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Ibarra-Ramírez M, Campos-Acevedo LD, Martínez de Villarreal LE. Chromosomal Abnormalities of Interest in Turner Syndrome: An Update. J Pediatr Genet 2023; 12:263-272. [PMID: 38162151 PMCID: PMC10756729 DOI: 10.1055/s-0043-1770982] [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: 03/28/2022] [Accepted: 06/01/2023] [Indexed: 01/03/2024]
Abstract
Turner syndrome (TS) is caused by the total or partial loss of the second sex chromosome; it occurs in 1 every 2,500-3,000 live births. The clinical phenotype is highly variable and includes short stature and gonadal dysgenesis. In 1959, the chromosomal origin of the syndrome was recognized; patients had 45 chromosomes with a single X chromosome. TS presents numerical and structural abnormalities in the sex chromosomes, interestingly only 40% have a 45, X karyotype. The rest of the chromosomal abnormalities include mosaics, deletions of the short and long arms of the X chromosome, rings, and isochromosomes. Despite multiple studies to establish a relationship between the clinical characteristics and the different chromosomal variants in TS, a clear association cannot yet be established. Currently, different mechanisms involved in the phenotype have been explored. This review focuses to analyze the different chromosomal abnormalities and phenotypes in TS and discusses the possible mechanisms that lead to these abnormalities.
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Affiliation(s)
- Marisol Ibarra-Ramírez
- Department of Genetics, “Dr. José Eleuterio González” University Hospital of the Autonomous University of Nuevo León, Monterrey, México
| | - Luis Daniel Campos-Acevedo
- Department of Genetics, “Dr. José Eleuterio González” University Hospital of the Autonomous University of Nuevo León, Monterrey, México
| | - Laura E. Martínez de Villarreal
- Department of Genetics, “Dr. José Eleuterio González” University Hospital of the Autonomous University of Nuevo León, Monterrey, México
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Kremen J, Davis SM, Nahata L, Kapa HM, Dattilo TM, Liu E, Hutaff-Lee C, Tishelman AC, Crerand CE. Neuropsychological and mental health concerns in a multicenter clinical sample of youth with turner syndrome. Am J Med Genet A 2023; 191:962-976. [PMID: 36608170 PMCID: PMC10031628 DOI: 10.1002/ajmg.a.63103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 01/07/2023]
Abstract
Clinical practice guidelines for individuals with Turner syndrome (TS) recommend screening for neuropsychological concerns (NC) and mental health concerns (MHC). However, current provider screening and referral patterns for NC and MHC are not well characterized. Additionally, prevalence of and risk factors for NC and MHC vary across studies. This multicenter chart review study examined the prevalence, risk factors for, and management of NC and MHC in a cohort of 631 patients with TS from three pediatric academic medical centers. NC and/or MHC were documented for 48.2% of patients. Neuropsychological evaluation recommendations were documented for 33.9% of patients; 65.4% of the sample subsequently completed these evaluations. Mental health care recommendations were documented in 35.0% of records; subsequent documentation indicated that 69.7% of these patients received such services. Most notably, rates of documented MHC, NC, and related referrals differed significantly by site, suggesting the need for standardized screening and referral practices. TS diagnosis in early childhood was associated with an increased risk of NC. Spontaneous menarche was associated with increased risk of MHC. Younger age at growth hormone initiation was associated with both increased risk of isolated NC and co-occurring NC and MHC. Mosaic karyotype was associated with decreased risk of NC and MHC.
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Affiliation(s)
- Jessica Kremen
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA
| | - Shanlee M. Davis
- Department of Pediatrics, University of Colorado, Aurora, CO
- eXtraOrdinary Kids Turner Syndrome Clinic, Children’s Hospital Colorado, Aurora, CO
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- Division of Endocrinology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
| | - Hillary M. Kapa
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Taylor M. Dattilo
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Enju Liu
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA
| | | | - Amy C. Tishelman
- Boston College, Department of Psychology and Neuroscience, Boston, MA
| | - Canice E. Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
- Division of Endocrinology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
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Álvarez-Nava F, Soto-Quintana M. The Hypothesis of the Prolonged Cell Cycle in Turner Syndrome. J Dev Biol 2022; 10:16. [PMID: 35645292 PMCID: PMC9149809 DOI: 10.3390/jdb10020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/13/2022] [Indexed: 01/27/2023] Open
Abstract
Turner syndrome (TS) is a chromosomal disorder that is caused by a missing or structurally abnormal second sex chromosome. Subjects with TS are at an increased risk of developing intrauterine growth retardation, low birth weight, short stature, congenital heart diseases, infertility, obesity, dyslipidemia, hypertension, insulin resistance, type 2 diabetes mellitus, metabolic syndrome, and cardiovascular diseases (stroke and myocardial infarction). The underlying pathogenetic mechanism of TS is unknown. The assumption that X chromosome-linked gene haploinsufficiency is associated with the TS phenotype is questioned since such genes have not been identified. Thus, other pathogenic mechanisms have been suggested to explain this phenotype. Morphogenesis encompasses a series of events that includes cell division, the production of migratory precursors and their progeny, differentiation, programmed cell death, and integration into organs and systems. The precise control of the growth and differentiation of cells is essential for normal development. The cell cycle frequency and the number of proliferating cells are essential in cell growth. 45,X cells have a failure to proliferate at a normal rate, leading to a decreased cell number in a given tissue during organogenesis. A convergence of data indicates an association between a prolonged cell cycle and the phenotypical features in Turner syndrome. This review aims to examine old and new findings concerning the relationship between a prolonged cell cycle and TS phenotype. These studies reveal a diversity of phenotypic features in TS that could be explained by reduced cell proliferation. The implications of this hypothesis for our understanding of the TS phenotype and its pathogenesis are discussed. It is not surprising that 45,X monosomy leads to cellular growth pathway dysregulation with profound deleterious effects on both embryonic and later stages of development. The prolonged cell cycle could represent the beginning of the pathogenesis of TS, leading to a series of phenotypic consequences in embryonic/fetal, neonatal, pediatric, adolescence, and adulthood life.
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Affiliation(s)
- Francisco Álvarez-Nava
- Biological Sciences School, Faculty of Biological Sciences, Central University of Ecuador, Quito 170113, Ecuador
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Liang L, Mei L, Shi Y, Huang L, Su Z, Zeng Y, Gao H, He X, Huang H, Huang Y, Li P, Chen J. Turner syndrome with Xp deletions and rare endometrial abnormalities: A case report. Medicine (Baltimore) 2021; 100:e27571. [PMID: 34797278 PMCID: PMC8601299 DOI: 10.1097/md.0000000000027571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 09/18/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Turner syndrome (TS) is a genetic disorder associated with abnormalities of the X chromosome related to ovarian function, but whether it is associated with endometrial abnormalities is still not clear. PATIENT CONCERNS We report the case of a 26-year-old Han Chinese woman with TS and Xp11.2 deletion, presenting with short final stature, ovarian hypofunction, unexplained cystic dilatation of the entire endometrium, and endometrial thickening. DIAGNOSES The patient was diagnosed with chromosome Xp11.2 deletion through cytogenetic analysis and ultrasonic and endometrial pathology. INTERVENTIONS The patient was treated with conventional in vitro fertilization preimplantation genetic testing for 1 cycle. OUTCOMES Cytogenetic examination showed karyotype 45, X, del (X) del (p11, 2). Ultrasonic examination showed uneven endometrium thickness and a full-stage cystic dilation echo. After 1 cycle of in vitro fertilization treatment, 4 eggs were obtained without forming an available embryo. LESSONS To our knowledge, the present case is the first report of a patient with TS with Xp deletions and ultrasound imaging endometrial abnormalities. Our findings expand the phenotypic spectrum of TS and may provide a reference for other clinicians.
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Affiliation(s)
- Lei Liang
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Libin Mei
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
- School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yingying Shi
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Lingling Huang
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Zhiying Su
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Yu Zeng
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Haijie Gao
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Xuemei He
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Hui Huang
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Yanru Huang
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ping Li
- Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Key Laboratory of Reproduction and Genetics, Xiamen, Fujian, China
| | - Jing Chen
- Reproductive Medicine Center, the First Affiliated Hospital of Xiamen University, Fujian, Xiamen, China
- Research Group for Reproductive Medicine and IVF Laboratory, Department of Obstetrics and Gynecology, Cologne University, Cologne, Germany
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Culen C, Herle M, Ertl D, Fröhlich‐Reiterer E, Blümel P, Wagner G, Häusler G. Less ready for adulthood?-Turner syndrome has an impact on transition readiness. Clin Endocrinol (Oxf) 2020; 93:449-455. [PMID: 33464630 PMCID: PMC7540424 DOI: 10.1111/cen.14293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Young women with Turner syndrome (TS) are known to be at risk for loss to medical follow-up. Recent literature indicates that there are disparities regarding transition readiness between different chronic conditions. So far, studies in young women with TS investigating their transition readiness compared to youths with other chronic conditions with no or minor neurocognitive challenges have not been reported. METHODS Patients (n = 52), 26 patients with Turner syndrome (mean age 17.24 ± 2.10) and 26 controls with type 1 diabetes or a rheumatic disease (mean age 17.41 ± 2.44), were recruited from specialized paediatric endocrine outpatient clinics. The Transition Readiness Assessment Questionnaire TRAQ-GV-15 was used to compare transition readiness scores between TS and controls. In addition, information on individual handling of the questionnaire was obtained. Descriptive statistics and nonparametric methods were used to analyse the data. RESULTS Significant differences for transition readiness scores were found between the two study groups. The global TRAQ-GV-15 score was significantly lower for females with TS. In particular, subscale 1 'autonomy' of the TRAQ-GV-15 showed lower scores in patients with TS. Patients with TS needed significantly more help and more time to complete the questionnaire. CONCLUSION Special attention should be given to young women with Turner syndrome in the preparation for the transitional phase. By incorporating the assessment of transition readiness specialists will find it easier to identify underdeveloped skills and knowledge gaps in their patients. Unless a multidisciplinary young adult clinic is established, an older age than 18 years at transfer to adult endocrine care might be beneficial.
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Affiliation(s)
- Caroline Culen
- Department of Pediatrics and Adolescent Medicine, Division of Paediatric Pulmology, Allergology and EndocrinologyMedical University of ViennaViennaAustria
| | - Marion Herle
- Department of Pediatrics and Adolescent Medicine, Division of Paediatric Pulmology, Allergology and EndocrinologyMedical University of ViennaViennaAustria
| | - Diana‐Alexandra Ertl
- Department of Pediatrics and Adolescent Medicine, Division of Paediatric Pulmology, Allergology and EndocrinologyMedical University of ViennaViennaAustria
- Vienna Bone and Growth CenterViennaAustria
| | | | - Peter Blümel
- Department of Paediatrics and Adolescent MedicineSozialmedizinisches Zentrum Süd ‐ Kaiser‐Franz‐Josef‐Spital mit Gottfried von Preyer'schem KinderspitalViennaAustria
| | - Gudrun Wagner
- Department for Child and Adolescent PsychiatryMedical University of ViennaViennaAustria
| | - Gabriele Häusler
- Department of Pediatrics and Adolescent Medicine, Division of Paediatric Pulmology, Allergology and EndocrinologyMedical University of ViennaViennaAustria
- Vienna Bone and Growth CenterViennaAustria
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Manotas MC, Calderón JC, López-Kleine L, Suárez-Obando F, Moreno OM, Rojas A. Identification of common differentially expressed genes in Turner (45,X) and Klinefelter (47,XXY) syndromes using bioinformatics analysis. Mol Genet Genomic Med 2020; 8:e1503. [PMID: 32959501 PMCID: PMC7667333 DOI: 10.1002/mgg3.1503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/14/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background Analysis of patients with chromosomal abnormalities, including Turner syndrome and Klinefelter syndrome, has highlighted the importance of X‐linked gene dosage as a contributing factor for disease susceptibility. Escape from X‐inactivation and X‐linked imprinting can result in transcriptional differences between normal men and women as well as in patients with sex chromosome abnormalities. Objective To identify differentially expressed genes among patients with Turner (45,X) and Klinefelter (46,XXY) syndrome using bioinformatics analysis. Methodology Two gene expression data sets of Turner (45,X) and Klinefelter syndrome (47,XXY) were obtained from the Gene Omnibus Expression (GEO) database of the National Center for Biotechnology Information (NCBI). Statistical analysis was performed using R Bioconductor libraries. Differentially expressed genes (DEGs) were determined using significance analysis of microarray (SAM). The functional annotation of the DEGs was performed with DAVID v6.8 (The Database for Annotation, Visualization, and Integrated Discovery). Results There are no genes over‐expressed simultaneously in both diseases. However, when crossing the list of under‐expressed genes for 45,X cells and the list of over‐expressed genes for 47,XXY cells, there are 16 common genes: SLC25A6, AKAP17A, ASMTL, KDM5C, KDM6A, ATRX, CSF2RA, DHRSX, CD99, ZBED1, EIF1AX, MVB12B, SMC1A, P2RY8, DOCK7, DDX3X, eight of which are involved in the regulation of gene expression by epigenetic mechanisms, regulation of splicing processes and protein synthesis. Conclusion Of the 16 identified as under‐expressed in 45,X cells and over‐expressed in 47,XXY cells, 14 are located in X chromosome and 2 in autosomal chromosome; 8 of these genes are involved in the regulation of gene expression: 5 genes are related to epigenetic mechanisms, 2 in regulation of splicing processes, and 1 in the protein synthesis process. Our results are limited by it being the product of a bioinformatic analysis from mRNA isolated from whole blood, this makes necessary further exploration of the relationships between these genes and Turner syndrome and Klinefelter syndrome in the future.
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Affiliation(s)
- María Carolina Manotas
- Institute of Human Genetics. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Juan Camilo Calderón
- Department of Statistics, Faculty of Science, Universidad Nacional de Colombia, Ciudad Universitaria, Bogotá, Colombia
| | - Liliana López-Kleine
- Department of Statistics, Faculty of Science, Universidad Nacional de Colombia, Ciudad Universitaria, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Institute of Human Genetics. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Olga M Moreno
- Institute of Human Genetics. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Adriana Rojas
- Institute of Human Genetics. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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Mohamed AM, Zaki MS, Kamel AK, Issa MY, Mekkawy M, Safwat P, Mazen I. Unbalanced 14;X Translocation and Pattern of X Inactivation in a Female Patient with Multiple Congenital Anomalies. Cytogenet Genome Res 2018; 156:71-79. [PMID: 30273929 DOI: 10.1159/000492546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 11/19/2022] Open
Abstract
We report on a female patient who was first evaluated at the age of 6 years with developmental delay, dysmorphic facial features, seizures, and autistic behavior. A brain CT showed complete agenesis of the corpus callosum, and EEG recorded bilateral epileptogenic foci. Karyotype analysis revealed 45,X,psu dic(14;X)(p11;p22). FISH using 14q and Xp subtelomeric probes, combined with a SHOX gene-specific probe, and centromere X and XIST gene analysis revealed ish psu dic(14;X)(D14S1420+; DXYS129-, SHOX-, DXZ1+, XIST+). Array CGH detected a 2-Mb loss at Xp22.33 and a 4.6-Mb gain at Xp22.2p22.12. The deletion contains 34 genes, of which CSF2RA and SHOX are OMIM morbid genes. The duplication also contains some OMIM morbid genes, of which CDKL5, NH5, RPS6KA3, and AP1S2 are the most important. The late replicating chromatin technique was used to detect the pattern of X inactivation in the normal X and in the translocated chromosome. The translocated X was found to be inactive in 70% of the studied blood lymphocytes with patchy extension of inactivation to chromosome 14. In conclusion, the phenotype of the patient may be partially affected by the haploinsufficiency of the genes that are known to escape X inactivation and that lie within the deleted region and by other deleted or duplicated genes on the abnormal X chromosome due to an alternative pattern of X inactivation. The phenotype of the patient was significantly aggravated and complicated by the functional monosomy of some genes on chromosome 14 due to partial spreading of inactivation and silencing of those genes. This case report indicates the importance of structural and functional studies and emphasizes the clinical importance of the follow-up of abnormal microarrays.
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Papoulidis I, Vetro A, Paspaliaris V, Ziegler M, Kreskowski K, Daskalakis G, Papadopoulos V, Dagklis T, Liehr T, Thomaidis L, Manolakos E. A Girl with 10 Mb Distal Xp Deletion Arising from Maternal Pericentric Inversion: Clinical Data and Molecular Characterization. Curr Genomics 2018; 19:240-246. [PMID: 29606911 PMCID: PMC5850512 DOI: 10.2174/1389202918666170725102220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 01/27/2017] [Accepted: 02/01/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Short arm deletions of the X-chromosome are challenging issues for genetic counseling due to their low penetrance in population. Female carriers of these deletions have milder phenotype than male ones, considering the intellectual ability and social skills, probably because of the X-chromosome inactivation phenomenon. Case report: A female patient with a 10Mb distal Xp deletion and an Xq duplication, showing mild intellectual disability, is described in this report. While the deletion arose from a maternal pericentric inversion, the duplication was directly transmitted from the mother who is phenotypically normal. Conclusion: This report underlines the usefulness of molecular cytogenetic technics in postnatal diagnosis.
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Affiliation(s)
- Ioannis Papoulidis
- Access to Genome P.C., Clinical Laboratory Genetics, Athens-Thessaloniki, Greece
| | - Annalisa Vetro
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Vassilis Paspaliaris
- Access to Genome P.C., Clinical Laboratory Genetics, Athens-Thessaloniki, Greece
| | - Monika Ziegler
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Kollegiengasse 10, D-07743Jena, Germany
| | - Katharina Kreskowski
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Kollegiengasse 10, D-07743Jena, Germany
| | - George Daskalakis
- Department of Obstetrics & Gynecology, "Alexandra" Hospital, University of Athens, Athens, Greece
| | | | - Themistoklis Dagklis
- 3 Obstetrics and Gynecology Clinic, Ippokrateion Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Kollegiengasse 10, D-07743Jena, Germany
| | - Loretta Thomaidis
- Developmental Assessment Unit, 2 Department of Pediatrics, P. & A. Kyriakou Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Manolakos
- Access to Genome P.C., Clinical Laboratory Genetics, Athens-Thessaloniki, Greece.,Developmental Assessment Unit, 2 Department of Pediatrics, P. & A. Kyriakou Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Medical Genetics, University of Cagliari, Binaghi Hospital, Cagliari, Italy
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Culen C, Ertl DA, Schubert K, Bartha-Doering L, Haeusler G. Care of girls and women with Turner syndrome: beyond growth and hormones. Endocr Connect 2017; 6:R39-R51. [PMID: 28336768 PMCID: PMC5434744 DOI: 10.1530/ec-17-0036] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 01/10/2023]
Abstract
Turner syndrome (TS), although considered a rare disease, is the most common sex chromosome abnormality in women, with an incident of 1 in 2500 female births. TS is characterized by distinctive physical features such as short stature, ovarian dysgenesis, an increased risk for heart and renal defects as well as a specific cognitive and psychosocial phenotype. Given the complexity of the condition, patients face manifold difficulties which increase over the lifespan. Furthermore, failures during the transitional phase to adult care result in moderate health outcomes and decreased quality of life. Guidelines on the optimal screening procedures and medical treatment are easy to find. However, recommendations for the treatment of the incriminating psychosocial aspects in TS are scarce. In this work, we first reviewed the literature on the cognitive and psychosocial development of girls with TS compared with normal development, from disclosure to young adulthood, and then introduce a psychosocial approach to counseling and treating patients with TS, including recommendations for age-appropriate psychological diagnostics. With this work, we aim to facilitate the integration of emphasized psychosocial care in state-of-the-art treatment for girls and women with TS.
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Affiliation(s)
- Caroline Culen
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Diana-Alexandra Ertl
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Katharina Schubert
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Lisa Bartha-Doering
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
| | - Gabriele Haeusler
- University Clinic of Pediatrics and Adolescent MedicineMedical University of Vienna, Vienna, Austria
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Baker JM, Reiss AL. A meta-analysis of math performance in Turner syndrome. Dev Med Child Neurol 2016; 58:123-30. [PMID: 26566693 PMCID: PMC4724271 DOI: 10.1111/dmcn.12961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/29/2022]
Abstract
AIM Studies investigating the relationship between Turner syndrome and math learning disability have used a wide variation of tasks designed to test various aspects of mathematical competencies. Although these studies have revealed much about the math deficits common to Turner syndrome, their diversity makes comparisons between individual studies difficult. As a result, the consistency of outcomes among these diverse measures remains unknown. The overarching aim of this review is to provide a systematic meta-analysis of the differences in math and number performance between females with Turner syndrome and age-matched neurotypical peers. METHOD We provide a meta-analysis of behavioral performance in Turner syndrome relative to age-matched neurotypical populations on assessments of math and number aptitude. In total, 112 comparisons collected across 17 studies were included. RESULTS Although 54% of all statistical comparisons in our analyses failed to reject the null hypothesis, our results indicate that meaningful group differences exist on all comparisons except those that do not require explicit calculation. INTERPRETATION Taken together, these results help elucidate our current understanding of math and number weaknesses in Turner syndrome, while highlighting specific topics that require further investigation.
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Affiliation(s)
- Joseph M Baker
- Division of Brain Sciences, Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Allan L Reiss
- Division of Brain Sciences, Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA,Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
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Ibarra-Ramírez M, Martínez-de-Villarreal L. Clinical and genetic aspects of Turner's syndrome. MEDICINA UNIVERSITARIA 2016. [DOI: 10.1016/j.rmu.2016.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 5. Gonadal Dysgenesis. Pediatr Dev Pathol 2015; 18:259-78. [PMID: 25105336 DOI: 10.2350/14-04-1471-pb.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
One of the most challenging areas in pediatric testicular pathology is the appropriate understanding and pathological diagnosis of disorders of sexual development (DSD), and in particular, the issue of gonadal dysgenesis. Here we present the main concepts necessary for their understanding and appropriate classification, with extensive genetic correlations.
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Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo #2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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Hong YH, Shin YL. Turner syndrome masquerading as normal early puberty. Ann Pediatr Endocrinol Metab 2014; 19:225-8. [PMID: 25654070 PMCID: PMC4316414 DOI: 10.6065/apem.2014.19.4.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/13/2014] [Accepted: 09/07/2014] [Indexed: 11/20/2022] Open
Abstract
Approximately 50% of patients with Turner syndrome (TS) have complete loss of one X chromosome, whereas the rest of the patients with TS display mosaicism or structural abnormalities of the X chromosome. Most well-known common features are short stature and gonadal failure. Approximately one third of girls with TS may enter spontaneous puberty, but only half those completed with menarche. However, some atypical features of TS have been described. Many studies have been conducted to verify and delineate proposed loci for genes pertaining to the TS phenotype, and correlations between karyotype and phenotype. A few rare cases of precocious puberty with TS have been described. Here we describe a case of TS with the Xp22.1 deletion presenting with short final stature, early normal onset of spontaneous puberty, and Graves' disease, without short stature during puberty.
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Affiliation(s)
- Yong Hee Hong
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young Lim Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Abstract
Studies of sex effects on neurodevelopment have traditionally focused on animal models investigating hormonal influences on brain anatomy. However, more recent evidence suggests that sex chromosomes may also have direct upstream effects that act independently of hormones. Sex chromosome aneuploidies provide ideal models to examine this framework in humans, including Turner syndrome (TS), where females are missing one X-chromosome (45X), and Klinefelter syndrome (KS), where males have an additional X-chromosome (47XXY). As these disorders essentially represent copy number variants of the sex chromosomes, investigation of brain structure across these disorders allows us to determine whether sex chromosome gene dosage effects exist. We used voxel-based morphometry to investigate this hypothesis in a large sample of children in early puberty, to compare regional gray matter volumes among individuals with one (45X), two (typically developing 46XX females and 46XY males), and three (47XXY) sex chromosomes. Between-group contrasts of TS and KS groups relative to respective sex-matched controls demonstrated highly convergent patterns of volumetric differences with the presence of an additional sex chromosome being associated with relatively decreased parieto-occipital gray matter volume and relatively increased temporo-insular gray matter volumes. Furthermore, z-score map comparisons between TS and KS cohorts also suggested that this effect occurs in a linear dose-dependent fashion. We infer that sex chromosome gene expression directly influences brain structure in children during early stages of puberty, extending our understanding of genotype-phenotype mechanisms underlying sex differences in the brain.
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Mandelblatt JS, Hurria A, McDonald BC, Saykin AJ, Stern RA, VanMeter JW, McGuckin M, Traina T, Denduluri N, Turner S, Howard D, Jacobsen PB, Ahles T. Cognitive effects of cancer and its treatments at the intersection of aging: what do we know; what do we need to know? Semin Oncol 2013; 40:709-25. [PMID: 24331192 PMCID: PMC3880205 DOI: 10.1053/j.seminoncol.2013.09.006] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
There is a fairly consistent, albeit non-universal body of research documenting cognitive declines after cancer and its treatments. While few of these studies have included subjects aged 65 years and older, it is logical to expect that older patients are at risk of cognitive decline. Here, we use breast cancer as an exemplar disease for inquiry into the intersection of aging and cognitive effects of cancer and its therapies. There are a striking number of common underlying potential biological risks and pathways for the development of cancer, cancer-related cognitive declines, and aging processes, including the development of a frail phenotype. Candidate shared pathways include changes in hormonal milieu, inflammation, oxidative stress, DNA damage and compromised DNA repair, genetic susceptibility, decreased brain blood flow or disruption of the blood-brain barrier, direct neurotoxicity, decreased telomere length, and cell senescence. There also are similar structure and functional changes seen in brain imaging studies of cancer patients and those seen with "normal" aging and Alzheimer's disease. Disentangling the role of these overlapping processes is difficult since they require aged animal models and large samples of older human subjects. From what we do know, frailty and its low cognitive reserve seem to be a clinically useful marker of risk for cognitive decline after cancer and its treatments. This and other results from this review suggest the value of geriatric assessments to identify older patients at the highest risk of cognitive decline. Further research is needed to understand the interactions between aging, genetic predisposition, lifestyle factors, and frailty phenotypes to best identify the subgroups of older patients at greatest risk for decline and to develop behavioral and pharmacological interventions targeting this group. We recommend that basic science and population trials be developed specifically for older hosts with intermediate endpoints of relevance to this group, including cognitive function and trajectories of frailty. Clinicians and their older patients can advance the field by active encouragement of and participation in research designed to improve the care and outcomes of the growing population of older cancer patients.
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Affiliation(s)
- Jeanne S Mandelblatt
- Departments of Oncology and Population Sciences, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
| | - Arti Hurria
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Brenna C McDonald
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Andrew J Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences and the Melvin and Bren Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Robert A Stern
- Departments of Neurology and Neurosurgery and Director, Clinical Core, BU Alzheimer's Disease Center, Boston University School of Medicine, Boston, MA
| | - John W VanMeter
- Department of Neurology, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Meghan McGuckin
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Tiffani Traina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neelima Denduluri
- Department of Medicine, Georgetown University; Virginia Cancer Specialists, US Oncology, Arlington, VA
| | - Scott Turner
- Department of Neurology, Georgetown University Medical Center, Georgetown University, Washington, DC
| | - Darlene Howard
- Department of Psychology, Georgetown University, Washington, DC
| | - Paul B Jacobsen
- Division of Population Science, Moffitt Cancer Center, Tampa, FL
| | - Tim Ahles
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Psychiatry, Weill Cornell Medical College, New York, NY
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Gould HN, Bakalov VK, Tankersley C, Bondy CA. High levels of education and employment among women with Turner syndrome. J Womens Health (Larchmt) 2013; 22:230-5. [PMID: 23421579 DOI: 10.1089/jwh.2012.3931] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Turner Syndrome (TS) is due to X chromosome monosomy and affects ~1 per 2500 females at birth. The major features are short stature and primary ovarian failure. Short stature and monosomy for a maternal X chromosome have been implicated in impaired functionality in adult life; however, data on adult outcomes in TS are limited. In this study we evaluated the influence of adult height and parental origin of the single X chromosome on education, employment, and marital outcomes among women with TS. METHODS This was a cross-sectional study of 240 women (25-67 years old) with TS participating in an intramural National Institutes of Health (NIH) study. Parental origin of the single X chromosome was determined by genotyping proband and parental genomic DNA. Information on education, employment, and family status was self reported. Normative data was obtained from the U.S. Bureaus of Census and Labor and Statistics. RESULTS Seventy percent of the TS group had a baccalaureate degree or higher, compared with 30% of U.S. women (p<0.0001). Eighty percent of the TS group was employed compared with 70% of the U.S. female population. Approximately 50% of the TS group had ever married, compared with 78% of the general female population (p<0.0001). Height and parental origin of the single normal X chromosome had no association with education, employment, or marital status. CONCLUSION Women with TS currently achieve education and employment levels higher than the female U.S. population but are less likely to marry. Neither adult height nor parental origin of the single X chromosome influenced outcomes in education, employment, or marriage.
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Affiliation(s)
- Harley N Gould
- National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA
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17
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Turner syndrome: advances in understanding altered cognition, brain structure and function. Curr Opin Neurol 2012; 25:144-9. [PMID: 22322416 DOI: 10.1097/wco.0b013e3283515e9e] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Turner syndrome, which results from the complete or partial loss of a sex chromosome, is associated with a particular pattern of cognitive impairments and strengths and an increased risk for specific neurodevelopmental disorders. This review highlights recent progress in understanding brain structure and function in Turner syndrome and identifies several critical research needs. RECENT FINDINGS Recent work on social cognition in Turner syndrome has identified a range of difficulties despite a maintained social appetite, a disconnect which could result in distress for affected individuals. Progress has been made in identifying foundational deficits in attention and executive function that could explain visual-spatial and arithmetical impairments. Neuroimaging studies have advanced our understanding of brain development and function through the application of cutting edge analysis techniques. Haploinsufficiency of genes, failure to express parentally imprinted genes, uncovering of X chromosome mutations, and gonadal steroid deficiency may all contribute to altered brain development, but additional work is required to link specific mechanisms to specific phenotypes. Also needed are studies of interventions to assist individuals with Turner syndrome in visual-spatial, mathematical, and social skills. SUMMARY Ultimately a better understanding of brain structure and function in Turner syndrome will generate new therapeutic approaches for this population.
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Temple CM, Shephard EE. Exceptional lexical skills but executive language deficits in school starters and young adults with Turners syndrome: implications for X chromosome effects on brain function. BRAIN AND LANGUAGE 2012; 120:345-359. [PMID: 22240237 DOI: 10.1016/j.bandl.2011.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 11/23/2011] [Accepted: 12/04/2011] [Indexed: 05/31/2023]
Abstract
TS school starters had enhanced receptive and expressive language on standardised assessment (CELF-P) and enhanced rhyme judgements, spoonerisms, and lexical decision, indicating enhanced phonological skills and word representations. There was marginal but consistent advantage across lexico-semantic tasks. On executive tasks, speeded naming of numbers was impaired but not pictures. Young TS adults had enhanced naming and receptive vocabulary, indicating enhanced semantic skills. There were consistent deficits in executive language: phonemic oral fluency, rhyme fluency, speeded naming of pictures, numbers and colours; sentence completion requiring supression of prepotent responses. Haploinsufficiency of X-chromosome drives mechanisms that affect the anatomical and neurochemical development of the brain, resulting in enhanced temporal lobe aspects of language. These strengths co-exist with impaired development of frontal lobe executive language systems. This means not only that these elements of language can decouple in development but that their very independence is driven by mechanisms linked to the X-chromosome.
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Affiliation(s)
- Christine M Temple
- Developmental Neuropsychology Unit, Department of Psychology, University of Essex, Wivenhoe Park, Colchester CO7 9JU, UK.
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Knickmeyer RC, Davenport M. Turner syndrome and sexual differentiation of the brain: implications for understanding male-biased neurodevelopmental disorders. J Neurodev Disord 2011; 3:293-306. [PMID: 21818630 PMCID: PMC3261262 DOI: 10.1007/s11689-011-9089-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 07/13/2011] [Indexed: 01/24/2023] Open
Abstract
Turner syndrome (TS) is one of the most common sex chromosome abnormalities. Affected individuals often show a unique pattern of cognitive strengths and weaknesses and are at increased risk for a number of other neurodevelopmental conditions, many of which are more common in typical males than typical females (e.g., autism and attention-deficit hyperactivity disorder). This phenotype may reflect gonadal steroid deficiency, haploinsufficiency of X chromosome genes, failure to express parentally imprinted genes, and the uncovering of X chromosome mutations. Understanding the contribution of these different mechanisms to outcome has the potential to improve clinical care for individuals with TS and to better our understanding of the differential vulnerability to and expression of neurodevelopmental disorders in males and females. In this paper, we review what is currently known about cognition and brain development in individuals with TS, discuss underlying mechanisms and their relevance to understanding male-biased neurodevelopmental conditions, and suggest directions for future research.
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Affiliation(s)
- Rebecca Christine Knickmeyer
- Department of Psychiatry CB 7160, University of North Carolina at Chapel Hill, 343 Medical Wings C, Campus Box #7160, Chapel Hill, NC, 27599-7160, USA,
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Lepage JF, Dunkin B, Hong DS, Reiss AL. Contribution of Executive Functions to Visuospatial Difficulties in Prepubertal Girls With Turner Syndrome. Dev Neuropsychol 2011; 36:988-1002. [DOI: 10.1080/87565641.2011.584356] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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21
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Wijchers PJ, Festenstein RJ. Epigenetic regulation of autosomal gene expression by sex chromosomes. Trends Genet 2011; 27:132-40. [DOI: 10.1016/j.tig.2011.01.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/10/2011] [Accepted: 01/12/2011] [Indexed: 12/11/2022]
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Paul LK. Developmental malformation of the corpus callosum: a review of typical callosal development and examples of developmental disorders with callosal involvement. J Neurodev Disord 2011; 3:3-27. [PMID: 21484594 PMCID: PMC3163989 DOI: 10.1007/s11689-010-9059-y] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 08/13/2010] [Indexed: 12/11/2022] Open
Abstract
This review provides an overview of the involvement of the corpus callosum (CC) in a variety of developmental disorders that are currently defined exclusively by genetics, developmental insult, and/or behavior. I begin with a general review of CC development, connectivity, and function, followed by discussion of the research methods typically utilized to study the callosum. The bulk of the review concentrates on specific developmental disorders, beginning with agenesis of the corpus callosum (AgCC)-the only condition diagnosed exclusively by callosal anatomy. This is followed by a review of several genetic disorders that commonly result in social impairments and/or psychopathology similar to AgCC (neurofibromatosis-1, Turner syndrome, 22q11.2 deletion syndrome, Williams yndrome, and fragile X) and two forms of prenatal injury (premature birth, fetal alcohol syndrome) known to impact callosal development. Finally, I examine callosal involvement in several common developmental disorders defined exclusively by behavioral patterns (developmental language delay, dyslexia, attention-deficit hyperactive disorder, autism spectrum disorders, and Tourette syndrome).
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Affiliation(s)
- Lynn K Paul
- Division of Humanities and Social Sciences, California Institute of Technology, HSS 228-77, Caltech, Pasadena, CA, 91125, USA,
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23
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de Smith AJ, Trewick AL, Blakemore AIF. Implications of copy number variation in people with chromosomal abnormalities: potential for greater variation in copy number state may contribute to variability of phenotype. THE HUGO JOURNAL 2010; 4:1-9. [PMID: 22132061 PMCID: PMC3051043 DOI: 10.1007/s11568-010-9144-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Revised: 07/21/2010] [Accepted: 07/26/2010] [Indexed: 10/27/2022]
Abstract
Abstract
Copy number variation is common in the human genome with many regions, overlapping thousands of genes, now known to be deleted or amplified. Aneuploidies and other forms of chromosomal imbalance have a wide range of adverse phenotypes and are a common cause of birth defects resulting in significant morbidity and mortality. “Normal” copy number variants (CNVs) embedded within the regions of chromosome imbalance may affect the clinical outcomes by altering the local copy number of important genes or regulatory regions: this could alleviate or exacerbate certain phenotypes. In this way CNVs may contribute to the clinical variability seen in many disorders caused by chromosomal abnormalities, such as the congenital heart defects (CHD) seen in ~40% of Down’s syndrome (DS) patients. Investigation of CNVs may therefore help to pinpoint critical genes or regulatory elements, elucidating the molecular mechanisms underlying these conditions, also shedding light on the aetiology of such phenotypes in people without major chromosome imbalances, and ultimately leading to their improved detection and treatment.
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Mazzocco MM, Hanich LB. Math achievement, numerical processing, and executive functions in girls with Turner syndrome: Do girls with Turner syndrome have math learning disability? LEARNING AND INDIVIDUAL DIFFERENCES 2010. [DOI: 10.1016/j.lindif.2009.10.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ross JL, Mazzocco MMM, Kushner H, Kowal K, Cutler GB, Roeltgen D. Effects of treatment with oxandrolone for 4 years on the frequency of severe arithmetic learning disability in girls with Turner syndrome. J Pediatr 2009; 155:714-20. [PMID: 19643440 DOI: 10.1016/j.jpeds.2009.05.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Revised: 04/14/2009] [Accepted: 05/21/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To study androgen treatment effects on arithmetic performance in girls with Turner syndrome. STUDY DESIGN Forty-four girls, ages 10 to 14 years at baseline, completed 4 years of treatment with oxandrolone (Ox) or placebo (Pl). All received growth hormone and estrogen replacement therapy. We assessed the number of girls with severe learning disability (LD, standard score <or=5(th) percentile) on measures of academic arithmetic and reading achievement (WRAT-3, arithmetic and reading), given yearly, and the WIAT numerical operations (NOS) and reading subtests, given at year 4. RESULTS On the WRAT-3 arithmetic, the frequency of severe arithmetic LD was similar in the Ox and Pl groups at baseline and at years 1 and 2. At years 3 and 4, fewer girls in the Ox than Pl group had a severe arithmetic LD (year 4: 0/22 vs 5/21, P = .02). On the WIAT NOS (year 4), fewer girls in the Ox than Pl groups had a severe arithmetic LD (3/21 vs 8/20, P = .09). WIAT NOS error analysis suggested that the improved performance in the Ox group was associated with better performance on multiplication and division (P < .01). The frequency of severe LD for the WRAT-3 reading was similar for the Ox and Pl groups (all years) and for the WIAT reading subtest (year 4). CONCLUSIONS Androgen treatment for 4 years in girls with Turner syndrome resulted in a small decrease in frequency of severe arithmetic LD, with no effect on reading LD.
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Affiliation(s)
- Judith L Ross
- Thomas Jefferson University, Department of Pediatrics, Philadelphia, PA 19107, USA.
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Dennis M, Berch DB, Mazzocco MMM. Mathematical learning disabilities in special populations: phenotypic variation and cross-disorder comparisons. ACTA ACUST UNITED AC 2009; 15:80-9. [PMID: 19213019 DOI: 10.1002/ddrr.54] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
What is mathematical learning disability (MLD)? The reviews in this special issue adopt different approaches to defining the construct of MLD. Collectively, they demonstrate the current status of efforts to establish a consensus definition and the challenges faced in this endeavor. In this commentary, we reflect upon the proposed pathways to mathematical learning difficulties and disabilities presented across the reviews. Specifically we consider how each of the reviews contributes to identifying the MLD phenotype by specifying the range of assets and deficits in mathematics, identifying sources of individual variation, and characterizing the natural progression of MLD over the life course. We show how principled comparisons across disorders address issues about the cognitive and behavioral co-morbidities of MLD, and whether commonalities in brain dysmorphology are associated with common mathematics performance profiles. We project the status of MLD research ten years hence with respect to theoretical gains, advances in methodology, and principled intervention studies.
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Affiliation(s)
- Maureen Dennis
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Departments of Surgery & Psychology, University of Toronto, Toronto, Canada.
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27
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Mazzocco MM. Mathematical learning disability in girls with Turner syndrome: A challenge to defining MLD and its subtypes. ACTA ACUST UNITED AC 2009; 15:35-44. [DOI: 10.1002/ddrr.50] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Puusepp H, Zordania R, Paal M, Bartsch O, Ounap K. Girl with partial Turner syndrome and absence epilepsy. Pediatr Neurol 2008; 38:289-92. [PMID: 18358412 DOI: 10.1016/j.pediatrneurol.2007.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 09/17/2007] [Accepted: 11/20/2007] [Indexed: 11/30/2022]
Abstract
This report describes a 16-year-old girl with short stature (-5 standard deviations), normal puberty, panic attacks, absence epilepsy, some stigmata of Turner syndrome, and a Madelung deformity. Routine chromosomal analysis revealed a female karyotype with one abnormal chromosome X, with the suspicion of additional material on the short arm. With fluorescent in situ hybridization and array-multiplex amplifiable probe hybridization methodology, a complex aberration was detected, with a deletion of the distal part of Xp22.33 (including the short-stature homeobox gene) and a duplication of Xp22.32-p22.12 proximal to the deleted segment. The deletion in our patient involves the Xp22.33 region. Two genes in this region may contribute to the patient's phenotype: short-stature homeobox, and visuospatial/perceptual abilities. The duplication in our patient involves the Xp22.12-p22.32 region, which, according to the Online Mendelian Inheritance in Man database, contains at least 93 genes, 49 of which are of unknown function. It is difficult to conjecture which gene overexpression in this region may have contributed to the phenotype of our patient. To our knowledge, this small, complex chromosome X aberration was not described previously.
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Affiliation(s)
- Helen Puusepp
- Department of Pediatrics, University of Tartu, Tartu, Estonia
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Sheaffer AT, Lange E, Bondy CA. Sexual Function in Women with Turner Syndrome. J Womens Health (Larchmt) 2008; 17:27-33. [DOI: 10.1089/jwh.2007.0488] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexis T. Sheaffer
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Eileen Lange
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Carolyn A. Bondy
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Anam S, Jummani R, Coffey B, Wieland N. Treatment of juvenile-onset bipolar disorder in a child with Turner's syndrome. J Child Adolesc Psychopharmacol 2007; 17:384-90. [PMID: 17630874 DOI: 10.1089/cap.2007.17304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Seeba Anam
- NYU Child Study Center, New York, New York 10016, USA
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Dupont C, Lebbar A, Teinturier C, Baverel F, Viot G, Le Tessier D, Le Bozec J, Cuisset L, Dupont JM. First reported case of intrachromosomal cryptic inv dup del Xp in a boy with developmental retardation. Am J Med Genet A 2007; 143A:1236-43. [PMID: 17497716 DOI: 10.1002/ajmg.a.31744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We report here on a 6-year-old boy referred to the laboratory for karyotyping and SHOX microdeletion testing. The most significant clinical findings in this boy were small stature, Madelung deformity, facial dysmorphism, mild mental retardation and behavioral problems. R-, G- and RTBG-banding chromosome analysis showed a normal male karyotype. Fine molecular characterization, by FISH, of terminal Xp microdeletion revealed an associated partial duplication. Further refinement of the molecular analysis indicated an inverted duplication of the Xp22.31-Xp22.32 (13.7 Mb) region including the STS, VCX-A and KAL1 genes, associated with a terminal Xp deletion Xp22.33-Xpter (3.6 Mb) encompassing the SHOX and ARSE genes. Such rearrangements have been characterized for other chromosomal pairs, but this is the first reported male patient involving the short arm of the X chromosome. Molecular analysis of the maternal and patient's microsatellite markers showed interchromatid mispairing leading to non-allelic homologous recombination to be the most likely mechanism underlying this rearrangement. This case highlights the importance of clinically driven FISH investigations in order to uncover cryptic micro-rearrangements.
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Affiliation(s)
- Celine Dupont
- AP-HP, Hôpital Cochin, Service Histologie Embryologie Cytogénétique, Université Paris-Descartes, Faculté de Médecine, Unité INSERM U709, Paris, France.
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Zinn AR, Roeltgen D, Stefanatos G, Ramos P, Elder FF, Kushner H, Kowal K, Ross JL. A Turner syndrome neurocognitive phenotype maps to Xp22.3. BEHAVIORAL AND BRAIN FUNCTIONS : BBF 2007; 3:24. [PMID: 17517138 PMCID: PMC1891305 DOI: 10.1186/1744-9081-3-24] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Accepted: 05/21/2007] [Indexed: 01/16/2023]
Abstract
BACKGROUND Turner syndrome (TS) is associated with a neurocognitive phenotype that includes selective nonverbal deficits, e.g., impaired visual-spatial abilities. We previously reported evidence that this phenotype results from haploinsufficiency of one or more genes on distal Xp. This inference was based on genotype/phenotype comparisons of individual girls and women with partial Xp deletions, with the neurocognitive phenotype considered a dichotomous trait. We sought to confirm our findings in a large cohort (n = 47) of adult women with partial deletions of Xp or Xq, enriched for subjects with distal Xp deletions. METHODS Subjects were recruited from North American genetics and endocrinology clinics. Phenotype assessment included measures of stature, ovarian function, and detailed neurocognitive testing. The neurocognitive phenotype was measured as a quantitative trait, the Turner Syndrome Cognitive Summary (TSCS) score, derived from discriminant function analysis. Genetic analysis included karyotyping, X inactivation studies, fluorescent in situ hybridization, microsatellite marker genotyping, and array comparative genomic hybridization. RESULTS We report statistical evidence that deletion of Xp22.3, an interval containing 31 annotated genes, is sufficient to cause the neurocognitive phenotype described by the TSCS score. Two other cardinal TS features, ovarian failure and short stature, as well as X chromosome inactivation pattern and subject's age, were unrelated to the TSCS score. CONCLUSION Detailed mapping suggests that haploinsufficiency of one or more genes in Xp22.3, the distal 8.3 megabases (Mb) of the X chromosome, is responsible for a TS neurocognitive phenotype. This interval includes the 2.6 Mb Xp-Yp pseudoautosomal region (PAR1). Haploinsufficiency of the short stature gene SHOX in PAR1 probably does not cause this TS neurocognitive phenotype. Two genes proximal to PAR1 within the 8.3 Mb critical region, STS and NLGN4X, are attractive candidates for this neurocognitive phenotype.
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Affiliation(s)
- Andrew R Zinn
- Eugene McDermott Center for Human Growth and Development and Department of Internal Medicine, The University of Texas Southwestern Medical School, Dallas TX, USA
| | - David Roeltgen
- Cooper University Hospital, Robert Wood Johnson Medical School, Camden, NJ, USA
| | - Gerry Stefanatos
- MossRehab Research Institute, Albert Einstein Medical Center, Thomas Jefferson University, Philadelphia, PA
| | - Purita Ramos
- Eugene McDermott Center for Human Growth and Development and Department of Internal Medicine, The University of Texas Southwestern Medical School, Dallas TX, USA
| | - Frederick F Elder
- Department of Pathology, The University of Texas Southwestern Medical School, Dallas TX 75390, USA
| | - Harvey Kushner
- Biomedical Computer Research Institute, Philadelphia, PA, USA
| | - Karen Kowal
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Judith L Ross
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, PA, USA
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Lynn PMY, Davies W. The 39,XO mouse as a model for the neurobiology of Turner syndrome and sex-biased neuropsychiatric disorders. Behav Brain Res 2007; 179:173-82. [PMID: 17367875 DOI: 10.1016/j.bbr.2007.02.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 02/09/2007] [Accepted: 02/15/2007] [Indexed: 02/08/2023]
Abstract
Turner syndrome (TS) is a developmental disorder most frequently arising from the loss of a complete X chromosome (karyotype 45,XO). The disorder is characterised by physiological abnormalities (notably short stature and ovarian dysfunction), emotional anomalies (including heightened anxiety) and by a neuropsychological profile encompassing deficits in visuospatial skills, memory, attention, social cognition and emotion recognition. Moreover, TS subjects are at significantly increased risk of developing attention deficit hyperactivity disorder (ADHD) and autism. At the neuroanatomical level, TS subjects display abnormalities across a number of brain structures, including the amygdala, hippocampus and orbitofrontal cortex. The TS phenotype arises due to reduced dosage of X-linked genes, and may also be modulated by parental origin of the single X chromosome. In this review, we discuss the utility of a mouse model of TS, the 39,XO mouse, in which the parental origin of the single X chromosome can be varied. This model provides the opportunity to investigate the effects of X-linked gene dosage/parent-of-origin effects on neurobiology in the absence of gross physiological abnormalities. Initial findings indicate that several features of the TS behavioural phenotype may be accurately recapitulated in the mouse. Furthermore, as X-linked gene dosage/imprinting can influence sex-specific neurobiology, investigations in the 39,XO mouse are also likely to offer insights into why certain neuropsychiatric disorders (including ADHD and autism) affect the sexes differently.
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Affiliation(s)
- Phoebe M Y Lynn
- Behavioural Genetics Group, School of Psychology and Department of Psychological Medicine, University of Cardiff, UK
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Abstract
Global descriptors of the cognitive phenotype of Turner syndrome are well established and are thus commonly referred to. For example, Turner syndrome is a proposed etiology of the nonverbal learning disability - because of reported relative strengths in verbal skills, and relatively weaker nonverbal skills - particularly in arithmetic, select visuospatial skills, and processing speed. This profile is observed throughout and beyond the school age years. Reliance on this gross level description of the cognitive profile (e.g., nonverbal learning disability) may be helpful as a starting point when determining whether an individual with Turner syndrome has educational needs, but it carries limited practical significance when determining the specific nature of these needs. The limitations stem from the fact that the severity of the cognitive profile is highly variable among individuals with Turner syndrome; that the "nonverbal" difficulties are specific rather than widespread; and that any individual with Turner syndrome may also manifest cognitive characteristics independent of Turner syndrome. In view of the increased risk for specific cognitive difficulties, a detailed assessment prior to the onset of formal schooling (or at the time of diagnosis, when diagnosis occurs after 5 years of age) can play an important role in determining school readiness and potential need for educational support among individual girls with Turner syndrome.
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Xu J, Disteche CM. Sex differences in brain expression of X- and Y-linked genes. Brain Res 2006; 1126:50-5. [PMID: 16962077 DOI: 10.1016/j.brainres.2006.08.049] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Revised: 08/07/2006] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
The X chromosome plays an important role in brain development and function, as evidenced by its disproportionately high content of genes whose mutations cause mental retardation. These X-linked brain genes may play a role in sexual differentiation if they are expressed at a higher level in XX females than in XY males, due to incomplete X inactivation in females. The expression of several X escapee genes is indeed higher in brain tissues from females when compared to males. In mouse, some of the sex differences are only found in adult brains but not in other tissues. Determining the brain expression pattern of these X escapee genes is important for a better understanding of their role in the neurological phenotypes of XO Turner syndrome.
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Affiliation(s)
- Jun Xu
- Department of Pathology, University of Washington, Seattle, WA 98195, USA.
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Benito-Sanz S, Gorbenko del Blanco D, Huber C, Thomas NS, Aza-Carmona M, Bunyan D, Maloney V, Argente J, Cormier-Daire V, Campos-Barros A, Heath KE. Characterization of SHOX deletions in Leri-Weill dyschondrosteosis (LWD) reveals genetic heterogeneity and no recombination hotspots. Am J Hum Genet 2006; 79:409-14; author reply 414. [PMID: 16826534 PMCID: PMC1559488 DOI: 10.1086/506390] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Mazzocco MMM, Singh Bhatia N, Lesniak-Karpiak K. Visuospatial skills and their association with math performance in girls with fragile X or Turner syndrome. Child Neuropsychol 2006; 12:87-110. [PMID: 16754531 DOI: 10.1080/09297040500266951] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study was designed to assess object identification ("what") and location ("where") skills among girls with fragile X or Turner syndrome and girls with neither disorder. Participants completed standardized subtests of visual perception and tasks of visuospatial "what" and "where" memory. Girls with fragile X had average performance on most object identification tasks, yet 53% failed to accurately recreate the gestalt of a design during the "where" memory task. Fewer than 7% of girls in the Turner or comparison group made this error. Girls with Turner syndrome had lower scores and longer response times on object perception tasks and had poorer recall of location for internal features of the design on the "where" memory task, relative to girls in the comparison or fragile X group. When limiting analyses to IQ-matched samples, correlations between math and visual perception tasks emerged, but only for girls with fragile X. These results reflect important differences between two cognitive phenotypes and have implications for the role of visuospatial processing in early math performance.
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Doswell BH, Visootsak J, Brady AN, Graham JM. Turner syndrome: an update and review for the primary pediatrician. Clin Pediatr (Phila) 2006; 45:301-13. [PMID: 16703153 DOI: 10.1177/000992280604500402] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Turner syndrome (TS) is among the most common of the sex chromosomal aneuploidies. It results from the absence of one sex chromosome (or part of an X chromosome) in a female, leaving only one X chromosome present in the cell. Primary care physicians should be able to recognize the presenting signs and symptoms of TS, and once the diagnosis is confirmed by a chromosome analysis, they should be able to serve as a valuable source of support for the patient and her family and understand the most current treatments available.
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Zinn AR, Ramos P, Ross JL. A second recombination hotspot associated with SHOX deletions. Am J Hum Genet 2006; 78:523-5. [PMID: 16572514 PMCID: PMC1380296 DOI: 10.1086/500958] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Andrew R. Zinn
- McDermott Center for Human Growth and Development and Department of Internal Medicine, The University of Texas Southwestern Medical School, Dallas; and Department of Pediatrics, Thomas Jefferson University, Philadelphia
| | - Purita Ramos
- McDermott Center for Human Growth and Development and Department of Internal Medicine, The University of Texas Southwestern Medical School, Dallas; and Department of Pediatrics, Thomas Jefferson University, Philadelphia
| | - Judith L. Ross
- McDermott Center for Human Growth and Development and Department of Internal Medicine, The University of Texas Southwestern Medical School, Dallas; and Department of Pediatrics, Thomas Jefferson University, Philadelphia
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Hart SJ, Davenport ML, Hooper SR, Belger A. Visuospatial executive function in Turner syndrome: functional MRI and neurocognitive findings. ACTA ACUST UNITED AC 2006; 129:1125-36. [PMID: 16504970 PMCID: PMC5403411 DOI: 10.1093/brain/awl046] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Turner syndrome is a genetic disorder that results from an abnormal or missing X chromosome in females and is typically associated with impairments in visuospatial, but not verbal, information processing. These visuospatial processing impairments may be exacerbated with increased task demands, such as those engaged during working memory (WM). While previous studies have examined spatial WM function in Turner syndrome, none have directly compared the neural correlates of spatial and verbal WM processes across the encoding, maintenance and retrieval phases. We employed both neurocognitive assessments and functional MRI (fMRI) to examine the neural circuitry underlying both verbal and visuospatial WM functions in individuals with Turner syndrome and normal controls. We furthermore examined the vulnerability of task-related fMRI activation to distracters presented during WM maintenance. Fifteen healthy female volunteers and eight individuals with Turner syndrome performed a delayed-response WM task during fMRI scanning. Neurocognitive tests revealed impaired performance across both verbal and spatial domains in Turner syndrome, with greater impairment on tasks with WM demands. Frontoparietal regions in controls showed significantly sustained levels of activation during visuospatial WM. This sustained activation was significantly reduced in the group with Turner syndrome. Domain-specific activation of temporal regions, in contrast, did not differ between the two groups. Sensory distraction during the WM maintenance phase did not differentially alter frontoparietal activation between the two groups. The results reveal impaired frontoparietal circuitry recruitment during visuospatial executive processing in Turner syndrome, suggesting a significant role for the X chromosome in the development of these pathways.
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Affiliation(s)
- Sarah J. Hart
- Correspondence to: Aysenil Belger, Department of Psychiatry, CB #7160, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA E-mail:
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Orellana C, Badía L, Martínez F, Oltra JS, Monfort S, Roselló M, Cervera JV, García Z, Prieto F. Recombinant X chromosome in a prenatal diagnosis. Cytogenet Genome Res 2006; 112:337-40. [PMID: 16484792 DOI: 10.1159/000089890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The prenatal cytogenetic study of an amniotic fluid sample of a 39-year-old female showed one X chromosome with a fragment of extra material in the short arm. The G-band pattern suggested that the extra material could be the long arm of an X chromosome. Several complementary studies were performed in order to better clarify the origin of the material. These studies included parental karyotypes, microsatellite typing and comparative genomic hybridization (CGH). The results obtained allowed us to conclude that the derivative chromosome arose de novo as a recombinant X chromosome with duplication of Xq and partial deletion of Xp. Once informed, the parents decided to continue with the pregnancy, after which a healthy girl was born with no apparent disorders.
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Affiliation(s)
- C Orellana
- Unidad de Genética y Diagnóstico Prenatal, Hospital Universitario La Fe, Valencia, Spain.
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Ross J, Roeltgen D, Zinn A. Cognition and the sex chromosomes: studies in Turner syndrome. HORMONE RESEARCH 2006; 65:47-56. [PMID: 16397401 DOI: 10.1159/000090698] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Turner syndrome (TS) is a human genetic disorder involving females who lack all or part of one X chromosome. The complex phenotype includes ovarian failure, a characteristic neurocognitive profile and typical physical features. TS features are associated not only with complete monosomy X but also with partial deletions of either the short (Xp) or long (Xq) arm (partial monosomy X). Impaired visual-spatial/perceptual abilities are characteristic of TS children and adults of varying races and socioeconomic status, but global developmental delay is uncommon. The cognitive phenotype generally includes normal verbal function with relatively impaired visual-spatial ability, attention, working memory, and spatially dependent executive function. The constellation of neurocognitive deficits observed in TS is most likely multifactorial and related to a complex interaction between genetic abnormalities and hormonal deficiencies. Furthermore, other determinants, including an additional genetic mechanism, imprinting, may also contribute to cognitive deficits associated with monosomy X. As a relatively common genetic disorder with well-defined manifestations, TS presents an opportunity to investigate genetic and hormonal factors that influence female cognitive development. TS is an excellent model for such studies because of its prevalence, the well-characterized phenotype, and the wealth of molecular resources available for the X chromosome. In the current review, we summarize the hormonal and genetic factors that may contribute to the TS neurocognitive phenotype. The hormonal determinants of cognition in TS are related to estrogen and androgen deficiency. Our genetic hypothesis is that haploinsufficiency for gene/genes on the short arm of the X chromosome (Xp) is responsible for the hallmark features of the TS cognitive phenotype. Careful clinical and molecular characterization of adult subjects missing part of Xp links the TS phenotype of impaired visual spatial/perceptual ability to specific distal Xp chromosome regions. We demonstrate that small, nonmosaic deletion of the distal short arm of the X chromosome in adult women is associated with the same hallmark cognitive profile seen in adult women with TS. Future studies will elucidate the cognitive deficits and the underlying etiology. These results should allow us to begin to design cognitive interventions that might lessen those deficits in the TS population.
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Affiliation(s)
- Judith Ross
- Department of Pediatrics, Thomas Jefferson University, A.I. duPont Hospital for Children, Philadelphia, PA 19107, USA.
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Abstract
This review has tried to update our view of TS, highlighting the less severe phenotype we are seeing today, aiming to motivate clinicians to scrutinize normal looking short girls more closely, and to provide more relevant information for those counseling prospective parents on the implications of a TS karyotype during prenatal screening. New approaches to cardiac evaluation, including imaging with MR and ECG analysis-were suggested to strengthen our ability to detect and prevent potentially life-threatening cardiac complications. The new emphasis on reproductive potential and concerns about the adequacy and safety of current HRT regimens certainly require further studies and adjustment of treatment strategies in light of new priorities and safety concerns. In the same vein, prospective studies are required to assess the outcome and safety of assisted pregnancy in TS, which, despite the warning ofa potential catastrophic increase in maternal morbidity is going to become a much more common occurrence in the near future.
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Affiliation(s)
- Carolyn A Bondy
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA.
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45
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Lachlan KL, Youings S, Costa T, Jacobs PA, Thomas NS. A clinical and molecular study of 26 females with Xp deletions with special emphasis on inherited deletions. Hum Genet 2005; 118:640-51. [PMID: 16283387 DOI: 10.1007/s00439-005-0081-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Accepted: 09/23/2005] [Indexed: 10/25/2022]
Abstract
We have undertaken a clinical study of 26 females with deletions of Xp including five mother-daughter pairs. Cytogenetic and molecular analyses have mapped the breakpoints of the deletions. We determined the parental origin of each abnormality and studied the X-inactivation patterns. We describe the clinical features and compare them with the amount of Xp material lost. We discuss the putative loci for features of Turner syndrome and describe how our series contributes further to their delineation. We conclude that (1) fertility can be retained even with the loss of two-thirds of Xp, thus, if there are genes on Xp for ovarian development, they must be at Xp11-Xp11.2; (2) in our sample of patients there is no evidence to support the existence of a single lymphogenic gene on Xp; (3) there is no evidence for a second stature locus in proximal Xp; (4) there is no evidence to support the existence of a single gene for naevi; (5) we suggest that the interval in Xp21.1-Xp11.4 between DXS997 and DXS1368 may contain a gene conferring a predisposition to hypothyroidism.
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Affiliation(s)
- K L Lachlan
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK.
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Loesch DZ, Bui QM, Kelso W, Huggins RM, Slater H, Warne G, Bergman PB, Bergman P, Rodda C, Mitchell RJ, Prior M. Effect of Turner's syndrome and X-linked imprinting on cognitive status: analysis based on pedigree data. Brain Dev 2005; 27:494-503. [PMID: 16198207 DOI: 10.1016/j.braindev.2004.12.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2004] [Revised: 12/01/2004] [Accepted: 12/28/2004] [Indexed: 11/24/2022]
Abstract
The effects of a monosomy of either the maternally or paternally derived X chromosome in Turner's syndrome (TS) on general neurocognitive status and some executive abilities were assessed using the maximum likelihood estimators for pedigree data. This method increases the power of analysis by accounting for the effect of background heritable variation on a trait. The sample comprised 42 females with regular non-mosaic X monosomy and their non-affected relatives. Wechsler neurocognitive scores and several executive function tests' scores, including the Behaviour Dyscontrol Scale (BDS-2), the Wisconsin Card Sorting Test (WCST), and the Rey Complex Figure Test (RCFT), were considered in the analysis. Results showed a significant effect of TS on all Wechsler index and subtest scores, with greatest deficits observed in Arithmetic, Block Design, Object Assembly and Picture Arrangement, and on the total BDS, RCFT and WCST scores, regardless of parental origin of the single X-chromosome. Our data also showed a significantly higher effect of a paternally derived X chromosome in diminishing the performance on several Wechsler scores relevant to verbal skills, which might suggest X-linked imprinting loci relevant to these skills. Possible reasons for the inconsistency of the results concerning X-linked imprinting of cognitive loci using TS patients are discussed, and the relevance of pedigree analysis to future studies of this problem is emphasized.
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Affiliation(s)
- Danuta Z Loesch
- School of Psychological Science, La Trobe University, Melbourne, Victoria 3086, Australia.
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Affiliation(s)
- Virginia P Sybert
- Division of Medical Genetics, Department of Medicine, University of Washington School of Medicine, Seattle, USA
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Abstract
Turner syndrome, resulting from a complete or partial absence of one X chromosome, is the most commonly occurring chromosomal abnormality in females. Patients have traditionally been carefully followed in paediatric practice during childhood, but were often discharged to primary care on reaching adulthood. Adults with Turner syndrome are thought to have a reduced life expectancy, mainly due to excess cardiovascular risk, but they may also have multiple comorbidities including hypothyroidism, deafness, osteoporosis and the attendant problems of oestrogen deficiency and infertility. A multidisciplinary approach to focused adult care is needed, with consideration of how to optimise surveillance strategies in these women.
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Affiliation(s)
- Julia E Ostberg
- Department of Endocrinology, Middlesex Hospital, London, UK.
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Boycott KM, Parslow MI, Ross JL, Miller IP, Bech-Hansen NT, MacLeod PM. A familial contiguous gene deletion syndrome at Xp22.3 characterized by severe learning disabilities and ADHD. Am J Med Genet A 2003; 122A:139-47. [PMID: 12955766 DOI: 10.1002/ajmg.a.20231] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We describe a mother and two sons with a 6-Mb terminal deletion of the short arm of the X chromosome. The breakpoint was localized to a region between DXS6837 and sAJ243947 in Xp22.33. The two boys were shown to be deleted for the SHOX and ARSE genes on their X chromosome. Both sons were short in stature and showed mild to moderate skeletal abnormalities. The most significant findings in the younger son were severe learning disabilities and attention deficit hyperactivity disorder (ADHD). The older son tested in the mild mental retardation range and was also affected by ADHD. The VCX-A gene, implicated recently in X-linked nonspecific mental retardation, was found to be present in both boys. The mother's stature was greater than one standard deviation below her target height and she had only subtle radiographic evidence of Madelung deformity. Our findings indicate that loss of the Xp22.3 region is not always associated with the classic presentations of Léri-Weill syndrome, or chondrodysplasia punctata, and that one or more genes involved in learning and attention may reside in Xp22.3.
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Affiliation(s)
- Kym M Boycott
- Department of Medical Genetics, University of Calgary, Calgary, Alberta, Canada.
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Abstract
X-chromosome inactivation is a remarkable epigenetic event in mammalian females that results in the transcriptional silencing of one of the pair of X chromosomes. However, not all X-linked genes are subject to inactivation, and in humans, the proportion of genes on the X chromosome that escapes inactivation is more than 15%. Here we examine the causes and consequences of failure to silence the entire X chromosome. We discuss the impact of the evolutionary history of the X (and Y) chromosome, and the bioinformatic approaches that promise to provide new insights into the genomic architecture of genes or regions that escape X-chromosome inactivation.
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Affiliation(s)
- Carolyn J Brown
- Department of Medical Genetics, University of British Columbia, 6174 University Blvd, Vancouver, British Columbia, Canada V6T 1Z3.
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