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Siwek T, Zwiernik B, Jezierska-Woźniak K, Jezierska K, Mycko MP, Selmaj KW. Intrathecal administration of mesenchymal stem cells in patients with adrenomyeloneuropathy. Front Neurol 2024; 15:1345503. [PMID: 38370525 PMCID: PMC10869536 DOI: 10.3389/fneur.2024.1345503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Background and objectives X-linked adrenomyeloneuropathy (AMN) is an inherited neurodegenerative disorder associated with mutations in the ABCD1 gene and the accumulation of very long-chain fatty acids (VLFCAs) in plasma and tissues. Currently, there is no effective treatment for AMN. We have aimed to evaluate the therapeutic effects of mesenchymal stem cell (MSC) transplantation in patients with AMN. Methods This is a small cohort open-label study with patients with AMN diagnosed and treated at the University Hospital in Olsztyn, Poland. All patients met clinical, biochemical, MRI, and neuropsychological criteria for AMN. MSCs derived from Wharton jelly, 20 × 106 cells, were administered intrathecally three times every 2 months, and patients were followed up for an additional 3 months. The primary outcome measures included a blinded assessment of lower limb muscle strength with the Medical Research Council Manual Muscle Testing scale at baseline and on every month visits until the end of the study. Additional outcomes included measurements of the timed 25-feet walk (T25FW) and VLFCA serum ratio. Results Three male patients with AMN with an age range of 26-37 years participated in this study. All patients experienced increased muscle strength in the lower limbs at the end of the study versus baseline. The power grade increased by 25-43% at the baseline. In addition, all patients showed an improvement trend in walking speed measured with the T25FW test. Treatment with MSCs in patients with AMN appeared to be safe and well tolerated. Discussion The results of this study demonstrated that intrathecal administration of WJ-MSC improves motor symptoms in patients with AMN. The current findings lend support to the safety and feasibility of MSC therapy as a potentially viable treatment option for patients with AMN.
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Affiliation(s)
- Tomasz Siwek
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- University Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Beata Zwiernik
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- University Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Katarzyna Jezierska-Woźniak
- Laboratory for Regenerative Medicine, Department of Neurosurgery, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Kamila Jezierska
- University Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Marcin P. Mycko
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- University Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Krzysztof W. Selmaj
- Department of Neurology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Center of Neurology, Lodz, Poland
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Pecker LH, Oteng-Ntim E, Nero A, Lanzkron S, Christianson MS, Woolford T, Meacham LR, Mishkin AD. Expecting more: the case for incorporating fertility services into comprehensive sickle cell disease care. Lancet Haematol 2023; 10:e225-e234. [PMID: 36708736 DOI: 10.1016/s2352-3026(22)00353-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 01/27/2023]
Abstract
Assisted reproductive technologies (ART) are not yet systematically available to people with sickle cell disease or their parents. Fertility care for these groups requires addressing sickle cell disease-associated infertility risks, fertility preservation options, pregnancy possibilities and outcomes, and, when needed, infertility treatment. People with a chance of having a child with sickle cell disease can use in-vitro fertilisation with preimplantation genetic testing to conceive a child unaffected by sickle cell disease. Also, parents of children with sickle cell disease can use this technology to identify embryos to become potential future matched sibling donors for stem cell transplant. In the USA, disparities in fertility care for the sickle cell disease community are especially stark. Universal screening of newborn babies' identifies sickle cell disease and sickle cell trait, guidelines direct preconception genetic carrier screening, and standard-of-care fertility preserving options exist. However, potentially transformative treatments and cures for patients with sickle cell disease are not used due to iatrogenic infertility concerns. In diversely resourced care settings, obstacles to providing fertility care to people affected by sickle cell disease persist. In this Viewpoint, we contend that fertility care should be incorporated into the comprehensive care model for sickle cell disease, supporting alignment of treatment goals with reproductive life plans and delivering on the promise of individualised high-quality care for people with sickle cell disease and their families. We consider the obligation to provide fertility care in light of medical evidence, with acknowledgment of formidable obstacles to optimising care, and powerful historical and ethical considerations.
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Affiliation(s)
- Lydia H Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Eugene Oteng-Ntim
- Women's Health Academic Centre, King's College London, London, UK; Women's Services, Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene and Tropical Medicine, London, UK
| | - Alecia Nero
- Division of Hematology-Oncology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mindy S Christianson
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Reproductive Endocrinology & Infertility, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Teonna Woolford
- Sickle Cell Reproductive Health Education Directive, Washington, DC, USA
| | - Lillian R Meacham
- Aflac Cancer and Blood Disorders Center Children's Healthcare of Atlanta; Division of Hematology & Oncology, Department of Pediatrics Emory University, Atlanta, GA, USA
| | - Adrienne D Mishkin
- Blood and Marrow Transplantation and Cell Therapy Program, Division of Hematology & Oncology and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
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Kuek CY, Gurmukh Singh SKA, Tay PS. Conception of Saviour Siblings: Ethical Perceptions of Selected Stakeholders in Malaysia. Asian Bioeth Rev 2021; 13:167-178. [PMID: 33968213 PMCID: PMC8079567 DOI: 10.1007/s41649-021-00166-2] [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: 12/21/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 10/21/2022] Open
Abstract
The conception of saviour siblings using preimplantation genetic diagnosis coupled with human leukocyte antigen (HLA) typing or HLA typing alone is controversial and receives a wide divergence of legal responses among countries around the world. The resulting child conceived through this procedure is dubbed a 'saviour sibling' as the child can potentially act as a compatible donor for an elder ailing sibling who needs a haematopoietic stem cell transplantation. At present, the acceptability of this procedure in Malaysia is ambiguous as there is no specific statute governing assisted reproductive technology, and the guideline issued by the Malaysian Medical Council does not expressly address this issue. The ethical arguments relating to the conception of saviour siblings in the current literature are mainly thought to reflect a liberal viewpoint which is predominantly Western in nature. This paper seeks to explore the perception of selected key stakeholders on the acceptability of and ethical concerns related to this procedure in the Malaysian context. The findings indicate that stakeholders generally support the conception of saviour siblings and some of their concerns echo the Western viewpoint. Interestingly, many were highly anxious about its economic implication, which is rarely discussed in the current literature on saviour siblings.
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Affiliation(s)
| | | | - Pek San Tay
- Advocate & Solicitor, High Court of Malaya, Selangor, Malaysia
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4
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Bonfim C. Special pre- and posttransplant considerations in inherited bone marrow failure and hematopoietic malignancy predisposition syndromes. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2020; 2020:107-114. [PMID: 33275667 PMCID: PMC7727534 DOI: 10.1182/hematology.2020000095] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Advances in the diagnosis and treatment of inherited bone marrow failure syndromes (IBMFS) have provided insight into the complexity of these diseases. The diseases are heterogeneous and characterized by developmental abnormalities, progressive marrow failure, and predisposition to cancer. A correct diagnosis allows for appropriate treatment, genetic counseling, and cancer surveillance. The common IBMFSs are Fanconi anemia, dyskeratosis congenita, and Diamond-Blackfan anemia. Hematopoietic cell transplantation (HCT) offers curative treatment of the hematologic complications of IBMFS. Because of the systemic nature of these diseases, transplant strategies are modified to decrease immediate and late toxicities. HCT from HLA-matched related or unrelated donors offers excellent survival for young patients in aplasia. Challenges include the treatment of adults with marrow aplasia, presentation with myeloid malignancy regardless of age, and early detection or treatment of cancer. In this article, I will describe our approach and evaluation of patients transplanted with IBMFS and review most frequent complications before and after transplant.
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Affiliation(s)
- Carmem Bonfim
- Division of Bone Marrow Transplantation, General Hospital of the Federal University of Parana, Curitiba, Brazil
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Abstract
Hemoglobinopathies are the most common single-gene diseases and are estimated to affect millions of people worldwide. Thalassemia and sickle cell disease are the most prevalent diseases of this group. Today, despite the decreasing number of newborns diagnosed with a hemoglobinopathy, it remains an important health problem for many countries. Although regular red blood cell (RBC) transfusions, advanced iron chelation, and supportive therapy alternatives have improved life expectancy, allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative option for patients with hemoglobinopathies to prevent irreversible organ damage. Modern transplantation approaches and careful posttransplantation follow-up of patients have improved survival outcomes, and HSCT has now been performed in several patients with hemoglobinopathies worldwide. Considering current experiences, hematopoietic stem cell transplantation is recommended in cases of β-thalassemia (β-thal) in the presence of a matched family or unrelated donor, without secondary organ damage due to transfusion. In patients with sickle cell anemia, transplantation indications include transfusion dependence and cases of secondary organ damage. Recently, gene therapy as a possible treatment option has yielded promising results, though it is not in routine clinical use at its current stage.
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Affiliation(s)
- M Akif Yesilipek
- Department of Pediatric Hematology and Pediatric Stem Cell Transplantation Unit, Medicalpark Antalya Hospital, Antalya, Turkey
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6
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Kalkan BM, Kala EY, Yuce M, Karadag Alpaslan M, Kocabas F. Development of gene editing strategies for human β-globin (HBB) gene mutations. Gene 2020; 734:144398. [PMID: 31987908 DOI: 10.1016/j.gene.2020.144398] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 01/19/2023]
Abstract
Recent developments in gene editing technology have enabled scientists to modify DNA sequence by using engineered endonucleases. These gene editing tools are promising candidates for clinical applications, especially for treatment of inherited disorders like sickle cell disease (SCD). SCD is caused by a point mutation in human β-globin gene (HBB). Clinical strategies have demonstrated substantial success, however there is not any permanent cure for SCD available. CRISPR/Cas9 platform uses a single endonuclease and a single guide RNA (gRNA) to induce sequence-specific DNA double strand break (DSB). When this accompanies a repair template, it allows repairing the mutated gene. In this study, it was aimed to target HBB gene via CRISPR/Cas9 genome editing tool to introduce nucleotide alterations for efficient genome editing and correction of point mutations causing SCD in human cell line, by Homology Directed Repair (HDR). We have achieved to induce target specific nucleotide changes on HBB gene in the locus of mutation causing SCD. The effect of on-target activity of bone fide standard gRNA and newly developed longer gRNA were examined. It is observed that longer gRNA has higher affinity to target DNA while having the same performance for targeting and Cas9 induced DSBs. HDR mechanism was triggered by co-delivery of donor DNA repair templates in circular plasmid form. In conclusion, we have suggested methodological pipeline for efficient targeting with higher affinity to target DNA and generating desired modifications on HBB gene.
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Affiliation(s)
- Batuhan Mert Kalkan
- Regenerative Biology Research Laboratory, Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey; Koc University, Istanbul, Turkey
| | - Ezgi Yagmur Kala
- Regenerative Biology Research Laboratory, Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey; Koc University, Istanbul, Turkey
| | - Melek Yuce
- Regenerative Biology Research Laboratory, Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey; Department of Medical Biology and Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Medine Karadag Alpaslan
- Regenerative Biology Research Laboratory, Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey; Department of Medical Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fatih Kocabas
- Regenerative Biology Research Laboratory, Department of Genetics and Bioengineering, Faculty of Engineering, Yeditepe University, Istanbul, Turkey.
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De Rycke M, De Vos A, Belva F, Berckmoes V, Bonduelle M, Buysse A, Keymolen K, Liebaers I, Nekkebroeck J, Verdyck P, Verpoest W. Preimplantation genetic testing with HLA matching: from counseling to birth and beyond. J Hum Genet 2020; 65:445-454. [PMID: 32103123 DOI: 10.1038/s10038-020-0732-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 11/09/2022]
Abstract
Preimplantation genetic testing-human leukocyte antigen '(PGT-HLA) only' refers to the HLA typing of single or few cells biopsied from in vitro fertilized preimplantation embryos. The aim of the procedure is to establish a pregnancy, in which the fetus is HLA compatible with an affected sibling in need of a hematopoietic stem cell transplantation (HSCT). During PGT-M-HLA, the identification of a HLA-compatible embryo is combined with the detection of mutation(s) underlying immunodeficiencies and hemoglobinopathies. We report a combined retrospective and prospective cohort analysis of PGT-(M-)HLA procedures carried out from 1998 until 2017, with follow-up of transplantations to 2019. During the study period, 234 couples from 22 countries were invited for a multidisciplinary consultation. Two couples were rejected and 70 couples declined (various reasons), leaving 162 couples for which 414 clinical cycles were carried out. Cleavage stage biopsy followed by single-cell multiplex PCR for short tandem repeat-based haplotyping was applied in most cases (98.7%). The diagnostic efficiency was high (94.8%) but only 16.5% of the embryos was genetically suitable for transfer. Fresh and frozen-thawed embryo transfer resulted in 67 clinical pregnancies, 63 deliveries, and 74 live births, of which 60 children were HLA compatible. This yielded a live birth delivery rate of 30.3% per transfer. Information on neonatal characteristics of the matching PGT-(M-)HLA children showed reassuring outcomes. So far, HSCT was carried out successfully for 25 out of 26 cases. In conclusion, our data show that PGT-(M-)HLA is a valuable procedure: the high complexity and limited delivery rate are balanced by the successful HSCT outcome and the positive impact on families.
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Affiliation(s)
- M De Rycke
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. .,Vrije Universiteit Brussel (VUB), Reproduction and Genetics, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - A De Vos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - F Belva
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - V Berckmoes
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - M Bonduelle
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - A Buysse
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - K Keymolen
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - I Liebaers
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - J Nekkebroeck
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.,Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - P Verdyck
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - W Verpoest
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Tiewsiri K, Manipalviratn S, Sutheesophon W, Vanichsetakul P, Thaijaroen P, Ketcharoon P, Bradley CK, McArthur SJ, Krutsawad W, Marshall JTA, Papadopoulos KI. The First Asian, Single-Center Experience of Blastocyst Preimplantation Genetic Diagnosis with HLA Matching in Thailand for the Prevention of Thalassemia and Subsequent Curative Hematopoietic Stem Cell Transplantation of Twelve Affected Siblings. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5292090. [PMID: 32685500 PMCID: PMC7335404 DOI: 10.1155/2020/5292090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/30/2020] [Indexed: 02/08/2023]
Abstract
RESULTS In 221 cycles from 138 patients (104 cycles requiring HLA matching), 90.5% had embryo(s) biopsied for genetic testing. There were 119 embryo transfers for thalassemia (76) and thalassemia-HLA cases (43), respectively, resulting in overall clinical pregnancy rates of 54.6%, implantation rates of 45.7%, and live birth rates of 44.1%. Our dataset included fifteen PGD-HLA live births with successful HSCT in twelve affected siblings, 67% using umbilical cord blood stem cells (UCBSC) as the only SC source. CONCLUSIONS We report favorable thalassemia PGD and PGD-HLA laboratory and clinical outcomes from a single center. The ultimate success in PGD-HLA is of course the cure of a thalassemia-affected sibling by HSCT. Our PGD-HLA HSCT series is the first and largest performed entirely in Asia with twelve successful and two pending cures and predominant UCBSC use.
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Affiliation(s)
- Kasorn Tiewsiri
- 1Superior A.R.T., 1126/2 Vanit Building II, New Petchburi Road, Makkasan, Ratchathewi, Bangkok 10400, Thailand
| | - Somjate Manipalviratn
- 1Superior A.R.T., 1126/2 Vanit Building II, New Petchburi Road, Makkasan, Ratchathewi, Bangkok 10400, Thailand
| | - Warachaya Sutheesophon
- 2THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, Wangthonglang, Bangkok 10310, Thailand
| | - Preeda Vanichsetakul
- 3Hematopoietic Stem Cell Transplant Unit, Wattanosoth Hospital, 2 Soi Soonvijai 7, New Petchburi Road, Huaykwang, Bangkok 10310, Thailand
| | - Piyarat Thaijaroen
- 1Superior A.R.T., 1126/2 Vanit Building II, New Petchburi Road, Makkasan, Ratchathewi, Bangkok 10400, Thailand
| | - Pagawadee Ketcharoon
- 1Superior A.R.T., 1126/2 Vanit Building II, New Petchburi Road, Makkasan, Ratchathewi, Bangkok 10400, Thailand
| | - Cara K. Bradley
- 4Genea, 321 Kent Street, Sydney, New South Wales 2000, Australia
| | | | - Weena Krutsawad
- 1Superior A.R.T., 1126/2 Vanit Building II, New Petchburi Road, Makkasan, Ratchathewi, Bangkok 10400, Thailand
| | - James T. A. Marshall
- 1Superior A.R.T., 1126/2 Vanit Building II, New Petchburi Road, Makkasan, Ratchathewi, Bangkok 10400, Thailand
| | - Konstantinos I. Papadopoulos
- 2THAI StemLife, 566/3 Soi Ramkhamhaeng 39 (Thepleela 1), Prachaouthit Rd., Wangthonglang, Wangthonglang, Bangkok 10310, Thailand
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Rechitsky S, Kuliev A, San Ramon G, Tur-Kaspa I, Wang Y, Wang W, Wu X, Wang L, Leigh D, Cram DS. Single-Molecule Sequencing: A New Approach for Preimplantation Testing and Noninvasive Prenatal Diagnosis Confirmation of Fetal Genotype. J Mol Diagn 2019; 22:220-227. [PMID: 31751677 DOI: 10.1016/j.jmoldx.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/11/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022] Open
Abstract
We investigated the potential of next-generation sequencing (NGS) as an alternative method for preimplantation genetic testing of monogenic disease (PGT-M) with human leukocyte antigen (HLA) matching and for noninvasive prenatal diagnosis follow-up. The case involved parents who were carriers of the Fanconi anemia complementation group G (FANCG) 260delG mutation. After clinical PGT using conventional short tandem repeat and mutation analysis, two euploid disease-free embryos were transferred, resulting in a twin pregnancy. Using the original embryo whole genome amplification products from 10 embryos, NGS confirmed the genotypes of the eight nontransferred embryos for both mutation status and HLA combination. NGS also confirmed that the two transferred embryos, which resulted in a twin pregnancy, were euploid, Fanconi disease free, and HLA matched to their sick sibling. At 15 weeks' gestation, noninvasive prenatal diagnosis of the maternal cell-free DNA determined fetal fractions of 14% and 6.6% for twins 1 and 2, respectively. The maternal plasma FANCG 260delG mutation ratio was measured at 46.2%, consistent with the presence of a carrier fetus and a normal fetus. These findings provide proof of concept that NGS has clinical utility as a safe and effective PGT-M method for embryo genotyping as well as more complex direct HLA matching. In addition, NGS can be used to confirm the original PGT-M and HLA matching embryo results in early pregnancy without the need for invasive prenatal diagnosis.
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Affiliation(s)
| | - Anver Kuliev
- Reproductive Genetic Innovations, Chicago, Illinois
| | | | | | - Yin Wang
- Research and Development Department, Berry Genomics Corporation, Beijing, People's Republic of China
| | - Wenjie Wang
- Women Health Center of Shanxi, Children's Hospital of Shanxi, Taiyuan, People's Republic of China
| | - Xueqing Wu
- Women Health Center of Shanxi, Children's Hospital of Shanxi, Taiyuan, People's Republic of China
| | - Li Wang
- IVF Center, First Hospital of Kunming, Kunming, People's Republic of China
| | - Don Leigh
- IVF Center, First Hospital of Kunming, Kunming, People's Republic of China
| | - David S Cram
- Research and Development Department, Berry Genomics Corporation, Beijing, People's Republic of China; Women Health Center of Shanxi, Children's Hospital of Shanxi, Taiyuan, People's Republic of China; IVF Center, First Hospital of Kunming, Kunming, People's Republic of China.
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10
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The need to address legal ambiguity on conceiving saviour siblings in Malaysia. HEALTH POLICY AND TECHNOLOGY 2019. [DOI: 10.1016/j.hlpt.2019.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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11
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Kakourou G, Kahraman S, Ekmekci GC, Tac HA, Kourlaba G, Kourkouni E, Sanz AC, Martin J, Malmgren H, Giménez C, Gold V, Carvalho F, Billi C, Chow JFC, Vendrell X, Kokkali G, Liss J, Steffann J, Traeger-Synodinos J. The clinical utility of PGD with HLA matching: a collaborative multi-centre ESHRE study. Hum Reprod 2019; 33:520-530. [PMID: 29432583 DOI: 10.1093/humrep/dex384] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/26/2017] [Indexed: 12/16/2022] Open
Abstract
STUDY QUESTION Has PGD-HLA been successful relative to diagnostic and clinical efficacy? SUMMARY ANSWER The diagnostic efficacy of PGD-HLA protocols was found lower in this study in comparison to published PGD-HLA protocols and to that reported for general PGD by ESHRE (78.5 vs 94.1% and vs 92.6%, respectively), while the clinical efficacy has proven very difficult to assess due to inadequate follow-up of both the ART/PGD and HSCT procedure outcomes. WHAT IS KNOWN ALREADY The first clinical cases for PGD-HLA were reported in 2001. It is now a well-established procedure, with an increasing number of cycles performed every year. However, PGD-HLA is still offered by relatively few PGD centres, the currently available data is fragmented and most reports on PGD-HLA applications are limited in number and scope. Published systematic details on methodology, diagnostic results, overall ART success and haematopoietic stem cell transplantation (HSCT) outcomes are limited, precluding an evaluation of the true clinical utility of PGD-HLA cycles. STUDY DESIGN, SIZE, DURATION This retrospective multi-centre cohort study aimed to investigate the diagnostic and clinical efficacy of the PGD-HLA procedure and the aspects of PGD-HLA cycles influencing positive outcomes: birth of genetically suitable donor-baby (or babies) and HSCT. In April 2014, 32 PGD centres (Consortium members and non-members) with published/known PGD-HLA activity were invited to participate. Between February and September 2015, 14 centres submitted their data, through a custom-designed secure database, with unique login access for each centre. Data parameters covered all aspects of PGD-HLA cycles (ART, embryology and genetic diagnosis), donor-babies born and HSCT. PARTICIPANTS/MATERIALS, SETTING, METHODS From 716 cycles submitted by 14 centres (performed between August 2001 and September 2015), the quality evaluation excluded 12 cycles, leaving 704, from 364 couples. The online database, based on REDCap, a free, secure, web-based data-capture application, was customized by Centre for Clinical Epidemiology and Outcomes Research (CLEO), Athens. Continuous variables are presented using mean, standard deviation, median and interquartile range, and categorical variables are presented as absolute and relative frequencies. MAIN RESULTS AND THE ROLE OF CHANCE The data included 704 HLA-PGD cycles. Mean maternal age was 33.5 years. Most couples (81.3%) requested HLA-typing with concurrent exclusion of a single monogenic disease (58.6% for beta-thalassaemia). In 92.5% couples, both partners were fertile, with an average 1.93 HLA-PGD cycles/couple. Overall, 9751 oocytes were retrieved (13.9/cycle) and 5532 embryos were analysed (7.9/cycle). Most cycles involved fresh oocytes (94.9%) and Day 3 embryo biopsy (85.3%). In 97.5% of cycles, the genotyping method involved PCR only. Of 4343 embryos diagnosed (78.5% of analysed embryos), 677 were genetically suitable (15.4% of those analysed for HLA alone, 11.6% of those analysed for HLA with exclusion of monogenic disease). Of the 364 couples, 56.6% achieved an embryo transfer (ET) and 598 embryos were transferred in 382 cycles, leading to 164 HCG-positive pregnancies (pregnancy rate/ET 41.3%, pregnancy rate/initiated cycle 23.3%) and 136 babies born (live birth rate/ET 34.3%, live birth rate/initiated cycle 19.3%) to 113 couples. Data analysis identified the following limitations to the overall success of the HLA-PGD procedure: the age of the mother undergoing the treatment cycle, the number of oocytes collected per cycle and genetic chance. HSCT was reported for 57 cases, of which 64.9% involved combined umbilical cord-blood and bone marrow transplantation from the HLA-identical sibling donor; 77.3% of transplants reported no complications. LIMITATIONS REASONS FOR CAUTION The findings of the study may be limited as not all PGD centres with PGD-HLA experience participated. Reporting bias on completion of the online database may be another potential limitation. Furthermore, the study is based on retrospective data collection from centres with variable practices and strategies for ART, embryology and genetic diagnosis. WIDER IMPLICATIONS OF THE FINDINGS This is the first multi-centre study evaluating the clinical utility of PGD-HLA, indicating variations in practice and outcomes throughout 15 years and between centres. The study highlights parameters important for positive outcomes and provides important information for both scientists and couples interested in initiating a cycle. Above all, the study underlines the need for better collaboration between all specialists involved in the ART-PGD/HLA procedure, as well as the need for comprehensive and prospective long-term data collection, and encourages all specialists to aim to properly evaluate and follow-up all procedures, with the ultimate aim to promote best practice and encourage patient informed decision making. STUDY FUNDING/COMPETING INTEREST(S) The study wishes to acknowledge ESHRE for funding the customization of the REDCap database. There are no competing interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- G Kakourou
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens, Thivon & Livadias, Athens 11527, Greece
| | - S Kahraman
- Istanbul Memorial Hospital, ART and Reproductive Genetics Unit, Piyale Pasa Bulvari, 34385 Okmeydani sisli-Instanbul, Turkey
| | - G C Ekmekci
- Istanbul Memorial Hospital, ART and Reproductive Genetics Unit, Piyale Pasa Bulvari, 34385 Okmeydani sisli-Instanbul, Turkey
| | - H A Tac
- Istanbul Memorial Hospital, ART and Reproductive Genetics Unit, Piyale Pasa Bulvari, 34385 Okmeydani sisli-Instanbul, Turkey
| | - G Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), 5 Chatzigianni Mexi 11528, Athens, Greece
| | - E Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), 5 Chatzigianni Mexi 11528, Athens, Greece
| | - A Cervero Sanz
- Igenomix, Parc Científic Universitat de Valéncia, Calle Catedrático Agustín Escardino 9, 46980 Paterna (València), Spain
| | - J Martin
- Igenomix, Parc Científic Universitat de Valéncia, Calle Catedrático Agustín Escardino 9, 46980 Paterna (València), Spain
| | - H Malmgren
- Stockholm PGD Center, Karolinska University Hospital, Karolinska Universitetssjukhuset, Karolinska vägen, 171 76 Solna, Sweden
| | - C Giménez
- Reprogenetics Spain, Carrer de Tuset, 23, 08006 Barcelona, Spain
| | - V Gold
- PGD Lab, Lis Fertility Institute, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - F Carvalho
- Department of Pathology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen, 4200-135 Porto, Portugal
| | - C Billi
- Preimplantation Diagnosis Department, Alfalab Private Diagnostic Laboratory Medical S.A., Anastasiou Georgiou 11, 115 24 Athens, Greece
| | - J F C Chow
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Tsan Yuk Hospital Preimplantation Genetic Diagnosis Laboratory, Tsan Yuk Hospital, 30 Hospital Road, Sai Ying Pun, Hong Kong
| | - X Vendrell
- Reproductive Genetics Unit, Sistemas Genómicos Ltd, Ronda G.Marconi 6, 46980 Paterna (València), Spain
| | - G Kokkali
- Genesis Athens Clinic, Reproductive Medicine Unit, 14 Papanikoli Str, Chalandri 15232, Athens, Greece
| | - J Liss
- Invicta Fertility and Reproductive Center, 10 Rajska St., 80-850 Gdansk, Poland
| | - J Steffann
- Université Paris Descartes-Sorbonne Paris Cité, Institut Imagine, INSERM UMR1163, Laboratoire de Génétique, APHP Hopital Necker-Enfants Malades, 149 rue de Sévres, 75743 PARIS CEDEX 15, Paris, France
| | - J Traeger-Synodinos
- Department of Medical Genetics, Choremio Research Laboratory, National and Kapodistrian University of Athens, Thivon & Livadias, Athens 11527, Greece
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12
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Griffin DK, Ogur C. Chromosomal analysis in IVF: just how useful is it? Reproduction 2018; 156:F29-F50. [PMID: 29945889 DOI: 10.1530/rep-17-0683] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/23/2018] [Indexed: 12/11/2022]
Abstract
Designed to minimize chances of genetically abnormal embryos, preimplantation genetic diagnosis (PGD) involves in vitro fertilization (IVF), embryo biopsy, diagnosis and selective embryo transfer. Preimplantation genetic testing for aneuploidy (PGT-A) aims to avoid miscarriage and live born trisomic offspring and to improve IVF success. Diagnostic approaches include fluorescence in situ hybridization (FISH) and more contemporary comprehensive chromosome screening (CCS) including array comparative genomic hybridization (aCGH), quantitative polymerase chain reaction (PCR), next-generation sequencing (NGS) and karyomapping. NGS has an improved dynamic range, and karyomapping can detect chromosomal and monogenic disorders simultaneously. Mosaicism (commonplace in human embryos) can arise by several mechanisms; those arising initially meiotically (but with a subsequent post-zygotic 'trisomy rescue' event) usually lead to adverse outcomes, whereas the extent to which mosaics that are initially chromosomally normal (but then arise purely post-zygotically) can lead to unaffected live births is uncertain. Polar body (PB) biopsy is the least common sampling method, having drawbacks including cost and inability to detect any paternal contribution. Historically, cleavage-stage (blastomere) biopsy has been the most popular; however, higher abnormality levels, mosaicism and potential for embryo damage have led to it being superseded by blastocyst (trophectoderm - TE) biopsy, which provides more cells for analysis. Improved biopsy, diagnosis and freeze-all strategies collectively have the potential to revolutionize PGT-A, and there is increasing evidence of their combined efficacy. Nonetheless, PGT-A continues to attract criticism, prompting questions of when we consider the evidence base sufficient to justify routine PGT-A? Basic biological research is essential to address unanswered questions concerning the chromosome complement of human embryos, and we thus entreat companies, governments and charities to fund more. This will benefit both IVF patients and prospective parents at risk of aneuploid offspring following natural conception. The aim of this review is to appraise the 'state of the art' in terms of PGT-A, including the controversial areas, and to suggest a practical 'way forward' in terms of future diagnosis and applied research.
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Affiliation(s)
- Darren K Griffin
- School of BiosciencesCentre for Interdisciplinary Studies of Reproduction, University of Kent, Canterbury, UK
| | - Cagri Ogur
- Bahceci Genetic Diagnosis Centerİstanbul, Turkey.,Department of BioengineeringYildiz Technical University, İstanbul, Turkey
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13
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Darbari I, O'Brien JE, Hardy SJ, Speller-Brown B, Thaniel L, Martin B, Darbari DS, Nickel RS. Views of parents of children with sickle cell disease on pre-implantation genetic diagnosis. Pediatr Blood Cancer 2018; 65:e27102. [PMID: 29667775 DOI: 10.1002/pbc.27102] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 01/10/2023]
Abstract
Pre-implantation genetic diagnosis (PGD) is an option for parents who have a child with sickle cell disease (SCD) to have another child without SCD. We conducted a survey of 19 parents with at least one child with SCD to investigate views on PGD. Before education, 44% of parents were aware of PGD. All parents rated PGD education as important. All parents considering another child also reported interest in using PGD if insurance covered its costs. Parents who have a child with SCD appear to be interested in PGD and educational tools informing this group about PGD should be developed.
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Affiliation(s)
- Isha Darbari
- Division of Hematology, Children's National Health System, Washington, District of Columbia
| | | | - Steven J Hardy
- Division of Hematology, Children's National Health System, Washington, District of Columbia
| | - Barbara Speller-Brown
- Division of Hematology, Children's National Health System, Washington, District of Columbia
| | - Lisa Thaniel
- Division of Hematology, Children's National Health System, Washington, District of Columbia
| | - Brenda Martin
- Division of Hematology, Children's National Health System, Washington, District of Columbia
| | - Deepika S Darbari
- Division of Hematology, Children's National Health System, Washington, District of Columbia
| | - Robert S Nickel
- Division of Hematology, Children's National Health System, Washington, District of Columbia
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14
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Preimplantation High-Resolution HLA Sequencing Using Next Generation Sequencing. Biol Blood Marrow Transplant 2018; 24:1575-1580. [DOI: 10.1016/j.bbmt.2018.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/27/2018] [Indexed: 11/17/2022]
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15
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Rondelli D. Haploidentical Transplants: An Answer to Ethical Challenges on the Use of Preimplantation Donor Selection. Biol Blood Marrow Transplant 2018; 24:2167-2168. [PMID: 30003955 DOI: 10.1016/j.bbmt.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 07/03/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Damiano Rondelli
- Division of Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois.
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17
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Handyside AH. ‘Designer babies’ almost thirty years on. Reproduction 2018; 156:F75-F79. [DOI: 10.1530/rep-18-0157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 06/12/2018] [Indexed: 11/08/2022]
Abstract
The first pregnancies and live births following in vitro fertilisation (IVF) and preimplantation genetic testing (PGT), formerly known as preimplantation genetic diagnosis, were reported in 1990, almost 30 years ago, in several couples at risk of X-linked inherited conditions, which typically only affect boys inheriting the X chromosome with the affected gene from their carrier mothers. At that time, it was only possible to identify the sex of the embryo by amplifying a Y-linked repeat sequence in single cells biopsied at cleavage stages and avoid the transfer of males, half of which would be affected. The extensive publicity surrounding these cases and the perceived risk of using IVF and PGT for desirable characteristics not related to health, such as sex selection, led to the epithet of ‘designer babies’ which continues to resonate to this day. Here, I briefly reflect on how the technology of PGT has evolved over the decades and whether it deserves this reputation. With efficient methods for whole genome amplification and the genomic revolution, we now have highly accurate universal tests that combine marker-based diagnosis of almost any monogenic disorder with the detection of aneuploidy. PGT is now clinically well established and is likely to remain a valuable alternative for couples at risk of having affected children.
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18
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Martinhago CD, Endo KR, Oliveira MA, Dias AM, Pereira GS, Azzolini AM, Estrada PR, Bruzaca CG, Martinhago ACN. The first South American case of pre-implantation genetic diagnosis to select compatible embryo for cord blood transplantation as treatment for sickle cell anemia. JBRA Assist Reprod 2018; 22:71-74. [PMID: 29345446 PMCID: PMC5844664 DOI: 10.5935/1518-0557.20180017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sickle cell anemia is an inherited systemic hemoglobinopathy that affects
hemoglobin production in red blood cells, leading to early morbidity and
mortality. It is caused by a homozygous nucleotide substitution (c.20A>T) in
the β-globin gene (HBB) that changes a glutamic acid to
a valine in the protein. We present a case report of a fertile couple, both
carriers of the sickle cell anemia mutation, with one affected daughter. Six
cycles of assisted reproductive techniques were performed, resulting in 53
embryos in cleavage stage. Each embryo was biopsied and analyzed for
pre-implantation genetic diagnosis (PGD) by fluorescent polymerase chain
reaction, using polymorphic markers of the region of interest followed by
capillary electrophoresis in an automated genetic analyzer. HLA Compatible and
normal embryos for the mutation represented 3 (5.66%); while the carriers and
compatible 6 (11.32%); therefore, embryos matching those of the affected
daughter represented 9 (16.98%). A selected embryo in blastocyst stage was
transferred, resulting in a healthy male newborn, who had the umbilical cord
blood cells collected and stored. The affected daughter was immunosuppressed and
received transplanted cells from the umbilical cord blood of her brother; the
treatment was successful. Embryo selection using PGD technologies represent the
most effective treatment plan for parents who want to have a healthy child, and
it could cure another child already affected by inherited hemoglobinopathy.
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Affiliation(s)
| | | | | | - Alex Mm Dias
- Chromosome Medicina Genômica, São Paulo, SP, Brazil
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19
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Nickel RS, Kamani NR. Ethical Challenges in Hematopoietic Cell Transplantation for Sickle Cell Disease. Biol Blood Marrow Transplant 2018; 24:219-227. [DOI: 10.1016/j.bbmt.2017.08.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 08/28/2017] [Indexed: 12/19/2022]
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20
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Giri N, Reed HD, Stratton P, Savage SA, Alter BP. Pregnancy outcomes in mothers of offspring with inherited bone marrow failure syndromes. Pediatr Blood Cancer 2018; 65:10.1002/pbc.26757. [PMID: 28801981 PMCID: PMC7408308 DOI: 10.1002/pbc.26757] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/20/2017] [Accepted: 07/20/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Children with inherited bone marrow failure syndromes (IBMFSs) may be symptomatic in utero, resulting in maternal and fetal problems during the pregnancy. Subsequent pregnancies by their mothers should be considered "high risk". METHODS We retrospectively analyzed outcomes of 575 pregnancies in 165 unaffected mothers of offspring with Fanconi anemia (FA), dyskeratosis congenita (DC), Diamond-Blackfan anemia (DBA), and Shwachman-Diamond syndrome (SDS) for events noted during pregnancy, labor, and delivery. We compared outcomes of pregnancies with affected and unaffected offspring within each group of mothers and with the general population. RESULTS The rates of miscarriage (12-20%), elective abortion (5-10%), and live birth (68-78%) among mothers of all IBMFS groups were similar and comparable with general population rates but recurrent miscarriages (≥2) were significantly more common in mothers of offspring with DBA and SDS. Offspring with FA were more frequently born small for gestational age (SGA) than unaffected babies (39% vs. 4%) and had fetal malformations (46%) with 18% having three or more, often necessitating early delivery and surgery; offspring with DC had higher rates of SGA (39% vs. 8%) and fetal distress (26% vs. 3%); and offspring with DBA had fetal hypoxia (19% vs. 1%) leading to preterm and emergency cesarean deliveries (26% vs. 6%). Offspring with early-onset severe phenotypes had the most prenatal and peripartum adverse events. CONCLUSION We identified the high-risk nature of pregnancies in mothers with IBMFS-affected fetuses, suggesting the need for prepregnancy counseling and monitoring of subsequent pregnancies by high-risk fetal-maternal specialists.
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Affiliation(s)
- Neelam Giri
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Helen D Reed
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD,Baylor College of Medicine, Houston, TX
| | - Pamela Stratton
- Office of the Clinical Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Sharon A Savage
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Blanche P Alter
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
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21
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Kakourou G, Vrettou C, Moutafi M, Traeger-Synodinos J. Pre-implantation HLA matching: The production of a Saviour Child. Best Pract Res Clin Obstet Gynaecol 2017; 44:76-89. [DOI: 10.1016/j.bpobgyn.2017.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/09/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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22
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Novel Multiplex Fluorescent PCR-Based Method for HLA Typing and Preimplantational Genetic Diagnosis of β-Thalassemia. Arch Med Res 2017; 47:293-8. [PMID: 27664489 DOI: 10.1016/j.arcmed.2016.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Thalassemia is curable by bone marrow transplantation; however, finding suitable donors with defined HLA combination remains a major challenge. Cord blood stem cells with preselected HLA system through preimplantation genetic diagnosis (PGD) proved very useful for resolving scarce HLA-matched bone marrow donors. METHODS A thalassemia trait couple with an affected child was included in this study. We used informative STR markers at the HLA and beta globin loci to develop a single cell multiplex fluorescent PCR protocol. The protocol was extensively optimized on single lymphocytes isolated from the couple's peripheral blood. The optimized protocol was applied on single blastomeres biopsied from day 3 cleavage stage IVF embryos of the couple. RESULTS Four IVF embryos biopsied on day 3 and a single blastomere of each were provided for genetic diagnosis of combined β-thalassemia mutations and HLA typing. Of these, one embryo was diagnosed as homozygous normal for the thalassemia mutation and HLA matched with the existing affected sibling. CONCLUSION The optimized protocol worked well in PGD clinical cycle for selection of thalassemia-unaffected embryos with the desired HLA system.
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23
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Kurekci E, Küpesiz A, Anak S, Öztürk G, Gürsel O, Aksoylar S, Ileri T, Kuşkonmaz B, Eker İ, Cetin M, Tezcan Karasu G, Kaya Z, Fışgın T, Ertem M, Kansoy S, Yeşilipek MA. Hematopoietic Stem Cell Transplantation Using Preimplantation Genetic Diagnosis and Human Leukocyte Antigen Typing for Human Leukocyte Antigen–Matched Sibling Donor: A Turkish Multicenter Study. Biol Blood Marrow Transplant 2017; 23:790-794. [DOI: 10.1016/j.bbmt.2017.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
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24
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Sermon K. Novel technologies emerging for preimplantation genetic diagnosis and preimplantation genetic testing for aneuploidy. Expert Rev Mol Diagn 2016; 17:71-82. [PMID: 27855520 DOI: 10.1080/14737159.2017.1262261] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Preimplantation genetic diagnosis (PGD) was introduced as an alternative to prenatal diagnosis: embryos cultured in vitro were analysed for a monogenic disease and only disease-free embryos were transferred to the mother, to avoid the termination of pregnancy with an affected foetus. It soon transpired that human embryos show a great deal of acquired chromosomal abnormalities, thought to explain the low success rate of IVF - hence preimplantation genetic testing for aneuploidy (PGT-A) was developed to select euploid embryos for transfer. Areas covered: PGD has followed the tremendous evolution in genetic analysis, with only a slight delay due to adaptations for diagnosis on small samples. Currently, next generation sequencing combining chromosome with single-base pair analysis is on the verge of becoming the golden standard in PGD and PGT-A. Papers highlighting the different steps in the evolution of PGD/PGT-A were selected. Expert commentary: Different methodologies used in PGD/PGT-A with their pros and cons are discussed.
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Affiliation(s)
- Karen Sermon
- a Research Group Reproduction and Genetics , Vrije Universiteit Brussel , Brussels , Belgium
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25
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Derrington SF, Essner BS. The Complex Needs of Pediatric Hematopoietic Stem Cell Donors and Their Families: Challenges and Opportunities. J Pediatr 2016; 178:14-15. [PMID: 27597732 DOI: 10.1016/j.jpeds.2016.08.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Affiliation(s)
| | - Bonnie S Essner
- Department of Psychiatry and Behavioral Sciences Northwestern University Feinberg School of Medicine; Ann and Robert H. Lurie Children's Hospital of Chicago Chicago, Illinois
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Balobaid A, Qari A, Al-Zaidan H. Genetic counselors' scope of practice and challenges in genetic counseling services in Saudi Arabia. Int J Pediatr Adolesc Med 2016; 3:1-6. [PMID: 30805460 PMCID: PMC6372413 DOI: 10.1016/j.ijpam.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 12/18/2022]
Abstract
Genetic counseling is an evolving field in Saudi Arabia. In 2015, genetic counseling was recognized as a Master's program by the Saudi Commission for Health Specialties. Our genetic counselors combine their knowledge of genetics, counseling theory and interpersonal communication to serve Saudi and non-Saudi patients affected with a range of genetic conditions and/or birth defects. Most patients are referred to the clinic from different clinics at King Faisal Specialist Hospital and Research Centre (KFSHRC) and outside of KFSHRC for various indications. Carrier testing and preventative reproduction options rank highly on the reasons for referral to our clinics. The Saudi population has unique customs and beliefs, such as consanguinity and the evil eye. Challenges that are routinely encountered in our genetic counseling clinics include, but are not limited to, preventative reproductive options and termination of pregnancy, manifesting carriers, stigmatization of women and approaches to complex molecular findings. Working with families from different backgrounds and beliefs undoubtedly requires professionals with a distinctive set of skills and a structured clinical setting. This review article presents the scope of genetic counseling practice and tackles some of the challenges faced in providing genetic counseling in Saudi Arabia.
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Affiliation(s)
- Ameera Balobaid
- Department of Medical Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Alya Qari
- Department of Medical Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hamad Al-Zaidan
- Department of Medical Genetics, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Kakourou G, Vrettou C, Kattamis A, Destouni A, Poulou M, Moutafi M, Kokkali G, Pantos K, Davies S, Kitsiou-Tzeli S, Kanavakis E, Traeger-Synodinos J. Complex preimplantation genetic diagnosis for beta-thalassaemia, sideroblastic anaemia, and human leukocyte antigen (HLA)-typing. Syst Biol Reprod Med 2015; 62:69-76. [DOI: 10.3109/19396368.2015.1100692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Origa R, Baldan A, Marsella M, Borgna-Pignatti C. A complicated disease: what can be done to manage thalassemia major more effectively? Expert Rev Hematol 2015; 8:851-62. [PMID: 26470003 DOI: 10.1586/17474086.2015.1101339] [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] [Indexed: 01/19/2023]
Abstract
Patients with thalassemia major suffer from many complications, but in the last two decades their lives have improved both in length and quality. We report herein the most common complications and the recent advances that have changed the course of this disease. Also, we report in detail some of the new therapeutic strategies already introduced in practice and briefly some that are still being developed.
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Affiliation(s)
- Raffaella Origa
- a Department of Public Health, Clinical and Molecular Medicine, Thalassemia Unit , University of Cagliari , Cagliari , Italy
| | - Alessandro Baldan
- b Department of Medical Sciences, Section of Pediatrics , University of Ferrara , Ferrara , Italy
| | - Maria Marsella
- c Pediatrics and Adolescentology Unit, Maternal and Child Health Department , "G. Rummo" Hospital , Benevento , Italy
| | - Caterina Borgna-Pignatti
- b Department of Medical Sciences, Section of Pediatrics , University of Ferrara , Ferrara , Italy
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Strocchio L, Romano M, Cefalo MG, Vinti L, Gaspari S, Locatelli F. Cord blood transplantation in children with hemoglobinopathies. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1076724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Bogliolo M, Surrallés J. Fanconi anemia: a model disease for studies on human genetics and advanced therapeutics. Curr Opin Genet Dev 2015; 33:32-40. [PMID: 26254775 DOI: 10.1016/j.gde.2015.07.002] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 07/19/2015] [Accepted: 07/21/2015] [Indexed: 12/18/2022]
Abstract
Fanconi anemia (FA) is characterized by bone marrow failure, malformations, and chromosome fragility. We review the recent discovery of FA genes and efforts to develop genetic therapies for FA in the last five years. Because current data exclude FANCM as an FA gene, 15 genes remain bona fide FA genes and three (FANCO, FANCR and FANCS) cause an FA like syndrome. Monoallelic mutations in 6 FA associated genes (FANCD1, FANCJ, FANCM, FANCN, FANCO and FANCS) predispose to breast and ovarian cancer. The products of all these genes are involved in the repair of stalled DNA replication forks by unhooking DNA interstrand cross-links and promoting homologous recombination. The genetic characterization of patients with FA is essential for developing therapies, including hematopoietic stem cell transplantation from a savior sibling donor after embryo selection, gene therapy, or genome editing using genetic recombination or engineered nucleases. Newly acquired knowledge about FA promises to provide therapeutic strategies in the near future.
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Affiliation(s)
- Massimo Bogliolo
- Centre for Biomedical Network Research on Rare Diseases (CIBERER), Spain
| | - Jordi Surrallés
- Genome Instability and DNA Repair Group, Department of Genetics and Microbiology, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain; Centre for Biomedical Network Research on Rare Diseases (CIBERER), Spain.
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Bhatia M, Sheth S. Hematopoietic stem cell transplantation in sickle cell disease: patient selection and special considerations. J Blood Med 2015. [PMID: 26203293 PMCID: PMC4506029 DOI: 10.2147/jbm.s60515] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Hematopoietic stem cell transplantation remains the only curative treatment currently in use for patients with sickle cell disease (SCD). The first successful hematopoietic stem cell transplantation was performed in 1984. To date, approximately 1,200 transplants have been reported. Given the high prevalence of this disorder in Africa, and its emergence in the developed world through immigration, this number is relatively small. There are many reasons for this; primary among them are the availability of a donor, the risks associated with this complex procedure, and the cost and availability of resources in the developing world. Of these, it is fair to say that the risks associated with the procedure have steadily decreased to the point where, if currently performed in a center with experience using a matched sibling donor, overall survival is close to 100% and event-free survival is over 90%. While there is little controversy around offering hematopoietic stem cell transplantation to symptomatic SCD patients with a matched sibling donor, there is much debate surrounding the use of this modality in “less severe” patients. An overview of the current state of our understanding of the pathology and treatment of SCD is important to show that our current strategy is not having the desired impact on survival of homozygous SCD patients, and should be changed to significantly impact the small proportion of these patients who have matched siblings and could be cured, especially those without overt clinical manifestations. Both patient families and providers must be made to understand the progressive nature of SCD, and should be encouraged to screen full siblings of patients with homozygous SCD for their potential to be donors. Matched siblings should be referred to an experienced transplant center for evaluation and counseling. In this review, we will discuss the rationale for these opinions and make recommendations for patient selection.
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Affiliation(s)
- Monica Bhatia
- Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Columbia University Medical Center, New York, NY, USA
| | - Sujit Sheth
- Division of Pediatric Hematology and Oncology, Weill Cornell Medical College, New York, NY, USA
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32
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Worth AJJ, Thrasher AJ. Current and emerging treatment options for Wiskott–Aldrich syndrome. Expert Rev Clin Immunol 2015; 11:1015-32. [DOI: 10.1586/1744666x.2015.1062366] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kahn J, Smilow E, Bhatia M. Hematopoietic Cell Transplantation and Sickle-Cell Disease: An Option for Everyone? CURRENT PEDIATRICS REPORTS 2015. [DOI: 10.1007/s40124-015-0079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Wiesinger C, Eichler FS, Berger J. The genetic landscape of X-linked adrenoleukodystrophy: inheritance, mutations, modifier genes, and diagnosis. APPLICATION OF CLINICAL GENETICS 2015; 8:109-21. [PMID: 25999754 PMCID: PMC4427263 DOI: 10.2147/tacg.s49590] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
X-linked adrenoleukodystrophy (X-ALD) is caused by mutations in the ABCD1 gene encoding a peroxisomal ABC transporter. In this review, we compare estimates of incidence derived from different populations in order to provide an overview of the worldwide incidence of X-ALD. X-ALD presents with heterogeneous phenotypes ranging from adrenomyeloneuropathy (AMN) to inflammatory demyelinating cerebral ALD (CALD). A large number of different mutations has been described, providing a unique opportunity for analysis of functional domains within ABC transporters. Yet the molecular basis for the heterogeneity of clinical symptoms is still largely unresolved, as no correlation between genotype and phenotype exists in X-ALD. Beyond ABCD1, environmental triggers and other genetic factors have been suggested as modifiers of the disease course. Here, we summarize the findings of numerous reports that aimed at identifying modifier genes in X-ALD and discuss potential problems and future approaches to address this issue. Different options for prenatal diagnosis are summarized, and potential pitfalls when applying next-generation sequencing approaches are discussed. Recently, the measurement of very long-chain fatty acids in lysophosphatidylcholine for the identification of peroxisomal disorders was included in newborn screening programs.
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Affiliation(s)
- Christoph Wiesinger
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Florian S Eichler
- Department for Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Berger
- Department of Pathobiology of the Nervous System, Center for Brain Research, Medical University of Vienna, Vienna, Austria
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Tur-Kaspa I, Jeelani R. Clinical guidelines for IVF with PGD for HLA matching. Reprod Biomed Online 2015; 30:115-9. [DOI: 10.1016/j.rbmo.2014.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/27/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
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