Ada Rosenmann

Meiotic association between the XY chromosomes and unpaired autosomal elements as a cause of human male sterility

Intimate association between autosomal translocation trivalents and XY bivalents at pachytene was observed in a majority of cells of two men ascertained through primary sterility and found to be heterozygous for a 14;21 Robertsonian translocation. The association, studied by light and electron microscopy of spread first spermatocytes, was between the unpaired short arms of the normal chromosomes of the translocation trivalent and the differential axes of the XY chromosomes. In a minority of cells, this contact was not established, or not maintained, as alternative combinations between the elements available for non-homologous pairing were realized. Following a suggestion of Lifschytz and Lindsley (1972), sterility in these patients was attributed to spermatogenic arrest caused by physical contact of sex chromosomes with autosomal material and consequent interference with the normal metabolism of the sex chromosomes. Autosomal aberrations and polymorphisms, which lead to the presence of unpaired segments at meiosis, may thus play a critical role in a general mechanism of chromosomally-derived male sterility. It is proposed that such a mechanism may also be instrumental in the initiation of reproductive barriers in nature.

11‐DEOXYCORTISOL IN AMNIOTIC FLUID: PRENATAL DIAGNOSIS OF CONGENITAL ADRENAL HYPERPLASIA DUE TO 11 β‐HYDROXYLASE DEFICIENCY

The mean control level of 11‐deoxycortisol as determined by radioimmunoassay in eighty‐one human amniotic fluid samples was 1·20 ± 0·07 ng/ml. Markedly elevated levels were found at term in amniotic fluid of two pregnancies with fetuses affected with 11 β‐hydroxylase deficiency, congenital adrenal hyperplasia (135·0 and 64·0 ng/ml respectively) as well as in the maternal serum of one of these cases (28·0 ng/ml). It is suggested that the determination of 11‐deoxycortisol in amniotic fluid be a prenatal diagnostic test for 11 β‐hydroxylase deficiency congenital adrenal hyperplasia.

Dicentric X-isochromosome (Xqi dic) and pericentric inversion of No. 2 inv(2) (p15) q21) in a patient with gonadal dysgenesis

A patient with the clinical stigmata of gonadal dysgenesis is presented. Cytogenetic investigations revealed two distinct structural chromosome rearrangements. One of these, an isochromosome for the long arm of the X, proved to be a dicentric element following C‐banding. The second abnormality, an inherited familial marker, was a pericentric inversion of No. 2 {(inv 2) (p15) q21).

Genetics and Disease Expression in the CNGA3 Form of Achromatopsia: Steps on the Path to Gene Therapy.

PURPOSE Achromatopsia (ACHM) is a congenital, autosomal recessive retinal disease that manifests cone dysfunction, reduced visual acuity and color vision, nystagmus, and photoaversion. Five genes are known causes of ACHM. The present study took steps toward performing a trial of gene therapy in ACHM by characterizing the genetics of ACHM in Israel and the Palestinian Territories and analyzing retinal function and structure in CNGA3 ACHM patients from the Israeli-Palestinian population and US patients with other origins. DESIGN Case series study. PARTICIPANTS Patients with clinically suspected ACHM, cone dysfunction phenotypes, and unaffected family members were included. The protocol was approved by the local institutional review board and informed consent was obtained from all participants. METHODS Genetic analyses included homozygosity mapping and exome sequencing. Phenotype was assessed with electroretinography (ERG), optical coherence tomography, psychophysics, and photoaversion testing. MAIN OUTCOME MEASURES Single nucleotide polymorphism microarray, exome analysis, DNA sequence analysis, visual function testing including ERG, and photoaversion. RESULTS We identified 148 ACHM patients from 57 Israeli and Palestinian families; there were 16 CNGA3 mutations (5 novel) in 41 families and 5 CNGB3 mutations (1 novel) in 8 families. Two CNGA3 founder mutations underlie >50% of cases. These mutations lead to a high ACHM prevalence of ∼1:5000 among Arab-Muslims residing in Jerusalem. Rod ERG abnormalities (in addition to cone dysfunction) were detected in 59% of patients. Retinal structure in CNGA3 ACHM patients revealed persistent but abnormal foveal cones. Under dark- and light-adapted conditions, patients use rod-mediated pathways. Photoaversion was readily demonstrated with transition from the dark to a dim light background. CONCLUSIONS Among Israeli and Palestinian patients, CNGA3 mutations are the leading cause of ACHM. Retinal structural results support the candidacy of CNGA3 ACHM for clinical trials for therapy of cone photoreceptors. Efficacy outcome measures would include chromatic light-adapted psychophysics, with attention to the photoreceptor basis of the response, and quantitation of photoaversion.

Refractive profile in oculocutaneous albinism and its correlation with final visual outcome

Purpose To evaluate the prevalence of refractive errors in different subtypes of oculocutaneous albinism, and to see if there is any correlation between refractive errors and final visual outcome in this population. Patients/methods This is a retrospective study of 132 albino patients, ranging in age from 0.5 to 35 years. They were divided into four subtypes: OCA1A, OCA1B and OCA1C, and OCA2. Refractive errors were evaluated objectively by cycloplegic refraction and subjectively in cooperative patients. Best corrected visual acuity was assessed binocularly. Refractive errors were divided into three groups—hypermetropia, myopia and astigmatism—to avoid the use of spherical equivalent. Results Refractive errors were mainly astigmatism and hypermetropia. The OCA1A group showed high hypermetropia (≥5 dioptres) in 43.4% of patients, reaching significantly higher levels than in other subgroups (p=0.007). Mean visual acuity in logMAR was: OCA1A=0.81, OCA1B=0.64, OCA1C=0.61 and OCA2=0.48. Astigmatism averaged 2.1 dioptres (consistently with-the-rule), and it was homogeneously distributed between all subgroups (53%). Conclusions The poorest visual acuity was found in those with OCA1A, which was associated with the highest rate of high hypermetropia (statistically significant different from other subgroups). Astigmatism was the most common visually significant refractive error across all subtypes of albinism. These results may help to clarify the prevalence of refractive errors in albino patients and aid the prediction of visual outcome in this heterogeneous population.

Original articleGenetics and Disease Expression in the CNGA3 Form of Achromatopsia: Steps on the Path to Gene Therapy

PURPOSE Achromatopsia (ACHM) is a congenital, autosomal recessive retinal disease that manifests cone dysfunction, reduced visual acuity and color vision, nystagmus, and photoaversion. Five genes are known causes of ACHM. The present study took steps toward performing a trial of gene therapy in ACHM by characterizing the genetics of ACHM in Israel and the Palestinian Territories and analyzing retinal function and structure in CNGA3 ACHM patients from the Israeli-Palestinian population and US patients with other origins. DESIGN Case series study. PARTICIPANTS Patients with clinically suspected ACHM, cone dysfunction phenotypes, and unaffected family members were included. The protocol was approved by the local institutional review board and informed consent was obtained from all participants. METHODS Genetic analyses included homozygosity mapping and exome sequencing. Phenotype was assessed with electroretinography (ERG), optical coherence tomography, psychophysics, and photoaversion testing. MAIN OUTCOME MEASURES Single nucleotide polymorphism microarray, exome analysis, DNA sequence analysis, visual function testing including ERG, and photoaversion. RESULTS We identified 148 ACHM patients from 57 Israeli and Palestinian families; there were 16 CNGA3 mutations (5 novel) in 41 families and 5 CNGB3 mutations (1 novel) in 8 families. Two CNGA3 founder mutations underlie >50% of cases. These mutations lead to a high ACHM prevalence of ∼1:5000 among Arab-Muslims residing in Jerusalem. Rod ERG abnormalities (in addition to cone dysfunction) were detected in 59% of patients. Retinal structure in CNGA3 ACHM patients revealed persistent but abnormal foveal cones. Under dark- and light-adapted conditions, patients use rod-mediated pathways. Photoaversion was readily demonstrated with transition from the dark to a dim light background. CONCLUSIONS Among Israeli and Palestinian patients, CNGA3 mutations are the leading cause of ACHM. Retinal structural results support the candidacy of CNGA3 ACHM for clinical trials for therapy of cone photoreceptors. Efficacy outcome measures would include chromatic light-adapted psychophysics, with attention to the photoreceptor basis of the response, and quantitation of photoaversion.

Chromatin-positive Klinefelter's syndrome with undetectable peripheral FSH levels

An 18 year old phenotypic man is described with chromatin-positive Klinefelters syndrome and undetectable peripheral human follicle stimulating hormone levels. The subject manifested chromosomal mosaicism consisting of three stem cell lines (45X; 46XY; and 47XXY). Testicular biopsy specimen showed germinal cell aplasia: the tubules were lined by Sertoli cells only, whereas the Leydig cells appeared normal. Serum human follicle stimulating hormone levels were undetectable and rose to only 5 mIU/ml after the administration of luteinizing hormone releasing hormone. Serum human luteinizing hormone varied between normal and moderately elevated values, and serum testosterone was in the low normal range. We discuss the features which distinguish this syndrome from isolated gonadotropin deficiency and from classic germinal cell aplasia. We suggest that the patient represents a new variant of Klinefelters syndrome, with failure of human follicle stimulating hormone release secondary to prolonged hypersecretion.

Chromosomally derived sterile mice have a ‘fertile’ active XY chromatin conformation but no XY body

We have previously shown that the sex chromosome bivalent of normal, fertile male mice possesses extensive regions of potentially active chromatin, even though, as has been shown by others, certain X-linked genes, and perhaps most of the X chromosome, become inactivated during pachytene. The male meiosis of a fertile (2; 11) translocation carrier mouse, a chromosomally derived sterile (11; 19) translocation carrier and that of normal mice is compared. In situ nick translation shows a similar DNase I sensitivity pattern in the sex chromosomes of all examined mice. The X chromosome has four regions of potentially active chromatin conformation, two at the ends of the chromosome and two interstitial ones, coinciding with flexures which become prominent towards late pachytene. The Y chromosome is almost uniformly sensitive to DNase I. The similarity of chromatin conformation patterns in fertile and sterile mice is compatible with the hypothesis that unscheduled transcription of particular genes, possibly included in the active conformation regions, occurs in mice which become sterile. In the sterile (11; 19) translocation carrier, a vast majority of all pachytenes are “associated”: usually one unpaired segment of chromosome 19 is in end-to-end contact with the X chromosome. The tips of both unpaired segments of chromosome 19 have a thickened axis and display a peculiar chromatin appearance, similar to the modification of the centromeric tip of the X chromosome. Telomeric unpairedness of certain chromosome segments seems to be conducive to ausotome-X chromosome association. We suggest that compartmentalization of the nucleus into an autosome mass and a fully developed, protruding, metabolically quiescent XY body, is a precondition for the normal progressing of meiosis. In the associated cells, the autosomal quadrivalent anchors the XY bivalent among the autosomes; as a consequence no XY body is formed. This interference with the course of compartmentalization leads to the abolishment of inactivation of part or all of the potentially active genes and results in meiotic arrest, and hence in sterility.

Prenatal diagnosis of oculocutaneous albinism type I: review and personal experience.

ABSTRACT Oculocutaneous albinism type I (OCA I) comprises autosomal recessive syndromes of hypopigmentation and low vision, caused by the lack of tyrosinase activity. Affected families seek genetic counseling and prenatal diagnosis as preventive measures. Until recently, prenatal diagnosis of OCA I was achieved by histologic and electron microscopic examination of fetal skin biopsies. Lately, a molecular genetic approach has become possible by the identification of the two mutated copies of the TYR gene, coding the tyrosinase, in which over 60 mutations have been identified.We report here our experience in prenatal diagnosis of OCA I using the two strategies. Thirty-four prenatal tests were performed in fetuses at risk for OCA I. In 31 cases the diagnosis was made in fetal scalp biopsies using the histological approach. The microscopic observations revealed normal melanogenesis in 26 biopsies. Five albino fetuses were diagnosed by the demonstration of arrest of melanogenesis in early stages I and II. In three pregnancies, molecular genetic tests were performed on DNA extracted from amniocytes, using direct mutation analysis (in one), and complemented by linkage analysis (in two). One albino and two normally pigmented fetuses were diagnosed.The prenatal molecular genetic test can be applied to families when at least one mutation is diagnosed in the albino patient. The histological approach is applicable in all families at risk for OCA I.

A long unidentifiable extra chromosomal segment--a possible duplication of human 7q.

Limitation of current techniques in identifying extra chromosomal segments arising de novo is illustrated by a putative case of a duplication of the long arm of chromosome 7. The propositus, demonstrating multiple congenital anomalies and severe mental retardation, had a large extra segment of chromatin on chromosome 7q that was absent in his parents. The banding pattern of this segment resembled that of the long arm of chromosomes 7, 8, or 9. Various procedures indicated that the additional material did not include the secondary constriction of 9q. The phenotype of the propositus did not fit well with that of trisomy 8.