Achondroplasia is the prototype of chondrodysplasia in humans.  Its major features include short limb dwarfism and a large head with mid-facial hypoplasia.  Achondroplasia arises most often as a sporadic event to normal parents and there is a pronounced paternal age effect.  It results from activating mutations of Fibroblast Growth Factor Receptor 3 (FGFR3), which encodes the transmembrane receptor.  FGFR3 mutations have several unique features including that they arise de novo almost exclusively during spermatogenesis and that almost all involve the same G-to-A transition at base pair 1138 (G1138A) of the gene resulting in a glycine to arginine substitution in the transmembrane domain of the receptor.  Taken together, these observations have led to the commonly accepted views that FGFR3 is exceptionally mutagenic and that the paternal age effect reflects replication errors that occur during spermatogenesis.  Spermatogenesis continues throughout life and presents many more opportunities for erroneous copying of DNA than does oogenesis in which replication ceases before birth.  Although this explanation makes good sense, there is now evidence that it is incorrect.

 

To test if increased mutagenesis accounted for the paternal age effect in achondroplasia, Tiemann-Boege et al determined the frequency of the common G1138A FGFR3 mutation in sperm from 118 healthy men ranging in age from 18 to 80 years.  They expected to detect a progressive increase in sperm mutation frequency comparable to the increase in number of achondroplasia births to older fathers.  However, to their surprise, using a carefully controlled polymerase chain reaction assay, they found only a small increase in the G1138A mutation which by itself could not account for the paternal age effect.

 

More specifically, they observed that the mutation rate for G1138A averaged about 1 per 11,000 haploid genomes over all ages.  Broken down by age, the mutation frequency changed little between the ages of 18 - 40 and 55 - 80 years.  It increased about 2-fold between the two age groups, but this was nowhere near the increased frequency of achondroplasia births in older fathers.  

 

The authors addressed in considerable depth various possible explanations for their findings.  Several involve experimental biases or artifacts.  For example, fathers of children with sporadic achondroplasia may constitute a subgroup of men with distinct mutation properties that differ from the sperm donor population.  There may be unappreciated ascertainment biases with regard to the makeup of donor population or in previous studies. Despite extensive controls, there could have been underreporting of mutations in the PCR assay. These studies may have led to overestimating the magnitude of the paternal age effect.

 

Two of the possibilities deserve special attention. The first is that there may be an age-dependent increase in germ-line permutations at the G1138A site that are neither converted to a full mutation or repaired before fertilization.  One candidate lesion would be an unrepaired G/T mismatch resulting from deamination of 5-methyl cytosine.  The cytosine at position 1138 is known to be highly methylated in sperm and therefore a candidate for such a premutation, which might go undetected under conditions of PCR.

 

Another possibility is that the G1138A mutation gives a selective advantage to sperm that carry it.  The authors acknowledge the highly speculative nature of this possibility, but point out that FGFR3 is expressed and presumably active in mature sperm cells. They also caution that invoking this possibility must include an explanation of how a potential selective advantage would increase with age. 

 

Tiemann-Boege et al. PNAS 99 2002;14952-57.

 

Hurst LD, Ellegren H. Nature 2002;420:365-66.

 

Editor’s comment:  Many observations over the last several years have led to the dogma that FGFR3, especially the site where achondroplasia mutations arise, is extraordinarily mutable during spermatogenesis and that this mutability increases dramatically with age.  The idea that DNA is prone to replication or mitotic errors, that there are many more opportunities for such errors to occur during spermatogenesis compared to oogenesis, and these can somehow accumulate with age has been conceptually appealing and is easy to explain during counseling.  However, the results reported here cast serious doubt on its validity.  Assuming they hold up, which seems highly likely given the considerable lengths to which the authors went to control their experiments and validate their results, the dogma will need to change.

 

The notion of genetic premutation in achondroplasia is not new.  It was proposed by John Opitz and others long before mutations of FGFR3 were discovered.  It never gained much momentum, probably because it lacked experimental data with regard to a specific locus or mutation; however, the paper by Tiemann-Boege et al may add new life to this concept.

 

The possibility that sperm which harbor activating mutations of FGFR3 have a selective advantage for motility, fertilization or the like, is intriguing.  Of note is that activating FGFR3 mutations found in the achondroplasia family of disorders have been detected in several types of cancer, including multiple myeloma and bladder, breast and colon carcinoma.  The mechanisms through which the mutations contribute to neoplasia are not well understood.  However, they may well give the cancer cells a competitive advantage over the normal cells. 

 

William Horton, MD

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