Abnormal elevation ofFMR1mRNA is associated with psychological symptoms in individuals with the fragile X premutation

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Abstract
Until recently, individuals with premutation alleles (55–200 CGG repeats) of the fragile X mental retardation 1 (FMR1) gene were believed to be psychologically unaffected. However, the recent documentation of abnormal elevation ofFMR1mRNA, discovery of fragile X‐associated tremor/ataxia syndrome (FXTAS), and reports of psychiatric disorders in children and adults with the premutation have suggested a pathogenic gene–brain–behavior mechanism. In a large collaborative study, 68 men and 144 women with theFMR1premutation completed a psychological symptoms checklist andFMR1genetic testing, including determination of CGG repeat size, percentage ofFMR1protein (FMRP)‐positive lymphocytes, andFMR1mRNA levels. Relative to published norms, men and women with FXTAS symptoms reported higher levels of several types of psychological symptoms. In addition, men and women with the premutation and no overt evidence of FXTAS reported higher levels of obsessive‐compulsive symptoms. ElevatedFMR1mRNA, but not CGG repeat size or reduced FMRP (as measured by immunocytochemistry), was significantly associated with increased psychological symptoms, predominantly obsessive‐compulsive symptoms and psychoticism, in premutation men with and without FXTAS symptoms. There was no relationship between CGG repeat size,FMR1mRNA or FMRP and psychological symptoms in premutation women unless the sample was restricted to those with skewed X‐activation ratio toward >50% active premutation alleles. The results of this study support the hypothesis thatFMR1function is associated with psychological difficulties in individuals with the premutation, and provide evidence concordant with an RNA toxic gain‐of‐function model in a neuropsychiatric phenotype.