Prenatal diagnosis and genetic analysis of double trisomy 48,XXX,+18

Prenatal diagnosis of simultaneous occurrence of double trisomy involving chromosomes 18 and X is extremely rare. We report on the prenatal diagnosis, genetic analysis and clinical manifestations of a fetus with both trisomy 18 and trisomy X. A 26-year-old, para 1 woman was referred for genetic counselling at 36 weeks' gestation with the sonographic findings of intrauterine growth retardation (IUGR), polyhydramnios, ventricular septal defect, and an enlarged cisterna magna. Both cordocentesis and amniocentesis revealed a consistent karyotype of 48,XXX,+18. Quantitative fluorescent polymerase chain reaction using polymorphic small tandem repeat markers specific for chromosomes 18 and X rapidly determined that both aneuploidies arose as a result of non-disjunction in maternal meiosis II. Our case shows that two non-disjunction events can occur not only in the same parent, but also in the same cell division. Our case also shows that double trisomy, 48,XXX,+18, can demonstrate an enlarged cisterna magna, IUGR and polyhydramnios in prenatal ultrasound.

Prenatal diagnosis and genetic analysis of X chromosome polysomy 49, XXXXY

We report on the prenatal diagnosis, genetic analysis and clinical manifestations of a 49,XXXXY fetus. A 31-year-old, primigravida woman was referred for genetic counselling at 17 weeks' gestation with the sonographic findings of intrauterine growth retardation, generalized oedema, a large septated cystic hygroma colli measuring 5x4 cm, and abnormal posturing of the lower extremities. Quantitative fluorescent polymerase chain reaction (QF-PCR) with small tandem repeat (STR) markers specific for chromosome X and a pentanucleotide marker X22 for the Xq/Yq pseudoautosomal region PAR2 rapidly detected the X-chromosome polysomy from amniotic fluid cells. This abnormality appeared to arise from successive non-disjunction during maternal meiosis I and meiosis II. Cytogenetic analysis revealed a karyotype of 49,XXXXY. Our case shows that a 49,XXXXY fetus in the second trimester may demonstrate hydrops fetalis and a large septated cystic hygroma colli by prenatal ultrasound. Our case also shows that QF-PCR assays with sex chromosome specific STR markers provide rapid prenatal diagnosis of numerical sex chromosome aneuploidy as well as its genetic cause in fetal cystic hygroma.

Interleukin-1 receptor signaling rather than that of tumor necrosis factor is critical in protecting the host from the severe consequences of a polymicrobe anaerobic infection

Infection of the dental pulp leads to an osteolytic lesion that results from a polymicrobial infection consisting largely of pathogenic anaerobes. Infection causes significant morbidity and mortality mediated by bacterial factors and in some cases by the up-regulation of inflammatory cytokines. The inflammatory cytokines interleukin-1 (IL-1) and tumor necrosis factor (TNF), in particular, play a complex and central role in the responses to microbial pathogens. However, relatively little is known about the significance of these cytokines in protecting the host from focal polymicrobial anaerobic infections. To establish the relative importance of IL-1 and TNF in mediating the response to a mixed anaerobic infection, we inoculated the dental pulp of mice with six anaerobic pathogens containing functional deletions of receptors to IL-1 (IL-1R1(-/-)), TNF (TNFRp55(-/-)-p75(-/-)), or both (TNFRp55(-/-)-IL-1RI(-/-)). The results indicate that IL-1 receptor signaling and TNF receptor signaling both play similarly important roles in protecting the host from local tissue damage. However, IL-1 receptor signaling is considerably more important than TNF receptor signaling in preventing the spread of infection into surrounding fascial planes, since IL-1R1(-/-) but not TNFRp55(-/-)-p75(-/-) mice exhibited significantly higher morbidity and mortality. Moreover, all of the fatal infections occurred in male mice, suggesting the importance of gender differences in limiting the impact of these infections.

Immunocytochemical study of the dorsal and median raphe nuclei in patients with Alzheimer's disease prospectively assessed for behavioural changes

The dorsal and median raphe nuclei were examined with immunocytochemistry to display the 5-HT neurones in 16 cases of post-mortem-proven Alzheimer's disease (AD) and 12 age and sex-matched controls. The AD cases had been prospectively assessed during life for expression of behavioural changes as well as for cognitive decline. A significant (P < 0.001) 41% reduction in density of dorsal raphe neurones was found along with a significant (P < 0.02) 29% reduction in density of median raphe neurones in AD. There were significantly more neurofibrillary tangles in both dorsal and median raphe nuclei in AD than in controls (P < 0.001). There was no correlation between reduction in neurone density in these nuclei and behavioural change, cognitive decline, neurofibrillary tangle counts in these nuclei or plaque and tangle pathology in frontal and temporal cortex. It was concluded from these findings that the raphe nuclei are significantly affected by the pathology of AD and that plasticity in the 5-HT system is the probable reason for the lack of correlation of reduced 5-HT neurone density and clinical disease parameters.

Tissue interactions in the control of trophoblast invasion

On the basis of observations made in an explant model of anchoring villus development, it is proposed that two discrete types of signal are required to trigger the entry of cytotrophoblast into the migratory extravillous lineage. The first is mediated by contact of the tip of the first trimester mesenchymal villus with decidual extracellular matrix, in response to which stem villous cytotrophoblast undergoes a proliferative burst and differentiates into cells of the cytotrophoblast column, anchoring peripheral villi to the uterus. Column stability is dependent on the interaction between extracellular fibronectin and integrin alpha 5 beta 1 expressed at the cell surface, both of which are upregulated in this pathway. Subsequently, cells detach in large numbers from the periphery of the column and become migratory infiltrative cells. This step is dependent on paracrine signalling from the mesenchymal cells that lie directly beneath the villous basement membrane. As the signal decreases with increasing distance from the placental anchoring villus, this mechanism might account for the fact that trophoblast invasion progresses no deeper than the inner myometrium.

Protection of the kidney by Wen-Pi-Tang against ischemia-reperfusion injury

Electrophoretic and densitometric data revealed induction of apoptosis in the kidney due to experimentally induced ischemia-reperfusion injury. Such apoptosis in the kidney was reduced in rats given 62.5 or 125 mg/kg body wt./day Wen-Pi-Tang orally for 30 days prior to ischemia-reperfusion. An increase in the dose of Wen-Pi-Tang was associated with suppressed fragmentation of DNA, a ladder pattern of low-molecular-weight molecules, resulting in a beneficial effect on renal function.

A study on the nitric oxide production-suppressing activity of sanguisorbae radix components

The active components of an aqueous extract of Sanguisorbae Radix, which possesses nitric oxide (NO) production-suppressing activity, were determined using macrophages that were activated by the addition of lipopolysaccharide. Significant inhibitory activity against the formation of both NO and inducible NO synthase, and NADPH-diaphorase activity, which is involved in NO generation, was shown by Sanguisorbae Radix fractions T-B and T-C. On further fractionation, the subfractions of T-B and T-C all showed high anti-NO activity. Sanguiin H-6, sanguiin H-11, 1,2,3,4,6-penta-O-galloyl-beta-D-glucose, eugeniin and polymeric proanthocyanidin were isolated from TB-3 and TC-4, and all were identified as exhibiting strong anti-NO activity. We have confirmed that sanguiin H-6 is the most active component of Sanguisorbae Radix with respect to the suppression of NO production. It is suggested that tannin makes a prominent contribution to the biological activity of Sanguisorbae Radix.

Prenatal diagnosis of inherited satellited non-acrocentric chromosomes

We report on the prenatal diagnosis of two sib female fetuses with a satellited short arm of chromosome 4 and a male fetus with a satellited long arm of chromosome X. The first two fetuses had a cryptic balanced translocation (4;15)(p16;p11.1) inherited from a mother carrying a satellited 4p and having an affected child with the Wolf-Hirschhorn syndrome. The third fetus had a satellited Xq, with a deletion of subtelomeric region of Xq. The mother was subsequently found to have the same satellited Xq but without the presence of a reciprocal translocation. She decided to continue the pregnancy. The proband with a satellited Xq manifested developmental delay, mental retardation, hypertelorism, ptosis of one eye, low-set ears, and hearing disturbance at age 6 months. Fluorescence in situ hybridization (FISH) with a specific telomeric or subtelomeric probe, and genetic marker analyses were used to confirm the diagnosis. Pregnant women with satellited non-acrocentric chromosomes are at risk for carrying fetuses with chromosome abnormalities. If the X chromosome is involved, the fetuses can be affected with X-linked recessive disorders including mental retardation. Detailed genetic counselling, cytogenetic studies, FISH and genetic marker analyses are useful in prenatal detection of abnormal chromosome rearrangements.

Molecular prenatal diagnosis of thalassemia in Taiwan

OBJECTIVE

Thalassemia is a highly prevalent genetic disorder in Taiwan. The major goal of this study was to present a feasible protocol for the prenatal diagnosis of thalassemia.

METHOD

Prenatal investigation of thalassemia was performed on 57 at-risk cases at the Mackay Memorial Hospital, Taipei, Taiwan. We developed a method using polymerase chain reaction (PCR) and high-throughput DNA sequencing to detect mutations. All diagnoses were confirmed after delivery.

RESULT

Prenatal testing revealed 16 normal fetuses, 24 alpha-thal-1 carriers, eight Hb Bart's hydrops fetalis, seven beta-thalassemia minor, and two beta-thalassemia major fetuses. No false-positive or false-negative cases were found during the postnatal follow-ups.

CONCLUSION

The results of this study indicate that prenatal diagnosis of thalassemia syndromes in Taiwan is successful with the use of a rapid and accurate molecular method.

A fetus with VACTERL association, unilateral aplasia of the humerus and partial hemihypoplasia

We report simultaneous occurrence of right partial hemihypoplasia and ipsilateral aplasia of humerus in a fetus with VACTERL association. Our case has further demonstrated the overlap between VACTERL and body hemihypoplasia.

Rapid determination of zygosity and common aneuploidies from amniotic fluid cells using quantitative fluorescent polymerase chain reaction following genetic amniocentesis in multiple pregnancies

Following second-trimester twin amniocentesis, we used quantitative fluorescent polymerase chain reaction (QF-PCR) assays and polymorphic small tandem repeats (STR) for rapid determination of zygosity and common aneuploidies from amniotic fluid (AF) cells in four pregnancies with like-sex twins, fused placentae and inconclusive chorionicity. The first and the second cases were suspected to have inadvertent sampling of the same amniotic cavity twice. The first case showed a dizygotic (DZ) pattern and repeat amniocentesis was thus avoided. The second case was monozygotic (MZ) and was complicated by discordant fetal growth and twin-twin transfusion syndrome. The third case was associated with a co-twin malformation, occipital encephalocele. DNA studies revealed MZ twinning with a discordant structural defect. The fourth case was associated with co-twin abnormalities of cystic hygroma and hydrops fetalis. DNA studies showed DZ twinning with discordant structural and chromosomal defects. The QF-PCR assay with STR has the advantages of rapid determination of zygosity and common aneuploidies in AF cells. This simple test appears to be useful in the instances of possible inadvertent puncture of the same amniotic cavity twice during amniocentesis and of discordant fetal structural and/or chromosomal abnormalities following genetic amniocentesis in multiple pregnancies with uncertain chorionicity.

Role of Salviae Miltiorrhizae Radix extract and its compounds in enhancing nitric oxide expression

Excessive production of nitric oxide (NO) and its peroxidant product, peroxynitrite, has been implicated in the pathology of acute and chronic renal failure, and inhibitors of NO production have been shown to exert protective and ameliorative effects against renal epithelial cell damage mediated by enhanced generation of NO. Salviae Miltiorrhizae Radix has exhibited a beneficial effect in the improvement of renal failure. In order to clarify the mechanism responsible, we investigated whether Salviae Miltiorrhizae Radix extract and several of its related compounds, including caffeic acid and its polymers which were isolated by our research group, can regulate the generation and release of NO. The results demonstrated that Salviae Miltiorrhizae Radix extract and these compounds suppressed NO effectively in the systems employing activated macrophages and the arginine-hydrogen peroxide, and that, furthermore, the activity shown by the compounds was higher than that shown by the extract. In addition, direct scavenging of NO was also observed. The present findings suggest that Salviae Miltiorrhizae Radix extract and its compounds are potent NO inhibitors, and that their inhibitory effect on the generation and release of NO may contribute to the previously reported pharmacological effect of Salviae Miltiorrhizae Radix in improving renal function.

Prenatal diagnosis of cystic bladder distension secondary to obstructive uropathy

We report the perinatal findings of a huge midline posterior cystic bladder distension secondary to lower urinary tract obstruction and prune-belly syndrome in a male fetus. A 40-year-old woman, gravida 3, para 0, was referred at 21 gestation weeks with sonographic findings of anhydramnios and a fetus with a 9.5 x 6.0 cm intra-abdominal cystic mass containing two chambers. The in utero ultrasound-guided fetal bladder drainage using a single needle aspiration and the ultrasound follow-ups of fetal bladder filling provided a diagnostic aid. This method helped to show the position of the bladder and the cystic bladder mass as well as the status of communication in response to decompression or filling of the fetal bladder. Cytogenetic analysis revealed a 46,XY karyotype. Autopsy showed agenesis of the posterior urethra, prominent megacystis, a cystically distended mass arising from the lower posterior bladder, hydronephrosis, megaureters, and anorectal agenesis with an intestinal blind end adherent to the posterior wall of the uterus. There were no urogenital duplication, hindgut duplication, or urachal abnormalities. The contracted bladder had a full-thickness muscular wall with a trigone and two ureteral orifices while the cystically distended bladder did not have any opening and was lined by a very thin wall. Histology of the cystic bladder wall demonstrated typical urothelium, lamina propria and muscularis propria. The pathogenesis and differential diagnosis of cystic bladder distension are discussed.

Growth factor-extracellular matrix synergy in the control of trophoblast invasion

At the periphery of the human placenta, trophoblast attaches to the uterine wall. The tissue interface contains many anchoring sites, with cytotrophoblast columns that form bridges between the overlying extraembryonic (villous) mesenchyme and the maternal decidual stroma beneath. From the periphery of these columns, large numbers of trophoblast cells detach, migrate through the decidua and eventually colonize and transform maternal arteries. In this way the placenta increases and gives priority to the maternal blood supply to the conceptus. We have shown that when early villous tissue is explanted on a collagen gel in serum-free medium, anchoring-site morphogenesis occurs. Thus, in the presence of placental mesenchyme but in the absence of maternal cells, contact with a permissive extracellular matrix (ECM) is necessary and sufficient for cytotrophoblast column development. Proliferation of trophoblast occurs, followed by differentiation into a columnar cell phenotype in which cells remain attached to one another and to the ECM. At this stage, interaction between fibronectin and integrin alpha5beta1 at the cell surface stabilizes the column and the cells remain as a contiguous multilayered sheet. However, the addition of serum-free conditioned medium from first-trimester placental fibroblasts stimulates cytotrophoblast to detach from the distal column and migrate in streams across the ECM. The removal of insulin-like growth factor I (IGF-I) from the fibroblast medium decreases streaming activity, whereas the addition of exogenous IGF-I (10 ng/ml) to serum-free medium produces a streaming phenotype. In contrast, transforming growth factor beta1 (10 ng/ml) maintains the cells in a tight sheet. These results suggest the possibility of a paracrine interaction between villous mesenchyme and cytotrophoblast in anchoring sites to stimulate the infiltration of the maternal ECM by trophoblast. Such a mechanism would be self-limiting because the signal diminishes with distance from the placenta.

Inhibition of nitric oxide release by an aqueous extract of Tinospora tuberculata

An aqueous extract of Tinospora tuberculata stems was found to scavenge nitric oxide (NO) in vitro in both cell and cell-free systems. When the aqueous extract was added to lipopolysaccharide-stimulated murine macrophages, it inhibited NO release dose-dependently, and similar activity was found in a cell-free system using sodium nitroprusside as a NO donor. These findings may help to explain, in part, certain pharmacological activities of Tinospora tuberculata.

Protective effects of Glycyrrhizae radix extract and its compounds in a renal hypoxia (ischemia)-reoxygenation (reperfusion) model

Glycyrrhizae radix water extract (GRWE) and its two major constituents glycyrrhizin and 3-glycyrrhetinic monodesmoside, significantly suppressed LDH leakage and MDA release, whereas glycyrrhetinic acid had no effect. On the other hand, in rats subjected to ischemia-reperfusion, the activities of endogenous antioxidant enzymes including catalase and glutathione peroxidase showed recovery, whereas the levels of urea nitrogen and creatinine in serum were reduced by administration of glycyrrhizin orally for 30 days prior to ischemia-reperfusion. These results indicate that GRWE and its two constituents may be promising for amelioration of hypoxia (ischemia)-reoxygenation (reperfusion) injury and improvement of renal function by acting directly or indirectly as antioxidant and oxygen radical-scavenging agents.

Direct scavenging of nitric oxide by traditional crude drugs

Thirty-one traditional crude drugs and several pure compounds were examined for their possible regulatory effect on nitric oxide (NO) levels using sodium nitroprusside as a NO donor in vitro. Most of the crude drugs tested demonstrated direct scavenging of NO. Eight crude drugs, including Sanguisorbae Radix, Caryophylli Flos, Gambir, Coptidis Rhizoma, Granati Cortex, Gallae Rhois, Rhei Rhizoma and Cinnamomi Cortex exhibited significant activity (IC50 values < 1000 micrograms/ml), and with the exception of Coptidis Rhizoma, all were found to contain tannins as their major constituents. In addition, some crude drugs containing flavonoids or essential oils also appeared to act against NO. Ten major tannins contained in Sanguisorbae Radix and Rhei Rhizoma showed high scavenging activity (IC50 values < 326.3 micrograms/ml), and 6 of 8 alkaloids obtained from Coptidis Rhizoma also effectively scavenged the NO radical (IC50 values < 455.4 micrograms/ml). It was indicated that these compounds may be the active principles of the crude drugs responsible for NO scavenging. The present results suggest that traditional crude drugs might be potent and novel therapeutic agents for scavenging of NO and the regulation of pathological conditions caused by excessive NO and its oxidation product, peroxynitrite. These findings may also help to explain, at least in part, certain pharmacological activities of crude drugs, especially anti-infection and anti-inflammatory activities.