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NEUROLOGY 2009;72:1242-1247
© 2009 American Academy of Neurology

The common BDNF polymorphism may be a modifier of disease severity in Rett syndrome

B. Ben Zeev, MD, A. Bebbington, BSc, G. Ho, MSc, H. Leonard, MBChB, N. de Klerk, PhD, E. Gak, PhD, M. Vecksler, MSc and J. Christodoulou, PhD

From the Pediatric Neurology Unit, Safra Pediatric Hospital (B.B.Z.), and Sagol Neuroscience Center (E.G.), Sheba Medical Center, Ramat-Gan, Israel; Telethon Institute for Child Health Research (A.B., H.L., N.d.K.), Centre for Child Health Research, University of Western Australia; NSW Centre for Rett Syndrome Research (G.H., J.C.), Children’s Hospital at Westmead, Sydney, Australia; Department of Molecular Genetics and Biochemistry (E.G., M.V.), Sackler Medical School, Tel-Aviv University, Israel; and Disciplines of Paediatrics & Child Health and Genetic Medicine (G.H., J.C.), University of Sydney, Australia.

Address correspondence and reprint requests to Dr. Helen Leonard, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Australia

Background: Rett syndrome (RTT) is caused by mutations in the transcriptional repressor methyl CpG-binding protein 2 (MECP2). Brain-derived neurotrophic factor (BDNF) is a neurotrophic factor playing a major role in neuronal survival, neurogenesis, and plasticity, and it has been shown that BDNF expression is regulated by MeCP2 through a complex interaction. A common polymorphism of BDNF (Val66Met [p.V66M]) has been found to correlate with severity and course of several neuropsychiatric disorders.

Methods: We examined the association between disease severity score, assessed by the modified Percy score, and BDNF polymorphism, using regression methods, in 125 mutation-positive patients with RTT from the Australian Rett Syndrome Database and an Israeli cohort.

Results: Those who were heterozygous (Val/Met) had slightly more severe disease than those who were homozygous for the wild-type (Val/Val) BDNF polymorphism (increased severity score 2.1, p = 0.09). In those with p.R168X, a commonly occurring MECP2 mutation in RTT, there was a 6-point increase in severity score for those who were heterozygous for the BDNF polymorphism, both unadjusted (p = 0.02) and adjusted for age (p = 0.03). Individuals with the p.R168X mutation and heterozygous for the BDNF polymorphism were also at an increased risk of seizure onset (hazard ratio 5.3, 95% confidence interval 1.6–17.7) compared with those homozygous for the wild-type BDNF allele.

Conclusions: In addition to mutation type and degree of X-chromosome skewing, the common brain-derived neurotrophic factor (BDNF) polymorphism appears to be another genetic modifier of Rett syndrome (RTT) severity. This suggests that BDNF function may play a significant role in the pathogenesis of RTT.

ARSD = Australian Rett Syndrome Database; BDNF = brain-derived neurotrophic factor; CI = confidence interval; HR = hazard ratios; MECP2 = methyl CpG-binding protein 2; Met = methionine; NAA = N-acetylaspartate; RTT = Rett syndrome; Val = valine.

hleonard{at}ichr.uwa.edu.au

Supported by the NIH (5R01HD043100-05) (major aspects of the Australian Rett Syndrome program) and National Medical and Health Research Council (NHMRC) project grant 303189 (certain clinical aspects). The international Rett Syndrome Research Program through which the Israeli data were accessed is funded by the International Rett Syndrome Foundation. H.L. is funded by a NHMRC program grant (353514) and J.C. is funded by NHMRC project grants (346603 and 457238) and the Rett Syndrome Australian Research Fund.

Disclosure: The authors report no disclosures.

Received July 31, 2008. Accepted in final form December 30, 2008.






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