Tetrasomy 9p

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Tetrasomy 9p
Other namesIsochromosome 9p
Human male karyotpe high resolution - Chromosome 9 cropped.png
Chromosome 9, the chromosome involved in this condition

Tetrasomy 9p (also known tetrasomy 9p syndrome) is a rare chromosomal disorder characterized by the presence of two extra copies of the short arm of chromosome 9 (called the p arm), in addition to the usual two. [1] Symptoms of tetrasomy 9p vary widely among affected individuals but typically include varying degrees of delayed growth, abnormal facial features and intellectual disability. [1] Symptoms of the disorder are comparable to those of trisomy 9p. [2]

Contents

Symptoms and signs

The symptoms and prognosis of tetrasomy 9p are highly variable. [3] The severity of the symptoms is largely determined by the size of the isochromosome, the specific regions of chromosome 9p that are duplicated, as well as the number and type of tissues that are affected in the mosaic form. [4]

Most patients exhibit some degree of intellectual disability, abnormal skeletal and muscular development, and abnormal facial structures. [1] Cognitive symptoms range from slight learning disabilities to severe deficits in intellectual functioning. [4] Due to abnormal development of the muscles, individuals often experience limited or delayed mobility. [2] Atypical facial features are characteristic of the syndrome, including widely spaced eyes, a large nose, and unusually positioned ears. [1] [4] Additionally, patients often have extra skin around the neck and widely spaced nipples. [4] A wide range of renal, digestive, cardiac, respiratory, and nervous system abnormalities have been observed. [4]

Though rare, a few cases of phenotypically normal individuals with tetrasomy 9p have been documented. [1] [3]

Causes

Tetrasomy 9p is caused by the presence of two additional copies of the short arm of chromosome 9. These two extra copies are found in the cell as an isochromosome, in addition to the normal 46 chromosomes. [4] An isochromosome is formed when one of the arms of a chromosome is duplicated (in this case, the short arm), and the other is lost (in this case, the long arm), forming a chromosome with two identical arms. [3] Varying amounts of the short arm may be incorporated into the isochromosome, and occasionally, small regions of DNA from the long arm are included as well. [4] This extra isochromosome is classified as a small supernumerary marker chromosome. [5]

The disorder is almost never inherited; it most commonly arises through the improper distribution of chromosomes during the formation of eggs or sperm. [1]

Mechanism

The tetrasomy is typically caused by the incorrect distribution of chromosomes during meiosis or mitosis, called nondisjunction. [4] When cell division occurs normally, each daughter cell receives one short arm and one long arm of each chromosome. However, errors during this process may cause one daughter cell to receive two short arms of chromosome 9, while the other cell receives two long arms. The identical arms are subsequently connected via a centromere. In most cases, isochromosomes of 9p contain two centromeres, called a dicentric chromosome. [4]

The tetrasomy can also be formed independently of cell division. Double stranded breaks in the short arm of chromosome 9 may be repaired incorrectly, resulting in the formation of an isochromosome of 9p with a single centromere. [4] This isochromosome can then be passed on during cell division.[ citation needed ]

Mosaicism

In most cases, affected individuals carry the tetrasomy in every cell in their bodies. [2] However, some patients have the tetrasomy in some of their tissues but not in others; this is referred to as the mosaic form of the syndrome, and often results in less severe symptoms. [2] Non-mosaic tetrasomy 9p is most often the result of abnormal chromosome separation during the formation of eggs or sperm. In contrast, the mosaic form is often a result of a nondisjunction event that occurs early in embryonic development. [2] The type and number of tissues affected in the mosaic form is dependent upon the timing and location of the abnormal division within the developing embryo.[ citation needed ]

Diagnosis

After birth, galactose-1-phosphate uridyltransferase (GALT) activity in the infant's blood is measured. [2] GALT is regulated by a protein encoded on chromosome 9p, so irregular levels of GALT activity may indicate an underlying chromosomal abnormality. [2] Abnormal results are followed by analysis of blood, skin, and inner cheek cells, typically via fluorescence in situ hybridization, [4] which allows genetic counsellors to physically view the chromosomal composition of the cells. [6] Analysis of more than one tissue type is necessary in order to determine if the tetrasomy is present in its mosaic form. [1] If tetrasomy 9p is confirmed, chromosomal analysis of additional tissue types may be performed in order to estimate the ratio of affected cells in the body. [3]

Management

Prognosis

Though the outcome for individuals with either form of the tetrasomy is highly variable, mosaic individuals consistently experience a more favourable outcome than those with the non-mosaic form. [3] Some affected infants die shortly after birth, particularly those with the non-mosaic tetrasomy. [1] Many patients do not survive to reproductive age, while others are able to function relatively normally in a school or workplace setting. [1] Early diagnosis and intervention has been shown to have a strong positive influence on the prognosis. [1]

Recurrence risk

Since tetrasomy 9p is not usually inherited, the risk of a couple having a second child with the disorder is minimal. [4] While patients often do not survive to reproductive age, those who do may or may not be fertile. [1] The risk of a patient's child inheriting the disorder is largely dependent on the details of the individual's case. [1]

See also

Related Research Articles

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Turner syndrome (TS), also known as 45,X, or 45,X0, is a genetic condition in which a female is partially or completely missing an X chromosome. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low hairline at the back of the neck, short stature, and swollen hands and feet are seen at birth. Typically, those affected do not develop menstrual periods and breasts without hormone treatment and are unable to have children without reproductive technology. Heart defects, diabetes, and low thyroid hormone occur in the disorder more frequently than average. Most people with TS have normal intelligence; however, many have problems with spatial visualization that may be needed in order to learn mathematics. Vision and hearing problems also occur more often than average.

Phocomelia Medical condition

Phocomelia is a condition that involves malformations of human arms and legs. Although many factors can cause phocomelia, the prominent roots come from the use of the drug thalidomide and from genetic inheritance.

Aneuploidy Presence of an abnormal number of chromosomes in a cell

Aneuploidy is the presence of an abnormal number of chromosomes in a cell, for example a human cell having 45 or 47 chromosomes instead of the usual 46. It does not include a difference of one or more complete sets of chromosomes. A cell with any number of complete chromosome sets is called a euploid cell.

Edwards syndrome Chromosomal disorder in which there are three copies of chromosome 18

Edwards syndrome, also known as trisomy 18, is a genetic disorder caused by the presence of a third copy of all or part of chromosome 18. Many parts of the body are affected. Babies are often born small and have heart defects. Other features include a small head, small jaw, clenched fists with overlapping fingers, and severe intellectual disability.

Nondisjunction Failure to separate properly during cell division

Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division. There are three forms of nondisjunction: failure of a pair of homologous chromosomes to separate in meiosis I, failure of sister chromatids to separate during meiosis II, and failure of sister chromatids to separate during mitosis. Nondisjunction results in daughter cells with abnormal chromosome numbers (aneuploidy).

A small supernumerary marker chromosome (sSMC) is an abnormal extra chromosome. It contains copies of parts of one or more normal chromosomes and like normal chromosomes is located in the cell's nucleus, is replicated and distributed into each daughter cell during cell division, and typically has genes which may be expressed. However, it may also be active in causing birth defects and neoplasms. The sSMC's small size makes it virtually undetectable using classical cytogenetic methods: the far larger DNA and gene content of the cell's normal chromosomes obscures those of the sSMC. Newer molecular techniques such as fluorescence in situ hybridization, next generation sequencing, comparative genomic hybridization, and highly specialized cytogenetic G banding analyses are required to study it. Using these methods, the DNA sequences and genes in sSMCs are identified and help define as well as explain any effect(s) it may have on individuals.

Isochromosome

An isochromosome is an unbalanced structural abnormality in which the arms of the chromosome are mirror images of each other. The chromosome consists of two copies of either the long (q) arm or the short (p) arm because isochromosome formation is equivalent to a simultaneous duplication and deletion of genetic material. Consequently, there is partial trisomy of the genes present in the isochromosome and partial monosomy of the genes in the lost arm.

Polysomy Abnormal multiples of one or more chromosomes

Polysomy is a condition found in many species, including fungi, plants, insects, and mammals, in which an organism has at least one more chromosome than normal, i.e., there may be three or more copies of the chromosome rather than the expected two copies. Most eukaryotic species are diploid, meaning they have two sets of chromosomes, whereas prokaryotes are haploid, containing a single chromosome in each cell. Aneuploids possess chromosome numbers that are not exact multiples of the haploid number and polysomy is a type of aneuploidy. A karyotype is the set of chromosomes in an organism and the suffix -somy is used to name aneuploid karyotypes. This is not to be confused with the suffix -ploidy, referring to the number of complete sets of chromosomes.

XXYY syndrome Extra X and Y chromosome in males

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Tetrasomy 18p Presence of four copies of the short arm of chromosome 18

Tetrasomy 18p is a genetic condition that is caused by the presence of an isochromosome composed of two copies of the short arm of chromosome 18 in addition to the two normal copies of the chromosome. It is characterized by multiple medical and developmental concerns.

Cat eye syndrome Genetic partial duplication of chromosome 22

Cat eye syndrome (CES) or Schmid–Fraccaro syndrome is a rare condition caused by an abnormal extra chromosome, i.e. a small supernumerary marker chromosome. This chromosome consists of the entire short arm and a small section of the long arm of chromosome 22. In consequence, individuals with the cat eye syndrome have three (trisomic) or four (tetrasomic) copies of the genetic material contained in the abnormal chromosome instead of the normal two copies. The prognosis for patients with CES varies depending on the severity of the condition and their associated signs and symptoms, specially when heart or kidney abnormalities are seen.

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Tetrasomy X Chromosomal disorder with 4 X chromosomes

Tetrasomy X, also known as 48,XXXX, is a chromosomal disorder in which a female has four, rather than two, copies of the X chromosome. It is associated with intellectual disability of varying severity, characteristic "coarse" facial features, heart defects, and skeletal anomalies such as increased height, clinodactyly, and radioulnar synostosis. Tetrasomy X is a rare condition, with few medically recognized cases; it is estimated to occur in approximately 1 in 50,000 females.

Pentasomy X Chromosomal disorder

Pentasomy X, also known as 49,XXXXX, is a chromosomal disorder in which a female has five, rather than two, copies of the X chromosome. Pentasomy X is associated with short stature, intellectual disability, characteristic facial features, heart defects, skeletal anomalies, and pubertal and reproductive abnormalities. The condition is exceptionally rare, with an estimated prevalence between 1 in 85,000 and 1 in 250,000.

Trisomy X Chromosome disorder in women

Trisomy X, also known as triple X syndrome and characterized by the karyotype 47,XXX, is a chromosome disorder in which a female has an extra copy of the X chromosome. It is relatively common and occurs in 1 in 1,000 women but it is rarely diagnosed; fewer than 10% of those with the condition know they have it.

References

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  2. 1 2 3 4 5 6 7 "Chromosome 9, Tetrasomy 9p". National Organization for Rare Disorders. Retrieved 2015-11-29.
  3. 1 2 3 4 5 Lazebnik, Noam; Cohen, Leslie (2015-07-01). "Prenatal diagnosis and findings of tetrasomy 9p". Journal of Obstetrics and Gynaecology Research. 41 (7): 997–1002. doi:10.1111/jog.12706. ISSN   1447-0756. PMID   25944096.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 "Tetrasomy 9p Syndrome". Atlas of Genetic Diagnosis and Counseling. Humana Press. 2006-01-01. pp. 947–949. doi:10.1007/978-1-60327-161-5_179. ISBN   978-1-58829-681-8.
  5. Jafari-Ghahfarokhi H, Moradi-Chaleshtori M, Liehr T, Hashemzadeh-Chaleshtori M, Teimori H, Ghasemi-Dehkordi P (2015). "Small supernumerary marker chromosomes and their correlation with specific syndromes". Advanced Biomedical Research. 4 (1): 140. doi:10.4103/2277-9175.161542. PMC   4544121 . PMID   26322288.
  6. Grass, Frank S.; Parke, James C.; Kirkman, Henry N.; Christensen, Vicky; Roddey, O. F.; Wade, Ronald V.; Knuston, Cam; Spence, J. Edward (1993-11-01). "Tetrasomy 9p: Tissue-limited idic(9p) in a child with mild manifestations and a normal CVS result. Report and review". American Journal of Medical Genetics. 47 (6): 812–816. doi:10.1002/ajmg.1320470603. ISSN   1096-8628. PMID   7506483.
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