Review of drug-induced limb defects in mammals

Ectrodactyly in a Chinese patient born to a mother with neuromyelitis optica spectrum disorder

NMOSD develops primarily in women of childbearing age, and several previous studies have shown that the disorder may increase the risk of miscarriage. However, there are no reports, to our knowledge, of fetal malformation, other than neonatal hydrocephalus, related to NMOSD. We report a 30-year-old woman who experienced recurrent neuritis and who was seropositive for AQP4-IgG. She became pregnant, and the fetus was found to have ectrodactyly. Histological analysis of the placenta showed moderate inflammatory infiltration; however, whether fetal malformation in NMOSD is related to inflammation and AQP4-IgG remains to be determined.

Increased SCE levels in Mediterranean Italian buffaloes affected by limb malformation (transversal hemimelia)

In recent years some buffalo farms in Campania have reported the birth of calves with limb malformation, especially with transversal hemimelia. We investigated 20 Mediterranean Italian buffaloes (8 males and 12 females) from one day to six months of age, of which 10 were affected by transversal hemimelia (group 1) and 10 were healthy controls (group 2). The following clinical and radiological patterns were observed in the malformed animals: hind limbs amputated, the right amputated off the second tarsus bones and the left amputated off the proximal epiphysis metatarsus, and the right thoracic limb hypoplasic (1 female); left hind limb amputated off the proximal epiphysis metatarsus (2 females and 1 male); left hind limb amputated off the third tarsus bones (1 female); left hind limb amputated off the tibia (1 female and 1 male); left hind limb amputated off the distal epiphysis metatarsus (1 female); left hind limb amputated off the first phalanx (1 male); right hind limb amputated off the proximal epiphysis metatarsus (1 male). In their malformed limbs all the animals presented more or less developed outlines of claws. The mean rate of SCE/cell in animals with transversal hemimelia was 8.80 +/- 3.19, that of the controls 6.61 +/- 2.73. The difference was statistically significant (P < 0.001).

Asymmetric lateral distribution of obstructed hemivagina and renal agenesis in women with uterus didelphys: institutional case series and a systematic literature review

OBJECTIVE

To investigate if an asymmetry exists in the lateral distribution of obstructed hemivagina and renal agenesis in women with uterus didelphys.

DESIGN

All English-language medical papers on uterus didelphys, obstructed hemivagina, and associated renal agenesis published from 1980 to 2005 and identified by Embase, Medline, and Pubmed database searches were retrieved. In addition, 41 institutional cases are described. We considered articles in which the presence of a uterus didelphys, obstructed hemivagina, and renal agenesis was assessed as well as the affected side. Data were stratified based on surgical confirmation or imaging evidence of the specific müllerian anomaly. Two authors abstracted data independently on standardized forms, and the combined frequency of right- and left-side malformation subtype was computed.

RESULT(S)

Thirty-six reports including 138 subjects were selected. Unilateral hemato- or pyocolpos was on the right side in 91 patients (66%). Among the 125 cases with surgical demonstration of the müllerian malformation subtype, 81 (65%) had the anomaly on the right side. In the institutional series, lesions were on the right side in 25 cases (61%). Combining the above figures, the observed proportion of right-sided anomalies (116/179) was 65% (95% CI 57% to 72%).

CONCLUSION(S)

Left-right asymmetry may be induced before organogenesis, establishing differences in morphogenesis on the left and right sides of the embryo.

Ectrodactyly in a West Highland white terrier

A case of monomelic forelimb ectrodactyly (lobster-claw deformity) in a West Highland white terrier is reported. Clinical and radiographic findings are described. The dog was treated with a soft tissue reconstruction of the cleft. It later developed a slight varus-type deformity at the carpus but remained sound with occasional bouts of mild lameness following vigorous exercise. To the author's knowledge, this is the first reported case of canine ectrodactyly treated by simple cleft reconstruction, and only the second report of ectrodactyly in this breed.

Radiological findings in three cases of paraxial radial hemimelia in goats

Hemimelia is a congenital abnormality characterized by the absence of a portion of the normal structures in a limb. Hemimelia is classified as transversal and paraxial and is related to genetical and environmental factors. This article shows the radiological findings observed in three different cases of paraxial hemimelia occurred in goats (radial agenesia, absence of the portion of the distal epiphysis of the radius and anomalous radius with ulnar hypoplasia). Possible causes related to these abnormalities are discussed.

Laterality patterns in infants with external birth defects

The lateral distribution of external birth defects has not been reported in a comprehensive way, and patterns in this distribution have not been examined. This study presents the lateral distribution of 6,390 unilateral defects from among 102 defect categories in data collected by the Metropolitan Atlanta Congenital Defects Program. Among all defects, 49% (95% CI 48-51%) were right-sided. Among males and females, 51% (95% CI 50-53%) and 47% (95% CI 46-49%) of the defects, respectively, were right-sided. Of the 102 defect types, 57 had an excess of defects on the right side of the body; 39 had an excess of defects on the left side; and 6 were equally distributed. The excess on the right side was statistically significant for inguinal hernia, incarcerated inguinal hernia, microtia, preauricular sinus, talipes calcaneovalgus, and lambdoidal craniosynostosis. For the left side, the excess was statistically significant for preauricular tags, cleft lip, fused lip and cleft gum, cleft lip with cleft palate, congenital hip dysplasia, unstable hip, absent forearm or hand, anomaly of the knee, and skin tags. The percentage of right-sided defects among case subjects with unilateral defects was correlated with the percentage of males among all case subjects (r = 0.24, P < 0.05). Among male case subjects with unilateral defects, the correlation coefficient was 0.31 (P < 0. 01), and among females with unilateral defects, it was 0.11 (P > 0. 10). Differences in the lateral distribution of specific birth defects may be due to subtle differences in morphogenesis on the left and right sides of the embryo brought about by establishment of left-right asymmetry prior to organogenesis. The fact that more defect categories were right-sided than left-sided may be related to the observation that mitochondrial maturation in rat embryos is delayed on the right side. The right side, therefore, may be more susceptible than the left to defects caused by prenatal hypoxia. The significant correlation between the percentage right-sided and percentage male may then also be related to the observation that male sex hormones lower the mitochondrial respiration rate in rats and increase rat sensitivity to chemical hypoxia. Investigators should consider reporting the laterality of specific defects in both laboratory and epidemiological studies of birth defects. Right- and left-sided defects should perhaps be considered separately in etiologic studies of birth defects. Teratology 60:265-271, 1999. Published 1999 Wiley-Liss, Inc.

Developmental toxicity induced during early stages of mammalian embryogenesis

Both a conceptual and a practical borderland between teratology and mutagenesis is early embryogenesis, the period between fertilization and gastrulation. Radiation and a variety of chemicals adversely affect the early conceptus leading to in utero mortality and malformations. The post-fertilization period of susceptibility differs from exposures of gametes, the later producing excessive pre- and peri-implantational death and low rates of fetal anomalies predominated by growth retardation. In contrast mutagen exposure of the zygote induces peri-implantational death, pan-gestational death and fetal anomalies predominated by hydrops, abdominal wall defects, and eye aberrations. The mechanism for this pathology remains unclear. These same agents produce a broader range of phenotypic anomalies during the remainder of pre-gastrulation development with anomalies overlapping those induced during organogenesis. Retinoic acid and 5-azacytidine administered prior to gastrulation produce novel malformation syndromes indicative of gene expression modification. The rates and types of defects from mutagen treatment of both gametes and the early conceptus contrast with those resulting from embryonic treatment during organogenesis, and the mechanisms are likely to differ. The pre-gastrulation period has not been explored to the extent reported during gametogenesis or organogenesis. Pre-gastrulation teratology is a new area of investigation with relevance both to reproductive toxicology and to mammalian developmental biology.

Hand and foot postaxial polydactyly: two different traits

The aim of this work was to test whether postaxial hexadactyly had different clinical and epidemiological characteristics depending on hand or foot involvement. In the period 1967-1993, the Latin-American Collaborative Study of Congenital Malformations (ECLAMC) enrolled 1,582,289 births, and 2,271 cases with isolated (nonsyndromal) postaxial polydactyly (5th-digit hexadactyly). The prevalence was 14.3/10,000 births. Postaxial polydactyly (PP) of the hand (HPP) was the most frequent type (N:1,733; 76.3%; prevalence: 11.0/10,000), followed by foot PP (FPP=N:351; 15.5%; prevalence: 2.2), and hand and foot PP (BPP=N:187; 8.2%; prevalence: 1.2). Unlike HPP (55.0% bilateral; 77.2% left), FPP was less frequently bilateral (19.4%), with lower preference for the left side (55.5%). As expected, HPP was associated with African Black ethnicity, male sex, twinning, low maternal education, parental consanguinity, and there was frequent recurrence in 1st-degree relatives. Conversely, FPP was associated with Amerindian racial background, parental subfertility, and bleeding in the 1st trimester of pregnancy. BPP displayed the highest frequency of associated congenital defects (23.4%, vs HPP:6.6%, FPP: 15.4%). In its isolated form, BPP resembled HPP more than FPP with respect to left preference (90.9%), familial recurrence (11.0% of 1st degree relatives), and low maternal education. Although male sex preference and high frequency of twinning was observed in the 3 PP subtypes, statistical significance was present only in HPP. None of the 3 PP subtypes showed abnormal values for perinatal mortality, birth weight, length of gestation, parental ages, or parity. A logistic regression analysis showed Black race only to be associated with HPP, parental subfertility with FPP, parental consanguinity with BPP, and non-Black race with both FPP and BPP. The data presented here are the first indication that HPP and FPP are 2 different entities, with a larger genetic component in HPP than in FPP.

Demonstration of congenital anomalies in the joints of the forelimbs and hindlimbs caused by several pharmacological agents

In this study, fetal joint abnormalities caused by cytosine arabinoside, caffeine, sodium salicylate, and retinyl acetate administration during pregnancy, were investigated. In the cytosine-arabinoside-administered group, complete disappearance of joint spaces in the forelimbs, and narrowing or complete disappearance of joint spaces in the hindlimbs was highly noticeable. In the caffeine group, in all forelimb joints starting from art, humeri, there were abnormal fusions in bones, together with occasional disappearance of the joint space. In hindlimbs, similar findings were observed. In the sodium salicylate group, the complete disappearance of joint space and surfaces among humerus-radius and ulna was striking, and occasional fusions in tarsometatarsal joints were also present. Severe narrowing of the same joint space in the retinyl acetate group was striking. Total disappearance of the articulation manus and carpometacarpal joints was observed, together with hindlimb joint and bone findings.

Teratogenic effects of ethanol in the Quackenbush special mouse

The intragastric exposure of QS mice to alcohol both under short-term (6-day period) (3.0 g/kg, but not 1.5 g/kg, body weight/day through gestation day (GD) 7 to GD 12) and long-term (chronic) (15% ethanol in drinking water beginning several weeks before mating and continuing into pregnancy) conditions reduced the weight, size, and protein content of GD 12 embryos, and the weight of GD 18 embryos. The incidence of brachydactyly with delayed ossification was also significantly greater in embryos chronically exposed to alcohol than in controls (45% vs. 6.7%). The short-term and long-term exposure regimens produced incidences of only 1% and 5.8%, respectively, of forelimb ectrodactyly in GD 18 embryos. It was concluded that alcohol exerts embryo growth retarding effects in pregnant QS mice without inducing a high incidence of skeletal defects. Thus, the QS mouse could serve as an excellent model to resolve the mechanisms whereby alcohol induces pre- and post-natal growth restrictions during pregnancy.

Aspirin-alcohol interaction in the production of cleft palate and limb malformations in the TO mouse

Our objective in the present study was to determine the effects of alcohol on stages when the limb buds and renal primordia develop in the TO mouse and to see if aspirin pretreatment would prevent these organ systems from being malformed as was shown by Randall et al. ('91) in the C57 mice. On one of days 9-12 of gestation, groups of TO mice were injected intraperitoneally (IP) with a single dose of 200 mg/kg of aspirin, or a proportionate volume of physiological saline. An hour later, half of the aspirin-treated animals received a single dose of 0.03 ml/g of freshly prepared 25% (v/v) solution of absolute alcohol and the other half received a proportionate volume of saline. Half of the saline-treated animals received a single dose of 0.03 ml/g of saline or a proportionate volume of alcohol solution. All animals were killed on day 18 of gestation. Alcohol significantly increased embryonic resorption and caused remarkable intrauterine growth retardation (IUGR). It also induced arched palate, cleft palate and deformities of the digits with haematomas in a modest number of embryos. Aspirin alone did not have any teratogenic effects. Pretreatment with aspirin significantly augmented alcohol-induced resorption, IUGR, cleft palate and digital malformations associated with haematomas. Chronological observations on the development of the treated limbs showed the occurrence of vascular stasis, haematomas, edema and cell death at early stages. Subsequently, digital rays were either destroyed (ectrodactyly) or remained hypoplastic (brachydactyly). It appears that limb development in the aspirin- and alcohol-treated TO mouse embryos is largely affected by vascular disruption. These data provide further evidence to our earlier observation that alcohol and aspirin interact in the production of malformations and that the teratogenic effects of alcohol in the TO mouse are possibly not mediated via treatment related prostaglandin elevation.

Limb reduction defects in South America

OBJECTIVE

Limb reduction defects were considered as possible indicators of environmental teratogenesis; it was suggested that also invasive prenatal procedures could increase the risk for limb reduction defects. The purpose of this work is to give a baseline frequency for limb reduction defects, using data from a population not exposed to prenatal diagnosis procedures.

DESIGN

Using data collected in the period 1967 to 1992 within the frame of the Latin American Collaborative Study of Congenital Malformations which clinically examined 2,917,074 newborn infants, a total of 1715 with limb reduction defects were found. All cases were classified and analysed in 25 categories. Geographic differences in recorded rates were tested by chi 2 for homogeneity. Secular trends were analysed using chi 2 test for linear trends.

RESULTS

The overall birth prevalence rate of limb reduction defects among liveborn infants was 4.91(per 10,000 births) (3.05 for isolated and 1.85 for associated cases). For stillbirths, the total prevalence was 26.73/10,000 (5.53 for isolated and 21.20 for associated cases). The inclusion of the brachydactylies increased those figures to 5.55/10,000 (3.39 for isolated and 2.16 for associated cases), and 27.42, respectively, (5.53 for isolated and 21.89 for associated cases). When isolated and associated cases were considered together, a geographic heterogeneity was found in pre-axial limb reduction defects; there was also some heterogeneity for amputations. A maternal age effect was found for the isolated hypoplasias. Standardising by maternal age, the overall prevalence of limb reduction in liveborn infants was 5.66 per 10,000 (95% CI = 5.38-5.93). An increasing trend was suggested by the isolated form of distal amputations which involved hands, feet, or digits.

CONCLUSIONS

Our data suggest that clustering limb reduction defects in wide groups as transverse and longitudinal may lead to heterogeneous entities. When a possible association is suspected, it would be preferable to present and analyse data in the most discriminant form available. Due to the maternal age effect, it would be advisable to standardise the rates of transversal limb reduction defects by this variable.

Heritable oligodactyly occurring only in male rats

Heritable oligodactylism in male rats was discovered in Wistar-derived rats. In this study, external and skeletal features of the limb anomalies were examined to clarify the type of oligodactyly. External observation revealed absence and hypoplasia (with respective percentage incidence) in digits II (100, 0), III (87, 13), and IV (23, 1) of the forefeet and in digits II (26, 34), III (34, 11), and V (0, 3) of the hindfeet. Fusion was also observed in digits IV and V in the forefeet (4%) and in digits I and II in the hindfeet (15%). Skeletal examination disclosed absence of all three (proximal, middle, and distal) phalanges in digits II (97%), III (93%), and IV (67%) and of the middle phalanx in digit V (12%) of the forefeet. In the hindfeet, the missing pattern of phalanges in digits II and III was similar to, but less severe than that in the forefeet; the incidence of absence of the three phalanges in digits II and III was 43% and 45%, respectively. Digit V was more affected than that in the forefeet; absence of the middle phalanx was found at 30%. Although no absence was found in the bones proximal to the phalanges, hypoplasia and/or fusion were detected with various degree and incidences among carpi/metacarpi and tarsi/metatarsi. Based on these observations, the types of limb anomalies in this mutant rat were classified as oligodactyly of digits II-V in the forefeet and II, III, and V in the hindfeet with hypoplasia and/or fusion of the carpi/metacarpi and tarsi/metatarsi.

Limb and lower-body duplications induced by retinoic acid in mice

The zygote and subsequent preimplantation stages of early mammalian development are susceptible to certain chemical perturbations that cause abnormal development of the conceptus. In certain cases, disruption in patterns of gene expression could be a primary event leading to abnormal development. To investigate this hypothesis, we treated pregnant mice with trans-retinoic acid, a known modulator of gene expression. Treatments were administered at various times during pregastrulation stages and the presumed onset of gastrulation. trans-Retinoic acid induced a distinctive set of malformations, as manifest by supernumerary and ectopic limbs and duplication of portions of the lower body, but only when administered during the period of 4.5-5.5 days after mating. (Other malformations were induced at different stages.) The limb and lower-body duplications suggest that exogenous trans-retinoic acid may influence not only the pattern for the hindlimbs but also that for the entire lower body. Since it appears likely that the embryos were affected in the late blastocyst and proamniotic-embryo stages, the provocative possibility arises that aspects of pattern formation of limbs and lower body actually occur prior to gastrulation.

Upper limb deficiencies and associated malformations: a population-based study

As part of an ongoing analysis of limb deficiencies occurring among 1,213,913 consecutive livebirths in British Columbia during the years 1952-1984, all cases with deficiencies of the upper limbs were analysed with a view to identifying associated patterns of anomalies. This analysis resulted in seven subgroups. For each subgroup, incidence figures for cases with and without additional anomalies were calculated separately. The proportion of cases with additional anomalies varied markedly by subgroup. For example, 89% of cases with longitudinal defects of the radius had additional malformations, while only 28% of cases with transverse defects of the radius had other organ anomalies (chi 2 = 40.55; P < 0.001, one degree of freedom). A preponderance of males was found among the cases with associated defects, particularly in the group with longitudinal defects of the radius (28 males, 14 females; chi 2 = 14.10; P < 0.001). Clustering of specific patterns of associated malformations is described within subgroups.