CMTRID

COX6A1 | 2014

What Is CMTRID?

CMTRID is a type of CMT caused by autosomal recessive mutations in the COX6A1 gene. This gene provides instructions for making a component of the mitochondrial enzyme complex responsible for producing cellular energy. Mutations in the COX6A1 gene disrupt this function, leading to impaired nerve signal transmission.

CMTRID 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 CMTRID 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, consistent with an intermediate form of CMT.

CMTRID 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

CMTRID 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
CMTRID

Classification
CMTRI

Neuropathy Type
Intermediate

Inheritance Pattern
autosomal recessive

Genetic Context

HGNC-Approved Gene Symbol
COX6A1

Gene Full Name
cytochrome c oxidase subunit 6A1

HGNC Gene Alias(es)
COX6AL

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:
Assays in patient fibroblasts support a biallelic loss-of-function mechanism for CMTRID: COX6A1 encodes a nuclear-encoded structural subunit of cytochrome c oxidase, and the recessive splice-region and loss variants remove functional subunit from both copies, leaving complex IV under-assembled with measurably reduced activity. The deficit is quantitative, scaling with how much intact subunit survives, and one preserved allele is enough to keep carriers healthy.

Rationale:
A structural subunit missing from the holoenzyme lowers the amount of assembled cytochrome c oxidase rather than producing an aberrant one, and fibroblast measurements track that shortfall. Why peripheral nerve bears the burden while other high-demand tissues are spared has not been explained, and with few reported families the mechanism is graded medium.

ClinVar Pathogenic Variants

View COX6A1 ClinVar Variants

CMTRID OMIM Entry

CMTRID OMIM

COX6A1 OMIM Entry

COX6A1 OMIM

More Info

CMTRID Research Opportunity

CMT Natural History Study

Original Discovery Publication

Publication Title

A Mutation of COX6A1 Causes a Recessive Axonal or Mixed Form of Charcot-Marie-Tooth Disease

Authors

Tamiya, G., Makino, S., Hayashi, M., Abe, A., Numakura, C., Ueki, M., Tanaka, A., Ito, C., Toshimori, K., Ogawa, N., Terashima, T., Maegawa, H., Yanagisawa, D., Tooyama, I., Tada, M., Onodera, O., & Hayasaka, K.

Publication Date
September 4, 2014

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

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