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Cantone                                                                                                                                                                          Reversal of X chromosome inactivation


           Table 1: Differences between mouse and human X chromosome inactivation
                                                   Mouse                               Human
           Random XCI initiation                Late blastocyst                        Unknown
           X chromosome dampening                Not detected           Dosage compensation mechanism (pre-implantation)
           Imprinted XCI (embryonic)  Xp inactivation (4-cell stage) /reverted in epiblast   Not detected
                                              (mid-blastocyst stage)
           Imprinted XCI (extra-embryonic)  Xp inactivation (mantained in trophoectoderm)  Not detected
           XIST expression and localization  Mono-allelic Xi expression and coating upon   Bi-allelic expression and XaXa coating ahead of
                                                 random XCI                           random XCI
           Tsix/TSIX expression and function  Xa expression; Xist antagonist  No expression (pre-implantation)/ Xi expression (foetal
                                                                                  cells); unknown function
           XACT expression and function      No orthologue identified   XaXa expression and coating ahead of random XCI;
                                                                                    XIST antagonist?
           XCI: X chromosome inactivation; Xi: inactive X chromosome; Xp: paternal X chromosome; Xa: active X chromosome

           be used to segregate different pluripotent states with   This information might help us to achieve locus-
           distinct X chromosome epigenetic features in single cells,   specific control of Xi reactivation and to engineer novel
           as it can induce the expression of genes associated with   therapeutic strategies for X-linked diseases that will be
           both the primed and naïve human pluripotent states [129] .   based on the re-expression of the silent allele from the
           This information might be useful for identifying pathways   Xi. Furthermore, these studies will give us mechanistic
           that stabilize naïve pluripotency and for refining culture   insights into human diseases in which the reactivation
           conditions.                                        of genes along the Xi has been observed, including
                                                              cancer [135-137] , age-related [138,139]  and autoimmune
           The controversies regarding XCI state in human     diseases [140] .
           pluripotent cells also highlight the importance of
           standardized protocols for determining XCI status.   DECLARATIONS
           Indirect measurements of XCI, such as the presence of
           XIST nuclear foci and/or the expression ratio between
           X and autosomes, as well as analyses of few X-linked   Authors’ contributions
                                                              I. Cantone contributed solely to the paper.
           genes with only one methodology (e.g. RNA-FISH
           or allele-specific RT-PCR) might be misleading [57] .
           The advent of genome-wide techniques that can be   Financial support and sponsorship
                                                              None.
           used to assess allele-specific expression at the single
           cell level will be fundamental in defining different XCI   Conflicts of interest
           states and investigating the susceptibility of distinct   There are no conflicts of interest.
           Xi loci to reactivation. In addition, it will be important
           to reach an agreement about whether Xi expression   Patient consent
           should be defined as percentage of expression      Not applicable.
           relative to the Xa or based on more sophisticated
           statistical methods [129,132-134] . Notably, the combination   Ethics approval
           of molecular and cell biology techniques applied to   Not applicable.
           human pluripotent cells before and after differentiation
           is required to distinguish naïve from primed and
           eroded pluripotency. Finally, another important aspect   REFERENCES
           to consider is the variability of XCI in different tissues
           and individuals [10] . This variable Xi expression will   1.   Lyon MF. Gene action in the X-chromosome of the mouse (Mus
           need to be taken into account, and studies of XCI in   musculus L.). Nature 1961;190:372-3.
           a large number of subjects and in different tissues   2.   Deng X, Berletch JB, Nguyen DK, Disteche CM. X chromosome
           will be required to achieve a better understanding of   regulation: diverse patterns in development, tissues and disease. Nat
           how cellular context influence locus susceptibility to   Rev Genet 2014;15:367-78.
           reactivation.                                      3.   Schmidt M, Du Sart D. Functional disomies of the X chromosome
                                                                 influence the cell selection and hence the X inactivation pattern in
           In perspective, studies of human pluripotent          females with balanced X-autosome translocations: a review of 122
                                                                 cases. Am J Med Genet 1992;42:161-9.
           reprogramming will allow us to dissect the precise   4.   Peeters SB, Yang C, Brown CJ. Have humans lost control: the elusive
           molecular mechanisms of Xi reactivation and to        X-controlling element. Semin Cell Dev Biol 2016;56:71-7.
           unravel locus-specific susceptibilities to reactivation.   5.   Dobyns WB, Filauro A, Tomson BN, Chan AS, Ho AW, Ting
             10                                                       Journal of Translational Genetics and Genomics ¦ Volume 1 ¦ November 16, 2017
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