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Guha S, Reddi HV, Aarabi M, DiStefano M, Wakeling E, Dungan JS, Gregg AR. Laboratory testing for preconception/prenatal carrier screening: A technical standard of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2024; 26:101137. [PMID: 38814327 DOI: 10.1016/j.gim.2024.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 05/31/2024] Open
Abstract
Carrier screening has historically assessed a relatively small number of autosomal recessive and X-linked conditions selected based on frequency in a specific subpopulation and association with severe morbidity or mortality. Advances in genomic technologies enable simultaneous screening of individuals for several conditions. The American College of Medical Genetics and Genomics recently published a clinical practice resource that presents a framework when offering screening for autosomal recessive and X-linked conditions during pregnancy and preconception and recommends a tier-based approach when considering the number of conditions to screen for and their frequency within the US population in general. This laboratory technical standard aims to complement the practice resource and to put forth considerations for clinical laboratories and clinicians who offer preconception/prenatal carrier screening.
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Affiliation(s)
| | - Honey V Reddi
- Department of Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Mahmoud Aarabi
- UPMC Medical Genetics and Genomics Laboratories, UPMC Magee-Womens Hospital, Pittsburgh, PA; Departments of Pathology and Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | | | - Jeffrey S Dungan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anthony R Gregg
- Department of Obstetrics and Gynecology, Prisma Health, Columbia, SC
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2
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Mei JY, Platt LD. Reproductive genetic carrier screening in pregnancy: improving health outcomes and expanding access. J Perinat Med 2024; 0:jpm-2024-0059. [PMID: 38924780 DOI: 10.1515/jpm-2024-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/16/2024] [Indexed: 06/28/2024]
Abstract
Reproductive genetic carrier screening (RGCS) serves to screen couples for their risk of having children affected by monogenic conditions. The included conditions are mostly autosomal recessive or X-linked with infantile or early-childhood onset. Cystic fibrosis, spinal muscular atrophy, and hemoglobinopathies are now recommended by the American College of Obstetricians and Gynecologists (ACOG) for universal screening. Recommendations for further RGCS remain ethnicity based. The American College of Medical Genetics and Genomics and the National Society of Genetic Counselors in recent years have recommended universal expanded-panel RGCS and moving towards a more equitable approach. ACOG guidelines state that offering RGCS is an acceptable option, however it has not provided clear guidance on standard of care. Positive results on RGCS can significantly impact reproductive plans for couples, including pursuing in vitro fertilization with preimplantation genetic testing, prenatal genetic testing, specific fetal or neonatal treatment, or adoption. RGCS is a superior approach compared to ethnicity-based carrier screening and moves away from single race-based medical practice. We urge the obstetrics and gynecology societies to adopt the guidelines for RGCS put forward by multiple societies and help reduce systemic inequalities in medicine in our new genetic age. Having national societies such as ACOG and the Society for Maternal-Fetal Medicine officially recommend and endorse RGCS would bolster insurance coverage and financial support by employers for RGCS. The future of comprehensive reproductive care in the age of genomic medicine entails expanding access so patients and families can make the reproductive options that best fit their needs.
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Affiliation(s)
- Jenny Y Mei
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Lawrence D Platt
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
- Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA, USA
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Zhang L, Yu L, Shu X, Ding J, Zhou J, Zhong C, Pan B, Guo W, Zhang C, Wang B. Whole exome sequencing reveal 83 novel Mendelian disorders carrier P/LP variants in Chinese adult patients. J Hum Genet 2023; 68:737-743. [PMID: 37386068 DOI: 10.1038/s10038-023-01179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/26/2023] [Accepted: 06/17/2023] [Indexed: 07/01/2023]
Abstract
Carrier screening can identify people at risk of conceiving pregnancies affected with inherited genetic disorders or who have a genetic disorder with late or variable onset. Carrier screening based on whole exome sequencing (WES) data can offer more comprehensive assessment than on-target carrier screening tests. A total of 224 Chinese adult patients WES data was analyzed, except positive variants associated with the patients' major complaint, 378 pathogenic (P) and "likely pathogenic" (LP) variants from 175 adult patients were identified. Whole exome-wide frequency of carriers for Mendelian disorders in Chinese adult patients was about 78.13% in this study, which was lower than the previously reported carrier frequency in healthy population. Contrary to expectations, the number of P or LP variants did not increase with larger chromosome size or decrease with smaller chromosome size. Totally 83 novel P or LP variants were identified which could further expand the carrier variants spectrum of the Chinese population. GJB2: NM_004004.6:c.299_300delAT:p.His100fs*14 and C6:NM_000065.4:c.654T>A:p.Cys218* were found in two or more patients, which might be two underestimated carrier variants in Chinese population. We also found 9 late-onset or atypical symptoms autosomal/X-linked dominant Mendelian disorders causative genes, which were easily overlooked during pathogenicity analysis. These results can provide a strong basis for preventing and avoiding the prevalence rates of birth defects and reducing social and family burdens. By comparing with three different expanded carrier screening gene panels, we further confirmed carrier screening based on WES could offer more comprehensive assessment and WES was applicable for carrier screening.
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Affiliation(s)
- Li Zhang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Li Yu
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Jing Ding
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jingmin Zhou
- Department of Cardiology Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunjiu Zhong
- Department of Neurology, Zhongshan Hospital, State Key Laboratory, Fudan University, Shanghai, China
| | - Baishen Pan
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Guo
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunyan Zhang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Beili Wang
- Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
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Gunsel AS, Ergoren MC, Kemal H, Kafshboran HR, Cerit L, Turgay A, Duygu H. Determination of Carrier Frequency of Actionable Pathogenic Variants in Autosomal Recessive Genetic Diseases in the Turkish Cypriot Population. Genes (Basel) 2023; 14:1967. [PMID: 37895316 PMCID: PMC10606490 DOI: 10.3390/genes14101967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Whole-exome DNA sequencing is a rich source of clinically useful information for specialists, patients, and their families, as well as elucidating the genetic basis of monogenic and complex diseases in clinical diagnosis. However, interpreting and reporting variants encompassing exome and genome sequence analysis outcome data are one of the greatest challenges of the genomic era. In this study, we aimed to investigate the frequency and allele frequency spectrum of single nucleotide variants accepted as recessive disease carrier status in Turkish Cypriot exomes. The same sequencing platform and data processing line were used for the analysis of data from 100 Turkish Cypriot whole-exome sequence analysis. Identified variants were classified according to ACMG guidelines, and pathogenic variants were confirmed in other databases such as ClinVar, HGMD, Varsome, etc. Pathogenic variants were detected in 68 genes out of 100 whole-exome sequence data. The carriage rate was the highest in the CYP21A2 gene, causing 21-hydroxylase deficiency (14.70%), 11.76% in the HBB gene causing β-thalassemia, 10.29% in the BTD gene causing biotinidase deficiency, 8.82% in the CFTR gene causing cystic fibrosis, 8.82% in the RBM8A gene causing thrombocytopenia-absent radius syndrome, which is an ultra-rare disease, and 5.88% in the GAA gene causing glycogen storage disease II. The carriage of pathogenic variants in other genes causing the disease (GJB2, PAH, GALC, CYP11B2, COL4A3, HBA1, etc.) was determined as less than 5.00%. Also, the identified variations in the mentioned gene within the examined population were reported. The most prevalent mutation in North Cyprus was a missense variant (c.1360 C>T, p.Pro454Ser) detected in the CYP21A2 gene (rs6445), and the most frequently seen variant in the HBB gene was c.93-21G>A (rs35004220). We investigated reported pathogenic variants by estimating the lower and upper limits of carrier and population frequencies for autosomal recessive diseases, for which exome sequencing may reveal additional medically relevant information. Determining the lower and upper limits of these frequencies will shed light on preventive medicine practices and governmental actions.
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Affiliation(s)
- Aziz Suat Gunsel
- Department of Cardiology, Faculty of Medicine, Near East University, Nicosia 99138, Cyprus; (A.S.G.); (H.K.); (L.C.); (H.D.)
| | - Mahmut Cerkez Ergoren
- Department of Medical Genetics, Faculty of Medicine, Near East University, Nicosia 99138, Cyprus;
- Laboratory of Medical Genetics, Near East University Hospital, Near East University, Nicosia 99138, Cyprus;
| | - Hatice Kemal
- Department of Cardiology, Faculty of Medicine, Near East University, Nicosia 99138, Cyprus; (A.S.G.); (H.K.); (L.C.); (H.D.)
| | | | - Levent Cerit
- Department of Cardiology, Faculty of Medicine, Near East University, Nicosia 99138, Cyprus; (A.S.G.); (H.K.); (L.C.); (H.D.)
| | - Ayla Turgay
- Laboratory of Medical Genetics, Near East University Hospital, Near East University, Nicosia 99138, Cyprus;
| | - Hamza Duygu
- Department of Cardiology, Faculty of Medicine, Near East University, Nicosia 99138, Cyprus; (A.S.G.); (H.K.); (L.C.); (H.D.)
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Khera HK, Mishra R. Nucleic Acid Based Testing (NABing): A Game Changer Technology for Public Health. Mol Biotechnol 2023:10.1007/s12033-023-00870-4. [PMID: 37695473 DOI: 10.1007/s12033-023-00870-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
Timely and accurate detection of the causal agent of a disease is crucial to restrict suffering and save lives. Mere symptoms are often not enough to detect the root cause of the disease. Better diagnostics applied for screening at a population level and sensitive detection assays remain the crucial component of disease surveillance which may include clinical, plant, and environmental samples, including wastewater. The recent advances in genome sequencing, nucleic acid amplification, and detection methods have revolutionized nucleic acid-based testing (NABing) and screening assays. A typical NABing assay consists of three modules: isolation of the nucleic acid from the collected sample, identification of the target sequence, and final reading the target with the help of a signal, which may be in the form of color, fluorescence, etc. Here, we review current NABing assays covering the different aspects of all three modules. We also describe the frequently used target amplification or signal amplification procedures along with the variety of applications of this fast-evolving technology and challenges in implementation of NABing in the context of disease management especially in low-resource settings.
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Affiliation(s)
- Harvinder Kour Khera
- Tata Institute for Genetics and Society, New inStem Building NCBS Campus, GKVK Post, Bellary Road, Bengaluru, 560065, India.
| | - Rakesh Mishra
- Tata Institute for Genetics and Society, New inStem Building NCBS Campus, GKVK Post, Bellary Road, Bengaluru, 560065, India.
- CSIR-Centre for Cellular and Molecular Biology, Uppal Rd, IICT Colony, Habsiguda, Hyderabad, Telangana, 500007, India.
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Veneruso I, Ranieri A, Falcone N, Tripodi L, Scarano C, La Monica I, Pastore L, Lombardo B, D’Argenio V. The Potential Usefulness of the Expanded Carrier Screening to Identify Hereditary Genetic Diseases: A Case Report from Real-World Data. Genes (Basel) 2023; 14:1651. [PMID: 37628702 PMCID: PMC10454493 DOI: 10.3390/genes14081651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Expanded carrier screening (ECS) means a comprehensive genetic analysis to evaluate an individual's carrier status. ECS is becoming more frequently used, thanks to the availability of techniques such as next generation sequencing (NGS) and array comparative genomic hybridization (aCGH), allowing for extensive genome-scale analyses. Here, we report the case of a couple who underwent ECS for a case of autism spectrum disorder in the male partner family. aCGH and whole-exome sequencing (WES) were performed in the couple. aCGH analysis identified in the female partner two deletions involving genes associated to behavioral and neurodevelopment disorders. No clinically relevant alterations were identified in the husband. Interestingly, WES analysis identified in the male partner a pathogenic variant in the LPL gene that is emerging as a novel candidate gene for autism. This case shows that ECS may be useful in clinical contexts, especially when both the partners are analyzed before conception, thus allowing the estimation of their risk to transmit an inherited condition. On the other side, there are several concerns related to possible incidental findings and difficult-to-interpret results. Once these limits are defined by the establishment of specific guidelines, ECS may have a greater diffusion.
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Affiliation(s)
- Iolanda Veneruso
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy
| | - Annaluisa Ranieri
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
| | - Noemi Falcone
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy
| | - Lorella Tripodi
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy
| | - Carmela Scarano
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy
| | - Ilaria La Monica
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
| | - Lucio Pastore
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy
| | - Barbara Lombardo
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, via Sergio Pansini 5, 80131 Naples, Italy
| | - Valeria D’Argenio
- CEINGE-Biotecnologie Avanzate Franco Salvatore, via G. Salvatore 486, 80145 Naples, Italy
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, via di Val Cannuta 247, 00166 Rome, Italy
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Strauss TS, Schneider E, Boniferro E, Brockhoff E, Johnson A, Stoffels G, Feldman K, Grubman O, Cole D, Hussain F, Ashmead G, Al-Ibraheemi Z, Brustman L. Barriers to completion of expanded carrier screening in an inner city population. Genet Med 2023; 25:100858. [PMID: 37087636 DOI: 10.1016/j.gim.2023.100858] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/16/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023] Open
Abstract
PURPOSE The American College of Medical Genetics and Genomics emphasizes a "consistent and equitable approach for offering carrier screening." At our academic center, publicly insured prenatal patients underwent universal expanded carrier screening (ECS) to promote equitable care. The aim of the study was to evaluate rates, time, and barriers to complete ECS. This was defined as post-test counseling and partner testing after a patient was found heterozygous for a pathogenic variant. METHODS In this descriptive retrospective cohort study from 2018 to 2021, patients were offered ECS, consisting of 283 recessive and X-linked genes. Heterozygotes were contacted by genetic counselors (≤5 attempts) for education and partner testing. Rates of counseling, partner testing, diagnostic procedures, follow-up times, and barriers to completion were assessed. RESULTS During this time, 643 women underwent ECS. Of these 643 women, 462 were heterozygotes and 326 of 462 had undergone counseling. Two hundred twenty-two of 462 partners obtained testing, with a median of 32 days from patient to partner result. Approximately 21 couples were heterozygous for the same pathogenic variant. One patient pursued diagnostic testing. CONCLUSION ECS offers useful information; however, this study highlights significant barriers to completion. There was suboptimal patient follow-up and low partner screening, perhaps from insufficient time to educate and counsel. Future directions include implementing quality measures to ensure optimal completion.
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Affiliation(s)
- Tirtza S Strauss
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY.
| | - Emily Schneider
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Emily Boniferro
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Erika Brockhoff
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Anna Johnson
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Guillaume Stoffels
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Kristina Feldman
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Olivia Grubman
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - David Cole
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Farrah Hussain
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Graham Ashmead
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Zainab Al-Ibraheemi
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
| | - Lois Brustman
- Division of Maternal Fetal Medicine, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York City, NY
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Hagiwara N, Duffy C, Quillin J. Implicit and explicit racial prejudice and stereotyping toward Black (vs. White) Americans: The prevalence and variation among genetic counselors in North America. J Genet Couns 2022; 32:397-410. [PMID: 36341692 PMCID: PMC10168592 DOI: 10.1002/jgc4.1648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
Research has shown that patient experiences and outcomes of genetic counseling are not equitable across racial categories, disadvantaging Black patients relative to White patients. One major factor contributing to such racial disparities might be genetic counselor racial bias. The present study examined the prevalence of and variation in racial bias toward Black (vs. White) Americans among genetic counselors in North America. This study extends the current literature of racial disparities in experiences and outcomes of genetic counseling by distinguishing prejudice (negative feelings or attitudes) and stereotyping (beliefs) at the implicit and explicit levels as well as by including both certified genetic counselors and genetic counseling trainees. Two-hundred and fifteen genetic counselors (107 genetic counselors Board-certified by the American Board of Genetic Counseling, 108 genetic counseling trainees from Accreditation Council for Genetic Counseling accredited programs) completed four measures in a random order: the Race Implicit Association Test (IAT, for implicit prejudice), feeling thermometer (for explicit prejudice), the Medical Cooperativeness IAT (for implicit stereotyping), and a self-report measure of explicit stereotypes (for explicit stereotyping). On average, genetic counselors (both certified genetic counselors and genetic counseling trainees) were slightly to moderately in favor of White Americans over Black Americans at the implicit level. They were also slightly more likely to associate "medically cooperative" stereotypes with White Americans more than Black Americans implicitly. In contrast, genetic counselors, on average, did not display either explicit prejudice or explicit negative stereotyping, which may reflect social desirability concerns among genetic counselors. However, genetic counselors as a group strongly endorsed stereotypes related to mistrust (mistrustful of the healthcare system, skeptical of genetic testing, mistrustful of genetic counselors) to be more true for Black (vs. White) Americans. Finally, our study revealed relatively large variability in each type of bias across genetic counselors. Future research should examine how such variability in each type of bias is associated with patient experiences and outcomes of genetic counseling.
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Affiliation(s)
- Nao Hagiwara
- Department of Psychology Virginia Commonwealth University Richmond Virginia USA
| | - Conor Duffy
- Department of Psychology Virginia Commonwealth University Richmond Virginia USA
| | - John Quillin
- Department of Pediatrics Virginia Commonwealth University School of Medicine Richmond Virginia USA
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Current Updates on Expanded Carrier Screening: New Insights in the Omics Era. Medicina (B Aires) 2022; 58:medicina58030455. [PMID: 35334631 PMCID: PMC8951681 DOI: 10.3390/medicina58030455] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/28/2022] Open
Abstract
Genetic carrier screening has been successfully used over the last decades to identify individuals at risk of transmitting specific DNA variants to their newborns, thus having an affected child. Traditional testing has been offered based on familial and/or ethnic backgrounds. The development of high-throughput technologies, such as next-generations sequencing, able to allow the study of large genomic regions in a time and cost-affordable way, has moved carrier screening toward a more comprehensive and extensive approach, i.e., expanded carrier screening (ECS). ECS simultaneously analyses several disease-related genes and better estimates individuals’ carrier status. Indeed, it is not influenced by ethnicity and is not limited to a subset of mutations that may arise from poor information in some populations. Moreover, if couples carry out ECS before conceiving a baby, it allows them to obtain a complete estimation of their genetic risk and the possibility to make an informed decision regarding their reproductive life. Despite these advantages, some weakness still exists regarding, for example, the number of genes and the kind of diseases to be analyzed and the interpretation and communication of the obtained results. Once these points are fixed, it is expectable that ECS will become an ever more frequent practice in clinical settings.
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10
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Molina Romero M, Yoldi Chaure A, Gañán Parra M, Navas Bastida P, del Pico Sánchez JL, Vaquero Argüelles Á, de la Fuente Vaquero P, Ramírez López JP, Castilla Alcalá JA. Probability of high-risk genetic matching with oocyte and semen donors: complete gene analysis or genotyping test? J Assist Reprod Genet 2022; 39:341-355. [PMID: 35091964 PMCID: PMC8956772 DOI: 10.1007/s10815-021-02381-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/17/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To estimate the probability of high-risk genetic matching when assisted reproductive techniques (ART) are applied with double gamete donation, following an NGS carrier test based on a complete study of the genes concerned. We then determine the results that would have been obtained if the genotyping tests most widely used in Spanish gamete banks had been applied. METHODS In this descriptive observational study, 1818 gamete donors were characterised by NGS. The pathogenic variants detected were analysed to estimate the probability of high-risk genetic matching and to determine the results that would have been obtained if the three most commonly used genotyping tests in ART had been applied. RESULTS The probability of high-risk genetic matching with gamete donation, screened by NGS and complete gene analysis, was 5.5%, versus the 0.6-2.7% that would have been obtained with the genotyping test. A total of 1741 variants were detected, including 607 different variants, of which only 22.6% would have been detected by all three genotyping tests considered and 44.7% of which would not have been detected by any of these tests. CONCLUSION Our study highlights the considerable heterogeneity of the genotyping tests, which present significant differences in their ability to detect pathogenic variants. The complete study of the genes by NGS considerably reduces reproductive risks when genetic matching is performed with gamete donors. Accordingly, we recommend that carrier screening in gamete donors be carried out using NGS and a complete study with nontargeted analysis of the variants of the screened genes.
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Affiliation(s)
- Marta Molina Romero
- CEIFER Biobanco - NextClinics, Calle Maestro Bretón, 1, 18004 Granada, Spain
| | | | | | | | | | | | | | | | - José Antonio Castilla Alcalá
- CEIFER Biobanco - NextClinics, Calle Maestro Bretón, 1, 18004 Granada, Spain ,U. Reproducción, UGC Obstetricia y Ginecología, HU Virgen de Las Nieves, Granada, Spain ,Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
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11
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Liscum M, Garcia ML. You can't keep a bad idea down: Dark history, death, and potential rebirth of eugenics. Anat Rec (Hoboken) 2021; 305:902-937. [PMID: 34919789 DOI: 10.1002/ar.24849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022]
Abstract
"Be careful what you wish for": This adage guides both how this project came to life, and how the topic covered in this review continues to unfold. What began as talks between two friends on shared interests in military history led to a 4-year discussion about how our science curriculum does little to introduce our students to societal and ethical impacts of the science they are taught. What emerged was a curricular idea centered on how "good intentions" of some were developed and twisted by others to result in disastrous consequences of state-sanctioned eugenics. In this article, we take the reader (as we did our students) through the long and soiled history of eugenic thought, from its genesis to the present. Though our focus is on European and American eugenics, we will show how the interfaces and interactions between science and society have evolved over time but have remained ever constant. Four critical 'case studies' will also be employed here for deep, thoughtful exploration on a particular eugenic issue. The goal of the review, as it is with our course, is not to paint humanity with a single evil brush. Instead, our ambition is to introduce our students/readers to the potential for harm through the misapplication and misappropriation of science and scientific technology, and to provide them with the tools to ask the appropriate questions of their scientists, physicians, and politicians.
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Affiliation(s)
- Mannie Liscum
- Division of Biological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Michael L Garcia
- Division of Biological Sciences, University of Missouri, Columbia, Missouri, USA
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12
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Qiao L, Ge J, Li C, Liu Y, Hu C, Hu S, Li W, Li T. Pathogenic gene variation spectrum and carrier screening for Wilson's disease in Qingdao area. Mol Genet Genomic Med 2021; 9:e1741. [PMID: 34240825 PMCID: PMC8404232 DOI: 10.1002/mgg3.1741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background Despite the increasing number of reports on the analysis of ATP7B variants, reports on carrier screening for Wilson's disease (WD, OMIM:277900) are rare. Methods Peripheral blood samples were collected from 42 patients from Qingdao Women and Children's Hospital diagnosed with WD for direct sequencing of ATP7B gene. Twelve hotspot variants of ATP7B were selected for carrier screening in Qingdao area based on an analysis of information related to ATP7B variants and literature reports in China. We screened 5012 dried blood spots (DBSs) from asymptomatic newborns in Qingdao area to estimate carrier frequency. DNA was extracted from dried blood spots. Gene sequencing was performed using multiplex polymerase chain reaction (PCR) combined with second‐generation sequencing. The carrier frequency of each hotspot variant was calculated using the count data (expressed as number of carriers (%) obtained by direct counting. Results The carrier frequency of 12 hotspot variants was 1.46% (95% CI: 1.16–1.83%). The ATP7B variant with the highest carrier frequency was c.2333G>T, accounting for 54.79% of all variants screened, followed by c.2975C>T and c.2621C>T, accounting for 17.81% and 15.07% of all variants screened, respectively. Conclusion Carrier frequency of ATP7B gene pathogenic variants is high in the population in Qingdao area.
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Affiliation(s)
- Lingyan Qiao
- Department of Pediatric Endocrinology and Genetic Metabolic Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Juan Ge
- Department of Pediatric Endocrinology and Genetic Metabolic Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Cheng Li
- Department of Pediatric Endocrinology and Genetic Metabolic Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Yusheng Liu
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Conghui Hu
- Department of Pediatric Endocrinology and Genetic Metabolic Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Sicui Hu
- Department of Pediatric Endocrinology and Genetic Metabolic Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Wenjie Li
- Neonatal Screening Laboratory, Qingdao Women and Children's Hospital, Qingdao, China
| | - Tang Li
- Department of Pediatric Endocrinology and Genetic Metabolic Diseases, Qingdao Women and Children's Hospital, Qingdao, China
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13
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Nesbit CB, Pollack CC, Mascia NS, LaCroix VH, Applebee DM, Bosco AW, Wilkinson-Ryan I, Erekson ED, Evans RH. Interest in and uptake of genetic counseling for preconception carrier screening when offered to predominantly white reproductive-age persons seeking gynecologic care at a single U.S. academic medical center. J Genet Couns 2021; 31:109-119. [PMID: 34223670 DOI: 10.1002/jgc4.1457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 04/24/2021] [Accepted: 05/28/2021] [Indexed: 11/08/2022]
Abstract
The objective of this study was to assess the level of interest in preconception carrier screening among reproductive-aged persons presenting for gynecologic care and to identify demographic factors predictive of pursuing screening. Patients aged 18-40 who were presenting for gynecologic care at a single U.S. academic medical center were provided with information about current options for preconception carrier screening and were offered genetic counseling referral with the possibility to undergo screening. Outcomes of interest were desire for genetic counseling referral and attendance at genetic counseling visit. Statistical analyses were performed as appropriate using R version 3.6.1 with variables significant at 0.1 included in a multivariable logistic regression. Of 193 participants, 79 (41%) desired genetic counseling referral. Participants aged 25-34 (OR 3.39, 95% CI 1.47-8.10) and nulliparas (OR 2.69, 95% CI 1.23-6.03) were more likely to desire referral. Thirty-five participants (44.3% of those who desired referral) attended a visit with genetic counseling. Having an advanced degree (OR 3.27, 95% CI 1.06-10.4) was associated with visit attendance. Thirteen participants underwent screening, and five were found to be a carrier of at least one X-linked or autosomal recessive condition. Surprisingly, presenting for a gynecologic visit directly related to planning a pregnancy was not associated with increased interest in preconception carrier screening. Nulliparas and those aged 25-34 likely expressed greater interest in referral due to high potential for future childbearing in these groups. The increased level of visit attendance in participants with advanced degrees is likely confounded by the high level of health literacy and financial resources in this group.
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Affiliation(s)
- Carleigh B Nesbit
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Catherine C Pollack
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.,Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | | | - Valerie H LaCroix
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Devin M Applebee
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Amy W Bosco
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Ivy Wilkinson-Ryan
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Elisabeth D Erekson
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth College, Hanover, NH, USA.,Department of Obstetrics & Gynecology, Maine Medical Center, Portland, ME, USA
| | - Rebecca H Evans
- Department of Obstetrics & Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
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14
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McQueen DB, Warren CM, Xiao AH, Shulman LP, Jain T. Disparities among infertility patients regarding genetic carrier screening, sex selection, and gene editing. J Assist Reprod Genet 2021; 38:2319-2325. [PMID: 34169402 DOI: 10.1007/s10815-021-02261-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate the perspectives of infertility patients regarding genetic carrier screening, embryo sex selection, embryo research, and gene editing. METHODS An anonymous 32-question survey was distributed electronically to all patients who seen at a single academic fertility center for at least one visit between June 2018 and September 2019. Survey questions evaluated patient perspectives on genetic carrier screening, embryo sex selection, embryo research, and gene editing. RESULTS There were 1460 survey responses (32.0% response rate). There were significant differences in the proportion of respondents receiving genetic carrier screening between racial groups, 73.1% of White, 45.5% of Black, 49.4% of Hispanic, and 62.8% of Asian respondents. The likelihood of having genetic carrier screening was also significantly influenced by respondent income, insurance status, and religion. Religion significantly influenced the acceptance of embryonic research and embryonic sex selection. While only 8.9% felt that genetically modifying embryos for physical traits should be allowed, 74.1% felt that genetic modification to correct disease should be allowed. CONCLUSION Racial, religious, and socioeconomic factors significantly impacted respondents' likelihood to have genetic carrier screening and views on embryo sex selection, embryo research, and gene editing. These findings highlight the importance of tailoring genetic counseling to the individual, acknowledging individual and cultural differences in agreement with genetic testing and emerging genetic therapies.
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Affiliation(s)
- Dana B McQueen
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, 60611, USA
| | - Christopher M Warren
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander H Xiao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 676 N Saint Clair, Suite, Chicago, IL, 2310, USA
| | - Lee P Shulman
- Division of Clinical Genetics, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tarun Jain
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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15
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Fabiani M, Cogo F, Poli M, Capalbo A. Technical factors to consider when developing an Expanded Carrier Screening platform. Curr Opin Obstet Gynecol 2021; 33:178-183. [PMID: 33741771 DOI: 10.1097/gco.0000000000000706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Expanded Carrier Screening (ECS) is a genetic test able to detect carriers for a large number of autosomal recessive and X-linked diseases. Its clinical utilization is increasing but some technical aspects for its implementation are still controversial. RECENT FINDINGS In the current literature, several aspects of ECS panel implementation have been addressed. One of the most relevant topics involves which genes/pathologies should be included in an optimized ECS panel and which variants should be reported. SUMMARY Here, we review the best practice criteria to refine and improve clinical utility and validity of an ECS panel. The criteria for optimal ECS panel implementation include the severity of pathologies, the prevalence of diseases in general population and a definitive or strong gene/disease association. Moreover, we discuss the main complications associated with the reporting of Variant of Uncertain Significance and the need for periodic reassessment.
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Affiliation(s)
| | | | | | - Antonio Capalbo
- Igenomix Italia, Marostica, Vicenza, Italy.,Igenomix Foundation, Valencia, Spain
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16
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de Wert G, van der Hout S, Goddijn M, Vassena R, Frith L, Vermeulen N, Eichenlaub-Ritter U. The ethics of preconception expanded carrier screening in patients seeking assisted reproduction. Hum Reprod Open 2021; 2021:hoaa063. [PMID: 33604456 PMCID: PMC7880037 DOI: 10.1093/hropen/hoaa063] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/30/2020] [Indexed: 02/02/2023] Open
Abstract
Expanded carrier screening (ECS) entails a screening offer for carrier status for multiple recessive disorders simultaneously and allows testing of couples or individuals regardless of ancestry or geographic origin. Although universal ECS—referring to a screening offer for the general population—has generated considerable ethical debate, little attention has been given to the ethics of preconception ECS for patients applying for assisted reproduction using their own gametes. There are several reasons why it is time for a systematic reflection on this practice. Firstly, various European fertility clinics already offer preconception ECS on a routine basis, and others are considering such a screening offer. Professionals involved in assisted reproduction have indicated a need for ethical guidance for ECS. Secondly, it is expected that patients seeking assisted reproduction will be particularly interested in preconception ECS, as they are already undertaking the physical, emotional and economic burdens of such reproduction. Thirdly, an offer of preconception ECS to patients seeking assisted reproduction raises particular ethical questions that do not arise in the context of universal ECS: the professional’s involvement in the conception implies that both parental and professional responsibilities should be taken into account. This paper reflects on and provides ethical guidance for a responsible implementation of preconception ECS to patients seeking assisted reproduction using their own gametes by assessing the proportionality of such a screening offer: do the possible benefits clearly outweigh the possible harms and disadvantages? If so, for what kinds of disorders and under what conditions?
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Affiliation(s)
- Guido de Wert
- Department of Health, Ethics and Society; CAPHRI School for Public Health and Primary Care, Maastricht University; and GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Sanne van der Hout
- Department of Health, Ethics and Society; CAPHRI School for Public Health and Primary Care, Maastricht University; and GROW School for Oncology and Developmental Biology, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Mariëtte Goddijn
- Centre for Reproductive Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Rita Vassena
- Clinica EUGIN, Carrer de Balmes 236, Barcelona 08006, Spain
| | - Lucy Frith
- Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool L69 3BX, UK
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17
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Current attitudes and preconceptions towards expanded carrier screening in the Eastern Chinese reproductive-aged population. J Assist Reprod Genet 2021; 38:697-707. [PMID: 33409754 DOI: 10.1007/s10815-020-02032-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE A growing number of Chinese individuals of reproductive age will face the choice of accepting or refusing expanded carrier screening (ECS). This study aimed to explore the awareness, wishes, and possible misconceptions of ECS among this population, as well as factors affecting their decision-making. METHODS Chinese reproductive-aged individuals in Eastern China who sought cell-free fetal DNA screening and peripheral blood karyotype were invited to complete a 31-item ECS survey by scanning a specific quick response code. We evaluated the relationship between awareness, attitudes, and intentions to participate in ECS, along with possible misconceptions. RESULTS Overall, 93.1% of participants intended to undergo ECS at their expenses, and 53.6% indicated they would pay less than 1000 CNY (approximately 145 USD) for the test. Around 96.5% of participants had misconceptions about ECS and genetic diseases. Participants whose first reaction was interest, who had prior awareness of the test, or who perceived benefits were more likely to intend to use ECS (p < 0.001). Participants with a bachelor's degree or above or with a household income over 150,000 CNY (approximately 21,700 USD) would be more likely to pay ≥ 1000 CNY (p < 0.05). CONCLUSIONS Our study indicates that overall, the Eastern Chinese reproductive-aged population has positive attitudes towards ECS, although there are some misconceptions about ECS and genetic disorders. Population-based ECS appears to be desired by the reproductive-aged people in Eastern China. Steps should be taken to offer ECS along with pre- and post-test education and genetic counseling to raise awareness and to reduce misconceptions.
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18
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Snir M, Nazareth S, Simmons E, Hayward L, Ashcraft K, Bristow SL, Esplin ED, Aradhya S. Democratizing genomics: Leveraging software to make genetics an integral part of routine care. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2020; 187:14-27. [PMID: 33296144 DOI: 10.1002/ajmg.c.31866] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/25/2022]
Abstract
Genetic testing can provide definitive molecular diagnoses and guide clinical management decisions from preconception through adulthood. Innovative solutions for scaling clinical genomics services are necessary if they are to transition from a niche specialty to a routine part of patient care. The expertise of specialists, like genetic counselors and medical geneticists, has traditionally been relied upon to facilitate testing and follow-up, and while ideal, this approach is limited in its ability to integrate genetics into primary care. As individuals, payors, and providers increasingly realize the value of genetics in mainstream medicine, several implementation challenges need to be overcome. These include electronic health record integration, patient and provider education, tools to stay abreast of guidelines, and simplification of the test ordering process. Currently, no single platform offers a holistic view of genetic testing that streamlines the entire process across specialties that begins with identifying at-risk patients in mainstream care settings, providing pretest education, facilitating consent and test ordering, and following up as a "genetic companion" for ongoing management. We describe our vision for using software that includes clinical-grade chatbots and decision support tools, with direct access to genetic counselors and pharmacists within a modular, integrated, end-to-end testing journey.
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19
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Capalbo A, Poli M, Riera-Escamilla A, Shukla V, Kudo Høffding M, Krausz C, Hoffmann ER, Simon C. Preconception genome medicine: current state and future perspectives to improve infertility diagnosis and reproductive and health outcomes based on individual genomic data. Hum Reprod Update 2020; 27:254-279. [PMID: 33197264 DOI: 10.1093/humupd/dmaa044] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Our genetic code is now readable, writable and hackable. The recent escalation of genome-wide sequencing (GS) applications in population diagnostics will not only enable the assessment of risks of transmitting well-defined monogenic disorders at preconceptional stages (i.e. carrier screening), but also facilitate identification of multifactorial genetic predispositions to sub-lethal pathologies, including those affecting reproductive fitness. Through GS, the acquisition and curation of reproductive-related findings will warrant the expansion of genetic assessment to new areas of genomic prediction of reproductive phenotypes, pharmacogenomics and molecular embryology, further boosting our knowledge and therapeutic tools for treating infertility and improving women's health. OBJECTIVE AND RATIONALE In this article, we review current knowledge and potential development of preconception genome analysis aimed at detecting reproductive and individual health risks (recessive genetic disease and medically actionable secondary findings) as well as anticipating specific reproductive outcomes, particularly in the context of IVF. The extension of reproductive genetic risk assessment to the general population and IVF couples will lead to the identification of couples who carry recessive mutations, as well as sub-lethal conditions prior to conception. This approach will provide increased reproductive autonomy to couples, particularly in those cases where preimplantation genetic testing is an available option to avoid the transmission of undesirable conditions. In addition, GS on prospective infertility patients will enable genome-wide association studies specific for infertility phenotypes such as predisposition to premature ovarian failure, increased risk of aneuploidies, complete oocyte immaturity or blastocyst development failure, thus empowering the development of true reproductive precision medicine. SEARCH METHODS Searches of the literature on PubMed Central included combinations of the following MeSH terms: human, genetics, genomics, variants, male, female, fertility, next generation sequencing, genome exome sequencing, expanded carrier screening, secondary findings, pharmacogenomics, controlled ovarian stimulation, preconception, genetics, genome-wide association studies, GWAS. OUTCOMES Through PubMed Central queries, we identified a total of 1409 articles. The full list of articles was assessed for date of publication, limiting the search to studies published within the last 15 years (2004 onwards due to escalating research output of next-generation sequencing studies from that date). The remaining articles' titles were assessed for pertinence to the topic, leaving a total of 644 articles. The use of preconception GS has the potential to identify inheritable genetic conditions concealed in the genome of around 4% of couples looking to conceive. Genomic information during reproductive age will also be useful to anticipate late-onset medically actionable conditions with strong genetic background in around 2-4% of all individuals. Genetic variants correlated with differential response to pharmaceutical treatment in IVF, and clear genotype-phenotype associations are found for aberrant sperm types, oocyte maturation, fertilization or pre- and post-implantation embryonic development. All currently known capabilities of GS at the preconception stage are reviewed along with persisting and forthcoming barriers for the implementation of precise reproductive medicine. WIDER IMPLICATIONS The expansion of sequencing analysis to additional monogenic and polygenic traits may enable the development of cost-effective preconception tests capable of identifying underlying genetic causes of infertility, which have been defined as 'unexplained' until now, thus leading to the development of a true personalized genomic medicine framework in reproductive health.
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Affiliation(s)
- Antonio Capalbo
- Igenomix Italy, Marostica, Italy.,Igenomix Foundation, INCLIVA, Valencia, Spain
| | | | - Antoni Riera-Escamilla
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Vallari Shukla
- Department of Cellular and Molecular Medicine, DRNF Center for Chromosome Stability, University of Copenhagen, Copenhagen, Denmark
| | - Miya Kudo Høffding
- Department of Cellular and Molecular Medicine, DRNF Center for Chromosome Stability, University of Copenhagen, Copenhagen, Denmark
| | - Csilla Krausz
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain.,Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Centre of Excellence DeNothe, University of Florence, Florence, Italy
| | - Eva R Hoffmann
- Department of Cellular and Molecular Medicine, DRNF Center for Chromosome Stability, University of Copenhagen, Copenhagen, Denmark
| | - Carlos Simon
- Igenomix Foundation, INCLIVA, Valencia, Spain.,Department of Obstetrics and Gynecology, University of Valencia, Valencia, Spain.,Department of Obstetrics and Gynecology BIDMC, Harvard University, Cambridge, MA, USA
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20
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McGlynn JA, Langfelder-Schwind E. Bridging the Gap between Scientific Advancement and Real-World Application: Pediatric Genetic Counseling for Common Syndromes and Single-Gene Disorders. Cold Spring Harb Perspect Med 2020; 10:cshperspect.a036640. [PMID: 31570386 DOI: 10.1101/cshperspect.a036640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Screening and diagnostic testing for single-gene disorders and common syndromes in the pediatric setting frequently generate data that are challenging to interpret, and the ability to diagnose genetic conditions has outpaced the development of successful treatments or cures. Genetic testing is now integrated purposefully into a variety of primary and specialty care clinics, creating an increased requirement for genetic literacy among providers and patients, as well as a growing need to incorporate genetic counseling services into mainstream clinical practice. The practice of pediatric genetic counseling encompasses a unique combination of skills and training designed to address the evolving psychological, social, educational, medical, and reproductive concerns of patients and their families, which complements the multidisciplinary services of physicians, nurses, and other allied health professionals caring for patients with pediatric-onset genetic conditions. The potential range of genetic counseling needs in the pediatric setting transcends the diagnostic period. The sustained nature of pediatric care presents opportunities for development of trusting and longstanding professional relationships that permit the evolving genetic counseling needs of patients and families to be met. A discussion of cystic fibrosis, a common autosomal recessive single-gene disorder with an increasingly broad clinical spectrum and genotype-phenotype variability, serves as a useful case study to illustrate the current and emerging genetic counseling practices, goals, and challenges impacting patients and their families.
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Affiliation(s)
- Julie A McGlynn
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut 06510, USA
| | - Elinor Langfelder-Schwind
- The Cystic Fibrosis Center, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York 10003, USA
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21
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Simone L, Khan S, Ciarlariello M, Lin J, Trackman S, Heiman GA, Ashkinadze E. Reproductive male partner testing when the female is identified to be a genetic disease carrier. Prenat Diagn 2020; 41:21-27. [PMID: 32902862 DOI: 10.1002/pd.5824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To quantify carrier testing uptake rates for male partners of women found to be a carrier(s) for autosomal recessive conditions and to understand reasons for declining testing (uptake rate). METHODS A retrospective chart review of 513 female patients seen at Rutgers-Robert Wood Johnson Medical School found to be carriers through expanded carrier screening (ECS) panels. The aims of this study were to determine how often their male partner chose testing, reasons for declining and the type of methodology chosen for their screening. RESULTS Male partner uptake rate was 77%. We identified that the most significant barrier to male partner testing is female patients not following up on their own carrier screening results, thus missing the opportunity for partner testing. When male partners were provided options for testing, the most reported reason for declining is the belief it would have no impact on pregnancy management (20%). A carrier couple rate of 8.3% was identified of partners tested. CONCLUSION Despite a relatively high male testing uptake rate, a quarter of carrier females did not proceed with testing their partner. To ascertain fetal risk, results for both parents is necessary. Pretest counseling should stress need for potential male partner follow-up testing.
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Affiliation(s)
- Laurie Simone
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Shama Khan
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Molly Ciarlariello
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Julia Lin
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sarah Trackman
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, the State University of New Jersey, Piscataway, New Jersey, USA
| | - Elena Ashkinadze
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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22
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Dolitsky S, Mitra A, Khan S, Ashkinadze E, Sauer MV. Beyond the "Jewish panel": the importance of offering expanded carrier screening to the Ashkenazi Jewish population. F S Rep 2020; 1:294-298. [PMID: 34223259 PMCID: PMC8244264 DOI: 10.1016/j.xfre.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/12/2020] [Accepted: 08/02/2020] [Indexed: 11/20/2022] Open
Abstract
Objective To assess whether or not the current American College of Obstetricians and Gynecologists (ACOG) recommendations regarding carrier screening are sufficiently robust in detecting mutations in the Ashkenazi Jewish (AJ) population. Design Cross-sectional study. Setting Outreach program at university community center. Patient(s) Self-identified Jewish students, 18–24 years of age, interested in genetic carrier testing. Intervention(s) Expanded carrier screening (ECS) with the use of a commercially available targeted genotyping panel including >700 mutations in 180 genes. Main Outcome Measure(s) Gene mutations found in this population were grouped into three categories based on ACOG’s 2017 committee opinion regarding carrier screening: category 1: the four commonly recommended genetic conditions known to be a risk for this population; category 2: 14 genetic disorders that should be considered for more comprehensive screening, including those of category 1; and category 3: the ECS panel, which includes category 2. Result(s) A total of 81 students underwent screening and 36 (44.4%) were ascertained to be carriers of at least one mutation. A total of 45 mutations were identified, as 8 students were carriers for more than one condition. If testing were limited to category 1, 84% of the mutations would not have been identified, and if limited to category 2, 55% of mutations would have gone undetected. Conclusion(s) Individuals of Ashkenazi Jewish descent are at significant risk for carrying a variety of single-gene mutations and therefore they should be offered panethnic ECS to increase the likelihood of detecting preventable disorders.
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Affiliation(s)
- Shelley Dolitsky
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Anjali Mitra
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shama Khan
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Elena Ashkinadze
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Mark V Sauer
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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23
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Stagnaro-Green A, Dong A, Stephenson MD. Universal screening for thyroid disease during pregnancy should be performed. Best Pract Res Clin Endocrinol Metab 2020; 34:101320. [PMID: 31530447 DOI: 10.1016/j.beem.2019.101320] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Thyroid disease can significantly impact the pregnant woman and her child. Human and animal studies have firmly linked overt hypothyroidism and overt hyperthyroidism to miscarriage, preterm delivery and other adverse pregnancy outcomes. Overt hypothyroidism and overt hyperthyroidism affect 1% of all pregnancies. Treatment is widely available, and if detected early, results in decreased rates of adverse outcomes. Universal screening for thyroid disease in pregnancy can identify patients with thyroid disease requiring treatment, and ultimately decrease rates of complications. Universal screening is cost-effective compared to the currently accepted practice of targeted screening and may even be cost-saving in some healthcare systems. Targeted screening, which is recommended by most professional associations, fails to detect a large proportion of pregnant women with thyroid disease. In fact, an increasing number of providers are performing universal screening for thyroid disease in pregnancy, contrary to society guidelines. Limited evidence concerning the impact of untreated and treated subclinical disease and thyroid autoimmunity has distracted from the core rationale for universal screening - the beneficial impact of detecting and treating overt thyroid disease. Evidence supporting universal screening for overt disease stands independently from that of subclinical and autoimmune disease. The time to initiate universal screening is now.
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Affiliation(s)
- Alex Stagnaro-Green
- Department of Medicine, Obstetrics & Gynecology and Medical Education, University of Illinois College of Medicine at Rockford, 1601 Parkview Avenue, Rockford, IL 61107, USA.
| | - Allan Dong
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Chicago, 820 S. Wood Street, M/C 808, Chicago, IL 60612, USA.
| | - Mary D Stephenson
- Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Chicago, 820 S. Wood Street, M/C 808, Chicago, IL 60612, USA.
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Xi Y, Chen G, Lei C, Wu J, Zhang S, Xiao M, Zhang W, Zhang Y, Sun X. Expanded carrier screening in Chinese patients seeking the help of assisted reproductive technology. Mol Genet Genomic Med 2020; 8:e1340. [PMID: 32573981 PMCID: PMC7507411 DOI: 10.1002/mgg3.1340] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 01/05/2023] Open
Abstract
Background Expanded carrier screening (ECS) has emerged as an effective approach to identify at‐risk couples (ARCs)—before they initiate attempts at reproduction—who possess a high probability of having a child affected by severe recessive diseases. The objective of this study was to evaluate the clinical utility of ECS in Chinese patients seeking the help of assisted reproductive technology (ART). Methods An ECS test, which covers 201 genes implicated in 135 recessive (autosomal or X‐linked) diseases, was routinely offered to all ART patients in a single genetics and in vitro fertilization clinic. Additional options for preimplantation or prenatal genetic diagnosis were discussed and offered to all ARCs. All ECS results were aggregated and the clinical decisions of the ARCs were surveyed. Results A total of 2,923 ART patients, representing 1,462 couples, were screened. Overall, 46.73% of the individuals were found to be the carriers for at least 1 of the 135 diseases. Of the tested couples, 2.26% (n = 33) were identified as ARCs. As of the completion of this study, 21 (63.6%) ARCs have decided to avert an affected pregnancy with the help of preimplantation genetic testing for monogenetic conditions. The cumulative carrier rate of the 187 autosomal recessive genes in the ECS panel for the 2,836 Han Chinese individuals without a family history was estimated to be 45.91%. The estimated at‐risk couple rate indicates that the screening for only the top 31 genes with gene carrier rates >0.5% would identify more than 94% of the ARCs identified by screening all 187 genes. Conclusion Our study demonstrates that ESC yields a significant clinical value for ART patients in China. In addition, by estimating the yields of the ECS panel, we identify genes that are appropriate for screening the Han population.
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Affiliation(s)
- Yanping Xi
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Guangquan Chen
- WuXi NextCODE Genomics (Shanghai) Co., Ltd., Shanghai, China
| | - Caixia Lei
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Junping Wu
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Shuo Zhang
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Min Xiao
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Wenbi Zhang
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yueping Zhang
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaoxi Sun
- Shanghai Ji Ai Genetics & IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Key Laboratory of Female Reproductive Endocrine Related Diseases, Obstetrics, and Gynecology Hospital of Fudan University, Shanghai, China
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25
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Zhytnik L, Simm K, Salumets A, Peters M, Märtson A, Maasalu K. Reproductive options for families at risk of Osteogenesis Imperfecta: a review. Orphanet J Rare Dis 2020; 15:128. [PMID: 32460820 PMCID: PMC7251694 DOI: 10.1186/s13023-020-01404-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background Osteogenesis Imperfecta (OI) is a rare genetic disorder involving bone fragility. OI patients typically suffer from numerous fractures, skeletal deformities, shortness of stature and hearing loss. The disorder is characterised by genetic and clinical heterogeneity. Pathogenic variants in more than 20 different genes can lead to OI, and phenotypes can range from mild to lethal forms. As a genetic disorder which undoubtedly affects quality of life, OI significantly alters the reproductive confidence of families at risk. The current review describes a selection of the latest reproductive approaches which may be suitable for prospective parents faced with a risk of OI. The aim of the review is to alleviate suffering in relation to family planning around OI, by enabling prospective parents to make informed and independent decisions. Main body The current review provides a comprehensive overview of possible reproductive options for people with OI and for unaffected carriers of OI pathogenic genetic variants. The review considers reproductive options across all phases of family planning, including pre-pregnancy, fertilisation, pregnancy, and post-pregnancy. Special attention is given to the more modern techniques of assisted reproduction, such as preconception carrier screening, preimplantation genetic testing for monogenic diseases and non-invasive prenatal testing. The review outlines the methodologies of the different reproductive approaches available to OI families and highlights their advantages and disadvantages. These are presented as a decision tree, which takes into account the autosomal dominant and autosomal recessive nature of the OI variants, and the OI-related risks of people without OI. The complex process of decision-making around OI reproductive options is also discussed from an ethical perspective. Conclusion The rapid development of molecular techniques has led to the availability of a wide variety of reproductive options for prospective parents faced with a risk of OI. However, such options may raise ethical concerns in terms of methodologies, choice management and good clinical practice in reproductive care, which are yet to be fully addressed.
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Affiliation(s)
- Lidiia Zhytnik
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.
| | - Kadri Simm
- Institute of Philosophy and Semiotics, Faculty of Arts and Humanities, University of Tartu, Tartu, Estonia.,Centre of Ethics, University of Tartu, Tartu, Estonia
| | - Andres Salumets
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Institute of Genomics, University of Tartu, Tartu, Estonia.,COMBIVET ERA Chair, Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - Maire Peters
- Competence Centre on Health Technologies, Tartu, Estonia.,Department of Obstetrics and Gynaecology, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Aare Märtson
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.,Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Katre Maasalu
- Clinic of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia.,Department of Traumatology and Orthopaedics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
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Cook L, Schulze J, Kopil C, Hastings T, Naito A, Wojcieszek J, Payne K, Alcalay RN, Klein C, Saunders-Pullman R, Simuni T, Foroud T. Genetic Testing for Parkinson Disease: Are We Ready? Neurol Clin Pract 2020; 11:69-77. [PMID: 33968475 DOI: 10.1212/cpj.0000000000000831] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/07/2020] [Indexed: 11/15/2022]
Abstract
Purpose of Review With the advent of precision medicine and demand for genomic testing information, we may question whether it is time to offer genetic testing to our patients with Parkinson disease (PD). This review updates the current genetic landscape of PD, describes what genetic testing may offer, provides strategies for evaluating whom to test, and provides resources for the busy clinician. Recent Findings Patients with PD and their relatives, in various settings, have expressed an interest in learning their PD genetic status; however, physicians may be hesitant to widely offer testing due to the perceived low clinical utility of PD genetic test results. The rise of clinical trials available for patients with gene-specific PD and emerging information on genotype-phenotype correlations are starting to shift this discussion about testing. Summary By learning more about the various genetic testing options for PD and utility of results for patients and their care, clinicians may become more comfortable with widespread PD genetic testing in the research and clinical setting.
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Affiliation(s)
- Lola Cook
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Jeanine Schulze
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Catherine Kopil
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Tara Hastings
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Anna Naito
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Joanne Wojcieszek
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Katelyn Payne
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Roy N Alcalay
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Christine Klein
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Rachel Saunders-Pullman
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Tatyana Simuni
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics (LC, JS, TF), Indiana University School of Medicine, Indianapolis; The Michael J. Fox Foundation for Parkinson's Research (CK, TH), New York; Parkinson's Foundation (AN), Miami, FL; Department of Neurology (JW, KP), Indiana University School of Medicine, Indianapolis; Department of Neurology (RNA), Columbia University Irving Medical Center, New York; Institute of Neurogenetics (CK), University of Lübeck, Germany; Department of Neurology (RS-P), Mount Sinai Beth Israel, New York; and Parkinson's Disease and Movement Disorders Center (TS), Northwestern University Feinberg School of Medicine, Chicago IL
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Hernandez-Nieto C, Alkon-Meadows T, Lee J, Cacchione T, Iyune-Cojab E, Garza-Galvan M, Luna-Rojas M, Copperman AB, Sandler B. Expanded carrier screening for preconception reproductive risk assessment: Prevalence of carrier status in a Mexican population. Prenat Diagn 2020; 40:635-643. [PMID: 32003480 DOI: 10.1002/pd.5656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/30/2019] [Accepted: 01/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Genetic carrier screening has the potential to identify couples at risk of having a child affected with an autosomal recessive or X-linked disorder. However, the current prevalence of carrier status for these conditions in developing countries is not well defined. This study assesses the prevalence of carrier status of selected genetic conditions utilizing an expanded, pan-ethnic genetic carrier screening panel (ECS) in a large population of Mexican patients. METHODS Retrospective chart review of all patients tested with a single ECS panel at an international infertility center from 2012 to 2018 were included, and the prevalence of positive carrier status in a Mexican population was evaluated. RESULTS Eight hundred five individuals were analyzed with ECS testing for 283 genetic conditions. Three hundred fifty-two carriers (43.7%) were identified with 503 pathogenic variants in 145 different genes. Seventeen of the 391 participating couples (4.34%) were identified as being at-risk couples. The most prevalent alleles found were associated with alpha thalassemia, cystic fibrosis, GJB2 nonsyndromic hearing loss, biotinidase deficiency, and familial Mediterranean fever. CONCLUSION Based on the prevalence and severity of Mendelian disorders, we recommend that couples who wish to conceive regardless of their ethnicity background explore carrier screening and genetic counseling prior to reproductive medical treatment.
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Affiliation(s)
- Carlos Hernandez-Nieto
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Tamar Alkon-Meadows
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Joseph Lee
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA
| | - Teresa Cacchione
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA
| | - Esther Iyune-Cojab
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Maria Garza-Galvan
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Martha Luna-Rojas
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
| | - Alan B Copperman
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford CT, USA
| | - Benjamin Sandler
- Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York, New York, USA.,Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Reproductive Endocrinology and Infertility, Reproductive Medicine associates of New York-Mexico, Mexico City, Mexico
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28
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Sparks TN. Expanded carrier screening: counseling and considerations. Hum Genet 2019; 139:1131-1139. [PMID: 31679051 DOI: 10.1007/s00439-019-02080-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 10/25/2019] [Indexed: 12/16/2022]
Abstract
The primary goal of carrier screening is to identify asymptomatic individuals who carry variants associated with genetic diseases, to inform about the risk of having a child with a genetic disease. Carrier screening can be accomplished through different approaches including ethnicity-based screening, pan-ethnic screening, and expanded carrier screening (ECS), and the decision to pursue carrier screening is voluntary. ECS takes a broad approach by screening for a large number of genetic diseases irrespective of ethnic background, and ideally is performed prior to conception. ECS has many benefits, including that it does not depend on accuracy of reported ancestry, as well as its greater yield of information that can be used for reproductive decision-making. However, there are also many important limitations of ECS to consider, ranging from the yield of unexpected information, uncertainty about the phenotype of a particular disease for which an individual is a carrier, and greater downstream costs associated with further testing and genetic counseling. Detailed genetic counseling both prior to and after ECS is essential in order for patients to understand the breadth of this approach, potential and actual results, and limitations.
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Affiliation(s)
- Teresa N Sparks
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, 550 16th St, Box 0132, San Francisco, CA, 94143, USA.
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Fakih A, Spector-Bagdady K. Should Clinicians Leave "Expanded" Carrier Screening Decisions to Patients? AMA J Ethics 2019; 21:E858-E864. [PMID: 31651385 PMCID: PMC6988386 DOI: 10.1001/amajethics.2019.858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Many patients choose to undergo some type of carrier screening when pregnant or planning to become pregnant. "Expanded" carrier screening products test all patients for the same conditions, regardless of family history, race, or ethnicity. Proponents of expanded screening argue that testing everyone for everything can identify more couples at risk of having an affected fetus. However, most conditions on expanded carrier screening panels do not adhere to criteria recommended by professional organizations and can leave patients with a positive test result but little helpful information about actual clinical risk for their future baby. Confusion persists about whether clinicians should leave carrier screening decisions to patients.
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Affiliation(s)
- Amanda Fakih
- An administrative fellow at UCLA Health in Los Angeles, California
| | - Kayte Spector-Bagdady
- An assistant professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School in Ann Arbor, where she is also the chief of the Research Ethics Service, the chair of the Research Ethics Committee, and a clinical ethicist at the Center for Bioethics and Social Sciences in Medicine
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30
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Kiryluk K, Goldstein DB, Rowe JW, Gharavi AG, Wapner R, Chung WK. Precision Medicine in Internal Medicine. Ann Intern Med 2019; 170:635-642. [PMID: 31035290 PMCID: PMC7437606 DOI: 10.7326/m18-0425] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Medicine has long sought to match diagnostic and treatment approaches to the particular needs and risks of individual patients. The decreasing cost and increasing ease of genetic sequencing have propelled the rise of precision medicine. Precision medicine aims to use genetic and other information to provide care tailored to the individual patient, with the goal of improving clinical outcomes and minimizing unnecessary diagnostic and therapeutic interventions. Although developments in genetic sequencing have the potential to transform clinical care, there are important limitations, including uncertainty in the clinical interpretation of many genetic variants and concerns about privacy, discrimination, and cost. To help clinicians understand the basics of genetic sequencing and how to apply it in clinical practice, Annals of Internal Medicine is launching a new "Precision Medicine" series. This introduction provides a general overview of clinical sequencing, with a focus on germline variation. Subsequent articles will use a case-based format to provide concise summaries of specific clinical precision medicine scenarios that are relevant to the practice of internal medicine. These cases will highlight specific clinical indications; interpretation of genetic test results; and ethical, legal, cost, and privacy issues related to genetic testing. The goal is to provide practical information on the appropriate application and interpretation of genomics in routine clinical practice.
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Affiliation(s)
- Krzysztof Kiryluk
- College of Physicians and Surgeons, Columbia University, New York, New York (K.K., D.B.G., A.G.G., R.W., W.K.C.)
| | - David B Goldstein
- College of Physicians and Surgeons, Columbia University, New York, New York (K.K., D.B.G., A.G.G., R.W., W.K.C.)
| | - John W Rowe
- Mailman School of Public Health, Columbia University, New York, New York (J.W.R.)
| | - Ali G Gharavi
- College of Physicians and Surgeons, Columbia University, New York, New York (K.K., D.B.G., A.G.G., R.W., W.K.C.)
| | - Ronald Wapner
- College of Physicians and Surgeons, Columbia University, New York, New York (K.K., D.B.G., A.G.G., R.W., W.K.C.)
| | - Wendy K Chung
- College of Physicians and Surgeons, Columbia University, New York, New York (K.K., D.B.G., A.G.G., R.W., W.K.C.)
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Thompson J, Vogel Postula K, Wong K, Spencer S. Prenatal genetic counselors' practices and confidence level when counseling on cancer risk identified on expanded carrier screening. J Genet Couns 2019; 28:908-914. [PMID: 30888734 DOI: 10.1002/jgc4.1118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Jennifer Thompson
- Center for Personalized Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | | | - Kenny Wong
- Counsyl Inc., South San Francisco, California
| | - Sara Spencer
- Department of Obstetrics and Gynecology, Northwestern Medicine, Chicago, Illinois
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Larsen D, Ma J, Strassberg M, Ramakrishnan R, Van den Veyver IB. The uptake of pan‐ethnic expanded carrier screening is higher when offered during preconception or early prenatal genetic counseling. Prenat Diagn 2019; 39:319-323. [DOI: 10.1002/pd.5434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 01/25/2019] [Accepted: 01/31/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Dana Larsen
- Department of Obstetrics and GynecologyBaylor College of Medicine, One Baylor Plaza Houston TX USA
| | - Jingmei Ma
- Department of Obstetrics and GynecologyBaylor College of Medicine, One Baylor Plaza Houston TX USA
| | - Melissa Strassberg
- Department of Obstetrics and GynecologyBaylor College of Medicine, One Baylor Plaza Houston TX USA
- Texas Children's Hospital, Pavilion for Women Houston TX USA
| | - Rajesh Ramakrishnan
- Department of Obstetrics and GynecologyBaylor College of Medicine, One Baylor Plaza Houston TX USA
| | - Ignatia B. Van den Veyver
- Department of Obstetrics and GynecologyBaylor College of Medicine, One Baylor Plaza Houston TX USA
- Texas Children's Hospital, Pavilion for Women Houston TX USA
- Department of Molecular and Human GeneticsBaylor College of Medicine, One Baylor Plaza Houston TX USA
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Plantinga M, Birnie E, Schuurmans J, Buitenhuis AH, Boersma E, Lucassen AM, Verkerk MA, van Langen IM, Ranchor AV. Expanded carrier screening for autosomal recessive conditions in health care: Arguments for a couple-based approach and examination of couples' views. Prenat Diagn 2019; 39:369-378. [PMID: 30756401 PMCID: PMC6593986 DOI: 10.1002/pd.5437] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 02/01/2019] [Accepted: 02/05/2019] [Indexed: 12/17/2022]
Abstract
Background Expanded carrier screening (ECS) is aimed at detecting carrier states for autosomal recessive (AR) or X‐linked conditions in couples from the general population planning a pregnancy. ECS is currently usually offered on an individual basis despite the fact that, for AR conditions, only carrier couples are at risk of affected offspring. In this paper, we present a couple‐based ECS test‐offer for AR conditions, where results are offered as couple‐results only, and describe how couples view such an offer. Methods and results An online survey covering attitudes, perceived difficulty, and intention to take up couple‐based ECS was used to examine couples' views. Results show that in 76% of the participating couples there is no objection at all towards receiving couple‐results only. Most couples display similar views. Observed discrepancies usually involved one of the couple members having a positive view, whilst the other was neutral. Although views stayed strikingly stable after discussion, the partner's opinion was regarded as important in deciding whether or not to have testing. Conclusion This study shows that most couples do not object to receiving couple rather than individual ECS results, have similar views towards the offer, and are able to discuss differences in views and intentions. What's already known about this topic?
Expanded carrier screening (ECS) has become widely available ECS is usually offered on individual basis, and individual carrier states are reported Views of potential individual users have been researched
What does this study add?
A couple‐based ECS test‐offer for autosomal recessive conditions, where results are offered as couple‐results only An examination of couples' views towards this offer: most couples do not object to receiving couple‐results only
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Affiliation(s)
- Mirjam Plantinga
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erwin Birnie
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Juliette Schuurmans
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anne H Buitenhuis
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elise Boersma
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anneke M Lucassen
- Clinical Ethics and Law, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Marian A Verkerk
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Irene M van Langen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Boardman FK, Hale R. "I didn't take it too seriously because I'd just never heard of it": Experiential knowledge and genetic screening for thalassaemia in the UK. J Genet Couns 2019; 28:141-154. [PMID: 30629758 PMCID: PMC7814888 DOI: 10.1002/jgc4.1042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 01/25/2023]
Abstract
Members of the public face particular challenges when undergoing reproductive genetic screening. Lack of family history with genetic disease has been identified as a key barrier affecting screening uptake and responses to genetic risk. This study explores this obstacle using beta thalassaemia as a case study. Fifteen in-depth qualitative interviews were conducted exploring the reproductive views and decisions of people at risk of transmitting thalassaemia. Eleven participants had thalassaemia themselves and/or were members of an affected family. Four participants were identified as thalassaemia carriers through genetic screening programmes with no family history. Notable differences were observed between these two groups. For thalassaemic individuals and families, past experience clarified and facilitated their sense of reproductive responsibility, however carriers struggled to relate to, and incorporate the information into their lives. It was witnessing their child becoming symptomatic-rather than receiving a diagnosis or genetic risk information per se that had the most substantial influence on carriers' subsequent views and decisions. Educational resources used to support genetic screening programmes would benefit from an engagement with the experiential accounts of life with genetic disease in order to more effectively bridge the chasm in knowledge and understanding between affected families and the general public, towards whom expansive genetic screening is aimed.
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Bristow SL, Morris JM, Peyser A, Gamma A, Singer T, Mullin C, Onel K, Hershlag A. Choosing an expanded carrier screening panel: comparing two panels at a single fertility centre. Reprod Biomed Online 2019; 38:225-232. [DOI: 10.1016/j.rbmo.2018.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 11/02/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
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To what extent is the testing of the reproductive risk of a couple aiming to conceive meaningful in the contemporary clinical context? Fertil Steril 2019; 111:227-228. [PMID: 30642572 DOI: 10.1016/j.fertnstert.2018.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 11/21/2022]
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Peyser A, Singer T, Mullin C, Bristow SL, Gamma A, Onel K, Hershlag A. Comparing ethnicity-based and expanded carrier screening methods at a single fertility center reveals significant differences in carrier rates and carrier couple rates. Genet Med 2018; 21:1400-1406. [PMID: 30327537 DOI: 10.1038/s41436-018-0331-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/26/2018] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the efficiency of expanded carrier screening (ECS) compared with ethnicity-based screening in identifying carriers. METHODS A total of 4232 infertility patients underwent ECS from a single genetic testing laboratory at our center between June 2013 and July 2015. Self-reported ethnicity was recorded. Carrier rates based on ECS were calculated. In addition, carrier status was determined for two other screening panels: ethnicity-based guidelines or the ECS panel recommended by the American College of Obstetricians and Gynecologists (ACOG) using ECS results. Carrier rate and carrier couple rates were compared in the overall study population and in each self-reported ethnicity. RESULTS The ECS panel used to screen the patient population identified 1243 carriers (29.4%). For the same population, ethnicity-based screening and the ACOG panel would have identified 359 (8.5%) and 659 carriers (15.6%), respectively, representing statistically significant differences. Differences in identifying carriers across self-reported ethnicities varied. In 15 couples (1.2%), both partners carried pathogenic variants for the same genes, 47% of whom would have been missed had screening been ethnicity-based. CONCLUSION We propose that all reproductive-aged women should be offered ECS. Carrier couple rates would likely increase further with expansion of the panel, playing a pivotal role in preventing genetic disease in fertility clinics.
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Affiliation(s)
- Alexandra Peyser
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Tomer Singer
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Christine Mullin
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Sara L Bristow
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Amber Gamma
- Department of Pediatrics, Northwell Health, Division of Human Genetics and Genomics, Great Neck, NY, USA
| | - Kenan Onel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Pediatrics, Northwell Health, Division of Human Genetics and Genomics, Great Neck, NY, USA.,Robert S Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Avner Hershlag
- Department of Obstetrics and Gynecology, Northwell Health, Division of Reproductive Endocrinology, Manhasset, NY, USA. .,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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38
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Kraft SA, Duenas D, Wilfond BS, Goddard KAB. The evolving landscape of expanded carrier screening: challenges and opportunities. Genet Med 2018; 21:790-797. [PMID: 30245516 PMCID: PMC6752283 DOI: 10.1038/s41436-018-0273-4] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
Carrier screening allows individuals to learn their chance of passing on an autosomal or X-linked condition to their offspring. Initially introduced as single-disease, ancestry-based screening, technological advances now allow for the possibility of multi-disease, pan-ethnic carrier screening, which we refer to as “expanded carrier screening.” There are numerous potential benefits to expanded carrier screening, including maximizing the opportunity for couples to make autonomous reproductive decisions, and efficiency and marginal additional costs of including more conditions if the test is already being offered. While numerous laboratories currently offer expanded carrier screening services, it is not yet commonly used in clinical practice, and there is a lack of consensus among experts about the service, including whether this should be offered to individuals and couples, whether this should be offered preconception or prenatally, and what conditions to include in screening programs. Challenges for expanded carrier screening programs include a lack of demand from the public, low prioritization by health systems, the potential for pressure to undergo screening, the possibility of disability-based discrimination, needed adaptations to pre- and post-test counseling, technical limitations, and the evolving technological and socio-political landscape.
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Affiliation(s)
- Stephanie A Kraft
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Devan Duenas
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA
| | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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39
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Porter KM, Kauffman TL, Koenig BA, Lewis KL, Rehm HL, Richards CS, Strande NT, Tabor HK, Wolf SM, Yang Y, Amendola LM, Azzariti DR, Berg JS, Bergstrom K, Biesecker LG, Biswas S, Bowling KM, Chung WK, Clayton EW, Conlin LK, Cooper GM, Dulik MC, Garraway LA, Ghazani AA, Green RC, Hiatt SM, Jamal SM, Jarvik GP, Goddard KAB, Wilfond BS. Approaches to carrier testing and results disclosure in translational genomics research: The clinical sequencing exploratory research consortium experience. Mol Genet Genomic Med 2018; 6:898-909. [PMID: 30133189 PMCID: PMC6305639 DOI: 10.1002/mgg3.453] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/23/2018] [Accepted: 06/12/2018] [Indexed: 12/11/2022] Open
Abstract
Background Clinical genome and exome sequencing (CGES) is primarily used to address specific clinical concerns by detecting risk of future disease, clarifying diagnosis, or directing treatment. Additionally, CGES makes possible the disclosure of autosomal recessive and X‐linked carrier results as additional secondary findings, and research about the impact of carrier results disclosure in this context is needed. Methods Representatives from 11 projects in the clinical sequencing exploratory research (CSER) consortium collected data from their projects using a structured survey. The survey focused on project characteristics, which variants were offered and/or disclosed to participants as carrier results, methods for carrier results disclosure, and project‐specific outcomes. We recorded quantitative responses and report descriptive statistics with the aim of describing the variability in approaches to disclosing carrier results in translational genomics research projects. Results The proportion of participants with carrier results was related to the number of genes included, ranging from 3% (three genes) to 92% (4,600 genes). Between one and seven results were disclosed to those participants who received any positive result. Most projects offered participants choices about whether to receive some or all of the carrier results. There were a range of approaches to communicate results, and many projects used separate approaches for disclosing positive and negative results. Conclusion Future translational genomics research projects will need to make decisions regarding whether and how to disclose carrier results. The CSER consortium experience identifies approaches that balance potential participant interest while limiting impact on project resources.
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Affiliation(s)
- Kathryn M Porter
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington
| | - Tia L Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Barbara A Koenig
- Institute for Health and Aging, University of California, San Francisco, California
| | - Katie L Lewis
- Medical Genomics and Metabolic Genetics Branch of the National Human Genome Research Institute, Bethesda, Maryland
| | - Heidi L Rehm
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Partners Personalized Medicine, Boston, Massachusetts.,Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, Massachusetts
| | - Carolyn Sue Richards
- Knight Diagnostic Laboratories and Department of Molecular and Medical Genetics, Oregon Health and Science University, Portland, Oregon
| | - Natasha T Strande
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Holly K Tabor
- Stanford Center for Biomedical Ethics, Palo Alto, California
| | - Susan M Wolf
- University of Minnesota Law School, Medical School and Consortium on Law and Values in Health, Environment & the Life Sciences, Minneapolis, Minnesota
| | - Yaping Yang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington
| | - Danielle R Azzariti
- Laboratory for Molecular Medicine, Partners Healthcare Personalized Medicine, Cambridge, Massachusetts
| | - Jonathan S Berg
- Department of Genetics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katie Bergstrom
- Texas Children's Cancer Center and the Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Leslie G Biesecker
- Medical Genomics and Metabolic Genetics Branch of the National Human Genome Research Institute, Bethesda, Maryland
| | - Sawona Biswas
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin M Bowling
- Hudson Alpha Institute for Biotechnology, Huntsville, Alabama
| | - Wendy K Chung
- Department of Pediatrics, Columbia University, New York, New York.,Department of Medicine, Columbia University Medical Center, New York, New York
| | - Ellen W Clayton
- Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura K Conlin
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Matthew C Dulik
- Division of Genomic Diagnostics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Arezou A Ghazani
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Department of Medical Oncology and Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert C Green
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Partners Personalized Medicine, Boston, Massachusetts.,Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan M Hiatt
- Hudson Alpha Institute for Biotechnology, Huntsville, Alabama
| | - Seema M Jamal
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario
| | - Gail P Jarvik
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, Washington.,Department of Genome Sciences, University of Washington, Seattle, Washington
| | | | - Benjamin S Wilfond
- Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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Punj S, Akkari Y, Huang J, Yang F, Creason A, Pak C, Potter A, Dorschner MO, Nickerson DA, Robertson PD, Jarvik GP, Amendola LM, Schleit J, Simpson DK, Rope AF, Reiss J, Kauffman T, Gilmore MJ, Himes P, Wilfond B, Goddard KAB, Richards CS. Preconception Carrier Screening by Genome Sequencing: Results from the Clinical Laboratory. Am J Hum Genet 2018; 102:1078-1089. [PMID: 29754767 DOI: 10.1016/j.ajhg.2018.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 04/05/2018] [Indexed: 12/20/2022] Open
Abstract
Advances in sequencing technologies permit the analysis of a larger selection of genes for preconception carrier screening. The study was designed as a sequential carrier screen using genome sequencing to analyze 728 gene-disorder pairs for carrier and medically actionable conditions in 131 women and their partners (n = 71) who were planning a pregnancy. We report here on the clinical laboratory results from this expanded carrier screening program. Variants were filtered and classified using the latest American College of Medical Genetics and Genomics (ACMG) guideline; only pathogenic and likely pathogenic variants were confirmed by orthologous methods before being reported. Novel missense variants were classified as variants of uncertain significance. We reported 304 variants in 202 participants. Twelve carrier couples (12/71 couples tested) were identified for common conditions; eight were carriers for hereditary hemochromatosis. Although both known and novel variants were reported, 48% of all reported variants were missense. For novel splice-site variants, RNA-splicing assays were performed to aid in classification. We reported ten copy-number variants and five variants in non-coding regions. One novel variant was reported in F8, associated with hemophilia A; prenatal testing showed that the male fetus harbored this variant and the neonate suffered a life-threatening hemorrhage which was anticipated and appropriately managed. Moreover, 3% of participants had variants that were medically actionable. Compared with targeted mutation screening, genome sequencing improves the sensitivity of detecting clinically significant variants. While certain novel variant interpretation remains challenging, the ACMG guidelines are useful to classify variants in a healthy population.
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Affiliation(s)
- Sumit Punj
- Department of Molecular and Medical Genetics, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yassmine Akkari
- Department of Molecular and Medical Genetics, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jennifer Huang
- Department of Molecular and Medical Genetics, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, OR 97239, USA
| | - Fei Yang
- Department of Molecular and Medical Genetics, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, OR 97239, USA
| | - Allison Creason
- Department of Molecular and Medical Genetics, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, OR 97239, USA
| | - Christine Pak
- Department of Molecular and Medical Genetics, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, OR 97239, USA
| | - Amiee Potter
- Department of Molecular and Medical Genetics, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, OR 97239, USA
| | - Michael O Dorschner
- Pathology, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA; Genome Sciences, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Deborah A Nickerson
- Genome Sciences, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Peggy D Robertson
- Genome Sciences, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Gail P Jarvik
- Genome Sciences, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA; Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Laura M Amendola
- Department of Medicine, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Jennifer Schleit
- Pathology, Division of Medical Genetics, University of Washington, Seattle, WA 98195, USA
| | - Dana Kostiner Simpson
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Alan F Rope
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Jacob Reiss
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Tia Kauffman
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Marian J Gilmore
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Patricia Himes
- Department of Medical Genetics, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - Benjamin Wilfond
- Department of Pediatrics, Division of Bioethics, University of Washington, Seattle, WA 98195, USA; Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, WA 98101, USA
| | - Katrina A B Goddard
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
| | - C Sue Richards
- Department of Molecular and Medical Genetics, Knight Diagnostic Laboratories, Oregon Health & Science University, Portland, OR 97239, USA.
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Ghiossi CE, Goldberg JD, Haque IS, Lazarin GA, Wong KK. Clinical Utility of Expanded Carrier Screening: Reproductive Behaviors of At-Risk Couples. J Genet Couns 2018; 27:616-625. [PMID: 28956228 PMCID: PMC5943379 DOI: 10.1007/s10897-017-0160-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Abstract
Expanded carrier screening (ECS) analyzes dozens or hundreds of recessive genes to determine reproductive risk. Data on the clinical utility of screening conditions beyond professional guidelines are scarce. Individuals underwent ECS for up to 110 genes. Five-hundred thirty-seven at-risk couples (ARC), those in which both partners carry the same recessive disease, were invited to participate in a retrospective IRB-approved survey of their reproductive decision making after receiving ECS results. Sixty-four eligible ARC completed the survey. Of 45 respondents screened preconceptionally, 62% (n = 28) planned IVF with PGD or prenatal diagnosis (PNDx) in future pregnancies. Twenty-nine percent (n = 13) were not planning to alter reproductive decisions. The remaining 9% (n = 4) of responses were unclear. Of 19 pregnant respondents, 42% (n = 8) elected PNDx, 11% (n = 2) planned amniocentesis but miscarried, and 47% (n = 9) considered the condition insufficiently severe to warrant invasive testing. Of the 8 pregnancies that underwent PNDx, 5 were unaffected and 3 were affected. Two of 3 affected pregnancies were terminated. Disease severity was found to have significant association (p = 0.000145) with changes in decision making, whereas guideline status of diseases, controlled for severity, was not (p = 0.284). Most ARC altered reproductive planning, demonstrating the clinical utility of ECS. Severity of conditions factored into decision making.
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Affiliation(s)
- Caroline E Ghiossi
- California State University Stanislaus, 1 University Cir, Turlock, CA, 95382, USA.
| | | | - Imran S Haque
- Counsyl, 180 Kimball Way, South San Francisco, 94080, CA, USA
| | | | - Kenny K Wong
- Counsyl, 180 Kimball Way, South San Francisco, 94080, CA, USA
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Pros and cons of implementing a carrier genetic test in an infertility practice. Curr Opin Obstet Gynecol 2018; 28:172-7. [PMID: 27054511 DOI: 10.1097/gco.0000000000000272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Carrier screening is promptly evolving thanks to the rapid development of new technologies and mutation knowledge. Expanded carrier screening is already being used in assisted reproduction. Medical, ethical, psychological and legal aspects appear from the general public, patients, healthcare providers and scientific societies. Pros and cons of implementing this technique are highlighted. RECENT FINDINGS Recent publications show the development of wider gene screening panels with lowering cost. Human genome is continually being updated as are the number of mutations and their corresponding phenotype known. Classical criteria established to consider a genetic screening protocol are nowadays overtaken, and scientific societies are developing guidelines and criteria adapted to expanded genetic testing. There is no universal agreement on the mutations that should be included in the panel. Patients' perceptions on carrier genetic testing seem to be positive. Counselling patients is of paramount importance stressing implications when testing positive on their clinical decision making. Gamete donor genetic testing implies a modified approach and blinded matching must be offered. SUMMARY There are important positive aspects implementing a carrier genetic test in assisted reproductive technique, but controversial issues appear. Reproductive providers must be appropriately aware and follow the new guidelines.
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Chokoshvili D, Borry P, Vears DF. A systematic analysis of online marketing materials used by providers of expanded carrier screening. Genet Med 2017; 20:976-984. [PMID: 29240075 DOI: 10.1038/gim.2017.222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/03/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Expanded carrier screening (ECS) for a large number of recessive disorders is available to prospective parents through commercial providers. This study aimed to analyze the content of marketing materials on ECS providers' websites. METHODS To identify providers of ECS tests, we undertook a comprehensive online search, reviewed recent academic literature on commercial carrier screening, and consulted with colleagues familiar with the current ECS landscape. The identified websites were archived in April 2017, and inductive content analysis was performed on website text, brochures and educational materials, and video transcripts. RESULTS We identified 18 ECS providers, including 16 commercial genetic testing companies. Providers typically described ECS as an important family planning tool. The content differed in both the tone used to promote ECS and the accuracy and completeness of the test information provided. We found that most providers offered complimentary genetic counseling to their consumers, although this was often optional, limited to the posttest context, and, in some cases, appeared to be available only to test-positive individuals. CONCLUSION The quality of ECS providers' websites could be improved by offering more complete and accurate information about ECS and their tests. Providers should also ensure that all carrier couples receive posttest genetic counseling to inform their subsequent reproductive decision making.
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Affiliation(s)
- Davit Chokoshvili
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
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45
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Krier JB, Kalia SS, Green RC. Genomic sequencing in clinical practice: applications, challenges, and opportunities. DIALOGUES IN CLINICAL NEUROSCIENCE 2017. [PMID: 27757064 PMCID: PMC5067147 DOI: 10.31887/dcns.2016.18.3/jkrier] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The development of massively parallel sequencing (or next-generation sequencing) has facilitated a rapid implementation of genomic sequencing in clinical medicine. Genomic sequencing (GS) is now an essential tool for evaluating rare disorders, identifying therapeutic targets in neoplasms, and screening for prenatal aneuploidy. Emerging applications, such as GS for preconception carrier screening and predisposition screening in healthy individuals, are being explored in research settings and utilized by members of the public eager to incorporate genomic information into their health management. The rapid pace of adoption has created challenges for all stakeholders in clinical GS, from standardizing variant interpretation approaches in clinical molecular laboratories to ensuring that nongeneticist clinicians are prepared for new types of clinical information. Clinical GS faces a pivotal moment, as the vast potential of new quantities and types of data enable further clinical innovation and complicated implementation questions continue to be resolved.
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Affiliation(s)
- Joel B Krier
- Genomes2People Research Program, Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | | | - Robert C Green
- Genomes2People Research Program, Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
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Janssens S, Chokoshvili D, Vears DF, De Paepe A, Borry P. Pre- and post-testing counseling considerations for the provision of expanded carrier screening: exploration of European geneticists' views. BMC Med Ethics 2017; 18:46. [PMID: 28764782 PMCID: PMC5539885 DOI: 10.1186/s12910-017-0206-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 07/24/2017] [Indexed: 12/28/2022] Open
Abstract
Background Carrier screening is generally performed with the aim of identifying healthy couples at risk of having a child affected with a monogenic disorder to provide them with reproductive options. Expanded carrier screening (ECS), which provides the opportunity for multiple conditions to be screened in one test, offers a more cost-effective and comprehensive option than screening for single disorders. However, implementation of ECS at a population level would have implications for genetic counseling practice. Methods We conducted semi-structured interviews with sixteen European clinical and molecular geneticists with expertise in carrier screening to explore their views on the implementation of ECS in the clinical setting. Results Using inductive content analysis, we identified content categories relevant to the pre- and post-test settings. Participants believed ECS would ideally be targeted at couples before pregnancy. There was some disagreement regarding the acceptability of performing ECS in individuals, with several participants actively opposing individual-based screening. In addition, participants discussed the importance of ensuring informed and voluntary participation in ECS, recommending measures to minimize external pressure on prospective parents to undergo testing. A need for adequate counseling to foster informed, autonomous reproductive decision-making and provide support for couples found to be at risk was emphasized. Conclusions Practical challenges in optimizing pre-test education and post-test counseling should not be underestimated and they should be carefully addressed before implementing ECS in the clinical setting.
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Affiliation(s)
- Sandra Janssens
- Centre for Medical Genetics Ghent, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Davit Chokoshvili
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Leuven Institute for Human Genomics and Society, KU Leuven - University of Leuven, Leuven, Belgium
| | - Danya F Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Leuven Institute for Human Genomics and Society, KU Leuven - University of Leuven, Leuven, Belgium
| | - Anne De Paepe
- Centre for Medical Genetics Ghent, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Leuven Institute for Human Genomics and Society, KU Leuven - University of Leuven, Leuven, Belgium
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Chokoshvili D, Vears D, Borry P. Expanded carrier screening for monogenic disorders: where are we now? Prenat Diagn 2017; 38:59-66. [DOI: 10.1002/pd.5109] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Davit Chokoshvili
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care; University of Leuven; Leuven Belgium
| | - Danya Vears
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care; University of Leuven; Leuven Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care; University of Leuven; Leuven Belgium
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Chokoshvili D, Belmans C, Poncelet R, Sanders S, Vaes D, Vears D, Janssens S, Huys I, Borry P. Public Views on Genetics and Genetic Testing: A Survey of the General Public in Belgium. Genet Test Mol Biomarkers 2017; 21:195-201. [PMID: 28306397 DOI: 10.1089/gtmb.2016.0418] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS To explore the views of the Belgian public on various topics surrounding genetics and genetic testing (GT). MATERIALS AND METHODS A written questionnaire was administered to visitors of the annual cartoon festival in Knokke-Heist, Belgium, during the summer of 2014. The main theme of the festival was challenges and progress in human genetics and it was attended by more than 100,000 visitors. RESULTS The survey was completed by 1182 respondents, resulting in a demographically diverse sample with a mean age of 48.5 years. Our respondents expressed moderate interest in predictive GT, with 39.1% willing to learn about their predisposition to diseases through GT and 49.5% indicating interest in getting tested exclusively for treatable/preventable diseases. We observed higher interest in GT for reproductive purposes, such as preconception screening for recessive disorders (53.8%) and prenatal GT (60.7%). A substantial minority (46.4%) of the respondents were worried that GT could further stigmatize people with disabilities, while 39.7% believed that carrier screening for recessive diseases would lead to an inferior image of people affected by them. CONCLUSION Paying due attention to the attitudes, beliefs, and concerns of the general public is important to ensure ethically sound and socially acceptable implementation of new genetic technologies.
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Affiliation(s)
- Davit Chokoshvili
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Carmen Belmans
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Roxanne Poncelet
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Sofie Sanders
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Deborah Vaes
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Danya Vears
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Sandra Janssens
- 2 Centre for Medical Genetics Ghent, University Hospital Ghent , Ghent, Belgium
| | - Isabelle Huys
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
| | - Pascal Borry
- 1 Department of Public Health and Primary Care, Centre for Biomedical Ethics and Law, University of Leuven, Leuven, Belgium
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Growing complexity of (expanded) carrier screening: Direct-to-consumer, physician-mediated, and clinic-based offers. Best Pract Res Clin Obstet Gynaecol 2017; 44:57-67. [PMID: 28302443 DOI: 10.1016/j.bpobgyn.2017.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 11/21/2022]
Abstract
Since the introduction of out-of-hospital health-related genetic tests more than a decade ago, the landscape of genetic testing services has grown in complexity. Although initially most genetic tests for health purposes were offered as direct-to-consumer services, that is, without the mediation of a medical professional, currently many commercial providers require that their tests be ordered by a licensed physician. At the same time, some commercially developed health-related genetic tests are gaining support from the professional medical community and are finding their way into clinical practice. Therefore, we differentiated between three types of genetic testing offers: direct-to-consumer, physician-mediated, and clinic-based genetic testing. Expanded carrier screening tests for recessive disorders are currently available through all the three models of genetic testing. Herein, we review the present landscape of expanded carrier screening offers by highlighting the distinct issues associated with each of the three types of genetic testing.
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Abstract
PURPOSE OF REVIEW Expanded carrier screening, which detects carriers for a large number of autosomal recessive and X-linked diseases, is increasing in clinical utilization. A recent joint statement from multiple professional societies, in addition to a growing literature base, offers perspective on rationale, decision points, and reasonable methods of implementation. RECENT FINDINGS Current literature addresses three areas: pre- and posttest education, including optimal use of formal genetic counseling, and differing characteristics of laboratory tests. Surveys of obstetricians and genetics providers also offer insight into optimal practice methods. SUMMARY We review the carrier screening process in chronological sequence - pretest, test selection, and posttest results disclosure - and points to be considered, recommending possible practice protocols based on available literature and our combined laboratory and clinical practice experience.
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