Menkes disease (MD) is a rare and severe X-linked recessive disorder of copper metabolism. The MD gene, ATP7A (ATPase Cuϩϩ transporting alpha polypeptide), encodes an ATPdependent copper-binding membrane protein. In this report, we describe a girl with typical clinical features of MD, carrying a balanced translocation between the chromosomes X and 16 producing the disruption of one copy of ATP7A gene and the silencing of the other copy because of the chromosome X inactivation. Fluorescence in situ hybridization experiments with bacterial derived artificial chromosome probes revealed that the breakpoints were located within Xq13.3 and 16p11.2. Replication pattern analysis demonstrated that the normal X chromosome was late replicating and consequently inactivated, whereas the der(X)t(X;16), bearing the disrupted ATP7A gene, was active. An innovative approach, based on FMR1 (fragile X mental retardation 1) gene polymorphism, has been used to disclose the paternal origin of the rearrangement providing a new diagnostic tool for determining the parental origin of defects involving the X chromosome and clarifying the mechanism leading to the cytogenetic rearrangement that occurred in our patient.
Menkes disease (MD) is a recessive X-linked syndrome described by Menkes (1) more than 40 y ago. It is characterized by progressive cerebral and cerebellar degeneration, growth retardation, and peculiar scalp hair (2). The incidence is 1/250,000 (ORPHA565, http://www.orpha.net) and, in most of the cases, it is responsible for death before 3 y of age. Patients with MD have been found to have a defect in copper metabolism and low levels of serum copper and ceruloplasmin (3). MD phenotype is due to mutations occurring in the ATP7A (ATPase Cuϩϩ transporting alpha polypeptide) gene, which encodes an ATP-dependent membrane protein (4) that regulates the release of Cu ions at the outer cell membrane, affecting the amount of copper-loaded enzymes, as ceruloplasmin and metallothionein (5).Diagnosis can be established by detecting low levels of copper and ceruloplasmin in the serum, and high levels in cutaneous fibroblasts. The diagnosis can be confirmed by identification of the gene mutations. Genetic analysis also allows screening of carrier females, who may have patches with cutaneous and hair anomalies, and prenatal diagnosis through chorionic villus sampling.Because MD is X-linked recessive, affected females are very rare. So far, only eight cases have been described in literature and cytogenetic studies have been reported only in five cases (Table 1): one displayed a mosaicism 45,X/46,XX and the remaining four showed a de novo balanced translocation between the chromosome X and an autosome. The breakpoint on the X chromosome is Xq13 where the gene ATP7A has been mapped.In this article, we describe a female with MD carrying a balanced translocation between the chromosomes X and 16 producing the disruption of one copy of ATP7A gene and silencing of the other copy. Moreover, the late-replicating chromosome X has been inve...