Teratogenesis Associated With Gastrulation

Teratogenesis Associated With Gastrulation
The beginning of the thirdweek of development, when gastrulation is initiated,
is a highly sensitive stage for teratogenic insult. At this time, fate maps can
be made for various organ systems, such as the eyes and brain anlage, and
these cell populations may be damaged by teratogens. For example, high
doses of alcohol at this stage kill cells in the anterior midline of the germ disc,
producing a deficiency of the midline in craniofacial structures and resulting
in holoprosencephaly. In such a child, the forebrain is small, the two lateral
ventricles often merge into a single ventricle, and the eyes are close together
(hypotelorism). Because this stage is reached 2 weeks after fertilization, it is
approximately 4 weeks from the last menses. Therefore, the woman may not
recognize she is pregnant, having assumed that menstruation is late and will
begin shortly. Consequently, she may not take precautions shewould normally
consider if she knew she was pregnant.
Gastrulation itself may be disrupted by genetic abnormalities and toxic
insults. In caudal dysgenesis (sirenomelia), insufficient mesoderm is formed
in the caudal-most region of the embryo. Because this mesoderm contributes
to formation of the lower limbs, urogenital system (intermediate mesoderm),
and lumbosacral vertebrae, abnormalities in these structures ensue. Affected
individuals exhibit a variable range of defects, including hypoplasia and fusion
of the lower limbs, vertebral abnormalities, renal agenesis, imperforate anus,
and anomalies of the genital organs (Fig. 4.13). In humans, the condition is
associated with maternal diabetes and other causes. In mice, abnormalities
of Brachyury (T), Wnt, and engrailed genes produce a similar phenotype.
Situs inversus is a condition in which transposition of the viscera in the
thorax and abdomen occurs. Despite this organ reversal, other structural abnormalities
occur only slightly more frequently in these individuals. Approximately
20% of patients with complete situs inversus also have bronchiectasis
and chronic sinusitis because of abnormal cilia (Kartagener syndrome). Interestingly,
cilia are normally present on the ventral surface of the primitive node
and may be involved in left-right patterning during gastrulation. Other conditions
of abnormal sidedness are known as laterality sequences. Patients with
these conditions do not have complete situs inversus but appear to be predominantly
bilaterally left sided or right sided. The spleen reflects the differences;
those with left-sided bilaterality have polysplenia, and those with right-sided
bilaterality have asplenia or hypoplastic spleen. Patients with laterality sequences
also are likely to have other malformations, especially heart defects.