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 people 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

<span class="mw-page-title-main">Turner syndrome</span> X chromosome monosomy

Turner syndrome (TS), commonly known as 45,X, or 45,X0, is a chromosomal disorder in which cells have only one X chromosome or are partially missing an X chromosome leading to the complete or partial deletion of the pseudoautosomal regions in the affected X chromosome. Most people have two sex chromosomes. The chromosomal abnormality is often present in just some cells, in which case it is known as Turner syndrome with mosaicism. 45,X0 with mosaicism can occur in males or females, but Turner syndrome without mosaicism only occurs in females. Signs and symptoms vary among those affected. Often, additional skin folds on the neck, arched palate, low-set ears, low hairline at the nape of the neck, shorter height, and lymphedema of the hands and feet. Typically, those affected do not develop menstrual periods or mammary glands without hormone treatment and are unable to reproduce without assistive reproductive technology. Small chin (micrognathia), loose folds of skin on the neck, slanted eyelids and prominent ears are found in Turner syndrome, though not all will show it. Heart defects, Type II diabetes, and hypothyroidism occur in the disorder more frequently than average. Most people with Turner syndrome have normal intelligence; however, many have problems with spatial visualization that may be needed in order to learn mathematics. Ptosis and conductive hearing loss also occur more often than average.

<span class="mw-page-title-main">Nondisjunction</span> Failure to separate properly during cell division

Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division (mitosis/meiosis). 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).

<span class="mw-page-title-main">Small supernumerary marker chromosome</span> Abnormal partial or mixed chromosome

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.

<span class="mw-page-title-main">Isochromosome</span> Chromosome abnormality

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.

<span class="mw-page-title-main">Polysomy</span> 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.

<span class="mw-page-title-main">XXYY syndrome</span> Extra X and Y chromosome in males

XXYY syndrome is a sex chromosome anomaly in which males have two extra chromosomes, one X and one Y chromosome. Human cells usually contain two sex chromosomes, one from the mother and one from the father. Usually, females have two X chromosomes (XX) and males have one X and one Y chromosome (XY). The appearance of at least one Y chromosome with a properly functioning SRY gene makes a male. Therefore, humans with XXYY are genotypically male. Males with XXYY syndrome have 48 chromosomes instead of the typical 46. This is why XXYY syndrome is sometimes written as 48, XXYY syndrome or 48, XXYY. It affects an estimated one in every 18,000–40,000 male births.

The Pallister–Killian syndrome (PKS), also termed tetrasomy 12p mosaicism or the Pallister mosaic aneuploidy syndrome, is an extremely rare and severe genetic disorder. PKS is due to the presence of an extra and abnormal chromosome termed a small supernumerary marker chromosome (sSMC). sSMCs contain copies of genetic material from parts of virtually any other chromosome and, depending on the genetic material they carry, can cause various genetic disorders and neoplasms. The sSMC in PKS consists of multiple copies of the short arm of chromosome 12. Consequently, the multiple copies of the genetic material in the sSMC plus the two copies of this genetic material in the two normal chromosome 12's are overexpressed and thereby cause the syndrome. Due to a form of genetic mosaicism, however, individuals with PKS differ in the tissue distributions of their sSMC and therefore show different syndrome-related birth defects and disease severities. For example, individuals with the sSMC in their heart tissue are likely to have cardiac structural abnormalities while those without this sSMC localization have a structurally normal heart.

<span class="mw-page-title-main">Genetics of Down syndrome</span>

Down syndrome is a chromosomal abnormality characterized by the presence of an extra copy of genetic material on chromosome 21, either in whole or part. The effects of the extra copy varies greatly from individual to individual, depending on the extent of the extra copy, genetic background, environmental factors, and random chance. Down syndrome can occur in all human populations, and analogous effects have been found in other species, such as chimpanzees and mice. In 2005, researchers have been able to create transgenic mice with most of human chromosome 21.

A chromosomal abnormality, chromosomal anomaly, chromosomal aberration, chromosomal mutation, or chromosomal disorder is a missing, extra, or irregular portion of chromosomal DNA. These can occur in the form of numerical abnormalities, where there is an atypical number of chromosomes, or as structural abnormalities, where one or more individual chromosomes are altered. Chromosome mutation was formerly used in a strict sense to mean a change in a chromosomal segment, involving more than one gene. Chromosome anomalies usually occur when there is an error in cell division following meiosis or mitosis. Chromosome abnormalities may be detected or confirmed by comparing an individual's karyotype, or full set of chromosomes, to a typical karyotype for the species via genetic testing.

<span class="mw-page-title-main">Ring chromosome 20 syndrome</span> Medical condition

Ring chromosome 20, ring-shaped chromosome 20 or r(20) syndrome is a rare human chromosome abnormality where the two arms of chromosome 20 fuse to form a ring chromosome. The syndrome is associated with epileptic seizures, behaviour disorders and intellectual disability.

<span class="mw-page-title-main">Isodicentric 15</span> Condition caused by two joined and mirrored duplications of part of chromosome 15

Isodicentric 15, also called marker chromosome 15 syndrome, idic(15), partial tetrasomy 15q, or inverted duplication 15, is a chromosome abnormality in which a child is born with extra genetic material from chromosome 15. People with idic(15) are typically born with 47 chromosomes in their body cells, instead of the normal 46. The extra chromosome, which is classified as a small supernumerary marker chromosome, is made up of a piece of chromosome 15 that has been duplicated end-to-end like a mirror image. It is the presence of this extra genetic material that is thought to account for the symptoms seen in some people with idic(15). Individuals with idic(15) have a total of four copies of this chromosome 15 region instead of the usual two copies. The term isodicentric refers to a duplication and inversion of a centromere-containing chromosomal segment.

Emanuel syndrome, also known as derivative 22 syndrome, or der(22) syndrome, is a rare disorder associated with multiple congenital anomalies, including profound intellectual disability, preauricular skin tags or pits, and conotruncal heart defects. It can occur in offspring of carriers of the constitutional chromosomal translocation t(11;22)(q23;q11), owing to a 3:1 meiotic malsegregation event resulting in partial trisomy of chromosomes 11 and 22. An unbalanced translocation between chromosomes 11 and 22 is described as Emanuel syndrome. It was first described in 1980 by American medical researchers Beverly S. Emanuel and Elaine H. Zackai, and a consortium of European scientists the same year.

<span class="mw-page-title-main">Tetrasomy 18p</span> 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. Tetrasomy 18P World Day is 18th April.

<span class="mw-page-title-main">Cat eye syndrome</span> 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, especially when heart or kidney abnormalities are seen.

<span class="mw-page-title-main">Klinefelter syndrome</span> Human chromosomal condition

Klinefelter syndrome (KS), also known as 47,XXY, is a chromosome anomaly where a male has an extra X chromosome. These complications commonly include infertility and small, poorly functioning testicles. These symptoms are often noticed only at puberty, although this is one of the most common chromosomal disorders, occurring in one to two per 1,000 live births. It is named after American endocrinologist Harry Klinefelter, who identified the condition in the 1940s, along with his colleagues at Massachusetts General Hospital.

<span class="mw-page-title-main">Roberts syndrome</span> Medical condition

Roberts syndrome, or sometimes called pseudothalidomide syndrome, is an extremely rare autosomal recessive genetic disorder that is characterized by mild to severe prenatal retardation or disruption of cell division, leading to malformation of the bones in the skull, face, arms, and legs.

<span class="mw-page-title-main">13q deletion syndrome</span> Medical condition

13q deletion syndrome is a rare genetic disease caused by the deletion of some or all of the large arm of human chromosome 13. Depending upon the size and location of the deletion on chromosome 13, the physical and mental manifestations will vary. It has the potential to cause intellectual disability and congenital malformations that affect a variety of organ systems. Because of the rarity of the disease in addition to the variations in the disease, the specific genes that cause this disease are unknown. This disease is also known as:

<span class="mw-page-title-main">Tetrasomy X</span> 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.

<span class="mw-page-title-main">Pentasomy X</span> 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.

<span class="mw-page-title-main">Trisomy X</span> 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 females, but is rarely diagnosed; fewer than 10% of those with the condition know they have it.

References

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