X-linked Christianson syndrome: heterozygous female Slc9a6 knockout mice develop mosaic neuropathological changes and related behavioral abnormalities

Dis Model Mech. 2016 Jan;9(1):13-23. doi: 10.1242/dmm.022780. Epub 2015 Oct 29.


Christianson syndrome (CS) is an X-linked neurodevelopmental and neurological disorder characterized in males by core symptoms that include non-verbal status, intellectual disability, epilepsy, truncal ataxia, postnatal microcephaly and hyperkinesis. CS is caused by mutations in the SLC9A6 gene, which encodes a multipass transmembrane sodium (potassium)-hydrogen exchanger 6 (NHE6) protein, functional in early recycling endosomes. The extent and variability of the CS phenotype in female heterozygotes, who presumably express the wild-type and mutant SLC9A6 alleles mosaically as a result of X-chromosome inactivation (XCI), have not yet been systematically characterized. Slc9a6 knockout mice (Slc9a6 KO) were generated by insertion of the bacterial lacZ/β-galactosidase (β-Gal) reporter into exon 6 of the X-linked gene. Mutant Slc9a6 KO male mice have been shown to develop late endosomal/lysosomal dysfunction associated with glycolipid accumulation in selected neuronal populations and patterned degeneration of Purkinje cells (PCs). In heterozygous female Slc9a6 KO mice, β-Gal serves as a transcriptional/XCI reporter and thus facilitates testing of effects of mosaic expression of the mutant allele on penetrance of the abnormal phenotype. Using β-Gal, we demonstrated mosaic expression of the mutant Slc9a6 allele and mosaically distributed lysosomal glycolipid accumulation and PC pathology in the brains of heterozygous Slc9a6 KO female mice. At the behavioral level, we showed that heterozygous female mice suffer from visuospatial memory and motor coordination deficits similar to but less severe than those observed in X-chromosome hemizygous mutant males. Our studies in heterozygous Slc9a6 KO female mice provide important clues for understanding the likely phenotypic range of Christianson syndrome among females heterozygous for SLC9A6 mutations and might improve diagnostic practice and genetic counseling by helping to characterize this presumably underappreciated patient/carrier group.

Keywords: Christianson syndrome; Female heterozygotes; Mosaicism; NHE6 protein; Slc9a6; X-chromosome inactivation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alleles
  • Animals
  • Ataxia / genetics*
  • Behavior, Animal
  • Cognition Disorders / genetics
  • Disease Models, Animal
  • Epilepsy / genetics*
  • Female
  • G(M2) Ganglioside / immunology
  • Genetic Diseases, X-Linked / genetics*
  • Genotype
  • Heterozygote
  • Intellectual Disability / genetics*
  • Male
  • Mice
  • Mice, Knockout
  • Microcephaly / genetics*
  • Mosaicism*
  • Mutation
  • Ocular Motility Disorders / genetics*
  • Phenotype
  • Purkinje Cells / cytology
  • Sodium-Hydrogen Exchangers / genetics*
  • Sodium-Hydrogen Exchangers / physiology


  • NHE6 protein, mouse
  • Sodium-Hydrogen Exchangers
  • G(M2) Ganglioside

Supplementary concepts

  • Mental Retardation, X-Linked, Syndromic, Christianson Type