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Eggenhuizen GM, Go A, Koster MPH, Baart EB, Galjaard RJ. Confined placental mosaicism and the association with pregnancy outcome and fetal growth: a review of the literature. Hum Reprod Update 2021; 27:885-903. [PMID: 33984128 PMCID: PMC8382909 DOI: 10.1093/humupd/dmab009] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/30/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chromosomal mosaicism can be detected in different stages of early life: in cleavage stage embryos, in blastocysts and biopsied cells from blastocysts during preimplantation genetic testing for aneuploidies (PGT-A) and later during prenatal testing, as well as after birth in cord blood. Mosaicism at all different stages can be associated with adverse pregnancy outcomes. There is an onward discussion about whether blastocysts diagnosed as chromosomally mosaic by PGT-A should be considered safe for transfer. An accurate diagnosis of mosaicism remains technically challenging and the fate of abnormal cells within an embryo remains largely unknown. However, if aneuploid cells persist in the extraembryonic tissues, they can give rise to confined placental mosaicism (CPM). Non-invasive prenatal testing (NIPT) uses cell-free (cf) DNA released from the placenta in maternal blood, facilitating the detection of CPM. In literature, conflicting evidence is found about whether CPM is associated with fetal growth restriction (FGR) and/or other pregnancy outcomes. This makes counselling for patients by clinicians challenging and more knowledge is needed for clinical decision and policy making. OBJECTIVE AND RATIONALE The objective of this review is to evaluate the association between CPM and prenatal growth and adverse pregnancy outcomes. All relevant literature has been reviewed in order to achieve an overview on merged results exploring the relation between CPM and FGR and other adverse pregnancy outcomes. SEARCH METHODS The following Medical Subject Headings (MESH) terms and all their synonyms were used: placental, trophoblast, cytotrophoblast, mosaicism, trisomy, fetal growth, birth weight, small for gestational age and fetal development. A search in Embase, PubMed, Medline Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases was conducted. Relevant articles published until 16 July 2020 were critically analyzed and discussed. OUTCOMES There were 823 articles found and screened based on their title/abstract. From these, 213 articles were selected and full text versions were obtained for a second selection, after which 70 publications were included and 328 cases (fetuses) were analyzed. For CPM in eight different chromosomes (of the total 14 analyzed), there was sufficient evidence that birth weight was often below the 5th percentile of fetal growth standards. FGR was reported in 71.7% of CPM cases and preterm birth (<37 weeks of delivery) was reported in 31.0% of cases. A high rate of structural fetal anomalies, 24.2%, in cases with CPM was also identified. High levels of mosaicism in CVS and presence of uniparental disomy (UPD) were significantly associated with adverse pregnancy outcomes. WIDER IMPLICATIONS Based on the literature, the advice to clinicians is to monitor fetal growth intensively from first trimester onwards in case of CPM, especially when chromosome 2, 3, 7, 13, 15, 16 and 22 are involved. In addition to this, it is advised to examine the fetuses thoroughly for structural fetal anomalies and raise awareness of a higher chance of (possibly extreme) premature birth. Despite prematurity in nearly a fifth of cases, the long-term follow-up of CPM life borns seems to be positive. More understanding of the biological mechanisms behind CPM will help in prioritizing embryos for transfer after the detection of mosaicism in embryos through PGT-A.
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Affiliation(s)
- Geerke M Eggenhuizen
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Attie Go
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Maria P H Koster
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Esther B Baart
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands.,Department of Developmental Biology, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
| | - Robert Jan Galjaard
- Department of Clinical Genetics, Erasmus MC, University Medical Center, Rotterdam 3015CN, The Netherlands
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2
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Hoyas PC, Tárrega ER, Vázquez Rodríguez S, Quiroga de la Cruz R, Diago Almela V, Perales Marín A. Monozygotic twins discordant for trisomy 4: a case report and a literature review. J OBSTET GYNAECOL 2020; 41:147-149. [PMID: 32657184 DOI: 10.1080/01443615.2019.1650013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Paula Calvo Hoyas
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine, University Hospital La Fe, Valencia, Spain
| | - Elisabet Rodríguez Tárrega
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine, University Hospital La Fe, Valencia, Spain
| | - Sheila Vázquez Rodríguez
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine, University Hospital La Fe, Valencia, Spain
| | - Ramiro Quiroga de la Cruz
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine, University Hospital La Fe, Valencia, Spain
| | - Vicente Diago Almela
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine, University Hospital La Fe, Valencia, Spain
| | - Alfredo Perales Marín
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine, University Hospital La Fe, Valencia, Spain
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3
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Cioppi F, Riera-Escamilla A, Manilall A, Guarducci E, Todisco T, Corona G, Colombo F, Bonomi M, Flanagan CA, Krausz C. Genetics of ncHH: from a peculiar inheritance of a novel GNRHR mutation to a comprehensive review of the literature. Andrology 2018; 7:88-101. [PMID: 30575316 DOI: 10.1111/andr.12563] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/21/2018] [Accepted: 10/10/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Normosmic congenital hypogonadotropic hypogonadism (ncHH) is caused by the deficient production, secretion, or action of gonadotropin-releasing hormone (GnRH). Its typical clinical manifestation is delayed puberty and azoospermia. Homozygous and compound heterozygous mutations in the GNRHR gene (4q13.2) are the most frequent genetic causes of ncHH. OBJECTIVES (i) Characterization at the molecular level (genetic origin and functional effect) of a unique homozygous mutation (p.Gly99Glu) in a ncHH man; (ii) to provide a comprehensive catalog of GNRHR mutations with genotype-phenotype correlation and comparison of in vitro studies vs. in silico prediction tools. MATERIAL AND METHODS A ncHH man and his parents, in whom we performed the following: (i) Sanger sequencing, qPCR of the GNRHR gene; (ii) chromosome 4 SNP array; and (iii) competition binding assay and inositol phosphate signaling assay. PubMed and Human Genome Mutation Database (HGMD) search for GNRHR mutations. Bioinformatic analysis of 55 reported variants. RESULTS qPCR showed two GNRHR copies in the index case. SNP array revealed the inheritance of two homologous chromosomes 4 from the mother (maternal heterodisomy; hUPD) with two loss of heterozygosity regions, one of them containing the mutated gene (maternal isodisomy; iUPD). Functional studies for the p.Gly99Glu mutation demonstrated a right-shifted GnRH-stimulated signaling response. Bioinformatic tools show that commonly used in silico tools are poor predictors of the function of ncHH-associated GNRHR variants. DISCUSSION Functional analysis of the p.Gly99Glu mutation is consistent with severely decreased GnRH binding affinity (a severe partial loss-of-function mutation). Complete LOF variants are associated with severe and severe/moderate phenotype, whereas partial LOF variants show wide range of clinical manifestations. CONCLUSION This is the first ncHH patient carrying a novel causative missense mutation of GNRHR with proven 'severe pLOF' due to maternal hUPD/iUPD of chromosome 4. Our literature review shows that functional studies remain essential both for diagnostic and potential therapeutic purposes.
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Affiliation(s)
- F Cioppi
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - A Riera-Escamilla
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Catalonia, Spain
| | - A Manilall
- School of Physiology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - E Guarducci
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - T Todisco
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Corona
- Endocrinology Unit, Maggiore-Bellaria Hospital Bologna, Bologna, Italy
| | - F Colombo
- Department of Urology and Gynecology, Bologna University Hospital - Policlinico S.Orsola, Bologna, Italy
| | - M Bonomi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Division of Endocrinology and Metabolism, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - C A Flanagan
- School of Physiology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - C Krausz
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, Florence, Italy
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4
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Grati FR. Implications of fetoplacental mosaicism on cell-free DNA testing: a review of a common biological phenomenon. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:415-423. [PMID: 27240559 DOI: 10.1002/uog.15975] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/16/2016] [Accepted: 05/24/2016] [Indexed: 06/05/2023]
Affiliation(s)
- F R Grati
- Research and Development, Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A., Busto Arsizio, Varese, Italy .
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5
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Bouman A, van der Kevie-Kersemaekers AM, Huijsdens-van Amsterdam K, Dahhan N, Knegt L, Vansenne F, Cobben JM. Trisomy 4 mosaicism: Delineation of the phenotype. Am J Med Genet A 2016; 170A:1040-5. [DOI: 10.1002/ajmg.a.37522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 12/07/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Arjan Bouman
- Department of Clinical Genetics; Academic Medical Center; Amsterdam The Netherlands
| | | | | | - Nordin Dahhan
- Department of Paediatrics; Academic Medical Center; Amsterdam The Netherlands
| | - Lia Knegt
- Department of Clinical Genetics; Academic Medical Center; Amsterdam The Netherlands
| | - Fleur Vansenne
- Department of Clinical Genetics; University Medical Center Groningen; Groningen The Netherlands
| | - Jan Maarten Cobben
- Department of Paediatrics; Academic Medical Center; Amsterdam The Netherlands
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6
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Liu W, Zhang H, Wang J, Yu G, Qiu W, Li Z, Chen M, Choy KW, Sun X. Prenatal diagnosis of complete maternal uniparental isodisomy of chromosome 4 in a fetus without congenital abnormality or inherited disease-associated variations. Mol Cytogenet 2015; 8:85. [PMID: 26539248 PMCID: PMC4632482 DOI: 10.1186/s13039-015-0190-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
Background The prenatal diagnosis of subjects with complete uniparental isodisomy of chromosome 4 (iUPD4) has rarely been reported and poses a great challenge for genetic counseling. In this study, a prenatal case with a high (1 in 58) risk of Down syndrome was diagnosed with iUPD4 by combined chromosomal microarray analysis (CMA), whole exome sequencing (WES) and ultrasound morphology scan. Results By CMA, a pathogenic copy number variant was not detected; however, a complete maternal iUPD4 was identified in this fetus after analyzing the parental genotype results. To detect potentially autosomal recessive variants, WES was performed. Two missense and two frameshift variants were identified but were predicted with uncertain significance; none of the mutations were definitively associated with congenital abnormality or inherited disease. In addition, a detailed ultrasound morphology scan did not identify any structural abnormalities, facial dysmorphisms or intrauterine growth restriction. The family history was unremarkable. The couple was counseled with the prenatal diagnostic results, and they opted to give birth to the child. No phenotypic abnormalities were observed in this child after the first year of life. Conclusion This study provides further evidence that iUPD4 can result in a healthy live birth and demonstrates that the combined use of CMA, WES and ultrasound technology provides additional information for the prenatal diagnosis and clinical management of rare UPD events. Electronic supplementary material The online version of this article (doi:10.1186/s13039-015-0190-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- WeiQiang Liu
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 P. R. China
| | - HuiMin Zhang
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 P. R. China
| | - Jian Wang
- Department of Laboratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127 P. R. China
| | - GuoJiu Yu
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 P. R. China
| | - WenJun Qiu
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 P. R. China
| | - ZhiHua Li
- Department of Prenatal Diagnosis and Fetal Medical, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 P. R. China
| | - Min Chen
- Department of Prenatal Diagnosis and Fetal Medical, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 P. R. China
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, P. R. China
| | - XiaoFang Sun
- Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Key Laboratory for Major Obstetric Diseases of Guangdong Province, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150 P. R. China
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7
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Malvestiti F, Agrati C, Grimi B, Pompilii E, Izzi C, Martinoni L, Gaetani E, Liuti MR, Trotta A, Maggi F, Simoni G, Grati FR. Interpreting mosaicism in chorionic villi: results of a monocentric series of 1001 mosaics in chorionic villi with follow-up amniocentesis. Prenat Diagn 2015. [DOI: 10.1002/pd.4656] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Francesca Malvestiti
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Cristina Agrati
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Beatrice Grimi
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Eva Pompilii
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
- GYNEPRO; V.le Carducci, 2/3 Bologna Italy
| | - Claudia Izzi
- UO Diagnosi Prenatale; Azienda Ospedaliera Spedali Civili; Brescia Italy
| | - Lorenza Martinoni
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Elisa Gaetani
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Maria Rosaria Liuti
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Anna Trotta
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Federico Maggi
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Giuseppe Simoni
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
| | - Francesca Romana Grati
- Research and Development, Cytogenetics and Molecular Biology; TOMA Advanced Biomedical Assays S.p.A.; Busto Arsizio VA Italy
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8
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Uhlmann WR, Peñaherrera MS, Robinson WP, Milunsky JM, Nicholson JM, Albin RL. Biallelic mutations in huntington disease: A new case with just one affected parent, review of the literature and terminology. Am J Med Genet A 2015; 167A:1152-60. [DOI: 10.1002/ajmg.a.37009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 01/22/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Wendy R. Uhlmann
- Division of Molecular Medicine and Genetics; Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
- Department of Human Genetics; University of Michigan; Ann Arbor Michigan
| | - Maria S. Peñaherrera
- Department of Medical Genetics; University of British Columbia; Vancouver British Columbia
- Child and Family Research Institute; Vancouver British Columbia
| | - Wendy P. Robinson
- Department of Medical Genetics; University of British Columbia; Vancouver British Columbia
- Child and Family Research Institute; Vancouver British Columbia
| | | | - Jane M. Nicholson
- Division of Molecular Medicine and Genetics; Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
- Department of Obstetrics and Gynecology; University of Michigan; Ann Arbor Michigan
| | - Roger L. Albin
- Department of Neurology; University of Michigan; Ann Arbor Michigan
- VA Ann Arbor Healthcare System; Geriatrics Research, Education, and Clinical Center; Ann Arbor Michigan
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9
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Aminoff A, Gunnar E, Barbaro M, Mannila MN, Duponchel C, Tosi M, Robinson KL, Hernell O, Ehrenborg E. Novel mutations in microsomal triglyceride transfer protein including maternal uniparental disomy in two patients with abetalipoproteinemia. Clin Genet 2011; 82:197-200. [DOI: 10.1111/j.1399-0004.2011.01828.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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van der Kevie-Kersemaekers AMF, Suijkerbuijk RF, Moll FCP, Dijkhuizen T, van Spaendonck-Zwarts KY, Drok G, Bouman K, Sikkema-Raddatz B. A live-born child with a mosaic chromosomal pattern of either monosomy 21 or trisomy 4 in different embryonal germ layers. Prenat Diagn 2010; 30:86-8. [PMID: 19960447 DOI: 10.1002/pd.2415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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11
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Kamnasaran D, Morin F, Gekas J. Prenatal diagnosis and molecular genetic studies on a new case of agnathia-otocephaly. Fetal Pediatr Pathol 2010; 29:207-11. [PMID: 20594144 DOI: 10.3109/15513811003796946] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Otocephaly is a severe and lethal malformation. We report a new case of a fetus with agnathia-otocephaly, presenting only the facial findings but with otherwise normal organs. The fetal karyotype was normal. We examined the fetal DNA for uniparental disomy of chromosomes 3 and 4, since the mother is a carrier of a t(3;4) chromosome, but did not identify any evidence. We were also unable to find mutations or possible associations with candidate otocephalic genes, including OTX2 and PGAP1. These findings suggest that the molecular etiology of agnathia-otocephaly is still unknown with a mutation yet to be identified in humans.
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Affiliation(s)
- Deepak Kamnasaran
- Department of Pediatrics, Laval University, Centre de recherche de CHUL, 1705 Boulevard Laurier, Québec, Québec, Canada.
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12
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Yong PJ, von Dadelszen P, McFadden DE, Barrett IJ, Kalousek DK, Robinson WP. Placental weight in pregnancies with trisomy confined to the placenta. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:605-610. [PMID: 19761633 DOI: 10.1016/s1701-2163(16)34239-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Mosaicism with trisomy confined to the placenta is present in ~1% of ongoing pregnancies at the time of chorionic villus sampling. Some studies have found reduced fetal growth in confined placental trisomy. The objective of this study was to assess placental weight and feto-placental weight ratio in pregnancies with trisomy confined to the placenta, and to correlate them with the level of trisomy in the three major placental lineages. METHODS We conducted a retrospective study of 69 pregnancies with prenatally diagnosed mosaic trisomy in which the trisomic cells were confined to the placenta. Placental weight and feto-placental weight ratio were compared to those of matched controls, and placental weight was also analyzed for associations with the type and level of trisomy. Placental pathology was also reviewed. RESULTS The pregnancies with mosaic trisomy were found to have lower placental weights than matched controls, but normal feto-placental weight ratios. Placental weight was not associated with the type or level of trisomic cells in the three placental lineages at term (chorionic plate, chorionic villus mesenchyme, and trophoblast). There were no pathognomonic findings on routine placental pathology of the trisomic placentas. CONCLUSION Although placental weight was reduced (with normal feto-placental weight ratio) in pregnancies with trisomy confined to the placenta, the level of placental trisomy was not correlated with placental weight. Thus, trisomy may alter placental function rather than have a direct hypoplastic effect on placental growth. More in-depth studies beyond routine pathology are required to identify how trisomy affects placental function.
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Affiliation(s)
- Paul J Yong
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC
| | - Deborah E McFadden
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC
| | - Irene J Barrett
- Department of Medical Genetics, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC
| | - Dagmar K Kalousek
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC
| | - Wendy P Robinson
- Department of Medical Genetics, University of British Columbia, Vancouver BC; Child and Family Research Institute, Vancouver BC
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13
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Gentile M, Volpe P, Cariola F, Di Carlo A, Marotta V, Buonadonna AL, Boscia FM. Prenatal diagnosis of chromosome 4 mosaicism: Prognostic role of cytogenetic, molecular, and ultrasound/MRI characterization. Am J Med Genet A 2005; 136:66-70. [PMID: 15940687 DOI: 10.1002/ajmg.a.30506] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Trisomy 4 mosaicism is extremely rare: herein we report the cytogenetic and molecular characterization and prenatal US findings of a case diagnosed prenatally. The diagnosis of level III mosaicism was established in cultured amniotic fluid cells (22.5%). At 22 weeks gestation, micrognathia and hypotelorism were suspected at 2-D sonography, and confirmed at 3-D examination. In addition, 2-D US showed cerebellar hypoplasia associated with borderline ventriculomegaly (confirmed at magnetic resonance imaging, MRI), spine deformity (hemivertebra), and a complete atrioventricular septal defect (AVSD). The pregnancy was terminated. Trisomy 4 mosaicism was confirmed in placental and fetal skin cultured cells. The cord blood karyotype was normal. Molecular analysis excluded uniparental disomy of chromosome 4, and indicated that the trisomy 4 was of maternal meiotic origin. In presence of chromosome 4 mosaicism, accurate fetal sonography and echocardiography are mandatory. Low level mosaicism and normal echographic examinations seem to be associated with good prognosis. In postnatal life, chromosome 4 mosaicism should be suspected, and cytogenetic analysis proposed of further tissues (i.e., skin), in presence of craniofacial dysmorphism, cardiac defects, and abnormal hands/feet, even if mental development is appropriate or only slightly impaired.
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Affiliation(s)
- Mattia Gentile
- Department of Medical Genetics, I.R.C.C.S. Saverio de Bellis, Castellana Grotte, Bari, Italy.
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Abstract
The predominance of females segregating chromosome aberrations to their offspring has been explained mostly by selection disadvantage of unbalanced products of spermatogenesis. However, analysis of data from the literature supports the idea that somatic cells of early female embryos are similar to female germ cells in that they are prone to malsegregation. The goal of this study was to compare the sex ratio (male to female ratio) of carriers of presumably mitotic-occurring chromosome abnormalities to identify any sex biases. In examining the literature, we found a female prevalence in cases of mosaicism associated with uniparental disomy (UPD) (26 male individuals/conceptions and 45 female individuals/conceptions, sex ratio is 0.58, significantly different from 1.06 in newborn population, P = 0.0292). This predominance was highest at gestational age <16 week (8 male and 22 female conceptuses, sex ratio is 0.36, significantly different from expected figure of 1.28, P = 0.0025), which diminished at later stages of fetal development indicating potential correction of trisomies predominantly in females. There is a threefold prevalence of 46,XX/45,X mosaics over 46,XY/45,X mosaics in prenatally diagnosed cases, which also suggests a gender-specific postzygotic chromosome loss. The male prevalence in Prader-Willi syndrome with maternal UPD of chromosome 15 also can be explained by sex-specific trisomy correction, with predominant loss of a maternal chromosome causing biparental inheritance and therefore, complete correction of trisomy in females (without UPD). Finally, there is a female predominance in carriers of chromosome rearrangement with pericentromere break (mosaicism for Robertsonian translocation/isochromosome, centric fission, nonacrocentric isochromosome, and whole arm rearrangement), in both prenatal (21 males and 36 females, sex ratio is 0.58, P < 0.0184) and postnatal ill-defined cases (14 males and 35 females, sex ratio is 0.40, P = 0.001). Thus, the findings presented in this paper suggest that, in addition to reduction in male fertility, and to probable selection against abnormal cell line(s), there are two mechanisms that contribute to female preponderance among carriers of mosaicism: sex-specific chromosome loss and sex-specific centromere instability. The data obtained suggest that females may have gonadal mosaicism for aneuploidies and structural rearrangements more often than males. This may lead to the maternal origin bias in offspring with trisomies or structural rearrangements.
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Affiliation(s)
- Natalia V Kovaleva
- St. Petersburg Centre for Medical Genetics, St. Petersburg, Russian Federation.
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15
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Kotzot D, Utermann G. Uniparental disomy (UPD) other than 15: Phenotypes and bibliography updated. Am J Med Genet A 2005; 136:287-305. [PMID: 15957160 DOI: 10.1002/ajmg.a.30483] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Uniparental disomy (UPD) describes the inheritance of a pair of chromosomes from only one parent. The concept was introduced in Medical Genetics by Engel (1980); Am J Med Genet 6:137-143. Aside UPD 15, which is the most frequent one, up to now (February 2005) 197 cases with whole chromosome maternal UPD other than 15 (124 X heterodisomy, 59 X isodisomy, and 14 cases without information of the mode of UPD) and 68 cases with whole chromosome paternal UPD other than 15 (13 X heterdisomy, 53 X isodisomy, and 2 cases without information of the mode of UPD) have been reported. In this review we discuss briefly the problems associated with UPD and provide a comprehensive clinical summary with a bibliography for each UPD other than 15 as a guide for genetic counseling.
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Affiliation(s)
- Dieter Kotzot
- Department of Medical Genetics, Molecular and Clinical Pharmacology, Division of Clinical Genetics, Medical University of Innsbruck, Innsbruck, Austria.
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16
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Brady AN, May KM, Fernhoff PM. Mosaic trisomy 4: Long-term outcome on the first reported liveborn. Am J Med Genet A 2005; 132A:411-3. [PMID: 15633177 DOI: 10.1002/ajmg.a.30339] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In a previous report, we described the first liveborn with trisomy 4 mosaicism [Marion et al. (1990) Am J Med Genet 37:362-365]. To our knowledge, since our original report, there have been only four additional reports of a prenatal diagnosis of mosaic trisomy 4 resulting in a liveborn child [Hsu et al. (1997) Prenat Diag 17:201-242; Kuchinka et al. (2001) Prenat Diag 21:36-39; Wieczorek et al. (2003) Prenat Diag 23:128-133; Zaslav et al. (2000) Am J Med Genet 95:381-384]. Three of the more recent reports lacked confirmation of the mosaicism in tissue samples collected from the child after delivery, and likely represent cases of confined placental mosaicism. We recently examined our original patient, N.J., in an effort to provide long-term follow-up. N.J. is currently 14-years-old, and is enrolled in both special education and mainstream eighth grade classes at a local public middle school. Although she generally scores below average on standardized intellectual tests, her verbal skills and social interactions are more age appropriate. Our initial report described abnormalities of N.J.'s right hand and right ear, for which several reconstructive surgeries have been performed. A current medical concern is her entrance into puberty, as menarche has not yet occurred, and asymmetrical breast development is present. Overall, N.J. has developed into a generally healthy adolescent with low-normal intellect. This report demonstrates the importance of long-term follow-up in providing accurate counseling for rare chromosomal disorders.
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Affiliation(s)
- April N Brady
- Division of Medical Genetics, Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA.
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17
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Spena S, Duga S, Asselta R, Peyvandi F, Mahasandana C, Malcovati M, Tenchini ML. Congenital afibrinogenaemia caused by uniparental isodisomy of chromosome 4 containing a novel 15-kb deletion involving fibrinogen Aα-chain gene. Eur J Hum Genet 2004; 12:891-8. [PMID: 15489905 DOI: 10.1038/sj.ejhg.5201207] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Among rare inherited deficiencies of coagulation factors, congenital afibrinogenaemia is characterised by the lack of fibrinogen in plasma. In the last few years, several genetic defects underlying afibrinogenaemia (mostly point mutations) have been described in the fibrinogen gene cluster. In this study, the molecular basis responsible for afibrinogenaemia in a Thai proband was defined. Point mutation screening was accomplished by directly sequencing the three fibrinogen genes. The impossibility to amplify fibrinogen Aalpha-chain gene (FGA) exons 5 and 6 suggested the presence of a homozygous deletion. A specific long-range PCR assay enabled the identification of a novel 15-kb deletion, representing the largest afibrinogenaemia-causing deletion described so far. Direct sequencing of the deletion junction allowed mapping of the breakpoints in FGA intron 4 and in the intergenic region between Aalpha- and Bbeta-chain genes. Since the mutation was inherited only from the mother and nonpaternity was ruled out, a maternal uniparental disomy (UPD) was hypothesised. UPD test, carried out with markers covering the whole chromosome 4, revealed that maternal isodisomy was responsible for homozygosity of the 15-kb deletion in the proband. The apparently normal phenotype of the proband, except for afibrinogenaemia, suggests that UPD for chromosome 4 is clinically silent. This represents the first case of a documented complete isodisomy of chromosome 4 causing the phenotypic expression of a recessive disorder. In silico analyses of the regions surrounding the breakpoints suggested that the 15-kb deletion might have originated from an inappropriate repair of a double-strand break by the nonhomologous end joining mechanism.
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Affiliation(s)
- Silvia Spena
- Department of Biology and Genetics for Medical Sciences, University of Milan, Italy
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18
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Beechey CV. A reassessment of imprinting regions and phenotypes on mouse chromosome 6: Nap1l5 locates within the currently defined sub-proximal imprinting region. Cytogenet Genome Res 2004; 107:108-14. [PMID: 15305064 DOI: 10.1159/000079579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Accepted: 04/05/2004] [Indexed: 11/19/2022] Open
Abstract
Previous studies (Beechey, 2000) have shown that mouse proximal chromosome (Chr) 6 has two imprinting regions. An early embryonic lethality is associated with two maternal copies of the more proximal imprinting region, while mice with two maternal copies of the sub-proximal imprinting region are growth retarded at birth, the weight reduction remaining similar to adulthood. No detectable postnatal imprinting phenotype was seen in these earlier studies with two paternal copies of either region. The sub-proximal imprinting region locates distal to the T77H reciprocal translocation breakpoint in G-band 6A3.2 and results reported here show that it does not extend beyond the breakpoint of the more distal T6Ad translocation in 6C2. It has been confirmed that the postnatal growth retardation observed with two maternal copies of the sub-proximal region is established in utero, although placental size was normal. A new finding is that 16.5-18.5-dpc embryos, with two paternal copies of the sub-proximal imprinting region, were larger than their normal sibs, although placental size was normal. As no postnatal growth differences have been observed in these mice, the fetal overgrowth must normalize by birth. The imprinted genes Peg1/Mest, Copg2, Copg2as and Mit1/Lb9 map to the sub-proximal imprinting region and are thus candidates for the observed imprinting phenotypes. Another candidate is the recently reported imprinted gene Nap1l5. Expression studies of Nap1l5 in mice with two maternal or two paternal copies of different regions of Chr 6 have demonstrated that the gene locates within the sub-proximal imprinting region. FISH has mapped Nap1l5 to G-band 6C1, within the sub-proximal imprinting region but several G-bands distal to the Peg1/Mest cluster. This location, and the 30-Mb separation of these loci on the sequence map, makes it probable that Nap1l5 defines a new imprinting domain within the currently defined sub-proximal imprinting region.
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Affiliation(s)
- C V Beechey
- Mammalian Genetics Unit, Medical Research Council, Harwell, Didcot, Oxfordshire, UK.
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Chen CP, Chern SR, Lee CC, Chang TY, Wang W, Tzen CY. Clinical, cytogenetic, and molecular findings of prenatally diagnosed mosaic trisomy 4. Prenat Diagn 2004; 24:38-44. [PMID: 14755408 DOI: 10.1002/pd.792] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To present the clinical, cytogenetic, and molecular findings of prenatally diagnosed mosaic trisomy 4. CASE An amniocentesis was performed at 21 weeks' gestation because of maternal anxiety. Cytogenetic analysis revealed mosaicism for trisomy 4, 47,XX,+4[4]/46,XX[16]. Level II ultrasound demonstrated tetralogy of Fallot. Repeated amniocentesis at 23 weeks' gestation revealed 47,XX,+4[4]/46,XX[19]. The pregnancy was terminated. Phenotypic findings included tetralogy of Fallot, hypertelorism, micrognathia, abnormal ears, duplicated phalanges of the left thumb, clinodactyly, and overlapping of the toes. The karyotype of the cord blood was 46,XX. Cytogenetic analyses of the multiple tissue samplings showed a karyotype of 47,XX,+4 in 40/40 cells of the amniotic membrane (amnion), and 47,XX,+4/46,XX with various levels of trisomy 4 in the cells of the liver, lungs, placenta, skin, and umbilical cord. The levels of trisomy 4 were 11/40 in the liver, 8/40 in the lungs, 31/40 in the placenta, 9/40 in the skin, and 8/40 in the umbilical cord. METHOD The parental origin and meiotic origin of trisomy 4 were determined by examining the amniotic membrane using quantitative fluorescent polymerase chain reaction assays with polymorphic markers specific for chromosome 4. The result was consistent with a paternal meiosis I nondisjunction error. The cord blood showed a biparental inheritance. An extra paternal heterozygous allele with partial dosage increase was noted in other fetal and extraembryonic tissues studied. CONCLUSION A diagnosis of trisomy 4 mosaicism in amniocytes indicates an increased risk for fetal abnormalities. Associated abnormal findings include congenital heart defects and anomalies of the digits and thumb. A confirmatory placental sampling may be helpful, whereas a fetal blood sampling is of a very limited value. A postnatal amnion sampling may provide additional clues to the fetal involvement of trisomy 4.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
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Wieczorek D, Prott EC, Robinson WP, Passarge E, Gillessen-Kaesbach G. Prenatally detected trisomy 4 and 6 mosaicism--cytogenetic results and clinical phenotype. Prenat Diagn 2003; 23:128-33. [PMID: 12575019 DOI: 10.1002/pd.557] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report on a live-born male with 46,XY/47,XY+4/47,XY,+6 mosaicism. Trisomy 4 mosaicism was detected by karyotyping chorionic villus samples (CVS) and was confirmed by the analysis of 16 metaphases obtained from cultured amniotic fluid cells. Eight metaphases were normal (46,XY), two had trisomy 4 (47,XY,+4), and two had trisomy 6 (47,XY,+6). Two postnatal chromosomal analyses of blood lymphocytes at birth and at the age of one week were normal. Chromosomal analysis of cultured skin fibroblasts from the right inguinal region at the age of 12 months revealed trisomy 4 (47,XY,+4) in 49 metaphases, trisomy 6 (47,XY,+6) in 2 metaphases, and a normal karyotype (46,XY) in 49 cells of the 100 analyzed metaphases, respectively. The main clinical findings consist of prenatal growth retardation, hypoplasia of the right side of the face, a dysplastic and posteriorly rotated right ear, a high vaulted palate, retrognathia, aplasia of the right thumb, hypoplasia of the fingernails, a deep sacral dimple, and patchy skin hypopigmentation of the right leg. When last seen at the age of 14 months, his development was nearly normal. Five patients with trisomy 4 mosaicism have been reported previously, but none with an additional trisomy 6 mosaicism.
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Affiliation(s)
- Dagmar Wieczorek
- Institut für Humangenetik, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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21
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Starke H, Mitulla B, Nietzel A, Heller A, Beensen V, Grosswendt G, Claussen U, von Eggeling F, Liehr T. First patient with trisomy 21 accompanied by an additional der(4)(:p11 --> q11:) plus partial uniparental disomy 4p15-16. Am J Med Genet A 2003; 116A:26-30. [PMID: 12476447 DOI: 10.1002/ajmg.a.10830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We report on a rare additional numerical chromosomal aberration in a child with Down syndrome due to free trisomy 21. The karyotype showed 48,XY,+21,+mar after GTG banding, with the marker present in 80% of cells. The supernumerary marker chromosome (SMC) was as small as approximately one-third of 18p, and with the recently developed centromere-specific multi-color fluorescence in situ hybridization (cenM-FISH) technique, it was shown that the SMC was a derivative chromosome 4. The SMC was not specifically stained by arm-specific probes for chromosome 4; thus, it has been described as der(4)(:p11 --> q11:). Microsatellite analysis resulted in a partial maternal uniparental isodisomy (UPD) for chromosome 4p15-16 and a maternal origin for two chromosomes 21. Until now only two similar cases have been described in the literature, but without clarifying the origin of the SMC and without looking for an additional UPD. This is the only reported case of a UPD 4p in a liveborn child.
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Affiliation(s)
- Heike Starke
- Institute of Human Genetics and Anthropology, Jena, Germany
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Abstract
Genomic imprinting is the phenomenon by which one of the two alleles of a subset of genes is preferentially expressed according to its parental origin. This pattern of inheritance is different from the more frequent mode of Mendelian inheritance, which is not influenced by the parental origin of the allele. The idea that imprinted genes can affect fetal growth is becoming increasingly intriguing as it has been shown that most imprinted genes are expressed in the placenta and some play a role in regulating the interactions between its fetal and maternal interfaces. This article considers genomic imprinting by reviewing recent findings of alterations in fetal growth related to different types of genetic changes affecting the expression of imprinted genes. Among the genetic anomalies, the uniparental disomy (UPD) defines the inheritance of both homologous chromosomes from only one parent. UPDs of a number of chromosomes have been described in association with effects on the phenotype. We reviewed cases of UPD reported till now with particular reference to those associated to growth alterations.
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Affiliation(s)
- Monica Miozzo
- Laboratory of Medical Genetics, Clinic of Obstetrics and Gynecology, Department of Medicine, Surgery and Dentistry, San Paolo School of Medicine, University of Milan, Italy.
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Horn LC, Faber R, Meiner A, Piskazeck U, Spranger J. Current awareness in prenatal diagnosis. Prenat Diagn 2001; 21:427-33. [PMID: 11360293 DOI: 10.1002/pd.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Peñaherrera MS, Barrett IJ, Brown CJ, Langlois S, Yong SL, Lewis S, Bruyère H, Howard-Peebles PN, Kalousek DK, Robinson WP. An association between skewed X-chromosome inactivation and abnormal outcome in mosaic trisomy 16 confined predominantly to the placenta. Clin Genet 2000; 58:436-46. [PMID: 11149612 DOI: 10.1034/j.1399-0004.2000.580603.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Skewed X-chromosome inactivation (XCI) is frequently found in the diploid fetal tissues of individuals with mosaic trisomy that originated from a 'trisomic zygote rescue' event. This may result from a high number of trisomic cells in the embryonic cell pool at the time of XCI, which are subsequently eliminated by selection. We hypothesize that extremely skewed XCI in these mosaic cases will be associated with a poor fetal outcome due to failure to completely eliminate the trisomy from all fetal tissues. To test this hypothesis, XCI status was evaluated in 17 cases of prenatally detected trisomy 16 mosaicism. Ten of the 15 informative cases showed extreme XCI skewing ( > or = 90% inactivation of one allele) in blood or other diploid fetal tissues compared to six of the 111 controls (p < 0.001). Among these 10 'skewed' cases, 6 showed an abnormal outcome, defined as developmental abnormalities and/or intrauterine or neonatal death. In contrast, of the 5 cases without extreme skewing, none showed abnormal outcome, although outcome information was incomplete in 1 case. An additional 6 cases analyzed, involving trisomy mosaicism for other chromosomes, showed similar results. Further studies are warranted to determine if XCI status adds useful information to the prediction of pregnancy outcome in prenatally detected mosaic trisomy.
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Affiliation(s)
- M S Peñaherrera
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
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