Improved prenatal detection of fra(X)(q27.3): methods for prevention of false negatives in chorionic villus and amniotic fluid cell cultures

The reliable detection of fra(X)(q27.3) in prenatal samples is important for providing genetic counseling. We have identified 5 new cases of prenatal fragile X [fra(X)] detection in 3 chorionic villus sample (CVS) and 2 amniotic fluid (AF) cell cultures. In 4 of the 5 cases, either excess thymidine (THY) or a combination of THY and 5-fluorodeoxyuridine (FUdR) was clearly superior to FUdR alone as fra(X) inducers. Amniocytes from one case were cultured only in RPMI-1640 and later exposed to FUdR or THY separately. They showed only 2% fra(X) while parallel cultures initiated in Chang medium and incubated in RPMI for at least 7 days (recovery) before fra(X) induction exhibited strikingly increased fra(X) frequencies. Chang medium alone will not allow fra(X) induction in AF (Jenkins EC, Brown WT [1986]: "Genetic Disorders and the Fetus: Diagnosis, Prevention and Treatment." New York: Plenum Press, pp 185-204). Now, using CVS cells, we report that only 1% and 0% fra(X) were detected using FUdR or THY in cells cultured in RPMI for 4 days after removal from Chang medium. Cells with 7 days "recovery" in RPMI exhibited increases from 2 to 6%. Therefore, we have found that Chang medium is very helpful when the appropriate recovery time in another medium is allowed before fra(X) induction. Some false negative reports can be attributed to: induction in Chang medium alone; lack of sufficient recovery time after initiating cells in Chang before induction; and unavailability of the excess THY fra(X) induction system.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution of autosomal fragile sites in specimens cultured for prenatal fragile X diagnosis

We reviewed the distribution of autosomal fragile sites (FS) and spontaneous chromosome breaks or gaps (CB) at chromosome locations other than those recognized as FS from 100 amniotic fluid samples (AF), 19 chorionic villus samples (CVS), and 5 percutaneous umbilical blood samples (PUBS) referred for fragile X [fra(X)] analysis. We present data on the degree of expression of autosomal fragility in AF, CVS, and PUBS samples, and the relationship between degree of expression and induction system. The most common observed FS were: 3p14, 9p32, and 6q26 in AF; 9q32, 3q27, and 8q22 in CVS; and 3p14, Xq22, and 16q23 in PUBS cases. Distribution of FS and CB, when compared by induction system, was not found to be identical. Our data also indicate that the presence of any particular FS cannot be used as an indicator for the effectiveness of the fra(X) induction system in prenatal samples.

Biochemical events associated with rapid cellular damage during the oxygen- and calcium-paradoxes of the mammalian heart

The O2- and Ca2(+)-paradoxes have a number of features in common and it is suggested that release of cytosolic proteins in both paradoxes is initiated by the activation of a sarcolemma NAD(P)H dehydrogenase which can generate a transmembrane flow of H+ and e- and also oxygen radicals or redox cycling which damage ion channels and membrane proteins (phase I). Entry of Ca2+ through the damaged ion channels then exacerbates the damage by further activating this system, either directly or indirectly, and the redox cycling and/or oxygen radicals cause further damage to integral and cytoskeletal proteins of the sarcolemma resulting in microdamage to the integrity of the membrane (phase II) and the consequent release or exocytosis of cytoplasmic proteins and, under specialised conditions, the blebbing of the sarcolemma. The system may be primed either by removal of extracellular Ca2+ or by raising [Ca2+]i by a variety of measures, these two actions being synergistic. The system is initially activated in the Ca2(+)-paradox by the membrane perturbation associated with removal of extracellular Ca2+; prolonged anoxia in the metabolically active cardiac muscle causes a depletion of the ATP supply, particularly in the absence of glucose, and hence a rise in [Ca2+]i in phase I of the oxygen paradox with the consequent activation of the NAD(P)H oxidase at the sarcolemma. Oxygen radicals are probably generated in both paradoxes and may have a partial role in the genesis of damage, but are not essential in the Ca2(+)-paradox which continues under anoxia. Massive entry of Ca2+ also activates an intracellularly localised dehydrogenase (probably at the SR) which produces myofilament damage by redox cycling.

Progress toward an internal control system for fragile-X induction by 5-fluorodeoxyuridine in whole-blood cultures

We have been attempting to develop a consistently reliable internal control to assure the effectiveness of the 5-fluorodeoxyuridine (FUdR) fragile-X [fra(X)] induction system. We carried out a systematic study of whole-blood specimens cultured from 56 individuals from two different laboratories. An analysis of nearly 9,000 cells demonstrated: (1) the importance of establishing baseline levels of fragile sites in each laboratory, and (2) that a combination of common fragile sites (different for each laboratory) could serve as a consistently reliable indicator of the effectiveness of the FUdR fra(X) induction system. It was suggested that a non-FUdR culture(s) should be incorporated into a laboratory's fra(X)-screening protocol, so that if there are any doubts about the effectiveness of the FUdR system a comparison to background or spontaneously occurring fragile sites can be made within the laboratory. Repeat cultures are recommended where no increase in common fragile-site frequency is observed in the FUdR induction system, and where fra(X) was strongly suspected but not found. In addition, the necessity of using more than one fra(X) induction system in whole-blood cultures was demonstrated, including the effectiveness of an FUdR/excess thymidine double-induction system. Finally, 2 cases of apparent mosaicism for Klinefelter syndrome in fra(X) individuals were observed.

Mechanisms that produce rapid damage to myofilaments of amphibian skeletal muscle

The system causing myofilament damage is separate from the phospholipase A2 pathway, Ca activation of which ultimately causes sarcolemma breakdown in muscle cells. Mitochondrial agents cause myofilament damage in saponin-skinned frog pectoris cutaneous muscle when [Ca] = 0. There are parallels with other systems that generate oxygen radicals. However, a variety of protectors against oxygen radicals, or anoxia, failed to protect; Ca-activated damage was not augmented by diethylthiocarbamate, nor was it accompanied by a respiratory burst. Thus, there is no firm evidence implicating oxygen radicals in myofilament damage. Thiol-oxidizing agents cause contraction damage in skinned muscle that resembles the quasirigor induced in myosin by N-ethylmaleimide. Activation of transmembrane dehydrogenases and electron flow produced damage and increased Ca sensitivity in skinned muscle, and it is suggested that this enzyme system may be implicated in characteristic damage to the myofilaments via redox cycling and modification of sulphydryl groups; its possible location on the sarcoplasmic reticulum is discussed.

Dystrophin and the integrity of the sarcolemma in Duchenne muscular dystrophy

It is suggested that in Duchenne muscular dystrophy the absence of dystrophin, which is probably a cytoskeletal protein underlying the sarcolemma, causes changes in stretch-activated cation channels rather than direct mechanical tearing of the surface membrane.

Chromosomal abnormalities in amniotic fluid cell cultures: a comparison of apparent pseudomosaicism in Chang and RPMI-1640 media

The finding of chromosome mosaicism is one of the most difficult problems in fetal chromosome analysis. Whether the finding indicates true mosaicism or pseudomosaicism must be investigated. Studies detailing the incidence of true mosaicism and pseudomosaicism have been reported (Hsu & Perlis 1984, Bui et al. 1984, Worton & Stern 1984) but do not correlate pseudomosaicism with any particular type of culture media. Benn & Hsu (1985) compared cell growth and chromosome abnormalities in amniotic fluid cell cultures grown in Chang medium and RPMI-1640 medium and found no statistically significant difference in the rate of abnormalities in the two media. We have previously shown that Chang medium exhibited more abnormalities which were not verified in second and third cultures (Masia et al. 1986). In the current study we examined 212 cases grown in both Chang and RPMI-1640 media, and compared apparent single and multiple cell pseudomosaic abnormalities to medium type. The number of observed abnormalities was 22, occurring in 19 of the cases studied. Apparent pseudomosaic chromosome anomalies were observed in 18 Chang cultures and in 4 RPMI-1640 cultures. Statistical analysis found significant correlation between medium type and the degree of observed pseudomosaic cells. We conclude that the rate at which pseudomosaic cells are observed is partly a function of medium type, and in our laboratory Chang medium caused apparent pseudomosaicism at a greater level than RPMI-1640 medium.

Independent pathways causing cellular damage in mouse soleus muscle under hypoxia

1. Mouse soleus muscle incubated in vitro released creatine kinase (CK) and underwent ultrastructural damage under hypoxic conditions. 2. Both events were exacerbated by contractile activity following field stimulation. 3. Ultrastructural damage preceded CK release. 4. Omission of extracellular Ca2+ protected against CK release whereas ultrastructural damage was unaffected. 5. Excessive contractile activity for 30 min under normoxic conditions caused myofilament damage, but this was not accompanied by CK release. 6. The results support the hypothesis that the pathways leading to myofilament breakdown and to CK release are separate and independent. 7. The results are discussed in relation to changes in the supply of high energy phosphates and consequently in the regulation of Ca2+-homeostasis under hypoxia. 8. Both pathways are believed to be triggered by rises in [Ca2+]i. 9. A high rate of oxygenation (10 ml sec-1) had no damaging effects, unlike its action on mouse diaphragm in vitro. 10. Since damage is exacerbated under N2, there is no evidence to support the view that O2 metabolites are necessarily implicated in cell damage in skeletal muscle.

A model for the oxygen-paradox in mouse cardiac muscle

1. Mouse ventricle strips provide a good model system for studying cellular damage in mammalian cardiac muscle. 2. Anoxia rapidly causes destruction of the myofilament apparatus that is characteristic of calcium-triggered damage in muscle cells, and it is suggested that anoxia promotes release of calcium from the mitochondria. 3. Oxygen exacerbates this damage which is independent of extracellular calcium; it is suggested that it initiates myofilament damage by activation at an intracellular site, probably the sarcoplasmic reticulum.

Cytotoxic effect of phenazine methosulphate on the isolated frog heart

1. Perfusion of isolated frog hearts with phenazine methosulphate (PMS) at 0.3-1.0 mM caused a fall in amplitude and frequency of beat, and finally a cessation of contractile activity, together with widespread ultrastructural damage. 2. Sarcolemma blebs were a characteristic feature of the damage. 3. No protection was provided by mannitol (10-100 mM), superoxide dismutase, catalase or a pHo of 6.6. 4. Potassium ferricyanide (1-6 mM), an artificial electron acceptor, also caused ultrastructural damage. 5. Comparisons are made with the oxygen paradox of mammalian heart, and the possible role of Ca2+ fluxes and oxygen radicals in muscle damage are discussed.

Effects of anoxia on cellular damage in the incubated mouse diaphragm

Satisfactory ultrastructural integrity of the mouse diaphragm was maintained in vitro in modified Krebs-henseleit saline for 3h when the rate of oxygenation was 2.8 ml sec-1 (95% O2 + 5% CO2). Hypoxic (O2 = 1.6-2.0 ml sec-1) or anoxic (95% N2 + 5% CO2) conditions triggered typical Ca-triggered myofilament damage, believed to be induced by a rise in [Ca]i. It was unaffected by omission of Ca from the saline, but the muscle was protected at 7.8 degrees C. 'High-O2' gassing (10 ml sec-1) also caused a characteristic, but different, damage with swollen sarcoplasmic reticulum and spacing of the myofibrils.

Cytotoxic effect of oxygen on the skeletal muscle of mouse diaphragm

Incubation of the isolated mouse diaphragm with a high rate of oxygenation (10 ml s-1, 95% O2 + 5% CO2) causes a characteristic cellular damage with widely-separated myofibrils and swollen sarcotubular system within 10 min. This damage was ameliorated by inhibitors of the hydroxyl radical (.OH), desferrioxamine, dimethyl thiourea and 120 mM mannitol, and by incubation at 8 degrees C. It was not prevented either by inhibitors of the pathway leading to sarcolemma damage (nordihydroguaiaretic acid, alpha-tocopherol, butylated hydroxytoluene) nor by agents and treatments that inhibit the oxygen paradox of cardiac muscle (glucose, omission of extracellular calcium, incubation at 30 degrees C, superoxide dismutase and catalase). Nevertheless there are similarities between these two types of damage triggered by O2 and the possibility that in both an NAD(P)H oxidase is stimulated and cytotoxic oxygen radicals are generated is discussed.

Cytotoxic action of the lysosomotropic agent L-leucine methyl ester on mammalian skeletal muscle. The role of the sarcoplasmic reticulum in producing myofilament damage

Incubation in vitro of mouse or rat diaphragms or mouse soleus muscle with the lysosomotropic agent leucine methyl ester (10 mM) produced a slowly-developing swelling of the sarcoplasmic reticulum (SR), showing that this organelle is able to take up amino acid methyl esters and conforming with previous suggestions that the SR may serve some of the functions of the lysosomal system in muscle cells. Cellular damage followed, sometimes associated with the shrinkage of the SR, but experiments with inhibitors of lysosomal cathepsins suggest that acid hydrolases were not implicated in this damage. It is suggested that the system producing myofilament damage is located on the SR and that it may be directly activated by membrane perturbation.

Sarcolemma blebs and cell damage in mammalian skeletal muscle

Plasma membrane blebs are an early sign of cellular damage in isolated cells. Phenazine methosulphate (PMS) triggers the production of conspicuous and characteristic sarcolemma blebs in mouse diaphragm skeletal muscle incubated in vitro and also causes severe myofilament damage. It is suggested that PMS activates transmembrane NAD(P)H dehydrogenases and, in turn, a modification of sulphydryl groups of the cytoskeleton, thereby permitting bleb formation in contracting cells.

Are lysosomal enzymes involved in rapid damage in vertebrate muscle cells? A study of the separate pathways leading to cellular damage

Experiments with lysosomotropic agents suggest that the sarcotubular system subserves some of the functions of the lysosomal apparatus in frog skeletal muscle. Dinitrophenol or A23187 trigger lysosome labilization and myofilament damage in mammalian cardiac muscle. Lysolecithin labilizes isolated liver lysosomes, but has no action following phospholipase A2 activation in vivo. Zinc ions or a pHi of 7.5 do not protect against myofilament damage. In fractions from mammalian cardiac muscle, calcium and calmodulin do not cause lysosomal labilization whereas cGMP does but only at high concentration (10(-4) M). It is concluded that lysosomal hydrolases play no significant part in rapid muscle damage. It is suggested that rises in [Ca]i activate two separate pathways causing (i) myofilament damage; (ii) sarcolemmal (and possibly lysosomal) membrane damage via phospholipase A2 and lipoxygenase activity. Dinitrophenol triggers both pathways independently and thus may cause lysosome labilization. The possibility that the sarcoplasmic reticulum is the site generating myofilament damage is discussed.

The role of phospholipase A2 in calcium-induced damage in cardiac and skeletal muscle

This study compares the action of inhibitors of the eicosanoid cascade on calcium-induced myofilament damage in cardiac muscle of the perfused frog heart and incubated frog ventricle slices, and in skeletal muscle of incubated mammalian diaphragm and isolated and saponin-skinned amphibian pectoris cutaneous muscle. Mepacrine (10(-5) M) and indomethacin (3 x 10(-6) M) protected completely against myofilament damage induced by entry of calcium in the 'calcium-paradox' in frog heart. However, inhibition of phospholipase A2 (PLA2) (with chlorpromazine, 2 x 10(-4) M, or mepacrine, 10(-5) M, 5 x 10(-5) M), of cyclo-oxygenase enzymes (with indomethacin, 3 x 10(-6) M to 10(-5) M or BW755C, 3.8 x 10(-4) M), or of lipoxygenase enzymes (with BW755C, 3.8 x 10(-4) M or nordihydroguaiaretic acid, 2 x 10(-6) M or 5 x 10(-6) M) all failed in intact cardiac or skeletal muscle cells to prevent the myofilament damage that is rapidly triggered by 10(-2) M caffeine, 6 x 10(-6) M ruthenium red, 10(-4) M DNP or 5 micrograms ml-1 A23187. These agents also failed completely to protect against myofilament damage in saponin-skinned amphibian skeletal muscle when [Ca]i was raised to 8 x 10(-6) M. Thus, inhibition of PLA2 does not protect the myofilament apparatus against calcium released intracellularly, and it is suggested that mepacrine and indomethacin can block entry of calcium in the calcium-paradox in the amphibian heart. Chlorpromazine (2 x 10(-4) M) and mepacrine (10(-3) M) at zero [Ca] caused severe myofilament damage in skinned muscle, possibly due to an effect on membranes.(ABSTRACT TRUNCATED AT 250 WORDS)

Constitutive fragile sites in fra(X) individuals

Recently, it was proposed that the constitutive fragile site at 3p14 be used as an "internal control" to indicate the effectiveness of the FUdR fragile site induction system. We have tested this hypothesis by determining the frequency of constitutive fragile sites at 1p31, 3p14, and 16q23 in cultures from 42 known fra(X) individuals. At least 50 cells were analyzed from each case. Seventy-four percent (31/42), 95% (40/42) and 90% (38/42) of the fra(X) individuals exhibited frequencies of less than 4% at constitutive fragile sites 3p14, 1p31 and 16q23, respectively. Of the 42 individuals tested, 12 or 28.6% showed no fragility at any of the 3 sites studied. On the other hand, at least one constitutive fragile site was observed in 50 cells studied from over 70% of the 42 people studied. It is suggested that "positive controls" continue to be used, while at the same time recording all fragile sites to identify a combination of constitutive fragile sites that may serve as an internal control indicator, and that DNA marker studies be used to complement cytogenetic testing.

Recent experience in prenatal fra(X) detection

At least 35 cases of prenatal fra(X) diagnosis have been confirmed and reported. Amniotic fluid, fetal blood and chorion -ic villus samples have exhibited fra(X) (q27.3) in cultures from 26 males and 9 females. Here we have detected fra(X) in female and male amniotic fluid specimens, AF1/fra(X),X and AF2/fra(X),Y, respectively, and a male CVS/fra(X),Y using both FUdR and excess thymidine (THY) to demonstrate the marker chromosome. Both FUdR and THY detected fra(X) and usually FUdR was superior to THY with the exception of placental cultures. It was important to examine more than one culture per protocol since no fra(X) was observed in one AF2 FUdR culture while another exhibited 19.2% expression. Similarly, confirmation studies in lung fibroblast cultures for AF2 exhibited 4.3% fra(X) in one lab while another found negative results. A similar observation in whole blood cultures was also made recently by us. In addition, we have recently experienced our first false negative fra(X),X prenatal diagnosis. We have observed another case where only one cell in 300 exhibited fra(X) where the male fetus was 50% at-risk and was referred to us after the 20th week of gestation by sonography. On the basis of our experience we recommend the following: 1) the excess THY fra(X) induction system is effective but not superior to FUdR; 2) at least two duplicate cultures per induction system should be analyzed for the marker chromosome to avoid the possibility of false-negative diagnosis; 3) where fra(X) is not demonstrated or is present in very low frequencies in CVS and/or amniotic fluid cultures, complementary DNA marker studies and/or fetal blood cultures must be made available; 4) gestational age dating by ultrasonography is recommended as early as possible.

Ultrastructural changes in the cardiomyopathy of dystrophic hamsters and mice

Changes in the ultrastructure of the cardiac muscle cells have been followed in dystrophic mice and hamsters (22-40 weeks of age) and in both species a severe cardiomyopathy accompanies the cellular damage of the skeletal muscle. The degradative changes of the myofilament apparatus of the heart cells and the specific changes in mitochondrial ultrastructure (including swelling, septation and apparent division) are characteristic of the cellular damage of both the dystrophic skeletal muscle and of normal cardiac muscle in which [Ca]i has been experimentally raised, confirming the suggestions that (i) the same gene is responsible for the myopathy of skeletal and cardiac muscle in animal dystrophy and (ii) that changes in [Ca]i are implicated in the degradative changes of muscle cells.

Failure to detect changes in sarcolemma permeability in amphibian muscle following severe cellular damage

1. Isolated amphibian hearts and pectoris cutaneous muscles were exposed either to DNP or to caffeine, thereby producing severe myofilament damage. 2. No accompanying change in sarcolemma permeability was detected by monitoring either CK or LDH release or Procion yellow entry in the heart, or by Procion entry in amphibian skeletal muscle. 3. The findings are in contrast with mammalian cardiac and skeletal muscles, and confirm that the pathways leading to myofilament degradation and to the breakdown in sarcolemma organization are separate.

Role of calcium in triggering rapid ultrastructural damage in muscle: a study with chemically skinned fibres

Agents (A23187, caffeine) believed to raise [Ca]i in vertebrate cardiac and skeletal muscles cause rapid and characteristic subcellular damage in vitro and in vivo. By using saponin-skinned amphibian pectoris cutaneous muscle and Ca-EGTA-buffered solutions it is shown that low [Ca] consistently triggers the same rapid (2–20 min), ultrastructural damage. Electron micrographs reveal a close similarity between the damaged intact and skinned preparations, namely loss of myofilament organization, specific Z-line damage, dissolution and hypercontraction bands, characteristic mitochondrial swelling and division. Where both actin and myosin filaments were lost, an underlying cytoskeletal network frequently remained, still attached to the Z-line framework. Ca was effective in skinned preparations from 5 X 10(−7) M to 8 X 10(−6) M, within the concentration range experienced by a contracting muscle. Damage was [Ca]- and time-dependent and it is suggested that it is probably the active movement of Ca ions across key membrane sites that is critical in triggering damage of the myofilament apparatus. Strontium can substitute for Ca at higher concentrations. The action of saponin suggests that the chemically skinned cell is partially activated. Ca-triggering can be bypassed experimentally by membrane-active agents or by sulphydryl agents. Ruthenium Red and trifluoperazine indirectly cause damage in the intact cell by raising [Ca]i. Studies with saponin-skinned cells and protease inhibitors show that changes in pHi, loss of ATP, Ca-activated neutral protease, or release of lysosomal enzymes (cathepsins B, D, L or H), are not involved in characteristic rapid myofilament damage.

Further evidence for genetic heterogeneity in the fragile X syndrome

The X-linked fragile X [fra(X)] syndrome, associated with a fragile site at Xq27.3, is the most common Mendelian inherited form of mental deficiency. Approximately 1 in 1060 males and 1 in 677 females carry the fra(X) chromosome. However, diagnosis of carrier status can be difficult since about 20% of males and 44% of females are nonpenetrant for mental impairment and/or expression of fra(X). We analyzed DNA from 327 individuals in 23 families segregating fra(X) for linkage to three flanking polymorphic probes: 52A, F9, and ST14. This allowed probable nonpenetrant, transmitting males and carrier females to be identified. A combined linkage analysis was conducted using these families and published probe information on F9 in 27 other families, 52A in six families, and ST14 in five families. The two-point recombination fraction for 52A-F9 was 0.13 (90% confidence interval, 0.10-0.16), for F9-fra(X) was 0.21 (0.17-0.24), and for fra(X)-ST14 was 0.12 (0.07-0.17). Tight linkage between F9 and fra(X) was observed in some families; in others loose linkage was seen suggesting genetic linkage heterogeneity. Risk analysis of carrier status using flanking DNA probes showed that probable nonpenetrant transmitting males were included in families showing both tight and loose linkage. Thus, in contrast to our previous conclusions, it appears that the presence or absence of nonpenetrant, transmitting males in a family is not an indicator of heterogeneity. To determine if heterogeneity was present, we employed the admixture test. Evidence for linkage heterogeneity between F9 and fra(X) was found, significant at P less than 0.0005. Nonsignificant heterogeneity was seen for 52A-F9 linkage. No heterogeneity was found for fra(X)-ST14. The frequency of fra(X) expression was significantly lower in families with tight F9-fra(X) linkage than in families with loose linkage. Cognition appeared to relate to linkage type: affected males in tight linkage families had higher IQs than those in loose linkage families. These findings of genetic heterogeneity can account in part for the high prevalence and apparent high new mutation rate of fra(X). They will affect genetic counseling using RFLPs. An understanding of the basis for genetic heterogeneity in fra(X) will help to clarify the nature of the unusual pattern of inheritance seen in this syndrome.