The physiological importance of genomic imprinting in humans can be demonstrated by the diseases resulting from mutations or epimutations in imprinted genes. Human imprinting disorders are somewhat rare but comprise a large group of diverse pathologies, primarily involving growth or neurological development. Consistent with the growth phenotypes observed, many of the imprinted genes known to-date are expressed in the human placenta ()
[32],
[33].
| Table 1Imprinted genes expressed in the human placenta, with phenotpyes associated with loss of gain of expression, where reported. |
Disease pathologies resulting from inappropriate imprinted gene expression may each be due in part, or completely, to an aberrantly functioning placenta. The placenta is fundamental to fetal growth, and highlights the imprinted genes expressed in the placenta that have been implicated in fetal growth disorders. As previously stated, IUGR is a defining characteristic of the imprinting disorder SRS. Up to half of all SRS cases may be caused by a reduction in
IGF2 expression, as outlined above, but in the remainder the cause is unknown
[23]. Whilst IUGR is often idiopathic, it is commonly accompanied by reduced blood flow through the placenta and limited invasion of the decidua and maternal blood vessels
[34]. This phenotype is consistent with either the loss of expression of an imprinted gene involved in maximising recruitment of maternal resources (i.e., a paternally expressed gene), or an increase in expression of an imprinted gene acting to limit maternal input (i.e., a maternally expressed gene). A second disease associated with reduced placental perfusion is preeclampsia, whose matrilineal inheritance pattern has highlighted the possibility that imprinted genes might involved in its pathogenesis
[35],
[36]. In a recent study of 96 cases of BWS, seven resulted from maternally inherited
CDKN1C mutations and of these, three pregnancies were complicated by preeclampsia, compared to three of the 89 BWS cases not related to
CDKN1C mutations
[37]. Interestingly, transgenic mice whose litters carry mutations of the maternal
Cdkn1c copy display preeclampsia-like features, including hypertension, proteinuria, and abnormal trophoblast proliferation
[38],
[39]. These data suggest an important role for
CDKN1C in a subset of preeclampsia cases, however, other imprinted susceptibility loci for this complication of pregnancy remain elusive
[40].
The imprinted gene
PHLDA2 on human Chromosome 11 (Hsa11) is expressed predominately in the placenta, and its expression in the placenta at term correlates negatively with fetal birth weight
[41]. Given that
PHLDA2 is maternally expressed, this trend is consistent with the parental resource conflict theory, that maternally expressed genes act to limit maternal resource provision. Further evidence that
PHLDA2 expression levels in the human placenta might be important in regulating fetal growth comes from two studies comparing placentas from normal and IUGR pregnancies. Both studies found higher levels of
PHLDA2 expression in placentas from IUGR pregnancies than placentas from non-IUGR pregnancies
[33],
[42].
Paternally expressed
MEST is thought to play a role in angiogenesis in human trophoblast tissue and decidua, is highly expressed and robustly imprinted in the placenta
[43].
MEST is located on Hsa7, and maternal uniparental disomy (mUPD) 7, is implicated in 7–10% of SRS cases. Additionally, one SRS case has been reported with a segmental mUPD for 7q31-qter, specifically implicating the
MEST imprinting cluster in this instance, rather than any of the other imprinted genes on Hsa7
[44]. Currently, no direct evidence exists to link human
MEST with disease, but mice deficient in
Mest are pre- and postnatally growth restricted
[45].
GRB10 is a growth factor binding protein, maternally expressed specifically in cytotrophoblast and biallelic elsewhere, located on Hsa7
[46]. The mUPD7 implicated in 7–10% SRS cases would lead to biallelic expression of
GRB10 and may be linked to the growth restriction characteristic of SRS for this subset of patients. Currently, however, no evidence exists to directly link
GRB10 expression levels with growth in humans
[47],
[48]. In mouse embryos,
Grb10 is widely expressed from the maternally derived chromosome, and ablation of this copy causes embryonic overgrowth, such that neonates are 30% larger than wild-type littermates at birth
[49]. This is accompanied by disproportionate overgrowth of the placental labyrinth
[50].