CMT-MTRFR

MTRFR | 2014

What Is CMT-MTRFR?

CMT-MTRFR is a type of CMT caused by autosomal recessive mutations in the MTRFR gene. This gene provides instructions for making a protein involved in the quality control of protein synthesis within mitochondria. Mutations in the MTRFR gene disrupt this function, leading to impaired nerve signal transmission.

CMT-MTRFR is autosomal recessive, meaning that both copies of the gene must have a mutation to cause this subtype.

Clinical Features

The age of symptom onset in CMT-MTRFR is variable, ranging from childhood to adulthood. Symptoms typically begin in the lower extremities and progress over time to involve the upper limbs. Nerve conduction studies usually show somewhat slowed conduction velocities and reduced amplitudes, consistent with an axonal form of CMT.

CMT-MTRFR symptoms may include:

  • Weakness in the feet and lower legs
  • Muscle atrophy
  • Foot drop
  • Reduced or absent reflexes
  • Reduced sensation
  • A steppage-style walking pattern
  • Foot deformities, including high arches, and hammertoes (clawed toes)
  • Progressive involvement of the hands and forearms
  • Difficulty with fine motor skills and manual dexterity
  • Additional symptoms not listed here

Disease Course

CMT-MTRFR shows wide variability in severity and progression. Some individuals are mildly affected, while others develop a more severe disease. Disease progression is generally slow, and life expectancy is not reduced.

Clinical Basics

Subtype
CMT-MTRFR

Classification
Unclassified Subtypes

Neuropathy Type
Axonal

Inheritance Pattern
autosomal recessive

Genetic Context

HGNC-Approved Gene Symbol
MTRFR

Gene Full Name
mitochondrial translation release factor in rescue

HGNC Gene Alias(es)
C12ORF65

Chromosome
12q24.31

Zygosity of Responsible Variant
Homozygous

Mitochondrial Involvement
Yes

Variant Mechanism

Loss of Function (LoF)

Details

Mechanistic basis:
Complete loss

Confidence:
Medium

Prediction:
Published evidence points to a biallelic loss-of-function mechanism for CMT-MTRFR: MTRFR (C12orf65) encodes a GGQ-domain member of the mitochondrial release-factor family that acts in rescue and recycling of stalled mitoribosomes rather than in standard stop-codon termination. The reported truncating variants remove that activity outright, mitochondrial protein synthesis stalls, and combined respiratory-chain deficiency follows in long motor and optic axons. Because the protein is simply absent, restored wild-type is predicted to rescue.

Rationale:
Loss of the recycling factor leaves stalled mitoribosomes sequestered and depletes the pool available for translation, starving the respiratory chain of mtDNA-encoded subunits. Truncating alleles on both copies, with unaffected heterozygous parents, place the defect in absent protein rather than in a mutant product. Reported cohorts stay small and phenotypically mixed across optic atrophy, spastic paraparesis, and CMT, which keeps confidence at medium.

ClinVar Pathogenic Variants

View MTRFR ClinVar Variants

MTRFR OMIM Entry

MTRFR OMIM

More Info

CMT-MTRFR Research Opportunity

CMT Natural History Study

Original Discovery Publication

Publication Title

Novel C12orf65 Mutations in Patients with Axonal Neuropathy and Optic Atrophy.

Authors

Tucci, A., Liu, Y. T., Preza, E., Pitceathly, R. D., Chalasani, A., Plagnol, V., Land, J. M., Trabzuni, D., Ryten, M., UKBEC, Jaunmuktane, Z., Reilly, M. M., Brandner, S., Hargreaves, I., Hardy, J., Singleton, A. B., Abramov, A. Y., & Houlden, H.

Publication Date
April 10, 2014

Updated: July 18, 2026 | By: K. Raymond

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