UK families with children with rare chromosome disorders: Changing experiences of diagnosis and counselling (2003-2013).

The latest United Kingdom (UK) strategy for rare diseases emphasises the need to empower affected populations to improve diagnosis, intervention, and coordination of care. Families who have a child with a rare chromosome disorder (RCD) are a challenging group to include. We report the findings of 2 large-scale surveys, undertaken by the UK RCD Support Group Unique, of these families' experiences over a 10-year period. Seven stages of the patient journey were examined. From pre-testing, through diagnosis, genetics consultation, clinical follow-up and peer support. Overall, 1158 families replied; 36.4% response rate (2003) and 53.6% (2013). Analysis of responses identifies significant differences (P < .001) over time with a decrease in results reported face to face (76%-62%), doubling by telephone (12%-22%), improved explanation of chromosome disorder (57%-75%), and increased signposting to peer support group (34%-62%). However, conduct of the consultation raises a number of important questions. Overall, 28 aspects of the patient journey are recognised as requiring improvement; only 12/28 are currently incorporated in UK service specifications. Involvement of RCD families has identified key service improvements. This approach can empower those affected by such extremely rare disorders, and also enable professionals to design improved services in partnership with "expert families." Further surveys are planned.

Trisomy 21 mosaicism: we may all have a touch of Down syndrome.

Ever increasing sophistication in the application of new analytical technology has revealed that our genomes are much more fluid than was contemplated only a few years ago. More specifically, this concerns interindividual variation in copy number (CNV) of structural chromosome aberrations, i.e. microdeletions and microduplications. It is important to recognize that in this context, we still lack basic knowledge on the impact of the CNV in normal cells from individual tissues, including that of whole chromosomes (aneuploidy). Here, we highlight this challenge by the example of the very first chromosome aberration identified in the human genome, i.e. an extra chromosome 21 (trisomy 21, T21), which is causative of Down syndrome (DS). We consider it likely that most, if not all, of us are T21 mosaics, i.e. everyone carries some cells with an extra chromosome 21, in some tissues. In other words, we may all have a touch of DS. We further propose that the occurrence of such tissue-specific T21 mosaicism may have important ramifications for the understanding of the pathogenesis, prognosis and treatment of medical problems shared between people with DS and those in the general non-DS population.

Crossing over analysis at pachytene in man.

The distribution of anti-MLH1 (MutL homologue 1) antibody labelling was studied in human prophase meiocytes. A labelling pattern consisting of distinct foci, always associated with the synaptonemal complex (SC) and never in closely juxtaposed pairs, was observed. Comparison of the number and general positions of autosomal foci with previous studies of the number and positions of autosomal chiasmata indicates that the anti-MLH1 antibody marks sites of crossing over in human pachytene spermatocytes. A mean number of 50.9 autosomal foci was observed from 46 human pachytene spermatocytes corresponding to a genetic length of 2545 cm. Division of these spermatocytes into sub-stages revealed that the number of foci remains stable throughout pachytene. A focus was found on the XY bivalent in 56.5% of the nuclei. The presence or absence of foci from the XY bivalent could not be correlated to pachytene sub-stage.

Analysis of the primary sex ratio, sex chromosome aneuploidy and diploidy in human sperm using dual-colour fluorescence in situ hybridisation.

In situ hybridisation technology provides a new tool for chromosome analysis of human spermatozoa. We have used dual-colour fluorescence in situ with probes specific for the X and Y chromosomes and chromosomes 1 and 12 to (a) identify the primary male gametic sex chromosome ratio; (b) assess the number of numerical sex chromosome abnormalities, and (c) quantify the incidence of diploid sperm. We have examined over 60,000 sperm from three normal males and found the primary sex ratio to be indistinguishable from unity. The frequency of hyperhaploid sperm was 0.8, 1.03 and 2.27 per thousand for XX, YY and XY respectively, whilst 1.67 per thousand sperm were diploid. A comparison of our results with estimates of sex chromosome aneuploidy in human populations suggests that sperm carrying two sex chromosomes may be at a selective disadvantage.

Study of Alu sequences at the hypoxanthine phosphoribosyltransferase (hprt) encoding region of man.

The hypoxanthine phosphoribosyltransferase (hprt) encoding region of man is considered rich in Alu sequences: with 49 sequences present within 57 kilobases. Subfamily classification of the Alu sequences and identification of flanking direct repeats has been carried out to detect past rearrangements associated with their insertion into the region. Members of the Alu-J and three Alu-S subfamilies are present, along with the existence of free left arm sequences. Using available data, a comparison is made of the Alu subfamilies present at different gene regions. The heterogeneity in the number of each subfamily present at different genes shows that no one particular subfamily attained saturation in the genome. Several adjacent insertions of Alu sequences are seen at the hprt region. Furthermore two novel sequences are described, there is an incident where one Alu sequence has inserted into the middle poly(A) tract of an existing sequence at the hprt region; while another result from an Alu/Alu cross-over event elsewhere in the genome, before insertion into the hprt region. Once inserted, the Alu sequences are rarely subject to loss or rearrangement.

Inter-sex variation in synaptonemal complex lengths largely determine the different recombination rates in male and female germ cells.

Meiotic chromosomes in human oocytes are packaged differently than in spermatocytes at the pachytene stage of meiosis I, when crossing-over takes place. Thus the meiosis-specific pairing structure, the synaptonemal complex (SC), is considerably longer in oocytes in comparison to spermatocytes. The aim of the present study was to examine the influence of this length factor on meiotic recombination in male and female human germ cells. The positions of crossovers were identified by the DNA mismatch repair protein MLH1. Spermatocytes have approximately 50 crossovers per cell in comparison to more than 70 in oocytes. Analyses of inter-crossover distances (and presumptively crossover interference) along SCs suggested that while there might be inter-individual variation, there was no consistent difference between sexes. Thus the higher rate of recombination in human oocytes is not a consequence of more closely spaced crossovers along the SCs. The rate of recombination per unit length of SC is higher in spermatocytes than oocytes. However, when the so-called obligate chiasma is excluded from the analysis, then the rates of recombination per unit length of SC are essentially identical in the two sexes. Our analyses indicate that the inter-sex difference in recombination is largely a consequence of the difference in meiotic chromosome architecture in the two sexes. We propose that SC length per se, and therefore the size of the physical platform for crossing-over (and not the DNA content) is the principal factor determining the difference in rate of recombination in male and female germ cells. A preliminary investigation of SC loop size by fluorescence in situ hybridization (FISH) indicated loops may be shorter in oocytes than in spermatocytes.

The initiation of homologous chromosome synapsis in mouse fetal oocytes is not directly driven by centromere and telomere clustering in the bouquet.

We investigated the behaviour of centromeres and distal telomeres during the initial phases of female meiosis in mice. In particular, we wished to determine whether clustering of centromeres and telomeres (bouquet formation) played the same crucial role in homologous chromosome pairing in female meiosis as it does in the male. We found that synapsis (intimate homologous chromosome pairing) is most frequently initiated in the interstitial regions of homologous chromosomes, apparently ahead of the distal regions. The proximal ends of the chromosomes appear to be disfavoured for synaptic initiation. Moreover, initiation of synapsis occurred in oocytes that showed little or no evidence of bouquet formation. A bouquet was present in a substantial proportion of cells at mid to late zygotene, and was still present in some pachytene oocytes. This pattern of bouquet formation and pairing initiation is in stark contrast to that previously described in the male mouse. We propose that although dynamic movements of centromeres and telomeres to form clusters may facilitate alignment of homologues or homologous chromosome segments during zygotene, in the female mouse positional control of synaptic initiation is dependent on some other mechanism.

Cytogenetic analysis in a case of cancer of the male breast.

Sequential chromosome banding of direct preparations from an infiltrating ductal carcinoma of the left breast of a male, aged 56 years, showed a diploid chromosome range with a mode at 44. Consistent monosomy of chromosomes #2, #3, #4, #6, #11, #15, and #17 and nullisomy of chromosomes #1, #8, and #12 were found. In addition, each cell contained 11-14 markers and 1-7 abnormal chromosomes. Altogether, 16 markers were characterized, and 2 of these involved the long arm of chromosome #1. This chromosome pattern is similar to that in diploid breast carcinomas of the female.

Cytogenetic analysis in human breast carcinoma. I. Nine cases in the diploid range investigated using direct preparations.

Cells in mitosis were found in 51 of 110 (47%) breast tumor samples; karyotypes of nine tumors in the diploid range are presented. The simplest stemline karyotype found was 46,XX, -16, +del(1)(qter----p21). The chromosome homologues most frequently lost were #8, #13, and #16. Monosomy or partial monosomy for chromosome #16 was seen in six cases, including the two simplest and chromosome #16 might be of relevance for initiation of malignant transformation in breast carcinoma. The only chromosome feature common to all nine breast carcinomas was the presence of a marker involving the long arm of chromosome #1, the region shared by all being 1qter----1q21.

Cytogenetic analysis in human breast carcinoma. II. Seven cases in the triploid/tetraploid range investigated using direct preparations.

This report presents karyotypes of seven breast carcinomas with high ploidy from our total of 111 cases. These karyotypes were highly complex and there was no indication of a specific deletion of 16p12----pter as indicated by the previous analysis of some near-diploid tumors. A comparison of numerical changes did not demonstrate a common loss of chromosome #16 as in the near-diploid tumors, but an equivalent loss of chromosomes #8 and #13 was found.

Cytogenetics of a cell line derived from an ovarian papillary serous cystadenocarcinoma.

The cell line OAW 42 was established from the ascites of a patient with papillary serous cystadenocarcinoma of the ovary. Cytogenetic analysis at three different passages showed that the line was hypotetraploid, with no distinct mode, and was characterized by 14 stable markers, involving chromosomes #1, #3, #4, #5, #12, #17, #18, #20, and #21. Neither component of the translocation t(6;14)(q21;q24), previously reported to characterize ovarian papillary serous cystadenocarcinoma, was found.

Cytogenetic analysis of SV40-transformed human breast epithelial cells.

The SV40-transformed breast epithelial cell lines established by Chang et al. [1] were shown to be hypotetraploid and characterized by six chromosome markers: M1 i(1q), M2 del(1)(q21), M3 i(6p), M4 del(1)(q11), M5 t(8p;12q), and M6 dir dup(11)(p12 leads to pter). The presence of common chromosome markers indicates that these cell lines are probably derived from the same original transformed cell.

Analysis of lymphocytes from uranium mineworkers in Namibia for chromosomal damage using fluorescence in situ hybridization (FISH).

Workers in the open pit uranium mine in Namibia appear to suffer from health problems including malignant diseases at a much higher prevalence when compared with the general population. The objective of the present study was to determine whether long-term exposure to low-dose uranium increases the risk of biological radiation damage which could lead to malignant diseases. In order to investigate this risk, we measured the relative frequency of chromosome alterations using Fluorescence in situ hybridization (FISH). A representative cohort of 11 non-smoking miners, were compared to a control group of 9 individuals with no occupational history in mining. We determined a significant increase in chromosome aberrations in the circulating lymphocytes of miners versus the non-smoking controls (p = 0.0000096). Therefore, we concluded that these uranium exposed miners are at an increased risk to acquire genetic damage, which may be associated with an increased risk for malignant transformation.

The origin of aneuploidy: bivalent instability and the maternal age effect in trisomy 21 Down syndrome.

The mechanism behind the high rate of maternal first meiotic non-disjunction and the maternal age effect in trisomy 21 is unknown. Much attention has been paid to the causal role of univalence 21 by lack of chiasma formation. Here I suggest that not only achiasmatic bivalents may be susceptible to nondisjunction, but the chiasmatic bivalent shape per se may play an important role. Considering the topology of the chiasmata and the orientation of the bivalent at first meta- and anaphase, some bivalent shapes may have a greater segregational potential than others. For any one chromosome there may at first meta- and anaphase be an optimal balance between chromosome coiling/condensation on the one hand and chiasma frequency distribution on the other. Chromosome coiling/condensation may play an interesting dual role in both determining bivalent flexibility and dictating chiasma formation. I propose that the higher rate of double- and triple-chiasma bivalents 21 in oocytes contributes to its higher rate of spontaneous first meiotic nondisjunction; and the maternal age effect is associated with chromosome laxity, secondary to an impairment of appropriate chromosome coiling/condensation in oocytes of older women. In spermatocytes of older men some compensatory increase in chiasma frequency with a shift towards double- and triple-chiasma bivalents 21 might take place, i.e., if a general age-related chromosome decondensation is counteracted by an auto-regulatory "length effect" remaining intact in pachytene spermatocytes.

Electron microscopic investigations of synaptonemal complexes in an infertile human male carrier of a pericentric inversion inv(1)(p32q42). Regular loop formation but defective synapsis including a possible interchromosomal effect.

Electron microscopic investigations of surface spread synaptonemal complexes in spermatocytes from a 37-year-old man ascertained for infertility detected a pericentric inv(1), and subsequent lymphocyte analysis placed the breakpoints at p32 and q42. Most spermatocytes showed a maturation arrest at mid-pachytene explaining the azoospermia. As in two other comparatively large loop-forming pericentric inversions, initiation of synapsis took place in the middle of the inverted segment. Thus there is no indication of interstitial synaptic initiation being restricted to special pairing sites along the length of the chromosome. All spermatocytes investigated at mid-pachytene showed inversion loops, none of which was fully synapsed with a specific delay in pairing of the heterochromatic block 1qh and adjacent segments. The loops were of similar size in all the cells examined and synaptic adjustment had not taken place. There was no indication of a preferential association between the inv(1) bivalent and the XY configuration, and a functional disturbance of the X seems an unlikely reason for the meiotic maturation arrest. The most likely cause may be the failure of adequate synapsis of the inverted segment and the possibly associated pairing abnormalities of other homologues, including asynapsis and/or precocious desynapsis.

Chromosome in situ suppression hybridisation in human male meiosis.

Chromosome in situ suppression hybridisation with biotinylated whole chromosome libraries permits the unequivocable identification of specific human somatic chromosomes in numerous situations. We have now used this so called 'chromosome painting' technique in meiotically dividing cells, isolated from human testicular biopsy. It is shown that the method allows identification of target homologues, bivalents, and sister chromatids throughout the relevant stages of meiosis. Thus, a more accurate study of meiosis per se is now available to increase our understanding of such processes as first meiotic synapsis of homologues and chiasma formation/meiotic crossing over, which are still outstanding biological enigmas. The new technology also makes it possible, for the first time, (1) to obtain direct numerical data in first meiotic non-disjunction for individual chromosomes, and (2) to quantify segregation in male carriers of structural rearrangements. We exemplify the use of the chromosome painting technique for a first meiotic segregation analysis of an insertional translocation carrier.

Combined immunocytogenetic and molecular cytogenetic analysis of meiosis I human spermatocytes.

We have used a combination of immunocytogenetic and molecular cytogenetic technology on human spermatocytes to investigate (1) meiosis I chromosome pairing, and (2) organization of synaptonemal complex (SC)-associated chromatin with respect to whole chromosome paints, unique DNA sequences and repetitive DNA of heterochromatic blocks, centromeres and telomeres. It is evident that synapsis normally starts at the termini of homologues. In general, synapsis proceeds synchronously from termini towards the centre of bivalents without any indication of interstitial initiation. Some aberrant meiosis I spermatocytes showed asynchronous pairing, demonstrating not only large differences in the degree of SC formation between bivalents, but also chromosome alignment without synapsis as well as clear interstitial synaptic initiation. It may be the case that alignment normally takes place along the entire length of homologues before synapsis occurs and that the potential for synaptic initiation exists along the length of chromosomes. Telomeric sequences were seen tightly associated with the SCs, as might be expected considering their kinetic properties in relation to the nuclear membrane. Other repetitive DNA, i.e. centromeric alpha-satellites and classical satellites of the heterochromatic blocks 1qh and 9qh, were all found to form loops that are associated with SCs only at their bases. A unique DNA cosmid probe (21q22.3) was found to produce a hybridization pattern consisting of spots located outside SC. The fluorescence in situ hybridization (FISH) signals of these spread DNA sequences have a granular appearance, probably reflecting the pattern of coiling and chromatin condensation of the target DNAs.