Distinct Phenotypic and microRNA Expression in X-Linked Charcot–Marie–Tooth Correlated with a Novel Mutation in the GJB1 Gene

Abstract

We investigated genetic and clinical features in two siblings with an unreported frameshift mutation in the GJB1 gene, encoding connexin 32, to study CMTX-1 and its intrafamilial phenotypic variability. Connexin 32 is a gap junction protein that is located in paranodal regions and Schmidt–Lanterman incisures. Clinical features, family history, and genetic and microRNA information were collected. Genetic analysis determination was performed on genomic DNA from the two cases. Muscle-specific miR-206 was also investigated in serum. A muscle biopsy was conducted in one case, and EMG with conduction velocities was performed in both patients. In the first genetic analysis, no duplication of the PMP22 gene was found. A second genetic analysis of a panel of genes associated with inherited peripheral neuropathies was performed. We found a frameshift mutation in the connexin 32 (GJB1) gene, c.281_287del in hemizygosity, not previously reported, that segregated with the clinical phenotype. An X-linked hereditary sensory motor neuropathy was caused by the mutation in the connexin 32 gene. We found overexpression of miR-206 that was 4-fold up-regulated in the older brother and over 10-fold in the younger brother versus the controls; this might be correlated with a different muscle mass and regeneration. The two siblings presented differently evolving neuropathies due to environmental factors and lifestyles that caused nerve degeneration. We hypothesized that in this X-linked CMT, there is no expression of a truncated connexin 32 (Cx32) protein, with loss of function markedly reduced in the gap junction. In the peripheral nervous system (PNS), this might be mitigated by the presence of another connexin, Cx43. Such a reduction might affect not only gap junction formation but also myelination and muscle trophism, resulting in variable miR-206 expressivity.