Cytogenetics and Learning Disorders Flashcards
What percentage of people with learning disorders have a cytogenetic abnormality?
About 16%
What % of unselected newborns have a cytogenetic abnormality?
About 1%
What is better tolerate by humans? Loss or gain of autosomal material?
Gain of chromosomal material is better tolerated by humans.
Which 3 autosomal trisomy syndromes are viable to term in non-mosaic form?
1) . Trisomy 21 - Down syndrome
2) . Trisomy 13 - Patau syndrome
3) . Trisomy 18 - Edwards syndrome
What trisomies (other than trisomy 21, 13 and 18) may be viable in mosaic form?
Mosaic trisomy 8 and 9.
Are any autosome monosomies viable at term?
No autosome monosomy is viable at term and very few are detected even in pregnancy loss.
What is the most common trisomy seen in early spontaneous miscarriage?
Trisomy 16.
Describe the genetic mechanisms that lead to the conception of a child with Down syndrome.
Down syndrome is the most common genetic cause of mental retardation. 94% of Down syndrome individuals are trisomy 21 (47,XX or XY,+21). The majority of these cases arise through non-disjunction at maternal meiotic 1st division.
About 4% of Down syndrome cases arise due to an unbalanced ‘robertsonian translocation’. This may be inherited from a balanced robertsonian carrier parent or may even arise de novo.
About 2% of cases of Down syndrome are mosaic. There arise due to post-zygotic mitotic non-disjunction events.
In very simple terms what happens when non-disjunction occurs?
The chromosome pairs do not segregate into the daughter cells evenly and so you can end up with disomic and nullisomic daughter cells. The disomic daughter cells that form disomic gametes will lead to trisomy when the zygote forms.
How can a non-disjunction event at mitosis result in a trisomy or a monosomy?
In mitosis the chromosomes are duplicated. 2 chromosome pairs will be duplicated to 4 pairs etc. If non-disjunction takes place at mitosis then it is possible for a daughter cell with 3 chromosome pairs to form.
How does mosaicism usually arise in Down syndrome?
Mosaicism usually arises as a result of mitotic, post-zygotic, non-disjunction events.
This could also be a corrective event - also referred to as ‘trisomy rescue’ resulting in a cell line with a normal chromosome complement. Rescue events can lead to a normal embryo with a trisomic placenta and vice versa.
List the physical features of Down Syndrome.
- Flat facial profile - flattened nose
- Eyes (palpebral fissures) slant upwards with epicanthic folds
- Small ears
- Flat back of head (brachycephaly)
- Protruding tongue
- Bilateral single palmar crease
- Shorter than average with poor muscle tone
- Mild to moderate mental retardation
- Frequent autistic spectrum disorder
- Cardiac defects
- Increased risk of leukaemia particularly in childhood (may be transient leukaemia).
What usually causes Patau syndrome?
Trisomy 13 - 47,XX or XY,+13. The vast majority of these present as a non-disjunctional primary trisomy.
It can also present due to an unbalanced robertsonian translocation.
Vast majority arise de novo.
What are the general features of Patau syndrome?
- Severe mental retardation
- Microcephaly
- Polydactyly
- Holoprosencephaly - cleft palate, nose and eye anomalies
- Reduced life expectancy - 80% die within 1st year
What is the genetic cause of Edward syndrome?
95% are due to primary trisomy - 47,XX or XY, +18. Some also present as trisomy for 18q, sometimes in the form of an isochromosome.
What are the most common features seen in Edwards syndrome?
- Microcephaly
- Prominent occiput
- Micrognathia
- Hypertelorism
- Clenched hands
- Rocker bottom feet
- Heart defects
- Omphalocele (defects of the abdominal wall)
- Severely reduced life expectancy
- Very severe mental retardation
What are the most common features seen in mosaic trisomy 8?
- Mild to moderate mental retardation
- Deep plantar furrows - palms and soles of feet
What are the most common features seen in mosaic trisomy 9?
- Mental retardation
- Congenital heart disease
- Downturned corners of the mouth
How can you get trisomy for part of a chromosome?
You can get trisomy for part of a chromosome. A duplicated segment of chromosome may be either direct or inverted (mirror image). Duplicated material may also be inserted into another chromosome.
What is an ESAC or marker chromosome?
- Extra Small Additional Chromosomes
- Additional (supernumary) chromosomes are often termed marker chromosomes since the chromosome origin is unknown.
- Most marker chromosomes are small and will often be mosaic. Often rings or small structurally unstable forms.
- The clinical significance will be dependent on their genetic composition.
- C-banding, DA-DAPI and silver staining were traditionally used, as well as parental studies to determine their clinical significance.
- C-banding shows whether marker carries heterochromatin or euchromatin and thus whether it is likely to carry euchromatin or not.
- DA-DAPI and silver staining were used to establish whether the material was derived from an acrocentric chromosome. If silver staining material is present in a marker then that material represents the acrocentric short arms and they are known to be non-coding.
What does C-banding of marker chromosomes show?
C-banding shows whether marker carries heterochromatin or euchromatin and thus whether it is likely to carry euchromatin or not.
What was DA-DAPI and silver staining used for?
- DA-DAPI and silver staining were used to establish whether the material was derived from an acrocentric chromosome. If silver staining material is present in a marker then that material represents the acrocentric short arms and they are known to be non-coding.
What is Pallister Killian syndrome? In what cells may Pallister Killian syndrome be detected?
Pallister Killian syndrome is associated with mosaicism for an additional isochromosome consisting of 2 copies of 12p (resulting in tetrasomy for 12p in the cells that carry the isochromosome).
It is often expressed in a tissue specific way and is rarely seen in metaphase preparations from blood.
May be detected in metaphase from skin cells or other tissues and is often detectable by FISH in interphase cells in the blood.
In what cells may Pallister Killian syndrome be detected?
The 12p isochromosome is often expressed in a tissue specific way and is rarely seen in metaphase preparations from blood.
May be detected in metaphase from skin cells or other tissues and is often detectable by FISH in interphase cells in the blood.
What are the most common features associated with Pallister Killian syndrome?
- Mental retardation
- Epilepsy
- Hypotinia
- Hypo- and Hyperpigmented patches of skin
- Distinctive (coarse) facial features including high forehead, sparse hair, hypertelorism, epicanthal folds and a flat nose.
What causes Cat-Eye syndrome?
Cat-Eye syndrome is associated with mosaicism for an additional small isochromosome consisting of 2 copies of the proximal part of 22q.
Describe the main features that are associated with Cat-Eye syndrome.
- Often tissue specific.
- Verticle colobomas in the eye (hence cat eye).
- Mild to moderat mental retardation.
What mosaic ESACs are associated with syndromes other than isochromosome 12p (in Pallister Kallian syndrome) and isochromosome 22q (in Cat-Eye syndrome)?
Other mosaic ESACs associated with syndromes include:
- an isochromosome of the proximal region of 15q (+i(15)(q11)) - often appears as a bisatellited marker.
- an isochromosome of 5p (+i(5)(p10)).
Both are always mosaic and may be tissue specific.
What types of cytogenetic syndromes involve loss of genetic material?
1) . Deletion syndromes (such as Cri-du-chat, Wolf Hirschhorn), Miller Dieker, Smith Magensis).
2) . Microdeletion syndromes (such as Digeorge syndrome and Williams-Beuren syndrome).