Abstract
The X-linked FMR1 premutation (PM) is characterized by a 55–200 CGG triplet expansion in the 5′-untranslated region (UTR). Carriers of the PM were originally thought to be asymptomatic; however, they may present general neuropsychiatric manifestations including learning disabilities, depression and anxiety, among others. With age, both sexes may also develop the neurodegenerative disease fragile X-associated tremor/ataxia syndrome (FXTAS). Among carriers, females are at higher risk for developing immune disorders, hypertension, seizures, endocrine disorders and chronic pain, among others. Some female carriers younger than 40 years old may develop fragile X-associated primary ovarian insufficiency (FXPOI). To date, no studies have addressed the metabolic footprint – that includes mitochondrial metabolism – of female carriers and its link to clinical/cognitive manifestations. To this end, we performed a comprehensive biochemical assessment of 42 female carriers (24–70 years old) compared to sex-matched non-carriers. By applying a multivariable correlation matrix, a generalized bioenergetics impairment was correlated with diagnoses of the PM, FXTAS and its severity, FXPOI and anxiety. Intellectual deficits were strongly correlated with both mitochondrial dysfunction and with CGG repeat length. A combined multi-omics approach identified a down-regulation of RNA and mRNA metabolism, translation, carbon and protein metabolism, unfolded protein response, and up-regulation of glycolysis and antioxidant response. The suboptimal activation of the unfolded protein response (UPR) and endoplasmic-reticulum-associated protein degradation (ERAD) response challenges and further compromises the PM genetic background to withstand other, more severe forms of stress. Mechanistically, some of the deficits were linked to an altered protein expression due to decreased protein translation, but others seemed secondary to oxidative stress originated from the accumulation of either toxic mRNA or RAN-derived protein products or as a result of a direct toxicity of accumulated metabolites from deficiencies in critical enzymes.
Highlights
Carriers of the premutation (PM) are characterized by a moderate (55 to 200) expansion of the cytosine-guanine-guanine (CGG) nucleotide repeats in the first exon and promoter of the X-linked FMR1 gene (Verkerk et al, 1991; Bagni et al, 2012)
Mounting evidence has shown that female carriers of the PM are at higher risk for developing several health-related issues compared to non-carrier females (Bailey et al, 2008; Hunter et al, 2010; Winarni et al, 2012; Wheeler et al, 2014b; Movaghar et al, 2019)
Awareness of these risks and correlation of the clinical signs with the biochemical footprint of carriers could help to identify critical biomarkers in early diagnosis and likely prognosis. These associations could lead to an integrated approach between clinical specialties and basic science, which could be extremely beneficial in the management of symptoms and challenges that female PM carriers experience in their day-to-day life
Summary
Carriers of the premutation (PM) are characterized by a moderate (55 to 200) expansion of the cytosine-guanine-guanine (CGG) nucleotide repeats in the first exon and promoter of the X-linked FMR1 gene (Verkerk et al, 1991; Bagni et al, 2012). The PM has been associated with conditions beyond those involving the CNS, such as hypertension, hypothyroidism, high blood glucose, as well as a higher incidence of thyroid, prostate and other cancers (Lozano et al, 2016). With age, both female and male carriers of the PM are at a higher risk for developing the late-onset (usually appearing after age 50) neurodegenerative disorder fragile X-associated tremor/ataxia syndrome [FXTAS; OMIM:300623; (Hagerman et al, 2001, 2004; Hagerman and Hagerman, 2013)]. FXTAS-affected carriers may exhibit intention tremor and gait ataxia, accompanied by cerebral atrophy, white matter disease, parkinsonism, neuropathy, autonomic dysfunction, and cognitive deficits (Berry-Kravis et al, 2007a; Bourgeois et al, 2007; Lozano et al, 2016; Claeys et al, 2020)
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