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A metaphase cell positive
for the bcr/abl
rearrangement using FISH
Cytogenetics is the
study of the structure of
chromosome material. It
includes routine analysis of
G-Banded chromosomes, other
cytogenetic banding techniques, as
well as molecular cytogenetics
such as
fluorescent in situ hybridization
(FISH) and
comparative genomic hybridization
(CGH).
History
Early years
Barbara McClintock began her
career as a
maize cytogeneticist. In
1931 McClintock and
Harriet Creighton demonstrated
that cytological recombination of
marked
chromosomes correlated with
recombination of genetic
traits (genes).
McClintock continued her career in
cytogenetics studying the
mechanics and inheritance of
broken and ring (circular)
chromosomes of maize. During her
cytogenetic work, McClintock
discovered
transposons, a find which
eventually led to her
Nobel Prize in
1983.
Modern cytogenetics is
generally said to have begun in
1956 with the discovery that
normal
human cells contain 46
chromosomes by Tjio and Levan[1].
This discovery was aided by a new
technique of slide preparation
utilizing a hypotonic
solution discovered by
TC Hsu in
1952. A hypotonic solution is
a salt solution less concentrated
than that inside human cells, when
added to a cell solution this
causes the cells to swell. When
the cells are added to the slide
after treatment with hypotonic the
chromosomes spread much better
allowing for much easier
enumeration. Previously humans
were thought to have 48
chromosomes.
It is notable that while
Flemming and Arnold first observed
human chromosomes in the
1880s, the number of human
chromosomes remained unknown for
over 70 years. The causes for this
are numerous. For many valid
scientific reasons, many
geneticists at the time relied
heavily on animal models for their
research, and thus research in
human genetics did not keep up
with species like the fruit fly
Drosophila. This was also
the period of the
eugenics movement and many
geneticists wanted to distance
themselves from human genetics.
Progress in numerical
abnormalities
With the advent of harvest
procedures which allowed easy
enumeration of chromosomes,
discoveries were quickly made in
abnormalities arising from
nondysjunction events which cause
cells with aneusomy (additions or
deletions of entire chromosomes).
In
1959 Lejeune[2]
discovered patients with
Down syndrome had an extra
copy of chromosome 21. Down
syndrome is also referred to as
trisomy 21. In
1960 Nowell[3]
discovered a small chromosome,
dubbed the
Philadelphia chromosome, which
was shown to be the cause of
Chronic myelogenous leukemia.
13 years later this was shown by
Janet Rowley to be a
translocation of chromosomes 9 and
22.
Other numerical abnormalities
discovered include sex chromosome
abnormalities. An individual with
only one sex chromosome (the X)
has
Turner syndrome, an additional
X chromosome in a male, resulting
in 47 total chromosomes, has
Klinefelter's Syndrome. Many
other sex chromosome combinations
are compatible with live birth
including XXX, XYY, and XXXX. The
ability for mammals to tolerate
aneusomies in the sex chromosomes
arises from the ability to
inactivate them, which is
required in normal females to
compensate for having two copies
of the chromosome.
Trisomy 13 was associated with
Patau's Syndrome and trisomy
18 with
Edward's Syndrome.
Advent of banding techniques
In the late 1960's
Caspersson developed banding
techniques which differentially
stain chromosomes. This allows
chromosomes of otherwise equal
size to be differentiated as well
as to elucidate the breakpoints
and constituent chromosomes
involved in
chromosome translocations.
Deletions within one chromosome
could also now be more
specifically named and understood.
Deletion syndromes such as
DiGeorge syndrome,
Prader-Willi syndrome and
others were discovered to be
caused by deletions in chromosome
material.
Diagrams identifying the
chromosomes based on the banding
patterns are known as
cytogenetic maps. These maps
became the basis for both prenatal
and oncological fields to quickly
move cytogenetics into the
clinical lab where karyotyping
allowed scientists to look for
chromosomal alterations.
Techniques were expanded to allow
for culture of free amniocytes
recovered from amniotic fluid, and
elongation techniques for all
culture types that allow for
higher resolution banding.
Beginnings of molecular
cytogenetics
In the
1980s advances were made in
molecular cytogenetics. While
radioisotope-labeled probes had
been hybridized with
DNA since
1969, movement was now made in
using fluorescently labeled
probes. Hybridizing them to
chromosomes preparations made
using existing techniques came to
be known as fluorescent in situ
hybridization (FISH). This
change significantly increased the
usage of probing techniques as
fluorescently labeled probes are
safer and can be used almost
indefinitely. Further advances in
micromanipulation and examination
of chromosomes led to the
technique of
chromosome microdissection
whereby aberrations in chromosomal
structure could be isolated,
cloned and studied in ever greater
detail.
Uses
translocation 9;11
associated with AML
In some forms of
cancer, especially
hematological malignancies,
cytogenetics can determine
which
chromosomal translocations are
present in the malignant cells,
facilitating diagnosis and
susceptibility to treatment (e.g.
imatinib mesylate in the
presence of the
Philadelphia chromosome).
In congenital disorders, such
as
Down's syndrome,
cytogenetics can determine the
nature of the chromosomal defect -
a "simple" trisomy, a
mosaic,
"balanced" translocation, a
deletion, or an insertion in one -
or both - of the parents, or in
the fetus.
Techniques
Routine analysis
Routine chromosome analysis
refers to analysis of
metaphase
chromosomes which have been
banded using
trypsin followed by
Giemsa. This creates unique
banding patterns on the
chromosomes. The molecular
mechanism and reason for these
patterns is unknown, although it
likely related to replication
timing and chromatin packing.
Slide preparation
Cells from bone marrow, blood,
amniotic fluid,
cord blood, tumor, and tissues
(including skin, unbilical cord,
liver, and many other organs) can
be cultured using standard cell
culture techniques in order to
increase their number. A
mitotic inhibitor (colchicine,
colcemid) is then added to the
culture. This stops cell division
at
mitosis which allows an
increased yield of mitotic cells
for analysis. The cells are then
centrifuged and media and mitotic
inhibitor is removed, and replaced
with a hypotonic solution. This
causes the cells to swell so that
the chromosomes will spread when
added to a slide. After the cells
have been allowed to sit in
hypotonic, Carnoy's fixative (3:1
methanol to
glacial acetic acid) is added.
This kills the cells, lyses the
red blood cells, and hardens the
nuclei of the remaining white
blood cells. The cells are
generally fixed repeatedly to
remove any debris or remaining red
blood cells. The cell suspension
is then dropped onto specimen
slides. After aging the slides in
an oven or waiting a few days they
are ready for banding and
analysis.
Analysis
Analysis of banded chromosomes
is done at a
microscope by a clinical
laboratory specialist in
cytogenetics (CLSp(CG)). Generally
20 cells are analyzed which is
enough to rule out mosacism to an
acceptable level. The results are
summarized and given to a
board-certified medical geneticist
and a
pathologist for review, and to
write an interpretation taking
into account the patients previous
history and other clinical
findings. The results are then
given out reported in an
International System for Human
Cytogenetic Nomenclature 2005
(ISCN2005).
Fluorescent in situ
hybridization
Interphase cells positive
for a t(9;22) rearrangement
Fluorescent in situ
hybridization refers to using
fluorescently labeled probe to
hybridize to cytogenetic cell
preparations.
In addition to standard
preparations FISH can also be
performed on:
- bone marrow smears
- blood smears
- paraffin embedded tissue
preparations
- uncultured bone marrow
- uncultured amniocytes
- cytospin preparations
Slide preparation
This section refers to
preparation of standard
cytogenetic preparations
The slide is aged using a salt
solution usually consisting of 2X
SSC (salt, sodium citrate). The
slides are then dehydrated in
ethanol, and the probe mixture
is added. The sample
DNA and the probe DNA are then
co-denatured using a heated plate
and allowed to re-anneal for at
least 4 hours. The slides are then
washed to remove excess unbound
probe, and counterstained with
4',6-Diamidino-2-phenylindole (DAPI)
or propidium iodide.
Analysis
Analysis of FISH specimens is
done in
fluorescence microscopy by a
clinical laboratory specialist in
cytogenetics (CLSp(CG)). For
oncology generally a large number
of
interphase cells are scored in
order to rule out low level
residual disease, generally
between 200 and 1000 cells are
counted and scored. For congenital
problems usually 20 metaphase
cells are scored.
Future of cytogenetics
Advances now focus on
comparative genomic hybridization
arrays, and automated systems for
counting the results of standard
FISH preparations.
References
-
^ Tjio HJ,
Levan A. The chromosome
numbers of man. Hereditas
1956;42:1-6.
-
^ Lejeune J,
Gautier M, Turpin MR. Etude
des chromosomes somatiques de
neuf enfants mongoliens. C R
Acad Sci (Paris)
1959;248:1721-2.
-
^ Nowell PC,
Hungerford DA. A minute
chromosome in human chronic
granulocytic leukemia.
Science 1960;132:1497-1501.