NIMH Genetics Initiative Millenium Schizophrenia Consortium: linkage analysis of African-American pedigrees

The NIMH Genetics Initiative is a multi-site collaborative study designed to create a national resource for genetic studies of complex neuropsychiatric disorders. Schizophrenia pedigrees have been collected at three sites: Washington University, Columbia University, and Harvard University. This article-one in a series that describes the results of a genome-wide scan with 459 short-tandem repeat (STR) markers for susceptibility loci in the NIMH Genetics Initiative schizophrenia sample-presents results for African-American pedigrees. The African-American sample comprises 30 nuclear families and 98 subjects. Seventy-nine of the family members were considered affected by virtue of having received a DSMIII-R diagnosis of schizophrenia (n = 71) or schizoaffective disorder, depressed (n = 8). The families contained a total of 42 independent sib pairs. While no region demonstrated evidence of significant linkage using the criteria suggested by Lander and Kruglyak, several regions, including chromosomes 6q16-6q24, 8pter-8q12, 9q32-9q34, and 15p13-15q12, showed evidence consistent with linkage (P = 0.01-0.05), providing independent support of findings reported in other studies. Moreover, the fact that different genetic loci were identified in this and in the European-American samples, lends credence to the notion that these genetic differences together with differences in environmental exposures may contribute to the reported differences in disease prevalence, severity, comorbidity, and course that has been observed in different racial groups in the United States and elsewhere.

Genome scan of European-American schizophrenia pedigrees: results of the NIMH Genetics Initiative and Millennium Consortium

The Genetics Initiative of the National Institute of Mental Health (NIMH) was a multisite study that created a national repository of DNA from families informative for genetic linkage studies of schizophrenia, bipolar disorder, and Alzheimer's disease. The schizophrenia families were collected by three sites: Washington University, Harvard University, and Columbia University. This article, one in a series that describes the data collected for linkage analysis by the schizophrenia consortium, presents the results for the European-American sample. The European-American sample comprised 43 nuclear families and 146 subjects. Ninety-six of the family members were considered affected by virtue of having received a DSM-III-R diagnosis of schizophrenia (N = 82) or schizoaffective disorder, depressed (N = 14). The families contained a total of 50 independent sib-pairs. Using the significance threshold criteria suggested by Lander and Kruglyak [(1995): Nat Genet 241-247], no region showed statistically significant evidence for linkage; two markers on chromosome 10p showed statistical evidence suggestive of linkage using the criteria of Lander and Kruglyak [(1995): Nat Genet 241-247]: D10S1423 (nonparametric linkage (NPL) Z = 3.4, P = .0004) and its neighbor, D10S582 (NPL Z = 3.2, P = .0006).

Transcription and weak expression of HLA-DRB6: a gene with anomalies in exon 1 and other regions

HLA-DRB6 is one of the human major histocompatibility complex (MHC) genes present in DR1, DR2, and DR10 haplotypes (approximately 26% of individuals). It shows several anomalies in human and non-human primates, including exon 2 stop codons (non-randomly grouped between codons 74 and 94) and a promoter region, and an exon 1 coming from an inserted retrovirus. It has been shown that not only chimpanzee but also human Mhc-DRB6 lack the usual 3' untranslated (UT) polyadenylation signal, and in the present work it was found that the human DRB6 gene coming from an HLA-DR2 haplotype is effectively transcribed after transfection in mouse L cells, and that HLA-DRB6 molecules may be expressed on the cell surface. DRB6 transcription level is remarkably lower in human than in chimpanzee. Moreover, their exons 1 (both taken from the 3'LTR region of a mammary tumor retrovirus) are also different; this shows that these viral insertions may be an important mechanism for different evolutionary changes in orthologous genes of different species. The pathways by which DRB6 molecules may be expressed on the membrane are unclear but other examples of truncated protein expression have also been described, even within the human major histocompatibility complex (i. e., in HLA-G). Finally, the presence of mature HLA-DRB6 mRNA molecules supports the notion that splicing may take place even in the absence of a canonical 3'UT polyadenylation signal.

Management of a case of twin-to-twin transfusion syndrome by a combined surgical approach

OBJECTIVE

The management of a case of severe twin-to-twin transfusion syndrome at 24 weeks of gestation is presented, using a combined surgical and medical approach.

METHODS

Operative fetoscopy was used to coagulate placental vessels crossing the intertwin membranes. Repeated intrauterine transfusions were used to correct recurrent anemia in the donor twin. Selective three-dimensional placental angiography and directed histological analysis were used to study the placenta after delivery.

RESULTS

Resolution of twin-to-twin transfusion syndrome was obtained by coagulation of placental anastomoses, but was followed by recurrent anemia in the donor twin. This was successfully treated by serial intrauterine blood transfusions, and 2 healthy twins were delivered at 31 weeks of gestation. One artery-to-vein anastomosis was demonstrated to be the only communication left between the two circulations.

CONCLUSIONS

This case illustrates the limitations of placental surgery in twin-to-twin transfusion syndrome and highlights the need for ultrasound and Doppler follow-up of these high-risk fetuses to indicate further treatment. Placental anastomoses can be overlooked by macroscopic examination and injection technique, but can be demonstrated by placental angiography.

Prenatal diagnosis of neural tube defect before 12 weeks' gestation: direct and indirect ultrasonographic semeiology

We describe the direct and indirect ultrasonographic features of a case of lumbar open spina bifida. The spinal defect was the prominent feature at 10 weeks + 5 days' gestation; however, cranial signs including narrowing of the frontal bones and flattening of the occiput were helpful at 12 weeks. This 'acorn' sign is likely to precede the 'lemon' sign, describing scalloping of the frontal bones at a later gestation. The diagnosis of spina bifida was confirmed by electrophoresis of the amniotic fluid, which showed an abnormal migration of acetylcholinesterase. Postmortem ultrasound examination of the same fetus proved useful in refining the diagnosis and also revealed the presence of the Arnold-Chiari malformation. Development of ultrasound screening in the first trimester of pregnancy should allow further evaluation of these findings. It seems reasonable to confirm such an early diagnosis by electrophoresis of the amniotic fluid as an alternative to ultrasonographic confirmation at 13-14 weeks.

Triton tumor of the parotid area. Case report

A 27-year-old woman with a Malignant Triton Tumor (MTT), or malignant schwannoma with rhabdomyoblastic differentiation, located in the parotid cell and infiltrating the nasal sinuses and the left orbit is described. The initially resected tumor showed three recurrences within a 2 years follow-up period. During successive recurrences an increase in cellular density, number of mitoses and necrosis was noticed. Immunohistochemical analysis showed that the tumor was composed of a mixed population of cells. Some of them showed positivity for actin, desmin and myoglobin, while others were positive for S-100 protein, glial fibrillary acid protein, and IV-collagen. Cytokeratin stainings were negative. Up to now, 8 benign triton tumors and another 45 cases of MTT have been described. None of them was primarily located in the parotid gland, and infiltration to the orbital cavity has not been previously described.

Allelic diversity at the primate Mhc-G locus: exon 3 bears stop codons in all Cercopithecinae sequences

Twenty-seven major histocompatibility complex (Mhc)-G exon 2, exon 3, and exon 2 and 3 allelic sequences were obtained together with 12 different intron 2 sequences. Homo sapiens, Pan troglodytes, Pan paniscus, Gorilla gorilla, Pongo pygmaeus, Macaca fascicularis, Macaca mulatta, and Cercopithecus aethiops individuals were studied. Polymorphism does not follow the classical pattern of three hypervariable regions per domain and is found in all species studied; exon 3 (equivalent to the alpha 2 protein domain) shows stop codons in the Cercopithecinae group but not in the Pongidae and human groups. Dendrograms show that cotton top tamarin (Saguinus oedipus) Mhc-G sequences are closer to Homo sapiens and Pongidae than to Cercopithecinae, probably due to the stop codons existing at exon 3 of the latter. There is a clear trans-species evolution of allelism in Cercopithecinae and also in exon 2 of all the other apes studied, but a generation of allelism within each species may be present on exon 3 sequences. This discrepancy may be due to the preferential use of exon 2 over exon 3 at the mRNA splicing level within each species in order to obtain the appropriate functional G product. Mhc-G intron 2 shows conserved motifs in all species studied, particularly a 23 base pair deletion between positions 161 and 183 which is locus specific, and some of the invariant residues, important for peptide presentation, conserved in classical class I molecules from fish and reptiles to humans were not found in Mhc-G alleles; the intron 2 dendrogram also shows a particular pattern of allelism within each species. In summary, Mhc-G has substantial differences from other classical class I genes: polymorphism patterns, tissue distribution, gene structure, splicing variability, and probably an allelism variability within each species at exon 3. The G proteins may also be different. This indicates that the Mhc-G function may not be peptide presentation to the clonotypic T-cell receptor.

Hepatocellular carcinomas diagnosed following metastasis to the oral cavity. Report of 2 cases

Oral metastases from hepatocellular carcinomas are rare. Case 1 was a 66-year-old male without previous history of liver disease who presented with metastasis to the gingival jaw mucosae on the lingual side. Case 2 was a 71-year-old male, with a previous history of diabetes, hepatitis, and cirrhosis who presented with metastasis to the right palatine tonsil. Oral metastases were the first manifestation of the hepatocellular carcinoma in both cases. A review of the literature disclosed 20 cases of hepatocellular carcinoma metastasizing to the oral cavity, 7 affecting the gingival mucosae and none of them affecting the palatine tonsil.

Sonographic diagnosis and follow-up of diffuse neutropenic colitis: case report of a child treated for osteogenic sarcoma

The sonographic features of total neutropenic colitis in a 14-year-old girl with osteogenic sarcoma are presented. Sonography disclosed characteristic diffuse thickening of the colonic wall with hyperechoic bowel mucosa. Serial sonograms were performed to monitor the progress of the disease.

[Non surgical reduction of false aneurysms of the femoral artery with echo-Doppler control]

The authors report four cases of repair of femoral pseudoaneurysms under pulsed (1 case) and colour Doppler (3 cases) guidance, performed between January and October 1992 and compare the results with previously published reports of this new technique. They obtained 3 complete successes without complications and 1 failure with complications and a contraindication to the method. A review of the literature and the personal experience of the authors are described. This effective and usually complication-free technique should be proposed as an alternative to surgery. It should be undertaken as early as possible and remains a long and fastidious procedure poorly adapted to present nomenclature of medical procedures. It should be systematically proposed in cases of pseudo-aneurysms complicating the implantation of endoarterial prostheses.

Resistance to methicillin and virulence of Staphylococcus aureus strains in bacteriemic cancer patients

OBJECTIVE

To estimate the relation between resistance to methicillin and virulence in strains of Staph. aureus by estimating the survival at day 30.

DESIGN

Case control analysis.

SETTING

Inpatients at a major Cancer Referral Center.

PATIENTS

21 patients with methicillin-resistant Staph. aureus (MRSA) bactaeremia and 45 patients with methicillin-susceptible Staph. aureus (MSSA) bactaeremia, all treated with vancomycin.

MEASUREMENTS AND MAIN RESULTS

Fewer MRSA than MSSA patients were neutropenic (p = 0.04), but more MRSA patients were hospitalized in intensive care units (p = 0.03), had had surgical episodes (p = 0.06). MRSA patients also had more microbiological samples cultured (p = 0.007). The outcome of the bacteriemic episodes in 14 MRSA and 14 MSSA patients matched for these four factors showed that blood cultures from MRSA patients remained positive significantly longer (p = 0.04), but that survival and length of hospital stay were not significantly different.

CONCLUSIONS

These results do not indicate that methicillin-resistance in Staph. aureus is associated with increased virulence.

Unfractionated human thymocytes have a lower proliferative capacity than CD3-4-8- ones but have a similar capacity for expression of interleukin 2 receptors and production of interleukin 2

CD3-4-8- and unfractionated thymocytes were compared for their capacity to proliferate, to express interleukin 2 (IL-2) receptor, and to secret IL-2. Phorbol ester and Ca2+ ionophore were used as mitogens. CD3-4-8- thymocytes responded vigorously when stimulated with phorbol ester in the presence of IL-2 or in combination with Ca2+ ionophore. In contrast, unfractionated thymocytes responded weakly when stimulated with either of these mitogens. Surprisingly, however, the stimulation of these populations with either phorbol ester plus IL-2 or phorbol ester plus ionophore induced a high and similar level of IL-2 receptor expression in both thymocyte populations. A similar level of IL-2 secretion in both populations was also obtained when they were stimulated with a combination of phorbol ester plus ionophore. These results suggest that during the maturation process, the majority of thymocytes lose their capacity to be activated by some mitogens, although they maintain their capacity to secrete IL-2 and to express the IL-2 receptor.

Correlation of serum immunoglobulin subclass concentrations with antibody responses of children to immunization with Haemophilus influenzae type b polysaccharide-pertussis vaccine

Children less than 24 months of age respond poorly to immunization with the capsular polysaccharide of Haemophilus influenzae type b. Because human antibodies to polysaccharide antigens are relatively restricted to IgG2, a late-maturing subclass, we examined the relationship between serum subclass concentrations and anticapsular antibody responses of 41 healthy children, 9 to 38 months of age, following immunization with type b polysaccharide mixed with pertussis vaccine. Both total and IgG anticapsular antibody responses correlated significantly with preimmune serum concentrations of IgG2 but not with those if IgG1. This correlation was age dependent, however, and after the effect of age was removed by partial correlation, the correlation between anticapsular antibody responses and serum IgG2 concentrations was no longer significant. These findings indicate that the ability to respond to this vaccine coincides with maturation of the ability to secrete immunoglobulin of the IgG2 subclass; however, individual variation in IgG2 that is independent of age does not correlate with antibody response to the type b polysaccharide.

Relation of age, race, and allotype to immunoglobulin subclass concentrations

Concentrations of IgG1, IgG2, and total IgG were measured by a solid phase radioimmunoassay in sera from 36 healthy adults and 114 healthy children. As expected, IgG2 and total IgG had a positive correlation with age in children. In addition to age, several other factors were associated with significant differences in serum subclass concentrations. Female children had higher concentrations of IgG1 than males, and black subjects had significantly higher concentrations of IgG1, IgG2, and total IgG than whites. Although Km(1) and Gm(23) immunoglobulin allotypes had no relation to subclass concentrations when tested as single factors, the Km(1) allotype interacted significantly with race so that Km(1)-positive black children had higher IgG2 concentrations than other subjects. Our findings may explain, in part, recent observations of an association of the Km(1) allotype with altered immune responses of blacks to certain vaccines containing bacterial polysaccharides. In addition, our data indicate the need to control factors such as sex, race, and allotype in studies of subclass concentrations or immune responses.

Response to immunization with Haemophilus influenzae type b polysaccharide-pertussis vaccine and risk of Haemophilus meningitis in children with the Km(1) immunoglobulin allotype

In experimental animals, immune responses to certain antigens are regulated by immunoglobulin allotype-linked genes. In an effort to detect such genes in humans, we examined the antibody responses of 74 healthy children with different Km(1) or Gm(23) allotypes to a Haemophilus influenzae type b vaccine (type b polysaccharide capsule-pertussis vaccine). The anticapsular antibody responses of black or white children with the Km(1) allotype were 4.6- to 9.5-fold higher than those of children who lacked this determinant (P less than 0.004). No significant differences were found in antibody response with respect to the Gm(23) allotype. The frequencies of Km(1) and Gm(23) also were examined in 170 patients with Haemophilus meningitis, 71 patients with epiglottitis, and 173 control children. Km(1) was detected less frequently in black patients with meningitis (38%) than in those with epiglottitis (81%, P less than 0.002) or in controls (66%, P less than 0.0007). The relative risk of meningitis thus was 3.2-fold lower among black children with the Km(1) allotype than in those who lacked this allotype (odds ratio = 0.3, 95% confidence interval 0.2 to 0.6). However, the risk of meningitis was not decreased in white children with the Km(1) allotype (odds ratio = 1.0). There were no significant differences in the frequency of Gm(23) among the patient groups and controls. The Km(1) allotype but not the Gm(23) thus defines a subpopulation of children of both races who are high responders to this vaccine, and black children but not white children with the Km(1) allotype are at decreased risk of developing Haemophilus meningitis. These data indicate that in blacks, genes associated with Km(1) may affect immune response to a prototype type b Haemophilus vaccine, and perhaps interact with another factor related to race to affect susceptibility to Haemophilus meningitis.

Interactive effect of genes associated with immunoglobulin allotypes and HLA specificities on susceptibility to Haemophilus influenzae disease

Genes associated with immunoglobulin (Ig) allotype determinants are important in regulation of immune responses to bacterial polysaccharides. Furthermore, loci associated with Ig allotypes have been reported to interact with those associated with the major histocompatibility complex and affect susceptibility to certain diseases. In the present study we determined the frequencies of certain Gm phenotypes in patients with Haemophilus meningitis or epiglottitis and in controls. HLA-A, -B and -DR specificities had previously been determined in the majority of these subjects. Although no Ig phenotype was associated with increased or decreased relative risk of disease, the frequencies of several combinations of HLA specificities and Ig phenotypes were significantly different from those of controls. Thus, for subjects with the Gm phenotype (1, 3, 17; 23; 5, 13, 21), the risk of Haemophilus meningitis or epiglottitis was lower in individuals with HLA-B5 than in those without this specificity (odds ratio less than 0.1, P less than 0.004). In contrast, for subjects with the closely related Gm phenotype differing only by the absence of Gm(23), (1, 3, 17; ; 5, 13, 21), the risk of disease was higher in those with HLA-DR3 than in individuals who lacked DR3 (odds ratio = 11.0, P = 0.02). Although the present data require confirmation in an independent sample, they suggest that complex interactions between genes at two independent loci controlling HLA and Ig allotypes, respectively, may affect susceptibility to Haemophilus disease.

Siblings of patients with Haemophilus meningitis have impaired anticapsular antibody responses to Haemophilus vaccine

Siblings of patients with type b Haemophilus influenzae meningitis are at increased risk of developing Haemophilus disease. We immunized 26 healthy siblings and 25 control subjects using a vaccine containing the type b polysaccharide capsule (10 micrograms PRP) and pertussis vaccine (4 opacity units) (Lederle Laboratories) to determine whether siblings of patients with Haemophilus meningitis had an impaired antibody response to PRP. Using two intramuscular injections one month apart, we found that the siblings had a lower response to PRP. One month after the second injection, 12 of 24 of the siblings had serum concentrations of anticapsular (PRP) antibody thought to be sufficient to confer protection against Haemophilus disease (greater than or equal to 300 ng/ml), compared with 19 of 24 of the control children tested (50% vs 79%, P = 0.035 by chi-square analysis). In comparison with the normal controls, the siblings produced significantly less IgG anti-PRP antibody but similar amounts of IgM. The impaired responsiveness to PRP was most evident among the 16 children born after their sibling had meningitis and who were not known to have been exposed to type b Haemophilus infection previously. These data indicate that siblings of some patients with type b Haemophilus meningitis have reduced ability to form IgG anti-PRP antibody, which may be associated with increased susceptibility to Haemophilus disease.

Power of the affected-sib-pair method to defect disease susceptibility loci of small effect: an application to multiple sclerosis

The distribution of marker locus identity-by-descent scores in affected sib pairs provides a powerful tool for detecting the presence of a linked non-Mendelian disease susceptibility locus. This basic approach is here extended to include a trio of sibs. A special type of sib trio consisting of two affected and one unaffected sib is investigated. It is shown that compared to affected-sib-pairs, trios with the above configuration are less efficient in detecting the presence of a linked disease susceptibility locus. When the generalized two-allele single locus model is fitted to sib pairs affected with multiple sclerosis, an estimate of the recombination fraction of 0.21 between the putative disease susceptibility locus and the HLA complex is obtained. However, this transmission model is deemed inadequate since a recombination fraction this large is inconsistent with the variety of HLA associations observed at the population level.

Conditional concordance in monozygotic twins

Twin concordance rates are usually reported without reference to the number of parents affected, apparently because the simple demonstration that monozygotic (MZ) twins are more concordant than are dizygotic (DZ) twins is the goal of most twin studies. Depending on the underlying mechanism, however, twin concordance rates can vary widely when conditioned on the number of parents affected. For the generalized single-locus model it is shown that conditional concordance rates in monozygotic twins, along with an estimate of the disorder's prevalence in the population, uniquely specify the underlying parameters of this important model. Knowledge of the exact parameter set is essential for competent genetic counseling.