritan A, Hessl D, Hagerman P, Hagerman R. Women with Fragile X-associated Tremor/Ataxia Syndrome. Mov Disord Clin Pract 2020; 7:910-919. [PMID: 33163562 PMCID: PMC7604678 DOI: 10.1002/mdc3.13084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/16/2020] [Accepted: 08/03/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Fragile X-associated tremor and ataxia syndrome (FXTAS) is a late-onset neurodegenerative disorder linked to the FMR1 premutation. OBJECTIVES FXTAS in women is far less common than in men, and this study represents the largest sample reported to date. METHODS A total of 53 female premutation carriers with FXTAS (meanage, 66.83 years; FXTAS stages 2-5) and 55 age-matched and demographic background-matched control participants (meanage, 61.94 years) underwent a comprehensive molecular, physiological, neuropsychological, and psychiatric assessment. RESULTS The large sample of female premutation carriers showed a wide range of variability of clinical signs and symptom progression. The imaging results showed a middle cerebellar peduncles sign in only 6 patients; another symptom included high-signal intensity in the splenium of the corpus callosum, and diffuse cerebral deep white matter changes (e.g., in the pons) are more common. The rate of psychiatric disorders, especially depression, is higher than in the general population. There is a clear impairment in executive functioning and fine motor skills in connection with a higher FXTAS stage. CONCLUSIONS The manifestation of FXTAS symptoms in female carriers can be diverse with a milder phenotype and a lower penetrance than those observed in male premutation carriers. The middle cerebellar peduncles sign is present in only a small percentage of the sample, and we propose that the imaging criteria for FXTAS in women need to be expanded.
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Affiliation(s)
- Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders InstituteSacramentoCaliforniaUSA
- Department of Pediatrics, School of MedicineUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Scott Summers
- Department of Psychiatry and Behavioral SciencesUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Flora Tassone
- Department of BiochemistryUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Andreea Seritan
- Department of Psychiatry, UCSF Weill Institute for NeurosciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - David Hessl
- Medical Investigation of Neurodevelopmental Disorders InstituteSacramentoCaliforniaUSA
- Department of Psychiatry and Behavioral SciencesUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Paul Hagerman
- Department of BiochemistryUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders InstituteSacramentoCaliforniaUSA
- Department of Pediatrics, School of MedicineUniversity of California–Davis, Medical CenterSacramentoCaliforniaUSA
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20
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Robinson AC, Bajaj N, Hadjivassiliou M, Minshull J, Mahmood A, Roncaroli F. Neuropathology of a case of fragile X-associated tremor ataxia syndrome without tremor. Neuropathology 2020; 40:611-619. [PMID: 32830366 DOI: 10.1111/neup.12674] [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] [Received: 02/07/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 12/01/2022]
Abstract
Fragile X-associated tremor ataxia syndrome (FXTAS) is a neurodegenerative disorder caused by a CGG trinucleotide expansion from 55 to 200 repeats in the non-coding region of the fragile X mental retardation 1 (FMR1) gene (FMR1). Clinical features include cognitive decline, progressive tremor, and gait ataxia. Neuropathologically, FXTAS shows white matter changes, hippocampal and cerebellar involvement, and p62-positive eosinophilic intranuclear inclusions in astrocytes and neurons. Here, we document the neuropathological findings from a subject who developed cognitive impairment but not tremor and was proved to have genetically confirmed FMR1 premutation. Microscopically, typical p62-postive intranuclear inclusions were present in all the regions examined. Neocortical regions demonstrated gliosis of layer I and mild degree of neuronal loss and atrophy across the other layers. The molecular, Purkinje's cell, and granule cell layers of the cerebellar folia demonstrated mild gliosis, and cerebellar white matter was mildly affected. Aside from p62-positive inclusions, the hippocampus was spared. Arteries in the deep white matter often showed changes consistent with moderate small vessel disease (SVD). Reactive gliosis and severe SVD were features of basal ganglia. Florid reactive astrocytosis was found in the white matter of all regions. Axonal loss and features of axonal damage were found in the white matter of the centrum semiovale. Microglial activation was widespread and evenly seen in both the white matter and grey matter, although the grey matter appeared more severely affected. Pathology associated with Alzheimer's disease was limited. Similarly, no abnormal accumulations of α-synuclein were present. We postulate that age at death and disease duration may play a role in the extent of the pathological features associated with FXTAS. The present results suggest that immunohistochemical staining for p62 can help with the diagnosis of cases with atypical phenotype. In addition, it is likely that the cognitive impairment observed was a result of white matter changes.
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Affiliation(s)
- Andrew C Robinson
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Neuroscience & Experimental Psychology, The University of Manchester, Salford Royal Hospital, Salford, UK
| | - Nin Bajaj
- Department of Neurology, University of Nottingham, Nottingham, UK
| | - Marios Hadjivassiliou
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - James Minshull
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Neuroscience & Experimental Psychology, The University of Manchester, Salford Royal Hospital, Salford, UK
| | - Aiza Mahmood
- Neuropathology Unit, Salford Royal Hospital, Manchester, UK
| | - Federico Roncaroli
- Faculty of Biology, Medicine and Health, School of Biological Sciences, Division of Neuroscience & Experimental Psychology, The University of Manchester, Salford Royal Hospital, Salford, UK.,Neuropathology Unit, Salford Royal Hospital, Manchester, UK
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21
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Zafarullah M, Tang HT, Durbin-Johnson B, Fourie E, Hessl D, Rivera SM, Tassone F. FMR1 locus isoforms: potential biomarker candidates in fragile X-associated tremor/ataxia syndrome (FXTAS). Sci Rep 2020; 10:11099. [PMID: 32632326 PMCID: PMC7338407 DOI: 10.1038/s41598-020-67946-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 05/18/2020] [Indexed: 12/12/2022] Open
Abstract
Fragile X associated tremor/ataxia syndrome (FXTAS) is a late adult-onset neurodegenerative disorder that affects movement and cognition in male and female carriers of a premutation allele of 55–200 CGG repeats in the Fragile X mental retardation (FMR1) gene. It is currently unknown if and when an individual carrier of a premutation allele will develop FXTAS, as clinical assessment fails to identify carriers at risk before significant neurological symptoms are evident. The primary objective of this study was to investigate the alternative splicing landscape at the FMR1 locus in conjunction with brain measures in male individuals with a premutation allele enrolled in a very first longitudinal study, compared to age-matched healthy male controls, with the purpose of identifying biomarkers for early diagnosis, disease prediction and, a progression of FXTAS. Our findings indicate that increased expression of FMR1 mRNA isoforms, including Iso4/4b, Iso10/10b, as well as of the ASFMR1 mRNAs Iso131bp, are present in premutation carriers as compared to non-carrier healthy controls. More specifically, we observed a higher expression of Iso4/4b and Iso10/10b, which encode for truncated proteins, only in those premutation carriers who developed symptoms of FXTAS over time as compared to non-carrier healthy controls, suggesting a potential role in the development of the disorder. In addition, we found a significant association of these molecular changes with various measurements of brain morphology, including the middle cerebellar peduncle (MCP), superior cerebellar peduncle (SCP), pons, and midbrain, indicating their potential contribution to the pathogenesis of FXTAS. Interestingly, the high expression levels of Iso4/4b observed both at visit 1 and visit 2 and found to be associated with a decrease in mean MCP width only in those individuals who developed FXTAS over time, suggests their role as potential biomarkers for early diagnosis of FXTAS.
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Affiliation(s)
- Marwa Zafarullah
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, 95817 CA, USA
| | - Hiu-Tung Tang
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, 95817 CA, USA
| | - Blythe Durbin-Johnson
- Division of Biostatistics, School of Medicine, University of California Davis, Davis, CA, USA
| | - Emily Fourie
- Center for Mind and Brain, University of California Davis, Davis, CA, USA.,Department of Psychology, University of California, Davis, Davis, CA, USA
| | - David Hessl
- MIND Institute, University of California Davis Medical Center, Sacramento, 95817 CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, Sacramento, 95817 CA, USA
| | - Susan M Rivera
- Center for Mind and Brain, University of California Davis, Davis, CA, USA.,Department of Psychology, University of California, Davis, Davis, CA, USA.,MIND Institute, University of California Davis Medical Center, Sacramento, 95817 CA, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, 95817 CA, USA. .,MIND Institute, University of California Davis Medical Center, Sacramento, 95817 CA, USA.
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22
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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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23
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Salcedo-Arellano MJ, Cabal-Herrera AM, Tassanakijpanich N, McLennan YA, Hagerman RJ. Ataxia as the Major Manifestation of Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS): Case Series. Biomedicines 2020; 8:E136. [PMID: 32466255 PMCID: PMC7277845 DOI: 10.3390/biomedicines8050136] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 11/30/2022] Open
Abstract
Fragile X-associated tremor and ataxia syndrome (FXTAS) is a neurodegenerative disease developed by carriers of a premutation in the fragile X mental retardation 1 (FMR1) gene. The core clinical symptoms usually manifest in the early 60s, typically beginning with intention tremor followed by cerebellar ataxia. Ataxia can be the only symptom in approximately 20% of the patients. FXTAS has a slow progression, and patients usually experience advanced deterioration 15 to 25 years after the initial diagnosis. Common findings in brain imaging include substantial brain atrophy and white matter disease (WMD). We report three cases with an atypical clinical presentation, all presenting with gait problems as their initial manifestation and with ataxia as the dominant symptom without significant tremor, as well as a faster than usual clinical progression. Magnetic resonance imaging (MRI) was remarkable for severe brain atrophy, ventriculomegaly, thinning of the corpus callosum, and periventricular WMD. Two cases were diagnosed with definite FXTAS on the basis of clinical and radiological findings, with one individual also developing moderate dementia. Factors such as environmental exposure and general anesthesia could have contributed to their clinical deterioration. FXTAS should be considered in the differential diagnosis of patients presenting with ataxia, even in the absence of tremor, and FMR1 DNA testing should be sought in those with a family history of fragile X syndrome or premutation disorders.
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Affiliation(s)
- Maria Jimena Salcedo-Arellano
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (Y.A.M.)
- MIND Institute, University of California Davis, Sacramento, CA 95817, USA; (A.M.C.-H.); (N.T.)
| | - Ana Maria Cabal-Herrera
- MIND Institute, University of California Davis, Sacramento, CA 95817, USA; (A.M.C.-H.); (N.T.)
- Group on Congenital Malformations and Dysmorphology (MACOS), Faculty of Health, Universidad del Valle, Cali, Valle del Cauca 760041, Colombia
| | - Nattaporn Tassanakijpanich
- MIND Institute, University of California Davis, Sacramento, CA 95817, USA; (A.M.C.-H.); (N.T.)
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Yingratana A. McLennan
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (Y.A.M.)
- MIND Institute, University of California Davis, Sacramento, CA 95817, USA; (A.M.C.-H.); (N.T.)
| | - Randi J. Hagerman
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA; (M.J.S.-A.); (Y.A.M.)
- MIND Institute, University of California Davis, Sacramento, CA 95817, USA; (A.M.C.-H.); (N.T.)
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24
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Wang JY, Hessl D, Tassone F, Kim K, Hagerman RJ, Rivera SM. Interaction between ventricular expansion and structural changes in the corpus callosum and putamen in males with FMR1 normal and premutation alleles. Neurobiol Aging 2020; 86:27-38. [PMID: 31733943 PMCID: PMC6995416 DOI: 10.1016/j.neurobiolaging.2019.09.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/10/2019] [Accepted: 09/13/2019] [Indexed: 12/23/2022]
Abstract
Ventricular enlargement (VE) is commonly observed in aging and fragile X-associated tremor/ataxia syndrome (FXTAS), a late-onset neurodegenerative disorder. VE may generate a mechanical force causing structural deformation. In this longitudinal study, we examined the relationships between VE and structural changes in the corpus callosum (CC) and putamen. MRI scans (2-7/person over 0.2-7.5 years) were acquired from 22 healthy controls, 26 unaffected premutation carriers (PFX-), and 39 carriers affected with FXTAS (PFX+). Compared with controls, PFX- demonstrated enlarged fourth ventricles, whereas PFX+ displayed enlargement in both third and fourth ventricles, CC thinning, putamen atrophy/deformation (thinning and increased distance), and accelerated expansions in lateral ventricles. Common for all groups, baseline VE predicted accelerated CC thinning and putamen atrophy/deformation and conversely, baseline CC and putamen atrophy/deformation and enlarged third and fourth ventricles predicted accelerated lateral ventricular expansion. The results suggest a progressive VE within the 4 ventricles as FXTAS develops and a deleterious cycle between VE and brain deformation that may commonly occur during aging and FXTAS progression but become accelerated in FXTAS.
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Affiliation(s)
- Jun Yi Wang
- Center for Mind and Brain, University of California-Davis, Davis, CA, USA; MIND Institute, University of California-Davis Medical Center, Sacramento, CA, USA; Department of Biochemistry and Molecular Medicine, University of California-Davis, School of Medicine, Sacramento, CA, USA.
| | - David Hessl
- MIND Institute, University of California-Davis Medical Center, Sacramento, CA, USA; Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Flora Tassone
- MIND Institute, University of California-Davis Medical Center, Sacramento, CA, USA; Department of Biochemistry and Molecular Medicine, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Kyoungmi Kim
- MIND Institute, University of California-Davis Medical Center, Sacramento, CA, USA; Department of Public Health Sciences, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Randi J Hagerman
- MIND Institute, University of California-Davis Medical Center, Sacramento, CA, USA; Department of Pediatrics, University of California-Davis, School of Medicine, Sacramento, CA, USA
| | - Susan M Rivera
- Center for Mind and Brain, University of California-Davis, Davis, CA, USA; MIND Institute, University of California-Davis Medical Center, Sacramento, CA, USA; Department of Psychology, University of California-Davis, Davis, CA, USA
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25
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Mishra SK, Khosa S, Trikamji B, Khanli HM, Scheuner MT, Jamal NI, Hanssen AM. A case of Fragile X-associated tremor/ataxia syndrome (FXTAS). J Clin Neurosci 2019; 66:269-270. [DOI: 10.1016/j.jocn.2019.05.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
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26
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Parra-Damas A, Saura CA. Synapse-to-Nucleus Signaling in Neurodegenerative and Neuropsychiatric Disorders. Biol Psychiatry 2019; 86:87-96. [PMID: 30846302 DOI: 10.1016/j.biopsych.2019.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/18/2018] [Accepted: 01/04/2019] [Indexed: 01/07/2023]
Abstract
Synapse-to-nucleus signaling is critical for converting signals received at synapses into transcriptional programs essential for cognition, memory, and emotion. This neuronal mechanism usually involves activity-dependent translocation of synaptonuclear factors from synapses to the nucleus resulting in regulation of transcriptional programs underlying synaptic plasticity. Acting as synapse-to-nucleus messengers, amyloid precursor protein intracellular domain associated-1 protein, cAMP response element binding protein (CREB)-regulated transcription coactivator-1, Jacob, nuclear factor kappa-light-chain-enhancer of activated B cells, RING finger protein 10, and SH3 and multiple ankyrin repeat domains 3 play essential roles in synapse remodeling and plasticity, which are considered the cellular basis of memory. Other synaptic proteins, such as extracellular signal-regulated kinase, calcium/calmodulin-dependent protein kinase II gamma, and CREB2, translocate from dendrites or cytosol to the nucleus upon synaptic activity, suggesting that they could contribute to synapse-to-nucleus signaling. Notably, some synaptonuclear factors converge on the transcription factor CREB, indicating that CREB signaling is a key hub mediating integration of synaptic signals into transcriptional programs required for neuronal function and plasticity. Although major efforts have been focused on identification and regulatory mechanisms of synaptonuclear factors, the relevance of synapse-to-nucleus communication in brain physiology and pathology is still unclear. Recent evidence, however, indicates that synaptonuclear factors are implicated in neuropsychiatric, neurodevelopmental, and neurodegenerative disorders, suggesting that uncoupling synaptic activity from nuclear signaling may prompt synapse pathology, contributing to a broad spectrum of brain disorders. This review summarizes current knowledge of synapse-to-nucleus signaling in neuron survival, synaptic function and plasticity, and memory. Finally, we discuss how altered synapse-to-nucleus signaling may lead to memory and emotional disturbances, which is relevant for clinical and therapeutic strategies in neurodegenerative and neuropsychiatric diseases.
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Affiliation(s)
- Arnaldo Parra-Damas
- Institut de Neurociències, Department de Bioquímica i Biologia Molecular, Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos A Saura
- Institut de Neurociències, Department de Bioquímica i Biologia Molecular, Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas, Universitat Autònoma de Barcelona, Barcelona, Spain.
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27
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Brown SSG, Whalley HC, Kind PC, Stanfield AC. Decreased functional brain response to emotional arousal and increased psychiatric symptomology in FMR1 premutation carriers. Psychiatry Res Neuroimaging 2019; 285:9-17. [PMID: 30711710 DOI: 10.1016/j.pscychresns.2019.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 12/23/2018] [Accepted: 01/28/2019] [Indexed: 12/30/2022]
Abstract
The FMR1 premutation is an expansion of the CGG repeat island in the FMR1 gene to between 55 and 200 repeats. Evidence suggests that as well as conferring risk for neurodegeneration, the premutation is also associated with increased risk for autistic traits and psychiatric symptoms. An emotional processing fMRI task was used to examine the response to a change in emotional arousal in 17 male carriers and 17 matched controls. A psychiatric symptom checklist (SCL-90-R), autism spectrum and empathy quotients (AQ and EQ), and the Ekman Faces Test were used to investigate clinical symptoms and emotional processing. Carriers exhibited significantly lower activation compared to controls at the bilateral superior parietal lobe, bilateral Brodmann Area (BA) 17 (V1), right intraparietal area and right BA18 (V2) when comparing high and low arousal conditions. Group by age analyses were not significant. Assessments revealed that carriers displayed significantly worse symptoms of psychiatric symptoms and higher levels of autistic traits, as well as impaired facial emotion recognition. No measurements revealed an association with age. Here, we show significantly altered emotional processing in carriers which display stability over age, suggesting that, unlike degenerative aspects, emotional symptoms may be consistent over the lifespan in carriers.
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Affiliation(s)
- Stephanie S G Brown
- Patrick Wild Centre, Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom.
| | - Heather C Whalley
- Patrick Wild Centre, Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom
| | - Peter C Kind
- Patrick Wild Centre, Centre for Integrative Physiology, School of Biomedical Sciences, University of Edinburgh, Hugh Robson Building, 15 George Square, Edinburgh EH8 9XD, United Kingdom
| | - Andrew C Stanfield
- Patrick Wild Centre, Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh EH10 5HF, United Kingdom
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Pereverzeva DS, Tyushkevich SA, Gorbachevskaya NL, Mamokhina UA, Danilina KK. Heterogeneity of clinical characteristics of FMR1-related disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:103-111. [DOI: 10.17116/jnevro2019119071103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Shelton AL, Wang JY, Fourie E, Tassone F, Chen A, Frizzi L, Hagerman RJ, Ferrer E, Hessl D, Rivera SM. Middle Cerebellar Peduncle Width-A Novel MRI Biomarker for FXTAS? Front Neurosci 2018; 12:379. [PMID: 29988561 PMCID: PMC6026659 DOI: 10.3389/fnins.2018.00379] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/17/2018] [Indexed: 01/07/2023] Open
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a severe neurodegenerative movement disorder affecting over 40% of male and 16% of female FMR1 premutation carriers over the age of 50. However, there is a lack of prognostic biomarkers to aid early diagnosis and treatment planning. Therefore, this study aimed to assess the utility of the Magnetic Resonance Parkinson Index (MRPI) as a potential MRI biomarker for FXTAS. The four measurements required for the MRPI were assessed in 45 male premutation carriers at risk of developing FXTAS (Mean age = 59.54 years), 53 male patients with FXTAS (Mean age = 66.16 years) and 61 male controls (Mean age = 60.75 years), of which 73 participants had follow-up visits on average 1.96 years later. Middle cerebellar peduncle (MCP) width as well as midbrain and pons cross-sectional area were reduced in patients with FXTAS compared to both premutation carriers without FXTAS and controls. While these measurements were not found to change over time in the three-group analysis, age was an important predictor of midbrain cross-sectional area and pons/midbrain ratio. MCP width was initially reduced in a subset of premutation carriers who developed FXTAS symptoms between their initial and follow-up visits, which also decreased between visits, compared to age-matched premutation carriers who did not show any FXTAS symptom development over time. Therefore, while the MPRI may not be a useful biomarker for FXTAS, decreased MCP width may be one of the first notable signs of FXTAS, and therefore the first biomarker with the potential to identify those most at risk for the disorder.
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Affiliation(s)
- Annie L Shelton
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Jun Y Wang
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,Department of Biochemistry and Molecular Medicine, University of California, Davis, Sacramento, CA, United States
| | - Emily Fourie
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Flora Tassone
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Biochemistry and Molecular Medicine, University of California, Davis, Sacramento, CA, United States
| | - Anna Chen
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Lauren Frizzi
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Randi J Hagerman
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, United States
| | - Emilio Ferrer
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - David Hessl
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, Sacramento, CA, United States
| | - Susan M Rivera
- MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.,Center for Mind and Brain, University of California, Davis, Davis, CA, United States.,Department of Psychology, University of California, Davis, Davis, CA, United States
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Didonna A, Opal P. Advances in Sequencing Technologies for Understanding Hereditary Ataxias: A Review. JAMA Neurol 2017; 73:1485-1490. [PMID: 27749953 DOI: 10.1001/jamaneurol.2016.3097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance The hereditary progressive ataxias comprise genetic disorders that affect the cerebellum and its connections. Even though these diseases historically have been among the first familial disorders of the nervous system to have been recognized, progress in the field has been challenging because of the large number of ataxic genetic syndromes, many of which overlap in their clinical features. Observations We have taken a historical approach to demonstrate how our knowledge of the genetic basis of ataxic disorders has come about by novel techniques in gene sequencing and bioinformatics. Furthermore, we show that the genes implicated in ataxia, although seemingly unrelated, appear to encode for proteins that interact with each other in connected functional modules. Conclusions and Relevance It has taken approximately 150 years for neurologists to comprehensively unravel the genetic diversity of ataxias. There has been an explosion in our understanding of their molecular basis with the arrival of next-generation sequencing and computer-driven bioinformatics; this in turn has made hereditary ataxias an especially well-developed model group of diseases for gaining insights at a systems level into genes and cellular pathways that result in neurodegeneration.
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Affiliation(s)
| | - Puneet Opal
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois3Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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31
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Connon P, Larner AJ. Fragile X-associated tremor/ataxia syndrome: cognitive presentations. Br J Hosp Med (Lond) 2017; 78:230-231. [PMID: 28398884 DOI: 10.12968/hmed.2017.78.4.230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- P Connon
- Core Medical Trainee year 2 (CMT2), Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool
| | - A J Larner
- Consultant Neurologist, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ
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Kaub-Wittemer D, Hall DA, Kumpf U, Padberg F, Schneider SA. Fragile X-associated tremor ataxia syndrome presenting as chronic fatigue syndrome. Parkinsonism Relat Disord 2017; 39:85-86. [PMID: 28291595 DOI: 10.1016/j.parkreldis.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 02/27/2017] [Accepted: 03/04/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Dagmar Kaub-Wittemer
- Department of Neurology, Ludwig-Maximilians-University of München, Munich, Germany
| | - Deborah A Hall
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Ulrike Kumpf
- Department of Psychiatry, Ludwig-Maximilians-University of München, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry, Ludwig-Maximilians-University of München, Munich, Germany
| | - Susanne A Schneider
- Department of Neurology, Ludwig-Maximilians-University of München, Munich, Germany.
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Seritan AL, Kim K, Benjamin I, Seritan I, Hagerman RJ. Risk Factors for Cognitive Impairment in Fragile X-Associated Tremor/Ataxia Syndrome. J Geriatr Psychiatry Neurol 2016; 29:328-337. [PMID: 27647792 PMCID: PMC5357600 DOI: 10.1177/0891988716666379] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset neurodegenerative disease with motor, psychiatric, and cognitive manifestations that occurs in carriers of the fragile X mental retardation 1 ( FMR1) gene premutations. This was a retrospective chart review of 196 individuals (127 men and 69 women) with FXTAS. Forty-six (23%) participants were cognitively impaired, of whom 19 (10%) had dementia. Risk factors for dementia were examined (CGG repeat size; alcohol, benzodiazepine, and opioid use; diabetes; hyperlipidemia; hypertension; hypothyroidism; obesity; sleep apnea; surgeries with general anesthesia; depression; family history of dementia). Thirteen individuals with FXTAS and dementia were then compared to 13 cognitively intact individuals matched on age, gender, and FXTAS stage. CGG repeat size was significantly higher (mean = 98.5, standard deviation [SD] = 22.2) in the dementia group, compared to the cognitively intact group (mean = 81.6, SD = 11.5; P = .0256). These results show that CGG repeat size is a risk factor for FXTAS dementia.
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Affiliation(s)
- Andreea L. Seritan
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Kyoungmi Kim
- Department of Public Health Sciences, Division of Biostatistics, University of California, Davis, Davis California,Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, Sacramento, California
| | | | - Ioana Seritan
- University of California, Berkeley, Berkeley, California
| | - Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders (M.I.N.D.) Institute, Sacramento, California,Department of Pediatrics, University of California, Davis Medical Center, Sacramento, California
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Abstract
Fragile X syndrome (FXS) is the first of 3 syndromes identified as a health condition related to fragile X mental retardation (FMR1) gene dysfunction. The other 2 syndromes are fragile X-associated primary ovarian insufficiency syndrome (FXPOI) and fragile X-associated tremor/ataxia syndrome (FXTAS), which together are referred to as fragile X-associated disorders (FXDs). Collectively, this group comprises the 3 faces of fragile X. Even though the 3 conditions share a common genetic defect, each one is a separate health condition that results in a variety of body function impairments such as motor delay, musculoskeletal issues related to low muscle tone, coordination limitations, ataxia, tremor, undefined muscle aches and pains, and, for FXTAS, a late-onset neurodegeneration. Although each FXD condition may benefit from physical therapy intervention, available evidence as to the efficacy of intervention appropriate to FXDs is lacking. This perspective article will discuss the genetic basis of FMR1 gene dysfunction and describe health conditions related to this mutation, which have a range of expressions within a family. Physical therapy concerns and possible assessment and intervention strategies will be introduced. Understanding the intergenerational effect of the FMR1 mutation with potential life-span expression is a key component to identifying and treating the health conditions related to this specific genetic condition.
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Characterization and Early Detection of Balance Deficits in Fragile X Premutation Carriers With and Without Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS). THE CEREBELLUM 2016; 14:650-62. [PMID: 25763861 DOI: 10.1007/s12311-015-0659-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Fragile X-associated tremor/ataxia syndrome (FXTAS) results from a "premutation" size 55-200 CGG repeat expansion in the fragile X mental retardation 1 (FMR1) gene. Core motor features include cerebellar gait ataxia and kinetic tremor, resulting in progressive mobility disability. There are no published studies characterizing balance deficits in FMR1 premutation carriers with and without FXTAS using a battery of quantitative measures to test the sensory integration underlying postural control, automatic postural reflexes, and dynamic postural stability limits. Computerized dynamic posturography (CDP) and two performance-based balance measures were administered in 44 premutation carriers, 21 with FXTAS and 23 without FXTAS, and 42 healthy controls to compare balance and functional mobility between these groups. Relationships between FMR1 molecular variables, age, and sex and CDP scores were explored. FXTAS subjects demonstrated significantly lower scores on the sensory organization test (with greatest reductions in the vestibular control of balance), longer response latencies to balance perturbations, and reduced stability limits compared to controls. Premutation carriers without FXTAS also demonstrated significantly delayed response latencies and disrupted sensory weighting for balance control. Advancing age, male sex, increased CGG repeat size, and reduced X activation of the normal allele in premutation carrier women predicted balance dysfunction. These postural control deficits in carriers with and without FXTAS implicate dysfunctional cerebellar neural networks and may provide valuable outcome markers for tailored rehabilitative interventions. Our findings suggest that CDP may provide sensitive measures for early detection of postural control impairments in at-risk carriers and better characterize balance dysfunction and progression in FXTAS.
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Giulivi C, Napoli E, Tassone F, Halmai J, Hagerman R. Plasma Biomarkers for Monitoring Brain Pathophysiology in FMR1 Premutation Carriers. Front Mol Neurosci 2016; 9:71. [PMID: 27570505 PMCID: PMC4981605 DOI: 10.3389/fnmol.2016.00071] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/29/2016] [Indexed: 12/12/2022] Open
Abstract
Premutation carriers have a 55–200 CGG expansion in the fragile X mental retardation 1 (FMR1) gene. Currently, 1.5 million individuals are affected in the United States, and carriers are at risk of developing the late-onset neurodegenerative disorder Fragile X-associated tremor ataxia syndrome (FXTAS). Limited efforts have been made to develop new methods for improved early patient monitoring, treatment response, and disease progression. To this end, plasma metabolomic phenotyping was obtained for 23 premutation carriers and 16 age- and sex-matched controls. Three biomarkers, phenylethylamine normalized by either aconitate or isocitrate and oleamide normalized by isocitrate, exhibited excellent model performance. The lower phenylethylamine and oleamide plasma levels in carriers may indicate, respectively, incipient nigrostriatal degeneration and higher incidence of substance abuse, anxiety and sleep disturbances. Higher levels of citrate, isocitrate, aconitate, and lactate may reflect deficits in both bioenergetics and neurotransmitter metabolism (Glu, GABA). This study lays important groundwork by defining the potential utility of plasma metabolic profiling to monitor brain pathophysiology in carriers before and during the progression of FXTAS, treatment efficacy and evaluation of side effects.
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Affiliation(s)
- Cecilia Giulivi
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CAUSA; Medical Investigation of Neurodevelopmental Disorders Institute, University of California, Davis, Davis, CAUSA
| | - Eleonora Napoli
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA USA
| | - Flora Tassone
- Medical Investigation of Neurodevelopmental Disorders Institute, University of California, Davis, Davis, CAUSA; Department of Biochemistry and Molecular Medicine, University of California, Davis, Davis, CAUSA
| | - Julian Halmai
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA USA
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders Institute, University of California, Davis, Davis, CAUSA; Department of Pediatrics, University of California Davis Medical Center, Sacramento, CAUSA
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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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Grigsby J, Brega AG, Bennett RE, Bourgeois JA, Seritan AL, Goodrich GK, Hagerman RJ. Clinically significant psychiatric symptoms among male carriers of the fragile X premutation, with and without FXTAS, and the mediating influence of executive functioning. Clin Neuropsychol 2016; 30:944-59. [PMID: 27355103 PMCID: PMC5011752 DOI: 10.1080/13854046.2016.1185100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To clarify the neuropsychiatric phenotype of fragile X-associated tremor/ataxia syndrome (FXTAS), and assess the extent to which it is mediated by the dysexecutive syndrome that is a major feature of the disorder. METHODS We examined the prevalence of clinically meaningful psychiatric symptoms among male carriers of the fragile X premutation, with and without FXTAS, in comparison with men with a normal allele. Measures included the Neuropsychiatric Inventory (NPI), Symptom Checklist-90-R (SCL-90-R), and the Behavioral Dyscontrol Scale, a measure of executive functioning. Between-group differences were evaluated using logistic regression, followed by a mediation analysis with ordinary least squares regression to assess the contribution of dysexecutive syndrome to the observed psychiatric domains. RESULTS Men with FXTAS showed higher rates of clinically significant symptoms overall and in specific domains: somatization, obsessive compulsive, depression, anxiety, psychoticism, agitation/aggression, apathy/indifference, irritability, and nighttime behavior problems. Post hoc analyses suggested that findings of psychoticism among men with FXTAS may be associated with participants' accurate acknowledgment of cognitive and physical dysfunction, rather than reflecting psychosis. Asymptomatic carriers showed no evidence of clinically significant psychiatric symptoms, but when all carriers were compared with men having a normal FMR1 allele, executive function deficits were found to mediate scores in several domains on both NPI and SCL-90-R. CONCLUSIONS Building on prior research, the results provide evidence that the psychiatric phenotype for men includes clinically meaningful depression, hostility, and irritability, in association with behavioral and attentional disinhibition. It is likely that these problems reflect the effects of impaired executive functioning.
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Affiliation(s)
- Jim Grigsby
- a Department of Psychology , University of Colorado Denver , Denver , CO , USA
- b Department of Medicine , University of Colorado Denver , Aurora , CO , USA
| | - Angela G Brega
- c Department of Community and Behavioral Health , Colorado School of Public Health, University of Colorado Denver , Aurora , CO , USA
| | - Rachael E Bennett
- b Department of Medicine , University of Colorado Denver , Aurora , CO , USA
| | - James A Bourgeois
- d Department of Psychiatry , University of California , San Francisco , CA , USA
- e Langley Porter Psychiatric Institute , University of California , San Francisco , CA , USA
| | - Andreea L Seritan
- d Department of Psychiatry , University of California , San Francisco , CA , USA
| | - Glenn K Goodrich
- f Kaiser Permanente Institute for Health Research , Denver , CO , USA
| | - Randi J Hagerman
- g M.I.N.D. Institute , University of California, Davis , Sacramento , CA , USA
- h Department of Pediatrics , University of California, Davis, Medical Center , Sacramento , CA , USA
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Bourgeois JA. Neuropsychiatry of fragile X-premutation carriers with and without fragile X-associated tremor-ataxia syndrome: implications for neuropsychology. Clin Neuropsychol 2016; 30:913-28. [PMID: 27355575 DOI: 10.1080/13854046.2016.1192134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Clinical neuropsychologists benefit from clinical currency in recently ascertained neuropsychiatric illness, such as fragile X premutation (FXPM) disorders. The author reviewed the clinical literature through 2016 for neuropsychiatric phenotypes in FXPM disorders, including patients with fragile X-associated tremor/ataxia syndrome (FXTAS). METHODS A PubMed search using the search terms 'Fragile X,' 'Premutation,' 'Carriers,' 'Psychiatric,' 'Dementia,' 'Mood,' and 'Anxiety' for citations in the clinical literature through 2016 was reviewed for studies specifically examining the neuropsychiatric phenotype in FXPM patients. The relevant articles were classified according to specific neuropsychiatric syndromes, including child onset, adult onset with and without FXTAS, as well as common systemic comorbidities in FXPM patients. RESULTS Eighty-six articles were reviewed for the neuropsychiatric and other phenotypes in FXPM patients. The neuropsychiatric phenotype in FXPM patients is distinct from that of full mutation (Fragile X Syndrome) patients. FXTAS is associated with a specific cortical-subcortical major or mild neurocognitive disorder (NCD). CONCLUSIONS FXPM patients are at risk for neuropsychiatric illness. In addition, FXPM patients are at risk for other systemic conditions that should raise suspicion for FXPM-associated illnesses. Clinicians should consider a diagnosis of FXPM-associated neuropsychiatric illness when patients with specific clinical scenarios are encountered; especially in patient pedigrees consistent with a typical (often multigenerational) presentation of fragile X-associated conditions, confirmatory genetic testing should be considered. Clinical management should take into account the psychological challenges of a multigenerational genetic neuropsychiatric illness with a variable CNS and systemic clinical phenotype.
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Affiliation(s)
- James A Bourgeois
- a Department of Psychiatry , University of California San Francisco School of Medicine , San Francisco , CA , USA
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Song G, Napoli E, Wong S, Hagerman R, Liu S, Tassone F, Giulivi C. Altered redox mitochondrial biology in the neurodegenerative disorder fragile X-tremor/ataxia syndrome: use of antioxidants in precision medicine. Mol Med 2016; 22:548-559. [PMID: 27385396 DOI: 10.2119/molmed.2016.00122] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 06/23/2016] [Indexed: 11/06/2022] Open
Abstract
A 55-200 expansion of the CGG nucleotide repeat in the 5'-UTR of the fragile X mental retardation 1 gene (FMR1) is the hallmark of the triplet nucleotide disease known as the "premutation" as opposed to those with >200 repeats, known as the full mutation or fragile X syndrome. Originally, premutation carriers were thought to be free of phenotypic traits; however, some are diagnosed with emotional and neurocognitive issues and, later in life, with the neurodegenerative disease fragile X-associated tremor/ataxia syndrome (FXTAS). Considering that mitochondrial dysfunction has been observed in fibroblasts and post-mortem brain samples from carriers of the premutation, we hypothesized that mitochondrial dysfunction-derived ROS may result in cumulative oxidative-nitrative damage. Fibroblasts from premutation carriers (n=31, all FXTAS-free except 8), compared to age- and sex-matched controls (n=25), showed increased mitochondrial ROS production, impaired Complex I activity, lower expression of MIA40 (rate-limiting step of the redox-regulated mitochondrial-disulfide-relay-system), increased mtDNA deletions, and increased biomarkers of lipid and protein oxidative-nitrative damage. Most of the outcomes were more pronounced in FXTAS-affected individuals. Significant recovery of mitochondrial mass and/or function was obtained with superoxide or hydroxyl radicals' scavengers, a glutathione peroxidase analog, or by overexpressing MIA40. The effects of ethanol (a hydroxyl radical scavenger) were deleterious, while others (by N-acetyl-cysteine, quercetin and epigallocatechin-3-gallate) were outcome- and/or carrier-specifics. The use of antioxidants in the context of precision medicine is discussed with the goal of improving mitochondrial function in carriers with the potential of decreasing the morbidity and/or delaying FXTAS onset.
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Affiliation(s)
- Gyu Song
- Department of Molecular Biosciences, School of Veterinary Medicine, Davis, CA 95616
| | - Eleonora Napoli
- Department of Molecular Biosciences, School of Veterinary Medicine, Davis, CA 95616
| | - Sarah Wong
- Department of Molecular Biosciences, School of Veterinary Medicine, Davis, CA 95616
| | - Randi Hagerman
- Medical Investigations of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, CA 95817.,Department of Pediatrics, University of California Davis Medical Center, Sacramento CA 95817
| | - Siming Liu
- Department of Molecular Biosciences, School of Veterinary Medicine, Davis, CA 95616
| | - Flora Tassone
- Medical Investigations of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, CA 95817.,Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, CA 95817
| | - Cecilia Giulivi
- Department of Molecular Biosciences, School of Veterinary Medicine, Davis, CA 95616.,Medical Investigations of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, CA 95817
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Abstract
OBJECTIVE Fragile X tremor ataxia syndrome (FXTAS) is an inherited neurodegenerative disease in which dementia is common and disabling. The pathogenesis of dementia in FXTAS is poorly understood, but the salience of executive dysfunction and slowed processing speed, the frequent presence of the middle cerebellar peduncle sign on magnetic resonance imaging (MRI), and striking neuropathological alterations of white matter all suggest that myelinated tracts are significantly involved. This paper considers the role of white matter disease in FXTAS dementia, particularly with regard to the concept of white matter dementia (WMD). METHOD A focused review of FXTAS in relation to known white matter disorders is provided to propose that the concept of WMD may illuminate the basis of dementia in FXTAS. The putative pathogenetic contribution of white matter involvement in other neurodegenerative diseases is also considered. RESULTS Considerable evidence supports the importance of white matter disease in the pathogenesis of dementia in FXTAS. Whereas, gray matter regions are also involved, white matter degeneration is prominent, even early in the disease, and correlates with executive dysfunction and slowed processing speed. Evidence for white matter involvement in other neurodegenerative diseases lends additional support to the relevance of white matter in FXTAS. CONCLUSION The dementia of FXTAS is closely related to the profile of WMD, and white matter involvement is also supported by MRI and neuropathological observations. White matter pathology is also relevant to the pathogenesis of other neurodegenerative diseases. Further study of white matter promises to clarify the origin of dementia in FXTAS.
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Affiliation(s)
- Christopher M Filley
- a Departments of Neurology and Psychiatry, Denver Veterans Affairs Medical Center , University of Colorado School of Medicine , Aurora , CO , USA
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42
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Abstract
OBJECTIVE Fragile X syndrome (FXS) is the most common inherited form of intellectual disability. The objective of this study was to determine the relative importance that caregivers place on improving different phenotypic traits observed in males with FXS to better understand the greatest medical needs for developing and evaluating FXS treatments. METHOD Fragile X syndrome caregivers (n = 614) compared hypothetical treatments in a discrete-choice experiment. The treatments varied in their effects on 6 outcomes associated with FXS: learning and applying new skills, explaining needs, controlling behavior, taking part in new social activities, caring for oneself, and paying attention. The relative importance was calculated for improving severe or moderate levels of disability and transformed to a 10-point scale. Relative importance was also quantified by patient age group (child, adolescent, and adult). RESULTS Most important to caregivers were controlling behavior (10.0) and caring for oneself (9.9). Least important was taking part in new social activities (4.2). A partial improvement in controlling behavior or self-care was more important than full resolution of the least important disabilities. This was consistent across age groups. Improvements from severe to moderate disability were more important than from moderate to no disability. CONCLUSION Caregivers expressed strong preferences for improvement in self-care and behavioral control, independent of the age of the individual with FXS. These data may be helpful when designing studies to test the efficacy of FXS treatments because small treatment effects on very important outcomes may be valued more than large treatment effects on less valued outcomes.
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Filley CM. White matter disease and cognitive impairment in FMR1 premutation carriers. Neurology 2015; 20:158-73. [PMID: 20352350 DOI: 10.1007/s11065-010-9127-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Accepted: 03/16/2010] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This cross-sectional, observational study examined the role of white matter involvement in the cognitive impairment of individuals with the fragile X mental retardation 1 (FMR1) premutation. METHODS Eight asymptomatic premutation carriers, 5 participants with fragile X tremor/ataxia syndrome (FXTAS), and 7 noncarrier controls were studied. The mean age of the asymptomatic premutation carriers, participants with FXTAS, and noncarrier controls was 60, 71, and 67 years, respectively. Magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) were used to examine the middle cerebellar peduncles (MCP) and the genu and splenium of the corpus callosum in relation to executive function and processing speed. MRS measures were N-acetyl aspartate/creatine (NAA/Cr) and choline/creatine, and fractional anisotropy (FA) was used for DTI. Executive function was assessed with the Behavioral Dyscontrol Scale and the Controlled Oral Word Association Test (COWAT), and processing speed with the Symbol Digit Modalities Test. RESULTS Among all 13 FMR1 premutation carriers, significant correlations were found between N-acetyl aspartate/creatine and choline/creatine in the MCP and COWAT scores, and between FA in the genu and performance on the Behavioral Dyscontrol Scale, COWAT, and Symbol Digit Modalities Test; a correlation was also found between FA in the splenium and COWAT performance. In all regions studied, participants with FXTAS had the lowest mean FA. CONCLUSION Microstructural white matter disease as determined by MRS and DTI correlated with executive dysfunction and slowed processing speed in these FMR1 premutation carriers. Neuroimaging abnormalities in the genu and MCP suggest that disruption of white matter within frontocerebellar networks has an important role in the cognitive impairment associated with the FMR1 premutation.
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Affiliation(s)
- Christopher M Filley
- Behavioral Neurology Section, University of Colorado Denver School of Medicine, Denver, CO, USA.
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Filley CM, Brown MS, Onderko K, Ray M, Bennett RE, Berry-Kravis E, Grigsby J. White matter disease and cognitive impairment in FMR1 premutation carriers. Neurology 2015; 84:2146-52. [PMID: 25925982 DOI: 10.1212/wnl.0000000000001612] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 02/13/2015] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE This cross-sectional, observational study examined the role of white matter involvement in the cognitive impairment of individuals with the fragile X mental retardation 1 (FMR1) premutation. METHODS Eight asymptomatic premutation carriers, 5 participants with fragile X tremor/ataxia syndrome (FXTAS), and 7 noncarrier controls were studied. The mean age of the asymptomatic premutation carriers, participants with FXTAS, and noncarrier controls was 60, 71, and 67 years, respectively. Magnetic resonance spectroscopy (MRS) and diffusion tensor imaging (DTI) were used to examine the middle cerebellar peduncles (MCP) and the genu and splenium of the corpus callosum in relation to executive function and processing speed. MRS measures were N-acetyl aspartate/creatine (NAA/Cr) and choline/creatine, and fractional anisotropy (FA) was used for DTI. Executive function was assessed with the Behavioral Dyscontrol Scale and the Controlled Oral Word Association Test (COWAT), and processing speed with the Symbol Digit Modalities Test. RESULTS Among all 13 FMR1 premutation carriers, significant correlations were found between N-acetyl aspartate/creatine and choline/creatine in the MCP and COWAT scores, and between FA in the genu and performance on the Behavioral Dyscontrol Scale, COWAT, and Symbol Digit Modalities Test; a correlation was also found between FA in the splenium and COWAT performance. In all regions studied, participants with FXTAS had the lowest mean FA. CONCLUSION Microstructural white matter disease as determined by MRS and DTI correlated with executive dysfunction and slowed processing speed in these FMR1 premutation carriers. Neuroimaging abnormalities in the genu and MCP suggest that disruption of white matter within frontocerebellar networks has an important role in the cognitive impairment associated with the FMR1 premutation.
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Affiliation(s)
- Christopher M Filley
- From the Departments of Neurology (C.M.F.), Psychiatry (C.M.F.), Radiology (M.S.B.), and Medicine (R.E.B., J.G.), University of Colorado School of Medicine; Department of Psychology (K.O., M.R., J.G.), University of Colorado Denver; Denver Veterans Affairs Medical Center (C.M.F.), CO; and Departments of Neurological Sciences (E.B.-K.), Pediatrics (E.B.-K.), and Biochemistry (E.B.-K.), Rush University Medical Center, Chicago, IL.
| | - Mark S Brown
- From the Departments of Neurology (C.M.F.), Psychiatry (C.M.F.), Radiology (M.S.B.), and Medicine (R.E.B., J.G.), University of Colorado School of Medicine; Department of Psychology (K.O., M.R., J.G.), University of Colorado Denver; Denver Veterans Affairs Medical Center (C.M.F.), CO; and Departments of Neurological Sciences (E.B.-K.), Pediatrics (E.B.-K.), and Biochemistry (E.B.-K.), Rush University Medical Center, Chicago, IL
| | - Karen Onderko
- From the Departments of Neurology (C.M.F.), Psychiatry (C.M.F.), Radiology (M.S.B.), and Medicine (R.E.B., J.G.), University of Colorado School of Medicine; Department of Psychology (K.O., M.R., J.G.), University of Colorado Denver; Denver Veterans Affairs Medical Center (C.M.F.), CO; and Departments of Neurological Sciences (E.B.-K.), Pediatrics (E.B.-K.), and Biochemistry (E.B.-K.), Rush University Medical Center, Chicago, IL
| | - Megan Ray
- From the Departments of Neurology (C.M.F.), Psychiatry (C.M.F.), Radiology (M.S.B.), and Medicine (R.E.B., J.G.), University of Colorado School of Medicine; Department of Psychology (K.O., M.R., J.G.), University of Colorado Denver; Denver Veterans Affairs Medical Center (C.M.F.), CO; and Departments of Neurological Sciences (E.B.-K.), Pediatrics (E.B.-K.), and Biochemistry (E.B.-K.), Rush University Medical Center, Chicago, IL
| | - Rachael E Bennett
- From the Departments of Neurology (C.M.F.), Psychiatry (C.M.F.), Radiology (M.S.B.), and Medicine (R.E.B., J.G.), University of Colorado School of Medicine; Department of Psychology (K.O., M.R., J.G.), University of Colorado Denver; Denver Veterans Affairs Medical Center (C.M.F.), CO; and Departments of Neurological Sciences (E.B.-K.), Pediatrics (E.B.-K.), and Biochemistry (E.B.-K.), Rush University Medical Center, Chicago, IL
| | - Elizabeth Berry-Kravis
- From the Departments of Neurology (C.M.F.), Psychiatry (C.M.F.), Radiology (M.S.B.), and Medicine (R.E.B., J.G.), University of Colorado School of Medicine; Department of Psychology (K.O., M.R., J.G.), University of Colorado Denver; Denver Veterans Affairs Medical Center (C.M.F.), CO; and Departments of Neurological Sciences (E.B.-K.), Pediatrics (E.B.-K.), and Biochemistry (E.B.-K.), Rush University Medical Center, Chicago, IL
| | - Jim Grigsby
- From the Departments of Neurology (C.M.F.), Psychiatry (C.M.F.), Radiology (M.S.B.), and Medicine (R.E.B., J.G.), University of Colorado School of Medicine; Department of Psychology (K.O., M.R., J.G.), University of Colorado Denver; Denver Veterans Affairs Medical Center (C.M.F.), CO; and Departments of Neurological Sciences (E.B.-K.), Pediatrics (E.B.-K.), and Biochemistry (E.B.-K.), Rush University Medical Center, Chicago, IL
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Birch RC, Hocking DR, Cornish KM, Menant JC, Georgiou-Karistianis N, Godler DE, Wen W, Hackett A, Rogers C, Trollor JN. Preliminary evidence of an effect of cerebellar volume on postural sway in FMR1 premutation males. GENES BRAIN AND BEHAVIOR 2015; 14:251-9. [PMID: 25689687 DOI: 10.1111/gbb.12204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/27/2015] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
Recent evidence suggests that early changes in postural control may be discernible among females with premutation expansions (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene at risk of developing fragile X-associated tremor ataxia syndrome (FXTAS). Cerebellar dysfunction is well described in males and females with FXTAS, yet the interrelationships between cerebellar volume, CGG repeat length, FMR1 messenger RNA (mRNA) levels and changes in postural control remain unknown. This study examined postural sway during standing in a cohort of 22 males with the FMR1 premutation (ages 26-80) and 24 matched controls (ages 26-77). The influence of cerebellar volume, CGG repeat length and FMR1 mRNA levels on postural sway was explored using multiple linear regression. The results provide preliminary evidence that increasing CGG repeat length and decreasing cerebellar volume were associated with greater postural sway among premutation males. The relationship between CGG repeat length and postural sway was mediated by a negative association between CGG repeat size and cerebellar volume. While FMR1 mRNA levels were significantly elevated in the premutation group and correlated with CGG repeat length, FMR1 mRNA levels were not significantly associated with postural sway scores. These findings show for the first time that greater postural sway among males with the FMR1 premutation may reflect CGG repeat-mediated disruption in vulnerable cerebellar circuits implicated in postural control. However, longitudinal studies in larger samples are required to confirm whether the relationships between cerebellar volume, CGG repeat length and postural sway indicate greater risk for neurological decline.
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Affiliation(s)
- R C Birch
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney
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46
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Wong LM, Tassone F, Rivera SM, Simon TJ. Temporal dynamics of attentional selection in adult male carriers of the fragile X premutation allele and adult controls. Front Hum Neurosci 2015; 9:37. [PMID: 25698960 PMCID: PMC4318336 DOI: 10.3389/fnhum.2015.00037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/14/2015] [Indexed: 11/13/2022] Open
Abstract
Carriers of the fragile X premutation allele (fXPCs) have an expanded CGG trinucleotide repeat size within the FMR1 gene and are at increased risk of developing fragile x-associated tremor/ataxia syndrome (FXTAS). Previous research has shown that male fXPCs with FXTAS exhibit cognitive decline, predominantly in executive functions such as inhibitory control and working memory. Recent evidence suggests fXPCs may also exhibit impairments in processing temporal information. The attentional blink (AB) task is often used to examine the dynamics of attentional selection, but disagreements exist as to whether the AB is due to excessive or insufficient attentional control. In this study, we used a variant of the AB task and neuropsychological testing to explore the dynamics of attentional selection, relate AB performance to attentional control, and determine whether fXPCs exhibited temporal and/or attentional control impairments. Participants were adult male fXPCs, aged 18–48 years and asymptomatic for FXTAS (n = 19) and age-matched male controls (n = 20). We found that fXPCs did not differ from controls in the AB task, indicating that the temporal dynamics of attentional selection were intact. However, they were impaired in the letter-number sequencing task, a test of executive working memory. In the combined fXPC and control group, letter-number sequencing performance correlated positively with AB magnitude. This finding supports models that posit the AB is due to excess attentional control. In our two-pronged analysis approach, in control participants we replicated a previously observed effect and demonstrated that it persists under more stringent theoretical constraints, and we enhance our understanding of fXPCs by demonstrating that at least some aspects of temporal processing may be spared.
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Affiliation(s)
- Ling M Wong
- MIND Institute, University of California Davis School of Medicine Sacramento, CA, USA ; Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine Sacramento, CA, USA
| | - Flora Tassone
- MIND Institute, University of California Davis School of Medicine Sacramento, CA, USA ; Department of Biochemistry and Molecular Medicine, University of California Davis School of Medicine Sacramento, CA, USA
| | - Susan M Rivera
- MIND Institute, University of California Davis School of Medicine Sacramento, CA, USA ; Department of Psychology, University of California Davis Davis, CA, USA ; Center for Mind and Brain, University of California Davis Davis, CA, USA
| | - Tony J Simon
- MIND Institute, University of California Davis School of Medicine Sacramento, CA, USA ; Department of Psychiatry and Behavioral Sciences, University of California Davis School of Medicine Sacramento, CA, USA
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Jalnapurkar I, Rafika N, Tassone F, Hagerman R. Immune mediated disorders in women with a fragile X expansion and FXTAS. Am J Med Genet A 2014; 167A:190-7. [PMID: 25399540 DOI: 10.1002/ajmg.a.36748] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/06/2014] [Indexed: 12/17/2022]
Abstract
Premutation alleles in fragile X mental retardation 1 (FMR1) can cause the late-onset neurodegenerative disorder, fragile X-associated tremor ataxia syndrome (FXTAS) and/or the fragile X-associated primary ovarian insufficiency in approximately 20% of heterozygotes. Heterozygotes of the FMR1 premutation have a higher incidence of immune mediated disorders such as autoimmune thyroid disorder, especially when accompanied by FXTAS motor signs. We describe the time course of symptoms of immune mediated disorders and the subsequent development of FXTAS in four women with an FMR1 CGG expansion, including three with the premutation and one with a gray zone expansion. These patients developed an immune mediated disorder followed by neurological symptoms that become consistent with FXTAS. In all patients we observed a pattern involving an initial appearance of disease symptoms-often after a period of heightened stress (depression, anxiety, divorce, general surgery) followed by the onset of tremor and/or ataxia. Immune mediated diseases are associated with the manifestations of FXTAS temporally, although further studies are needed to clarify this association. If a cause and effect relationship can be established, treatment of pre-existing immune mediated disorders may benefit patients with pathogenic FMR1 mutations.
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Affiliation(s)
- Isha Jalnapurkar
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, California
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48
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Memantine effects on verbal memory in fragile X-associated tremor/ataxia syndrome (FXTAS): a double-blind brain potential study. Neuropsychopharmacology 2014; 39:2760-8. [PMID: 24871547 PMCID: PMC4200486 DOI: 10.1038/npp.2014.122] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/29/2014] [Accepted: 05/08/2014] [Indexed: 12/19/2022]
Abstract
Older FMR1 premutation carriers may develop fragile X-associated tremor/ataxia syndrome (FXTAS), a neurodegenerative disorder manifesting cognitive deficits that often subsequently progress to dementia. To date, there is no specific treatment available for FXTAS. Studies have demonstrated the premutation-associated overactivation of glutamatergic receptors in neurons. Memantine, a NMDA receptor antagonist approved for treatment of Alzheimer's disease, thus was tested in the first placebo-controlled, double-blind, randomized clinical trial in FXTAS. Prior event-related brain potential (ERP) studies in FXTAS found reduced N400 repetition effect, a glutamate-related electrophysiological marker of semantic priming, and verbal memory processes. This substudy of the randomized clinical trial of memantine in FXTAS sought to use the N400 repetition effect to evaluate effects of chronic memantine treatment on verbal memory. Subsequent recall and recognition memory tests for the experimental stimuli were administered to characterize verbal memory. Data from 41 patients who completed the 1-year memantine trial (21 on memantine) and also completed longitudinal ERP studies were analyzed. Results showed treatment-associated benefits on both cued-recall memory and N400 repetition effect amplitude. Importantly, improvement in cued recall was positively correlated with amplitude increase of the N400 repetition effect. The placebo group, in contrast, displayed a significant reduction of the N400 repetition effect after 1 year. These results suggest that memantine treatment may have beneficial effects on verbal memory in FXTAS. Additional studies of memantine, perhaps in combination with other therapeutic agents, appear warranted, as symptomatic treatments and neuroprotective treatments are both needed for this recently recognized neurodegenerative disorder.
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Muzar Z, Adams PE, Schneider A, Hagerman RJ, Lozano R. Addictive substances may induce a rapid neurological deterioration in fragile X-associated tremor ataxia syndrome: A report of two cases. Intractable Rare Dis Res 2014; 3:162-5. [PMID: 25606366 PMCID: PMC4298646 DOI: 10.5582/irdr.2014.01023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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
A debilitating late-onset disorder of the premutation in the FMR1 gene is the neurodegenerative disorder fragile X-associated tremor ataxia syndrome (FXTAS). We report two patients with FXTAS who have a history of substance abuse (opiates, alcohol, and cocaine) which may have exacerbated their rapid neurological deterioration with FXTAS. There has been no case report regarding the role of substance abuse in onset, progression, and severity of FXTAS symptoms. However, research has shown that substance abuse can have a negative impact on several neurodegenerative diseases, and we propose that in these cases, substance abuse contributed to a faster progression of FXTAS as well as exacerbated white matter disease.
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Affiliation(s)
- Zukhrofi Muzar
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, Sacramento, CA, USA
| | - Patrick E. Adams
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
| | - Andrea Schneider
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
| | - Randi J. Hagerman
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
- Address correspondence to: Dr. Randi J. Hagerman, MIND Institute, UC Davis Health System, 2825 50th Street, Sacramento, CA 95817, USA. E-mail:
| | - Reymundo Lozano
- Medical Investigation of Neurodevelopmental Disorders MIND Institute, Sacramento, CA, USA
- Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA
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50
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Pretto DI, Eid JS, Yrigollen CM, Tang HT, Loomis EW, Raske C, Durbin-Johnson B, Hagerman PJ, Tassone F. Differential increases of specific FMR1 mRNA isoforms in premutation carriers. J Med Genet 2014; 52:42-52. [PMID: 25358671 DOI: 10.1136/jmedgenet-2014-102593] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Over 40% of male and ∼16% of female carriers of a premutation FMR1 allele (55-200 CGG repeats) will develop fragile X-associated tremor/ataxia syndrome, an adult onset neurodegenerative disorder, while about 20% of female carriers will develop fragile X-associated primary ovarian insufficiency. Marked elevation in FMR1 mRNA transcript levels has been observed with premutation alleles, and RNA toxicity due to increased mRNA levels is the leading molecular mechanism proposed for these disorders. However, although the FMR1 gene undergoes alternative splicing, it is unknown whether all or only some of the isoforms are overexpressed in premutation carriers and which isoforms may contribute to the premutation pathology. METHODS To address this question, we have applied a long-read sequencing approach using single-molecule real-time (SMRT) sequencing and qRT-PCR. RESULTS Our SMRT sequencing analysis performed on peripheral blood mononuclear cells, fibroblasts and brain tissue samples derived from premutation carriers and controls revealed the existence of 16 isoforms of 24 predicted variants. Although the relative abundance of all mRNA isoforms was significantly increased in the premutation group, as expected based on the bulk increase in mRNA levels, there was a disproportionate (fourfold to sixfold) increase, relative to the overall increase in mRNA, in the abundance of isoforms spliced at both exons 12 and 14, specifically Iso10 and Iso10b, containing the complete exon 15 and differing only in splicing in exon 17. CONCLUSIONS These findings suggest that RNA toxicity may arise from a relative increase of all FMR1 mRNA isoforms. Interestingly, the Iso10 and Iso10b mRNA isoforms, lacking the C-terminal functional sites for fragile X mental retardation protein function, are the most increased in premutation carriers relative to normal, suggesting a functional relevance in the pathology of FMR1-associated disorders.
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Affiliation(s)
- Dalyir I Pretto
- Department of Biochemistry and Molecular Medicine, University of California, School of Medicine, Davis, California, USA
| | - John S Eid
- Pacific Biosciences, Menlo Park, California, USA
| | - Carolyn M Yrigollen
- Department of Biochemistry and Molecular Medicine, University of California, School of Medicine, Davis, California, USA
| | - Hiu-Tung Tang
- Department of Biochemistry and Molecular Medicine, University of California, School of Medicine, Davis, California, USA
| | - Erick W Loomis
- Department of Biochemistry and Molecular Medicine, University of California, School of Medicine, Davis, California, USA
| | - Chris Raske
- Department of Biochemistry and Molecular Medicine, University of California, School of Medicine, Davis, California, USA
| | - Blythe Durbin-Johnson
- Department of Public Health Sciences, University of California Davis, School of Medicine, Davis, California, USA
| | - Paul J Hagerman
- Department of Biochemistry and Molecular Medicine, University of California, School of Medicine, Davis, California, USA MIND Institute, University of California Davis Medical Center, Sacramento, California, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California, School of Medicine, Davis, California, USA MIND Institute, University of California Davis Medical Center, Sacramento, California, USA
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