Charcot–Marie–Tooth disease: frequency of genetic subtypes and guidelines for genetic testing
- Sinead M Murphy1,2,3,
- Matilde Laura1,2,
- Katherine Fawcett4,5,
- Amelie Pandraud1,2,
- Yo-Tsen Liu1,2,
- Gabrielle L Davidson1,2,
- Alexander M Rossor1,2,
- James M Polke3,
- Victoria Castleman1,2,
- Hadi Manji1,2,
- Michael P T Lunn1,2,
- Karen Bull1,2,
- Gita Ramdharry1,2,
- Mary Davis4,5,
- Julian C Blake6,7,8,
- Henry Houlden1,2,
- Mary M Reilly1,2
- 1MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
- 2Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- 3Department of Neurology, Adelaide and Meath Hospitals Dublin, Incorporating the National Children's Hospital, Tallaght, Dublin, Ireland
- 4Neurogenetics Unit, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
- 5Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- 6Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
- 7Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
- 8Department of Clinical Neurophysiology, Norfolk and Norwich University Hospital, Norwich, UK
- Correspondence to Professor M M Reilly, MRC Centre for Neuromuscular Disease, National Hospital for Neurology and Neurosurgery, 8–11 Queen Square, London WC1N 3BG, UK;
Contributors SMM wrote the first draft, and collected and analysed the data. ML, KF, AP, Y-TL, GLD, AMR, JMP, VC, HM, MPTL, KB and GR collected and analysed the data, and edited drafts of the manuscript. MD was involved in study conception, analysed the data and edited drafts of the manuscript. JCB, HH and MMR were involved in study conception, collected and analysed the data, and edited drafts of the manuscript.
- Received 6 February 2012
- Revised 13 April 2012
- Accepted 14 April 2012
- Published Online First 10 May 2012
Background Charcot–Marie–Tooth disease (CMT) is a clinically and genetically heterogeneous group of diseases with approximately 45 different causative genes described. The aims of this study were to determine the frequency of different genes in a large cohort of patients with CMT and devise guidelines for genetic testing in practice.
Methods The genes known to cause CMT were sequenced in 1607 patients with CMT (425 patients attending an inherited neuropathy clinic and 1182 patients whose DNA was sent to the authors for genetic testing) to determine the proportion of different subtypes in a UK population.
Results A molecular diagnosis was achieved in 62.6% of patients with CMT attending the inherited neuropathy clinic; in 80.4% of patients with CMT1 (demyelinating CMT) and in 25.2% of those with CMT2 (axonal CMT). Mutations or rearrangements in PMP22, GJB1, MPZ and MFN2 accounted for over 90% of the molecular diagnoses while mutations in all other genes tested were rare.
Conclusion Four commonly available genes account for over 90% of all CMT molecular diagnoses; a diagnostic algorithm is proposed based on these results for use in clinical practice. Any patient with CMT without a mutation in these four genes or with an unusual phenotype should be considered for referral for an expert opinion to maximise the chance of reaching a molecular diagnosis.
Funding MMR is grateful to the Medical Research Council (MRC) and the Muscular Dystrophy Campaign, and SMM, ML and MMR are grateful to the NINDS/ORD (1U54NS065712-01) for their support. Y-TL is grateful to the Ministry of Education, Taiwan, Republic of China, for scholarship support. AP is grateful to CMTUK for funding support. This work was undertaken at University College London Hospitals/University College London, which received a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme.
Competing interests None.
Ethics approval Ethics approval was provided by the National Hospital for Neurology and Neurosurgery Research Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.