Clinical application of 2.7M Cytogenetics array for CNV detection in subjects with idiopathic autism and/or intellectual disability

Higher resolution whole-genome arrays facilitate the identification of smaller copy number variations (CNVs) and their integral genes contributing to autism and/or intellectual disability (ASD/ID). Our study describes the use of one of the highest resolution arrays, the Affymetrix(®) Cytogenetics 2.7M array, coupled with quantitative multiplex polymerase chain reaction (PCR) of short fluorescent fragments (QMPSF) for detection and validation of small CNVs. We studied 82 subjects with ASD and ID in total (30 in the validation and 52 in the application cohort) and detected putatively pathogenic CNVs in 6/52 cases from the application cohort. This included a 130-kb maternal duplication spanning exons 64-79 of the DMD gene which was found in a 3-year-old boy manifesting autism and mild neuromotor delays. Other pathogenic CNVs involved 4p14, 12q24.31, 14q32.31, 15q13.2-13.3, and 17p13.3. We established the optimal experimental conditions which, when applied to select small CNVs for QMPSF confirmation, reduced the false positive rate from 60% to 25%. Our work suggests that selection of small CNVs based on the function of integral genes, followed by review of array experimental parameters resulting in highest confirmation rate using multiplex PCR, may enhance the usefulness of higher resolution platforms for ASD and ID gene discovery.

Molecular and clinical correlation study of Williams-Beuren syndrome: No evidence of molecular factors in the deletion region or imprinting affecting clinical outcome

Williams-Beuren syndrome (WBS) results from a deletion of 7q11.23 in 90-95% of all clinically typical cases. Clinical manifestation can be variable and therefore, deletion size, inherited elastin (ELN) and LIM kinase 1 (LIMK1) alleles, gender, and parental origin of deletion have been investigated for associations with clinical outcome. In an analysis of 85 confirmed deletion cases, no statistically significant associations were found after Bonferroni's correction for multiple pairwise comparisons. Furthermore, the present data do not support presence of imprinted genes in the WBS common deletion despite a nonsignificant excess of maternal over paternal deletions. Maternal deletion cases were more likely to have a large head circumference in the present data. Also, pairwise comparisons between individual WBS clinical features have been conducted and revealed significant associations between (1) low birth weight and poor postnatal weight gain (<10th percentile at the time of examination) and (2) transient infantile hypercalcemia and a stellate iris pattern. The latter association could indicate a common underlying etiology.

Bone dysplasias, nontraditional mechanisms of inheritance and monozygotic twins

New developments in the area of cytogenetics and molecular genetics have suggested a variety of newly recognized mechanisms that result in human genetic disorders. These mechanisms are being observed among individuals with bone dysplasias. Mosaicism imprinting, parent-of-origin differences, uni- parental disomy (UPD) and mono-zygotic twinning represent mechanisms which modify the phenotypic expression of the bone dysplasia.

Embryologic development and monozygotic twinning

In 1875, Sir Francis Galton was the first to propose that by comparing the concordance of a specific trait or disorder in monozygotic (MZ) twins (assumed to be genetically identical) and dizygotic (DZ) twins (which were assumed to be as similar or as different as any other pair of sibs), it would be possible to distinguish between environmental and heritable effects. DZ twins are derived from the fertilization of two eggs by two sperm. MZ twins are the result of the fertilization of one egg by one sperm that then divides to form two embryos.

Genetic research has made amazing progress since 1875. Advances in molecular DNA techniques and developmental genetics have made it possible to differentiate unequivocally between MZ and DZ twins [1, 14]. It is in this new light that this manuscript will review the recent knowledge about twins and the twinning process.

The incidence of DZ twins differs between population [11, 18]. A DZ twin birth in North America is estimated to occur 9–11 times in every 1000 live births or 1 in 100 births; i.e. 1 in every 50 people is a DZ twin.

The DZ twinning rate is closely related to maternal age, parity, height, weight and gonadotropin levels. An increased DZ twinning rate is seen with increasing maternal age and peaks around 35–39 years; higher parity is also associated with a higher DZ twinning rate [19]. Tall heavy women are more likely to give birth to DZ twins than short thin women. A higher incidence of DZ twins has also been reported with the use of new reproductive techniques.

An introduction to genomic imprinting and parent of origin effects

Recent developments in molecular genetics and cytogenetics have allowed for better understanding of the inheritance and expression of genes. Many newly recognized mechanisms such as genomic imprinting, mosaicism, allelic expansion, cytoplasmic inheritance and uniparental disomy have been recognized to play an important role in human heredity.

Genomic imprinting refers to differences in the phenotype which are observed depending on whether the gene was inherited from the father or from the mother. Genomic imprinting is a difficult concept to understand because imprinting has been used loosely to refer to a number of different mechanisms including psychological development, endocrinological actions of cells and protein-protein interactions. Genomic imprinting produces parent-of-origin effects. Parent-of-origin effects is a term that encompasses many of the non-traditional types of inheritance and other genetic and non-genetic mechanisms which show an effect depending on whether they were paternally or maternally derived.

Partial duplication of 3q (q25.1-->q26.1) without the Brachmann-de Lange phenotype

Partial duplications of chromosome 3 have previously been reported to have phenotypic characteristics similar to Brachmann-de Lange syndrome (BDLS). We present the case of a 13-year-old girl with an apparent duplication in the 3q25.1-->q26.1 region but none of the manifestations commonly seen in BDLS. The chromosome 3 duplication was confirmed with a FISH painting probe of the involved region. These results suggest that the region critical for Brachmann-de Lange syndrome is not within the duplicated region of 3q25.1-->q26.1.

Cardio-facio-cutaneous (CFC) syndrome in a child carrying an inherited inversion of chromosome 7

We describe a 6 1/2-year-old girl with the cardio-facio-cutaneous (CFC) syndrome. She presents with most of the characteristics of this condition: typical facial changes, congenital heart defect, slow growth, ectodermal dysplasia, and developmental delay. Chromosome analysis disclosed a 46,XX,inv(7)(q21.2q31.2) mat karyotype.

Williams syndrome in adults

There are few published reports of adults with Williams syndrome (WS). We have evaluated ten adult WS patients. The patients in our study were very variable in clinical presentation, ranging from severely affected patients with complicated medical histories to mildly affected patients who are generally in good health. Cardiovascular anomalies and hypertension were frequent. Supravalvular aortic stenosis was seen in four patients, mitral valve prolapse in three, bicuspid aortic valve in one, valvular aortic stenosis in one, and pulmonary stenosis with right ventricular hypertrophy in one. Typical facial features included stellate irides, prominent cheeks, full lips, and micrognathia. Mental retardation was seen in all patients. Verbal skills were better developed than motor skills. All patients in our study lead active lives, and most are involved in sports. Some hold supervised jobs. Eight of our patients live with their parents and two in group homes. Independent living is restricted by their mental and adaptive limitations.