[Investigation of fetal cells isolated from maternal blood by different methods]. / Issledovanie kletok ploda, vydelennykh iz krovi materi razlichnymi sposobami.

This paper presents the results of investigation of the isolated from maternal blood by 4 different methods according to the optimized protocols. All women had male fetuses. The mononuclear cells with fetal erythroblasts were preisolated by using density-gradient centrifugation of the maternal blood in the Ficoll solution. Fetal cells were detected by FISH for Y-chromosomal sequences. The fetal cells were 2.1% by fluorescence activated cell sorting (FACS); 3.8% by magnetic field sorting, and 2.6% by two-stage density gradient precipitation. The fetal lymphocytes were investigated through air-cultivation of peripheral maternal lymphocytes. Their proportion was 3.9% in the culture samples. The findings lead to the conclusion that the new non-invasive approach is useful for prenatal diagnosis of chromosomal aneuploidies.

Maternal serum free beta-hCG and PAPP-A in fetal sex chromosome defects in the first trimester.

We have studied maternal serum free beta-hCG and PAPP-A, and fetal nuchal translucency (NT) in a series of 46 cases of fetal Turner's syndrome, 13 cases of other sex chromosomal anomalies and compared these with 947 control pregnancies in the first trimester. In cases of Turner's syndrome (45,X) the median fetal NT was significantly higher than in controls (4.76 MoM), the median PAPP-A was significantly lower (0.49 MoM), whilst the free beta-hCG was not significantly different (1.11 MoM). For NT, 93% (43/46) of cases were equal to or greater than the 95th centile of controls, for PAPP-A 35% (16/46) of cases were less than or equal to the 5th centile of controls and for free beta-hCG 15% (7/46) of cases were equal to or greater than the 95th centile of controls. For other sex chromosomal anomalies (47XXX, XXY, XYY) the median NT was increased (2.07 MoM) whilst PAPP-A was not significantly decreased (0.88 MoM) and free beta-hCG was not significantly different (1.07 MoM) from controls. Using a previously derived multivariate risk algorithm for trisomy 21, incorporating NT, PAPP-A, free beta-hCG and maternal age, 96% of the Turner's cases and 62% of the other sex chromosomal anomalies would have been identified.

[Clinical case of the month. A male with 46,XX karyotype]. / Le cas clinique du mois Un homme à caryotype 46,XX.

The XX males represent a rare expression of the Klinefelter syndrome associated with hypergonadotropic hypogonadism. Generally the patients are of small stature with normal secondary sexual male features but with small testes and constant sterility. The plasma concentrations of FSH and LH are very high in accordance with the decrease of the testicular function. From the genetic point of view, the XX males may be divided in 3 groups: 1) in 80% of cases, the XX males bear the SRY gene and exhibit a XY translation during the paternal meiosis with the presence of the SRY gene on one of the X chromosomes as a marker of the male differentiation; 2) in 10% of cases, the males are (SRY-)XX; the abnormal development is then due to other genes than the TDF, which, when mutated, can induce sexual male differentiation. The remaining 10% of cases are due to chromosomal mosaïcism with more XX than XY.

Abnormal maternal serum alpha fetoprotein and pregnancy outcome.

The objective was to assess the occurrence of miscarriages, low birth weight, and karyotype abnormalities found with low and elevated maternal serum alpha-fetoprotein (MSAFP) among women who had genetic amniocentesis performed. A retrospective study of 2,159 women who had MSAFP analysis prior to amniocentesis was conducted. Pregnancy outcomes were obtained from record review and physicians follow-up. Limits of MSAFP used in analysis were <0.5 adjusted multiples of the median (MOM) (lower levels) and >2.0 MOM (upper levels). Autosomal trisomy was found in 1.6% with low, 0.9% normal, and 0.6% with elevated MSAFP values. Sex chromosome abnormalities were present only in patients with normal MSAFP, [45X (n = 6), 47XXY (n = 2), 69XXX]. Of five open neural tube defects, four had elevated MSAFP and one had a normal value. Omphalocele was identified in four patients, two with normal and two with elevated MSAFP. Gastroschisis was found in one low and one elevated MSAFP. Amniotic fluid alpha-fetoprotein (AFAFP) values did not correlate with MSAFP values. Patients with low MSAFP levels had a greater prevalence of abnormal karyotype (19 of 249, prevalence = 0.076) than patients with an elevated MSAFP level (2 or 166, prevalence = 0.012 OR (odds ratio) = 0.20 (P value = 0.024) when unadjusted for maternal age, and OR = 0.09 (P value = 0.001) when adjusted for maternal age. Spontaneous abortion occurred more often in patients with elevated (4 of 166, or 4%) than normal or low (20 of 1948, or 1%) values of MSAFP (odds ratio 4.32, P = 0.020 when adjusted for maternal age). Birth weight below 2,500 g was present less frequently with low or normal MSAFP (136 of 1,760, or 7.7%) than in elevated MSAFP (21 of 144 or 14.6%) (odds ratio 2.04, P = 0.005, unadjusted; and odds ratio = 2.32, P = 0.003, adjusted for maternal age). Female fetuses were present more often with low MSAFP (136 of 249, or 55%) than elevated levels 43% (71 of 164, or 43%; P = 0.024). We conclude that patients undergoing genetic amniocentesis with MSAFP <.5 MOM are less likely to miscarry, deliver a low birth weight newborn, or have a male infant than patients with MSAFP levels >2.0 MOM.

Cataplexy and monoamine oxidase deficiency in Norrie disease.

Norrie disease (ND) is an X-linked recessive disorder causing ocular atrophy, mental retardation, deafness, and dysmorphic features. Virtually absent monoamine oxidase (MAO) type-A and -B activity has been found in some boys with chromosome deletions. We report the coexistence of cataplexy and abnormal REM sleep organization with ND. Three related boys, referred for treatment of medically refractory atonic spells and apneas, underwent extended EEG-video-polysomnographic monitoring. They demonstrated attacks of cataplexy and inappropriate periods of REM sleep during which they were unarousable. One boy also had generalized tonic-clonic seizures. Previous testing revealed that all three have complete ND gene deletions. In all subjects, platelet MAO-B activity was absent, serum serotonin levels were markedly increased, and plasma catecholamine levels were normal. Data from the canine narcolepsy syndrome model implicate abnormal catecholaminergic and cholinergic activities in the pathogenesis of cataplexy. Our findings suggest that abnormal MAO activity or an imbalance between serotonin and other neurotransmitter levels may be involved in the pathogenesis of human cataplexy.

[Hypergonadotropic secondary amenorrhea: clinical analysis of 126 cases].

OBJECTIVE: To study the etiology and early diagnosis of hypergonadotropic amenorrhea and to explore the appropriate treatment for preserving their reproductive function. METHODS: 126 cases of secondary amenorrhea with serum follicular stimulating hormone (FSH) levels > or = 40 IU/I, were analysed. Their clinical manifestations, karyotypes, ovarian morphology and histology, reproductive hormone assays, and responses to estrogen therapy and ovulation induction were studied. RESULTS: 6 cases presented with histories of ovarian surgery, radiotherapy or chemotherapy. Among the other 120 cases, 18 manifested amenorrhea before or at 25 years of age, 102 developed amenorrhea after age 25. In the former group, 16 (88.9%) showed unilateral or bilateral gonadal dysgenesis, and the other 2(11.1%) were defined as resistant ovaries. Abnormalities of sex chromosome karyotype occurred in 44.4% (8/ 18). In the latter group, 68 underwent laparotomy or laparoscopy examination. Morphological and histological examinations of both ovaries showed atrophic ovaries in all cases accompanied by 30.9% (21/ 68) unilateral gonadal dysgenesis; sex chromosomal abnormality was found in only one with no sexual immaturation. The efficacy of estrogen treatment was significantly better among cases with amenorrhea less than 1 year as compared with those longer than 1 year. Clomiphene challenge test given to 8 cases during their irregular menstrual stages produced an elevation of FSH levels to > 20 IU/I. without any response of estradiol secretion. CONCLUSIONS: The earlier estrogen therapy is initiated, the greater possibility of pregnancy will be achieved in cases suffering from hypergonadotropic amenorrhea. The clomiphene challenge test may provide evidence of waning ovarian function for early diagnosis.

Two sisters with clinical diagnosis of Wiskott-Aldrich syndrome: is the condition in the family autosomal recessive?

We report two sisters in a family representing manifestations of Wiskott-Aldrich syndrome (WAS), an X-linked immunodeficiency disorder. An elder sister had suffered from recurrent infections, small thrombocytopenic petechiae, purpura, and eczema for 7 years. The younger sister had the same manifestations as the elder sister's for a 2-year period, and died of intracranial bleeding at age 2 years. All the laboratory data of the two patients were compatible with WAS, although they were females. Sialophorin analysis with the selective radioactive labeling method of this protein revealed that in the elder sister a 115-KD band that should be specific for sialophorin was reduced in quantity, and instead an additional 135-KD fragment was present as a main band. Polymerase chain reaction (PCR) analysis of the sialophorin gene and single-strand conformation polymorphism (SSCP) analysis of the PCR product demonstrated that there were no detectable size-change nor electrophoretic mobility change in the DNA from both patients. The results indicated that their sialophorin gene structure might be normal. Studies on the mother-daughter transmission of X chromosome using a pERT84-MaeIII polymorphic marker mapped at Xp21 and HPRT gene polymorphism at Xq26 suggested that each sister had inherited a different X chromosome from the mother. Two explanations are plausible for the occurrence of the WAS in our patients: the WAS in the patients is attributable to an autosomal gene mutation which may regulate the sialophorin gene expression through the WAS gene, or, alternatively, the condition in this family is an autosomal recessive disorder separated etiologically from the X-linked WAS.

Elevated human chorionic gonadotropin levels in pregnancies with sex chromosome abnormalities.

Numerous reports have dealt with the usefulness of the maternal serum alpha-fetoprotein marker (MsAFP) and human chorionic gonadotropin (MshCG) levels in the detection of Down syndrome (DS) and other autosomal trisomies. Only few reports have discussed the possible association of elevated levels of MshCG and sex chromosome aneuploidy. We wish to report on 3 cases in which this association was found.

Y-autosome translocation associated with azoospermia.

Y-autosome translocation is a rare condition. We report here a case of balanced Y-autosome translocation associated with azoospermia. Nineteen cases of a balanced Y-autosome translocation associated with azoospermia are reviewed, and hormone condition and testicular histology are discussed.

Chromosomal damage in lymphocytes of controls and patients with autosomal and sex-chromosomal disorders.

The frequency of chromosomal aberrations was studied in lymphocytes from karyotypically abnormal patients and normal donors. There was no difference between normal females and Down's syndrome female patients. Male Down's syndrome patients showed a significant increase in aberrations of normal diploid male lymphocytes and a significant difference was observed in male and female Down's syndrome patients. Sex-chromosomally abnormal patients, both X and Y chromosome deficient, showed elevated chromosomal aberrations compared with age and sex-matched normal diploid cells.

Y-derived sequence detected in minute chromosomes by polymerase chain reaction and in situ hybridization.

A 10-year-old girl and a 10-month-old girl, both with ambiguous genitalia, were found to have 45,X/46,X,mar and 45,X/46,X,r(?) mosaicism. The marker chromosomes in both girls were very small. Polymerase chain reaction, with synthetic oligonucleotide primers from Y-specific DNA sequences pY-80 and pY53.3 containing the sex-determining region Y(SRY), proved the marker chromosomes to contain the Y short arm material. In situ hybridization with probe pY-80 confirmed that the marker chromosomes included the Y short arms. These findings, together with ambiguous genitalia in the girls, indicate that the marker chromosomes include the testis-determining factor gene.

48, XXYY syndrome associated with ethylenediaminetetraacetic acid (EDTA)-dependent pseudothrombocytopenia.

A 56-yr-old man with hypogonadism, gynecomastia, and mental retardation was evaluated for chromosome constitution and thrombocytopenia. Chromosomal analysis demonstrated the mosaicism of 48, XXYY and 47, XXY in the peripheral lymphocytes. Twenty out of twenty-five cells were 48, XXYY karyotype and the remaining five were 47, XXY karyotype. Thrombocytopenia was the EDTA-dependent pseudothrombocytopenia type 1 (platelet agglutination). Serological examination suggests that the platelet agglutinin belongs to IgM-kappa type. The present case exhibited both EDTA-dependent pseudothrombocytopenia and the 48, XXYY syndrome. Although this combination may have occurred purely by change, the possibility of whether or not the mosaicism of lymphocytes produces platelet agglutinin remains to be clarified.

Long-range restriction map of the terminal part of the short arm of the human X chromosome.

The terminal part of the short arm of the human X chromosome has been mapped by pulsed-field gel electrophoresis (PFGE). The map, representing the distal two-thirds of Xp22.3 spans a total of 10,000 kilobases (kb) from Xpter to the DXS143 locus. A comparison with linkage data indicates that 1 centimorgan (cM) in this region corresponds to about 600 kb. CpG islands were essentially concentrated in the 1500 kb immediately proximal to the pseudoautosomal boundary. Several loci, including the gene encoding steroid sulfatase (STS) and the loci for the X-linked recessive form of chondrodysplasia punctata (CDPX) and for Kallmann syndrome (KAL) have been placed relative to the Xp telomere. CDPX is located between 2650 and 5550 kb from Xpter, and STS is located between 7250 and 7830 kb from Xpter. KAL maps to an interval of 350 kb between 8600 and 8950 kb from the telomere. The X-chromosomal breakpoints of a high proportion of XX males resulting from X-Y interchange cluster to a 920-kb region proximal and close to the pseudoautosomal boundary.

CA 125 levels in patients with hypoestrogenic ovarian failure.

The source of CA 125 in the sera of women is not known. Serum CA 125 concentrations were measured in 36 women with hypoestrogenic ovarian failure of whom 30 had hyper-(group A), 6 had hypo- or normogonado-tropic amenorrhea (group B). Group A consisted of 16 women with streak gonad syndrome, 6 with rudimentary ovary syndrome, 5 with premature menopause syndrome and 3 with gonadoblastoma. Serum CA 125 levels were normal in 34 patients irrespective of the presence of associated sex chromosome anomalies, and their mean values did not differ significantly from those of the 9 age-matched controls. We also measured normal CA 125 values in 2 females with müllerian agenesis. These data indicate that the derivatives of müllerian ducts do not contribute significantly to the presence of CA 125 in the sera of nonmenstruating adult women, and that the abnormalities of the X chromosome do not seem to influence CA 125 levels.

Diagnosis of recessive X-linked ichthyosis: quantitative HPLC/mass spectrometric analysis of plasma for cholesterol sulfate.

A specific, accurate liquid-chromatographic/mass-spectrometric (HPLC/MS) method for measurement of cholesterol sulfate in plasma from normal individuals and patients with recessive X-linked ichthyosis (RXLI) is described. The method is superior to previously described techniques because it measures the analyte intact rather than after hydrolysis. Traces of free cholesterol in the sample analyzed do not add to the measured result. We used either [13C2]cholesterol sulfate or [2H6]cholesterol sulfate as internal standards, which we add to plasma before extraction. Use of such standards makes quantitative extraction unimportant. We use a single solid-phase extraction (SPE) C18 cartridge for plasma extraction. After the cartridge is washed with methanol/ammonium acetate solutions, the fraction containing the steroid sulfates is eluted with methanol, evaporated, and subjected to HPLC/MS analysis, wherein the molecular anions of analyte and internal standards are monitored. The peak ratio gives the cholesterol sulfate concentration directly. Using this method, we have diagnosed 24 patients with RXLI. Their concentration of cholesterol sulfate ranged between 41.7 and 185.3 mumol/L (mean 93.85, SD 31.2 mumol/L). In normal individuals (n = 9) the mean cholesterol sulfate concentration was 2.77 mumol/L (SD 0.62, range 2.05-3.95 mumol/L). The instrumentation required is complex, but the assay is simple: sample preparation takes about 30 min; mass spectrometry, 10 min. About 0.1 mL of plasma is required for cholesterol sulfate measurement in RXLI patients and 0.5-1 mL in normal individuals.

Low serum alpha-fetoprotein level and sex chromosome monosomy.

A case of 45,X karyotype in association with low maternal serum alpha-fetoprotein levels is reported. Previous cases of trisomy have been linked to low alpha-fetoprotein levels. Cases of sex chromosome aneuploidy may be included in the group of aneuploidies with low levels of maternal serum alpha-fetoprotein.

Origin of sex chromosome aneuploidy.

Probabilities applicable to RFLPs are derived for the genotypes of XXY, XXX, and XO children, conditional on their mode of origin and the parental mating type, and the theory is applied to family data on the XG locus. The proportion of XXY males arising in spermatogenesis is shown to be 0.41 +/- 0.09. The large distance of XG from the centromere makes distinction between maternal meiosis I and II unreliable, but if man is like Drosophila, most of the maternal non-disjunctions arise in meiosis I, among tetrads that have undergone one or more exchanges. Data from XG show that 0.78 +/- 0.05 of XO females arise from an error involving the paternal sex chromosomes. The XG locus is virtually uninformative about the origin of XXX. Application of the theory to selected RFLPs will be much more incisive because of their large number, lack of dominance, greater heterozygosity, and distribution along the chromosome. Study of RFLPs will facilitate diagnosis of the parental origin of sex chromosome abnormalities and the comparison of recombination rates in regular and trisomic progeny of maternal mei I and mei II origin. A pseudocentromeric model that estimates map distances from exceptional progeny is applied to non-disjunction of the X chromosomes in D. melanogaster, giving good recovery of the expected map and thereby validating this approach for RFLPs in man.

Fetal blood sampling in investigation of chromosome mosaicism in amniotic fluid cell culture.

41 pregnancies in which mosaicism had been found on amniotic fluid culture (AFC) were investigated by fetal blood and repeat AFC karyotyping. Results of both investigations, and the infants, were normal in 15 of 16 cases of autosomal trisomy (including trisomies 8, 9, 13, 18, and 21) and in the 8 cases of sex chromosome mosaicism. In 1 case of trisomy 20 mosaicism the fetal blood karyotype and the infant were normal but the repeat AFC showed mosaicism. Abnormality was confirmed in 5 of 11 cases of mosaicism for structural chromosomal rearrangements and in 4 of 6 cases with de-novo supernumerary marker mosaicism. These findings indicate the potential danger of terminating pregnancies because of trisomic mosaicism in AFC, and the importance of identifying the clinical significance of certain chromosome rearrangements which, even in mosaic form, might lead to severe mental and developmental handicap.

Sex chromosome anomalies, hormones, and sexuality.

Behavioral investigation of men with sex chromosome anomalies has been primarily limited to the study of institutionalized individuals or patient groups. A double-blind controlled investigation of XYY and XXY men found in a birth cohort of 4591 tall men born in Copenhagen gathered sexual information and assessed the role of hormonal determinants on sexual behavior. There were significant differences in several sexual dimensions and in gender role between XYY men and their controls and XXY men and their controls as well as between XYY and XXY men. Although both proband groups differed from each other and from their controls in pituitary gonadal function, there was no evidence that adult hormonal levels mediate the effect of sex chromosome anomalies on male sexuality.