Hi again to my readers. I’ve been off the blog for awhile as I decided first semester after I had surgery was enough with teaching. I felt I needed to take a break from many things. But I’m back and happy to be picking up some of the fun stuff, like writing, that I missed while taking my break.
My feet hurt. Probably if I’d sit and teach instead of my hyperactive movements around the classroom, they wouldn’t feel so swollen at the end of the day. I was sitting here thinking about this when I made an association (my brain is still functional at the end of the day, just not my feet) to a genetic disorder with an interesting name, Charcot-Marie-Tooth syndrome.
With an unusual name, Charcot-Marie-Tooth is not an unusual disease. The odd name comes from the three physicians, Jean-Martin Charcot, Pierre Marie, and Howard Henry Tooth who discovered and characterized the disease in 1886. Charcot-Marie-Tooth disease is the most common inherited disorder that involves the peripheral nerves, affecting an estimated 150,000 people in the United States. It occurs in all races and ethnic groups. Worldwide, this disorder affects about 1 in 3,300 people.
CMT is a neuro-muscular degenerative disease where the affected individual slowly loses normal use of their feet, legs, hands and arms due to deterioration of peripheral nerves. Peripheral nerves control movement by relaying impulses from the spinal cord to our muscles. CMT is also referred as hereditary motor and sensory neuropathies (HMSN), and are a group of genetically heterogeneous diseases (meaning that CMT can arise by a variety of different mutations in different genes) of the peripheral nervous system. As nerves break down, the muscles become weakened due to the loss of stimulation of affected nerves.
The characteristic symptoms are 1. Foot-Drop Walking Gait, 2. Foot bone abnormalities, 3. High arches and hammertoes, 4. Problems with balance, 5. Problems with hand function, 6. Occasional lower leg and forearm muscle cramping, 7. Loss of some normal reflexes, 8. Scoliosis and 9. Breathing difficulties.
CMT patients with foot bone abnormalities, including high arches.
Hammertoes: 
At last count, there are multiple different mutations in multiple different genes on various chromosomes that can cause this disorder. Type X CMT is caused by mutations in a gene on the X chromosome. Type 1 CMT disease is characterized by abnormalities in myelin, the protective substance that covers nerve cells. Type 2 CMT is characterized by abnormalities in the fiber, or axon, that extends from a nerve cell and transmits nerve impulses. In intermediate forms of Charcot-Marie-Tooth disease, abnormalities occur in axons and myelin. Type 4 Charcot-Marie-Tooth disease affects either the axon or myelin. Types 1, 2, 4, and intermediate forms are further categorized by subtypes (such as 1A, 2A, 4A). Subtypes are distinguished by the specific gene that is altered.
One specific gene that produces CMT is the BSCL2 gene, which stands for Berardinelli-Seip congenital lipodystrophy type 2. This mutation changes one of the protein building blocks (amino acids) used to make seipin. Specifically, the amino acid asparagine is replaced with the amino acid serine at protein position 88. The mutation probably alters the structure of this protein with no known function, causing it to fold into an incorrect 3-dimensional shape. Research findings indicate that misfolded seipin proteins accumulate in the endoplasmic reticulum. This accumulation likely damages and kills motor neurons, which leads to muscle weakness in the arms and legs.
Another gene, producing type 1B CMT produces “myelin protein zero” or MPZ. MPZ is the gene’s official symbol. It produces a protein that is the most abundant protein in the myelin sheath, the covering that protects nerve axons and promotes the efficient transmission of nerve impulses. To understand this, think of myelin as a type of electrical tape. Without the tape, electrical current can arc to other metals and not arrive at its appropriate destination.
Specialized cells called Schwann cells are the only cells that make myelin protein zero. Schwann cells are part of the peripheral nervous system that connects the brain and spinal cord to muscles and to sensory cells that detect sensations such as touch, pain, heat, and sound. Myelin protein zero is required for the proper formation and maintenance of myelin. This protein acts like a molecular glue (adhesion molecule) and plays a role in tightly packing the myelin (myelin compaction).
From inside Schwann cells, myelin protein zero is inserted through the cell membrane, the structure that encloses a cell. One end of the protein remains inside the cell and is called the intracellular domain. The other end of the protein pokes through the membrane to the outside of the cell; this part of the protein is called the extracellular domain. The extracellular domain interacts with other substances that make up the myelin sheath. The section of myelin protein zero that spans the cell membrane is called the transmembrane domain. Here is a gene map of MPZ.
The MPZ gene is located on the long (q) arm of chromosome 1 at position 22. More precisely, the MPZ gene is located from base pair 159,541,148 to base pair 159,546,367 on chromosome 1.

A third gene involves one type of kinesin, a microtubular motor that moves toward the positive end of microtubules. Recall that microtubules are necessary for movement of cell organelles (they are like train tracks and the kinesins and dyneins are the engines) and cell division.
Researchers have identified more than 100 MPZ mutations that cause a form of Charcot-Marie-Tooth known as type 1B. Many of these mutations alter the extracellular domain by replacing one of the building blocks (amino acids) in myelin protein zero with an incorrect amino acid. Other MPZ mutations lead to a protein that is missing one or more amino acids. The altered myelin protein zero probably cannot interact properly with other myelin components, which may disrupt the formation and maintenance of the myelin sheath. As a result, peripheral nerve cells cannot activate muscles used for movement or relay information from sensory cells back to the brain, causing the signs and symptoms of type 1B Charcot-Marie-Tooth disease.
A third gene involves one type of kinesin, a microtubular motor that moves toward the positive end of microtubules. Recall that microtubules are necessary for movement of cell organelles (they are like train tracks and the kinesins and dyneins are the engines) and cell division. The rapid transport of organelles, like vesicles and mitochondria, along the axons of neurons takes place along microtubules with their plus ends pointed toward the end of the axon. Since the motors are kinesins, the CMT mutations that occur in this gene impair the ability of the nerve cell to communicate properly with the muscle.
Depending upon the mutation, and due to the fact that a variety of genes are involved, inheritance of CMT can occur in a variety of ways. There is Autosomal Dominant inheritance, which produces the most common form of CMT. There are also autosomal recessive and X-linked inheritance patterns.
With the number of various mutations producing the disease, we find a variety of presentations of the disease so there are many forms of the CMT disease. The severity of symptoms is quite variable in different patients and some people may never realize they have the disorder. CMT is not fatal and people with most forms of CMT have a normal life expectancy.
References:
”An Overview of Charcot-Marie-Tooth Disorders.” Charcot-Marie-Tooth Association -CMTA. http://www.charcot-marie-tooth.org
Godwin, Mike. “File:Charcot-Marie-Tooth foot.jpg -Wikimedia Commons.” Wikimedia Commons. 20 Feb. 2009.
Harris, Nick. “Foot Clinic -A2FWiki.” Ankle Foot Clinic - A2F Wiki. 20 Feb. 2009