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Cantone                                                                                                                                                                          Reversal of X chromosome inactivation

           3 days after fusion) but not in all of them (50% at day 3).   somatic cells with low frequency and is enhanced upon
           XACT instead re-associates with either one or two X   reprogramming. Interestingly, recent studies of three-
           chromosomes later during reprogramming in a minority   dimensional X chromosome organization in mouse
           of both mono-allelic and bi-allelic cells (< 1% at day 6).   suggested that genes variably expressed from the Xi
           These results suggest that human Xi reactivation is   in a cell-specific context co-localize within topologically
           induced by cell fusion-mediated reprogramming ahead,   associated domains and showed reduced expression
           or immediately after, cell division and that it requires   upon disruption of the domain architecture [131] . As loci
           XIST delocalization, but not XACT re-association along   that escape X inactivation vary between different cell
           the Xi. Notably, delocalization of XIST upon cell fusion-  types and also between females [10] , future population
           mediated reprogramming results in a diffuse nuclear   analysis of somatic cells from different tissues will help
           signal that resembles the one observed in human    us to understand the molecular basis for this higher
           blastocysts and might represent remaining binding   reactivation susceptibility.
           at foci from where XIST initially spreads [127,128] . In
           addition, a minority of heterokaryon and hybrid nuclei   Another important finding of our Xi reactivation
           (7% at day 3 vs. 1% at day 0; unpublished data) have   study is the possibility of using cell fusion-mediated
           two diffused XIST clouds suggesting that cell fusion-  reprogramming to identify distinct subsets of Xi
           mediated reprogramming might be able to recapitulate   genes based on their susceptibility to reactivation
           some features of the in vivo epiblast cells. Consistently   upon further epigenetic perturbations. Indeed, DNA
           with this hypothesis, genome-wide expression analysis   demethylation of human fibroblasts allowed us to
           upon cell fusion-mediated reprogramming showed     identify a second subset of genes that was reactivated
           the reactivation of pluripotency genes associated with   only after reprogramming. This suggests that the
           both primed and naïve human pluripotent cells [129] . In   extensive Xi chromatin remodeling that takes place
           the future, single cell studies might indeed be used to   during reprogramming might unmask limiting factors in
           segregate different human pluripotent states and help   the reactivation of Xi gene subsets.
           us refine culture conditions for naïve pluripotency.
                                                              FINAL REMARKS
           To investigate the extent of Xi gene reactivation
           along the entire X chromosome, we derived human    Pluripotent reprogramming of somatic cells has been
           fibroblast clones with reciprocal Xi chromosomes   widely used to induce the reversal of X chromosome
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           (e.g. Xa Xi  and Xi Xa ) and performed allele-specific   inactivation and investigate its molecular mechanisms.
           RNA-seq analysis of these clones before and after   In the last decade, mouse somatic cell reprogramming
           reprogramming  [129] . This analysis showed that cell   allowed major steps forward in unraveling the molecular
           fusion-mediated reprogramming induces partial human   connections between pluripotency and X chromosome
           Xi reactivation with 10% of the sampled genes being   inactivation/reactivation [51,52,71,98] . Reprogramming,
           consistently reactivated at different times after fusion   indeed, represents a promising system to investigate
           and in different clones. Notably, clones with opposite Xi   the functional role of newly discovered XCI factors [23-27] .
           haplotype reactivate the same set of genes suggesting
           that neither parent of origin nor mutations in regulatory   In light of recent findings in human embryos, the
           sequences influence reactivation. We instead observed   interpretation  of  mouse  XCI  studies  need  to  be
           a preferential reactivation of Xi genes localized within   carefully considered when translated to human. Recent
           XCI “escape” domains at the telomeric end of the short   analyses of human pre-implantation development show
           Xp arm suggesting a higher susceptibility of these   remarkable differences between the events and the
           loci to reactivation. Similar results were obtained in a   molecular players that characterize X chromosome
           large iPSC population study that identified Xi domains   inactivation in human and mouse, suggesting unforeseen
           reactivating with higher frequency [130] . Conversely to   specie-specific mechanisms [60,61,103]  [Table 1]. In addition,
           iPSC erosion, however, Xi genes that were reactivated   the epigenetic instability and heterogeneity of human
           upon cell fusion-mediated reprogramming could not   pluripotent cells upon time in culture limit the possibility
           be predicted by H3K27me3 domains suggesting        of modelling human XCI and its reversal in vitro.
           that the mechanism leading to reactivation might be   Recently, comparison of transcriptome profiles of single
           different in these two systems [107] . Cell fusion-mediated   epiblast cells with human pluripotent cells allowed the
           Xi reactivation could instead be predicted by variable   identification of culture conditions that better preserve
           Xi expression among single cell-derived fibroblast   naïve pluripotency ex vivo [116,122,123] . XCI state, however,
           clones ahead of reprogramming. This probably       cannot be fully recapitulated in these cultures [62,103]  thus
           reflects an intrinsic predisposition of certain loci to   highlighting the need for further improvements. We
           transcriptional activation that can already occur in the   propose that cell fusion-mediated reprogramming might

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