1
|
Li Y, Chau MHK, Zhang YX, Zhao Y, Xue S, Li TC, Cao Y, Dong Z, Choy KW, Chung JPW. A pilot investigation of low-pass genome sequencing identifying site-specific variation in chromosomal mosaicisms by a multiple site sampling approach in first-trimester miscarriages. Hum Reprod 2023; 38:1628-1642. [PMID: 37218343 DOI: 10.1093/humrep/dead090] [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: 02/02/2023] [Revised: 04/06/2023] [Indexed: 05/24/2023] Open
Abstract
STUDY QUESTION Can multiple-site low-pass genome sequencing (GS) of products of conception (POCs) improve the detection of genetic abnormalities, especially heterogeneously distributed mosaicism and homogeneously distributed mosaicism in first-trimester miscarriage? SUMMARY ANSWER Multiple-site sampling combined with low-pass GS significantly increased genetic diagnostic yield (77.0%, 127/165) of first-trimester miscarriages, with mosaicisms accounting for 17.0% (28/165), especially heterogeneously distributed mosaicisms (75%, 21/28) that are currently underappreciated. WHAT IS KNOWN ALREADY Aneuploidies are well known to cause first-trimester miscarriage, which are detectable by conventional karyotyping and next-generation sequencing (NGS) on a single-site sampling basis. However, there are limited studies demonstrating the implications of mosaic genetic abnormalities in first-trimester miscarriages, especially when genetic heterogeneity is present in POCs. STUDY DESIGN, SIZE, DURATION This is a cross-sectional cohort study carried out at a university-affiliated public hospital. One hundred seventy-four patients diagnosed with first-trimester miscarriage from December 2018 to November 2021 were offered ultrasound-guided manual vacuum aspiration (USG-MVA) treatment. Products of conception were subjected to multiple-site low-pass GS for the detection of chromosomal imbalances. PARTICIPANTS/MATERIALS, SETTING, METHODS For each POC, multiple sites of villi (three sites on average) were biopsied for low-pass GS. Samples with maternal cell contamination (MCC) and polyploidy were excluded based on the quantitative fluorescence polymerase chain reaction (QF-PCR) results. The spectrum of chromosomal abnormalities, including mosaicism (heterogeneously distributed and homogeneously distributed) and constitutional abnormalities was investigated. Chromosomal microarray analysis and additional DNA fingerprinting were used for validation and MCC exclusion. A cross-platform comparison between conventional karyotyping and our multiple-site approach was also performed. MAIN RESULTS AND THE ROLE OF CHANCE One hundred sixty-five POCs (corresponding to 490 DNA samples) were subjected to low-pass GS. Genetic abnormalities were detected in 77.0% (127/165) of POCs by our novel approach. Specifically, 17.0% (28/165) of cases had either heterogeneously distributed mosaicism (12.7%, 21/165) or homogeneously distributed mosaicism (6.1%, 10/165) (three cases had both types of mosaicism). The remaining 60.0% (99/165) of cases had constitutional abnormalities. In addition, in the 71 cases with karyotyping performed in parallel, 26.8% (19/71) of the results could be revised by our approach. LIMITATIONS, REASONS FOR CAUTION Lack of a normal gestational week-matched cohort might hinder the establishment of a causative link between mosaicisms and first-trimester miscarriage. WIDER IMPLICATIONS OF THE FINDINGS Low-pass GS with multiple-site sampling increased the detection of chromosomal mosaicisms in first-trimester miscarriage POCs. This innovative multiple-site low-pass GS approach enabled the novel discovery of heterogeneously distributed mosaicism, which was prevalent in first-trimester miscarriage POCs and frequently observed in preimplantation embryos, but is currently unappreciated by conventional single-site cytogenetic investigations. STUDY FUNDING/COMPETING INTEREST(S) This work was supported partly by Research Grant Council Collaborative Research Fund (C4062-21GF to K.W.C), Science and Technology Projects in Guangzhou (202102010005 to K.W.C), Guangdong-Hong Kong Technology Cooperation Funding Scheme (TCFS), Innovation and Technology Fund (GHP/117/19GD to K.W.C), HKOG Direct Grant (2019.050 to J.P.W.C), and Hong Kong Health and Medical Research Fund (05160406 to J.P.W.C). The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Ying Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Matthew Hoi Kin Chau
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ying Xin Zhang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
- Center of Prenatal Diagnosis, Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yilin Zhao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Shuwen Xue
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ye Cao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Zirui Dong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Key Laboratory for Regenerative Medicine, Ministry of Education (Shenzhen Base), Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- The Chinese University of Hong Kong-Baylor College of Medicine Joint Center for Medical Genetics, Hong Kong, China
| | - Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
- Fertility Preservation Research Centre, Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
2
|
Mauro M, Wei S, Breborowicz A, Li X, Bognanni C, Fuller Z, Philipp T, McDonald T, Lattin MT, Williams Z. Endogenous retrotransposons cause catastrophic deoxyribonucleic acid damage in human trophoblasts. F&S SCIENCE 2023; 4:200-210. [PMID: 37225003 DOI: 10.1016/j.xfss.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine the mechanistic role of mobile genetic elements in causing widespread DNA damage in primary human trophoblasts. DESIGN Experimental ex vivo study. SETTING Hospital-affiliated University. PATIENT(S) Trophoblasts from a patient with unexplained recurrent pregnancy loss and patients with spontaneous and elective abortions (n = 10). INTERVENTION(S) Biochemical and genetic analysis and modification of primary human trophoblasts. MAIN OUTCOME MEASURE(S) To phenotype and systematically evaluate the underlying pathogenic mechanism for elevated DNA damage observed in trophoblasts derived from a patient with unexplained recurrent pregnancy loss, transcervical embryoscopy, G-band karyotyping, RNA sequencing, quantitative polymerase chain reaction, immunoblotting, biochemical and siRNA assays, and whole-genome sequencing were performed. RESULT(S) Transcervical embryoscopy revealed a severely dysmorphic embryo that was euploid on G-band karyotyping. RNA sequencing was notable for markedly elevated LINE-1 expression, confirmed with quantitative polymerase chain reaction, and that resulted in elevated expression of LINE-1-encoded proteins, as shown by immunoblotting. Immunofluorescence, biochemical and genetic approaches demonstrated that overexpression of LINE-1 caused reversible widespread genomic damage and apoptosis. CONCLUSION(S) Derepression of LINE-1 elements in early trophoblasts results in reversible but widespread DNA damage.
Collapse
Affiliation(s)
- Maurizio Mauro
- Department of Obstetrics and Gynecology, Columbia University Fertility Center, Columbia University Medical Center, New York, New York; Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
| | - Shan Wei
- Department of Obstetrics and Gynecology, Columbia University Fertility Center, Columbia University Medical Center, New York, New York
| | - Andrzej Breborowicz
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
| | - Xin Li
- Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York
| | - Claudia Bognanni
- The Rockefeller University, Howard Hughes Medical Institute, and Laboratory of RNA Molecular Biology, New York, New York
| | - Zachary Fuller
- Department of Biological Sciences, Columbia University, New York, New York
| | - Thomas Philipp
- Institute of Clinical Gynecology and Obstetrics, Danube Hospital, Vienna, Austria
| | - Torrin McDonald
- Department of Obstetrics and Gynecology, Columbia University Fertility Center, Columbia University Medical Center, New York, New York
| | - Miriam Temmeh Lattin
- Department of Obstetrics and Gynecology, Columbia University Fertility Center, Columbia University Medical Center, New York, New York
| | - Zev Williams
- Department of Obstetrics and Gynecology, Columbia University Fertility Center, Columbia University Medical Center, New York, New York.
| |
Collapse
|
3
|
D'Ippolito S, Longo G, Orteschi D, Busnelli A, Di Simone N, Pulcinelli E, Schettini G, Scambia G, Zollino M. Investigating the "Fetal Side" in Recurrent Pregnancy Loss: Reliability of Cell-Free DNA Testing in Detecting Chromosomal Abnormalities of Miscarriage Tissue. J Clin Med 2023; 12:3898. [PMID: 37373593 DOI: 10.3390/jcm12123898] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
(1) Background: The aim of our study is to evaluate whether cell-free DNA testing can overlap the genetic testing of miscarriage tissue in women with early pregnancy loss (EPL) and length of recurrent pregnancy loss (RPL); (2) Methods: We conducted a prospective cohort study at the Pregnancy Loss Unit of the Fondazione Policlinico Universitario A. Gemelli (IRCCS), Rome, Italy between May 2021 and March 2022. We included women with EPL and length of RPL. Gestational age was >9 weeks + 2 days and <12 weeks + 0 days of gestation corresponding to a crown rump length measurement of >25 and <54 mm. Women underwent both dilation and curettage for the collection of miscarriage tissue and for blood sample collection. Chromosomal microarray analysis (CMA) on miscarriage tissues was performed by oligo-nucleotide- and single nucleotide polymorphisms (SNP)-based comparative genomic hybridization (CGH+SNP). Maternal blood samples were analyzed by Illumina VeriSeq non-invasive prenatal testing (NIPT) to evaluate the cell-free fetal DNA (cfDNA) and the corresponding fetal fraction and the presence of genetic abnormalities; (3) Results: CMA on miscarriage tissues revealed chromosome aneuploidies in 6/10 cases (60%), consisting of trisomy 21 (5 cases) and monosomy X (one case). cfDNA analysis was able to identify all cases of trisomy 21. It failed to detect monosomy X. A large 7p14.1p12.2 deletion concomitant to trisomy 21 was, in one case, detected by cfDNA analysis but it was not confirmed by CMA on miscarriage tissue. (4) Conclusions: cfDNA largely reproduces the chromosomal abnormalities underlying spontaneous miscarriages. However, diagnostic sensitivity of cfDNA analysis is lower with respect to the CMA of miscarriage tissues. In considering the limitations when obtaining biological samples from aborted fetuses suitable for CMA or standard chromosome analysis, cfDNA analysis is a useful, although not exhaustive, tool for the chromosome diagnosis of both early and recurrent pregnancy loss.
Collapse
Affiliation(s)
- Silvia D'Ippolito
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| | - Giuliana Longo
- BioRep Srl, Centro di Risorse Biologiche, Sapio Group, 20900 Milan, Italy
| | - Daniela Orteschi
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Medicina Genomica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | | | | | - Giovanni Scambia
- Dipartimento della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marcella Zollino
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica, Sezione di Medicina Genomica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Genetica Medica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 00168 Rome, Italy
| |
Collapse
|
4
|
Wignarajah A, Alvero R, Lathi RB, Aghajanova L, Eisenberg M, Winn VD, Behr B, Murugappan G. Implementation of a comprehensive fertility biobanking initiative. F&S SCIENCE 2022; 3:228-236. [PMID: 35977803 PMCID: PMC9386165 DOI: 10.1016/j.xfss.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To present the framework of Stanford Fertility and Reproductive Health's comprehensive reproductive biobanking initiatives and the results of the first year of recruitment. DESIGN Technical description article. SETTING Academic fertility center. PATIENT(S) Fertility patients >18 years of age. INTERVENTION(S) Enroll the patients interested in research in biobanking protocols. MAIN OUTCOME MEASURE(S) Patient recruitment and sample inventory from September 2020 to September 2021. RESULT(S) A total of 253 patients have enrolled in the Stanford Fertility and Reproductive Health biobanking initiatives since September 2020. The current inventory consists of 1,176 samples, including serums, plasmas, buffy coats, endometria, maternal deciduae, miscarriage chorionic villi, and human embryos (zygote, cleavage, and blastocyst stages). CONCLUSION(S) This biobanking initiative addresses a critical, unmet need in reproductive health research to make it possible for patients to donate excess embryos and gametes and preserves, for future research, valuable somatic and reproductive tissues that would otherwise be discarded. We present the framework of this biobanking initiative in order to support future efforts of establishing similar biorepositories.
Collapse
Affiliation(s)
- Anjali Wignarajah
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Ruben Alvero
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Ruth B Lathi
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Lusine Aghajanova
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | | | - Virginia D Winn
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University, Stanford, California
| | - Barry Behr
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California
| | - Gayathree Murugappan
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, California.
| |
Collapse
|
5
|
Murugappan G, Leonard SA, Newman H, Shahine L, Lathi RB. Karyotype of first clinical miscarriage and prognosis of subsequent pregnancy outcome. Reprod Biomed Online 2021; 42:1196-1202. [PMID: 33962906 DOI: 10.1016/j.rbmo.2021.03.021] [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: 01/11/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
RESEARCH QUESTION Is the karyotype of the first clinical miscarriage in an infertile patient predictive of the outcome of the subsequent pregnancy? DESIGN Retrospective cohort study of infertile patients undergoing manual vacuum aspiration with chromosome testing at the time of the first (index) clinical miscarriage with a genetic diagnosis and a subsequent pregnancy. Patients treated at two academic-affiliated fertility centres from 1999 to 2018 were included; those using preimplantation genetic testing for aneuploidy were excluded. Main outcome was live birth in the subsequent pregnancy. RESULTS One hundred patients with euploid clinical miscarriage and 151 patients with aneuploid clinical miscarriage in the index pregnancy were included. Patients with euploid clinical miscarriage in the index pregnancy had a live birth rate of 63% in the subsequent pregnancy compared with 68% among patients with aneuploid clinical miscarriage (adjusted odds ratio [aOR] 0.75, 95% CI 0.47-1.39, P = 0.45, logistic regression model adjusting for age, parity, body mass index and mode of conception). In a multinomial logistic regression model with three outcomes (live birth, clinical miscarriage or biochemical miscarriage), euploid clinical miscarriage for the index pregnancy was associated with similar odds of clinical miscarriage in the subsequent pregnancy compared with aneuploid clinical miscarriage for the index pregnancy (32% versus 24%, respectively, aOR 1.49, 95% CI 0.83-2.70, P = 0.19). Euploid clinical miscarriage for the index pregnancy was not associated with likelihood of biochemical miscarriage in the subsequent pregnancy compared with aneuploid clinical miscarriage (5% versus 8%, respectively, aOR 0.46, 95% CI 0.14-1.55, P = 0.21). CONCLUSION Prognosis after a first clinical miscarriage among infertile patients is equally favourable among patients with euploid and aneuploid karyotype, and independent of the karyotype of the pregnancy loss.
Collapse
Affiliation(s)
- Gayathree Murugappan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale CA, USA.
| | - Stephanie A Leonard
- Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale CA, USA
| | - Hana Newman
- Pacific NW Fertility and IVF Specialists, Seattle WA, USA
| | - Lora Shahine
- Pacific NW Fertility and IVF Specialists, Seattle WA, USA
| | - Ruth B Lathi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale CA, USA
| |
Collapse
|
6
|
Zhang Y, Lei Q, Liu J, Lin M, Luo L, Li T, Wang Q, Zhou C. Selective growth of mosaic cells in chromosomal analysis of chorionic villi by conventional karyotyping. Mol Cell Probes 2020; 51:101532. [DOI: 10.1016/j.mcp.2020.101532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/01/2020] [Accepted: 02/09/2020] [Indexed: 10/25/2022]
|
7
|
Abstract
Rapid advances in genomics have expanded the use of chromosome testing following miscarriage. In addition to conventional cytogenetics, the availability of single nucleotide polymorphism microarray technology and array comparative geneomic hybridization have provided further options for clinicians. This review will cover the indications for testing and the advantages/disadvantages of the various methodologies available.
Collapse
Affiliation(s)
- Dana B McQueen
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, United States.
| | - Ruth B Lathi
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Northwestern University, Chicago, IL, United States; Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University, Palo Alto, United States
| |
Collapse
|
8
|
Vega M, Mauro M, Williams Z. Direct toxicity of insulin on the human placenta and protection by metformin. Fertil Steril 2019; 111:489-496.e5. [PMID: 30709546 DOI: 10.1016/j.fertnstert.2018.11.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 10/23/2018] [Accepted: 11/19/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To study the effects of insulin and metformin on primary trophoblasts from early pregnancies. DESIGN Experimental in vitro study. SETTING Academic research institute. PATIENT(S) Trophoblasts from healthy patients undergoing first trimester elective termination of pregnancy and primary lung fibroblasts (IMR-90). INTERVENTION(S) Culture and treatment with insulin and metformin of primary trophoblasts and primary lung fibroblasts (IMR-90). MAIN OUTCOME MEASURE(S) DNA damage measured by expression of γ-H2AX with immunofluorescence and Western blot. Apoptosis measured by expression of cleaved caspase-3 by Western blot. Cell survival measured by cell proliferation assay. RESULT(S) Culture of purified primary trophoblast cells in the presence of insulin at levels as low as 1 nM resulted in a 386% increase in the number of cell with elevated γ-H2AX expression, a 66% reduction in cell survival and a marked increase of cleaved caspase-3 expression. Pretreatment of trophoblasts with therapeutic doses of metformin prevented the detrimental effects of insulin. Treatment with insulin and/or metformin had no effects on primary fibroblasts. CONCLUSION(S) Elevated insulin levels are directly toxic to first trimester trophoblasts and result in increased DNA damage, apoptosis, and decreased cell survival. These effects are prevented by metformin. Trophoblast cells from early pregnancy are uniquely vulnerable to elevated levels of insulin. These findings, if confirmed in vivo, suggest that there may be a role for insulin resistance screening before attempting pregnancy and for focusing on prevention of hyperinsulinemia during early pregnancy.
Collapse
Affiliation(s)
- Mario Vega
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York; Columbia University Fertility Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Maurizio Mauro
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York; Columbia University Fertility Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Zev Williams
- Columbia University Fertility Center, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, New York.
| |
Collapse
|
9
|
Chung JPW, Chung CHS, Mak JSM, Li TC, Kong GWS. Efficacy, feasibility and patient acceptability of ultrasound-guided manual vacuum aspiration for treating early pregnancy loss. Aust N Z J Obstet Gynaecol 2018; 59:71-76. [PMID: 29672838 DOI: 10.1111/ajo.12811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultrasound-guided manual vacuum aspiration (USG-MVA) is an effective but underutilised alternative to medical or surgical evacuation of the uterus following first trimester miscarriage. AIMS To evaluate the efficacy, feasibility and patient acceptability of USG-MVA for treating early pregnancy loss. MATERIAL AND METHODS We invited patients with early pregnancy losses to participate in this prospective cohort study. We reviewed the medical records of the participants and their visual analogue pain score during MVA. Primary outcomes were efficacy, feasibility and patient acceptability of USG-MVA. Secondary outcomes included the success rate of culture of chorionic villi for chromosomal analysis and complications from the USG-MVA procedure. RESULTS We included a consecutive series of 35 women who underwent the USG-MVA procedure. The efficacy of USG-MVA in achieving complete evacuation was 97.1%. The procedure was well tolerated and the mean procedure-related pain score was 6.25 out of 10 (SD 1.55). Overall, all patients were satisfied with the procedure. The successful culture rate of chromosomal analysis was 94.3%. There were no major complications. CONCLUSION USG-MVA is an effective treatment for the management of early pregnancy loss in an out-patient setting. It is an alternative to surgical evacuation under general anaesthesia, particularly for women desiring chromosomal analysis of products of conception. Further studies are required to investigate its health-related and economic benefits in hospital service provision.
Collapse
Affiliation(s)
- Jacqueline Pui Wah Chung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cathy Hoi Sze Chung
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jennifer Sze Man Mak
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Tin Chiu Li
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Grace Wing Shan Kong
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| |
Collapse
|
10
|
Babu R, Van Dyke DL, Bhattacharya S, Dev VG, Liu M, Kwon M, Gu G, Koduru P, Rao N, Williamson C, Fuentes E, Fuentes S, Papa S, Kopuri S, Lal V. A rapid and reliable chromosome analysis method for products of conception using interphase nuclei. Mol Genet Genomic Med 2018; 6:370-381. [PMID: 29573570 PMCID: PMC6014463 DOI: 10.1002/mgg3.381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/04/2018] [Accepted: 02/01/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Karyotype determination has a central role in the genetic workup of pregnancy loss, as aneuploidy (trisomy and monosomy) and polyploidy (triploidy and tetraploidy) are the cause in at least 50% of first trimester, 25% of second trimester, and 11% of third trimester miscarriages. There are several limitations with the current approaches of obtaining a karyotype using traditional cytogenetics, fluorescence in situ hybridization with a limited number of probes, and chromosomal microarray. These include culture failure, incomplete results, lower sensitivity, and longer reporting time. METHODS To overcome current limitations, a novel molecular assay is developed with a Standard Resolution Interphase Chromosome Profiling probe set which is a variation of the recently developed High Resolution probe set. It generates a molecular karyotype that can detect all major changes commonly associated with pregnancy loss. Initial familiarization of signal patterns from the probe set was used, followed by validation of the method using 83 samples from miscarriages in a blind study from three different laboratories. Finally, the clinical utility of the method was tested on 291 clinical samples in two commercial reference laboratory settings on two different continents. RESULTS The new molecular approach not only identified all the chromosome changes observed by current methods, but also significantly improved abnormality detection by characterizing derivative chromosomes and finding subtle subtelomeric rearrangements, balanced and unbalanced. All Robertsonian translocations were also detected. The abnormality rate was 54% on clinical samples from commercial laboratory 1 and 63% from laboratory 2. CONCLUSION The attributes of this method make it an ideal choice for the genetic workup of miscarriages, namely (1) near 100% successful results, (2) greater sensitivity than conventional chromosome analysis or FISH panels, (3) rapid reporting time, and (4) favorable comparisons with chromosomal microarray.
Collapse
Affiliation(s)
- Ramesh Babu
- Department of Research and Development, InteGen LLC, Orlando, FL, USA
| | - Daniel L Van Dyke
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Saurabh Bhattacharya
- Departments of Cytogenetics and Administration, Dr. Lal PathLabs Ltd., New Delhi, India
| | - Vaithilingam G Dev
- Department of Clinical Cytogenetics, Genetics Associates Inc., Nashville, TN, USA
| | - Mingya Liu
- Department of Clinical Cytogenetics, Genetics Associates Inc., Nashville, TN, USA
| | - Minjae Kwon
- Department of Clinical Cytogenetics, Genetics Associates Inc., Nashville, TN, USA
| | - Guangyu Gu
- Department of Clinical Cytogenetics, Genetics Associates Inc., Nashville, TN, USA
| | - Prasad Koduru
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Nagesh Rao
- Department of Pathology and Laboratory Medicine, David Geffen UCLA School of Medicine, Los Angeles, CA, USA
| | - Cynthia Williamson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ernesto Fuentes
- Department of Research and Development, InteGen LLC, Orlando, FL, USA
| | - Sarah Fuentes
- Department of Research and Development, InteGen LLC, Orlando, FL, USA
| | - Stephen Papa
- Department of Research and Development, InteGen LLC, Orlando, FL, USA
| | - Srikanthi Kopuri
- Department of Research and Development, InteGen LLC, Orlando, FL, USA
| | | |
Collapse
|
11
|
D’ippolito S, Di Simone N, Orteschi D, Pomponi MG, Genuardi M, Sisti LG, Castellani R, Rossi ED, Scambia G, Zollino M. The chromosome analysis of the miscarriage tissue. Miscarried embryo/fetal crown rump length (CRL) measurement: A practical use. PLoS One 2017; 12:e0178113. [PMID: 28604823 PMCID: PMC5467807 DOI: 10.1371/journal.pone.0178113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/07/2017] [Indexed: 11/24/2022] Open
Abstract
Objective To investigate whether miscarried embryo/fetal crown rump length (CRL) measurement may yield a practical application for predicting a conclusive result at the cytogenetic analysis of miscarriage tissue. Our study might help in improving the cytogenetic method, the results of which may be affected by maternal cell contamination (MCC). In particular, we aimed at establishing whether the miscarried embryo/fetal CRL measurement shows accuracy in predicting the possibility of MCC and the scan cut-off value useful to this purpose and, as a result, suggest a multi-step procedure for the genetic ascertainment. Methods Women experiencing at least two miscarriages of less than 20 weeks size at the Pregnancy Loss Unit at Fondazione Policlinico A. Gemelli underwent a scan before surgery. The CRL value was recorded. After the dilatation and courettage (D&C) procedure, miscarriage tissue was processed through the proposed multi-step procedure before performing oligo-nucleotide-based and SNP (single nucleotide polymorphisms)-based comparative genomic hybridization (CGH+SNP) microarray analysis. Results 63 women and 63 miscarriages met the criteria. By using the Receiving Operator Characteristic (ROC) curves, CRL showed an AUC of 0.816 (95%CI:0.703–0.928,p<0.001). A CRL≥24.5 mm cut-off value showed a higher positive likelihood ratio (5.27) but, conversely, a higher negative likelihood ratio (0.64) in predicting the possibility of MCC. Microarray analysis was successful in the totality of cases in which the embryo/fetal origin of miscarriage tissues was proven. Conclusions The 24.5 mm CRL value emerges as the most suitable cut-off enabling the identification of cases in which the embryo-fetal component can be isolated in the absence of MCC and the chromosomal array provide informative results.
Collapse
Affiliation(s)
- Silvia D’ippolito
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Nicoletta Di Simone
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
- * E-mail:
| | - Daniela Orteschi
- Institute of Genomic Medicine, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Maria Grazia Pomponi
- Institute of Genomic Medicine, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Maurizio Genuardi
- Institute of Genomic Medicine, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | | | - Roberta Castellani
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Giovanni Scambia
- Department of Obstetrics and Gynecology, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Marcella Zollino
- Institute of Genomic Medicine, Università Cattolica Del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| |
Collapse
|
12
|
Shah MS, Cinnioglu C, Maisenbacher M, Comstock I, Kort J, Lathi RB. Comparison of cytogenetics and molecular karyotyping for chromosome testing of miscarriage specimens. Fertil Steril 2017; 107:1028-1033. [PMID: 28283267 DOI: 10.1016/j.fertnstert.2017.01.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 01/10/2017] [Accepted: 01/26/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare chromosome testing of miscarriage specimens between traditional cytogenetic analysis and molecular karyotyping using single nucleotide polymorphism microarrays (SNP) and array comparative genomic hybridization (aCGH). DESIGN Prospective blinded cohort study. SETTING University-based practice. PATIENT(S) Women undergoing dilation and curettage for first-trimester miscarriage between March 2014 and December 2015. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Chromosome analysis from chorionic villi separated equally and submitted for cytogenetics, SNP microarray, and aCGH testing. RESULT(S) Sixty samples were analyzed, of which 47 (78%) were chromosomally abnormal. A correct call was defined when a result was concordant with at least one other testing platform. The correct call rate was 85%, 93%, and 85% using cytogenetics, SNP array, and aCGH, respectively. We found a 33% overall discordance rate between results. Discordances were due to maternal cell contamination, balanced chromosome rearrangements, polyploidy, and placental mosaicism. Mosaicism was detected in 18% of all samples. Growth failure occurred in four samples sent to cytogenetics, of which three were chromosomally abnormal by molecular testing. CONCLUSION(S) This study demonstrates the many technical limitations of the three testing modalities. Our rates of maternal cell contamination were low, but it is important to note that this is a commonly reported limitation of cytogenetics. Given the similar overall performance of the three testing modalities, providers may choose a method based on individual availability and consideration of limitations as it applies to each clinical scenario. The unexpected high rate of placental mosaicism warrants further investigation.
Collapse
Affiliation(s)
- Meera Sridhar Shah
- Stanford University Reproductive Health and Fertility Center, Palo Alto, California.
| | | | | | - Ioanna Comstock
- Stanford University Reproductive Health and Fertility Center, Palo Alto, California
| | - Jonathan Kort
- Stanford University Reproductive Health and Fertility Center, Palo Alto, California
| | - Ruth Bunker Lathi
- Stanford University Reproductive Health and Fertility Center, Palo Alto, California
| |
Collapse
|
13
|
Massalska D, Zimowski JG, Bijok J, Pawelec M, Czubak-Barlik M, Jakiel G, Roszkowski T. First trimester pregnancy loss: Clinical implications of genetic testing. J Obstet Gynaecol Res 2016; 43:23-29. [DOI: 10.1111/jog.13179] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/21/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Diana Massalska
- I Department of Obstetrics and Gynecology; Professor Witold Orlowski Clinical Hospital, Centre of Postgraduate Medical Education; Warsaw Poland
| | | | - Julia Bijok
- I Department of Obstetrics and Gynecology; Professor Witold Orlowski Clinical Hospital, Centre of Postgraduate Medical Education; Warsaw Poland
| | - Magdalena Pawelec
- Department of Genetics; Institute of Psychiatry and Neurology; Warsaw Poland
| | - Małgorzata Czubak-Barlik
- Department of Pathology; Professor Witold Orlowski Clinical Hospital, Centre of Postgraduate Medical Education; Warsaw Poland
| | - Grzegorz Jakiel
- I Department of Obstetrics and Gynecology; Professor Witold Orlowski Clinical Hospital, Centre of Postgraduate Medical Education; Warsaw Poland
| | - Tomasz Roszkowski
- I Department of Obstetrics and Gynecology; Professor Witold Orlowski Clinical Hospital, Centre of Postgraduate Medical Education; Warsaw Poland
| |
Collapse
|
14
|
Zimowski JG, Massalska D, Pawelec M, Bijok J, Michałowska A, Roszkowski T. First-trimester spontaneous pregnancy loss - molecular analysis using multiplex ligation-dependent probe amplification. Clin Genet 2016; 89:620-4. [DOI: 10.1111/cge.12727] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 01/30/2023]
Affiliation(s)
- J. G. Zimowski
- Department of Genetics; Institute of Psychiatry and Neurology; Warsaw Poland
| | - D. Massalska
- Department of Obstetrics and Gynecology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - M. Pawelec
- Department of Genetics; Institute of Psychiatry and Neurology; Warsaw Poland
| | - J. Bijok
- Department of Obstetrics and Gynecology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - A. Michałowska
- Department of Obstetrics and Gynecology; Centre of Postgraduate Medical Education; Warsaw Poland
| | - T. Roszkowski
- Department of Obstetrics and Gynecology; Centre of Postgraduate Medical Education; Warsaw Poland
| |
Collapse
|
15
|
Yadav AK, Chaudhari H, Shah PK, Madan T. Expression and localization of collectins in feto-maternal tissues of human first trimester spontaneous abortion and abortion prone mouse model. Immunobiology 2015; 221:260-8. [PMID: 26603976 DOI: 10.1016/j.imbio.2015.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 11/16/2022]
Abstract
Dysregulation of immune response at the feto-maternal interface during first trimester of pregnancy is one of the leading causes of spontaneous abortion. Previously, we reported differential expression of collectins, soluble pattern recognition molecules involved in immunoregulation, in placental and decidual tissues during spontaneous labor. In the present pilot study, the expression of collectins was analyzed in the inflamed human gestational tissues of spontaneous abortion ('SA') and in 13.5 dpc placental tissues from resorption survived embryos of murine model (CBA/J X DBA/2J). Transcripts of SP-A were significantly down-regulated and SP-D were significantly up-regulated in placental and decidual tissues of 'SA' group compared to that of 'normal' group. Immunostaining for SP-D and MBL proteins was positive in placental and decidual tissues. However, levels of SP-D and MBL proteins were not significantly altered in placental as well as in decidual tissues of 'SA' group in comparison to the 'normal' group. Placental tissues of viable embryos from the abortion prone mouse model showed significantly enhanced expression of mSP-A and mSP-D transcripts at 13.5 day post coitus (dpc) and 14.5 dpc compared to the control group (CBA/J X Balb/c). Mouse collectins were localized in placental tissues (13.5 dpc), with increased staining in murine model compared to control. Human and murine data together indicate that SP-A, SP-D and MBL are synthesised in early gestational tissues, and may contribute to regulation of immune response at the feto-maternal interface during pregnancy.
Collapse
Affiliation(s)
- A K Yadav
- National Institute for Research in Reproductive Health, Indian Council of Medical Research, Jehangir Merwanji Street, Parel, Mumbai 400012, India
| | - H Chaudhari
- Department of Obstetrics and Gynecology, Seth Gordhandas Sunderdas Medical College and King Edwards Memorial (KEM) Hospital, Parel, Mumbai 400012, India
| | - P K Shah
- Department of Obstetrics and Gynecology, Seth Gordhandas Sunderdas Medical College and King Edwards Memorial (KEM) Hospital, Parel, Mumbai 400012, India
| | - T Madan
- National Institute for Research in Reproductive Health, Indian Council of Medical Research, Jehangir Merwanji Street, Parel, Mumbai 400012, India.
| |
Collapse
|