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Brain Advance Access published online on December 5, 2005
Brain, doi:10.1093/brain/awh683
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© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received July 14, 2005
Revised October 5, 2005
Accepted October 6, 2005

Article

Neuropathology of fragile X-associated tremor/ataxia syndrome (FXTAS)

C. M. Greco 1, R. F. Berman 2, R. M. Martin 2, F. Tassone 3, P. H. Schwartz 4, A. Chang 5, B. D. Trapp 5, C. Iwahashi 6, J. Brunberg 7, J. Grigsby 8, D. Hessl 9, E. J. Becker 6, J. Papazian 10, M. A. Leehey 11, R. J. Hagerman 12, and P. J. Hagerman 3 *

1 Department of Pathology, University of California, Davis, Medical Center, Sacramento, CA, USA
2 Department of Neurosurgery, University of California, Davis, School of Medicine, Davis, CA, USA
3 MIND Institute, University of California, Davis, Medical Center, Sacramento, CA, USA; Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Davis, CA, USA
4 Children's Hospital of Orange County Research Institute, Orange, CA, USA
5 Department of Neurosciences, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
6 Department of Biochemistry and Molecular Medicine, University of California, Davis, School of Medicine, Davis, CA, USA
7 Department of Radiology, University of California, Davis, Medical Center, Sacramento, CA, USA
8 Department of Medicine, University of Colorado Health Sciences Center, Denver, CO, USA
9 Department of Psychiatry and Behavioral Sciences, University of California, Davis, Medical Center, Sacramento, CA, USA; Department of Pediatrics, University of California, Davis, Medical Center, Sacramento, CA, USA
10 MIND Institute, University of California, Davis, Medical Center, Sacramento, CA, USA
11 Department of Neurology, University of Colorado Health Sciences Center, Denver, CO, USA
12 Department of Pediatrics, University of California, Davis, Medical Center, Sacramento, CA, USA; MIND Institute, University of California, Davis, Medical Center, Sacramento, CA, USA

* To whom correspondence should be addressed.
P. J. Hagerman, E-mail: pjhagerman{at}ucdavis.edu


  Abstract

Fragile X-associated tremor/ataxia syndrome (FXTAS) is an adult-onset neurodegenerative disorder that affects carriers, principally males, of premutation alleles (55-200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene. Clinical features of FXTAS include progressive intention tremor and gait ataxia, accompanied by characteristic white matter abnormalities on MRI. The neuropathological hallmark of FXTAS is an intranuclear inclusion, present in both neurons and astrocytes throughout the CNS. Prior to the current work, the nature of the associations between inclusion loads and molecular measures (e.g. CGG repeat) was not defined. Post-mortem brain and spinal cord tissue has been examined for gross and microscopic pathology in a series of 11 FXTAS cases (males, age 67-87 years at the time of death). Quantitative counts of inclusion numbers were performed in various brain regions in both neurons and astrocytes. Inclusion counts were compared with specific molecular (CGG repeat, FMR1 mRNA level) and clinical (age of onset, age of death) parameters. In the current series, the three most prominent neuropathological characteristics are (i) significant cerebral and cerebellar white matter disease, (ii) associated astrocytic pathology with dramatically enlarged inclusion-bearing astrocytes prominent in cerebral white matter and (iii) the presence of intranuclear inclusions in both brain and spinal cord. The pattern of white matter pathology is distinct from that associated with hypertensive vascular disease and other diseases of white matter. Spongiosis was present in the middle cerebellar peduncles in seven of the eight cases in which those tissues were available for study. There is inclusion formation in cranial nerve nucleus XII and in autonomic neurons of the spinal cord. The most striking finding is the highly significant association between the number of CGG repeats and the numbers of intranuclear inclusions in both neurons and astrocytes, indicating that the CGG repeat is a powerful predictor of neurological involvement in males, both clinically (age of death) and neuropathologically (number of inclusions).

Keywords: trinucleotide repeat; dementia; RNA toxicity; Parkinson; FMR1.
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