Identification of the origin of triploidy by HLA markers

Partial hydatidiform mole: histologic parameters in correlation with DNA genotyping

Histologic diagnosis of partial hydatidiform mole (PHM) continues to be problematic, and DNA genotyping has recently become cost-effective for precise separation of PHM from its mimics. We performed a comprehensive reevaluation of histologic parameters of PHM in correlation with DNA genotyping. A total of 143 early abortion specimens were subjected to genotyping as part of the routine workup, resulting in 60 cases of PHM, 52 cases of various chromosomal trisomies, and 31 cases of nonmolar diploid gestations. All available hematoxylin and eosin slides were reviewed retrospectively by 2 gynecologic pathologists blinded to the genotyping results. Significant histologic overlaps were present among genetically confirmed PHM, hydropic abortions, and chromosomal trisomy syndromes. The following morphologic parameters emerged with diagnostic significance for PHM: villus size, presence of 2 villous populations, round or oval pseudoinclusions, at least moderate villous hydrops, cistern formation, and trophoblastic hyperplasia. The most sensitive morphologic features for PHM included villous hydrops (86% sensitivity) or the presence of at least 1 of the following 3 parameters: 2 villous populations, round or oval pseudoinclusions, and cisterns (84% sensitivity). The presence of cisterns and villous size ≥2.5 mm had the highest positive predictive value (90%) for PHM. In conclusion, no single or combined morphologic features are sufficient for definitive diagnosis of PHM. The presence of any one of the following histologic findings should prompt DNA genotyping workup to rule out PHM: round or oval pseudoincludions, cistern formation, 2 populations of villi, and a villous size of ≥2.5 mm.

Parental and meiotic origin of triploidy in the embryonic and fetal periods

Triploidy is a common finding both in early spontaneous abortions and in the fetal period. Previous studies suggested that the majority of triploidy was the result of diandry, specifically dispermy. Molecular determination of parental origin in fetal triploids has shown that digyny accounts for the majority of triploids in the fetal period. The aim of this study was to determine the meiotic level at which the error leading to digynic triploidy occurs and to extend the molecular analysis of parental origin of triploidy into the embryonic period. Maternal age of digynic triploids was compared with that of the diandric cases. Using polymorphic pericentromeric markers, we have shown that the majority of digynic triploidy is the result of errors in the second meiotic division. Digyny accounted for the majority of triploids, even in the nonfetal cases. Diandry predominated in a subset of the non-fetal cases in which embryos were not present and in which the placental findings of partial hydatidiform mole (PHM) were encountered. Maternal age differed between the digynic and diandric groups only for the non-fetal cases; this was attributed to differences in ascertainment.

Placental pathology of triploidy

Triploidy is a common chromosome abnormality in spontaneous abortions. Previous studies of spontaneous abortions have suggested that approximately 85% of triploid abortuses show the placental changes of partial hydatidiform mole (PHM) and that this appearance was associated, possibly attributable, to paternal origin of the extra haploid set of chromosomes. More recent work, however, has shown that most triploidy is the result of digyny--the extra set of chromosomes originating from the mother. Given the association of PHM with diandry, these results would appear to be at odds with the results of previous studies of placental morphology in triploids. The authors reviewed the placental pathology of all cases of triploidy examined at their institution over a 2-year period and established that PHM occurs in a minority of triploid conceptuses. These results support the findings of studies showing that digyny is the most common origin of triploidy.

Parental origin of the extra haploid chromosome set in triploidies diagnosed prenatally

The parental origin of the additional chromosome complement in a total of 17 cases of triploidy was determined mainly using highly polymorphic microsatellites. Maternal origin of the triploidy was demonstrated in most cases. To the best of our knowledge, this is the first systematic evaluation of the parental origin of chromosome sets in fetuses who survived until a cytogenetic diagnosis was established. In contrast to previous investigations this study documented a predominance of maternal origin of the extra haploid set mainly due to longer survival time for digynic triploidies. The concept of 2 distinct fetal phenotypes in triploidy is clearly supported by this study.

Parental origin of triploidy in human fetuses: evidence for genomic imprinting

Two distinct phenotypes of triploid fetuses have been previously described and a correlation with parental origin of the triploidy has been suggested. We have studied the parental origin of the extra haploid set of chromosomes in nine triploid fetuses using analysis of DNA polymorphisms at a variety of loci. Maternal origin of the triploidy (digyny) was demonstrated in six fetuses with type II phenotype, paternal origin (diandry) in two cases with type I phenotype, and nonpaternity in one case. The predominance of digynic triploids in our study contrasts with the results reported in previous studies in which, through analysis of cytogenetic polymorphisms, paternal origin was found to account for the majority of triploid conceptuses. This difference may be accounted for by a combination of factors--the different methods of parental assignment used and analysis of a different subset of triploid conceptuses. The correlation between the observed phenotypes and the parental origin of triploidy may represent another example of imprinting in human development.

Hydatidiform mole and HLA. III. HLA-antigen expression related to genomic origin

In 52 conceptuses with known genomic origin, HLA determination was performed on whole villi and/or stromal cell cultures. In 26 androgenetic, diploid conceptuses, one or two paternal HLA-A,B haplotypes were found; twenty-four triploid conceptuses with two paternal and one maternal chromosome sets showed either one maternal and one paternal haplotype or one/two paternal HLA-A,B haplotypes. Consequently, androgenesis could not be demonstrated by lack of maternal antigens alone. Concomitant expression of three HLA haplotypes was not seen. HLA-A2 was passed on to the conceptus, both in the genetic subgroups and in the entire series, more frequently than expected.

Genetic studies on hydatidiform moles

Using an historical approach, this article describes how genetic studies have elucidated the two entities into which the syndrome of hydatidiform mole can now be divided. Partial moles are triploid, have a maternal chromosomal set, and are associated with the presence of a fetus. Complete moles lack a fetus and are always diploid and androgenetic in origin, having two sets of paternal chromosomes. They are most often XX and homozygous, the most likely origin being by duplication of a haploid sperm. About 4% of complete moles have been shown to by XY and heterozygous, the most likely origin being by dispermy. The frequency of partial and complete mole observed depends on the method of ascertainment. Among spontaneous abortions, partial moles are more common than complete moles, but among cases having an elective termination of pregnancy because of a prior diagnosis of hydatidiform mole, complete mole is the more common. Patients with either type of mole may require treatment for persistent trophoblastic activity. More prospective studies of cases in which the type of mole has been confirmed by genetic studies are required in order to find out whether (a) patients with complete moles are more likely than those with partial moles to require treatment for persistence of trophoblastic activity after evacuation; and (b) heterozygous complete moles have a different prognosis from the point of view of malignant sequelae than homozygous complete moles.

Low doses of X-rays decrease the risk of diploidy in mouse oocytes

Females from the NMRI/Han mouse strain ovulate a high number of diploid oocytes (about 12%) after gonadotrophin-stimulated ovulation. These oocytes can be fertilized and develop into triploid embryos subsequently. The exposure of such gonadotrophin-primed females to X-ray doses of 0.05, 0.10, 0.20 or 0.40 Gy during the preovulatory period (2 h after the HCG dose) significantly decreased the percentage of diploid oocytes. After the highest dose used, i.e. 0.80 Gy, however, the incidence was on the level from unirradiated females, again. We suggest that the observed negative hump-shaped dose response of diploidy is not caused by secondary modifications induced by irradiation, such as a selective killing of diploid oocytes before ovulation, or a (compensatory) super-ovulation of only normal oocytes, but rather is caused by a direct radiobiological interference of low doses in protecting from gonadotrophin-induced aneuploidy.

Genetic studies on hydatidiform moles. I. The origin of partial moles

A study was designed to investigate the genetic origin of hydatidiform moles. Fifty-nine specimens were obtained and, on a histological basis, separated into two entities: complete and partial. The study of the genetic origin of the 15 partial moles, using cytogenetic and biochemical markers, is described. All the partial moles examined cytogenetically were triploid. One had 71 chromosomes. The sex chromosome complements of seven cases were six XXY and one XXX. Origin by dispermy was possible in seven cases and was proven in four. With the use of biochemical markers a maternal contribution was identified in three cases, and the isoenzyme pattern suggested a trisomic state for at least one locus in four cases. The mechanism of origin of partial moles was compared with spontaneously aborted and liveborn triploids. All the patients were followed up for at least 9 months, and none required treatment for persistent trophoblastic activity.

Diplospermy II indicated as the origin of a liveborn human triploid (69,XXX)

A 69,XXX liveborn baby was shown to have the Rh genotype CDe/cDE/cde which suggested that 46 of her chromosomes were of paternal origin. Studies on C band polymorphisms and other genetic markers indicated that the most likely origin of this triploid was a failure of male meiosis II.

Technical and theoretical considerations in the HLA typing of amniotic fluid cells for prenatal diagnosis and paternity testing

HLA typing of amniotic fluid cells has been used for the prenatal diagnosis of the HLA linked diseases congenital adrenal hyperplasia (21-OH-deficiency (21-OH-def) type) and complement C4 deficiency and it has also been used for the prenatal determination of paternity. There are, however, technical difficulties in this test associated with the weak expression of some B locus antigens on amniotic fluid cells, and theoretical difficulties related to associations between particular HLA antigens and the 21-OH-def allele. Since certain HLA-B locus antigens are found in significantly increased frequencies among patients with 21-OH-def, there is a relatively high incidence of HLA-B homozygosity among the patients and over 40 per cent of the parents of these patients share one or more HLA-B locus antigens. Results of some prenatal HLA typing tests may thus be difficult to interpret, and supplementary tests should be used whenever possible. HLA typing of amniotic cells is, however, the only available procedure for prenatal diagnosis of C4 deficiency and it is the best available procedure for prenatal determination of paternity. A modification of our original procedure allows HLA typing to be performed with increased numbers of HLA typing sera, and sera with optimum reactivity for amniotic fluid cells have now been selected for the definition of most of the more commonly expressed HLA antigens. Although amniotic fluid cells do not express DR Antigens, amniotic fluid cells can be typed for the HLA-linked marker glyoxalase I (GLO) and this may be the informative for prenatal diagnosis in some cases.

Pathologic features of the eye in triploidy

Triploidy is a cytogenetic abnormality characterized by 69 chromosomes rather than the normal 46 in each cell. It is one of the most common chromosomal aberrations reported in early spontaneous abortion. Estimates are that 17-20% of chromosomally abnormal abortuses (early) are triploid. 1,2 Although the majority are stillborn, at least 25 liveborn triploidics have been reported. 3-9 All were premature and most died in the first 6 hours;the longest survival was 2 months. 4 By contrast, a diploid/triploid mosaic (mixed cell lines) individual may survive to adulthood. Although ocular lesions are one of the components of the triploidy syndrome, reports of histologic findings are comparatively rare. 1,3,6,10,11 This prompted us to study the ocular pathology in another case of triploidy. Our results confirm and extend those previously described and emphasize the pattern of ocular abnormalities in this disorder.

Stability of the "two active X" phenotype in triploid somatic cells

We examined triploid cells of XXY karyotype heterozygous for glucose 6 phosphate dehydrogenase (G6PD) electrophoretic variants with regard to the stability of their X chromosome phenotype. Clonal populations of cells derived from these human fibroblasts maintained a precise 1:2:1 ratio of A:heteropolymer:B isozymes throughout their life span, indicating stability of the two active X chromosomes in these cells. To determine the influence of the autosomal complement on X chromosome expression, we attempted to perturb the relationship. Fusion of these triploid cells with human diploid fibroblasts carrying a novel G6PD variant (B') resulted in heterokaryons exprssing a novel heteropolymer, presumably indicating that all three parental X chromosomes were active. However, no derepression of the inactive X chromosome was observed. Analysis of interspecific hybrids derived from triploid cells and mouse fibroblasts confirmed that activity of parental X chromosomes is maintained. Some human mouse hybrid clones, however, expressed only a single human G6PD isozyme, probably attributable to segregation of the pertinent X chromosome, but elimination of a relevant autosome cannot be excluded. The triploid cells transformed by SV40 showed alterations in LDH pattern and an approximately 10-20% decrease in chromosome number, but maintained the precise G6PD phenotype of the untransformed cell. These studies provide evidence for the stability of the X chromosome phenotype in triploid cells.

Origin of triploidy in spontaneous abortuses

Fourteen triploid spontaneous abortuses were studied cytogenetically by sequential Q and C banding and the marker chromosomes were compared with those of the parents. The abortuses comprised all triploid cases in a series of 288 consecutive abortuses of the first 16 weeks of pregnancy occurring in one hospital. In 12 of the triploids the origin of the extra haploid set was conclusively determined, revealing six cases of dispermy, five failures in the first maternal and one failure in the first paternal meiotic division. The results were combined with those of five other studies comprising a total of 48 informative cases. Non-reduction in the second meiotic division seems to be of little or no significance in the origin of human triploidy. Dispermy is the predominant source, accounting for 40--50% of the triploid spontaneous abortuses. Non-reduction in the first meiotic division of the father seems to be the second-most frequent source although in the present material the corresponding maternal non-reduction is much more common.