In patients with the 3p-syndrome, hemizygous deletion of 3p25-pter is associated with profound growth failure, characteristic facial features, and mental retardation. We performed a molecular genetic analysis of 3p25 breakpoints in four patients with the 3p-syndrome, and a fifth patient with a more complex abnormality, 46,XY,der(3)t(3;?)(p25.3;?). EBV transformed lymphoblasts from each of the patients were initially characterised using fluorescent in situ hybridisation (FISH) and polymorphic microsatellite analyses. The 3p-chromosome from each patient was isolated from the normal chromosome 3 in somatic cell hybrid lines and subsequently analysed with polymorphic and monomorphic PCR amplifiable markers from 3p25. The analysis clearly shows that all five breakpoints are distinct. Furthermore, we have identified yeast artificial chromosomes that cross the 3p25 breakpoints of all four 3p-patients. Two of the patients were deleted for the von Hippel-Lindau (VHL) tumour suppressor gene, although neither has yet developed evidence of VHL disease. The patient with the most centromeric breakpoint, between D3S1585 and D3S1263, had the most severe clinical phenotype including an endocardial cushion defect that was not observed in any of the four patients who had more telomeric breakpoints. This study should provide useful insights into critical regions within 3p25 that are involved in normal human growth and development.

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Since some patients with Ullrich-Turner syndrome (UTS) have mental retardation, we reviewed our experience to look for a high-risk subgroup. Among 190 UTS and gonadal dysgenesis patients with X chromosome abnormalities, 12 had mental retardation. All of the six (100%) with a small ring X were educable (EMI) or trainable mentally impaired (TMI) with more severe delay than expected in UTS. Among the 184 with other X abnormalities, only 6 had similar delays (2 from postnatal catastrophes), for a frequency of 3.3% mental retardation among those without a small ring X; only 2.2% of these had unexplained mental retardation. Polymerase chain reaction studies showed no Y-derived material in the 2 patients who were evaluated, and in situ hybridization confirmed X origin of the ring in the 6 subjects who were evaluated. We describe the phenotype of the 6 individuals with a small ring X, and an additional 2 patients with a small ring X who were identified outside the survey. The subjects with a small ring X comprised a clinically distinct subgroup which had EMI/TMI and shorter stature than expected in UTS. Seizures and a head circumference less than 10th centile were observed in half of the patients with a small ring X, and strabismus, epicanthus, and single palmar creases were present in more than half. A "triangular" face in childhood, pigmentary dysplasia, sacral dimple, and heart defects were also common. Neck webbing appeared to be less frequent than in 45,X. We hypothesize that the high risk of mental retardation in this form of the UTS results from lack of lyonization of the ring X due to loss of the X inactivation center. Excluding those with a small ring X, mental retardation is not significantly increased in patients with UTS.

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There are 23 females known with Duchenne or Becker muscular dystrophy (DMD or BMD) who have X;autosome translocations that disrupt the X chromosome within band p21. A female with a t(X;4)(p21;q35) translocation was identified prenatally at routine amniocentesis. At birth, she was found to have a raised CK level, consistent with a diagnosis of Duchenne muscular dystrophy. Her cells were fused with mouse RAG cells and the translocated chromosomes were separated from one another and from the normal X chromosome by segregation in the resulting somatic cell hybrids.Southern blot analysis of the hybrids indicated that the translocation occurred on the X chromosome between genomic probes GMGXll and J-66, both of which lie within the DMD gene. Further localisation with a subfragment of the DMD cDNA clone placed the translocation breakpoint in an intron towards the middle of the gene, confirming that the de novo translocation disrupted the DMD gene. RFLP analysis of the patient, her parents, and the hybrid cell lines showed that the translocation originated in the paternal genome. This brings to six out of six the number of DMD gene translocations of paternal origin, a fact that may be an important clue in future studies of the mechanism by which X;autosome translocations arise. Duchenne and Becker muscular dystrophies (DMD and BMD) are X linked muscle wasting disorders caused by mutation in a gene located at Xp21.1 Twenty-three females have been described with DMD and de novo X;autosome translocations with the X chromosome breakpoint at p21 and the autosomal breakpoint variable in location.2 Expression of the disease in these females is the result of nonrandom inactivation of the normal X chromosome and the variable severity of the disease is probably dependent on the percentage of active normal X chromosomes in the muscle fibres.2Although all of the translocations break on the X chromosome at p2 1, detailed cytogenetic examination has mapped the translocation exchange points over a large region of Xp21. The DMD gene has been estimated by pulsed field gel analysis to be as large as 2000 kbF7 and has a minimum of 60 exons.8 Southern blot analysis using DMD genomic probes on mousehuman somatic cell hybrids containing one of the two translocation derived chromosomes from several patients has confirmed that the translocation breakpoints are scattered throughout the gene.9 10 Further localisation of translocation breakpoints has been possible with the use of the DMD cDNA clones, 8 11 12 and analysis of four translocation patients has shown breakpoints within large introns, two in intron 1 and two in intron 7.13To date, all of the published translocation cases were ascertained as females with muscular dystrophy. We have recently had the opportunity to study a t(X;4) translocation first detected in amniotic fluid from a 31 year old undergoing routine prenatal diagnosis. At birth, the child was confirmed to have the translocation, and had a grossly raised CK level consistent with DMD. Molecular analysis has mapped the...