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Boer LL, Winter E, Gorissen B, Oostra RJ. Phenotypically Discordant Anomalies in Conjoined Twins: Quirks of Nature Governed by Molecular Pathways? Diagnostics (Basel) 2023; 13:3427. [PMID: 37998563 PMCID: PMC10669976 DOI: 10.3390/diagnostics13223427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
A multitude of additional anomalies can be observed in virtually all types of symmetrical conjoined twins. These concomitant defects can be divided into different dysmorphological patterns. Some of these patterns reveal their etiological origin through their topographical location. The so-called shared anomalies are traceable to embryological adjustments and directly linked to the conjoined-twinning mechanism itself, inherently located within the boundaries of the coalescence area. In contrast, discordant patterns are anomalies present in only one of the twin members, intrinsically distant from the area of union. These dysmorphological entities are much more difficult to place in a developmental perspective, as it is presumed that conjoined twins share identical intra-uterine environments and intra-embryonic molecular and genetic footprints. However, their existence testifies that certain developmental fields and their respective developmental pathways take different routes in members of conjoined twins. This observation remains a poorly understood phenomenon. This article describes 69 cases of external discordant patterns within different types of otherwise symmetrical mono-umbilical conjoined twins and places them in a developmental perspective and a molecular framework. Gaining insights into the phenotypes and underlying (biochemical) mechanisms could potentially pave the way and generate novel etiological visions in the formation of conjoined twins itself.
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Affiliation(s)
- Lucas L. Boer
- Department of Medical Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Eduard Winter
- Pathologisch-Anatomische Sammlung im Narrenturm-NHM, 1090 Vienna, Austria
| | - Ben Gorissen
- Department of Medical Imaging, Section Anatomy and Museum for Anatomy and Pathology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Roelof-Jan Oostra
- Department of Medical Biology, Sections Clinical Anatomy & Embryology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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Amico S, Smith P, Tobi S, Perry M, Wallace A, Evans DG. Neurofibromatosis type 2 discordance in monozygous twins. Fam Cancer 2021; 19:37-40. [PMID: 31965447 DOI: 10.1007/s10689-019-00148-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Neurofibromatosis type 2 (NF2) is an autosomal dominant condition caused by pathogenic variants in the NF2 gene. The pathogenic variant is either inherited or obtained by de novo mutation, characterised by the presence of schwannomas, meningiomas and ependymomas. Here we report the presence of NF2 in one twin, with bilateral vestibular schwannomas and a pathogenic variant of the NF2 gene identified in both tumour and lymphocytes, while his monozygous brother remains asymptomatic. Imaging of the unaffected twin showed no tumour load and genetic testing via Sanger sequencing and Amplification Refractory Mutation System assay demonstrated low levels of expression of the NF2 variant in lymphocytes. Further testing on non-haemopoietic tissue showed little expression or absence of the pathogenic variant. Given there is no family history and the low level of the variant, we assume the pathogenic variant is a de novo mutation during embryogenesis. De novo mutations have been described as occurring at three possible time points in the creation of monozygous twins with different genetic make-up; prior to the twinning event, as a cause of the event, or after the twinning event. Of these options, we hypothesise that the discordance in the expression of the NF2 variant between these twins is likely due to a mutational event that occurred as a result of either of the latter two possibilities, between which we cannot determine. The pathogenic variant in lymphocytes was likely transferred between the twins through a shared blood supply in utero, and the non-haemopoietic samples that showed low levels of expression, were likely due to the presence of lymphocytic cells. Therefore, we have a discordance between monozygous twins at the NF2 gene.
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Affiliation(s)
- S Amico
- Division of Evolution and Genomic Science, Department of Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester University Hospital Foundation Trust, Manchester, UK.
| | - P Smith
- Division of Evolution and Genomic Science, Department of Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester University Hospital Foundation Trust, Manchester, UK
| | - S Tobi
- Division of Evolution and Genomic Science, Department of Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester University Hospital Foundation Trust, Manchester, UK
| | - M Perry
- Division of Evolution and Genomic Science, Department of Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester University Hospital Foundation Trust, Manchester, UK
| | - A Wallace
- Division of Evolution and Genomic Science, Department of Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester University Hospital Foundation Trust, Manchester, UK
| | - D G Evans
- Division of Evolution and Genomic Science, Department of Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester University Hospital Foundation Trust, Manchester, UK
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Barnes‐Davis ME, Cortezzo DE. Two cases of atypical twinning: Phenotypically discordant monozygotic and conjoined twins. Clin Case Rep 2019; 7:920-925. [PMID: 31110715 PMCID: PMC6509934 DOI: 10.1002/ccr3.2113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 12/13/2022] Open
Abstract
Atypical twinning highlights that complex mechanisms responsible for twinning are not fully understood and may give further insight into the mechanisms involved. To assume that phenotypic difference is the result of dizygotic twinning would be erroneous and could have significant implications in the care and counseling provided to these patients.
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Affiliation(s)
- Maria E. Barnes‐Davis
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Neonatal and Pulmonary BiologyCincinnati Children’s Hospital Medical CenterCincinnatiOhio
| | - DonnaMaria E. Cortezzo
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Neonatal and Pulmonary BiologyCincinnati Children’s Hospital Medical CenterCincinnatiOhio
- Department of AnesthesiologyUniversity of Cincinnati College of MedicineCincinnatiOhio
- Division of Pain and Palliative MedicineCincinnati Children’s Hospital Medical CenterCincinnatiOhio
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Klimczewska K, Kasperczuk A, Suwińska A. The Regulative Nature of Mammalian Embryos. Curr Top Dev Biol 2018; 128:105-149. [DOI: 10.1016/bs.ctdb.2017.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Milsom SR, Ogilvie CM, Jefferies C, Cree L. Discordant Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome in identical twins - a case report and implications for reproduction in MRKH women. Gynecol Endocrinol 2015; 31:684-7. [PMID: 26291808 DOI: 10.3109/09513590.2015.1032928] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Infertility has previously been considered as an inevitable consequence of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. With modern assisted reproductive technology (ART) techniques becoming increasingly accessible, MRKH women have the opportunity for their own genetic offspring. The availability of such technology, however, increases the importance of understanding the aetiology of this complex condition. The literature debating the relevance of genetic versus post-zygotic events in the aetiology of MRKH syndrome is reviewed in the context of this report of monozygotic twins discordant for MRKH syndrome.
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Affiliation(s)
- Stella Ruth Milsom
- a Department of Reproductive Endocrinology, Womens' Health Division , Auckland District Health Board , Auckland , New Zealand
- b Department of Endocrinology , Fertility Associates Auckland , Auckland , New Zealand
- c Department of Obstetrics and Gynaecology , University of Auckland University , Auckland , New Zealand , and
| | - Cara Megan Ogilvie
- a Department of Reproductive Endocrinology, Womens' Health Division , Auckland District Health Board , Auckland , New Zealand
- b Department of Endocrinology , Fertility Associates Auckland , Auckland , New Zealand
| | - Craig Jefferies
- d Department of Paediatric Endocrinology , Auckland District Health Board , Auckland , New Zealand
| | - Lynsey Cree
- b Department of Endocrinology , Fertility Associates Auckland , Auckland , New Zealand
- c Department of Obstetrics and Gynaecology , University of Auckland University , Auckland , New Zealand , and
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Matias A, Silva S, Martins Y, Blickstein I. Monozygotic twins: Ten reasons to be different. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.diapre.2013.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Monozygotic twin discordant for Down syndrome: mos 47,XX,+21/46,XX and 46,XX. Eur J Pediatr 2013; 172:1117-20. [PMID: 23559333 DOI: 10.1007/s00431-013-1998-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 03/21/2013] [Indexed: 02/06/2023]
Abstract
Monozygotic twins, developed from a single zygote, are almost identical in clinical phenotype and concordant karyotypes. Monozygotic twins with discordant karyotypes are thought to be quite rare. Here, we report monochorionic-diamniotic twins discordant for Down syndrome. On findings of prenatal ultrasonography, nuchal translucency thickness was different between twins, and suggested that one of the twins was at high risk for having chromosomal abnormalities including Down syndrome. The twins were monochorionic-diamniotic; therefore, chorionic villi sampling of the common placenta was performed. The karyotype of the chorionic villi cells was 46,XX, and pregnancy was maintained. After delivery, dysmorphic clinical features suggesting Down syndrome were found in one of the twins, while the other twin showed a morphologically normal appearance. Karyotypes of peripheral blood leukocytes were repeatedly normal in the dysmorphic twin; however, the karyotype of skin fibroblasts from the dysmorphic twin indicated Down syndrome mosaicism; 47,XX,+21[99]/46,XX[2]. The karyotype of skin fibroblasts from the morphologically normal twin was 46,XX. Monozygosity of the twins was confirmed by a short tandem repeat analysis using 16 polymorphic markers. A mitotic nondisjunction followed by the twinning would explain the discordant karyotypes between monozygotic twins.
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Abstract
AbstractMy response is divided into four sections: (1) is devoted to a potpourri of commentaries that are essentially in agreement with the substance of my target article (with one exception); in (2) I address, in response to one of the commentaries, several issues relating to the use of candidate gene association studies in behavior genetics (in particular those proposing a specific G×E interaction); in (3) I provide a detailed response to several defenses of the twin study methodology; and in (4) I conclude with several reflections on that methodology and the conception of human nature it has fostered.
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Discordant phenotype in monozygotic twins with mosaic trisomy 12p in lymphocytes. Eur J Med Genet 2012; 55:480-4. [DOI: 10.1016/j.ejmg.2012.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Revised: 05/16/2012] [Accepted: 05/20/2012] [Indexed: 11/19/2022]
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Gentilin B, Guerneri S, Bianchi V, Natacci F, Colombo A, Fogliani R, Fortuna R, Coviello DA, Curcio C, Lalatta F. Discordant Prenatal Phenotype and Karyotype of Monozygotic Twins Characterized by the Unequal Distribution of Two Cell Lines Investigated by Different Methods: A Review. Twin Res Hum Genet 2012; 11:352-6. [DOI: 10.1375/twin.11.3.352] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractWe present the case of a monozygotic twin pregnancy discordant for phenotype and karyotype. A chorionic villus sample was performed at the 11th week of gestation in a primigravida because of cystic hygroma detected by ultrasound in one twin of a monochorionic, biamniotic pregnancy. Rapid testing by means of quantitative fluorescence polymerase chain reaction and conventional karyotyping, obtained by both short- and long-term culture, revealed a homogeneous monosomy X (45,X). Amniocentesis was performed separately for both twins before termination and showed an homogeneous monosomy X in one sample and a 46,X,del(X)(p11.1) karyotype in the other one. Postmortem fetal tissues culture confirmed the discordant karyotype between the two embryos. Placental samples obtained after termination revealed the cell line which was not detected at chorionic villus sampling. Based on this and previous reports, we suggest that in cases of a phenotypic discordance detected at ultrasound in the first trimester, it is advisable to perform a karyotype analysis on amniocytes because it better reflects fetal constitution rather than chorionic villi or lymphocytes in case of heterokaryotipic monosomy X monochorionic twins.
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Erlich Y. Blood ties: chimerism can mask twin discordance in high-throughput sequencing. Twin Res Hum Genet 2011; 14:137-43. [PMID: 21425895 DOI: 10.1375/twin.14.2.137] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Twin studies have long provided a means to separate the contributions of genetic and environmental factors. A recent pioneering report by Baranzini et al. presented an analysis of the complete genomes and epigenomes of a monozygotic (MZ) twin pair discordant for multiple sclerosis. This failed to find any difference between the twins, raising doubts regarding the value of whole-genome twin studies for defining disease susceptibility alleles. However, the study was carried out with DNA extracted from blood. In many cases, the hematopoietic lineages of MZ twins are chimeric due to twin-to-twin exchange of hematopoietic stem cells during embryogenesis. We therefore wondered how chimerism might impact the ability to identify genetic differences. We inferred the blood chimerism rates and profiles of more than 30 discordant twin cases from a wide variety of medical conditions. We found that the genotype compositions of the twins were highly similar. We then benchmarked the performance of SNP callers to detect discordant variations using high-throughput sequencing data. Our analysis revealed that chimerism patterns, well within the range normally observed in MZ twins, greatly reduce the sensitivity of SNP calls. This raises questions regarding any conclusions of genomic homogeneity that might be drawn from studies of blood-derived twin DNA.
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Affiliation(s)
- Yaniv Erlich
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142, United States of America.
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Abstract
Although popularly designated as "identical", monozygotic (MZ) twins are rarely identical. Much has been speculated on the origin of MZ twins and several theories have been proposed. Post-fertilization events, such as chromosomal mosaicism, skewed X-inactivation and imprinting mechanisms, as well as other epigenetic mechanisms are responsible for the differences between MZ twins. Numerous discordant MZ twins have been reported including discordance for lateral asymmetry, major malformation, growth and intrauterine death of the co-twin. This discrepancy may have long-term implications on complex diseases and their predisposition, organ transplantation and interpretation of twin-based studies. We reviewed the genotypic and phenotypic differences between MZ twins and discuss their main causes.
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Affiliation(s)
- Sara Silva
- Department of Obstetrics and Gynecology, University Hospital of S. Jo;atao, Medical Faculty of Porto, Porto, Portugal
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Zwijnenburg PJG, Meijers-Heijboer H, Boomsma DI. Identical but not the same: the value of discordant monozygotic twins in genetic research. Am J Med Genet B Neuropsychiatr Genet 2010; 153B:1134-49. [PMID: 20468073 DOI: 10.1002/ajmg.b.31091] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Monozygotic (MZ) twins show remarkable resemblance in many aspects of behavior, health, and disease. Until recently, MZ twins were usually called "genetically identical"; however, evidence for genetic and epigenetic differences within rare MZ twin pairs has accumulated. Here, we summarize the literature on MZ twins discordant for Mendelian inherited disorders and chromosomal abnormalities. A systematic literature search for English articles on discordant MZ twin pairs was performed in Web of Science and PubMed. A total number of 2,016 publications were retrieved and reviewed and 439 reports were retained. Discordant MZ twin pairs are informative in respect to variability of phenotypic expression, pathogenetic mechanisms, epigenetics, and post-zygotic mutagenesis and may serve as a model for research on genetic defects. The analysis of single discordant MZ twin pairs may represent an elegant approach to identify genes in inherited disorders.
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Affiliation(s)
- Petra J G Zwijnenburg
- Department of Clinical Genetics, VU University Medical Center, de Boelelaan 1117, Amsterdam, the Netherlands.
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Wuttikonsammakit P, Tanawattanacharoen S, Uerpairojkit B. Monochorionic twins with the same blood karyotype of 46,XY/47,XYY but different phenotypes. J Obstet Gynaecol Res 2010; 36:178-82. [DOI: 10.1111/j.1447-0756.2009.01115.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chimerism detected in fraternal twins using ABI AmpFlSTR® Identifiler. FORENSIC SCIENCE INTERNATIONAL GENETICS SUPPLEMENT SERIES 2009. [DOI: 10.1016/j.fsigss.2009.08.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Machin G. Non-identical monozygotic twins, intermediate twin types, zygosity testing, and the non-random nature of monozygotic twinning: A review. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2009; 151C:110-27. [DOI: 10.1002/ajmg.c.30212] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Vialard F, Salomon LJ, Winer N, Bussières L, Molina Gomes D, Ville Y. Fetal karyotype in feto-fetal transfusion syndrome: a 7-year experience. Prenat Diagn 2009; 29:804-5. [PMID: 19399755 DOI: 10.1002/pd.2272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tho SP, Jackson R, Kulharya AS, Reindollar RH, Layman LC, McDonough PG. Long-term follow-up and analysis of monozygotic twins concordant for 45,X/46,XY peripheral blood karyotype but discordant for phenotypic sex. Am J Med Genet A 2007; 143A:2616-22. [DOI: 10.1002/ajmg.a.31992] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE OF REVIEW With improved methods for detecting chimeras and growing numbers of stem cell transplantations, blood group and other forms of chimerism are observed with increasing frequency. This review will focus on the state of science and new insights into the multifaceted subject of blood group chimerism. RECENT FINDINGS Recognition that the immune system tolerates chimeric cells under certain conditions has led to efforts to elucidate related immune-modulating processes. The chimeric state following transplantation of hematopoietic stem cells, as well as after solid organ transplantation, is of special interest. Also, chimerism is considered to be a potential trigger for certain autoimmune diseases. Natural chimerism is more frequent than previously recognized. Using improved laboratory techniques, investigators can often trace chimeric tissues to their origin. New therapeutic strategies have been applied after stem cell transplantation depending on the chimeric state. Also, recent research has resulted in methods for determining chimerism in maternal peripheral blood that reflect fetal blood type and certain congenital diseases. SUMMARY The subject of human chimerism has evolved from a curiosity of nature to an important field of research and, potentially, holds the key to advancing our understanding of the fundamental mechanisms of immune tolerance.
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Affiliation(s)
- Camilla Drexler
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
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Willer CJ, Herrera BM, Morrison KME, Sadovnick AD, Ebers GC. Association between microchimerism and multiple sclerosis in Canadian twins. J Neuroimmunol 2006; 179:145-51. [PMID: 16843535 DOI: 10.1016/j.jneuroim.2006.06.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2005] [Revised: 06/07/2006] [Accepted: 06/13/2006] [Indexed: 11/21/2022]
Abstract
Microchimerism, the persistence of foreign cells thought to derive from previous pregnancies, has been associated with autoimmune diseases. A maternal parent-of-origin effect in MS remains unexplained. We tested for microchimerism in monozygotic and dizygotic twin-pairs with MS. Microchimerism was associated with MS in affected females from monozygotic concordant pairs when compared to both affected (p=0.020) and unaffected (p=0.025) females in monozygotic discordant pairs. Microchimerism was increased in affected females of dizygotic discordant pairs (p=0.059). The rate of microchimerism was significantly higher in affected twins than in unaffected co-twins (p=0.0059). These observations show an association in twins between the presence of microchimerism and having MS.
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Affiliation(s)
- Cristen J Willer
- Department of Clinical Neurology, University of Oxford, Oxford, UK
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Bourthoumieu S, Esclaire F, Yardin C. Chimerism in twins: Caution is needed in interpretation of karyotypes. Am J Med Genet A 2006; 140:533-5. [PMID: 16470796 DOI: 10.1002/ajmg.a.31111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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