Rearranjos cromossômicos envolvendo a presença de cromossomos marcadores extranumerário são achados citogenéticos freqüentes em pacientes que apresentam deficiência mental, alterações de crescimento, dismorfias e/ou malformações. A presença desse material é responsável por trissomia ou tetrassomia parcial de determinadas regiões cromossômicas, causando quadros clínicos distintos e inespecíficos. A variabilidade fenotípica está relacionada principalmente com os diferentes graus de mosaicismo, os genes presentes na região adicional, o cromossomo de origem, entre outros fatores. Sendo assim, a caracterização desse material cromossômico é de importância fundamental para a determinação do prognóstico e do aconselhamento genético dos pacientes e suas famílias. O presente estudo teve como objetivo a análise de cromossomos marcadores extranumerários por meio de técnicas de citogenética convencional e molecular. Foram selecionados onze pacientes que são acompanhados pelo o Serviço de Genética Médica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto USP, todos com diagnóstico citogenético convencional por bandeamentos GTG de cromossomo marcador extranumerário. Para determinação da origem e caracterização dos cromossomos marcadores foram aplicadas as técnicas de Cariótipo Espectral (SKY) e de Hibridação in situ Fluorescente (FISH). Em dez pacientes foi possível determinar a origem e composição dos marcadores. Dois pacientes apresentam cromossomos marcadores identificados como duplicações invertidas do cromossomo 15, com cariótipos definidos, respectivamente, como 47,XY,+idic(15)(pterq15::q15pter) e 47,XX,+idic(15)(pterq21::q21p11.2), um paciente possui cromossomo marcador derivativo do cromossomo 15, com cariótipo 47,XX,+der(15)(pterq21) e dois pacientes, sendo uma menina e seu pai, possuem cromossomos marcadores derivativos do cromossomo 15 com cariótipos, respectivamente, 48,XX,+2der(15)(pterq12) e 48,XY,+2der(15)(pterq12). Dois pacientes possuem cromossomos marcadores derivativos do cromossomo 9, com cariótipos definidos, respectivamente, como 47,XX,+der(9)(pterq21) e 47,XX,+der(9)(pterq32) e um paciente apresenta cromossomo derivativo do cromossomo 4 [47,XX,+der(4)(p16q21)[9]/48,XX,+der(4)(p16q21),+mar[91]]. Um paciente possui um cromossomo marcador translocado derivativo do cromossomo 22 [47,XY,+der(22)t(11;22)(q25:q11.2)] e outro paciente, um cromossomo translocado derivativo do cromossomo 15 [47,XY,+der(15)t(15;16)(q13;q13)], ambos herdados de mães portadoras de translocações aparente balanceadas. Em um caso, não foi possível a caracterização dos cromossomos marcadores por meio das técnicas aplicadas. Há uma grande variação fenotípica associada à presença de cromossomos marcadores e muitas vezes o prognóstico e o aconselhamento genético são difíceis de determinar. As técnicas de citogenética molecular são ferramentas importantes para a caracterização dos cromossomos marcadores, tanto durante o pré-natal, como para uma família que já possui um membro afetado, auxiliando no mapeamento gênico de cada região envolvida para futura correlação cariótipo-genótipo-fenótipo. / Chromosomal rearrangements involving supernumerary marker chromosomes are frequently found in patients with mental retardation, growth defects and malformations. The genetic materials presented in trisomy/tetrasomy are responsible by distinct and unspecific clinical symptoms. The phenotypic variation is related mainly to different mosaicismo degrees, genetic content and chromosomal origin. Thus, the characterization of marker chromosomes is important to determine the prognosis and genetic counseling to the patients and their families. The aim of this study was to analyze supernumerary marker chromosomes using conventional and molecular cytogenetic techniques. Eleven patients were included in this study, all assisted in Medical Genetic Division of Clinical Hospital of School of Medicine of Ribeirao Preto USP. They all presented supernumerary marker chromosomes detected by GTG band. The origin and composition were determined using Spectral Karyotype (SKY) and Fluorescence in situ Hybridization (FISH) techniques. To ten patients, the origin and composition were determined. Two patients presented inverted duplications of chromosome 15, and their karyotype were defined as 47,XY,+idic(15)(pterq15::q15pter) and 47,XX,+idic(15)(pterq21::q21p11.2), one patient had a derivative chromosome 15, with karyotype 47,XX,+der(15)(pterq21), and two patients, a girl and her father, had two derivatives chromosomes 15, with karyotypes 48,XX,+2der(15)(pterq12) e 48,XY,+2der(15)(pterq12), respectively. Two patients presented derivative chromosomes 9 and their karyotype were defined as 47,XX,+der(9)(pterq21) and 47,XX,+der(9)(pterq32), and one patient had a derivative chromosome 4, with karyotype 47,XX,+der(4)(p16q21)[9]/48,XX,+der(4)(p16q21),+mar[91]. One patient had a translocated marker chromosome, derivative 22, [47,XY,+der(22)t(11;22)(q25:q11.2)] and another patient had a translocated marker chromosome, derivative 15 [47,XY,+der(15)t(15;16)(q13;q13)]. In one case, was not possible to define the origin and composition of the marker chromosome using SKY and FISH techniques. A large phenotypic variation is associated with supernumerary marker chromosomes and many times, the prognosis and genetic counseling is difficult to determine. The molecular cytogenetic techniques are important tools to its characterization, during prenatal diagnosis or to a family with an affected person, helping the genetic mapping of each region to a future correlation karyotype-genotype-phenotype.

Rearranjos cromossômicos envolvendo a presença de cromossomos marcadores extranumerário são achados citogenéticos freqüentes em pacientes que apresentam deficiência mental, alterações de crescimento, dismorfias e/ou malformações. A presença desse material é responsável por trissomia ou tetrassomia parcial de determinadas regiões cromossômicas, causando quadros clínicos distintos e inespecíficos. A variabilidade fenotípica está relacionada principalmente com os diferentes graus de mosaicismo, os genes presentes na região adicional, o cromossomo de origem, entre outros fatores. Sendo assim, a caracterização desse material cromossômico é de importância fundamental para a determinação do prognóstico e do aconselhamento genético dos pacientes e suas famílias. O presente estudo teve como objetivo a análise de cromossomos marcadores extranumerários por meio de técnicas de citogenética convencional e molecular. Foram selecionados onze pacientes que são acompanhados pelo o Serviço de Genética Médica do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto USP, todos com diagnóstico citogenético convencional por bandeamentos GTG de cromossomo marcador extranumerário. Para determinação da origem e caracterização dos cromossomos marcadores foram aplicadas as técnicas de Cariótipo Espectral (SKY) e de Hibridação in situ Fluorescente (FISH). Em dez pacientes foi possível determinar a origem e composição dos marcadores. Dois pacientes apresentam cromossomos marcadores identificados como duplicações invertidas do cromossomo 15, com cariótipos definidos, respectivamente, como 47,XY,+idic(15)(pterq15::q15pter) e 47,XX,+idic(15)(pterq21::q21p11.2), um paciente possui cromossomo marcador derivativo do cromossomo 15, com cariótipo 47,XX,+der(15)(pterq21) e dois pacientes, sendo uma menina e seu pai, possuem cromossomos marcadores derivativos do cromossomo 15 com cariótipos, respectivamente, 48,XX,+2der(15)(pterq12) e 48,XY,+2der(15)(pterq12). Dois pacientes possuem cromossomos marcadores derivativos do cromossomo 9, com cariótipos definidos, respectivamente, como 47,XX,+der(9)(pterq21) e 47,XX,+der(9)(pterq32) e um paciente apresenta cromossomo derivativo do cromossomo 4 [47,XX,+der(4)(p16q21)[9]/48,XX,+der(4)(p16q21),+mar[91]]. Um paciente possui um cromossomo marcador translocado derivativo do cromossomo 22 [47,XY,+der(22)t(11;22)(q25:q11.2)] e outro paciente, um cromossomo translocado derivativo do cromossomo 15 [47,XY,+der(15)t(15;16)(q13;q13)], ambos herdados de mães portadoras de translocações aparente balanceadas. Em um caso, não foi possível a caracterização dos cromossomos marcadores por meio das técnicas aplicadas. Há uma grande variação fenotípica associada à presença de cromossomos marcadores e muitas vezes o prognóstico e o aconselhamento genético são difíceis de determinar. As técnicas de citogenética molecular são ferramentas importantes para a caracterização dos cromossomos marcadores, tanto durante o pré-natal, como para uma família que já possui um membro afetado, auxiliando no mapeamento gênico de cada região envolvida para futura correlação cariótipo-genótipo-fenótipo. / Chromosomal rearrangements involving supernumerary marker chromosomes are frequently found in patients with mental retardation, growth defects and malformations. The genetic materials presented in trisomy/tetrasomy are responsible by distinct and unspecific clinical symptoms. The phenotypic variation is related mainly to different mosaicismo degrees, genetic content and chromosomal origin. Thus, the characterization of marker chromosomes is important to determine the prognosis and genetic counseling to the patients and their families. The aim of this study was to analyze supernumerary marker chromosomes using conventional and molecular cytogenetic techniques. Eleven patients were included in this study, all assisted in Medical Genetic Division of Clinical Hospital of School of Medicine of Ribeirao Preto USP. They all presented supernumerary marker chromosomes detected by GTG band. The origin and composition were determined using Spectral Karyotype (SKY) and Fluorescence in situ Hybridization (FISH) techniques. To ten patients, the origin and composition were determined. Two patients presented inverted duplications of chromosome 15, and their karyotype were defined as 47,XY,+idic(15)(pterq15::q15pter) and 47,XX,+idic(15)(pterq21::q21p11.2), one patient had a derivative chromosome 15, with karyotype 47,XX,+der(15)(pterq21), and two patients, a girl and her father, had two derivatives chromosomes 15, with karyotypes 48,XX,+2der(15)(pterq12) e 48,XY,+2der(15)(pterq12), respectively. Two patients presented derivative chromosomes 9 and their karyotype were defined as 47,XX,+der(9)(pterq21) and 47,XX,+der(9)(pterq32), and one patient had a derivative chromosome 4, with karyotype 47,XX,+der(4)(p16q21)[9]/48,XX,+der(4)(p16q21),+mar[91]. One patient had a translocated marker chromosome, derivative 22, [47,XY,+der(22)t(11;22)(q25:q11.2)] and another patient had a translocated marker chromosome, derivative 15 [47,XY,+der(15)t(15;16)(q13;q13)]. In one case, was not possible to define the origin and composition of the marker chromosome using SKY and FISH techniques. A large phenotypic variation is associated with supernumerary marker chromosomes and many times, the prognosis and genetic counseling is difficult to determine. The molecular cytogenetic techniques are important tools to its characterization, during prenatal diagnosis or to a family with an affected person, helping the genetic mapping of each region to a future correlation karyotype-genotype-phenotype.

Les chromosomes marqueurs surnuméraires (CMS) sont définis comme des chromosomes de structure anormale qui ne peuvent pas être identifiés ni caractérisés de façon non ambigüe par les techniques de cytogénétique conventionnelle seules et qui sont de taille égale ou plus petits qu’un chromosome 20 de la même métaphase. La prévalence de cette anomalie chromosomique est estimée à 0,071% en post-natal, 0,075% en diagnostic prénatal et 0,288% chez les patients atteints de retard mental et/ou du développement. Chez les patients infertiles, la fréquence des CMS est estimée à 0,122% et varie selon le sexe. Les CMS sont sans conséquence clinique dans 70% des cas. Dans un tiers des cas, ils peuvent être responsables de nombreuses anomalies du développement et de la reproduction humaine. A ce jour, il existe très peu d’études de caractérisation des CMS permettant une cartographie précise des gènes présents. Dans ce travail, nous avons étudié une série de huit CMS par cytogénétique conventionnelle, FISH (fluorescent in situ hybridization) et CGH array (array comparative genomic hybridization). Nous avons établi une cartographie des gènes présents dans ces CMS. L’étude de la relation génotype-phénotype des patients nous a permis de proposer l’implication de certains gènes candidats dans des anomalies du développement et de la reproduction humaine. Notre étude de l’implication des CMS dans les anomalies du développement humain s’est basée sur l’étude cytogénétique de trois fœtus. Les deux premiers fœtus étaient porteurs d’un CMS(20) en anneau. Le sujet 1 présentait un retard de croissance intra-utérin (RCIU) et une dysmorphie cranio-faciale. Le sujet 2 n’avait pas d’anomalies particulières à part une obésité diagnostiquée à l’âge de quatre mois. La taille de ces CMS(20) était de 13,6 Mb pour le sujet 1 et 4,8 Mb pour le sujet 2. Le gène SSTR4 présent sur le CMS(20) du sujet 2 code pour un récepteur de la somatostatine. Cette hormone joue un rôle dans le comportement alimentaire. Le troisième fœtus présentait un hygroma kystique et un RCIU associé à un CMS(13) néocentromérique. Les explorations par CGH array ont révélé un gain chromosomique de la région 13q21.1qter de 39 Mb contenant 80 gènes dont GPC5, GPC6, SPRY2, EFNB2, SOX1 et DZIP1. La modification d’expression de ces gènes est susceptible d’être responsable du phénotype des sujets étudiés.Notre étude de l’implication des CMS dans les anomalies de la reproduction humaine s’est basée sur l’étude cytogénétique de cinq patients qui présentaient des troubles de la fertilité (anomalies de la spermatogenèse, insuffisance ovarienne prématurée, syndrome des ovaires polykystiques et fausses couches spontanées). Les CMS explorés par CGH array correspondaient aux régions chromosomiques 15q11.2 (3,6 Mb), 21p11.2 (0,266 Mb), 6p11.2q12 (9 Mb) et 20p11.21 (3,3 Mb). Le CMS d’une des patientes ne contenait pas d’euchromatine et une autre patiente était porteuse de deux CMS d’origines chromosomiques différentes. Plusieurs gènes candidats (POTE B, BAGE et THBD) ont pu être identifiés. La modification de leur expression ainsi que des effets mécaniques ou biochimiques perturbant la méiose et la maturation des gamètes pourraient être responsables des troubles de la fertilité observés chez ces patients. L’étude des CMS par CGH array nous a permis de caractériser précisément les points de cassure des CMS, leur taille et leur composition génétique afin de cartographier les gènes présents dans les CMS et d’établir des relations entre le génotype et le phénotype des patients. / Small supernumerary marker chromosomes (sSMC) are defined as structurally abnormal chromosomes which cannot be unambiguously identified or characterized by conventional banding cytogenetic techniques alone and are generally equal in size or smaller than a chromosome 20 of the same metaphase spread. sSMC frequency is estimated at 0.071% in postnatal cases, 0.075% in prenatal cases, and 0.288% for mentally and/or development retarded patients. In infertile patients cases, sSMC frequency is estimated at 0.122% and is different in male (0.165%) and female infertility (0.022%). sSMC have no clinical consequences in 70% of the cases. In one third of the cases, they can be responsible for various human development and reproduction anomalies. To date, only a few studies precisely characterizing the sSMC contents have been performed.In this study, we used conventional cytogenetics, FISH (fluorescent in situ hybridization) and array CGH (array comparative genomic hybridization) to characterize eight sSMC and to precisely localize the genes included. The study of the genotype-phenotype correlations of the patients led us to suppose the implication of some candidate genes in human development and reproduction anomalies.Our study of the implication of sSMC in human development anomalies was based on the cytogenetic study of three fetuses. The first two fetuses carried a ring sSMC(20). Case 1 presented with intrauterine growth retardation and craniofacial dysmorphism. Case 2 had a normal phenotype except for obesity diagnosed at the age of four months. The size of these sSMC(20) was approximately 13,6 Mb for case 1 and 4,8 Mb for case 2. The SSTR4 gene located on the case 2 sSMC(20) is coding for one of the somatostatin receptor. This hormone has multiple effects on variable cells and is implicated in the regulation of food behavior, which could explain the obesity of case 2. Case 3 presented with intrauterine growth retardation and a cystic hygroma associated with a neocentric sSMC(13). Array CGH investigations showed a 32.9 Mb gain from 13q31.1 to 13qter region containing 80 genes. Among these genes, six genes could be involved in the phenotype of the proband (GPC5, GPC6, SPRY2, EFNB2, SOX1 and DZIP1). The expression modification of these genes could be responsible for the phenotype observed.Our study of the implication of sSMC in human reproduction anomalies was based on the cytogenetic study of five patients presenting fertility troubles (spermatogenesis impairment, ovarian insufficiency, polycystic ovary syndrome and repeated abortions). The sSMC explored by array CGH corresponded to the 15q11.2 region (3.6 Mb), the 21p11.2 region (0.266 Mb), the 6p11.2q12 region (9 Mb) and 20p11.21 region (3.3 Mb). The sSMC of one of the patients did not contain euchromatin and one patient carried two sSMC derived from two different chromosomes. Among the genes present on the sSMC, some candidate genes (POTE B, BAGE and THBD) have been identified. The modification of their expression and mechanical or biochemical effects of the sSMC impeding meiosis could be directly responsible for the fertility trouble observed in these patients. A detailed molecular cytogenetic investigation using array CGH allowed us to precisely characterize the chromosomal breakpoints, the size and genomic constitution of sSMC. This study may be helpful to address genotype–phenotype correlations and for medical and genetic counseling.

The focus of this diploma thesis is on mosaic numerical and structural chromosomal aberrations. In its theoretical part, general problems of mosaicism, its phenotypic effect, mechanisms of origin, related epigenetic modifications, and diagnostic options are described. The methodical part of the thesis then primarily refers to fluorescence in situ hybridization (FISH) and its application in the diagnostics of mosaicism. This method was used in the examination of 29 patients with numerical as well as structural abnormalities of autosomes or gonosomes with proven or suspected mosaicism. On the basis of this analysis, possible errors of measurement were determined and data for statistic evaluation were retrieved. For the examinations of three patients an alternative of the comparative genomic hybridization, the array CGH technique, was applied. The FISH method, although being based on random selection and human factor, proved sufficient sensitivity as well as specificity in the field of low-frequency mosaicism diagnostics. The main critical factors responsible for potential misinterpretation of the data arose from inherent characteristics of the biological material, incorrect targeting of the analysis, probe instability, bleed through effect and absence of mitosis during the structural aberrations analysis.