[Clinical study of assessment of trisomy 21--precise risk evaluation in the first trimester of pregnancy]. / Eine klinische Studie zur Wertigkeit der Trisomie 21--Risikopräzisierung im ersten Trimester der Schwangerschaft.

BACKGROUND: In the past a non invasive risk analysis for detecting specific chromosomal aberrations was only possible from week 15 of pregnancy. In this paper the practicability of first trimester screening is analysed. MATERIAL AND METHODS: Blood samples were taken from 1000 pregnant women before a invasive prenatal diagnosis was performed. Total hCG, free beta-hCG and PAPP-A (pregnancy associated plasma protein A) was analysed. These data were combined with complete cytogenetic and ultrasonographic (CRL and nuchal translucency--NT) data. RESULTS: In more than 90% of cases the NT was below 3 mm. Here the rate of normal karyotypes was 97.8%. In 61 cases a abnormal karyotype was found. Here in the most cases we found an elevated NT. Also in the most cases of trisomy 21 and 18 and in triploidies a characteristic ratio of hCG/free beta-hCG and PAPP-A was discovered. Combining NT and biochemical analysis, 85% of trisomies 21 could be discovered as a risk group. CONCLUSIONS: This study demonstrates the possibilities of first trimester screening with a high detection rate for specific chromosomal aberrations. DISCUSSION: First trimester screening should only be performed in specialised centers because determination of NT and risk analysis needs extensive experience.

Biomarker monitoring for health risk based on sensitivity to environmental mutagens.

Ongoing human and environmental genome programs have generated a tremendous amount of information regarding the genetic basis for human disease. The information can be used to enhance existing bioassays, as well as to develop new bioassays for improving human monitoring with the goal of disease prevention. In this review, some biomarkers that can be used for the purpose are presented, with an emphasis on using biomarkers to monitor human sensitivity to environmental mutagens. The application of biomarkers in clarifying the role of inherited and acquired susceptibility for developing environmental disease will be discussed. We emphasize the use of biomarkers that can detect mutagen sensitivity and DNA repair deficiency in the humans as an indication of susceptibility to disease. Such sensitivity can be either genetically determined or acquired from the exposure to environmental mutagens.

[The cytogenetic assessment of the degree of severity of acute radiation sickness in those who cleaned up the Chernobyl catastrophe]. / Tsitogeneticheskaia otsenka stepeni tiazhesti ostroi luchevoi bolezni u likvidatorov Chernobyl'skoi katastrofy.

The study is of a retrospective character and is based on the author's own cytogenetic findings secured in May-June 1986 in the examination of patients diagnosed as having had a first to third-degree acute radiation sickness while receiving massive detoxicating therapy. We consider it expedient to employ the model of multiple linear regression relying on a complex of most informative cytogenetic indicators rather than on only one such indicator alongside the traditional dose reaction identifiable by the level of dicentric chromosomes in blood lymphocytes. This will allow the degree of severity of the radiation injury to be determined with greater precision and permits assessing the therapeutic efficiency of the measures implemented.

[Improved prognostic assessment of head-neck carcinomas by new genetic markers]. / Verbesserte Prognoseeinschätzung bei Kopf-Hals-Karzinomen durch neue genetische Marker.

In individual patients with head and neck squamous cell carcinomas (HNSCC), established prognostic factors do not satisfactorily predict clinical outcome. For the first time we investigated a total of 100 HNSCC by Comparative Genomic Hybridization (CGH) to define chromosomal alterations that are associated with the patients prognosis. Patients were followed for at latest 4 but at least 2 years after surgery or until death. During this observation period twenty-nine of them died because of cancer disease. The Kaplan-Meier method was used plotting survival curves for every single chromosomal alteration as well as every clinico-pathological parameter. The curves were tested for significance by the log rank as well as the Breslow test. Significance of particular prognostic parameters was then evaluated by the Cox regression model. The overall survival time as well as the recurrence free survival time were significantly lower in patients who's tumors showed amplifications of the chromosomal region 11q13 (p = 0.0008 for LR and p = 0.0024 for B). The survival time of the patients was also lower if the carcinomas carried over-representations of chromosome 3q (p = 0.0299 for LR and p = 0.0546 for B). Multivariate analysis (Cox's proportional hazards model) revealed both alterations as most important independent prognostic factors in HNSCC. None of the conventional clinicopathological parameters (pT-, pN-status, UICC stage, grading) achieved statistical significance in the multivariate model. These results suggest that in HNSCC the occurrence of 11q13 amplification and 3q overrepresentation are highly significant independent prognostic markers and of better value than the established TNM and grading criteria.

In situ detection of a PCR-synthesized human pancentromeric DNA hybridization probe by color pigment immunostaining: application for dicentric assay automation.

We report a low cost and efficient method for synthesizing a human pancentromeric DNA probe by the polymerase chain reaction (PRC) and an optimized protocol for in situ detection using color pigment immunostaining. The DNA template used in the PCR was a 2.4 kb insert containing human alphoid repeated sequences of pancentromeric DNA subcloned into pUC9 (Miller et al. 1988) and the primers hybridized to internal sequences of the 172 bp consensus tandem repeat associated with human centromeres. PCR was performed in the presence of biotin-11-dUTP, and the product was used for in situ hybridization to detect the pancentromeric region of human chromosomes in metaphase spreads. Detection of pancentromeric probe was achieved by immunoenzymatic color pigment painting to yield a permanent image detected at high resolution by bright field microscopy. The ability to synthesize the centromeric probe rapidly and to detect it with color pigment immunostaining will lead to enhanced identification and eventually to automation of various chromosome aberration assays.

Histological and genetic analysis and risk assessment for chromosomal aberration after ICSI for patients presenting with CBAVD.

Intracytoplasmic sperm injection (ICSI) has opened a new field in the treatment of male infertility, leading to a debate concerning its genetic safety. In this study we present an analysis of 11 patients presenting congenital bilateral absence of the vas deferens (CBAVD). In all 11 cases, genetic counselling, histological analysis of testicular biopsies, cystic fibrosis transmembrane conductance regulator (CFTR) mutation screenings of both partners and spermatozoa three-colour fluorescent in-situ hybridization (FISH) analysis were performed. A total of 31 CFTR mutations were screened and mutations were found in eight out of 11 cases, with DeltaF508 being the most common mutation found. Histological analyses showed that seven out of 11 patients had normal tubule/membrane/interstitium (TMI) and Johnsen scores, while the remaining four patients had mild impairment of testicular parenchyma. The average aneuploidy rate was 6.8 +/- 3.9% compared with two control subjects with 4.4 and 5.4% aneuploidy rates respectively, using FISH analysis. After ICSI, the fertilization and pregnancy rates were 66.2 and 22.7% respectively. Thus, in our case of CBAVD, the risk of chromosomal aberration following ICSI, in the absence of a CFTR mutation in the male patient and/or in his partner, was not higher than in normal fertile men. Furthermore, the pregnancy success rate following ICSI of these CBAVD patients was comparable to the general ICSI population, even when histological analysis showed limited spermatogenesis.

The long-term effect of external quality assessment on performance in service cytogenetics.

In 1993 a nationwide cytogenetic external quality assessment program (EQA) was initiated in the Federal Republic of Germany. Presently, some 70 laboratories, representing approximately 90% of all cytogenetic diagnostic tests, are participating in the study. Based on the quality assessment scheme of the Association of Clinical Cytogeneticists (1988) in the United Kingdom, quality of chromosome preparation and speed of routine diagnostic services are being evaluated. As a result of continuous external quality assessment, the mean banding level of participating laboratories rose from below 400 bands per haploid set (bphs) in 1994 to approximately 450 bphs in 1999 in prenatal tests and from about 400 to approximately 500 bphs in postnatal tests over the same 5-yr period. The percentage of participants achieving a banding level of 400 bphs or higher rose from approximately 50% to 93% in prenatal tests and from 60% to 96% in postnatal tests. No significant differences were observed in banding scores achieved by private laboratories compared to university institutes. The impact of the assessment of interpretation, reporting, and documentation remains difficult to evaluate. Preliminary data point to a more stringent adherence to ISCN nomenclature in karyotype designation by participants.

DNA in situ hybridization as an adjunct in tumor diagnosis.

DNA in situ hybridization (ISH) methods, particularly fluorescence in situ hybridization, have gained broad acceptance in the clinical cytogenetic and research communities, but are used less frequently by noncytogenetic diagnostic pathology services. This review discusses tumor-related ISH, including the advantages and limitations of enzymatic detection ("insituhistochemistry"). The ISH applications are categorized with respect to diagnostic capabilities, ease of use, and cost.

Assessment of genetic changes in hepatocellular carcinoma by comparative genomic hybridization analysis: relationship to disease stage, tumor size, and cirrhosis.

Hepatocellular carcinoma (HCC) is a common and highly malignant tumor that is prevalent in Southeast Asia. Although the etiological factors associated are now well recognized, the interactions between individual factors and the molecular mechanisms by which they lead to cancer remain unclear. Cytogenetic analysis on HCC has been limited because of poor hepatocyte growth in vitro. The recently developed technique of comparative genomic hybridization (CGH), however, permits screening of the entire genome without the need of cell culture. CGH was applied to the study of genomic aberrations in 67 surgically resected samples of HCC, 3 of adenomatous hyperplasia (AH), and 12 of nontumorous cirrhotic liver surrounding the tumors. All samples were from patients of a racially and etiologically homogeneous population in Southern China, where chronic hepatitis B virus infection is the main etiological factor. CGH analysis of the HCC samples revealed frequent copy number gain of 1q (48/67 cases, 72%), 8q (32/67 cases, 48%), 17q (20/67 cases, 30%), and 20q (25/67 cases, 37%) and common losses on 4q (29/67 cases, 43%), 8p (25/67 cases, 37%), 13q (25/67 cases, 37%), and 16q (20/67 cases, 30%). Our finding of a high incidence of 1q gain strongly suggested this aberration was associated with the development of HCC. Genomic abnormalities were detected in 1 of the 3 AH specimens but absent in all 12 cirrhotic tissues surrounding the tumor. Clinical staging classified 3/67 HCC cases as T1, 53 cases as T2, and 11 cases as T3. No significant difference in the pattern of genomic imbalances was detected between stages T2 and T3. A significant copy number loss of 4q11-q23 was, however, identified in those tumors larger than 3 cm in diameter. Of particular interest was the identification of 8q copy number gain in all 12 cases of HCC that arose in a noncirrhotic liver, compared with only 20/55 cases in HCC arising in a cirrhotic liver. We suggest that 8q over-representation is likely associated with a growth advantage and proliferative stimulation that have encouraged malignant changes in the noncirrhotic human liver.

Perinatal hospice: a response to partial birth abortion for infants with congenital defects.

This article discusses decisions involving whether to terminate late-term pregnancies when fetal anomalies have been detected. Partial-birth abortion performed on fetuses with chromosomal abnormalities, while performed under the guise of reducing suffering, threatens the best interests of the mother and infant. An alternative for parents faced with the decision to terminate their pregnancy is perinatal hospice. Perinatal hospice recognizes the value of bringing these infants to term by treating them as beings conceived with a tangible future. This alternative is preferred because of post-termination psychological distress and because biblical teachings emphasize the dignity and worth of each fetus. Perinatal hospice supports parents through their grief when their infant dies and maximizes the opportunity for authentic mourning.

In vitro assessment of asbestos fibers genotoxicity.

This study was carried out in order to assess the genotoxic effect of in vitro exposure to commercial chrysotile asbestos. V 79 cell line, known as a well-established cellular model, was used for detection of asbestos genotoxic potency. Conventional structural chromosomal aberration analysis and sister chromatid exchange (SCE) method were both used for asbestos genotoxicity assessment. Within the experimental protocol applied, V 79 cells were treated with asbestos in concentrations of 100 and 200 micrograms/ml F-10 (HAM) media during 90 days, respectively. Analysis of changes in chromosome structure as well as of cell ploidy was performed each tenth day of the experimental course, consecutively. Two hundred well spread metaphases were taken into account for chromosomal aberration analysis. Frequency of sister chromatid exchanges was observed in 50 cells per sample. The results of cytogenetic tests revealed structural chromosomal damages, SCE-elevation and changes in cell ploidy. Cytogenetic effect of asbestos obviously depended on the dose applied and on the period of incubation. The results of this study suggest that significant cytogenetic changes occurring after asbestos treatment might directly or indirectly be the part of the biological events responsible for eliciting asbestos-induced carcinogenesis.

[Clinical genetics in The Netherlands. I. Organization, activities and laboratory diagnosis]. / De klinische genetica in Nederland. I. Organisatie, activiteiten en laboratoriumdiagnostiek.

There are seven centres for clinical genetics in the Netherlands. In 1996, some 63,000 persons (patients and possible carriers of hereditary diseases) were tested. In centres for clinical genetics chromosomal studies, biochemical diagnostics of hereditary metabolic diseases and DNA diagnostics are integrated with genetic counseling and prenatal diagnosis. The borders between the three different forms of laboratory testing for congenital anomalies and hereditary diseases gradually diminish. The variations of the numbers of laboratory examinations, genetic advices and prenatal diagnoses over the last ten years show that there is no correlation between these activities and the method of funding. Owing to the low prevalence of the diseases involved, the total number of DNA diagnoses for monogenic diseases will not increase significantly. However, once genetic risk factors of diseases such as cancer, cardiovascular diseases, diabetes, asthma, rheumatism, some psychiatric disorders and Alzheimer dementia will have been mapped, DNA diagnostics will greatly expand and will have implications in a broad area of medicine.

Assessment of cancer hazard from environmental pollution in Silesia.

New concepts of cancer risk estimation have been developed during the past decade. Short-term bioassays dealing with mutagenicity and carcinogenicity of environmental samples are being replaced by more relevant molecular epidemiology studies. The general idea of using a battery of bioassays remains unchanged while the origin of tested samples is different. Instead of testing samples collected from the environment, body fluids or human cells from exposed populations are under investigation. This paper reviews the collaborative study on cancer risk assessment in highly polluted industrial region of Silesia in which both approaches had been employed during the 1985-1995 period. A potent carcinogenic activity of airborne pollutants was indicated in a battery of in vitro and in vivo short-term assays. These studies were followed by the molecular epidemiology study performed on human populations inhabiting the region of Silesia. An elevated damage of genetic material on the chromosome and/or DNA levels was observed in the Silesian populations as compared with proper rural controls.

Comparative assessment of DNA adduct formation, Salmonella mutagenicity, and chromosome aberration assays as short-term tests for DNA damage.

DNA adduct formation assay (DAFA) was carried out to compare dose responses with the Ames test and chromosomal aberration test using aflatoxin B1 (AFB1) and benzo[a]pyrene (BaP). In the bacterial mutation test, AFB1 and BaP (0-1 microgram/plate) were all positive in TA97a and TA100 with dose-related revertants. However, the slopes of the dose-response curves were gradual (slope 0.55-3.73, r = .84-.98). In the chromosome aberration test, a significant increase in the percentage of chromosomal aberrations was obtained from male ICR mouse spleen cells treated with AFB1 and BaP, but a dose-related increase was insensitive (slope 0.09-0.23, r = .75-.78). The incidence of chromosomally aberrant spleen cells treated with BaP was significantly increased compared with AFB1. DAFA was performed in vitro with [3H]-AFB1 and [3H]BaP. These two carcinogens were able to induce genotoxicity and showed good dose-related increases in terms of DNA adduct formation (slope 0.78-1.28, r = 1.00). Coefficients of variation (CV) for the slope of each dose-response curve were much lower in DAFA in vitro (CV 15.09- 18.34%) than those in any other test (CV 19.69-99.33%, Ames test; 18.89-44.58%, chromosome aberration test). Furthermore, DAFA in vivo was performed to investigate organotropic DNA adduct formation and persistence in Sprague-Dawley rats ip or orally treated with AFB1 and BaP. DNA adducts were monitored for 48-96 h by enzyme-linked immunosorbent assay (ELISA) using corresponding monoclonal antibodies, 6A10 and 8E11. DAFA in vivo demonstrated that the liver and kidney might be the probable target organs for AFB1 with the highest formation and persistence of DNA adducts and the lung and liver for BaP regardless of the route of administration. The results suggest that DAFA in vitro could be useful for detecting genotoxic compounds, and DAFA in vivo should also be considered as a good alternative method for the screening of organ-specific chemical carcinogens.

[What significance to genotype changes have in diagnosis of malignant hyperthermia?]. / Welche Bedeutung haben Genotypveränderungen in der Diagnostik der malignen Hyperthermie?

Malignant hyperthermia (MH) is a potentially fatal, inherited pharmacogenetic disorder characterised by a dysfunction of the intracellular calcium regulation. Linkage to DNA markers from the chromosome 19q12-13.2 region and the MHS-phenotype (MH susceptible) has been shown in about 50% of families with a history of MH. The ryanodine receptor gene encoding the human skeletal muscle ryanodine receptor has been localised to the chromosome 19q13.1-13.2 region. The ryanodine receptor, which is an intracellular calcium release channel, has been proposed to be one of the candidate structures for the MH defect. At present, eight different single point mutations have been identified in the human skeletal muscle ryanodine receptor gene in families with disposition to MH. The incidence of the various mutations has been reported as 2-10% each. A combination of different mutations within one pedigree has not been demonstrated. A few years ago, linkage of the MHS-phenotype to DNA markers from the chromosome 17q11.2-24 region was published by an American group. However, this observation has not been confirmed in any of the several European families susceptible to MH. Genes encoding for subunits of the dihydropyridine receptor and the sodium channel of the human skeletal muscle have been found to be located in the chromosome 17q11.2-24 region which, in fact, could be additional candidates for the MH defect. The dihydropyridine receptor is linked to the ryanodine receptor and involved in the calcium regulation of skeletal muscle. Very recent studies have shown linkage to DNA markers from chromosome 7q- and chromosome 3q13.1 regions and the MHS phenotype in two distinct families with history of MH. However, the relevance of this observation is so far unknown. At present, unambiguous preoperative screening of MH disposition based on molecular genetic characteristics is not available because of the enormous heterogeneity of the human MH syndrome. Thus, the halothane-caffeine in-vitro contracture test according to the standard protocol of the "European MH Group" must be performed in order to discover MH susceptibility.

Patients with polycystic kidney disease would benefit from routine magnetic resonance angiographic screening for intracerebral aneurysms: a decision analysis.

Autosomal dominant polycystic kidney disease (ADPKD) is associated with increased prevalence of cerebral aneurysms and increased risk of subarachnoid hemorrhage. A decision analysis by Levey et al. in 1983 demonstrated that patients with ADPKD would not significantly benefit from routine arteriographic screening for cerebral aneurysms. We reexamined this conclusion in light of new clinical data and the introduction of magnetic resonance imaging (MRI) as a screening method. We compared an MRI screening strategy with a nonscreening strategy. The screening strategy specified MRI screening and then neurosurgical management of detected aneurysms. The nonscreening strategy specified cerebrovascular care only in the event of subarachnoid hemorrhage. The decision tree incorporated estimates derived from the clinical literature for the prevalence of asymptomatic aneurysms in patients with ADPKD (15%), the annual incidence of aneurysmal rupture (1.6%), the morbidity and mortality rates associated with subarachnoid hemorrhage (70 and 56%, respectively), the risk of transfemoral arteriography (0.2%), the sensitivity and specificity of MRI, the morbidity and mortality rates associated with surgical treatment of an unruptured aneurysm (4.1 and 1.0%, respectively), and the life expectancy of patients with ADPKD. The model predicted that the screening strategy would provide 1.0 additional year of life without neurological disability to a 20-year-old patient with ADPKD. A sensitivity analysis showed that the model was most sensitive to estimates of the prevalence of aneurysms in ADPKD, the annual incidence of rupture, and the morbidity and mortality rates associated with rupture. A financial analysis showed that a screening strategy is likely to cost less than a nonscreening strategy. The model predicts that an MRI screening strategy would increase the life expectancy of young patients with ADPKD and reduce the financial impact on society of ADPKD.

Genetic toxicology assessment of HI-6 dichloride.

The oxime HI-6 dichloride [1-(2 hydroxyiminomethyl -1-pyridino)-3-(4-carbamoyl-1-pyridino)-2-oxapropane dichloride monohydrate] has shown to be a potent reactivator of cholinesterase activity and may have efficacy for the treatment of organophosphate intoxication [SIPRI, 1976; Schenk et al.; Arch Toxicol 36:71-81, 1976]. As part of a preclinical safety assessment program, the genetic toxicology of HI-6 dichloride was evaluated in a series of assays designed to measure induction of gene mutations and chromosomal aberrations. HI-6 dichloride gave negative responses in the Salmonella mutagenicity assay and in the CHO/HGPRT gene mutation assay. Dose-dependent increases in the frequency of chromosomal aberrations were noted when HI-6 dichloride was tested in cultured CHO cells and in cultured human peripheral blood lymphocytes. The mouse lymphoma gene mutation assay, reputed to measure both gene mutations and chromosomal deletions, was negative in the absence of metabolic activation. Depending on the criteria employed, a negative or equivocal response was seen in the presence of rat liver-derived S-9 mix. An in vivo rat bone marrow metaphase assay performed to further investigate the in vitro clastogenic responses was negative. The results from these studies indicate that HI-6 dichloride does not induce gene mutations in vitro; however, it is clastogenic in vitro but does not appear to be clastogenic in vivo.

Control of hereditary diseases. Report of a WHO Scientific Group.

Possibilities for treating--or, ideally, avoiding--hereditary diseases have increased enormously with the rapid and radical developments in the field of molecular biology. This report of a WHO Scientific Group deals first with the human genome and the genetic basis of disease, then continues with a review of the epidemiology of genetic disorders and the role of genetic predisposition in various common conditions, including coronary heart disease, cancer, asthma, diabetes and mental disorders. In discussing prevention, the report considers both genetic family studies and population screening. It is pointed out that the cost-benefit ratio of providing genetic services is extremely favourable, and prevention is often far cheaper than treatment. An entire section of the report is devoted to genetic counseling, which is particularly important because of the psychological impact of knowledge of genetic risk and the difficult decisions that often face individuals identified as being at risk. Obstetric aspects of prenatal diagnosis are considered; techniques discussed include ultrasound scanning, chorionic villus and fetal blood sampling, and amniocentesis. Organization of genetic services is reviewed, and the ethical, social and legal aspects of genetic technology in medicine are examined. The report concludes with a summary of the Scientific Group's recommendations.

Cytogenetic effects of cryopreservation on human sperm: assessment using an improved method for analyzing human sperm chromosomes.

OBJECTIVE: To evaluate any cytogenetic effects of cryopreservation on human sperm by comparing the frequencies of sperm chromosome anomalies and sex ratios before and after freezing. METHODS: Using in vitro fertilization of zona-free hamster oocytes, analysis of sperm chromosomes was first performed on portions of fresh human semen samples. The residual semen was then analyzed for sperm chromosomes after cryopreservation for several weeks. Sperm donors were 5 healthy men aged 26-38 years. RESULTS: A total of 166 sperm karyotypes were analyzed, 94 before freezing and 72 after freezing. The results indicated no significant differences between fresh and frozen sperm in either frequencies of aneuploidy (fresh: 0%, frozen: 2.8%) or structural anomalies (fresh: 7.5%, frozen: 9.7%). The sex ratios did not differ from the expected 1:1 ratio under either condition. CONCLUSIONS: The results of these studies indicate that cryopreservation does not exert any cytogenetic mutagenicity on human spermatozoa or alter X/Y ratio of human sperm.

[A cytogenetic assessment of the mutagenic background in the Dnieper River industrial area]. / Tsitogeneticheskaia otsenka mutagennogo fona v promyshlennom Pridneprov'e.

Cytogenetic investigation of plant cells and somatic cells of children from Dnepropetrovsk shown and increase of the frequency of chromosome aberrations and gene mutations in contaminated regions that testified the increased mutagenic background of urban environment.