Characterization of the Metabolic, Clinical and Neuropsychological Phenotype of Female Carriers of the Premutation in the X-Linked FMR1 Gene

Eleonora Napoli; Yingratana Amabel McLennan; Andrea Schneider; Flora Tassone; Randi J Hagerman; Cecilia Giulivi

doi:10.3389/fmolb.2020.578640

Characterization of the Metabolic, Clinical and Neuropsychological Phenotype of Female Carriers of the Premutation in the X-Linked FMR1 Gene

Front Mol Biosci. 2020 Oct 22:7:578640. doi: 10.3389/fmolb.2020.578640. eCollection 2020.

Authors

Eleonora Napoli¹, Yingratana Amabel McLennan², Andrea Schneider^{2

3}, Flora Tassone^{2

4}, Randi J Hagerman^{2

3}, Cecilia Giulivi^{1

2}

Affiliations

¹ Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States.
² MIND Institute, University of California Davis Medical Center, Sacramento, CA, United States.
³ Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, United States.
⁴ Department of Biochemistry and Molecular Medicine, School of Medicine, University of California, Davis, Davis, CA, United States.

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.

Keywords: cellular response to stress; fragile X-associated primary ovarian insufficiency; fragile X-associated tremor and ataxia syndrome; glycolysis; mitochondrial dysfunction; omics; oxidative phosphorylation.

Abstract

Grants and funding