#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Rett Syndrome


Authors: D. Záhoráková;  P. Martásek
Authors‘ workplace: Klinika dětského a dorostového lékařství 1. LF UK a VFN v Praze
Published in: Cesk Slov Neurol N 2009; 72/105(6): 525-533
Category: Review Article

Overview

Rett syndrome (RTT) is a severe X‑linked neurodevelopmental disorder affecting almost exclusively girls. It belongs to the family of autistic spectrum disorders, and it is characterized by psychomotor regression, loss of acquired speech, microcephaly, repetitive stereotypic hand movements, and seizures. Most of RTT cases are caused by de novo mutations in the gene for the methyl‑ CpG‑binding protein 2 (MECP2), and familial cases are extremely rare. The MECP2 gene product plays an important role in chromatin remodeling, regulation of gene expression and is also involved in RNA splicing. Some atypical RTT cases are caused by mutations in other genes, such as CDKL5, FOXG1 or NTNG1. In this paper we give an overview of RTT, its clinical aspects, molecular basis, diagnostic criteria, medical management and DNA diagnosis.

Key words:
Rett syndrome – mental retardation – MECP2 gene – CDKL5 gene – FOXG1 gene – NTNG1 gene


Sources

1. Rett A. On a unusual brain atrophy syndrome in hyperammonemia in childhood. Wien Med Wochenschr 1966; 116(37): 723– 726.

2. Hagberg B, Aicardi J, Dias K, Ramos O. A progressive syndrome of autism, dementia, ataxia, and loss of purposeful hand use in girls: Rett‘s syndrome: report of 35 cases. Ann Neurol 1983; 14(4): 471– 479.

3. Amir RE, Van den Veyver IB, Wan M, Tran CQ, Francke U, Zoghbi HY. Rett syndrome is caused by mutations in X‑linked MECP2, encoding methyl- CpG‑binding protein 2. Nat Genet 1999; 23(2): 185– 188.

4. Hagberg B, Hanefeld F, Percy A, Skjeldal O. An update on clinically applicable diagnostic criteria in Rett syndrome. Comments to Rett Syndrome Clinical Criteria Consensus Panel Satellite to European Paediatric Neurology Society Meeting, Baden Baden, Germany, 11 September 2001. Eur J Paediatr Neurol 2002; 6(5): 293– 297.

5. Burford B, Kerr AM, Macleod HA. Nurse recognition of early deviation in development in home videos of infants with Rett disorder. J Intellect Disabil Res 2003; 47(Pt 8): 588– 596.

6. Einspieler C, Kerr AM, Prechtl HF. Abnormal general movements in girls with Rett disorder: the first four months of life. Brain Dev 2005; 27 (Suppl 1): S8– S13.

7. Nomura Y, Segawa M. Characteristics of motor disturbances of the Rett syndrome. Brain Dev 1990; 12(1): 27– 30.

8. Nomura Y, Segawa M. Natural history of Rett syndrome. J Child Neurol 2005; 20(9): 764– 768.

9. Chahrour M, Zoghbi HY. The story of Rett syndrome: from clinic to neurobio­logy. Neuron 2007; 56(3): 422– 437.

10. Jian L, Nagarajan L, de Klerk N, Ravine D, Bower C,Anderson A et al. Predictors of seizure onset in Rett syndrome. J Pediatr 2006; 149(4): 542– 547.

11. Hagberg B. Rett syndrome: long‑term clinical follow‑up experiences over four decades. J Child Neurol 2005; 20(9): 722– 727.

12. Roze E, Cochen V, Sangla S, Bienvenu T, Roubergue A, Leu- Semenescu S et al. Rett syndrome: an overlooked diagnosis in women with stereotypic hand movements, psychomotor retardation, Parkinsonism, and dystonia? Mov Disord 2007; 22(3): 387– 389.

13. Mount RH, Hastings RP, Reilly S, Cass H, Charman T. Behavioural and emotional features in Rett syndrome. Disabil Rehabil 2001; 23(3– 4): 129– 138.

14. Glaze DG, Schultz RJ. Autonomic dysfunction and sudden death in Rett syndrome: Prolonged QTc intervals and diminished heart rate variability. In: Kerr AM, Witt- Engerström I (eds). Rett disorder and the developing brain. Oxford: Oxford University Press 2001: 251– 256.

15. Guideri F, Acampa M, Hayek G, Zappella M, Di Perri T. Reduced heart rate variability in patients affected with Rett syndrome. A possible explanation for sudden death. Neuropediatrics 1999; 30(3): 146– 148.

16. Sekul EA, Moak JP, Schultz RJ, Glaze DG, Dunn JK, Percy AK. Electrocardiographic findings in Rett syndrome: an explanation for sudden death? J Pediatr 1994; 125(1): 80– 82.

17. Zappella M, Meloni I, Longo I, Hayek G, Renieri A. Preserved speech variants of the Rett syndrome: molecular and clinical analysis. Am J Med Genet 2001; 104(1): 14– 22.

18. Hagberg B, Gillberg C. Rett variants –  rettoid phenotypes. In: Hagberg B, Anvret M, Wahlstrom J (eds.) Rett syndrome –  clinical and bio­logical aspects. London: MacKeith Press 1993: 40– 60.

19. Jellinger K, Armstrong D, Zoghbi HY, Percy AK. Neuropathology of Rett syndrome. Acta Neuropathol 1988; 76(2): 142– 158.

20. Reiss AL, Faruque F, Naidu S, Abrams M, Beaty T, Bryan RN et al. Neuroanatomy of Rett syndrome: a volumetric imaging study. Ann Neurol 1993; 34(2): 227– 234.

21. Jellinger K, Seitelberger F. Neuropathology of Rett syndrome. Am J Med Genet Suppl 1986; 1: 259– 288.

22. Bauman ML, Kemper TL, Arin DM. Pervasive neuroanatomic abnormalities of the brain in three cases of Rett‘s syndrome. Neurology 1995; 45(8): 1581– 1586.

23. Kaufmann WE, Moser HW. Dendritic anomalies in disorders associated with mental retardation. Cereb Cortex 2000; 10(10): 981– 991.

24. Belichenko PV, Oldfors A, Hagberg B, Dahlström A. Rett syndrome: 3- D confocal microscopy of cortical pyramidal dendrites and afferents. Neuroreport 1994; 5(12): 1509– 1513.

25. Belichenko PV, Dahlström A. Studies on the 3- dimensional architecture of dendritic spines and varicosities in human cortex by confocal laser scanning microscopy and Lucifer yellow microinjections. J Neurosci Methods 1995; 57(1): 55– 61.

26. Percy AK. Neurochemistry of the Rett syndrome. Brain Dev 1992; 14 (Suppl): S57– S62.

27. Wenk GL, Hauss‑ Wegrzyniak B. Altered cholinergic function in the basal forebrain of girls with Rett syndrome. Neuropediatrics 1999; 30(3): 125– 129.

28. Wenk GL. Alterations in dopaminergic function in Rett syndrome. Neuropediatrics 1995; 26(2): 123– 125.

29. Matsuishi T, Nagamitsu S, Yamashita Y, Murakami Y, Kimura A, Sakai T et al. Decreased cerebrospinal fluid levels of substance P in patients with Rett syndrome. Ann Neurol 1997; 42(6): 978– 981.

30. Lappalainen R, Lindholm D, Riikonen R. Low levels of nerve growth factor in cerebrospinal fluid of children with Rett syndrome. J Child Neurol 1996; 11(4): 296– 300.

31. Hamberger A, Gillberg C, Palm A, Hagberg B. Elevated CSF glutamate in Rett syndrome. Neuropediatrics 1992; 23(4): 212– 213.

32. Lappalainen R, Liewendahl K, Sainio K, Nikkinen P, Riikonen RS. Brain perfusion SPECT and EEG findings in Rett syndrome. Acta Neurol Scand 1997; 95(1): 44– 50.

33. Nielsen JB, Toft PB, Reske-Nielsen E, Jensen KE, Christiansen P, Thomsen C et al. Cerebral magnetic resonance spectroscopy in Rett syndrome. Failure to detect mitochondrial disorder. Brain Dev 1993; 15(2): 107– 112.

34. Yoshikawa H, Fueki N, Suzuki H, Sakuragawa N, Iio M. Cerebral blood flow and oxygen metabolism in the Rett syndrome. Brain Dev 1992; 14 (Suppl): S69– S74.

35. Ellaway CJ, Sholler G, Leonard H, Christodoulou J. Prolonged QT interval in Rett syndrome. Arch Dis Child 1999; 80(5): 470– 472.

36. Kálmánchey R. Evoked potentials in the Rett syndrome. Brain Dev 1990; 12(1): 73– 76.

37. Bader GG, Witt- Engerström I, Hagberg B. Neurophysiological findings in the Rett syndrome, I: EMG, conduction velocity, EEG and somatosensory- evoked potential studies. Brain Dev 1989; 11(2): 102– 109.

38. Glaze DG. Neurophysiology of Rett syndrome. J Child Neurol 2005; 20(9): 740– 746.

39. Oslejskova H, Dusek L, Makovska Z, Rektor I. Epilepsia, epileptiform abnormalities, non‑right– handedness, hypotonia and severe decreased IQ are associated with language impairment in autism. Epileptic Disord 2007; 9 (Suppl 1): S9– S18.

40. Ošlejšková H, Dušek L, Makovská Z, Dujíčková E, Austrata R, Šlapák I. Výskyt epileptických záchvatů a/ nebo epileptiformní EEG abnormity u dětí s dětským a atypickým autizmem. Cesk Slov Neurol N 2008; 71/ 104(4): 435– 444.

41. Reinhold JA, Molloy CA, Manning- Courtney P. Electroencephalogram abnormalities in children with autism spectrum disorders. J Neurosci Nurs 2005; 37(3): 136– 138.

42. Moser SJ, Weber P, Lütschg J. Rett syndrome: clinical and electrophysiologic aspects. Pediatr Neurol 2007; 36(2): 95– 100.

43. Kriaucionis S, Bird A. The major form of MeCP2 has a novel N‑terminus generated by alternative splicing. Nucleic Acids Res 2004; 32(5): 1818– 1823.

44. Mnatzakanian GN, Lohi H, Munteanu I, Alfred SE, Yamada T, MacLeod PJ et al. A previously unidentified MECP2 open reading frame defines a new protein isoform relevant to Rett syndrome. Nat Genet 2004; 36(4): 339– 341.

45. Lewis JD, Meehan RR, Henzel WJ, Maurer- Fogy I, Jeppesen P, Klein F et al. Purification, sequence, and cellular localization of a novel chromosomal protein that binds to methylated DNA. Cell 1992; 69(6): 905– 914.

46. Nan X, Meehan RR, Bird A. Dissection of the methyl- CpG binding domain from the chromosomal protein MeCP2. Nucleic Acids Res 1993; 21(21): 4886– 4892.

47. Galvão TC, Thomas JO. Structure‑specific binding of MeCP2 to four- way junction DNA through its methyl CpG‑binding domain. Nucleic Acids Res 2005; 33(20): 6603– 6609.

48. Harikrishnan KN, Chow MZ, Baker EK, Pal S, Bassal S,Brasacchio D et al. Brahma links the SWI/ SNF chromatin‑remodeling complex with MeCP2- dependent transcriptional silencing. Nat Genet 2005; 37(3): 254– 264.

49. Jones PL, Veenstra GJ, Wade PA, Vermaak D, Kass SU, Landsberger N et al. Methylated DNA and MeCP2 recruit histone deacetylase to repress transcription. Nat Genet 1998; 19(2): 187– 191.

50. Nan X, Ng HH, Johnson CA, Laherty CD, Turner BM, Eisenman RN et al. Transcriptional repression by the methyl- CpG‑binding protein MeCP2 involves a histone deacetylase complex. Nature 1998; 393(6683): 386– 389.

51. Nan X, Campoy FJ, Bird A. MeCP2 is a transcriptional repressor with abundant binding sites in genomic chromatin. Cell 1997; 88(4): 471– 481.

52. Jeffery L, Nakielny S. Components of the DNA methylation system of chromatin control are RNA‑binding proteins. J Biol Chem 2004; 279(47): 49479– 49487.

53. Young JI, Hong EP, Castle JC, Crespo‑Barreto J, Bowman AB, Rose MF et al. Regulation of RNA splicing by the methylation– dependent transcriptional repressor methyl- CpG binding protein 2. Proc Natl Acad Sci U S A 2005; 102(49): 17551– 17558.

54. Buschdorf JP, Strätling WH. A WW domain binding region in methyl- CpG‑binding protein MeCP2: impact on Rett syndrome. J Mol Med 2004; 82(2): 135– 143.

55. Jung BP, Jugloff DG, Zhang G, Logan R, Brown S, Eubanks JH. The expression of methyl CpG binding factor MeCP2 correlates with cellular differentiation in the developing rat brain and in cultured cells. J Neurobio­l 2003; 55(1): 86– 96.

56. Smrt RD, Eaves- Egenes J, Barkho BZ, Santistevan NJ, Zhao C, Aimone JB et al. Mecp2 deficiency leads to delayed maturation and altered gene expression in hippocampal neurons. Neurobio­l Dis 2007; 27(1): 77– 89.

57. Amir RE, Fang P, Yu Z, Glaze DG, Percy AK, Zoghbi HY et al. Mutations in exon 1 of MECP2 are a rare cause of Rett syndrome. J Med Genet 2005; 42(2): e15.

58. Trappe R, Laccone F, Cobilanschi J, Meins M, Huppke P, Hanefeld F et al. MECP2 mutations in sporadic cases of Rett syndrome are almost exclusively of paternal origin. Am J Hum Genet 2001; 68(5): 1093– 1101.

59. Wan M, Lee SS, Zhang X, Houwink- Manville I, Song HR, Amir RE et al. Rett syndrome and beyond: recurrent spontaneous and familial MECP2 mutations at CpG hotspots. Am J Hum Genet 1999; 65(6): 1520– 1529.

60. Matijevic T, Knezevic J, Slavica M, Pavelic J. Rett syndrome: from the gene to the disease. Eur Neurol 2009; 61(1): 3– 10.

61. Huppke P, Held M, Hanefeld F, Engel W, Laccone F.Influence of mutation type and location on phenotype in 123 patients with Rett syndrome. Neuropediatrics 2002; 33(2): 63– 68.

62. Charman T, Neilson TC, Mash V, Archer H, Gardiner MT, Knudsen GP et al. Dimensional phenotypic analysis and functional categorisation of mutations reveal novel genotype- phenotype associations in Rett syndrome. Eur J Hum Genet 2005; 13(10): 1121– 1130.

63. Weaving LS, Williamson SL, Bennetts B, Davis M, Ellaway CJ, Leonard H et al. Effects of MECP2 mutation type, location and X- inactivation in modulating Rett syndrome phenotype. Am J Med Genet A 2003; 118A(2): 103– 114.

64. Bebbington A, Anderson A, Ravine D, Fyfe S, Pineda M, de Klerk N et al. Investigating genotype– phenotype relationships in Rett syndrome using an international data set. Neurology 2008; 70(11): 868– 875.

65. Neul JL, Fang P, Barrish J, Lane J, Caeg EB, Smith EO et al. Specific mutations in methyl- CpG‑binding protein 2 confer different severity in Rett syndrome. Neurology 2008; 70(16): 1313– 1321.

66. Takahashi S, Ohinata J, Makita Y, Suzuki N, Araki A,Sasaki A et al. Skewed X chromosome inactivation failed to explain the normal phenotype of a carrier female with MECP2 mutation resulting in Rett syndrome. Clin Genet 2008; 73(3): 257– 261.

67. Xinhua B, Shengling J, Fuying S, Hong P, Meirong L, Wu XR. X chromosome inactivation in Rett Syndrome and its correlations with MECP2 mutations and phenotype. J Child Neurol 2008; 23(1): 22– 25.

68. Schwartzman JS, Bernardino A, Nishimura A, Gomes RR, Zatz M. Rett syndrome in a boy with a 47,XXY karyotype confirmed by a rare mutation in the MECP2 gene. Neuropediatrics 2001; 32(3): 162– 164.

69. Topçu M, Akyerli C, Sayi A, Törüner GA, Koçoğlu SR, Cimbiş M et al. Somatic mosaicism for a MECP2 mutation associated with classic Rett syndrome in a boy. Eur J Hum Genet 2002; 10(1): 77– 81.

70. Carney RM, Wolpert CM, Ravan SA, Shahbazian M,Ashley-Koch A, Cuccaro ML et al. Identification of MeCP2 mutations in a series of females with autistic disorder. Pediatr Neurol 2003; 28(3): 205– 211.

71. Couvert P, Bienvenu T, Aquaviva C, Poirier K, Moraine C, Gendrot C et al. MECP2 is highly mutated in X‑linked mental retardation. Hum Mol Genet 2001; 10(9): 941– 946.

72. Klauck SM, Lindsay S, Beyer KS, Splitt M, Burn J, Poustka A. A mutation hot spot for nonspecific X‑linked mental retardation in the MECP2 gene causes the PPM- X syndrome. Am J Hum Genet 2002; 70(4): 1034– 1037.

73. Watson P, Black G, Ramsden S, Barrow M, Super M, Kerr B et al. Angelman syndrome phenotype associated with mutations in MECP2, a gene encoding a methyl CpG binding protein. J Med Genet 2001; 38(4): 224– 228.

74. Mari F, Azimonti S, Bertani I, Bolognese F, Colombo E, Caselli R et al. CDKL5 belongs to the same molecular pathway of MeCP2 and it is responsible for the early- onset seizure variant of Rett syndrome. Hum Mol Genet 2005; 14(14): 1935– 1946.

75. Scala E, Ariani F, Mari F, Caselli R, Pescucci C, Longo I et al. CDKL5/ STK9 is mutated in Rett syndrome variant with infantile spasms. J Med Genet 2005; 42(2): 103– 107.

76. Tao J, Van Esch H, Hagedorn- Greiwe M, Hoffmann K, Moser B, Raynaud M et al. Mutations in the X‑linked cyclin‑dependent kinase‑like 5 (CDKL5/ STK9) gene are associated with severe neurodevelopmental retardation. Am J Hum Genet 2004; 75(6): 1149– 1154.

77. Weaving LS, Christodoulou J, Williamson SL, Friend KL, McKenzie OL, Archer H et al. Mutations of CDKL5 cause a severe neurodevelopmental disorder with infantile spasms and mental retardation. Am J Hum Genet 2004; 75(6): 1079– 1093.

78. Kalscheuer VM, Tao J, Donnelly A, Hollway G, Schwinger E, Kübart S et al. Disruption of the serine/ threonine kinase 9 gene causes severe X‑linked infantile spasms and mental retardation. Am J Hum Genet 2003; 72(6): 1401– 1411.

79. Huopaniemi L, Tyynismaa H, Rantala A, Rosenberg T, Alitalo T. Characterization of two unusual RS1 gene deletions segregating in Danish retinoschisis families. Hum Mutat 2000; 16(4): 307– 314.

80. Montini E, Andolfi G, Caruso A, Buchner G, Walpole SM, Mariani M et al. Identification and characterization of a novel serine- threonine kinase gene from the Xp22 region. Genomics 1998; 51(3): 427– 433.

81. Bertani I, Rusconi L, Bolognese F, Forlani G, Conca B, De Monte L et al. Functional consequences of mutations in CDKL5, an X‑linked gene involved in infantile spasms and mental retardation. J Biol Chem 2006; 281(42): 32048– 32056.

82. Lin C, Franco B, Rosner MR. CDKL5/ Stk9 kinase inactivation is associated with neuronal developmental disorders. Hum Mol Genet 2005; 14(24): 3775– 3786.

83. Ariani F, Hayek G, Rondinella D, Artuso R, Mencarelli MA, Spanhol- Rosseto A et al. FOXG1 is responsible for the congenital variant of Rett syndrome. Am J Hum Genet 2008; 83(1): 89– 93.

84. Mencarelli M, Spanhol- Rosseto A, Artuso R, Rondinella D, De Filippis R, Bahi- Buisson N et al. Novel FOXG1 mutations associated with the congenital variant of Rett syndrome. J Med Genet 2009. Epub ahead of print.

85. Papa FT, Mencarelli MA, Caselli R, Katzaki E, Sampieri K, Meloni I et al. A 3 Mb deletion in 14q12 causes severe mental retardation, mild facial dysmorphisms and Rett‑like features. Am J Med Genet A 2008; 146A(15): 1994– 1998.

86. Tan K, Shaw AL, Madsen B, Jensen K, Taylor- Papadimitriou J, Freemont PS. Human PLU- 1 Has transcriptional repression properties and interacts with the developmental transcription factors BF- 1 and PAX9. J Biol Chem 2003; 278(23): 20507– 20513.

87. Yao J, Lai E, Stifani S. The winged- helix protein brain factor 1 interacts with groucho and hes proteins to repress transcription. Mol Cell Biol 2001; 21(6): 1962– 1972.

88. Nakashiba T, Ikeda T, Nishimura S, Tashiro K, Honjo T, Culotti JG et al. Netrin‑G1: a novel glycosyl phosphatidylinositol‑linked mammalian netrin that is functionally divergent from classical netrins. J Neurosci 2000; 20(17): 6540– 6550.

89. Nakashiba T, Nishimura S, Ikeda T, Itohara S. Complementary expression and neurite outgrowth activity of netrin‑G subfamily members. Mech Dev 2002; 111(1– 2): 47– 60.

90. Borg I, Freude K, Kübart S, Hoffmann K, Menzel C, Laccone F et al. Disruption of Netrin G1 by a balanced chromosome translocation in a girl with Rett syndrome. Eur J Hum Genet 2005; 13(8): 921– 927.

91. Budden SS. Management of Rett syndrome: a ten year experience. Neuropediatrics 1995; 26(2): 75– 77.

92. Ellaway C, Williams K, Leonard H, Higgins G, Wilcken B, Christodoulou J. Rett syndrome: randomized controlled trial of L- carnitine. J Child Neurol 1999; 14(3): 162– 167.

93. Ellaway CJ, Peat J, Williams K, Leonard H, Christodoulou J. Medium‑term open label trial of L– carnitine in Rett syndrome. Brain Dev 2001; 23 (Suppl 1): S85– S89.

94. Plioplys AV, Kasnicka I. L- carnitine as a treatment for Rett syndrome. South Med J 1993; 86(12): 1411– 1412.

95. Egger J, Hofacker N, Schiel W, Holthausen H. Magnesium for hyperventilation in Rett‘s syndrome. Lancet 1992; 340(8819): 621– 622.

96. McArthur AJ, Budden SS. Sleep dysfunction in Rett syndrome: a trial of exogenous melatonin treatment. Dev Med Child Neurol 1998; 40(3): 186– 192.

97. Williamson SL, Christodoulou J. Rett syndrome: new clinical and molecular insights. Eur J Hum Genet 2006; 14(8): 896– 903.

98. Weaving LS, Ellaway CJ, Gécz J, Christodoulou J. Rett syndrome: clinical review and genetic update. J Med Genet 2005; 42(1): 1– 7.

99. Rosipal R, Zeman J, Hadac J, Misovicova N, Nevsimalova S, Martasek P. Analysis of the most frequent mutations in girls with Rett syndrome. Cas Lek Cesk 2001; 140(15): 473– 476.

100. Zahorakova D, Rosipal R, Hadac J, Zumrova A, Bzduch V, Misovicova N et al. Mutation analysis of the MECP2 gene in patients of Slavic origin with Rett syndrome: novel mutations and polymorphisms. J Hum Genet 2007; 52(4): 342– 348.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 6

2009 Issue 6

Most read in this issue
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#