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Sriretnakumar V, Harripaul R, Kennedy JL, So J. When rare meets common: Treatable genetic diseases are enriched in the general psychiatric population. Am J Med Genet A 2024; 194:e63609. [PMID: 38532509 DOI: 10.1002/ajmg.a.63609] [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: 11/02/2023] [Revised: 03/06/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024]
Abstract
Mental illnesses are one of the biggest contributors to the global disease burden. Despite the increased recognition, diagnosis and ongoing research of mental health disorders, the etiology and underlying molecular mechanisms of these disorders are yet to be fully elucidated. Moreover, despite many treatment options available, a large subset of the psychiatric patient population is nonresponsive to standard medications and therapies. There has not been a comprehensive study to date examining the burden and impact of treatable genetic disorders (TGDs) that can present with neuropsychiatric features in psychiatric patient populations. In this study, we test the hypothesis that TGDs that present with psychiatric symptoms are more prevalent within psychiatric patient populations compared to the general population by performing targeted next-generation sequencing of 129 genes associated with 108 TGDs in a cohort of 2301 psychiatric patients. In total, 48 putative affected and 180 putative carriers for TGDs were identified, with known or likely pathogenic variants in 79 genes. Despite screening for only 108 genetic disorders, this study showed a two-fold (2.09%) enrichment for genetic disorders within the psychiatric population relative to the estimated 1% cumulative prevalence of all single gene disorders globally. This strongly suggests that the prevalence of these, and most likely all, genetic diseases is greatly underestimated in psychiatric populations. Increasing awareness and ensuring accurate diagnosis of TGDs will open new avenues to targeted treatment for a subset of psychiatric patients.
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Affiliation(s)
- Venuja Sriretnakumar
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Ricardo Harripaul
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - James L Kennedy
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Joyce So
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Medical Genetics, Departments of Medicine and Pediatrics, University of California, San Francisco, California, USA
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Torres EB, Twerski G, Varkey H, Rai R, Elsayed M, Katz MT, Tarlowe J. The time is ripe for the renaissance of autism treatments: evidence from clinical practitioners. Front Integr Neurosci 2023; 17:1229110. [PMID: 37600235 PMCID: PMC10437220 DOI: 10.3389/fnint.2023.1229110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Recent changes in diagnostics criteria have contributed to the broadening of the autism spectrum disorders and left clinicians ill-equipped to treat the highly heterogeneous spectrum that now includes toddlers and children with sensory and motor issues. Methods To uncover the clinicians' critical needs in the autism space, we conducted surveys designed collaboratively with the clinicians themselves. Board Certified Behavioral Analysts (BCBAs) and developmental model (DM) clinicians obtained permission from their accrediting boards and designed surveys to assess needs and preferences in their corresponding fields. Results 92.6% of BCBAs are open to diversified treatment combining aspects of multiple disciplines; 82.7% of DMs also favor this diversification with 21.8% valuing BCBA-input and 40.6% neurologists-input; 85.9% of BCBAs and 85.3% of DMs advocate the use of wearables to objectively track nuanced behaviors in social exchange; 76.9% of BCBAs and 57.0% DMs feel they would benefit from augmenting their knowledge about the nervous systems of Autism (neuroscience research) to enhance treatment and planning programs; 50.0% of BCBAs feel they can benefit for more training to teach parents. Discussion Two complementary philosophies are converging to a more collaborative, integrative approach favoring scalable digital technologies and neuroscience. Autism practitioners seem ready to embrace the Digital-Neuroscience Revolutions under a new cooperative model.
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Affiliation(s)
- Elizabeth B. Torres
- Sensory Motor Integration Laboratory, Department of Psychology, Rutgers the State University of New Jersey, Piscataway, NJ, United States
- Rutgers Center for Cognitive Science, Rutgers the State University of New Jersey, Piscataway, NJ, United States
- Department of Computer Science, Rutgers Center for Biomedicine Imaging and Modeling, Rutgers the State University of New Jersey, Piscataway, NJ, United States
| | | | - Hannah Varkey
- Sensory Motor Integration Laboratory, Department of Psychology, Rutgers the State University of New Jersey, Piscataway, NJ, United States
| | - Richa Rai
- Sensory Motor Integration Laboratory, Department of Psychology, Rutgers the State University of New Jersey, Piscataway, NJ, United States
| | - Mona Elsayed
- Sensory Motor Integration Laboratory, Department of Psychology, Rutgers the State University of New Jersey, Piscataway, NJ, United States
| | - Miriam Tirtza Katz
- MTK Therapy, Yahalom NJ, Family Advocacy and Support, Agudas Yisroel of America, Lakewood, NJ, United States
| | - Jillian Tarlowe
- Sensory Motor Integration Laboratory, Department of Psychology, Rutgers the State University of New Jersey, Piscataway, NJ, United States
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Chubick A, Wang E, Au C, Grody WW, Ophoff RA. Large-Scale Whole Genome Sequence Analysis of >22,000 Subjects Provides no Evidence of FMR1 Premutation Allele Involvement in Autism Spectrum Disorder. Genes (Basel) 2023; 14:1518. [PMID: 37628570 PMCID: PMC10454383 DOI: 10.3390/genes14081518] [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: 05/26/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Expansion of a CGG repeat in the Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene on the X chromosome is the cause of Fragile X Syndrome (FXS). The repeat length of unaffected individuals varies between 5-40 repeats, whereas >200 repeats are observed in cases of FXS. The intermediate range between 55-200 repeats is considered the premutation range and is observed in roughly 1:300 females and 1:900 males in the general population. With the availability of large-scale whole genome sequence (WGS) data and the development of computational tools to detect repeat expansions, we systematically examined the role of FMR1 premutation alleles in autism spectrum disorder (ASD) susceptibility, assess the prevalence, and consider the allelic stability between parents and offspring. We analyzed the WGS data of 22,053 subjects, including 32 FXS positive controls, 1359 population controls, and 5467 ASD families. We observed no FMR1 full mutation range repeats among the ASD parent-offspring families but identified 180 family members with premutation range alleles, which represents a higher prevalence compared to the independent WGS control sample and previous reports in the literature. A sex-specific analysis between probands and unaffected siblings did not reveal a significant increase in the burden of premutation alleles in either males or females with ASD. PCR validation, however, suggests an overestimation of the frequency of FMR1 premutation range alleles through computational analysis of WGS data. Overall, we show the utility of large-scale repeat expansion screening in WGS data and conclude that there is no apparent evidence of FMR1 premutation alleles contributing to ASD susceptibility.
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Affiliation(s)
- Alex Chubick
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA 90095, USA (W.W.G.)
| | - Evan Wang
- Center for Neurobehavioral Genetics, Jane and Terry Semel Institute for Neuroscience and Human Behavior Los Angeles, University of California Los Angeles, Los Angeles, CA 90024, USA;
| | - Cora Au
- Department of Pathology & Laboratory Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA;
| | - Wayne W. Grody
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA 90095, USA (W.W.G.)
- Department of Pathology & Laboratory Medicine, University of California Los Angeles, Los Angeles, CA 90024, USA;
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA 90024, USA
| | - Roel A. Ophoff
- Department of Human Genetics, University of California Los Angeles, Los Angeles, CA 90095, USA (W.W.G.)
- Center for Neurobehavioral Genetics, Jane and Terry Semel Institute for Neuroscience and Human Behavior Los Angeles, University of California Los Angeles, Los Angeles, CA 90024, USA;
- Department of Psychiatry, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
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Sodhi DK, Hagerman R. Fragile X Premutation: Medications, Therapy and Lifestyle Advice. Pharmgenomics Pers Med 2022; 14:1689-1699. [PMID: 35002287 PMCID: PMC8721286 DOI: 10.2147/pgpm.s338846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/26/2021] [Indexed: 12/17/2022] Open
Abstract
The fragile X premutation is characterized by 55–200 CGG repeats in the 5ʹ untranslated region of FMR1, whereas full fragile X mutation has greater than 200 repeats and full methylation, which manifests as fragile X syndrome (FXS). The premutation spectrum of clinical involvement includes fragile X-associated tremor/ataxia syndrome (FXTAS), fragile X-associated primary ovarian insufficiency (FXPOI), and fragile X-associated neuropsychiatric disorders (FXAND). In addition, premutation carriers also suffer from various other health problems such as endocrine abnormalities and autoimmune problems. In this paper, we have discussed different health issues faced by the carriers and interventions including medications, therapy and lifestyle changes that could improve their health.
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Affiliation(s)
- Deepika Kour Sodhi
- The MIND Institute, University of California Davis Health, Sacramento, CA, USA
| | - Randi Hagerman
- The MIND Institute, University of California Davis Health, Sacramento, CA, USA.,Department of Pediatrics, University of California Davis Health, Sacramento, CA, USA
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Schmitt LM, Dominick KC, Liu R, Pedapati EV, Ethridge LE, Smith E, Sweeney JA, Erickson CA. Evidence for Three Subgroups of Female FMR1 Premutation Carriers Defined by Distinct Neuropsychiatric Features: A Pilot Study. Front Integr Neurosci 2022; 15:797546. [PMID: 35046780 PMCID: PMC8763356 DOI: 10.3389/fnint.2021.797546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/02/2021] [Indexed: 01/06/2023] Open
Abstract
Over 200 Cytosine-guanine-guanine (CGG) trinucleotide repeats in the 5' untranslated region of the Fragile X mental retardation 1 (FMR1) gene results in a "full mutation," clinically Fragile X Syndrome (FXS), whereas 55 - 200 repeats result in a "premutation." FMR1 premutation carriers (PMC) are at an increased risk for a range of psychiatric, neurocognitive, and physical conditions. Few studies have examined the variable expression of neuropsychiatric features in female PMCs, and whether heterogeneous presentation among female PMCs may reflect differential presentation of features in unique subgroups. In the current pilot study, we examined 41 female PMCs (ages 17-78 years) and 15 age-, sex-, and IQ-matched typically developing controls (TDC) across a battery of self-report, eye tracking, expressive language, neurocognitive, and resting state EEG measures to determine the feasibility of identifying discrete clusters. Secondly, we sought to identify the key features that distinguished these clusters of female PMCs. We found a three cluster solution using k-means clustering. Cluster 1 represented a psychiatric feature group (27% of our sample); cluster 2 represented a group with executive dysfunction and elevated high frequency neural oscillatory activity (32%); and cluster 3 represented a relatively unaffected group (41%). Our findings indicate the feasibility of using a data-driven approach to identify naturally occurring clusters in female PMCs using a multi-method assessment battery. CGG repeat count and its association with neuropsychiatric features differ across clusters. Together, our findings provide important insight into potential diverging pathophysiological mechanisms and risk factors for each female PMC cluster, which may ultimately help provide novel and individualized targets for treatment options.
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Affiliation(s)
- Lauren M. Schmitt
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Kelli C. Dominick
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Rui Liu
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Ernest V. Pedapati
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Lauren E. Ethridge
- Department of Psychology, University of Oklahoma, Norman, OK, United States
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Elizabeth Smith
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - John A. Sweeney
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Craig A. Erickson
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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