Inverted Insertion (9)(q34.3q22.3q21.2) and Its Recombination Product: Duplication 9@1.2q22.3To the Editor:We read with interest a recent article in your journal by Dr. Narahara and his colleagues (1986) who described a kindred with two carriers of what they interpreted as an intrachromosomal direct shift, dir ins(9)(q34.3q22.1q31.3), and a now 9-yearold girl with a recombinant chromosome 9. It was deduced that the rec(9) in the girl resulted from crossing over at one of two loops formed during meiosis I in her carrier mother, and thus carried duplication of the 9q22.1---~q31.3 segment. The ABO locus was assigned to 9q31.3-~ qter in view of the fact that the girl was a recombinant for the locus.We studied another kindred in which an apparently identical ins(9) chromosome is segregating through five generations. Our kindred and the maternal grandfather of the proband in Narahara's kindred both live in Tokuyama, a city with a 113,000 population. It is thus likely, but yet to be proven, that the two kindreds are related with each other.Our interpretation of the ins (9) is different from Narahara's (Fig. l, upper row). It involves insertion of an inverted 9@1.2-,q22.3 segment into 9q34.3. Pairing of the inv ins(9) chromosome with a normal chromosome 9 during meiosis I in a carrier individual would produce two loops, one involving the inverted q21.2--~ q22.3 segment and the other the @2.3--+q34.3 segment (Fig. l, lower row). Odd numbers of crossing over in the latter loop would produce a recombinant chromosome with duplication of the q21.2--, q22.3 segment and one with deficiency of the same segment (Fig. 2). Family studies in our kindred disclosed three ins(9) carriers and two individuals with dup 9q21.2--,q22.3 (Fig. 3). It was deduced that both l 1-2 and 11-3, and also either I-i or I-2, were carriers of the inv ins(9) chromosome. Thus, the trait was transmitted through at least five generations.V-4, the proband in our kindred, a 2 year 2 month-old girl with dup 9q21.2 ~-, q22.3, weighed 1,874 g at birth. She walked at 15 months but did not speak meaningful words at age 2 2/12 years. She measured 76.6 cm (-3.2 SD) and weighed 8 kg (-3 SD). She had ocular hypertelorism, a short nose with a depressed nasal tip, short neck, low-set, malformed ears, fifth finger clinodactyly, absence of bilateral palmar triradii C and distally placed axial triradii. Her bone age was correspondent to her chronological age. III-5, a maternal distant relative of the proband, also carries the dup(q) chromosome. She is now 45 years old and mentally retarded, but no other details are known to us. The proband in Narahara's kindred, a 5-year-old girl with dup 9q, had a low birth weight, growth deficiency, ocular hypertelorism, and dermatoglyphic abnormalities. Her IQ was 92 and her bone age 45