Charcot-Marie-Tooth (CMT) neuropathies are amongst the most common inherited diseases in neurology. While great strides have been made to identify the genesis of these diseases, a diagnostic gap of 30-60% remains. Classic models of genetic causation may be limited to fully close this gap and, thus, we review the current state and future role of alternative, non-Mendelian forms of genetics in CMT. Promising synergies exist to further define the full genetic architecture of inherited neuropathies, including affordable whole-genome sequencing, increased data aggregation and clinical collaboration, improved bioinformatics and statistical methodology, and vastly improved computational resources. Given the recent advances in genetic therapies for rare diseases, it becomes a matter of urgency to diagnose CMT patients with great fidelity. Otherwise, they will not be able to benefit from such therapeutic options, or worse, suffer harm when pathogenicity of genetic variation is falsely evaluated. In addition, the newly identified modifier and risk genes may offer alternative targets for pharmacotherapy of inherited and, potentially, even acquired forms of neuropathies.
Genetics of Charcot-Marie-Tooth DiseaseAs with many other Mendelian diseases, the introduction of next generation sequencing (NGS) revolutionized the genetic diagnosis of Charcot-Marie-Tooth disease with now over 90 known genes causing CMT. 1,2 Though CMT can be caused by an overwhelming amount of genetic defects, it is noteworthy that a handful of genes are responsible for the majority of cases. More than half of all CMT cases are caused by five genetic mutations: PMP22 duplication (39.5%), PMP22 point mutation (1.4%), GJB1 (10.8%), MFN2 (2.8%), and MPZ (3.1%). 3 For autosomal dominant (AD) demyelinating CMT (CMT1), the most commonly mutated genes are: GJB1, PMP22, MPZ, EGR2, LITAF, NEFL, or PMP2. 3 Unlike CMT1, AD axonal CMT (CMT2) and autosomal recessive (AR) axonal and/or demyelinating forms (CMT4) are caused by many, individually rare, genes that typically