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| ==Overview== | | ==Overview== |
| ==Causes== | | ==Causes== |
| | | Down's syndrome is caused by triplication of chromosome 21 (trisomy 21). The aneuploidy may occur in three possible ways: |
| [[Image:Human chromosome 21.png|left|thumb|Chromosome 21 from Human Genome Program]][[Image:Karyotype.png|left|thumb|Normal human [[Karyotype]].]]
| | * '''Meiotic nondisjunction of homologous chromosomes''' |
| '''Down syndrome''' is a chromosomal abnormality characterized by the presence of an extra copy of genetic material on the [[Chromosome 21 (human)|21st chromosome]], either in whole ([[Aneuploidy#Trisomy|trisomy]] [[Chromosome 21 (human)|21]]) or part (such as due to [[Chromosomal translocation|translocations]]). The effects of the extra copy varies greatly from individual to individual, depending on the extent of the extra copy, genetic background, environmental factors, and random chance. Down syndrome can occur in all human populations, and analogous effects have been found in other species, such as chimpanzees and mice. Recently, researchers have been able to create [[transgenic]] mice with most of human chromosome 21 (in addition to their normal chromosomes).<ref>{{cite web| url=http://news.bbc.co.uk/1/hi/health/4268226.stm| title=Down's syndrome recreated in mice| author=BBC News| accessdate=2006-06-14| date=[[22 September]] [[2005]]}}</ref> | | ** From improper division of chromosomes during meiosis I or meiosis II. One gamete will end up with extra 21st chromosome. |
| | | * '''Robertsonian translocation''' |
| A normal human [[karyotype]] is shown here. Every chromosome has two copies. In the bottom right, there are chromosomal differences between males (XY) and females (XX), which do not concern us. A normal human karyotype is designated as 46,XX or 46,XY, indicating 46 chromosomes with an XX arrangement for females and 46 chromosomes with an XY arrangement for males.<ref>For a description of human karyotype see {{cite web| author=Mittleman, A. (editor)| year=1995| url=http://www.iscn1995.org/| title=An International System for Human Cytogenetic Nomeclature| accessdate=2006-06-04}}</ref> For this section, we will use females for the karyotype designation (46,XX).
| | ** Individuals with normal number of chromosomes but an extra portion of 21st chromosome. |
| | | * '''Mosaicism''' |
| The extra chromosomal material can come about in several distinct ways. These are explained in the following sections.
| | ** Post-fertilization mitotic error |
| ====Trisomy 21====
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| [[Image:Down Syndrome Karyotype.png|left|thumb|[[Karyotype]] for trisomy Down syndrome. Notice the three copies of chromosome 21.]]
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| Trisomy 21 (47,XX,+21) is caused by a [[Meiosis|meiotic]] [[nondisjunction]] event.<ref>There is a nice animation that shows nondisjunction at {{cite web| url=http://www.screening.nhs.uk/downs/home.htm| title=Meiotic nondisjunction animation| accessdate=2006-07-01}}</ref> A normal [[gamete]] (either egg or sperm) has one copy of each chromosome (23 total). When it is combined with a gamete from the other parent during conception, the child has 46 chromosomes. However, with nondisjunction, a gamete is produced with an extra copy of chromosome 21 (the gamete has 24 [[chromosome]]s). When combined with a normal gamete from the other parent, the child now has 47 chromosomes, with three copies of chromosome 21. The trisomy 21 karyotype figure shows the chromosomal arrangement, with the prominent extra chromosome 21.
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| Trisomy 21 is the cause of approximately 95% of observed Down syndromes, with 88% coming from nondisjunction in the maternal gamete and 8% coming from nondisjunction in the paternal gamete.<ref name=occurrence>{{cite web|url=http://www.nichd.nih.gov/health/topics/down/Pages/default.aspx|title=Down syndrome occurrence rates (NIH)|accessdate=2006-06-02}}</ref> [[Mitosis|Mitotic]] nondisjunctions after conception would lead to mosaicism, and is discussed later.
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| There has been reported some cases of Down syndrome parents having trisomy 21 children.<ref>For an example of mosaic Down syndrome mother, see {{cite book| author=Karkany, J.| year=1971| title=Congenital Malformations| location=Chicago| publisher=Year Book Medical Publishers, Inc.| pages=319-322| id=ISBN 0-8151-9098-0}}</ref> In these cases (all from mothers), the ovaries were trisomy 21, leading to a secondary nondisjunction during gametogenesis and a gamete with an extra chromosome 21. Such Down syndrome trisomies are indistinguishable from Down syndrome trisomies created through meiotic nondisjunction.
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| ====Robertsonian translocation====
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| [[Image:Balanced Translocation.png|left|thumb|150px|Balanced translocation with chromosomes 14 and 21q.]]
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| [[Image:Down syndrome translocation.png|left|thumb|Translocation [[karyotype]] for Down syndrome with 14/21 Robertsonian translocation. Notice the three copies of 21q (the long arm of chromosome 21).]]
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| The extra chromosome 21 material that causes Down syndrome may be due to a [[Robertsonian translocation]]. The long arm of [[Chromosome 21 (human)|chromosome 21]] is attached to another chromosome, often [[Chromosome 14 (human)|chromosome 14]] (45,XX,t(14;21q)) or itself (called an [[isochromosome]], 45,XX,t(21q;21q)) as seen in the translocation karyotype figure.
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| Translocation Down syndrome can be ''de novo''; that is, not inherited but occurring at the time of an individual's conception, or may be inherited from a parent with a balanced translocation. The balanced translocation figure shows a 14/21 translocation, where the other chromosomes are not shown. The individual has two copies of everything on chromosome 14, and two copies of all of the material on the long arm of chromosome 21 (21q). The individual only has one copy of the material on the short arm of chromosome 21 (21p), but this appears to have no discernable effect. Individuals with this chromosomal arrangement are phenotypically normal. During [[meiosis]], the chromosomal arrangement interferes with normal [[disjunction|separation]] of chromosomes. Possible gametic arrangements are: Normal 14 and normal 21; Translocated 14/21 and normal 21; Translocated 14/21 only; Normal 14 only. When combined with a normal gamete from the other parent, the last is lethal, leading to [[spontaneous abortion]]. The first, combined with a normal gamete from the other parent, gives rise to a normal child. The second leads to a translocation Down syndrome child (see translocation karyotype figure). The third becomes a translocation carrier, like the parent.
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| Translocation Down syndrome is often referred to as ''familial Down syndrome''. It is the cause of 2-3% of the observed Down syndromes.<ref name=occurrence>{{cite web|url=http://www.nichd.nih.gov/health/topics/down/Pages/default.aspxtitle=Down syndrome occurrence rates (NIH)|accessdate=2006-06-02}}</ref> It does not show the maternal age effect, and is just as likely to have come from fathers as mothers.
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| ====Mosaicism====
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| Mosaic Down syndrome is when some of the cells in the body are normal and some cells have trisomy 21, an arrangement called a [[Mosaic (genetics)|mosaic]] (46,XX/47,XX,+21).<ref>[http://www.mosaicdownsyndrome.com Mosaic Down Syndrome on the Web]</ref> This can occur in one of two ways: A [[nondisjunction]] event during an early cell division leads to a fraction of the cells with trisomy 21; or a Down syndrome embryo undergoes [[nondisjunction]] and some of the cells in the embryo revert back to the normal chromosomal arrangement. There is considerable variability in the fraction of trisomy 21, both as a whole and tissue-by-tissue. This is the cause of 1–2% of the observed Down syndromes.<ref name=occurrence>{{cite web|url=http://www.nichd.nih.gov/health/topics/down/Pages/default.aspx|title=Down syndrome occurrence rates (NIH)|accessdate=2006-06-02}}</ref> There is evidence that mosaic Down syndrome may produce less developmental delay, on average, than full trisomy 21.<ref>{{cite web| author= Leshin, L.| year=2000| url=http://www.ds-health.com/mosaic.htm| title=Mosaic Down Syndrome|accessdate=2006-06-02}}</ref>
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| ====Duplication of a portion of chromosome 21====
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| Rarely, a region of chromosome 21 will undergo a duplication event. This will lead to extra copies of some, but not all, of the genes on chromosome 21 (46,XX,dup(21q)). If the duplicated region has genes that are responsible for Down syndrome physical and mental characteristics, such individuals will show those characteristics. This cause is very rare and no rate estimates are possible.
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| =====Maternal Drug Use=====
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| * [[Clomifene]]
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| ==References== | | ==References== |