Multiple sites of anterior neural tube closure in humans: evidence from anterior neural tube defects (anencephaly).

OBJECTIVE: Anterior neural tube closure in humans is thought to occur via a continuous process, culminating in the closure of the anterior neuropore. Recent studies have demonstrated that, in some species, the process is discontinuous, with four separate sites of closure initiation. In this study, we tested the hypothesis that humans, like mice and other experimental animals, have multiple sites of anterior neural tube closure. METHODS: Twenty human fetuses and neonates with open anterior neural tube defects were identified. The rostral and caudal boundaries of each defect was localized on a model cranium upon which was superimposed the four sites of anterior closure characterized in the mouse. RESULTS: Of the 20 cases, 7 (35%) defects involved the frontal region, 7 (35%) were limited to the parietal region, 4 (20%) to the occipital region, and 2 (10%) involved both the parietal and occipital regions. These defects clustered into discrete regions, corresponding to sites of closure in the mouse model. The location of the defects fell into two categories; those occurring at the junction of two closures, and those occurring within a single closure. CONCLUSION: The results of this study support the hypothesis that humans, like other species, have multiple sites of anterior neural tube closure. Furthermore, the data provide evidence for two mechanisms leading to anterior neural tube defects: one resulting from the failure of a closure to occur, and the second from the failure of two closures to meet. The findings provide insight into the variations observed in the location, recurrence risk, and etiologies of anterior neural tube defects in the human population.

Issues in regulatory protection of reproductive health in the workplace.

Provisions of federal laws that protect reproductive health in the workplace and information on recent federal actions that seek to enhance such protection are reviewed. California's Birth Defects Prevention Act and its Proposition 65, regulatory programs that specifically address reproductive toxicity, also are described.

Evidence for multi-site closure of the neural tube in humans.

Four separate initiation sites for neural tube (NT) fusion have been demonstrated recently in mice and other experimental animals. We evaluated the question of whether the multisite model vs. the traditional single-site model of NT closure provided the best explanation for neural tube defects (NTDs) in humans. Evidence for segmental vs. continuous NT closure was obtained by review of our recent clinical cases of NTDs and previous medical literature. With the multi-site NT closure model, we find that the majority of NTDs can be explained by failure of fusion of one of the closures or their contiguous neuropores. We hypothesize that: Anencephaly results from failure of closure 2 for meroacranium and closures 2 and 4 for holoacranium. Spina-bifida cystica results from failure of rostral and/or caudal closure 1 fusion. Craniorachischisis results from failure of closures 2, 4, and 1. Closure 3 non-fusion is rare, presenting as a midfacial cleft extending from the upper lip through the frontal area ("facioschisis"). Frontal and parietal cephaloceles occur at the sites of the junctions of the cranial closures 3-2 and 2-4 (the prosencephalic and mesencephalic neuropores). Occipital cephaloceles result from incomplete membrane fusion of closure 4. In humans, the most caudal NT may have a 5th closure site involving L2 to S2. Closure below S2 is by secondary neurulation. Evidence for multi-site NT closure is apparent in clinical cases of NTDs, as well as in previous epidemiological studies, empiric recurrence risk studies, and pathological studies. Genetic variations of NT closures sites occur in mice and are evident in humans, e.g., familial NTDs with Sikh heritage (closure 4 and rostral 1), Meckel-Gruber syndrome (closure 4), and Walker-Warburg syndrome (2-4 neuropore, closure 4). Environmental and teratogenic exposures frequently affect specific closure sites, e.g., folate deficiency (closures 2, 4, and caudal 1) and valproic acid (closure 5 and canalization). Classification of NTDs by closure site is recommended for all studies of NTDs in humans.(ABSTRACT TRUNCATED AT 400 WORDS)

Intermittent pattern of neural tube closure in two strains of mice.

Development of the neural tube is often described as a continuous process that begins in the cervical region of the embryo and proceeds both rostrally and caudally. Examination of neural tube closure in the cranial region of LM/Bc and SWV/Bc mice revealed an intermittent pattern with four distinct areas of closure. Closure I begins at the level of somites 1-3 and proceeds bidirectionally. Closure II is initiated at the prosencephalic-mesencephalic border and also proceeds bidirectionally. Closure III is unidirectional, beginning adjacent to the stomodeum and proceeding caudally to meet closure II. Finally, closure IV takes place over the rhombencephalon where it meets closure II to complete rostral neural tube closure. In these two strains of mice anterior neural tube closure progressed as somite number increased. However, the SWV strain required a longer gestational time to develop equal numbers of somites and therefore to complete closure. In light of the intermittent pattern of closure observed in mice, the development of the rostral nervous system in other mammals, including humans, should be reconsidered.

Prioritizing candidate reproductive/developmental toxicants for evaluation.

To provide a rational method for the timely evaluation of possible reproductive/developmental toxicants, a prioritization scheme was developed by the California Department of Health Services to select chemicals for consideration by the Proposition 65 Scientific Advisory Panel. Initially, four ascertainment methods were used to identify and construct a master list of 164 candidate agents. Using two criteria, the potential for human exposure and the perceived reproductive/developmental hazard as judged by an ad hoc committee of experts, 42 candidates from the master list were identified as priority agents. For practical purposes, the 15 priority agents with the highest rankings will be given the highest priority in the review process. Limitations in the prioritization method used and refinements to be incorporated in an annual update are described.

Hyperthermia-induced exencephaly in mice: effect of multiple exposures.

Pregnant LM/Bc female mice were given a 10-minute hyperthermic exposure in a 43 degrees C waterbath during the period of neural tube closure. On day 15.5 of gestation, the females were killed, and the fetuses were examined for exencephaly. Following a single treatment on day 8.0, 8.5, 8.75, or 9.0 of gestation 1.7, 13.6, 2.9, and 0.8% of the respective fetuses displayed exencephaly. With two treatments, one on each of gestational days 8.5 and 8.75, or three treatments, one on each of gestational days 8.5, 8.75, and 9.0, the percentage of exencephalic fetuses increased to 28.3 and 59.3%, respectively. The increased response to multiple treatments was not due to an increase in the number of susceptible embryos but rather was due to the increased number of treatments. The results of this study suggest that with increasing numbers of treatments, the embryo's ability to recover from the hyperthermic exposure is lessened, resulting in an increase in exencephaly.

Strain differences in phenobarbital-induced teratogenesis in mice.

Anticonvulsant drugs are widely prescribed medications known to complicate more than 11,500 pregnancies each year in the United States. Although there is no clear consensus as to the teratogenicity of all of the clinically available compounds, it appears that most anticonvulsant drugs can induce congenital abnormalities in susceptible individuals. In a study designed to examine the role of the genotype on sensitivity to phenobarbital-induced malformations, three highly inbred mouse strains (SWV, C57BL/6J, and LM/Bc) received the drug via chronic oral administration. Phenobarbital was found to have a significant teratogenic potential in mice, resulting in skeletal, cardiac, renal, neural, and urogenital defects in a dose-related fashion. The LM/Bc strain was most sensitive to phenobarbital, with 46.7% of the fetuses exposed to the highest maternal plasma concentrations having malformations. C57BL/6J fetuses were the most resistant strain, with only 28.6% abnormalities.

Investigation of the teratogenic effects of exercise on pregnancy outcome in mice.

Swiss Webster female mice were arbitrarily assigned to a heavily exercised group (HE), a moderately exercised group (ME), or a sedentary group (S). Exercised groups were subjected to a progressive treadmill training routine, 6 days a week (60 min per day) for a total of 9 wk. Following mating after 6 wk of training, treatment groups continued to exercise at preconceptual intensities. Pregnant mice were sacrificed on the 19th day of pregnancy, and the fetuses were recovered. A positive training effect was demonstrated by a significant increase in succinate dehydrogenase activity in the gastrocnemius muscles of exercising dams. The numbers of implants, resorptions, live fetuses, mean fetal weight, and developmental stage were unaffected by the exercise treatment. A detailed fetal examination revealed no significant skeletal or gross tissue abnormalities in any of the experimental groups.

Variable patterns in anticonvulsant drug-induced malformations in mice: comparisons of phenytoin and phenobarbital.

Anticonvulsant drugs are known to induce a varied pattern of malformation in both humans and in experimental rodent models. Often the clinical overlap between the pattern of defects induced by different anticonvulsant drugs is so striking that many clinicians question the role these compounds play relative to the existing maternal seizure disorder in the etiology of the observed malformations. In three inbred mouse strains exposed to phenytoin or phenobarbital in utero, the pattern of malformation differed markedly. From the types of anomalies observed, it is apparent that phenobarbital induced more malformations, while phenytoin produced a higher frequency of anomalies related to incomplete development. Thus, while there exists a certain degree of similarity between some of the minor features characteristic of each drug-induced syndrome, there are distinct differences in pregnancy outcome in experimental animals exposed to these drugs. Given the fact that phenobarbital induces more malformations that can be traced to exposure during early organogenesis, it may be wise to consider a therapeutic strategy in which phenytoin is utilized only during organogenesis, and is then replaced with phenobarbital for the remainder of the pregnancy.

Crooked calf disease: a histological and histochemical examination of eight affected calves.

Macroscopic, histopathologic, and histochemical investigations were made on a group of eight neonatal Angus X Hereford calves, selected from an ongoing outbreak of crooked calf disease among calving heifers. Arthrogryposis of the forelimbs was seen to varying degrees in all eight animals, and torticollis was present in six calves. Histopathology, using hematoxylin and eosin stain, did not reveal any striking or consistent lesion in the affected animals; the majority of the tissues sampled were normal. Muscle samples were processed for adenosine triphosphatase (ATPase) and NADH-tetrazolium reductase (NADH-tr) histochemistry, and the data suggest that a primary myopathy is not responsible for the congenital anomalies in the affected calves.

Central nervous system anomalies associated with meningomyelocele, hydrocephalus, and the Arnold-Chiari malformation: reappraisal of theories regarding the pathogenesis of posterior neural tube closure defects.

Complete gross and microscopic neuropathological examinations of 25 children who died with meningomyelocele, the Arnold-Chiari malformation, and hydrocephalus revealed a wide range and frequency of associated central nervous system malformations. The most remarkable of these anomalies were hypoplasia or aplasia of cranial nerve nuclei (20%), demonstrable obstruction of cerebrospinal fluid flow within the ventricular system (92%), cerebellar dysplasia (72%), a disorder of migration of cortical neurons (92%), fusion of the thalami (16%), agenesis of the corpus callosum (12%), and complete or partial agenesis of the olfactory tract and bulb (8%). The anomalies associated with posterior neural tube closure defects can no longer be considered secondary, but rather must be considered part of a spectrum of malformations caused by an unidentified primary insult to the central nervous system. The frequency and pattern of brain malformations associated with neural tube defects of some children with meningomyelocele suggest that such malformations may seriously affect intellectual outcome.

Strain differences in heat-induced neural tube defects in mice.

Neural tube defects are common congenital anomalies affecting approximately 0.1% of liveborn infants. It is widely accepted that these disorders are of a multifactorial origin, having both a genetic and an environmental component to their development. In a study designed to elucidate the genetic factors involved in a mouse model of hyperthermia-induced neural tube defects, it is apparent that a hierarchy of susceptibility exists among various inbred mouse strains. Female SWV mice were extremely sensitive to a 10-minute hyperthermic treatment on day 8.5 of gestation, with 44.3% of their offspring having exencephaly. The other strains used in these studies (LM/Bc, SWR/J, C57BL/6J, and DBA/2J) all had less than 14% affected offspring. In experimental situations where the environment is held constant and the only difference between the strains is their genotype, it is assumed that the difference in response to a teratogen is genetically mediated. To test the hypothesis that several genes are involved, reciprocal crosses were made between strains of high, moderate, and low sensitivity. When this was done, the high sensitivity of the SWV strain was lost in the F1 hybrid, implying not only that multiple genes are involved, but that it is the embryo's genotype and not the maternal genotype that is the major factor in determining susceptibility to heat-induced neural tube defects.

Variable patterns of malformation in the mouse fetal hydantoin syndrome.

Controversy over the existence of a fetal hydantoin syndrome continues in medical literature despite numerous recent clinical studies describing additional patients with a characteristic pattern of abnormalities. Resistance to its acceptance as a clinical entity seems to stem from the variability of the component malformations seen in this syndrome. To examine this variability in a controlled experimental situation, we utilized data obtained in previously reported studies of a mouse model of the fetal hydantoin syndrome. In the mouse, prenatally exposed fetuses had congenital anomalies similar to those observed in the human syndrome. In terms of overall frequency of malformation there were no differences among three inbred mouse strains. However, when considering the individual rates of the 11 most common malformations, considerable differences were noted among the strains. These strain differences in the pattern of malformations appear to be related to genotypic differences in susceptibility to specific malformations. These results provide one possible explanation for the variability observed in the human fetal hydantoin syndrome.

Detection of teratogens in the Drosophila embryonic cell culture test: assay of 100 chemicals.

An in vitro assay of teratogenesis has been developed that utilizes Drosophila embryonic cell cultures. The endpoint selected in assessing the teratogenic potential of any substance involves detection of interference with normal muscle and/or neuron differentiation. In the validation phase of this project, 100 chemicals were tested. With drugs for which extensive reliable mammalian data are available, the results in the Drosophila assay equate rather favorably with those observed in animals and humans (i.e., a low percentage of false positives and false negatives has been obtained). In an effort to determine if strain differences exist and also to establish that the system shows a dose response, cultures from three wild-type Drosophila strains (Canton S, Canton S109, and Oregon R) were tested. Dose-response differences were observed when diethylstilbestrol, diphenylhydantoin, imipramine, testosterone, and tolbutamide were added to the cultures. These results suggest that the Drosophila assay, with further testing and refinements, might be capable of identifying agents of high teratogenic potential by their effect on neurons and muscle differentiation. Furthermore, sensitive strains might be used to study mechanisms of abnormal development and gene involvement in teratogenic resistance.

Possible mesodermal origin for axial dysraphic disorders.

We report four patients who provide clinical evidence supporting the hypothesis that axial dysraphic states may result from a primary disturbance in the chordoaxial mesoderm. One infant had complete craniorachischisis, an omphalocele, and ambiguous genitalia. A second infant had anencephaly and an omphalocele. The third had iniencephaly. The fourth had cervical vertebral fusion defects, an occipital menigocele, and a laterality malformation sequence. Alteration in the development of structures derived from the chordoaxial mesoderm could explain all of the structure defects observed in the four patients. This hypothesis accounts for the nature of the defects seen in association with dysraphic disorders and for the genetic relationship observed between neural tube defects and vertebral anomalies.