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Chen CP, Chan CH, Chern SR, Wu PS, Chen SW, Wu FT, Town DD, Lee MS, Wang W. Prenatal diagnosis and molecular cytogenetic characterization of a small supernumerary marker chromosome derived from chromosome 15 in a pregnancy associated with recurrent Down syndrome. Taiwan J Obstet Gynecol 2021; 60:152-156. [PMID: 33494992 DOI: 10.1016/j.tjog.2020.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We present prenatal diagnosis and molecular cytogenetic characterization of a small supernumerary marker chromosome (sSMC) derived from chromosome 15 in a pregnancy associated with recurrent Down syndrome. CASE REPORT A 33-year-old, gravida 4, para 2, woman underwent amniocentesis at 16 weeks of gestation because of a previous child with Down syndrome and a karyotype of 46,XY,der(14;21)(q10; q10),+21. In this pregnancy, amniocentesis revealed a karyotype of 47,XX,+21[12]/48,XX,+21,+mar[3]. The parental karyotypes were normal. The pregnancy was terminated, and a malformed fetus was delivered with characteristic craniofacial appearance of Down syndrome and hypoplastic middle phalanx of the fifth fingers. The placenta had a karyotype of 47,XX,+21[37]/48,XX,+21,+mar[3]. The umbilical cord had a karyotype of 47,XX,+21[38]/48,XX,+21,+mar[2]. In addition to trisomy 21, array comparative genomic hybridization (aCGH) on the DNA extracted from umbilical cord revealed 40∼50% mosaicism for a 2.604-Mb duplication of 15q25.2-q25.3, or arr 15q25.2q25.3 (83,229,665-85,834,131) × 2.4 [GRCh37 (hg19)] encompassing 19 Online Mendelian Inheritance in Man (OMIM) genes. Quantitative fluorescent polymerase chain reaction (QF-PCR) using the DNAs extracted from cultured amniocytes and parental bloods revealed maternal origin of the sSMC(15) and the extra chromosome 21. CONCLUSION aCGH is useful for identification of the nature of sSMC, and QF-PCR is useful for determination of the parental origin of the aberrant chromosomes.
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Affiliation(s)
- Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan.
| | - Chia-Hao Chan
- Department of Obstetrics and Gynecology, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Schu-Rern Chern
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Shin-Wen Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Tzu Wu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Dai-Dyi Town
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Meng-Shan Lee
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wayseen Wang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
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2
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Blyth U, Craciunas L, Hudson G, Choudhary M. Maternal germline factors associated with aneuploid pregnancy loss: a systematic review. Hum Reprod Update 2021; 27:866-884. [PMID: 33969392 DOI: 10.1093/humupd/dmab010] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Miscarriage describes the spontaneous loss of pregnancy before the threshold of viability; the vast majority occur before 12 weeks of gestation. Miscarriage affects one in four couples and is the most common complication of pregnancy. Chromosomal abnormalities of the embryo are identified in ∼50% of first trimester miscarriages; aneuploidy accounts for 86% of these cases. The majority of trisomic miscarriages are of maternal origin with errors occurring during meiotic division of the oocytes. Chromosome segregation errors in oocytes may be sporadic events secondary to advancing maternal age; however, there is increasing evidence to suggest possible maternal germline contributions to this. OBJECTIVE AND RATIONALE The objective of this review was to appraise critically the existing evidence relating to maternal germline factors associated with pregnancy loss secondary to embryo aneuploidy, identify limitations in the current evidence base and establish areas requiring further research. SEARCH METHODS The initial literature search was performed in September 2019 and updated in January 2021 using the electronic databases OVID MEDLINE, EMBASE and the Cochrane Library. No time or language restrictions were applied to the searches and only primary research was included. Participants were women who had suffered pregnancy loss secondary to numerical chromosomal abnormalities of the embryo. Study identification and subsequent data extraction were performed by two authors independently. The Newcastle-Ottawa Scale was used to judge the quality of the included studies. The results were synthesized narratively. OUTCOMES The literature search identified 2198 titles once duplicates were removed, of which 21 were eligible for inclusion in this systematic review. They reported on maternal germline factors having variable degrees of association with pregnancy loss of aneuploid origin. The Online Mendelian Inheritance in Man (OMIM) gene ontology database was used as a reference to establish the functional role currently attributed to the genes reported. The majority of the cases reported and included were secondary to the inheritance of maternal structural factors such as Robertsonian translocations, deletions and insertions. Germline factors with a plausible role in aneuploid pregnancy loss of maternal origin included skewed X-inactivation and CGG repeats in the fragile X mental retardation (FMR1) gene. Studies that reported the association of single gene mutations with aneuploid pregnancy loss were conflicting. Single gene mutations with an uncertain or no role in aneuploid pregnancy loss included mutations in synaptonemal complex protein 3 (SYCP3), mitotic polo-like kinase 4 (PLK4) and meiotic stromal antigen 3 (STAG3) spindle integrity variants and 5,10-methylenetetrahydrofolate reductase (MTHFR). WIDER IMPLICATIONS Identifying maternal genetic factors associated with an increased risk of aneuploidy will expand our understanding of cell division, non-disjunction and miscarriage secondary to embryo aneuploidy. The candidate germline factors identified may be incorporated in a screening panel for women suffering miscarriage of aneuploidy aetiology to facilitate counselling for subsequent pregnancies.
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Affiliation(s)
- Ursula Blyth
- Newcastle Fertility Centre at Life, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Laurentiu Craciunas
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gavin Hudson
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Meenakshi Choudhary
- Newcastle Fertility Centre at Life, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Magalhães M, Marques C, Ramos F, Jardim A, Franco S, Coelho F, Carreira I, Moura P. Why could a woman have three Trisomy 21 pregnancies? - a case report. Clin Case Rep 2017; 5:1222-1225. [PMID: 28781828 PMCID: PMC5538204 DOI: 10.1002/ccr3.997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/03/2017] [Accepted: 04/09/2017] [Indexed: 01/27/2023] Open
Abstract
Mosaicism, an important cause for recurrent T21, should be suspected in families with more than one affected child wishing to receive prenatal counseling. Fluorescence in-situ hybridization analysis in a large number of cells and in different tissue samples is critical for detecting low-level mosaicism and is a key prognostic factor.
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Affiliation(s)
- Magda Magalhães
- Department of Obstetrics and Gynecology A Serviço de Ginecologia e Obstetrícia Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Cecília Marques
- Department of Obstetrics and Gynecology A Serviço de Ginecologia e Obstetrícia Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Fabiana Ramos
- Department of Medical Genetics Hospital Pediátrico Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Ana Jardim
- European Clinical Laboratory Geneticist Faculdade de Medicina da Universidade de Coimbra Coimbra Portugal
| | - Sofia Franco
- Department of Obstetrics and Gynecology A Serviço de Ginecologia e Obstetrícia Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Filomena Coelho
- Department of Obstetrics and Gynecology A Serviço de Ginecologia e Obstetrícia Centro Hospitalar e Universitário de Coimbra Coimbra Portugal
| | - Isabel Carreira
- European Clinical Laboratory Geneticist Faculdade de Medicina da Universidade de Coimbra Coimbra Portugal.,CIMAGO Faculdade de Medicina da Universidade de Coimbra Coimbra Portugal.,Cytogenetics and Genomics Laboratory Faculdade de Medicina da Universidade de Coimbra Coimbra Portugal
| | - Paulo Moura
- Department of Obstetrics and Gynecology A Centro Hospitalar e Universitário de Coimbra Coimbra Portugal.,Faculdade de Medicina da Universidade de Coimbra Coimbra Portugal
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Abstract
Two patients experiencing recurring trisomic pregnancies involving a different chromosome each time are presented. Mechanisms to explain recurrent trisomies include a gene or genes predisposing to nondisjunction in general or to nondisjunction of the acrocentric chromosomes, maternal age effects, and germ-line mosaicism. Genetic counseling is complicated by the lack of a clear explanation for the recurrences, difficulty in quoting a specific recurrence risk, concern regarding the risk for uniparental disomy, and the frustration, grief and guilt reactions of the patients.
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Affiliation(s)
- J E Ulm
- Presbyterian Laboratory Services, Presbyterian Healthcare System, Charlotte, NC. Janet E. Ulm, Perinatal Diagnostic Center, Charlotte, NC, 28204,
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Papavassiliou P, Charalsawadi C, Rafferty K, Jackson-Cook C. Mosaicism for trisomy 21: a review. Am J Med Genet A 2014; 167A:26-39. [PMID: 25412855 DOI: 10.1002/ajmg.a.36861] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 10/15/2014] [Indexed: 01/16/2023]
Abstract
The clinical and cytogenetic findings associated with mosaicism for trisomy 21/Down syndrome are the focus of this review. The primary topics discussed in this overview of the extant literature include the history of this condition and its diagnosis, the incidence of mosaicism, the meiotic and/or mitotic chromosomal malsegregation events resulting in mosaicism, the observation of mosaicism in the parents of children with the non-mosaic form of Down syndrome, and the variation in phenotypic outcome for both constitutional and acquired traits present in people with mosaicism for trisomy 21/Down syndrome, including cognition, fertility, and overall phenotypic findings. Additional topics reviewed include the social conditions of people with mosaicism, as well as age-related and epigenetic alterations observed in people with mosaicism for trisomy 21/Down syndrome. .
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Affiliation(s)
- Paulie Papavassiliou
- Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, Virginia
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Rowsey R, Kashevarova A, Murdoch B, Dickenson C, Woodruff T, Cheng E, Hunt P, Hassold T. Germline mosaicism does not explain the maternal age effect on trisomy. Am J Med Genet A 2013; 161A:2495-503. [PMID: 23950106 DOI: 10.1002/ajmg.a.36120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/03/2013] [Indexed: 11/08/2022]
Abstract
A variety of hypotheses have been proposed to explain the association between trisomy and increasing maternal age in humans, virtually all of which assume that the underlying mechanisms involve meiotic errors. However, recently Hultén and colleagues [Hulten et al., 2010b] proposed a provocative model-the Oocyte Mosaicism Selection Model (OMSM)-that links age-dependent trisomy 21 to pre-meiotic errors in the ovary. Specifically, they propose that nondisjunctional events occur in a proportion of germ cells as they mitotically proliferate, resulting in mosaicism for trisomy 21. Assuming that the presence of an additional chromosome 21 delays meiotic progression, these cells would be ovulated later in reproductive life, resulting in an age-dependent increase in aneuploid eggs. Because this model has important clinical implications, we initiated studies to test it. We first analyzed oocytes from two trisomy 21 fetuses, combining immunostaining with FISH to determine the likelihood of detecting the additional chromosome 21 at different stages of meiosis. The detection of trisomy was enhanced during the earliest stage of prophase (leptotene), before homologs synapsed. Accordingly, in subsequent studies we examined the chromosome content of leptotene oocytes in seven second trimester female fetuses, analyzing three chromosomes commonly associated with human trisomies (i.e., 13, 16, and 21). In contrast to the prediction of the OMSM, we found no evidence of trisomy mosaicism for any chromosome. We conclude that errors in pre-meiotic germ cells are not a major contributor to human aneuploidy and do not provide an explanation for the age-related increase in trisomic conceptions.
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Affiliation(s)
- Ross Rowsey
- Washington State University School of Molecular Biosciences and Center for Reproductive Biology, Pullman, Washington
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Morris CR, Haigh S, Cuthbert G, Crosier M, Harding F, Wolstenholme J. Origin of trisomy: no evidence to support the ovarian mosaicism theory. Prenat Diagn 2012; 32:668-73. [DOI: 10.1002/pd.3885] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Charlotte Rose Morris
- Northern Genetics Service; Institute of Genetic Medicine; Central Parkway Newcastle upon Tyne NE1 3BZ UK
| | - Shaun Haigh
- Northern Genetics Service; Institute of Genetic Medicine; Central Parkway Newcastle upon Tyne NE1 3BZ UK
| | - Gavin Cuthbert
- Northern Genetics Service; Institute of Genetic Medicine; Central Parkway Newcastle upon Tyne NE1 3BZ UK
| | - Moira Crosier
- Human Developmental Biology Resource, Institute of Genetic Medicine; Newcastle University; Central Parkway Newcastle upon Tyne NE1 3BZ UK
| | - Fiona Harding
- Northern Genetics Service; Institute of Genetic Medicine; Central Parkway Newcastle upon Tyne NE1 3BZ UK
| | - John Wolstenholme
- Northern Genetics Service; Institute of Genetic Medicine; Central Parkway Newcastle upon Tyne NE1 3BZ UK
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Ryu SW, Lee G, Baik CS, Shim SH, Kim JT, Lee JS, Lee KA. Down-Turner Syndrome (45,X/47,XY,+21): Case Report and Review. Ann Lab Med 2010; 30:195-200. [DOI: 10.3343/kjlm.2010.30.2.195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sook-Won Ryu
- Department of Laboratory Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Goeun Lee
- SamKwang Medical Laboratories, Seoul, Korea
| | | | - Sung Han Shim
- Genetic Laboratory, Fertility Center of CHA Gangnam Medical Center, Seoul, Korea
| | - Jin-Tack Kim
- Department of Pediatric Allergy & Pneumology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea
| | - Jung-Soo Lee
- Department of Rehabilitation Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University, Uijeongbu, Korea
| | - Kyung-A Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
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9
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Kovaleva NV. Germ-line transmission of trisomy 21: Data from 80 families suggest an implication of grandmaternal age and a high frequency of female-specific trisomy rescue. Mol Cytogenet 2010; 3:7. [PMID: 20298592 PMCID: PMC2857837 DOI: 10.1186/1755-8166-3-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 03/18/2010] [Indexed: 11/19/2022] Open
Abstract
Background Trisomy of chromosome 21 (T21; Down syndrome, DS) is the most common aneuploidy in live births. Though its etiology has been intensively studied for a half of century, there are surprisingly many problems awaiting their elucidation. Some of the open questions are related directly to germ line mosaicism for T21, other problems include the prevalence of males with non-mosaic trisomy over females (skewed sex ratio, SR), the genetic predisposition to non-disjunction, etc. Studies in families of gonadal mosaicism (GM) carriers might help resolving some of these problems. Results 80 families of carriers of GM, in which the sex of the offspring had been specified, were identified in the literature and in logbooks of two local genetic units. Mothers in these families were relatively young: only 8% of mothers were 35 years old and older at the time of delivery of their first affected offspring while the proportion of grandmothers on the GM carrier's side aged 35 years old and older was significantly higher (39%). Postzygotic rescue of T21 due to error in the meiosis I had been proposed as a mechanism of parental GM formation in 78% of the families with known origin of the T21. For the other 22%, rescue of errors in the meiosis II or postzygotic mitotic non-disjunction was assumed. Mosaicism for T21 in successive generations was reported in at least 12 families. The proportion of mosaics among affected female offspring (14%) is significantly higher compared to that among affected male offspring (0%). Male preponderance (SR = 1.5) is found in non mosaic liveborn offspring with either maternally- or paternally transmitted T21. Among unaffected offspring of male carriers of GM there is a notable excess of females (SR = 0.27). Conclusion Both direct (results of cytogenetic and molecular study of the origin of trisomic line) and indirect (advanced grandmaternal age on the side of GM carrier) evidences allow to assume that significant proportion of the mosaic parents had been conceived as trisomics. Female-specific trisomy rescue and genetic predisposition to postzygotic non-disjunction has been suggested as mechanisms of formation of both GM and somatic mosaicism. Typical male preponderance in affected non mosaic offspring with either maternally- or paternally transmitted trisomy 21, indicates than meiotic events are not responsible for the skewed sex ratio in DS. However a female excess among unaffected offspring of male carriers of GM might be the result of meiotic non homologous co-orientation of chromosomes 21 and X in spermatogenesis.
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Affiliation(s)
- Natalia V Kovaleva
- Scientific Research Centre at Saint-Petersburg State Pediatric Medical Academy under the Federal Agency of Health Care and Social Development, St Petersburg, Russian Federation.
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Hultén MA, Patel SD, Tankimanova M, Westgren M, Papadogiannakis N, Jonsson AM, Iwarsson E. On the origin of trisomy 21 Down syndrome. Mol Cytogenet 2008; 1:21. [PMID: 18801168 PMCID: PMC2564957 DOI: 10.1186/1755-8166-1-21] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 09/18/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Down syndrome, characterized by an extra chromosome 21 is the most common genetic cause for congenital malformations and learning disability. It is well known that the extra chromosome 21 most often originates from the mother, the incidence increases with maternal age, there may be aberrant maternal chromosome 21 recombination and there is a higher recurrence in young women. In spite of intensive efforts to understand the underlying reason(s) for these characteristics, the origin still remains unknown. We hypothesize that maternal trisomy 21 ovarian mosaicism might provide the major causative factor. RESULTS We used fluorescence in situ hybridization (FISH) with two chromosome 21-specific probes to determine the copy number of chromosome 21 in ovarian cells from eight female foetuses at gestational age 14-22 weeks. All eight phenotypically normal female foetuses were found to be mosaics, containing ovarian cells with an extra chromosome 21. Trisomy 21 occurred with about the same frequency in cells that had entered meiosis as in pre-meiotic and ovarian mesenchymal stroma cells. CONCLUSION We suggest that most normal female foetuses are trisomy 21 ovarian mosaics and the maternal age effect is caused by differential selection of these cells during foetal and postnatal development until ovulation. The exceptional occurrence of high-grade ovarian mosaicism may explain why some women have a child with Down syndrome already at young age as well as the associated increased incidence at subsequent conceptions. We also propose that our findings may explain the aberrant maternal recombination patterns previously found by family linkage analysis.
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Affiliation(s)
- Maj A Hultén
- Warwick Medical School, University of Warwick, UK.
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11
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Kovaleva NV. Parental mosaicism for trisomy 21: problems with its detection and an approach to determining its population rate. ACTA ACUST UNITED AC 2008; 11:341-4. [PMID: 17949298 DOI: 10.1089/gte.2006.0515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Natalia V Kovaleva
- St. Petersburg Medical Academy of Postgraduate Studies under the Federal Agency of Health Care and Social Development, St. Petersburg, Russian Federation.
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12
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Kovaleva NV, Takhmasebi-Khesari M. Detection of gonadal mosaicism in parents of offspring with down syndrome. CYTOL GENET+ 2007. [DOI: 10.3103/s0095452707050064] [Citation(s) in RCA: 1] [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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13
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Second pregnancy of trisomy 21 in a mother with mosaicism. Chin Med J (Engl) 2007. [DOI: 10.1097/00029330-200707020-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Somprasit C, Aguinaga M, Cisneros PL, Torsky S, Carson SA, Buster JE, Amato P, McAdoo SL, Simpson JL, Bischoff FZ. Paternal gonadal mosaicism detected in a couple with recurrent abortions undergoing PGD: FISH analysis of sperm nuclei proves valuable. Reprod Biomed Online 2004; 9:225-30. [PMID: 15333256 DOI: 10.1016/s1472-6483(10)62134-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Many couples are now seeking preimplantation genetic diagnosis (PGD) and fluorescence in-situ hybridization (FISH) as an alternative approach to avoid spontaneous abortion by ensuring transfer of presumed chromosomally normal embryos. This case report describes unexpected findings in a couple having three spontaneous abortions and two failed IVF cycles. In two IVF PGD cycles, four of 13 (30.8%) embryos (blastomeres) demonstrated duplication involving the Down syndrome critical region, detectable by a locus specific chromosome 21 probe. The same duplication was subsequently detected by FISH in 66 of 1002 (6.6%) sperm nuclei, demonstrating paternal gonadal mosaicism. Cytogenetic studies of peripheral blood revealed normal karyotypes in both the male and female partners. This identification of paternal germ cell or gonadal mosaicism suggests that analysis of sperm nuclei prior to undergoing IVF with PGD may be of value in patients with recurrent spontaneous abortions or multiple failed IVF.
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Affiliation(s)
- Charintip Somprasit
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas 77030, USA
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Robinson WP, McFadden DE, Stephenson MD. The origin of abnormalities in recurrent aneuploidy/polyploidy. Am J Hum Genet 2001; 69:1245-54. [PMID: 11675616 PMCID: PMC1235536 DOI: 10.1086/324468] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2001] [Accepted: 09/20/2001] [Indexed: 11/03/2022] Open
Abstract
Recurrent miscarriage due to sporadic chromosomal abnormalities may simply be a consequence of the dramatic increase of trisomic conceptions with increased maternal age. However, it is also possible that some couples are at increased risk of abnormalities as a result of gonadal mosaicism, factors affecting chromosome structure and segregation, increased sperm aneuploidy in the male partner, or accelerated "aging" of the ovaries. We report cytogenetic and molecular findings from 122 spontaneous abortions (SAs) from 54 couples who were ascertained as having two or more documented aneuploid or polyploid SAs. The distribution of abnormalities in this group was similar to those from 307 SAs that involved chromosome abnormalities and were diagnosed at the same center but did not involve documented recurrent aneuploidy/polyploidy. Although recurrence of the same abnormality was observed in eight families, this number was equal to that expected by chance, indicating that gonadal mosaicism is rarely the explanation for recurrence. The origin of the abnormality was determined in 37 SAs from 23 of the couples in the study. A maternal meiotic origin was involved in 30 trisomies and in 1 triploid SA; 3 additional maternal trisomies were of possible somatic origin. A paternal origin was found in the remaining two trisomies and in one triploid SA. In addition, one double trisomy was the consequence of both a maternal and a paternal meiotic error. These results confirm that the etiology of trisomy is predominantly a result of meiotic errors related to increased maternal age, regardless of whether the couple has experienced one or multiple aneuploid SAs. Furthermore, this is true even when a second SA involves the same abnormality. Nonetheless, these data do not exclude some population variability in risk for aneuploidy.
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Affiliation(s)
- W P Robinson
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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Bruyère H, Rupps R, Kuchinka BD, Friedman JM, Robinson WP. Recurrent trisomy 21 in a couple with a child presenting trisomy 21 mosaicism and maternal uniparental disomy for chromosome 21 in the euploid cell line. AMERICAN JOURNAL OF MEDICAL GENETICS 2000; 94:35-41. [PMID: 10982480 DOI: 10.1002/1096-8628(20000904)94:1<35::aid-ajmg8>3.0.co;2-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recurrence of trisomy 21 was observed in a family in which both parents had a normal chromosome complement. Mosaic trisomy 21 was found in a blood karyotype of the first child, a second pregnancy ended in spontaneous abortion, and a full trisomy 21 was found at prenatal diagnosis of the third pregnancy of this same couple. Although recurrent trisomy 21 may be due to chance, the possibility of germline mosaicism for trisomy 21 in one of the parents has important implications for recurrence risk. Molecular analysis was therefore undertaken in this family to determine the parental origin and the stage of nondisjunction of the extra chromosome 21 in both cases. Although a maternal origin of both instances of trisomy 21 was observed, the mosaic case showed homozygosity for all markers along the duplicated maternal chromosome. Such a finding would normally suggest a postzygotic origin of the trisomy 21. However, the diploid cell line in this same case showed maternal uniparental disomy 21, implying that it was the result of a trisomic conception. We suggest that a somatic nondisjunction in the maternal germ cells is the most likely explanation for these findings. The apparent meiotic II stage of nondisjunction of the nonmosaic trisomy 21 fetus was consistent with maternal mosaicism. A review of the literature for recurrent trisomy 21 cases studied by molecular means, suggests that mosaicism in germ cells may account for more cases than is detected cytogenetically. These results also show that DNA marker analysis does not provide a valuable tool for patient counseling in case of recurrent trisomy 21.
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Affiliation(s)
- H Bruyère
- Department of Medical Genetics, University of British Columbia, British Columbia Research Institute for Children's and Women's Health, Vancouver, British Columbia, Canada
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Abstract
The offspring of older parents are at a higher risk of suffering low birth weights and congenital birth defects that result from mutations and chromosomal anomalies. When the defect is paternal in origin, it often can be shown that the primary lesion arose during mitotic proliferation of the spermatogonial germ cell population. By contrast, germline mosaicism is seldom invoked to explain the age dependency of maternally derived aberrations because germline proliferation in the ovary is already completed during fetal development. Age-dependent defects of maternal origin might, however, be explained in part by the progressive loss of oocytes during the mother's reproductive life. A large number of oocytes undergo the initial stages of maturation each month, but typically only one completes maturation and is ovulated while the majority are discarded, probably by an apoptotic mechanism. Here we explore the possibility that the monthly choice of oocytes to undergo maturation is influenced by subtle phenotypic characters of those oocytes that may bear genetic defects such as trisomy 21. We have generated a mathematical model to describe the loss kinetics for such mutant oocytes relative to the overall pool of resting oocytes, and we assess evolutionary strategies that would favor their utilization faster than, at the same rate as, or slower than the normal oocytes. This formulation reveals that the slower-rate scheme would effectively diminish the utilization of mutant oocytes in young mothers but would increase the risk of related birth defects for older mothers. Accordingly, we propose that natural selection should have favored the delayed utilization of defective oocytes in a primitive high-mortality culture, but that this evolutionary strategy would be outmoded for modern society, because it would lead to an increased frequency of birth defects for older mothers.
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Affiliation(s)
- C J Zheng
- Division of Environmental and Occupational Health, University of Minnesota, Minneapolis 55455, USA.
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Sangha KK, Stephenson MD, Brown CJ, Robinson WP. Extremely skewed X-chromosome inactivation is increased in women with recurrent spontaneous abortion. Am J Hum Genet 1999; 65:913-7. [PMID: 10441596 PMCID: PMC1377996 DOI: 10.1086/302552] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Satge D, Geneix A, Goburdhun J, Lasne-Desmet P, Rosenthal C, Arnaud R, Malet P. A history of miscarriages and mild prognathism as possible mode of presentation of mosaic trisomy 18 in women. Clin Genet 1996; 50:470-3. [PMID: 9147875 DOI: 10.1111/j.1399-0004.1996.tb02714.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A 22-year-old woman seeking medical assistance for hypofertility after two miscarriages had very slight anomalies: mild macrogenia and prognathism, and temporal depilation. Peripheral lymphocytes and fibroblastic karyotypes disclosed the tenth published case of low-level mosaicism for trisomy 18 with normal intelligence. Subfertility is frequently observed among these patients. As women with this anomaly are at risk of trisomy 18 pregnancies and as five cases have been reported recently, this particular chromosomal anomaly may not be so exceptional and should be investigated in cases of hypofertility.
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Affiliation(s)
- D Satge
- Laboratory of Pathology, Centre Hospitalier, Tulle, France
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