Fragile X Syndrome

 

Fragile X syndrome is one of the most common inherited causes of cognitive impairment. This condition is known to be caused by a trinucleotide (CGG) repeat expansion in the 5’ untranslated region of the FMR1 gene located on the X chromosome.

 

FMR1 repeat expansion mutations are classified as follows:

<40 CGG repeats: Normal.
59-199 CGG repeats: Premutation
>200 CGG repeats: Full Mutation.
 
As this is an X-linked condition, males with a full mutation expansion nearly always have features of mild to severe cognitive impairment, autistic-like behavior, ADHD, speech delay and characteristic facial features. Females with a full mutation may exhibit a spectrum of clinical findings from mild to moderate cognitive impairment, which can be variable due to X-inactivation. Males with premutation range expansions are at increased risk of fragile X-associated tremor/ataxia syndrome (FXTAS). Female premutation carriers are at increased risk for premature ovarian failure.
 

REASONS FOR REFERRAL:

  • Child with unexplained developmental delay, cognitive impairment or a diagnosis of autism.
  • Carrier testing for at-risk relatives.
  • Women with unexplained premature ovarian failure.
  • Prenatal carrier testing for women with a family history of fragile X syndrome.
 

GENETICS CENTER FRAGILE X TESTING METHODS:

  • Polymerase chain reaction is performed to amplify the 5’ untranslated region of FMR1. The PCR products are detected using capillary electrophoresis. Patients with full mutation results (>200 CGG repeats) are reflexed to Southern blot analysis in order to clarify repeat size and determine methylation status of the expanded allele.
 

TURN AROUND TIME:

  • 6 days
 

SPECIMEN REQUIREMENTS AND SHIPPING/HANDLING:

  • Blood: A single tube with 1-5 mL whole blood in EDTA (lavender top).
    • Shipping: Store blood at 4°C until shipment. Ship at ambient temperature in an insulated container via overnight delivery within 96 hours of collection.
 

Send to:

Genetics Center
211. S Main Street
Suite AA
Orange, CA 92868
Tel: (714)288-3500
 

REQUIRED FORMS:

 

TEST LIMITATIONS:
The test interpretation is based on the clinical and family information provided and the current understanding of the molecular genetics of fragile X syndrome. The more rare forms of mutations (deletion or single nucleotide substitution) in the coding region of the FMR1 gene are not examined in this assay.

 

CPT CODES:

  • 83891, 83894, 83896, 83900, 83909, 88291.