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Fluorescence in situ
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Please help us to help you! hybridisation (FISH)
Produced with the support of
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This leaflet is not a substitute for personal medical advice. Families should consult a
medically qualified clinician in all matters relating to genetic diagnosis, management and
health. The information is believed to be the best available at the time of publication. It
was compiled by Unique and reviewed by Dr Shehla Mohammed and Dr Caroline Ogilvie,
Guy’s Hospital, London. UK and Professor Maj Hultén, Professor of Reproductive
Genetics, University of Warwick, UK. 2011, 2013 Version 2.1 (SW). 2023 Version 2.2 (AP).
Copyright © Unique 2023
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Fluorescence in situ hybridization (FISH) Notes
Chromosomes
Chromosomes are structures that contain the genetic information (DNA) that tells the
body how to develop and function. The cells in the body have 46 chromosomes which are
arranged in pairs. Each pair contains a chromosome from each parent and they are
arranged approximately according to size and numbered from 1 to 22. The last pair
contains the sex chromosomes. Girls have two Xs (XX) and boys have an X and a Y (XY).
Cytogenetic (chromosome) testing looks for changes in the number and structure of the
chromosomes and for losses (deletions) and gains (duplications) of genetic material.
People with these types of changes in their cells may have an increased risk of birth
defects, developmental delay, behavioural problems and intellectual disability.
Looking at chromosomes (chromosome analysis)
Chromosomes can be seen if they are stained and magnified
under the microscope. Chromosomes have a short (p) arm and a
long (q) arm held together at a structure called the centromere.
Each chromosome has a distinct pattern of light and dark bands
which are numbered outwards from the centromere. The
chromosome diagram on the right shows the banding pattern of
chromosome 10. Clinical scientists use microscope analysis to p arm
look for changes in the shape of the chromosomes and their
banding patterns. If the change is large enough,
rearrangements and imbalances (deletions and duplications)
involving chromosomes or parts of the chromosomes can be centromere
seen. Clinical scientists who do the analysis are very skilled at
detecting very small and often very subtle changes. However,
chromosome rearrangements and the loss or gain of material
can often be extremely small and frequently cannot be observed
with a routine chromosome test even by the most skilled of
scientists. FISH testing allows some of these changes to be q arm
detected.
What is FISH?
FISH is a method that can be used to detect small deletions and
duplications that are not visible using microscope analysis. It
can also be used to detect how many chromosomes of a certain
type are present in each cell and to confirm rearrangements
that are suspected after microscope analysis. FISH looks
specifically at the one specific area of a chromosome only. It
uses a very small chemical that glows brightly when it detects the
specific region on a chromosome. A scientist uses a special
microscope to look at the chromosome and see how many bright
spots are present. When a person has a deletion, only one bright Chromosome 10
spot can be seen instead of two (one on each chromosome). When a person has a
duplication, three bright spots can be seen instead of just two.
What are the advantages of FISH? How does FISH work?
◼ FISH is able to detect many small deletions, duplications and rearrangements that The DNA in our cells contains two strand-like molecules coiled
together into a structure known as a double helix (see right).
are not visible with standard microscope analysis
Each strand has a sequence containing a mixture of four bases
◼ A diagnosis from FISH may avoid your child having to undergo many other tests (A, T, G and C). The bases in each strand are able to bind to
each other and hold the DNA together, but can only do so if
What are the benefits of FISH? they are properly matched, or complementary, to those in the
◼ It may help you and your doctor watch for common health problems associated with other strand (an A can only bind to a T and a C can only bind to
a G). When two complementary sequences find each other they
your child’s chromosome imbalance
will bind together, or hybridise. FISH works by exploiting the
◼ It may help to predict what to expect as your child gets older ability of one DNA strand to hybridise specifically to another
◼ It may show which specific genes are included in your child’s deletion or duplication. DNA strand.
FISH uses small DNA strands called probes that have a
If the gene(s) has been associated with a particular feature or health problem it may
fluorescent label attached to them. The probes are
help to guide management or treatment for your child complementary to specific parts of a chromosome. When DNA
◼ It can help you to obtain specialist services for your child is heated, the patient’s two DNA strands break apart, or
denature, and the probes are able to hybridise to their
◼ You can choose to join a support group to meet other parents facing similar complementary sequence in the patient’s DNA (see diagram
challenges below).
◼ Parents and other family members can be tested to see if they are carriers of changes If a small deletion is present in the region complementary to the probe, the probe will not
hybridise. If a duplication is present, more of the probe is able to hybridise.
in their DNA that put them at risk of having more children with a chromosome change
What are the limitations of FISH?
◼ FISH testing does not usually screen all chromosomes for changes. Most FISH probes patient’s DNA
are specific for one particular deletion or duplication within one band of one
chromosome so it will only find what it is looking for
heating
◼ FISH probes are only available for the most well characterised deletion and
duplication syndromes. Your child may have a small imbalance that cannot be
detected with the standard FISH tests currently available
◼ FISH has limited ability to precisely define which genes and breakpoints are involved denaturation
in an imbalance
◼ It can be difficult for clinical scientists to see a duplication using FISH, as the
attachment of extra probes is not always easy to see
probe with
fluorescent
label
What other tests are available if FISH does not reveal cooling
any rearrangements?
If microscope analysis and FISH testing do not reveal a rearrangement, your child may be
referred for microarray-based comparative genomic hybridisation (array CGH). This test
hybridisation
examines all chromosomes for losses and gains of DNA and can detect smaller
imbalances than those detected with FISH or microscope analysis.
An overview of the FISH test
Why has FISH been offered for your child?
FISH is often performed alongside standard microscope analysis if your child has
characteristics that are strongly suggestive of a particular deletion syndrome or another
syndrome for which a FISH test is available. Your geneticist may request microscope
analysis and FISH testing together or may request FISH testing if microscope analysis
gives a normal result.
How will we be given the results?
The results are most likely to be given to you by your geneticist who will talk you through
your child’s results and you will almost certainly receive a follow up letter.
FISH results are often included with the results of microscope analysis in a combined
report. The first line of a report shows the results as a karyotype. If your child’s
chromosomes are not deleted, the karyotype may look something like this:
46,XX.ish 22q11.2(TUPLE1x2)(ARSAx2)
46 The total number of chromosomes present
XX The sex chromosomes present (XX for girls, XY for boys)
ish The analysis was by fluorescent in situ hybridisation (FISH)
22 The FISH test was performed on chromosome 22
q11.2 The FISH test targeted the q arm at band 11.2
(TUPLE1x2) The DNA segment (probe) called TUPLE is present in two copies
(as expected)
(ARSAx2) The DNA segment (probe) called ARSA2 is present in two copies
(as expected)
If a deletion is present, the karyotype is written slightly differently, as shown below
FISH testing for a deletion. Two probes are usually used;The first probe
(green) is a control probe used to identify both copies of the chromosome under test. It 46,XX.ish del(22)(q11.2q11.2)(TUPLE1-)
hybridises to a sequence that is not part of the deletion, so a signal is observed on each 46 The total number of chromosomes present
chromosome. The second probe (red) hybridises to the sequence that may be deleted. A XX The sex chromosomes present (XX for girls, XY for boys)
deletion is usually found in only one of the chromosomes in a pair, therefore the probe ish The analysis was by fluorescent in situ hybridisation (FISH)
can bind to the intact chromosome, but is unable to bind to the deleted chromosome and del A deletion, or material is missing
only one signal is seen. (22) The deletion is from chromosome 22
(q11.2q11.2) The chromosome has two breakpoints, both in band 22q11.2 and
What types of probes are used? material between these two breakpoints is missing
Many FISH probes bind to specific gene-containing parts of the DNA and are used to (TUPLE1-) One copy of the DNA segment (marker) called TUPLE is missing
detect small imbalances. These are known as locus-specific probes. Other probes bind to
the centromere or the telomeres (the ends of the chromosome arms) and are used to How long do the results take?
count the number of certain chromosomes and to detect rearrangements. Paint probes With blood testing, results are usually available in 4 weeks and can be available in under
are also available which bind to the whole chromosome. two weeks for priority cases such as newborn babies. Results may be available much
sooner if a blood sample has been provided previously for microscope analysis, as the
What samples are needed for FISH testing? same sample can be used for the FISH test.
FISH is most commonly performed on blood samples from adults and children. FISH can
also be used as a prenatal test for aneuploidy (extra copies of whole chromosomes) using
amniotic fluid from an amniocentesis or placental samples from chorionic villus
sampling (CVS). Less commonly it is used as a prenatal test for deletions, also using
amniotic fluid or CVS samples.
