1
|
Tang M, Tian X, Luo J, Zhang X, Ran S, Xiong J, Chen Y, Chen G. Twin-Twin Transfusion Syndrome After Radiofrequency Ablation in Dizygotic Monochorionic Triamniotic Triplet Pregnancy With Sex Discordance: A Case Report. Front Med (Lausanne) 2022; 9:924356. [PMID: 35847790 PMCID: PMC9280862 DOI: 10.3389/fmed.2022.924356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background We report a case of dizygotic monochorionic triamniotic triplet pregnancy. Twin-twin transfusion syndrome was subsequently diagnosed combined with sex discordance in the two surviving fetuses after one fetus was reduced, which is extremely rare and has not been previously reported. Case Presentation After reducing one fetus by radiofrequency ablation of a monochorionic triamniotic triplet pregnancy, twin-twin transfusion syndrome was subsequently diagnosed combined with sex discordance in the two surviving fetuses. Amniotic fluid for chromosome analysis showed normal karyotype 46, XY/46, XX of the donor and recipient fetus, and short tandem repeat (STR) analysis revealed dizygotic twins. Conclusions Through this is an unusual case, we aim to emphasize the importance of accurate diagnosis of chorionicity and zygosity in sex discordant triplet pregnancy, which is the key to appropriate clinical management.
Collapse
Affiliation(s)
- Mingming Tang
- Department of Perinatal Surgery, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xingbo Tian
- Department of Perinatal Surgery, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jianglai Luo
- Department of Perinatal Surgery, Chongqing Health Center for Women and Children, Chongqing, China
| | - Xiaohang Zhang
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
| | - Suzhen Ran
- Department of Ultrasound, Chongqing Health Center for Women and Children, Chongqing, China
| | - Jiaojiao Xiong
- Department of Prenatal Diagnosis, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yanlin Chen
- Department of Pathology, Chongqing Health Center for Women and Children, Chongqing, China
| | - Gongli Chen
- Department of Perinatal Surgery, Chongqing Health Center for Women and Children, Chongqing, China
- *Correspondence: Gongli Chen
| |
Collapse
|
2
|
Chen J, Xu J, Chen ZH, Yin MN, Guo XY, Sun L. Case Report: Identification of Germline Chimerism in Monochorionic Dizygotic Twins. Front Genet 2021; 12:744890. [PMID: 34868215 PMCID: PMC8641794 DOI: 10.3389/fgene.2021.744890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Monochorionic twins are generally considered to be monozygotic, as monochorionic dizygotic (MCDZ) twins are extremely rare in natural pregnancies. Several studies have reported this rare occurrence, and most of these pregnancies have been conceived by assisted reproductive technology (ART). These reports mostly focused on MCDZ twin pregnancies and the childhood development of the twins; a follow-up into adulthood and the effect on their reproduction has not been reported. In this case study, we report a case of chimerism in opposite-sex MCDZ twins who were naturally conceived and have reached reproductive maturity. We collected oral mucosal, endometrial, and germ cells from the twins and evaluated their chimerism using single-nucleotide polymorphism (SNP) array and droplet digital PCR (ddPCR). The SNP array showed that they had 4,049 non-allele shared loci, and they inherited nearly 50% informative SNP loci from each parent, confirming that they are dizygotic twins. We found that the female twin had a 46, XX (2)/46, XY (78) karyotype in her peripheral blood. The SNP array confirmed that the female twin and male twin had the same blood haplotype. The ddPCR result showed 92.84 (± 1.80%) chimerism in her blood. In case of chimerism in her germline, the female twin chose preimplantation genetic testing for aneuploidy for her blastocysts. Fortunately, the patient only had blood chimerism. A healthy boy was born at 39 weeks of gestation.
Collapse
Affiliation(s)
- Juan Chen
- Department of Assisted Reproductive technology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jian Xu
- Department of Assisted Reproductive technology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhi-Heng Chen
- Department of Assisted Reproductive technology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Min-Na Yin
- Department of Assisted Reproductive technology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xin-Yu Guo
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Guangzhou General Hospital of Guangzhou Military Region, Guangzhou, China
| | - Ling Sun
- Department of Assisted Reproductive technology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
3
|
Johnson BN, Ehli EA, Davies GE, Boomsma DI. Chimerism in health and potential implications on behavior: A systematic review. Am J Med Genet A 2020; 182:1513-1529. [PMID: 32212323 DOI: 10.1002/ajmg.a.61565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 02/03/2020] [Accepted: 03/02/2020] [Indexed: 12/12/2022]
Abstract
In this review, we focus on the phenomenon of chimerism and especially microchimerism as one of the currently underexplored explanations for differences in health and behavior. Chimerism is an amalgamation of cells from two or more unique zygotes within a single organism, with microchimerism defined by a minor cell population of <1%. This article first presents an overview of the primary techniques employed to detect and quantify the presence of microchimerism and then reviews empirical studies of chimerism in mammals including primates and humans. In women, male microchimerism, a condition suggested to be the result of fetomaternal exchange in utero, is relatively easily detected by polymerase chain reaction molecular techniques targeting Y-chromosomal markers. Consequently, studies of chimerism in human diseases have largely focused on diseases with a predilection for females including autoimmune diseases, and female cancers. We detail studies of chimerism in human diseases and also discuss some potential implications in behavior. Understanding the prevalence of chimerism and the associated health outcomes will provide invaluable knowledge of human biology and guide novel approaches for treating diseases.
Collapse
Affiliation(s)
- Brandon N Johnson
- Avera Institute for Human Genetics, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA
| | - Erik A Ehli
- Avera Institute for Human Genetics, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA
| | - Gareth E Davies
- Avera Institute for Human Genetics, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA
| | - Dorret I Boomsma
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Pregnancy and Multiple Gestations. CHIMERISM 2018. [DOI: 10.1007/978-3-319-89866-7_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Uysal NŞ, Gülümser Ç, Çelik ZY, Zeyneloğlu HB, Yanık FFB. Fetal sex discordance in a monochorionic twin pregnancy following intracytoplasmic sperm injection: A case report of chimerism and review of the literature. J Obstet Gynaecol Res 2017; 44:576-582. [DOI: 10.1111/jog.13514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 08/26/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Nihal Ş. Uysal
- Department of Obstetrics and Gynecology; Faculty of Medicine, Başkent University; Ankara Turkey
| | - Çağrı Gülümser
- Department of Obstetrics and Gynecology; Faculty of Medicine, Başkent University; Ankara Turkey
| | - Zerrin Y. Çelik
- Department of Medical Genetics; Faculty of Medicine, Başkent University; Ankara Turkey
| | - Hulusi B. Zeyneloğlu
- Department of Obstetrics and Gynecology; Faculty of Medicine, Başkent University; Ankara Turkey
| | - Filiz F. B. Yanık
- Department of Obstetrics and Gynecology; Faculty of Medicine, Başkent University; Ankara Turkey
| |
Collapse
|
6
|
Dziegiel MH, Hansen MH, Haedersdal S, Barrett AN, Rieneck K, Main KM, Hansen AT, Clausen FB. Blood Chimerism in Dizygotic Monochorionic Twins During 5 Years Observation. Am J Transplant 2017; 17:2728-2732. [PMID: 28422403 DOI: 10.1111/ajt.14318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/17/2017] [Accepted: 04/05/2017] [Indexed: 01/25/2023]
Abstract
Dizygotic monochorionic twin pregnancies can result in blood chimerism due to in utero twin-to-twin exchange of stem cells. In this case, we examined the proportion of allogeneic red blood cells by flow cytometry and the proportion of allogeneic nucleated cells by digital polymerase chain reaction at 7 months and again at 5 years. We found an increase in the proportion of allogeneic cells from 63% to 89% in one twin, and a similar increase in autologous cells in the other twin from 57% to 84%. A paradigm for stem cell therapy could be modeled on this case: induction of tolerance and chimerism by antenatal transfusion of donor stem cells. The procedure would hold the promise of transplantation and tolerance induction without myeloablative conditioning for inheritable benign hematological diseases such as sickle cell disease and thalassemia.
Collapse
Affiliation(s)
- M H Dziegiel
- Department of Clinical Immunology, Blood bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine (IKM), Copenhagen University, Copenhagen, Denmark
| | - M H Hansen
- Department of Clinical Biochemistry, Nordsjaellands Hospital Hillerød, Copenhagen University Hospital, Hillerød, Denmark
| | - S Haedersdal
- Department of Clinical Immunology, Blood bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A N Barrett
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K Rieneck
- Department of Clinical Immunology, Blood bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - K M Main
- Institute of Clinical Medicine (IKM), Copenhagen University, Copenhagen, Denmark.,Department of Growth and Reproduction, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - A T Hansen
- Department of Clinical Immunology, Blood bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - F B Clausen
- Department of Clinical Immunology, Blood bank, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
7
|
Unusual Twinning Resulting in Chimerism: A Systematic Review on Monochorionic Dizygotic Twins. Twin Res Hum Genet 2017; 20:161-168. [DOI: 10.1017/thg.2017.4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Traditionally, it is understood that dizygotic (DZ) twins always have a dichorionic placenta. However, with 8% blood chimerism in DZ twins, placental sharing is probably more common than previously has been recognized. In this article, we will review all available cases of monochorionic dizygotic (MCDZ) twins. A total of 31 twins have been described in literature. A monochorionic diamniotic placenta is reported in all cases. Assisted reproductive technology is responsible for the origin of the pregnancy in 82.1% of the cases. In 15.4% of the sex-discordant twins, a genital anomaly was reported in one of the twins. Chimerism is demonstrable in 90.3% of the twins, leading to various diagnostic difficulties. As this review shows that most MCDZ twins are discovered by accident, it can be argued that it is far more common than has been assumed until now. However, the prevalence is still unclear. Awareness of MCDZ twinning is important, with subsequently correct medical strategies. Similarly, the resulting (blood) chimerism is essential to consider in diagnostic procedures, pre- and postnatally. More research on the effect of placental transfusion between sex-discordant twins is required.
Collapse
|
8
|
Urhausen C, Wolf K, Beineke A, Dierks C, Schmicke M, Einspanier A, Günzel-Apel AR. Monochorial diamniotic dizygotic twins in a German Shepherd Dog: A case report. Reprod Domest Anim 2016; 52:140-143. [DOI: 10.1111/rda.12869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/10/2016] [Indexed: 12/01/2022]
Affiliation(s)
- C Urhausen
- Unit of Reproductive Medicine of Clinics - Small Animal Clinic; University of Veterinary Medicine Hannover; Hannover Germany
| | - K Wolf
- Unit of Reproductive Medicine of Clinics - Small Animal Clinic; University of Veterinary Medicine Hannover; Hannover Germany
| | - A Beineke
- Institute for Pathology; University of Veterinary Medicine Hannover; Hannover Germany
| | - C Dierks
- Institute for Animal Breeding and Genetics; University of Veterinary Medicine Hannover; Hannover Germany
| | - M Schmicke
- Clinic for Cattle; Laboratory for Endocrinology; University of Veterinary Medicine Hannover; Hannover Germany
| | - A Einspanier
- Faculty of Veterinary Medicine; Institute of Physiological Chemistry; University of Leipzig; Leipzig Germany
| | - AR Günzel-Apel
- Unit of Reproductive Medicine of Clinics - Small Animal Clinic; University of Veterinary Medicine Hannover; Hannover Germany
| |
Collapse
|
9
|
Korsun P, Bals-Pratsch M, Ortmann O, Markus S, Germer U. Antenatal Diagnosis of Dizygotic, Monochorionic Twins Following IVF/ICSI. Geburtshilfe Frauenheilkd 2016; 76:727-730. [PMID: 27365544 DOI: 10.1055/s-0042-101024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Monochorionic twins are usually monozygotic and thus usually have the same sex. A case of monochorionic diamniotic twins following IVF/ICSI and laser treatment of the zona pellucida ("assisted hatching") is presented in which partial embryo amalgamation appears to have occurred. Discordant sex between the twins was suspected on detailed antenatal ultrasound at 13 + 3 weeks gestation and was confirmed on subsequent examinations. The sexual phenotype at birth was female for one twin and male for the other. Placental histology confirmed the monochorionic, diamniotic situation. Cytogenetic analysis of both twins was carried out postpartum on various tissues. On karyotyping of blood lymphocytes the male and female twins each had one mosaic of male and female cells. Oral mucosal cells showed normal male and female karyotypes respectively. Analysis of urothelium showed a normal result for the male infant, and a weak gonosomal mosaic with an XX and XY constellation for the female infant. At least for blood lymphocytes, a diagnosis of chimerism was proven.
Collapse
Affiliation(s)
- P Korsun
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
| | - M Bals-Pratsch
- Profertilita, Zentrum für Fruchtbarkeitsmedizin, Regensburg
| | - O Ortmann
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
| | - S Markus
- Kompetenzzentrum für Humangenetik, Gynäkologie und Laboratoriumsmedizin, Dr. Staber und Kollegen, Regensburg
| | - U Germer
- Klinik für Frauenheilkunde und Geburtshilfe der Universität Regensburg am Caritas-Krankenhaus St. Josef, Regensburg
| |
Collapse
|
10
|
Twin-to-Twin Transfusion Syndrome: Definition, Staging, and Ultrasound Assessment. Twin Res Hum Genet 2016; 19:175-83. [DOI: 10.1017/thg.2016.34] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective: The purpose of this article is to review the definition of twin-to-twin transfusion syndrome (TTTS) and the sonographic diagnostic assessment of these cases prior to therapy.Materials and Methods: The article addresses the terminology used to refer to the condition and describes the systematic ultrasound assessment of the condition, including the ultrasound diagnosis, the staging of the disease, cervical assessment and pre-operative mapping.Results: From an etymologic and medical point of view, the term ‘fetofetal transfusion’ is more appropriate than ‘TTTS’. However, as the latter, and its attendant acronym TTTS, have been widely adopted in the English language, it is impractical to change at this point. TTTS is defined sonographically in the combined presence of a maximum vertical pocket (MVP) of 8 cm or greater in one sac and 2 cm or less in the other sac, regardless of the gestational age at diagnosis. Staging of the condition using the Quintero staging system is practical, reproducible, and accepted. Transvaginal cervical length assessment should be an integral part of the ultrasound evaluation. Pre-operative mapping to anticipate the location of the placental vascular anastomoses and avoid injuring the dividing membrane is also discussed.Conclusions: The term ‘TTTS’ can continue to be used in the English medical literature. The condition can be diagnosed and assessed following a systematic ultrasound methodology. The use of such ultrasound methodology breaks the examination into a distinct set of components, assuring a comprehensive examination and proper communication among caregivers.
Collapse
|
11
|
Mayeur Le Bras A, Petit F, Benachi A, Bedel B, Oucherif S, Martinovic J, Armanet N, Tosca L, Gautier V, Parisot F, Labrune P, Tachdjian G, Brisset S. Confined blood chimerism in a monochorionic dizygotic sex discordant twin pregnancy conceived after induced ovulation. ACTA ACUST UNITED AC 2016; 106:298-303. [DOI: 10.1002/bdra.23457] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 07/31/2015] [Accepted: 09/04/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Anne Mayeur Le Bras
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - François Petit
- Laboratoire de Génétique Moléculaire; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Bettina Bedel
- Service de Gynécologie-Obstétrique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Salima Oucherif
- Service de Néonatalogie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Jelena Martinovic
- Unité de Fœtopathologie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Narjes Armanet
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Lucie Tosca
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Valérie Gautier
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Frédéric Parisot
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Philippe Labrune
- Service de Pédiatrie; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Gérard Tachdjian
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| | - Sophie Brisset
- Service d'Histologie Embryologie et Cytogénétique; Hôpitaux Universitaires Paris Sud; Site Antoine Béclère, APHP Clamart France
| |
Collapse
|
12
|
McNamara HC, Kane SC, Craig JM, Short RV, Umstad MP. A review of the mechanisms and evidence for typical and atypical twinning. Am J Obstet Gynecol 2016; 214:172-191. [PMID: 26548710 DOI: 10.1016/j.ajog.2015.10.930] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 12/11/2022]
Abstract
The mechanisms responsible for twinning and disorders of twin gestations have been the subject of considerable interest by physicians and scientists, and cases of atypical twinning have called for a reexamination of the fundamental theories invoked to explain twin gestations. This article presents a review of the literature focusing on twinning and atypical twinning with an emphasis on the phenomena of chimeric twins, phenotypically discordant monozygotic twins, mirror-image twins, polar body twins, complete hydatidiform mole with a coexistent twin, vanishing twins, fetus papyraceus, fetus in fetu, superfetation, and superfecundation. The traditional models attributing monozygotic twinning to a fission event, and more recent models describing monozygotic twinning as a fusion event, are critically reviewed. Ethical restrictions on scientific experimentation with human embryos and the rarity of cases of atypical twinning have limited opportunities to elucidate the exact mechanisms by which these phenomena occur. Refinements in the modeling of early embryonic development in twin pregnancies may have significant clinical implications. The article includes a series of figures to illustrate the phenomena described.
Collapse
Affiliation(s)
- Helen C McNamara
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia
| | - Stefan C Kane
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeffrey M Craig
- Murdoch Childrens Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Roger V Short
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark P Umstad
- Department of Maternal-Fetal Medicine, Royal Womens Hospital, Melbourne, Victoria, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
13
|
Rodriguez-Buritica D, Rojnueangnit K, Messiaen LM, Mikhail FM, Robin NH. Sex-discordant monochorionic twins with blood and tissue chimerism. Am J Med Genet A 2015; 167A:872-7. [DOI: 10.1002/ajmg.a.37022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 02/02/2015] [Indexed: 11/10/2022]
Affiliation(s)
- David Rodriguez-Buritica
- Division of Genetics, Department of Pediatrics; School of Medicine University of Texas at Houston; Houston Texas
- Department of Genetics; University of Alabama at Birmingham; Birmingham Alabama
| | - Kitiwan Rojnueangnit
- Department of Pediatrics, Faculty of Medicine; Thammasat University; Bangkok Thailand
- Department of Genetics; University of Alabama at Birmingham; Birmingham Alabama
| | - Ludwine M. Messiaen
- Department of Genetics; University of Alabama at Birmingham; Birmingham Alabama
| | - Fady M. Mikhail
- Department of Genetics; University of Alabama at Birmingham; Birmingham Alabama
| | - Nathaniel H. Robin
- Department of Genetics; University of Alabama at Birmingham; Birmingham Alabama
| |
Collapse
|
14
|
Schiewe MC, Whitney JB, Anderson RE. Potential risk of monochorionic dizygotic twin blastocyst formation associated with early laser zona dissection of group cultured embryos. Fertil Steril 2015; 103:417-21. [DOI: 10.1016/j.fertnstert.2014.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
|
15
|
Lee OJ, Cho D, Shin MG, Kim SO, Park JT, Kim HK, Ryang DW. The first known case of blood group chimerism in monochorionic dizygotic twins in Korea. Ann Lab Med 2014; 34:259-62. [PMID: 24790918 PMCID: PMC3999329 DOI: 10.3343/alm.2014.34.3.259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/25/2013] [Accepted: 01/25/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- O-Jin Lee
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Duck Cho
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Myung-Geun Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Hospital and Medical School, Gwangju, Korea
| | - Jong-Tae Park
- Department of Forensic Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Kyung Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Dong-Wook Ryang
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
16
|
Monochorionic Dizygous Twins Presenting With Blood Chimerism and Discordant Sex. Twin Res Hum Genet 2013; 16:799-801. [DOI: 10.1017/thg.2013.41] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Monochorionic dizygous twins are probably more frequent than considered previously as many cases remain unrecognized, especially when the children have the same sex. Here we present a pair of dizygous, sex-discordant monochorionic twins who were conceived after artificial insemination. Histological examination of the placenta and extensive genetic studies of the healthy boy and girl clearly proved that they indeed were monochorionic dizygous twins with a fully joined blood circulation. We conclude that when counseling parents expecting monochorionic twins of discordant sex, not only a disorder of sexual differentiation in one of the twins should be addressed but also the possibility of dizygosity with a completely normal (sexual) development of both children.
Collapse
|
17
|
[Blood cell chimerism in dizygotic twins conceived by in vitro fertilization]. An Pediatr (Barc) 2013; 79:248-52. [PMID: 23726690 DOI: 10.1016/j.anpedi.2013.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/22/2022] Open
Abstract
We present a case of hematopoietic chimerism in dizygotic twins (male and female) conceived by in vitro fertilization (IVF). At 8 years of age a blood karyotype was performed on the female due to the presence of clitoromegaly. Two different lines: 46,XX (53%) and 46,XY (47%) were found. FISH studies confirmed the presence of the SRY gene in 46,XY cells. Karyotyping of the male showed two different lines: 46,XY (58%) and 46,XX (42%). SRY gene was present in 46,XY cells. Microsatellite analyses of blood DNA revealed tetra-allelic contribution at some autosomal loci with similar proportions of maternal and paternal alleles and X/Y chromosome dose. FISH in buccal mucous showed that all cells from the female were 46,XX and those from the male 46,XY. The gonadal karyotype in the female was 46,XX without SRY. Hence, we report 46,XX/46,XY chimerism in dizygotic twins. Blood chimerism was confirmed by performing FISH on the buccal cells of the patients.
Collapse
|
18
|
Chen K, Chmait RH, Vanderbilt D, Wu S, Randolph L. Chimerism in monochorionic dizygotic twins: Case study and review. Am J Med Genet A 2013; 161A:1817-24. [DOI: 10.1002/ajmg.a.35957] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 03/04/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Kristen Chen
- University of Southern California; Los Angeles, CA
| | - Ramen H. Chmait
- Department of Obstetrics & Gynecology; University of Southern California; Los Angeles, CA
| | - Douglas Vanderbilt
- Department of Pediatrics; Children's Hospital Los Angeles; Los Angeles, CA
| | - Samuel Wu
- Department of Pathology; Children's Hospital Los Angeles; Los Angeles, CA
| | - Linda Randolph
- Department of Pediatrics; Children's Hospital Los Angeles; Los Angeles, CA
| |
Collapse
|
19
|
Kanda T, Ogawa M, Sato K. Confined blood chimerism in monochorionic dizygotic twins conceived spontaneously. AJP Rep 2013; 3:33-6. [PMID: 23943707 PMCID: PMC3699156 DOI: 10.1055/s-0032-1331377] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 09/23/2012] [Indexed: 10/29/2022] Open
Abstract
Traditionally, monochorionicity has been regarded as synonymous with monozygosity. However, several recent cases of monochorionic dizygotic twins have shown that monochorionic twins can be dizygous. We report a rare case of monochorionic diamnionic, gender-discordant twins who were conceived spontaneously. Initially, a monochorionic placenta was diagnosed by ultrasonography at 8 weeks of gestation and then confirmed by pathology after delivery. The twins had different genders. A comparison of cytogenetic analyses using peripheral blood lymphocytes and skin fibroblasts revealed that chimerism was confined to blood cells. We have experienced two cases of monochorionic dizygotic twins since 2003. These cases suggest that monochorionic dizygotic twins are not as rare as previously thought.
Collapse
Affiliation(s)
- Takashi Kanda
- Department of Pediatrics, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | | | | |
Collapse
|
20
|
Abstract
Twin-to-twin transfusion syndrome (TTTS) is a disease that affects roughly 15% of monochorionic twins. Although TTTS is not extremely prevalent, the rate of mortality and morbidly approaches 100% without early detection and treatment. The following case study is a triplet pregnancy that included a set of monochorionic twins affected by TTTS. Typically, it is assumed that monochorionicity can identify the zygosity of twins, which was disproven in this case. Research indicates that there has been an increased rate of monochorionic twins with in vitro fertilization. There is great debate about the most appropriate treatment modality for TTTS. Perinatal treatment followed by neonatal management is the standard of care for TTTS. Implications for the neonatal nurse practitioner and care for the patients are discussed.
Collapse
|
21
|
Hansen MH, Clausen FB, Dziegiel MH. Increased Y-Chromosome Detection by SRY Duplexing. Fetal Diagn Ther 2012; 31:185-90. [DOI: 10.1159/000335350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 11/23/2011] [Indexed: 11/19/2022]
|
22
|
Biran V, Bornes M, Aboura A, Masmoudi S, Drunat S, Baumann C, Osimani S, Dalle JH, Sterkers G, Verloes A, Farnoux C, Maury L, Schmitz T, Khung S, Baud O. A long-term competent chimeric immune system in a dizygotic dichorionic twin. Pediatrics 2011; 128:e458-63. [PMID: 21746725 DOI: 10.1542/peds.2010-3557] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We present here a rare case that involved the long-term coexistence of 2 mature, functional, and equilibrated immune systems in a single child after fetofetal transfusion between dizygotic twins. A dichorionic diamniotic pregnancy complicated by twin anemia-polycythemia sequence resulted in the demise of 1 twin. The detection of abnormal vessels on the dichorionic plate strongly suggested the existence of functional vascular anastomoses leading to blood chimerism in the survivor. Genetic, phenotypic, and immunologic analyses at 2 years revealed chimeric lymphoid and myeloid cells in the surviving twin, although no tissue mosaicism was detected, which indicates that early transfusion led to mutual immune tolerance.
Collapse
|
23
|
Erlich Y. Blood ties: chimerism can mask twin discordance in high-throughput sequencing. Twin Res Hum Genet 2011; 14:137-43. [PMID: 21425895 DOI: 10.1375/twin.14.2.137] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Twin studies have long provided a means to separate the contributions of genetic and environmental factors. A recent pioneering report by Baranzini et al. presented an analysis of the complete genomes and epigenomes of a monozygotic (MZ) twin pair discordant for multiple sclerosis. This failed to find any difference between the twins, raising doubts regarding the value of whole-genome twin studies for defining disease susceptibility alleles. However, the study was carried out with DNA extracted from blood. In many cases, the hematopoietic lineages of MZ twins are chimeric due to twin-to-twin exchange of hematopoietic stem cells during embryogenesis. We therefore wondered how chimerism might impact the ability to identify genetic differences. We inferred the blood chimerism rates and profiles of more than 30 discordant twin cases from a wide variety of medical conditions. We found that the genotype compositions of the twins were highly similar. We then benchmarked the performance of SNP callers to detect discordant variations using high-throughput sequencing data. Our analysis revealed that chimerism patterns, well within the range normally observed in MZ twins, greatly reduce the sensitivity of SNP calls. This raises questions regarding any conclusions of genomic homogeneity that might be drawn from studies of blood-derived twin DNA.
Collapse
Affiliation(s)
- Yaniv Erlich
- Whitehead Institute for Biomedical Research, Cambridge, MA 02142, United States of America.
| |
Collapse
|
24
|
Jang JH, Jung H, Kim JH, Park WS, Kim SH. Blood chimerism in a dizygotic dichorionic pregnancy. Korean J Lab Med 2011; 30:521-4. [PMID: 20890086 DOI: 10.3343/kjlm.2010.30.5.521] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Blood chimerism in twins is known to occur through the transfer of hematopoietic stem cells between the fetuses via a common placenta. We present a case of blood chimerism in a dizygotic dichorionic twin pregnancy. The female twin was delivered at 34 weeks of gestation, and the male twin was stillborn. Pathologic examination confirmed dichorionic diamniotic placentas. The karyotype of the female child was obtained using peripheral blood sample, and it revealed a mixture of 46,XX and 46,XY cells (chi 46,XY[13]/46,XX[7]). FISH analysis performed on the buccal cells by using CEP X/Y probe (Abbott Molecular Inc., USA) revealed 100% XX signals (nuc ish Xcen(DXZ1x2)[500]). Gross examination of the external genitalia and abdominal ultrasonography revealed no definitive abnormal findings in relation to sex differentiation. When XX/XY chimerism is present in blood lymphocytes, careful examination of external genitalia and reproductive organs and further studies are required to detect chimerism in non-hematopoetic tissues. This is a rare case of blood chimerism in dichorionic placentas, in contrast to those in monochorionic placentas.
Collapse
Affiliation(s)
- Ja-Hyun Jang
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | | | | | | | | |
Collapse
|
25
|
Chimérisme tétragamétique : à propos d’un cas. ACTA ACUST UNITED AC 2011; 40:77-80. [DOI: 10.1016/j.jgyn.2010.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 06/16/2010] [Accepted: 06/18/2010] [Indexed: 11/18/2022]
|
26
|
Discordant Blood Chimerism in Dizygotic Monochorionic Laser-Treated Twin–Twin Transfusion Syndrome. Obstet Gynecol 2010; 116 Suppl 2:483-485. [DOI: 10.1097/aog.0b013e3181e4bec7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
27
|
Parva M, Donnenfeld AE, Gerson A. Trizygotic dichorionic triplets with 46,XX/46,XY chimerism in both fetuses of the monochorionic pair. Prenat Diagn 2009; 29:1091-3. [DOI: 10.1002/pd.2368] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
28
|
Boklage CE. Traces of embryogenesis are the same in monozygotic and dizygotic twins: not compatible with double ovulation. Hum Reprod 2009; 24:1255-66. [PMID: 19252194 PMCID: PMC2683734 DOI: 10.1093/humrep/dep030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 01/16/2009] [Accepted: 01/22/2009] [Indexed: 11/14/2022] Open
Abstract
Common knowledge of over a century has it that monozygotic and dizygotic twinning events occur by unrelated mechanisms: monozygotic twinning 'splits' embryos, producing anomalously re-arranged embryogenic asymmetries; dizygotic twinning begins with independent ovulations yielding undisturbed parallel embryogeneses with no expectation of departures from singleton outcomes. The anomalies statistically associated with twin births are due to the re-arranged embryos of the monozygotics. Common knowledge further requires that dizygotic pairs are dichorionic; monochorionicity is exclusive to monozygotic pairs. These are fundamental certainties in the literature of twin biology. Multiple observations contradict those common knowledge understandings. The double ovulation hypothesis of dizygotic twinning is untenable. Girl-boy twins differ subtly from all other humans of either sex, absolutely not representative of all dizygotics. Embryogenesis of dizygotic twins differs from singleton development at least as much as monozygotic embryogenesis does, and in the same ways, and the differences between singletons and twins of both zygosities represent a coherent system of re-arranged embryogenic asymmetries. Dizygotic twinning and monozygotic twinning have the same list of consequences of anomalous embryogenesis. Those include an unignorable fraction of dizygotic pairs that are in fact monochorionic, plus many more sharing co-twins' cells in tissues other than a common chorion. The idea that monozygotic and dizygotic twinning events arise from the same embryogenic mechanism is the only plausible hypothesis that might explain all of the observations.
Collapse
Affiliation(s)
- Charles E Boklage
- Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| |
Collapse
|
29
|
Abstract
Chimerism in an individual refers to the coexistence of cells arising from two distinct organisms. It can arise iatrogenically via transplant or blood transfusion, and physiologically via twin to twin transfer, or from trafficking between mother and fetus during pregnancy. Many of the diseases associated with microchimerism affect the endocrine system (e.g., autoimmune thyroid disease and diabetes mellitus type 1). Microchimerism is relevant to endocrine pathology because (a) it is associated with pregnancy, a condition of complex endocrine physiology; (b) materno-fetal and feto-maternal cellular migration must involve the placenta, itself an endocrine organ; and (c) in some species, chimerism results in states of intersexuality, a condition intimately involved with endocrine physiology. Studies of feto-maternal microchimerism in the thyroid have documented the presence of fetal cells in association with Hashimoto thyroiditis, Graves' disease, thyroid adenoma, and papillary thyroid carcinoma. Studies of materno-fetal microchimerism have documented the presence of maternal cells in juvenile diabetes and other pediatric conditions. Microchimerism plays a potential role in the repair of diseased thyroid and pancreatic tissues.
Collapse
Affiliation(s)
- Daniel W Rust
- Department of Pathology, Tufts Medical Center, Boston, MA, USA
| | | |
Collapse
|