Main Article Content

Authors

Fragile X Syndrome (FXS) is a genetic disease due to a CGG trinucleotide expansion, named full mutation (greater than 200 CGG repeats), in the fragile X mental retardation 1 gene locus Xq27.3; which leads to an hypermethylated region in the gene promoter therefore silencing it and lowering the expression levels of the fragile X mental retardation 1, a protein involved in synaptic plasticity and maturation.  Individuals with FXS present with intellectual disability, autism, hyperactivity, long face, large or prominent ears and macroorchidism at puberty and thereafter. Most of the young children with FXS will present with language delay, sensory hyper arousal and anxiety. Girls are less affected than boys, only 25% have intellectual disability. Given the genomic features of the syndrome, there are patients with a number of triplet repeats between 55 and 200, known as premutation carriers. Most carriers have a normal IQ but some have developmental problems. The diagnosis of FXS has evolved from karyotype with special culture medium, to molecular techniques that are more sensitive and specific including PCR and Southern Blot. During the last decade, the advances in the knowledge of FXS, has led to the development of investigations on pharmaceutical management or targeted treatments for FXS. Minocycline and sertraline have shown efficacy in children.

Wilmar Saldarriaga, Professor Morphology, Gynecology and Obstetrics. Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia

Professor Morphology, Gynecology and Obstetrics. Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia

Flora Tassone, Department of Biochemistry and Molecular Medicine; UC Davis MIND Institute, University of California, Sacramento, USA

Research Biochemist, Department of Biochemistry and Molecular Medicine; UC Davis MIND Institute, University of California, Sacramento, USA.

Laura Yuriko González-Teshima, Medicine and surgery School, University of Valle. Cali, Colombia

Medicine and surgery School, University of Valle. Cali, Colombia

Jose Vicente Forero-Forero, Medicine and surgery School, University of Valle. Cali, Colombia

Medicine and surgery School, University of Valle. Cali, Colombia

Sebastián Ayala-Zapata, Medicine and surgery School, University of Valle. Cali, Colombia

Medicine and surgery School, University of Valle. Cali, Colombia

Randi Hagerman, Medical director and distinguished professor. Holder Research Chair in Fragile X syndrome. Department of Pediatrics, School of Medicine. UC Davis MIND Institute, University of California, Davis, USA.

Medical director and distinguished professor. Holder Research Chair in Fragile X syndrome. Department of Pediatrics, School of Medicine. UC Davis MIND Institute, University of California, Davis, USA.

Martin JP, Bell J. A pedigree of mental defect showing sex-linkage. J Neurol Psychiatry. 1943;6(3-4):154–7. DOI: https://doi.org/10.1136/jnnp.6.3-4.154

Hagerman RJ, Hagerman PJ. Fragile X Syndrome. 3. Baltimore: The John Hopkins University Press; 2002. DOI: https://doi.org/10.56021/9780801868436

Bagni C, Tassone F, Neri G, Hagerman R. Fragile X syndrome: Causes, diagnosis, mechanisms, and therapeutics. J Clin Invest. 2012;122(12):4314–22. DOI: https://doi.org/10.1172/JCI63141

Liu Y, Winarni T, Zhang L, Tassone F, Hagerman R. Fragile X-associated tremor/ataxia syndrome (FXTAS) in grey zone carriers. Clin Genet. 2013;84:74–7. DOI: https://doi.org/10.1111/cge.12026

Hall D, Tassone F, Klepitskaya O, Leehey M. Fragile X associated tremor ataxia syndrome in FMR1 gray zone allele carriers. Mov Disord. 2012;27(2):296–300. DOI: https://doi.org/10.1002/mds.24021

Coffee B, Keith K, Albizua I, Malone T, Mowrey J, Sherman SL, et al. Incidence of Fragile X syndrome by newborn screening for methylated FMR1 DNA. Am J Hum Genet. 2009;85:503–14. DOI: https://doi.org/10.1016/j.ajhg.2009.09.007

Hirst MC, Knight SJ, Christodoulou Z, Grewal PK, Fryns JP, Davies KE. Origins of the fragile X syndrome mutation. J Med Genet. 1993;30(8):647–50. DOI: https://doi.org/10.1136/jmg.30.8.647

Gardeazabal AG. El divino. Bogota: Plaza Janes; 1986.

Payan C, Saldarriaga W, Isaza C, Alzate A. Estudio foco endémico de retardo mental en Ricaurte Valle. Acta Biológica Colombiana. 2001;6(2):88.

Hagerman R, Hagerman P. Advances in clinical and molecular understanding of the FMR1 premutation and fragile X-associated tremor/ataxia syndrome. Lancet Neurol. 2013;12(8):786–98. DOI: https://doi.org/10.1016/S1474-4422(13)70125-X

Fernandez-Carvajal I, Walichiewicz P, Xiaosen X, Pan R, Hagerman PJ, Tassone F. Screening for expanded alleles of the FMR1 gene in blood spots from newborn males in a Spanish population. J Mol Diagn. 2009;11(4):324–9. DOI: https://doi.org/10.2353/jmoldx.2009.080173

Tassone F, Iong KP, Tong TH, Lo J, Gane LW, Berry-Kravis E, et al. FMR1 CGG allele size and prevalence ascertained through newborn screening in the United States. Genome Med. 2012;4(12):1–113. DOI: https://doi.org/10.1186/gm401

Center for Disease Control and Prevention. Fragile X syndrome (FXS). Accessed: 20 November 2014. Available from:urihttp://www.cdc.gov/ncbddd/fxs/index.htmlhttp://www.cdc.gov/ncbddd/fxs/index.html.

Pietrobono R, Tabolacci E, Zalfa F, Zito I, Terracciano A, Moscato U, et al. Molecular dissection of the events leading to inactivation of the FMR1 gene. Hum Mol Genet. 2005;14(2):267–7. DOI: https://doi.org/10.1093/hmg/ddi024

Pieretti M, Zhang FP, Fu YH, Warren ST, Oostra BA, Caskey CT, et al. Absence of expression of the FMR-1 gene in fragile X syndrome. Cell. 1991;66(4):817–22. DOI: https://doi.org/10.1016/0092-8674(91)90125-I

Naumann A, Hochstein N, Weber S, Fanning E, Doerfler W. A distinct DNA-methylation boundary in the 5'-upstream sequence of the FMR1 promoter binds nuclear proteins and is lost in fragile X syndrome. Am J Hum Genet. 2009;85(5):606–16. DOI: https://doi.org/10.1016/j.ajhg.2009.09.018

Stöger R, Kajimura TM, Brown WT, Laird CD. Epigenetic variation illustrated by DNA methylation patterns of the fragile-X gene FMR1. Hum Mol Genet. 1997;6(11):1791–801. DOI: https://doi.org/10.1093/hmg/6.11.1791

Malter HE, Iber JC, Willemsen R, de Graaff E, Tarleton JC, Leisti J, et al. Characterization of the full fragile X syndrome mutation in fetal gametes. Nat Genet. 1997;15(2):165–9. DOI: https://doi.org/10.1038/ng0297-165

Sutcliffe JS, Nelson DL, Zhang F, Pieretti M, Caskey CT, Saxe D, et al. DNA methylation represses FMR-1 transcription in fragile X syndrome. Hum Mol Genet. 1992;1(6):397–400. DOI: https://doi.org/10.1093/hmg/1.6.397

Kniffin CL, Jackson JF. Fragile x mental retardation syndrome. Accessed: 20 November 2014. Available from:urihttp://omim.org/clinicalSynopsis/300624?search=fragile x highlight=x fragilehttp://omim.org/clinicalSynopsis/300624?search=fragile x highlight=x fragile.

Siomi H, Siomi MC, Nussbaum RL, Dreyfuss G. The protein product of the fragile X gene, FMR1, has characteristics of an RNA-binding protein. Cell. 1993;74(2):291–8. DOI: https://doi.org/10.1016/0092-8674(93)90420-U

Ashley CT, Wilkinson KD, Reines D, Warren ST. FMR1 protein: conserved RNP family domains and selective RNA binding. Science. 1993;262(5133):563–6. DOI: https://doi.org/10.1126/science.7692601

Darnell JC, Van Driesche SJ, Zhang C, Hung KYS, Mele A, Fraser CE, et al. FMRP stalls ribosomal translocation on mRNAs linked to synaptic function and autism. Cell. 2011;146(2):247–61. DOI: https://doi.org/10.1016/j.cell.2011.06.013

Brown V, Jin P, Ceman S, Darnell JC, O'Donnell WT, Tenenbaum SA, et al. Microarray identification of FMRP-associated brain mRNAs and altered mRNA translational profiles in fragile X syndrome. Cell. 2001;107(4):477–87. DOI: https://doi.org/10.1016/S0092-8674(01)00568-2

Chen L, Yun SW, Seto J, Liu W, Toth M. The fragile X mental retardation protein binds and regulates a novel class of mRNAs containing U rich target sequences. Neuroscience. 2003;120(4):1005–17. DOI: https://doi.org/10.1016/S0306-4522(03)00406-8

Bear MF, Huber KM, Warren ST. The mGluR theory of fragile X mental retardation. Trends Neurosci. 2004;27(7):370–7. DOI: https://doi.org/10.1016/j.tins.2004.04.009

Gatto CL, Broadie K. Genetic controls balancing excitatory and inhibitory synaptogenesis in neurodevelopmental disorder models. Front Synaptic Neurosci. 2010;2:4. DOI: https://doi.org/10.3389/fnsyn.2010.00004

Verkerk AJ, Pieretti M, Sutcliffe JS, Fu YH, Kuhl DP, Pizzuti A, et al. Identification of a gene (FMR-1) containing a CGG repeat coincident with a breakpoint cluster region exhibiting length variation in fragile X syndrome. Cell. 1991;65(5):905–14. DOI: https://doi.org/10.1016/0092-8674(91)90397-H

Yrigollen CM, Martorell L, Durbin-Johnson B, Naudo M, Genoves J, Murgia A, et al. AGG interruptions and maternal age affect FMR1 CGG repeat allele stability during transmission. J Neurodev Disord. 2014;6(1):1–11. DOI: https://doi.org/10.1186/1866-1955-6-24

Yrigollen CM, Durbin-Johnson B, Gane L, Nelson DL, Hagerman R, Hagerman PJ, et al. AGG interruptions within the maternal FMR1 gene reduce the risk of offspring with fragile X syndrome. Genetics Med. 2012;14(8):729–36. DOI: https://doi.org/10.1038/gim.2012.34

Fernandez-Carvajal I, Lopez Posadas B, Pan R, Raske C, Hagerman PJ, Tassone F. Expansion of an FMR1 grey-zone allele to a full mutation in two generations. J Mol Diagn. 2009;11(4):306–10. DOI: https://doi.org/10.2353/jmoldx.2009.080174

Nolin SL, Brown WT, Glicksman A, Houck GE, Gargano AD, Sullivan A, et al. Expansion of the fragile X CGG repeat in females with premutation or intermediate alleles. Am J Hum Genet. 2003;72(2):454–64. DOI: https://doi.org/10.1086/367713

Berry-Kravis E, Abrams L, Coffey SM, Hall DA, Greco C, Gane LW, et al. Fragile X-associated tremor/ataxia syndrome: clinical features, genetics, and testing guidelines. Mov Disord. 2007;22(14):2018–30. DOI: https://doi.org/10.1002/mds.21493

Seltzer MM, Baker MW, Hong J, Maenner M, Greenberg J, Mandel D. Prevalence of CGG expansions of the FMR1 gene in a US population-based sample. Am J Med Genet B Neuropsychiatr Genet. 2012;159B(5):589–97. DOI: https://doi.org/10.1002/ajmg.b.32065

Bourgeois JA, Cogswell JB, Hessl D, Zhang L, Ono MY, Tassone F, et al. Cognitive, anxiety and mood disorders in the fragile X-associated tremor/ataxia syndrome. Gen Hosp Psychiatry. 2007;29(4):349–56. DOI: https://doi.org/10.1016/j.genhosppsych.2007.03.003

Martin JR, Arici A. Fragile X and reproduction. Curr Opin Obstet Gynecol. 2008;20(3):216–20. DOI: https://doi.org/10.1097/GCO.0b013e3282fe7254

Filipovic-Sadic S, Sah S, Chen L, Krosting J, Sekinger E, Zhang W, et al. A novel FMR1 PCR method for the routine detection of low abundance expanded alleles and full mutations in fragile X syndrome. Clin Chem. 2010;56:399–408. DOI: https://doi.org/10.1373/clinchem.2009.136101

Tassone F, Pan R, Amiri K, Taylor AK, Hagerman PJ. A rapid polymerase chain reaction based screening method for identification of all expanded alleles of the fragile X (FMR1) gene in newborn and high-risk populations. J Mol Diagn. 2008;10:43–9. DOI: https://doi.org/10.2353/jmoldx.2008.070073

Chen L, Hadd A, Sah S, Filipovic-Sadic S, Krosting J, Sekinger E, et al. An information-rich CGG repeat primed PCR that detects the full range of fragile X expanded alleles and minimizes the need for southern blot analysis. J Mol Diagn. 2010;12:589–600. DOI: https://doi.org/10.2353/jmoldx.2010.090227

Firth HV, Hurst JA, Hall JG. Oxford Desk Reference? Oxford: Oxford University Press; 2005.

O'Neil MJF, Jackson JF. SOTOS SYNDROME 1 SOTOS1. Accessed: 20 November 2014. Available from:urihttp://omim.org/clinicalSynopsis/117550?search=highlight=sotoshttp://omim.org/clinicalSynopsis/117550?search=highlight=sotos.

Hamosh A, Jackson JF. PRADER-WILLI SYNDROME PWS. accessed: 20 November 2014. Available from:urihttp://omim.org/clinicalSynopsis/176270?search=prader highlight=praderhttp://omim.org/clinicalSynopsis/176270?search=prader highlight=prader.

Rueda JR, Ballesteros J, Guillen V, Tejada MI, Solà I. Folic acid for fragile X syndrome. Cochrane database Syst Rev. 2011;(5):CD008476. DOI: https://doi.org/10.1002/14651858.CD008476.pub2

Detich N, Bovenzi V, Szyf M. Valproate induces replication-independent active DNA demethylation. J Biol Chem. 2003;278(30):27586–92. DOI: https://doi.org/10.1074/jbc.M303740200

Tabolacci E, De Pascalis I, Accadia M, Terracciano A, Moscato U, Chiurazzi P, et al. Modest reactivation of the mutant FMR1 gene by valproic acid is accompanied by histone modifications but not DNA demethylation. Pharmacogenet Genomics. 2008;18(8):738–41. DOI: https://doi.org/10.1097/FPC.0b013e32830500a1

Torrioli M, Vernacotola S, Setini C, Bevilacqua F, Martinelli D, Snape M, et al. Treatment with valproic acid ameliorates ADHD symptoms in fragile X syndrome boys. Am J Med Genet A. 2010;152A(6):1420–7. DOI: https://doi.org/10.1002/ajmg.a.33484

Hagerman RJ, Berry-Kravis E, Kaufmann WE, Ono MY, Tartaglia N, Lachiewicz A, et al. Advances in the treatment of fragile X syndrome. Pediatrics. 2009;123(1):378–90. DOI: https://doi.org/10.1542/peds.2008-0317

Wirojanan J, Jacquemont S, Diaz R, Bacalman S, Anders TF, Hagerman RJ, et al. The efficacy of melatonin for sleep problems in children with autism, fragile X syndrome, or autism and fragile X syndrome. J Clin Sleep Med. 2009;5:145–50. DOI: https://doi.org/10.5664/jcsm.27443

Su T, Fan H-X, Jiang T, Sun W-W, Den W-Y, Gao M-M, et al. Early continuous inhibition of group 1 mGlu signaling partially rescues dendritic spine abnormalities in the Fmr1 knockout mouse model for fragile X syndrome. Psychopharmacology. 2011;215(2):291–300. DOI: https://doi.org/10.1007/s00213-010-2130-2

Dziembowska M, Pretto DI, Janusz A, Kaczmarek L, Leigh MJ, Gabriel N, et al. High MMP-9 activity levels in fragile X syndrome are lowered by minocycline. Am J Med Genet A. 2013;161A(8):1897–903. DOI: https://doi.org/10.1002/ajmg.a.36023

Bilousova T V, Dansie L, Ngo M, Aye J, Charles JR, Ethell DW, et al. Minocycline promotes dendritic spine maturation and improves behavioural performance in the fragile X mouse model. J Med Genet. 2009;46(2):94–102. DOI: https://doi.org/10.1136/jmg.2008.061796

Wilczynski GM, Konopacki FA, Wilczek E, Lasiecka Z, Gorlewicz A, Michaluk P, et al. Important role of matrix metalloproteinase 9 in epileptogenesis. J Cell Biol. 2008;180(5):1021–35. DOI: https://doi.org/10.1083/jcb.200708213

Wang X, Bozdagi O, Nikitczuk JS, Zhai ZW, Zhou Q, Huntley GW. Extracellular proteolysis by matrix metalloproteinase-9 drives dendritic spine enlargement and long-term potentiation coordinately. Proc Natl Acad Sci U S A. 2008;105(49):19520–5. DOI: https://doi.org/10.1073/pnas.0807248105

Dziembowska M, Milek J, Janusz A, Rejmak E, Romanowska E, Gorkiewicz T, et al. Activity-dependent local translation of matrix metalloproteinase-9. J Neurosci. 2012;32(42):14538–47. DOI: https://doi.org/10.1523/JNEUROSCI.6028-11.2012

Leigh MJS, Nguyen D V, Mu Y, Winarni TI, Schneider A, Chechi T, et al. A randomized double-blind, placebo-controlled trial of minocycline in children and adolescents with fragile x syndrome. J Dev Behav Pediatr. 2013;34(3):147–55. DOI: https://doi.org/10.1097/DBP.0b013e318287cd17

Indah Winarni T, Chonchaiya W, Adams E, Au J, Mu Y, Rivera SM, et al. Sertraline may improve language developmental trajectory in young children with fragile X syndrome: A retrospective chart review. Autism Res Treat. 2012; 2012: 104317. DOI: https://doi.org/10.1155/2012/104317

Moskowitz LJ, Carr EG, Durand VM. Behavioral intervention for problem behavior in children with fragile X syndrome. Am J Intellect Dev Disabil. 2011;116(6):457–78. DOI: https://doi.org/10.1352/1944-7558-116.6.457

Turk J. Fragile X syndrome: lifespan developmental implications for those without as well as with intellectual disability. Curr Opin Psychiatry. 2011;24(5):387. DOI: https://doi.org/10.1097/YCO.0b013e328349bb77

Dew-Hughes D. Educating children with fragile X syndrome. Florence: Routledge; 2003. DOI: https://doi.org/10.4324/9780203561539

Dyer-Friedman J, Glaser B, Hessl D, Johnston C, Huffman LC, Taylor A, et al. Genetic and environmental influences on the cognitive outcomes of children with fragile X syndrome. J Am Acad Child Adolesc Psychiatry. 2002;41(3):237–44. DOI: https://doi.org/10.1097/00004583-200203000-00002

Hessl D, Dyer-Friedman J, Glaser B, Wisbeck J, Barajas RG, Taylor A, et al. The influence of environmental and genetic factors on behavior problems and autistic symptoms in boys and girls with fragile X syndrome. Pediatrics. 2001;108(5):E88. DOI: https://doi.org/10.1542/peds.108.5.e88

Saldarriaga, W., Tassone, F., González-Teshima, L. Y., Forero-Forero, J. V., Ayala-Zapata, S., & Hagerman, R. (2014). Fragile X Syndrome. Colombia Medica, 45(4), 190–198. https://doi.org/10.25100/cm.v45i4.1810

Downloads

Download data is not yet available.

Similar Articles

You may also start an advanced similarity search for this article.