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Duplications of the MECP2 gene region and severe mental retardation in males. All Wales Molecular Genetics Laboratory. Classical Rett syndrome. X-dominant condition (Originally thought to be) Lethal in hemizygous males MECP2 mutations in males
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Duplications of the MECP2 gene region and severe mental retardation in males All Wales Molecular Genetics Laboratory All Wales Molecular Genetics Laboratory
Classical Rett syndrome • X-dominant condition • (Originally thought to be) Lethal in hemizygous males • MECP2 mutations in males • Aneuploidy of X chromosome, mosaics for MECP2 mutations • Lethal neonatal encephalopathy born to asymptomatic or mildly affected carrier mothers with mutations that usually cause the Rett phenotype in females • MECP2 mutations that cause a milder Rett phenotype in females, and classic or atypical Rett in males • Milder male cases with MECP2 mutations that do not result in classical Rett in female carriers (XLMR) All Wales Molecular Genetics Laboratory
Gene dossier: Expanding the testing criteria Minimum criteria required for testing to be appropriate as stated in the Gene Dossier: All Wales Molecular Genetics Laboratory
Gene map of duplicated region > 60 duplications (0.2Mb – large dups;Xq28-ter) All Wales Molecular Genetics Laboratory
Duplication pathogenicity • Phenotypic severity does not correlate with duplication size (flanking genes could play a role) • LICAM (spastic paraplegia) • Critical region – MECP2 & IRAK1 • Gene dosage influences phenotype (triplication – more severe) • Transgenic mice over-expressing Mecp2: Normal at birth but develop Rett-like progressive neurologic problems and die prematurely • Female carriers are asymptomatic if skewing is favourable • ?Due to LCRs All Wales Molecular Genetics Laboratory
Cardiff samples • 25 male samples now tested by MLPA • 12 rearrangements detected in 4 families All Wales Molecular Genetics Laboratory
Cardiff case 1: aCGH partial dup RP1-29A6 (unconfirmed) FMR-1 (unconfirmed) MECP2 (confirmed by MLPA, partial dup exon 4 only) All Wales Molecular Genetics Laboratory
Cardiff case 2: MLPA dup All Wales Molecular Genetics Laboratory
Cardiff case 3: MLPA dup / triplication All Wales Molecular Genetics Laboratory
Phenotype – Genotype correlation All Wales Molecular Genetics Laboratory
Phenotype of “duplicated” males • Severe MR • Initial hypotonia (floppiness) • Progressive spasticity • Recurrent infections (linked to IRAK1?) • Absent speech • Dysmorphic appearance • Undescended testicles • Constipation • Seizures • Severity increases with copy number of MECP2 • Need to expand MECP2 testing criteria to include Xq28 MR All Wales Molecular Genetics Laboratory
Thanks to Cardiff team: Ruth Lewis, Laz Lazarou, Sian Morgan, Hayley Archer, Angus Clarke, Referring clinicians: Sally Davies, Emma Baple, Ruth Newbury-Ecob, Frances Elmslie All Wales Molecular Genetics Laboratory