Multiple birth and Down's disease]

The frequency of twinning among newborns with Down's syndrome (2,11+/-0,6%)was significantly higher than in the general populaltion (0,73+/-0,3%). The increase in the rate of multiple births of children with trisomy-21 occurred due to almost three-fold excess in the frequency of dizygotic (discordant) twin pairs over the expected level. The increase in the frequency of dizygotic twins with Down's syndrome was explained by the combined effect of two independent factors: the increase in probability of dizgotic twins natality and the enhanced rate of children birth with trisomy-21, which depended on the increase in mother's age.     

Reexamination of paternal age effect in Down's syndrome

Summary The recent discovery that the extra chromosome in about 30% of cases of 47, trisomy 21 is of paternal origin has revived interest in the possibility of paternal age as a risk factor for a Down syndrome birth, independent of maternal age. Parental age distribution for 611 Down's syndrome 47,+21 cases was studied. The mean paternal age was 0.16 year greater than in the entire population of live births after controlling for maternal age. There was no evidence for a significant paternal age effect at the 0.05 level. For 242 of these Down's syndrome cases, control subjects were selected by rigidly matching in a systematic manner. Paternal age was the variable studied, with maternal age and time and place of birth controlled. There was no statistically significant association between paternal age and Down's syndrome. After adjustment for maternal age, these two studies were not consistent with an increase of paternal age in Down's syndrome.     

The incidence of Down's syndrome and progress towards its reduction

Down's syndrome is the most common autosomal aberration and single cause of mental retardation in man. There is a close relation between advanced maternal age and Down's syndrome. The limitation of family size has made a considerable impact on the incidence of Down's syndrome. In Denmark in the 1950s, 50% of Down's syndrome cases were born to mothers over the age of 35. The percentage went down to 25% in the 1970s and was reduced by prenatal diagnosis to 8% in the 1980s. For the period 1980-85 we followed the birth prevalence closely for different maternal age groups. The birth prevalence was lowered for the age group over 35, but there was a steady rise for the age groups below 35. Early diagnosis, high rate of survival of light-for-date babies and babies with congenital heart defect, and, possibly, exogenous factors working on gametogenesis might be an explanation. To achieve a reduction in incidence, maternal alpha-fetoprotein (AFP)-serum screening for low values may be a possibility. So far, avoidance, but not primary prevention, of Down's syndrome is available.     

Muscle power, locomotor performance and flexibility in aging mentally-retarded adults with and without Down's syndrome

Longer life expectancy is resulting in increasing numbers of elderly adults with mental retardation (MR). The objective of the study was to compare lower limb isokinetic muscle power, locomotor performance and flexibility of aged adult mentally-retarded individuals with and without Down's syndrome (DS). Nine subjects with MR and DS (mean age 61), and sixteen subjects with MR and without DS (mean age 63), performed leg power testing on a Biodex dynamometer. Parameters measured were dynamic torque, dynamic torque % body weight, and average power % body weight. Functional performance tests including "Timed Get-Up and Go" and flexibility were also analyzed and compared. Results indicate that in knee extension and flexion isokinetic power the MR group without DS showed significantly higher scores than the MR group with DS. The functional performance of elderly adults with MR and DS was significantly impaired compared with MR adults without DS, although no differences were observed between the two groups in the flexibility tests. It was concluded that muscle leg power, and gross motor performance of elderly mentally-retarded individuals without Down's syndrome is better than in those with Down's syndrome.     

Relationship between dermatoglyphic variability and finger length in genetic disorders: Down's syndrome]

Palmar and digital dermatoglyphics were compared in Down's syndrome patients with that in a control sample from a population. All dermatoglyphic changes characteristic of Down's syndrome were confirmed. The ridge counts along digital midlines were significantly lower in Down patients as compared to control data, especially, in little fingers, which corresponds to finger shortening in Down's syndrome. The findings agree with a suggestion that digital growth in man could be controlled by morphogenetic gradients which may be altered in genetic disorders.     

Dermatoglyphics of the relatives of children with congenital defects in development]

The localization of an axial triradius and the flexor creases were studied in 173 phenotypically normal mothers and 104 fathers of congenitally malformed children. The most pronounced changes ofdermatoglyphics were found in the parents of children with polygenic determined defects, less pronounced ones-- in the parents of children with multiple congenital non-chromosomal defects and with Down's syndrome. The frequency of the pathological features studied was similar both in children with polygenically determined isolated defects and with Down's syndrome. The frequency of the pathological determined isolated defects and in their parents. In multiple congenital defects and in Down's syndrome the abnormalities ofof the localization of an axial triradius and of the flexor creases were found in children more frequently than in the parents. It is suggested that the above mentioned peculiarities of parental dermatoglyphics may be useful for the genetic counsleling.     

Pseudocholinesterase activity and E1 phenotypes in Down's syndrome and mental retardation.

Pseudocholinesterase activity and the phenotypes controlled by the E1 locus have been determined in a sample of 307 Down's syndrome patients and 206 patients suffering from nonspecific mental retardation and compared to those in the healthy population. Both groups of patients have an elevated frequency of phenotypes possessing the rate E1f allele. The mentally retarded patients have a higher mean pseudocholinesterase activity than those with Down's syndrome who, in turn, have activity than the healthy controls.     

A survey on maternal age and karyotype in Down's syndrome in Japan, 1947–1975

Summary Data on karyotype and maternal age of 1954 cases of Down's syndrome were analyzed to see if the rate of chromosome mutations leading to this abnormality has been enhanced during the last 20 years. Comparison of the data for patients born in 1947–1960 with those in 1961–1975 revealed little change with time in the proportions of cases due to different karyotypes, the overwhelming majority being of 21 trisomy type in both periods. However, there has been a remarkable decline in the mean maternal age from 33.1 years to 29.7 years as well as in the variance from 50.5 to 29.4. While the rate of decline in the variance was almost the same as that for all births occurring in the same periods, the decline in the mean maternal age was much greater for the patients than for all births, suggesting that the rate of nondisjunction might have increased in younger rather than in older mothers. However, when the risk of brearing a child with Down's syndrome for mothers aged 40–44 is taken as unity, no evidence was found for an increase with time in the relative risk for younger mothers. Moreover, results of surveys made in 1960 and thereafter in different parts of Japan indicate that the crude incidence rate of Down's syndrome at birth has been around 0.10%, giving no indication of an upward trend. These findings are discussed with reference to the serious environmental pollution, including possible genetic hazards, with which Japan has been faced since the 1960s.     

Non-random centromere division: a mechanism of non-disjunction causing aneuploidy?

Early centromere separation was investigated in 12 normal children, 14 patients with Down's syndrome and in 12 patients of children with autosomal trisomies. A significantly non-random centromere division of chromosomes was found in each of the cases. A higher frequency of early separated G chromosomes was observed in Down's syndrome. In 2 mothers of trisomy-18 patients, the early division of chromosomes 18, generally seen in normal individuals, could not be demonstrated. The possible assoication between altered sequence of centromere disision and non-disjunction needs further confirmation.     

Birth weight corrected for gestational age is related to the incidence of Down's syndrome pregnancies.

Three recent studies reported that early depletion of the primordial follicle pool is likely to be an independent risk factor for Down's syndrome pregnancies. The size of the primordial follicle pool at birth is determined by oogenesis and by the rate of follicle atresia during the intra uterine period. Since intra uterine growth retardation was reported to be associated with a significantly reduced primordial follicle pool at birth, we investigated the possibility of a relation between low birth weight for gestational age and the risk of a Down's syndrome pregnancy. In a case control study, 95 women with a history of a Down's syndrome pregnancy and 85 controls provided information on their own birth weight and length of gestation. Birth weight standard deviation scores, indicating the difference in birth weight from a reference group, were significantly lower in Down's syndrome mothers than in controls. These findings illustrate that the risk of a Down's syndrome pregnancy is related to a low birth weight corrected for gestational age, possibly by a causal relation between intra uterine growth retardation and the size of the primordial follicle pool.     

Paternal age and Down's syndrome genotypes diagnosed prenatally: No association in New York State data

Summary An investigation of a paternal age effect independent of maternal age was undertaken for 98 cases of Down's syndrome genotypes diagnosed prenatally compared to 10,329 fetuses with normal genotype diagnosed prenatally in data reported to the New York State Chromosome Registry. The mean of the difference (delta) in paternal age of cases compared to those with normal genotypes after controlling for maternal age, was slightly negative,-0.27 with a 95% confidence interval of-1.59 to +1.06. A regression analysis was also done in which the data were first fit to an equation of the type lny=(bx+c) and then to the equation ln y=(bx+dz+c) where y = rate of Down's syndrome, x = maternal age, z = paternal age, and b, d, and c are parameters. This also revealed no evidence for a paternal age effect. The value of d (the paternal age coefficient) was in fact slightly negative,-0.0058, with an asymptotic 95% confidence interval of-0.0379 to +0.0263. Lastly, multiple applications of the Mantel-Haenszel test considering various boundaries in paternal age also revealed no statistically significant evidence for a paternal age effect independent of maternal age. These results are at variance with claims of others elsewhere of a very strong paternal age effect detected in studies at prenatal diagnoses. Five different hypotheses are suggested which may account for discrepancies among studies to date in findings on paternal age effects for Down's syndrome: (i) there are temporal, geographic, or ethnic variations in paternal age effects, (ii) there is no paternal age effect and statistical fluctuation accounts for all trends to date; (iii) methologic artifacts have obscured a paternal age effect in some studies which did not find a positive outcome; (iv) methodologic artifacts are responsible for the positive results in some studies to date; (v) there is a rather weak paternal age effect independent of maternal age in most if not all populations, but because of statistical fluctuation the results are significant only in some data sets. The results of all data sets to date which we have been able to analyze by one year intervals are consistent with a mean delta of +0.04 to +0.48 and in the value of d (the paternal age coefficient) of +0.006 to +0.017, and it appears the fifth hypothesis cannot be excluded. Projections based on this assumption are presented.     

Trisomy 21: Origin of non-disjunction

Summary The Q-band heteromorphisms of chromosome 21 were used in a sample of 48 families with a Down's syndrome child to evaluate the origin of non-disjunction.The parental origin and the meiotic error were determined in 27 families, and in eight families only partial information was obtained. Paternal and maternal origin of non-disjunction was in a 1:3 ratio. Failures were five times more frequent in first than in second meiotic division in both sexes.The mean parental age and environmental factors in relation to the origin of the anomaly are discussed.Our results are compared with those obtained previously in similar studies by other authors.     

Unusual genotypes in the COL6A1 gene in parents of children with trisomy 21 and major congenital heart defects

Collagen type VI is a candidate for a role in the pathogenesis of congenital heart defects (CHD) in Down's syndrome. Three restriction fragment length polymorphisms of the COL6A1 gene were used to determine COL6A1 genotypes in 50 families of affected children with trisomy 21 (29 with congenital heart defects and 21 without) and 37 unrelated volunteers. We found seven unusual genotypes in the parents of affected children with Down's syndrome, five being unique to the parents of children with trisomy 21 and CHD. There were no unusual genotypes associated with other chromosome 21 loci. No single COL6A1 genotype was associated with CHD. Thus, the unusual genotypes unique to parents of affected children suggest that genetic variation in the COL6A1 gene region contributes to the pathogenesis of CHD in Down's syndrome.     

Heterochromatic regions and the nondisjunction of human chromosome 21. I. Polymorphism of the C-bands of chromosomes 1, 9 and 16 in children with Down's syndrome

To test a hypothesis on potential role of large heterochromatic regions in chromosome nondisjunction polymorphism of C segments of chromosomes 1, 9, and 16 in 70 children with Down's syndrome were examined. The C segment lengths of the above chromosomes were shown not to deviate from the normal. To solve the problem, it seems unreasonable to examine children with Down's syndrome.     

Satellite association in Down's syndrome

Summary The frequency of association of acrocentric chromosomes is examined in 20 Down's syndrome children, their parents, and 60 controls. Chromosome 21 enters into satellite associations most frequently, and chromosome 15 least. The parents of Down's syndrome children do not show any increased tendency for satellite association of chromosome 21 or indeed any other acrocentric.     

Minutiae of skin ridges in Down's syndrome]

Minutiae of the epidermal ridges were examined in 16 children with Down's syndrome and 50 children without genetic and familial abnormalities. Minutiae in standard areas on the hand palms (according to Grzeszyk's concept) were examined. Comparative analysis confirmed by the statistical analysis showed significant differences in the incidence of particular minutiae types on the hand palms of children with Down's syndrome and control group.     

On the inadequacy of quinquennial data for analyzing the paternal age effect on Down's dyndrome rates

Summary Investigations of the influence of paternal age on the rate of Down's syndrome are complicated by the high correlation between parental ages and the strong dependence of the incidence rate upon maternal age. Two possible approaches to isolating an independent paternal age effect are shown to lead to erroncous results if based on data by quinquennial age intervals rather than by single-year intervals. For a multiple regression method the discrepancy can be removed by using the mean maternal and mean paternal age within each quinquennial cell. Failure to do so results in an artifactual paternal age effect.     

Familial Down's syndrome.

A family is reported in which the same mother conceived two children with trisomy 21. The pregnancy with the second affected child was interrupted after diagnostic amniocentesis. Maternal chromosome analysis was normal. This family and those previously reported suggest that there is an increased recurrence risk of trisomy 21 after the birth of an affected individual, possibly caused by a genetic tendency for non-disjunction. After the birth of a child with Down's syndrome, amniocentesis and chromosome analysis of cultured amniotic fluid cells is indicated in each further pregnancy, irrespective of maternal age.     

The determination of urinary fluoride/creatinine ratio (Q) in monitoring fluoride intake

Linear correlation (r = 0.6811, p less than 0.001) was found between the 24 hour urinary excreted fluoride quantity and fluoride/creatinine ratio (Q) of the morning urine sample of 21 school children living in a children's home in Hungary. The mean value of fluoride/creatinine ratio (Q) in groups of children from eight different parts of Hungary, also showed linear correlation (r = 0.9720, p less than 0.001) with the measured fluoride concentration of drinking water. The urinary fluoride/creatinine ratio (Q) seems sufficiently informative for controlling fluoride intake in the course of caries preventive field studies.     

Red blood cell glucose metabolism in Down's syndrome

The specific activity of red blood cell glycolytic enzymes was determined in 20 Down's syndrome patients and compared with 20 normal controls. According to previous evidence, a 50% increase of phosphofructokinase and a 30% increase of glucose-6-phosphate dehydrogenase and glutathione peroxidase activity was found. Metabolic studies of the patients' erythrocytes revealed a decrease in fructose-6-phosphate and 2, 3-diphosphoglycerate concentrations, while fructose-1, 6-diphosphate and ADP both increased. Glucose utilization by intact erythrocytes from Down's syndrome patients did not differ from that of normal controls. However, addition of methylene blue or inorganic phosphate produced a higher stimulation of erythrocyte glycolysis in patients with Down's syndrome compared to controls. These metabolic abnormalities could be, at least in part, ascribed to the increased phosphofructokinase activity which is due to a gene-dosage effect.