High functioning male with fragile X syndrome and fragile X-associated tremor/ataxia syndrome.
Fragile X syndrome (FXS) affects individuals with more than 200 CGG repeats (full mutation) in the fragile X mental retardation 1 (FMR1) gene. Those born with FXS experience cognitive and social impairments, developmental delays, and some features of autism spectrum disorders. Carriers of a premutation (55-200 CGG repeats) are generally not severely affected early in life; however, are at high risk of developing the late onset neurodegenerative disorder, Fragile X-associated Tremor/Ataxia Syndrome (FXTAS), or Fragile X-associated Primary Ovarian Insufficiency (FXPOI), and may have other medical conditions such as developmental delay, autism spectrum disorders, hypertension, anxiety, and immune-mediated disorders. Here we present a case of a 58-year-old man with a borderline IQ, average memory skills, and executive function deficits. He met criteria for multiple psychiatric diagnoses and presented with tremor and ataxia, meeting criteria for FXTAS. Molecular testing unveiled a completely unmethylated FMR1 full mutation in peripheral blood mononucleated cells with elevated FMR1 mRNA and premutation alleles of different sizes in two other tissues (primary fibroblasts and sperm), indicating the presence of allele instability based on both inter- and intra-tissue mosaicism. The observation of FXTAS in this case of a full mutation mosaic man suggests that the pathogenic mechanism underlying this disorder is not observed exclusively in premutation carriers as it was originally thought. The concomitant presence of features of FXS and late onset neurological deterioration with probable FXTAS likely result from a combined molecular pathology of elevated FMR1 mRNA levels, a molecular hallmark of FXTAS and low FMRP expression that leads to FXS.
Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Sacramento, California.
Kirin
K
Basuta
MIND Institute, University of California, Davis, Medical Center, Sacramento, California.|Department of Pediatrics, University of California at Davis Medical Center, Sacramento, California.
Andrea
A
Schneider
MIND Institute, University of California, Davis, Medical Center, Sacramento, California.
Louise
L
Gane
MIND Institute, University of California, Davis, Medical Center, Sacramento, California.|Department of Pediatrics, University of California at Davis Medical Center, Sacramento, California.
Jonathan
J
Polussa
Department of Neurology, Mayo Clinic, Scottsdale, Arizona.
Bryan
B
Woodruff
Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Sacramento, California.
Dalyir
D
Pretto
MIND Institute, University of California, Davis, Medical Center, Sacramento, California.|Department of Pediatrics, University of California at Davis Medical Center, Sacramento, California.
Randi
R
Hagerman
Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Sacramento, California.|MIND Institute, University of California, Davis, Medical Center, Sacramento, California.
Flora
F
Tassone
D001259:Ataxia / Q000235:genetics*; D051860:Fragile X Messenger Ribonucleoprotein 1 / Q000235:genetics; D005600:Fragile X Syndrome / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D012333:RNA, Messenger / Q000235:genetics; D014202:Tremor / Q000235:genetics*; D019680:Trinucleotide Repeat Expansion / Q000235:genetics
D051860:Fragile X Messenger Ribonucleoprotein 1; D012333:RNA, Messenger; C497683:FMR1 protein, human
FXTAS; fragile X syndrome