A five-year experience with fragile X testing. Setting laboratory standards of practice and a cost-effective protocol

A 6-year experience demonstrates the utility of screening for both cytogenetic and FMR-1 abnormalities in patients with mental retardation

Cytogenetic abnormalities were found in 81 of 2,757 cases (2.93%) screened for both cytogenetic and FMR-1 mutations because of mental retardation from 1992 to 1997. Of these, 38 (46.9%) were unbalanced autosomal abnormalities, 23 (28.4%) sex chromosomal abnormalities, and 20 (24.7%) balanced autosomal rearrangements. Five subtle deletions were found, of which three involved the long arm of chromosome 7 (7q22-q31.1). Although a high-resolution banding method was used for screening, we concluded that a banding level of 450-550, generally achieved in routine analysis, was sufficient to detect all of these abnormalities. Fragile-X DNA studies revealed CGG expansion mutations in 72 other cases (2.61%). Of the abnormals, 36 (50%) were males and 8 (11.1%) females with full mutations, and 12 (16.7%) were males and 16 (22.2%) females with premutations. Together, our cytogenetic and DNA screening gave 5.5% abnormal results. In this report, these findings are compared with similar surveys of 3,940 subjects from five previous studies. From the combined data of 6,697 cases, this testing approach should reveal nearly equal numbers of cytogenetic and fragile X abnormalities in approximately 6-7% of subjects. It is productive, cost-effective, and consistent with American College of Medical Genetics (ACMG) guidelines for screening of mentally handicapped individuals.