Congenital Defects and Teratology Flashcards
CONGENITAL DEFECTS AND TERATOLOGY
CONGENTIAL DEFECTS:
1. CONGENTITAL DEFECTS (BIRTH DEFECTS)- ALL STRUCTURAL AND
FUNCTIONAL ABNORMALITIES PRESENT BEFORE OR AT BIRTH
2. MAY BE APPARENT AT BIRTH, E.G. MEROMELIA
3. MAY NOT SHOW UP RIGHT AWAY, E.G. SOME OF THE HEART DEFECTS
4. DEFECTS VARY IN SEVERITY FROM MINOR TO INCOMPATIBLE W/ LIFE
5. IN GENERAL, THE EARLIER A PROBLEM OCCURS PRENATALLY, THE
MORE SERIOUS IT IS.
6. >20% OF INFANT DEATHS IN USA ARE CAUSED BY CONGENITAL DEFECTS
TERATOLOGY= STUDY OF ABNORMAL DEVELOPMENT/ CONGENITAL DEFECTS
1. CONCERNED WITH VARIOUS GENETIC AND ENVIRONMENTAL FACTORS THAT DISTURB NORMAL DEVELOPMENT
2. HELPS UNDERSTAND NORMAL AND ABNORMAL DEVELOPMENT
3. MAY ALLOW BETTER CONTROL OVER NORMAL DEVELOPMENT
4. MAY HELP PREVENT ABNORMAL DEVELOPMENT
HISTORY OF FIELD
POLYMASTIA - MANY MAMMARY GLANDS
1. KNOWN SINCE ANCIENT TIMES/ EGYPTIANS, PERUVIANS, EARLY ART
2. ORIGINALLY ASSOCIATED WITH DEVINE WILL, DEMONS, EVIL EYE;
MOTHER OFTEN BLAMED
3. ONLY RECENTLY REALIZED THESE ARE NOT CAUSES
4. NOW TOPIC OF CONSIDERABLE SCIENTIFIC STUDY
Polymastia=many mammary glands
crytorchism=testes remain in abdominal cavity
polydactale=too many fingers
osteogenesis imperfecta (fragile bones)
cystic fibrosis-respritory/intestine problem..sticky mucus
INCIDENCE OF DEFECTS IN HUMAN ORGANS
SLIDE: INCIDENCE OF DEFECTS IN HUMAN ORGANS AT BIRTH
- ORGANS SHOW DIFFERENT FREQUENCY OF CM
- BRAIN AND HEART HAVE A HIGH INCIDENCE
- EAR ALTHOUGH COMPLEX IN ORIGIN HAS LOW INCIDENCE
- SOME DEFECTS ARE NOT VISIBLE AT BIRTH BUT SHOW UP LATER
- SOME NEVER DIAGNOSED
PREVELANCE
1. 3-5% SHOW 1 OR MORE AT BIRTH
2. BY END OF 1 YEAR THIS = 5-10%
3. THE FREQUENCY OF A PARTICULAR DEFECT VARIES GEOGRAPHICALLY
A. ANECEPHALY IN 0.4% OF BIRTHS IN NORTHERN IRELAND BUT
ONLY 0.05% 9N WEST AFRICA
4. GIVEN COMPLEXITY OF DEVELOPMENT, AMAZING ANYONE IS NORMAL
FACTORS EFFECTING OCCURRENCE OF CONGENTIAL DEFECTS
- GENETIC
A. CHROMOSOMAL ABNORMALITIES - MAY BE NUMERICAL OR STRUCTURL
B. MUTANT GENES
C. ONLY RECOGNIZED RECENTLY (1940S) - ENVIRONMENTAL FACTORS
A. RUBELLA FIRST ENV FACTOR RECOGNIZED
B. INTRAUTERINE INJURY CAUSED BY DRUGS, RADIATION, INFECTION - MULTIFACTORIAL
A. COMBINATION OF GENETIC AND ENVIRONMENTAL FACTORS
CHROMOSOMAL ABNORMALITIES CAN BE EITHER NUMERICAL OR STRUCTURAL
TRIPLOIDY = EXAMPLE OF POLYPLOIDY = NUMERICAL PROBLEM
CHROMOSOMAL ABORMALITIES/ KARYOTYPE - USED TO STUDY
1. MAY BE NUMERICAL OR STRUCTURAL
2. NORMAL COMPLEMENT= 46 XX OR 46 XY
NUMERICAL/MOST IMPORTANT
1. POLYPLOIDY
A. CELLS HAVE MULTIPLES OF THE HAPLOID # OF CHROMOSOMES
B. TRIPLOIDY= TRIOS OF EACH CHROMOS.= 69XXX
1. MOST COMMON TYPE OF POLYPLOIDY IN HUMANS
2. DISPERMY COULD CAUSE IT OR FAILURE OF EGG TO CAST OFF 2ND PB
3. MAY DEVELOP OK 1ST 1/2 OF TERM THEN SICKEN AND DIE
4. A FEW HAVE BEEN BORN (PROB MOSAICS) BUT DIES SOON AFTER BIRTH
2. HAPLOIDY
A. 1/2 NORMAL # CHROMOSOMES
B. CAUSED BY PARTHENOGENESIS OR GYNOGENESIS (SPERM
ACTIVATES EGG BUT PLAYS NO FURTHER ROLE).
C. DO NOT DEVELOP BEYOND MID TERM
3. ANEUPLOIDY: A DEVIATION FROM THE DIPLOID # ( E.G.45=HYPODIPLOID)
A. MONOSOMY= ONE CHROMOSOME MISSING
1. MONOSOMY OF AUTOSOME CAUSES DEATH
2. MONOSOMY OF SEX CHROMOSOME- MANY DIE BUT SOME SURVIVE=
TURNERS (XO) SYNDROME.
A. USUALLY CAUSED BY NONDISJUNCTION IN THE MALE.
B. CHARACTERISTICS= WEBBED NECK, SWOLLEN HANDS,SHORT
STATURE, ABSENCE OF OVARIES, MENTAL RETARDATION
ANEUPLOIDY – another type of numerical defect – one too many or one too few chromosomes
Embryotoxic vs teratogenic
embryotoxic-kills embryo
teratogenic-congenital defect, not death
STRUCTURAL CHROMOSOMAL ABNORMALITIES
TRANSLOCATIONS
DELETIONS
DUPLICATIONS
INVERSION
ISOCHROMOSOME
STRUCTURAL ABNORMALITIES/STUDY INFO IN MOORE
1. INCLUDES TRANSLOCATIONS, DELETIONS, DUPLICATION, INVERSION, OR
ISOCHROMOSOME (CENTROMERE DIVIDES TRANSVERSELY NOT
LONGITUDINALLY)
NEXT SLIDE SHOWS AN EXAMPLE OF A DELETION
CRI DU CHAT – example of a deletion
CRI DU CHAT SYNDROME
1. CAUSED BY A PARTIAL TERMINAL DELETION FROM THE SHORT
ARM END OF CHROMOSOME #5.
2. ALL AFFLICTED INDIVIDUALS HAVE SEVERE MENTAL RETARDATION
3. MAY ALSO HAVE CONGENITAL HEART DISEASE AND A WEAK CAT
LIKE CRY
Rare about 1:50,000
ANGELMAN SYNDROME AND PRADER-WILLI SYNDROME
MICRODELETION ON CHROMOSOME #15
ANGELMAN
DEFECTIVE ALLELE ON #15 IS FROM MOTHER
MENTALLY RETARDED, CAN NOT SPEAK, POOR MOTOR DEVELOPMENT, INAPPROPRIATE LAUGHTER
PRADER-WILLI
DEFECTIVE ALLELE ON #15 IS FROM FATHER
OBESITY, MENTALLY RETARDED, HYPOGONADISM, CRYTORCHISIM
TWO INTERESTING DISTINCT MENTAL RETARDATION SYNDROMES
BOTH CAUSED BY THE SAME THING - MICRODELETION ON CHR #15
PHENOTYPES ARE VERY DIFFERENT - SEE PICTURES IN TEXT
ANGELMANS - DEFECTIVE #15 COMES FROM MOTHER
PRADER-WILLI - DEFECTIVE #15 COMES FROM FATHER
THE CRITICAL REGIONS FOR BOTH AS AND PWS ARE WITHIN THE 15Q REGION OF CHROMOSOME #15.
BUT THE CRITICAL REGIONS ARE SEPARATE WITHIN Q15
DEFECTIVE GENE IS AN IMPRINTED ONE - SO PHENOTYPE VARIES WITH SOURCE OF DEFECTIVE GENE (REVIEW IMPRINTING FROM EARLIER LECTURE)
NOTE: BOTH MALES AND FEMALES CAN INHERIT BOTH SYNDROMES
ANGELMAN’S: MENTAL RETARDATION, ABSENT SPEECH, SEIZURES, INAPPROPRIATE LAUGHTER, PECULIAR GAIT
PRADER-WILLI: MENTAL RETARDATION, HYPOGONADISM, HYPOTONIA, OBESITY
SYNDROMES CAN BE DETECTED BY FISH
MUTANT GENES CAN CAUSE ANOMALIES
SINGLE GENE DEFECTS
MUTANT GENES
1. SOME DEFECTS (ABOUT 8%) ARE CAUSED BY MUTANT GENES
2. USUALLY INVOLVES LOSS OR CHANGE IN FUNCTION OF A GENE
3. MOST MUTATIONS ARE HARMFUL
4. ARE INHERITED IN MENDELIAN MANNER
5. SOME EXAMPLES FOLLOW
AUTOSOMAL DOMINANT INHERITANCE
1. CAUSES DEFECT WHETHER HETEROZYGOUS OR HOMOZYGOUS
2. POLYDACTYLY, LOBSTER CLAW
3. ACHONDROPLASIA: MOST COMMON SKELETL DEFECT (1/15,000) - NORMAL IQ
A. 80-90% ARE NEW MUTATIONS - OCCURS IN ALLETHNIC GROUPS - HAS COMPLETE PENETRANCE
B. MAY BE ASSOCIATED WITH ADVANCED PATERNAL AGE
C. CAUSED BY A MUTATION IN FGF RECEPTOR3 - CAUSES DEFECT IN MATURATION OF CHONDROCYTES IN CARTILAGE GROWTH PLATE
4. OSTEOGENESIS IMPERFECTA: FRAGILE BONES WHICH FRACTURE PRENATALLY
AUTOSOMAL RECESSIVE
- RECESSIVE GENE EXPRESSES ITSELF ONLY WHEN HOMOZYGOUS INHERITED FROM BOTH PARENTS
- RARE /MANY CARRIERS REMAIN UNDETECTED
- E.G. MICROCEPHALY, CONGENITAL ADRENAL HYPERPLASIA
SEX LINKED INHERITANCE
- ABNORMAL GENES CARRIED ON X CHROMOSOME
- SEX LINKED DOMINATE NOT SHOWN FOR HUMAN
- RECESSIVE WOULD BE SHOWN IN XY BUT NOT XX/ ABOUT 300 FOR HUMANS
- TRANSMITTED FROM MOTHER TO SONS/ IN 1/2 SONS
- E.G., SLIDES: HYDROCEPHALUS (XS CSF), HEMOPHILIA
MUTANT GENES:
AUTOSOMAL RECESSIVE INHERITANCE
RECESSIVE MUTATION
AUTOSOMAL RECESSIVE
1. RECESSIVE GENE EXPRESSES ITSELF ONLY WHEN HOMOZYGOUS- INHERITED FROM BOTH PARENTS
2. RARE /MANY CARRIERS REMAIN UNDETECTED
3. CYSTIC FIBROUS IS CAUSED BY A RECESSIVE MUTATION
A. ABOUT 1 IN 23 PEOPLE IN US CARRY AT LAST ONE DEFECTIVE GENE
B. MOST COMMON GENETIC DEFECT OF ITS SEVERITY IN US
C. PEOPLE W/ CF HAVE CRONIC LUNG INECTIONS AND DIGESTIVE DISORDERS
D. LIFE EXPECTANCY NOW ABOUT 30 YEARS (USED TO BE 8 YEARS)
E. CAUSED BY DEFECT IN GENE PRODUCIN G PROTEIN CALLED CFTR
1. CONTROLS FLOW OF CHLORIDE ACROSS CELL MEMBRANE
3. OTHER DEFECTS THAT MAY BE INHERITED AS RECESSIVE MUTATIONS ARE. MICROCEPHALY, CONGENITAL ADRENAL HYPERPLASIA
MUTANT GENES: SEX-LINKED INHERITANCE
SEX LINKED INHERITANCE
- ABNORMAL GENES CARRIED ON X CHROMOSOME
- SEX LINKED DOMINATE NOT SHOWN FOR HUMAN
- RECESSIVE WOULD BE SHOWN IN XY BUT NOT XX/ ABOUT 300 FOR HUMANS
- TRANSMITTED FROM MOTHER TO SONS/ IN 1/2 SONS
- E.G., SLIDES: HYDROCEPHALUS (XS CSF), HEMOPHILIA
FRAGILE X SYNDROME
A. MOST FREQUENTLY INHERITED CAUSE OF MENTAL RETARDATION AFTER DOWNS SYNDROME
1. CAUSES 10% OF ALL CASES OF MENTAL RETARDATION
2. USUALLY FOUND IN MALES, BUT ALSO OCCURS IN FEMALES
B. JAW PROMINENT, EARS LARGE, FACE LONG AND NARROW BUT NOTICE HOW NORMAL THEY LOOK
C. A GENE (FMR-1 - FRAGILE X MENTAL RETARDATION GENE) ON LONG ARM OF X CHROMOSOME CAUSES AN UNSTABILE FRAGILE SITE IN CHROMOSOME
A. IF IN FMR1 GENE THERE ARE CGG REPEATS - IF FEWER THAN 40 REPEATS - NO PROBLEM
B. IF 55-200 REPEATS INDIVIDUAL HAS PREMUTATION STATE
C. MALES WITH MORE THAN 200 REPEAT HAVE SYNDROME
D. FEMALES WITH > 200 REPEATS HAVE ABOUT 50% OF HAVING LOW OR BORDERLINE IQ
1. FEMALES WITH >200 REPEATS W/ NORMAL IQ MAY HAVE LEARNING PROBLEMS
E. WHEN MORE THAN 200 REPEATS,GENE BECOMES METHYLATED - TURNED OFF
F. NO FMR1 PROTEIN IS MADE - CAUSES COGNITIVE FEATURES AND CONNECTIVE TISSUE PROBLEMS OF FRAGILE X
SIBS AT TOP. SISTER HAS MILD LEARNING DISABLITY - BOTH X CHROMOSOMES AFFECTED
C-KIT MUTATIONS/heterozygous mutation
MUTATIONS MAY AFFECT PHENOTYPE MILDLY WHEN HETEROZYGOUS
KIT MUTATION ON ONE ALLELE
HETEROZYGOUS FOR KIT
KIT IS NEED FOR CELL MIGRATIONS - E G., PGC, BLOOD CELLS, MELANOCYTES AND NCC
BOTH MOUSE AND BABY ARE HETEROZYGOUS - MAKE 1/2 NORMAL AMOUNT OF KIT GENE PRODUCT - NOT ENOUGH KIT GENE PRODUCT IS MADE FOR NORMAL MIGRATION OF ALL PIGMENT CELLS
NOTE THEIR PIGMENTATION IS AFFECTED
DEFECT IN KIT LIGAND (BINDS TO KIT) ON SURFACE OF CELLS ON MIGRATORY PATHWAY CAUSES SAME EFFECT
C-Kit heterozygous–>different color pattern
ENVIRONMENTAL FACTORS
INTRAUTERINE ENVIRONMENT
MECHANICAL DAMAGE
TERATOGENS
- INTRAUTERINE ENVIRONMENT
A. STRESS ON MOTHER MAY LEAD TO FETAL DEATH OR DEFECTS
B. STRESSES= UNDERNUTRITION, OVERFEEDING, VITAMIN DEFICIENCY, HOT CLIMATES
C. EMOTIONAL STRESS - NO NERVES IN PLACENTA
- CHEMICALS IN A STRESSED MOTHER MAY BE TRANSMITTED TO FETUS
- MECHANICAL DAMAGE
A. FETUS WELL PROTECTED BY UTERINE WALLS AND AMNIOTIC FLUID
B. SEVERE BLOWS OR FALLS MAY LEAD TO ABORTION/ USUSALLY
CAUSED BY HEMMORRAGE OF PLACENTA
C. AMNIOTIC BAND SYNDROME, OLLIGOHYDRAMNIOS - TERATOGENIC AGENT
A. ANY AGENT THAT CAN INDUCE OR INCREASE THE INCIDENCE OF
CONGENITAL DEFECTS - CAUSE 7% OF CONGENITAL MALFORMATIONS
- A TERATOGEN WILL PRODUCE A SPECIFIC EFFECT FOR A GIVEN
SPECIES WHEN APPLIED AT A SPECIFIC TIME AND DOSE
What is a teratogen?
Any agent that can produce a congenital anomaly or increase the incidence of an anomaly in the population.
Infectious agents
Drugs
Chemicals
Physical Agents