CMT-SETX

SETX | 2004

What Is CMT-SETX?

CMT-SETX is a type of CMT caused by autosomal recessive mutations in the SETX gene. This gene provides instructions for making senataxin, a protein involved in the processing of RNA and the maintenance of nerve cells. Mutations in the SETX gene disrupt this function, leading to impaired nerve signal transmission.

CMT-SETX 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-SETX 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-SETX symptoms may include:

  • Weakness in the feet and lower legs
  • Muscle atrophy
  • Foot drop
  • Brisk 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-SETX 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-SETX

Classification
Unclassified Subtypes

Neuropathy Type
Axonal

Inheritance Pattern
autosomal recessive

Genetic Context

HGNC-Approved Gene Symbol
SETX

Gene Full Name
senataxin

Chromosome
9q34.13

Zygosity of Responsible Variant
Homozygous or Compound Heterozygous

Variant Mechanism

Loss of Function (LoF)

Details

Mechanistic basis:
Complete loss

Confidence:
Medium

Prediction:
The literature predicts a biallelic loss-of-function mechanism for CMT-SETX: senataxin is an RNA/DNA helicase that resolves R-loops and supports transcription termination, and two null or hypomorphic SETX alleles drop that activity below the threshold neurons tolerate, giving ataxia with oculomotor apraxia type 2 with elevated alpha-fetoprotein and sensorimotor CMT. Heterozygous SETX missense variants such as p.Leu389Ser instead cause ALS4, a dominant gain-of-function-like disease at the same locus.

Rationale:
Senataxin activity is threshold-dependent, and the two SETX diseases separate cleanly on that axis: nonsense, frameshift, and splice alleles must be present on both copies to cause AOA2, while single missense alleles in ALS4 act through something the null alleles never reproduce. How R-loop accumulation connects reduced helicase activity to the neuronal phenotype is not fully mapped, and the medium grade reflects that gap.

ClinVar Pathogenic Variants

View SETX ClinVar Variants

SETX OMIM Entry

SETX OMIM

More Info

CMT-SETX Research Opportunity

CMT Natural History Study

Original Discovery Publication

Publication Title

DNA/RNA Helicase Gene Mutations in a Form of Juvenile Amyotrophic Lateral Sclerosis (ALS4).
“Dominant mutations in SETX cause HMN/ALS4 (Chen and el., 2004)”
–Inherited Neuropathies Consortium (INC), CMT in Depth: Hereditary Motor Neuropathies – https://www1.rarediseasesnetwork.org/cms/inc/Healthcare-Professionals/CMT

Authors

Chen, Y. Z., Bennett, C. L., Huynh, H. M., Blair, I. P., Puls, I., Irobi, J., Dierick, I., Abel, A., Kennerson, M. L., Rabin, B. A., Nicholson, G. A., Auer-Grumbach, M., Wagner, K., De Jonghe, P., Griffin, J. W., Fischbeck, K. H., Timmerman, V., Cornblath, D. R., & Chance, P. F.

Publication Date
June 1, 2004

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

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