Search

We have analysed the spread of X inactivation in an individual with an unbalanced 46,X,der(X)t(X;10)(q26.3;q23.3) karyotype. Despite being trisomic for the region 10q23.3-qter, both the proband and her aunt with the same karyotype presented only with secondary amenorrhoea and lacked any features normally associated with trisomy of distal 10q. Cytogenetic and molecular studies showed that the derivative X;10 chromosome was exclusively inactive. Transcribed polymorphisms were identified in five genes contained within the translocated region of chromosome 10 and were used to perform allele-specific transcription studies. We showed that four of the genes studied are inactive on the derivative chromosome, directly demonstrating the spread of X inactivation over some 30 Mb of autosomal DNA. However, the most distal gene examined remained active, indicating that this spreading was incomplete. In contrast to the gene expression data, replication timing studies showed no spreading of late replication into the translocated portion of 10q. We conclude that silencing of autosomal genes by X inactivation can occur without a delay in the replication timing of the surrounding chromatin. Our findings support the hypothesis that autosomal chromatin lacks certain features present on the X chromosome that are required for the effective spread and/or maintenance of X inactivation.

We have collected from the literature adult nonmosaic women with the following aberrant X chromosomes: Xp- (52), Xq- (67), idic(Xp-)(10), idic(Xq-)(9), and interstitial deletions (12). Lack of Xp, and especially Xcen-Xp11 (b region), may cause full-blown Turner syndrome. However, individual Turner symptoms, including gonadal dysgenesis, otherwise seem to be randomly distributed with respect to the different Xp and Xq deletions, although breakpoints distal to Xq25 do not give rise to any phenotypic anomalies except in a few cases of secondary amenorrhea or premature menopause. Of the carriers of an Xp- or Xq- chromosome, 65% and 93%, respectively, suffer from ovarian dysgenesis, whereas all idic(Xp-) and idic(Xq-) chromosomes cause primary or secondary amenorrhea. Xq deletions do not induce specific symptoms different from those caused by Xp deletions. Lack of the tip of Xp has led in 46/52 cases to short stature, but 43% of the Xq- carriers are also short. To explain these observations, we propose the following hypothesis. Since deletions of truly inactivated regions do not seem to cause any symptoms, we assume that the b region (Xcen-p11) always stays active in a normal inactive X, but is inactivated in deleted X chromosomes, especially in Xq- chromosomes. In some cases, inactivation may spread to the tip of Xp; this would explain the apparently variable behavior of the Xg and STS genes, and the short stature of some Xq- carriers. Full chromosome pairing seems to be a prerequisite for the viability of oocytes and thus for gonadal development. Deleted X chromosomes necessarily leave a portion of the normal X unpaired and isodicentrics probably interfere with pairing, resulting in atresia of oocytes. The role played by the "critical region" (Xq13-q24) in ovarian development is still unclear.

The effects of small, distal Xq deletions (Xq26----qter) have been reviewed in light of three cases of our own and five from the literature. The symptoms caused by such deletions range from apparently none through irregular menstruation to secondary amenorrhea (or premature menopause) to primary amenorrhea. That the abnormal chromosome has any effects when it is inactivated may best be explained by one or by a combination of the following hypotheses. (1) the Xq-chromosome might exert an effect during development when cells in which it is active compete with cells in which it is inactivated, assuming that the inactivation of the two X chromosomes is originally random. (2) a more probable hypothesis is that there is a position effect when a break has occurred in the critical region Xq13----q27 which apparently must be intact in both X chromosomes to allow normal development of the ovaries. (3) this position effect might, in turn, affect the oocytes (and thus the ovary) after the inactive X chromosome is reactivated before meiosis or the deletion as such might have a direct effect on the ovaries.

The sexual development of 14 girls with non-mosaic monocentric 46,X,iXq karyotype was studied. Seven out of eight girls were found to have immature secondary sexual characteristics and amenorrhoea, a finding greatly contrasting with that in Triplo-X girls. The relative ineffectiveness of the isochromosome Xq in maintaining fertility may be due to the absence of one short arm, which probably also carries a gonadal determinant. Alternatively, the presence of two inactivation sites on one isochromosome may render the gonadal determinants inactive at an important stage in gonadal development.

A partial long arm deletion of one X chromosome was observed in a patient with secondary amenorrhea and with no features of Turner's syndrome. It was shown that the deleted X chromosome was the inactivated one in all metaphases of the lymphocyte culture and of the tissue culture from gonadal biopsy. The patient was detected during a cytogenetic study of secondary amenorrhea of ovarian origin.

Cytogenetic investigations were carried out on 103 women presenting with either primary (n = 88) or secondary (n = 15) amenorrhea. A sex chromosome anomaly was found in 26% and 33% of these patients, respectively. Other studies on women with primary amenorrhea have found a similar or even higher percentage of patients with an abnormal karyotype. It is therefore suggested that all women with absence of menstruation after the age of 16 years should be investigated cytogenetically. The surprisingly high percentage of pathological karyotypes among the secondary amenorrhea group does indicate that sex chromosome anomalies cannot be ruled out in women who have had apparently normal ovarian function for at least some time, and therefore more patients from this group should be selected for chromosome analysis.

The correlations of abnormal X chromosome constitutions and the resulting phenotypes in the human female are reviewed. The following hypotheses put forward to explain these correlations are discussed in detail: (1) The damage is done before X inactivation; (2) An effect is exerted between reactivation of the X chromosome(s) and meiosis in oocytes; (3) A recessive gene(s) in hemizygous condition might be expressed in the cases in which the same X is active in all cells; (4) A change in the number of presumed active regions on the inactive X chromosomes might have an effect; (5) A position effect, in that the region Xq13-q27 has to be intact in both X chromosomes to allow normal development, may be responsible; (6) An effect during the period when cells with different inactivation patterns compete is a probability; (7) The original X inactivation may be neither regular nor random. The conclusion reached is that the phenotypic effects of a specific X chromosome aberration may be simultaneously exerted through different pathways (Tables 1 and 2). Hypotheses (2), (4), (5), and (6) are considered probable. Hypothesis (3) has been discarded, and there is very little evidence for hypotheses (1) and (7).

Cytogenetic investigations were carried out on 150 individuals. Out of these 107 were females and 43 males. Eighty seven of the above (43 males and 44 females) had been referred for sterility. Sixty three patients had primary amenorrhea and had been referred directly to this laboratory by clinicians, having been suspected of genetic abnormalities. Twenty-two cases (14.7%) involved in this study chromosomal abnormalities and seven cases (4.7%) showed chromosomal polymorphism. Of the 107 females (44 sterile and 63 with primary amenorrhea), 11 (10.2%) showed numerical or structural sex chromosomal abnormalities. Five patients (4.67%) showed chromosomal polymorphism (involving the paracentromeric and centromeric regions of chromosomes 1 and 9, double satellites, and giant satellites. Of the 43 males, 11 (25.59%) showed numerical and structural abnormalities. Ten cases were anomalies involving the sex chromosomes. One case of a triple autosomal translocation in an otherwise phenotypically normal azoospermic male was of particular interest. Two cases (4.65%) showed double satellites of the acrocentrics.

Utilizing the 5-bromo-deoxyuridine (BrdU) incorporation technique, we have recently studied the DNA replication kinetics in a dicentric X chromosome, formed by long arm-to-long arm fusion at band q23, for a 16-year-old black female with primary amenorrhea. The patient has a karyotype 45,X/46,X,dic(X)(q23). In the buccal smear the presence of X chromatin was found in 33% of the cells examined. The Barr bodies are large and 21% of them are bipartite. DNA replication studies were performed on the patient's lymphocytes by the thymidine pulse (T-pulse) method and confirmed comparatively by the BrdU pulse (B-pulse) method. The results indicate that the dicentric X chromosome is always late-replicating. The replication pattern is symmetric on both sides of the breakpoint and the replication sequence is, in order, p11, p22, q1(1-3), q22, q23, p21, and q21. This finding is comparable to those of other investigators and supports the theory that there exist two inactivation centers in the dicentric X chromosome, located on or near the q21 band.

Three sisters with XY gonadal dysgenesis are presented. All of them have primary amenorrhea and breast development, and in two, a gonadal tumor, seminoma (dysgerminoma) was found. The danger of gonadal neoplasm in XY females with normal female build is emphasized.

This paper presents the clinical and cytogenetic findings in a female patient with secondary amenorrhea and normal phenotype. Some difficulties related to karyotype-phenotype correlation are discussed.

A comparison of the sequence of DNA replication in an isodicentric (idic) X chromosome was made between peripheral blood lymphocytes and skin fibroblasts from a 33-year-old female with primary amenorrhea, somatic stigmata of Turner syndrome, and normal stature and intelligence. The patient had a karyotype 45,X/46,X,idic(X)(q27.1) to lymphocytes and 46,X,idic(X)(q27.1) in skin fibroblasts. Both centromeric regions of the idic X showed C-staining but only one primary constriction. BrdU-33258 Hoechst-Giemsa techniques were used to analyze regional DNA replication patterns. The idic X chromosome was always late replicating in lymphocytes and skin fibroblasts, except that about 1-2% of cells completed replication simultaneously in both normal and idic X chromosomes. Fifty-six percent of the asymmetric patterns in lymphocytes showed an equal proportion of early and late functional and non-functional centromere halves. In skin fibroblasts, 60.8% of cells were asymmetric: the functional half tended to replicate later than the non-functional half. Some differences were observed between these two cell types. As examples, band q23 was late replicating in lymphocytes, but early replicating in fibroblasts; q25 was intermediate to late replicating in lymphocytes, but one of the last bands to complete replication in fibroblasts. Thus, different cell typed influenced the replication kinetics of the idic(X). Furthermore, several variants of the replication sequence were found in both cell types. The findings support the hypothesis that the control of DNA replication in the inactive X chromosome is multifocal, and suggest that the active idic X chromosome replication may reflect a relative lack of self-control or heterogeneity of cell population.

A translocation of genetic material involving the long arm of the X chromosome and the heterochromatic portion of the Y chromosome is reported in a young woman. The phenotypic effect of this translocation and loss of almost half of the long arm of the X chromosome is described.

A sex-chromatin-positive woman without stunted growth, but with primary amenorrhea, and some stigmas of pure gonadal dysgenesis had the chromosome constitution 45,X/46,Xt(X;X)(q27;q27). The abnormal chromosome formed a large Barr body and was late-labeling. The chromosome consisted of two X chromosomes attached by their long arms (end-to-end), both apparently having the partial distal deletion. Both centromeric regions showed C-staining but only one constriction. The chromosome is interpreted as an isodicentric with only one centromere functioning. Some problems of phenotype-karyotype correlations are discussed.