1
|
Shao LN, Zheng ZW, Zhou SH, Song WQ, Xia YX, Liang XH. RHC genotyping in Chinese Han population. BMC Genomics 2024; 25:525. [PMID: 38807041 PMCID: PMC11134930 DOI: 10.1186/s12864-024-10444-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND The Rh blood group system is characterized by its complexity and polymorphism, encompassing 56 different antigens. Accurately predicting the presence of the C antigen using genotyping methods has been challenging. The objective of this study was to evaluate the accuracy of various genotyping methods for predicting the Rh C and to identify a suitable method for the Chinese Han population. METHODS In total, 317 donors, consisting 223 D+ (including 20 with the Del phenotype) and 94 D- were randomly selected. For RHC genotyping, 48C and 109bp insertion were detected on the Real-time PCR platform and -292 substitution was analyzed via restriction fragment length polymorphism (RFLP). Moreover, the promoter region of the RHCE gene was sequenced to search for other nucleotide substitutions between RHC and RHc. Agreement between prediction methods was evaluated using the Kappa statistic, and comparisons between methods were conducted via the χ2 test. RESULTS The analysis revealed that the 48C allele, 109bp insertion, a specific pattern observed in RFLP results, and wild-type alleles of seven single nucleotide polymorphisms (SNPs) were in strong agreement with the Rh C, with Kappa coefficients exceeding 0.8. However, there were instances of false positives or false negatives (0.6% false negative rate for 109bp insertion and 5.4-8.2% false positive rates for other methods). The 109bp insertion method exhibited the highest accuracy in predicting the Rh C, at 99.4%, compared to other methods (P values≤0.001). Although no statistical differences were found among other methods for predicting Rh C (P values>0.05), the accuracies in descending order were 48C (94.6%) > rs586178 (92.7%) > rs4649082, rs2375313, rs2281179, rs2072933, rs2072932, and RFLP (92.4%) > rs2072931 (91.8%). CONCLUSIONS None of the methods examined can independently and accurately predict the Rh C. However, the 109bp insertion test demonstrated the highest accuracy for predicting the Rh C in the Chinese Han population. Utilizing the 109bp insertion test in combination with other methods may enhance the accuracy of Rh C prediction.
Collapse
Affiliation(s)
- Lin-Nan Shao
- Dalian Blood Center, No.90 Yan'an Road, Zhongshan District, Dalian, 116001, China
| | - Zi-Wei Zheng
- College of Medical Laboratory, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Shi-Hang Zhou
- Dalian Blood Center, No.90 Yan'an Road, Zhongshan District, Dalian, 116001, China.
| | - Wen-Qian Song
- Dalian Blood Center, No.90 Yan'an Road, Zhongshan District, Dalian, 116001, China
| | - Yue-Xin Xia
- Dalian Blood Center, No.90 Yan'an Road, Zhongshan District, Dalian, 116001, China
| | - Xiao-Hua Liang
- Dalian Blood Center, No.90 Yan'an Road, Zhongshan District, Dalian, 116001, China.
| |
Collapse
|
2
|
McGowan EC, O'Brien H, Sarri ME, Lopez GH, Daly JJ, Flower RL, Gardener GJ, Hyland CA. Feasibility for non-invasive prenatal fetal blood group and platelet genotyping by massively parallel sequencing: A single test system for multiple atypical red cell, platelet and quality control markers. Br J Haematol 2024; 204:694-705. [PMID: 37984869 DOI: 10.1111/bjh.19197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
Non-invasive prenatal tests (NIPT) to predict fetal red cell or platelet antigen status for alloimmunised women are provided for select antigens. This study reports on massively parallel sequencing (MPS) using a red cell and platelet probe panel targeting multiple nucleotide variants, plus individual identification single nucleotide polymorphisms (IISNPs). Maternal blood samples were provided from 33 alloimmunised cases, including seven with two red cell antibodies. Cell-free and genomic DNA was sequenced using targeted MPS and bioinformatically analysed using low-frequency variant detection. The resulting maternal genomic DNA allele frequency was subtracted from the cell-free DNA counterpart. Outcomes were matched against validated phenotyping/genotyping methods, where available. A 2.5% subtractive allele frequency threshold was set after comparing MPS predictions for K, RhC/c, RhE/e and Fya /Fyb against expected outcomes. This threshold was used for subsequent predictions, including HPA-15a, Jka /Jkb , Kpa /Kpb and Lua . MPS outcomes were 97.2% concordant with validated methods; one RhC case was discordantly negative and lacked IISNPs. IISNPs were informative for 30/33 cases as controls. NIPT MPS is feasible for fetal blood group genotyping and covers multiple blood groups and control targets in a single test. Noting caution for the Rh system, this has the potential to provide a personalised service for alloimmunised women.
Collapse
Affiliation(s)
- Eunike C McGowan
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Helen O'Brien
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
- Red Cell Reference Laboratory, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Mia E Sarri
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Genghis H Lopez
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - James J Daly
- Pathology Services, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Robert L Flower
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Glenn J Gardener
- Maternal Fetal Medicine, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
| | - Catherine A Hyland
- Research and Development, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
3
|
Clausen FB, Hellberg Å, Bein G, Bugert P, Schwartz D, Drnovsek TD, Finning K, Guz K, Haimila K, Henny C, O’Brien H, Orzinska A, Sørensen K, Thorlacius S, Wikman A, Denomme GA, Flegel WA, Gassner C, de Haas M, Hyland C, Ji Y, Lane WJ, Nogués N, Olsson ML, Peyrard T, van der Schoot CE, Weinstock C, Legler T. Recommendation for validation and quality assurance of non-invasive prenatal testing for foetal blood groups and implications for IVD risk classification according to EU regulations. Vox Sang 2022; 117:157-165. [PMID: 34155647 PMCID: PMC10686716 DOI: 10.1111/vox.13172] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/20/2021] [Accepted: 06/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Non-invasive assays for predicting foetal blood group status in pregnancy serve as valuable clinical tools in the management of pregnancies at risk of detrimental consequences due to blood group antigen incompatibility. To secure clinical applicability, assays for non-invasive prenatal testing of foetal blood groups need to follow strict rules for validation and quality assurance. Here, we present a multi-national position paper with specific recommendations for validation and quality assurance for such assays and discuss their risk classification according to EU regulations. MATERIALS AND METHODS We reviewed the literature covering validation for in-vitro diagnostic (IVD) assays in general and for non-invasive foetal RHD genotyping in particular. Recommendations were based on the result of discussions between co-authors. RESULTS In relation to Annex VIII of the In-Vitro-Diagnostic Medical Device Regulation 2017/746 of the European Parliament and the Council, assays for non-invasive prenatal testing of foetal blood groups are risk class D devices. In our opinion, screening for targeted anti-D prophylaxis for non-immunized RhD negative women should be placed under risk class C. To ensure high quality of non-invasive foetal blood group assays within and beyond the European Union, we present specific recommendations for validation and quality assurance in terms of analytical detection limit, range and linearity, precision, robustness, pre-analytics and use of controls in routine testing. With respect to immunized women, different requirements for validation and IVD risk classification are discussed. CONCLUSION These recommendations should be followed to ensure appropriate assay performance and applicability for clinical use of both commercial and in-house assays.
Collapse
Affiliation(s)
- Frederik Banch Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
| | - Åsa Hellberg
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Sweden
| | - Gregor Bein
- Institute for Clinical Immunology and Transfusion Medicine, Justus-Liebig-University, Giessen, Germany
| | - Peter Bugert
- Institute of Transfusion Medicine and Immunology, Heidelberg University, Medical Faculty Mannheim, German Red Cross Blood Service Baden Württemberg – Hessen, Mannheim, Germany
| | - Dieter Schwartz
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Kirstin Finning
- National Health Service Blood and Transplant, International Blood Group Reference Laboratory, UK
| | - Katarzyna Guz
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | - Helen O’Brien
- Clinical Services and Research, Australian Red Cross Lifeblood, Brisbane, Australia
| | | | - Kirsten Sørensen
- Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Agneta Wikman
- Clinical Immunology and Transfusion Medicine Karolinska University Hospital and CLINTEC Karolinska Institutet, Stockholm, Sweden
| | - Gregory Andrew Denomme
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Versiti Blood Research Institute and Diagnostic Laboratories, Milwaukee, Wisconsin, USA
| | - Willy Albert Flegel
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Department of Transfusion Medicine, NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Christoph Gassner
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Institute for Translational Medicine, Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Masja de Haas
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Department of Immunohaematology Diagnostic Services, Sanquin Diagnostic Services and Sanquin Research, Amsterdam, The Netherlands
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - Catherine Hyland
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Clinical Services and Research, Australian Red Cross Lifeblood, Brisbane, Australia
- School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yanli Ji
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Guangzhou Blood Center, Institute of Clinical Blood Transfusion, Guangzhou, China
| | - William J. Lane
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Núria Nogués
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Immunohematology Laboratory, Blood and Tissue Bank, Barcelona, Spain
| | - Martin L. Olsson
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Department of Clinical Immunology and Transfusion Medicine, Office for Medical Services, Region Skåne, Sweden
- Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Thierry Peyrard
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Institut National de la Transfusion Sanguine, Centre National de Référence pour les Groupes Sanguins, Paris, France
| | - C. Ellen van der Schoot
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, The Netherlands
| | - Christof Weinstock
- cfDNA subgroup from the International Society of Blood Transfusion (ISBT) Working Party on Red Cell Immunogenetics and Blood Group Terminology (RCIBGT), Amsterdam, The Netherlands
- Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg-Hessen, and Institute of Transfusion Medicine, University of Ulm, Ulm, Germany
| | - Tobias Legler
- Department of Transfusion Medicine, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
4
|
O'Brien H, Hyland C, Schoeman E, Flower R, Daly J, Gardener G. Non-invasive prenatal testing (NIPT) for fetal Kell, Duffy and Rh blood group antigen prediction in alloimmunised pregnant women: power of droplet digital PCR. Br J Haematol 2020; 189:e90-e94. [PMID: 32062863 DOI: 10.1111/bjh.16500] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Helen O'Brien
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Catherine Hyland
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Elizna Schoeman
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Robert Flower
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - James Daly
- Clinical Services and Research, Australian Red Cross Lifeblood, Kelvin Grove, Queensland, Australia
| | - Glenn Gardener
- Mater Health Services, South Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Dauber EM, Mayr WR, Hustinx H, Schönbacher M, Budde H, Legler TJ, König M, Haas OA, Fritsch G, Körmöczi GF. Somatic mosaicisms of chromosome 1 at two different stages of ontogenetic development detected by Rh blood group discrepancies. Haematologica 2018; 104:632-638. [PMID: 30237270 PMCID: PMC6395338 DOI: 10.3324/haematol.2018.201293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 09/20/2018] [Indexed: 12/19/2022] Open
Abstract
Spontaneous Rh blood group changes are a striking sign, reported to occur mainly in patients with hematologic disorders. Upon routine blood grouping, 2 unrelated individuals showed unexplained mixed red cell phenotype regarding the highly immunogenic c antigen (RH4), clinically relevant for blood transfusion and fetomaternal incompatibility. About half of their red cells were c-positive, whereas the other half were c-negative. These apparently hematologically healthy females had no history of transfusion or transplantation, and they tested negative for chimerism. Genotyping of flanking chromosome 1 microsatellites in blood, finger nails, hair, leukocyte subpopulations, and erythroid progenitor cells showed partial loss of heterozygosity encompassing the RHD/RHCE loci, spanning a 1p region of 26.7 or 42.4 Mb, respectively. Remarkably, in one case this was detected in all investigated tissues, whereas in the other, exclusively myeloid cells showed loss of heterozygosity. Both carried the RhD-positive haplotypes CDe and the RhD-negative haplotype cde. RHD/RHCE genotypes of single erythroid colonies and dual-color fluorescent in situ hybridization analyses indicated loss of the cde haplotype and duplication of the CDe haplotype in the altered cell line. Accordingly, red cell C antigen (RH2) levels of both propositae were higher than those of heterozygous controls. Taken together, the Rhc phenotype splitting appeared to be caused by deletion of a part of 1p followed by duplication of homologous stretches of the sister chromosome. In one case, this phenomenon was confined to myeloid stem cells, while in the other, a pluripotent stem cell line was affected, demonstrating somatic mosaicism at different stages of ontogenesis.
Collapse
Affiliation(s)
- Eva-Maria Dauber
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Austria
| | - Wolfgang R Mayr
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Austria
| | - Hein Hustinx
- Blood Transfusion Service, Swiss Red Cross (SRK), Bern, Switzerland
| | - Marlies Schönbacher
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Austria
| | - Holger Budde
- Department of Transfusion Medicine, University of Göttingen, Germany
| | - Tobias J Legler
- Department of Transfusion Medicine, University of Göttingen, Germany
| | - Margit König
- Children's Cancer Research Institute, St. Anna Hospital, Vienna, Austria
| | - Oskar A Haas
- Children's Cancer Research Institute, St. Anna Hospital, Vienna, Austria
| | - Gerhard Fritsch
- Children's Cancer Research Institute, St. Anna Hospital, Vienna, Austria
| | - Günther F Körmöczi
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Austria
| |
Collapse
|
6
|
Moezzi L, Keshavarz Z, Ranjbaran R, Aboualizadeh F, Behzad-Behbahani A, Abdullahi M, Ramezani A, Samsami A, Sharifzadeh S. Fetal RHD Genotyping Using Real-Time Polymerase Chain Reaction Analysis of Cell-Free Fetal DNA in Pregnancy of RhD Negative Women in South of Iran. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:62-70. [PMID: 27123202 PMCID: PMC4845531 DOI: 10.22074/ijfs.2016.4770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/29/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Maternal-fetal RhD antigen incompatibility causes approximately 50% of clinically significant alloimmunization cases. The routine use of prophylactic anti-D immunoglobulin has dramatically reduced hemolytic disease of the fetus and newborn. Recently, fetal RHD genotyping in RhD negative pregnant women has been suggested for appropriate use of anti-D immunoglobulin antenatal prophylaxis and decrease unnecessary prenatal interventions. MATERIALS AND METHODS In this prospective cohort study, in order to develop a reliable and non-invasive method for fetal RHD genotyping, cell free fetal DNA (cffD- NA) was extracted from maternal plasma. Real-time quantitative polymerase chain reaction (qPCR) for detection of RHD exons 7, 5, 10 and intron 4 was performed and the results were compared to the serological results of cord blood cells as the gold standard method. SRY gene and hypermethylated Ras-association domain family member 1 (RASSF1A) gene were used to confirm the presence of fetal DNA in male and female fetuses, respectively. RESULTS Out of 48 fetuses between 8 and 32 weeks (wks) of gestational age (GA), we correctly diagnosed 45 cases (93.75%) of RHD positive fetuses and 2 cases (4.16%) of the RHD negative one. Exon 7 was amplified in one sample, while three other RHD gene sequences were not detected; the sample was classified as inconclusive, and the RhD serology result after birth showed that the fetus was RhD-negative. CONCLUSION Our results showed high accuracy of the qPCR method using cffDNA for fetal RHD genotyping and implicate on the efficiency of this technique to predict the competence of anti-D immunoglobulin administration.
Collapse
Affiliation(s)
- Leili Moezzi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zeinab Keshavarz
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Ranjbaran
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Aboualizadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Behzad-Behbahani
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masooma Abdullahi
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Ramezani
- School of Advanced Medical Science and Technology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alamtaj Samsami
- Department of Obstetrics and Gynecology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedigheh Sharifzadeh
- Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
7
|
Abstract
Determination of fetal RHD from maternal plasma is increasingly used as a valuable tool for prenatal diagnosis. A remaining pitfall which hampers its use in situations with severe consequences is the following: (a) The reliability of negative results, however, is limited by difficulties to distinguish true negative results from false negative results due to insufficient amounts of free fetal DNA (ffDNA). False negative results can result in severe complications for the fetus and have to be reliably excluded. Large studies were performed in the last 10 years to investigate the reliability of noninvasive fetal RHD typing with real-time PCR. The majority of the assays were performed without internal controls. We present a protocol for inclusion of standards to assess the presence of adequate amounts of ffDNA for prenatal genotyping in maternal blood.
Collapse
Affiliation(s)
- Andrea Doescher
- German Red Cross Blood Transfusion Service NSTOB, Brandenburger Str. 21, 26133, Oldenburg, Germany,
| | | |
Collapse
|
8
|
Orzińska A, Guz K, Dębska M, Uhrynowska M, Celewicz Z, Wielgo M, Brojer E. 14 Years of Polish Experience in Non-Invasive Prenatal Blood Group Diagnosis. Transfus Med Hemother 2015; 42:361-4. [PMID: 26733766 DOI: 10.1159/000440821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/02/2015] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Blood cell antigens may cause maternal alloimmunization leading to fetal/newborn disorders. Non-invasive prenatal diagnostics (NIPD) of the blood group permits the determination of feto-maternal incompatibility. AIM To evaluate 14 years of blood group NIPD at the Institute of Hematology and Transfusion Medicine (IHTM) in Warsaw. METHODS Plasma DNA from 536 RhD-negative, 24 Rhc-negative, 26 RhE-negative, 43 K-negative, and 42 HPA-1a-negative pregnant women was examined by real-time PCR to detect RHD, RHCE*c, RHCE*E, RHCE*C, KEL*01 and HPA*1A, respectively. We tested for CCR5, SRY or bi-allelic polymorphisms and quantified the total or fetal DNA. RESULTS The results of fetal antigen status prediction by NIPD in all but one case (false-positive result of KEL*01) were correct taking neonate serology as a reference. It was confirmed that all negative results of NIPD contained fetal DNA except for four cases where there was no difference between the parents' polymorphisms. CONCLUSIONS A fetal genotype compatible with the mother was determined in 25% of all pregnancies tested at the IHTM for the fetal blood group. These cases were not at risk of disease, so it was possible to avoid invasive procedures.
Collapse
Affiliation(s)
| | - Katarzyna Guz
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| | - Marzena Dębska
- 2nd Department of Obstetrics and Gynaecology Medical Centre of Postgraduate Education, Warsaw, Poland
| | | | - Zbigniew Celewicz
- Department of Obstetrics and Gynaecology, Pomeranian Medical University, Szczecin, Poland
| | - Mirosław Wielgo
- 1th Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Brojer
- Institute of Haematology and Transfusion Medicine, Warsaw, Poland
| |
Collapse
|
9
|
Zhu YJ, Zheng YR, Li L, Zhou H, Liao X, Guo JX, Yi P. Diagnostic accuracy of non-invasive fetal RhD genotyping using cell-free fetal DNA: a meta analysis. J Matern Fetal Neonatal Med 2014; 27:1839-44. [DOI: 10.3109/14767058.2014.882306] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
10
|
Clausen FB. Integration of noninvasive prenatal prediction of fetal blood group into clinical prenatal care. Prenat Diagn 2014; 34:409-15. [PMID: 24431264 DOI: 10.1002/pd.4326] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/08/2014] [Accepted: 01/12/2014] [Indexed: 12/21/2022]
Abstract
Incompatibility of red blood cell blood group antigens between a pregnant woman and her fetus can cause maternal immunization and, consequently, hemolytic disease of the fetus and newborn. Noninvasive prenatal testing of cell-free fetal DNA can be used to assess the risk of hemolytic disease of the fetus and newborn to fetuses of immunized women. Prediction of the fetal RhD type has been very successful and is now integrated into clinical practice to assist in the management of the pregnancies of RhD immunized women. In addition, noninvasive prediction of the fetal RhD type can be applied to guide targeted prenatal prophylaxis, thus avoiding unnecessary exposure to anti-D in pregnant women. The analytical aspect of noninvasive fetal RHD typing is very robust and accurate, and its routine utilization has demonstrated high sensitivities for fetal RHD detection. A high compliance with administering anti-D is essential for obtaining a clinical effect. Noninvasive fetal typing of RHC/c, RHE/e, and KEL may become more widely used in the future.
Collapse
Affiliation(s)
- Frederik Banch Clausen
- Laboratory of Blood Genetics, Department of Clinical Immunology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
11
|
Kolialexi A, Tounta G, Mavrou A. Noninvasive fetal RhD genotyping from maternal blood. Expert Rev Mol Diagn 2014; 10:285-96. [DOI: 10.1586/erm.10.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
12
|
Doescher A, Petershofen EK, Wagner FF, Schunter M, Müller TH. Evaluation of single-nucleotide polymorphisms as internal controls in prenatal diagnosis of fetal blood groups. Transfusion 2012; 53:353-62. [DOI: 10.1111/j.1537-2995.2012.03738.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
13
|
Moussa H, Tsochandaridis M, Chakroun T, Jridi S, Abdelneji B, Hmida S, Silvy M, Bailly P, Gabert J, Levy-Mozziconacci A, Jemni-Yacoub S. Molecular background of D-negative phenotype in the Tunisian population. Transfus Med 2012; 22:192-8. [PMID: 22420413 DOI: 10.1111/j.1365-3148.2012.01142.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most studies of the molecular basis of Rhesus D-negative phenotype have been conducted in Caucasian and African populations. A comprehensive survey of RHD alleles was lacking in people from North Africa (Tunisians, Moroccans and Algerians) which could be very efficient for managing donors and patients carrying an RHD molecular variant. We analyse the molecular background of D-negative population in Tunisia in the present study. MATERIALS AND METHODS Blood samples were collected from native Tunisians. A total of 448 D-negative donors from different regions of Tunisia were analysed by RHD genotyping according to an adopted strategy using real-time PCR, ASP-PCR and sequencing. RESULTS Among the 448 D-negative samples, 443 were phenotyped unequivocally as true D-negative including three molecular backgrounds which were RHD gene deletion (n = 437), RHDψ pseudogene (n = 2) and RHD-CE-D hybrid gene (n = 4) with the respective frequencies of 0·9900, 0·0023 and 0·0046. The remaining five samples, in discordance with the serological results, were identified as two weak D type 11, one weak D type 29, one weak D type 4·0 and one DBT-1 partial D. CONCLUSION This study showed that the Tunisian population gets closer to Caucasians, given that the RHD gene deletion is the most prevalent cause of D-negative phenotype, but it is slightly different by the presence of the RHDψ pseudogene which was found with a very low frequency compared with that described in the African population. Nevertheless, the relative occurrence of weak D variants among studied serologically D-negative samples make necessary the adaptation of RHD genotyping strategy to the spectrum of prevalent alleles.
Collapse
Affiliation(s)
- H Moussa
- Unité de Recherche UR06SP05 Centre Régional de Transfusion Sanguine, Sousse, Tunisia
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Amaral DRT, Credidio DC, Pellegrino J, Castilho L. Fetal RHD genotyping by analysis of maternal plasma in a mixed population. J Clin Lab Anal 2011; 25:100-4. [PMID: 21438001 DOI: 10.1002/jcla.20440] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Maternal plasma analysis for the determination of the fetal RHD status is an exciting tool for the management of RhD-negative pregnant women, specially sensitized women. We assessed the accuracy of fetal RHD genotyping by analysis of maternal plasma in a multi-ethnic population. METHODS We analyzed plasma samples from 88 RhD-negative pregnant women between 11 and 39 weeks of gestation, median age of 28 years old to determine the fetal RHD genotype. This population was from Southeastern Brazil with high mixed ethnic background. Fourteen patients (16%) had anti-D alloantibody. We used Taqman primers and probes to detect by real-time PCR, exons 4, 5, and 10 of RHD. As internal controls we used primers/probes sets to SRY and CCR5. Peripheral or umbilical cord bloods from respective neonates were collected during delivery and hemagglutination was performed. RESULTS Fifty-eight samples (66%) were genotyped as RHD+, 27 samples (31%) showed complete absence of RHD and 3 samples (3 %) presented a D variant (RHDψ). All the results agreed with the neonatal typing, including the three fetuses with the RHDψ, phenotyped as RhD-negative. Thus, the accuracy of the fetal RHD genotyping in this mixed population was 100%. The earliest pregnancy in which fetal RHD was detected was 11 weeks. CONCLUSION Our findings indicate that the accuracy of RHD gene using three regions (exons 4, 5, and 10) can be sufficient for clinical application in a multi-ethnic population. This knowledge helped us on the development of a feasible protocol for fetal RHD genotyping on DNA from maternal plasma for our population.
Collapse
|
15
|
Abstract
Rhesus is the clinically most important protein-based blood group system. It represents the largest number of antigens and the most complex genetics of the 30 known blood group systems. The RHD and RHCE genes are strongly homologous. Some genetic complexity is explained by their close chromosomal proximity and unusual orientation, with their tail ends facing each other. The antigens are expressed by the RhD and the RhCE proteins. Rhesus exemplifies the correlation of genotype and phenotype, facilitating the understanding of general genetic mechanisms. For clinical purposes, genetic diagnostics of Rhesus antigens will improve the cost-effective development of transfusion medicine.
Collapse
Affiliation(s)
- Willy A Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892, United States.
| |
Collapse
|
16
|
Allele-specific oligonucleotide polymerase chain reaction for the determination of Rh C/c and Rh E/e antigens in thalassaemic patients. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2011; 9:301-5. [PMID: 21251469 DOI: 10.2450/2011.0055-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 10/08/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Thalassaemia is a genetic disease in which there is a relative or complete lack of alpha or beta globin chains. Patients with moderate to severe forms of thalassaemia need transfusions from the early years of life. Antibody production against blood group antigens may cause many problems in preparing compatible blood units for transfusion. The identification of definite blood group phenotypes by the haemagglutination method can be difficult because of the mixed population of red blood cells from the donor and recipient. MATERIALS AND METHODS Forty multiply transfused thalassaemic patients and ten healthy controls with no history of blood transfusion were enrolled in this study. Allele-specific oligonucleotide polymerase chain reaction (ASO-PCR) and haemagglutination methods were used to determine the presence of Rhesus (Rh) C, c, E and e antigens. RESULTS In this study four primer sets were used for ASO-PCR amplification of RhC/c and RhE/e. Although PCR assays for RhC/c and RHE/e genotyping have been described previously, in this study we used a new condition for PCR by decreasing the annealing temperature from 63 °C to 58 °C in order to amplify all four genes in the same condition. In order to evaluate this single run molecular method, we used the haemagglutination test as the standard method and compared the results from the two methods. We found discrepancies between phenotype and genotype results among patients with beta thalassaemia, but complete agreement between phenotype and genotype in the control group. CONCLUSIONS The advantage of this new ASO-PCR method compared to a restriction fragment length polymorphism (RFLP) PCR method is that with the former all four genes can be amplified at the same time by PCR, and electrophoresis can be performed immediately to determine individual antigen profiles. The simplicity of the ASO-PCR method makes it suitable for routine use in medical centres and it is also cheaper than RFLP-PCR. Furthermore, as shown by previous studies, the results of haemagglutination and PCR tests often differ because the existence of donor red blood cells in the patient's circulation can interfere with the interpretation of the haemagglutination test.
Collapse
|
17
|
Clausen FB, Krog GR, Rieneck K, Råsmark EEF, Dziegiel MH. Evaluation of Two Real-Time Multiplex PCR Screening Assays Detecting Fetal RHD in Plasma from RhD Negative Women to Ascertain the Requirement for Antenatal RhD Prophylaxis. Fetal Diagn Ther 2011; 29:155-63. [DOI: 10.1159/000321347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Accepted: 09/20/2010] [Indexed: 11/19/2022]
|
18
|
Rusterholz C, Messerli M, Hoesli I, Hahn S. Placental Microparticles, DNA, and RNA in Preeclampsia. Hypertens Pregnancy 2010; 30:364-75. [DOI: 10.3109/10641951003599571] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
19
|
Zejskova L, Jancuskova T, Kotlabova K, Doucha J, Hromadnikova I. Feasibility of fetal-derived hypermethylated RASSF1A sequence quantification in maternal plasma--next step toward reliable non-invasive prenatal diagnostics. Exp Mol Pathol 2010; 89:241-7. [PMID: 20868679 DOI: 10.1016/j.yexmp.2010.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 09/08/2010] [Accepted: 09/10/2010] [Indexed: 01/26/2023]
Abstract
We determined the feasibility of universal fetal marker detection in maternal circulation. Using real-time PCR, we compared the levels of fetal (SRY and hypermethylated RASSF1A) and total (GLO gene and total RASSF1A) extracellular DNA and fractions of extracellular fetal DNA (SRY/GLO vs. hypermethylated RASSF1A/total RASSF1A) in maternal circulation. Sensitivity and specificity reached 100% as the fetal-specific hypermethylated RASSF1A sequence was detected in all 151 examined plasma samples derived from 70 normal pregnancies with a singleton male (n=51) or female (n=19) fetus sampled throughout gestation and absent in non-pregnant individuals (n=29). A strong positive correlation was observed between fetal-derived hypermethylated RASSF1A and SRY (ρ=0.66, P<0.001), total RASSF1A and GLO (ρ=0.65,P<0.001), SRY/GLO vs. hypermethylated RASSF1A/total RASSF1A ratio (ρ=0.62, P<0.001) in maternal plasma. The results indicate that a universal fetal marker could be useful not only for the confirmation of the presence of fetal cell-free DNA in maternal plasma but could enable quantification of cell-free fetal DNA in pregnancy associated disorders, independently of the sex of the fetus.
Collapse
Affiliation(s)
- L Zejskova
- Department of Molecular Biology and Cell Pathology, Third Faculty of Medicine, Charles University, Ruska 87, 100 00 Prague, Czech Republic.
| | | | | | | | | |
Collapse
|
20
|
|
21
|
Gutensohn K, Müller SP, Thomann K, Stein W, Suren A, Körtge-Jung S, Schlüter G, Legler TJ. Diagnostic accuracy of noninvasive polymerase chain reaction testing for the determination of fetal rhesus C, c and E status in early pregnancy. BJOG 2010; 117:722-9. [DOI: 10.1111/j.1471-0528.2010.02518.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
22
|
Karina E, Tomasz P, Bilar M, Agnieszka O, Ewa B, Elzbieta RW. Assessment of the female fetal DNA concentration in the plasma of the pregnant women as preeclampsia indicator--preliminary report. Eur J Obstet Gynecol Reprod Biol 2009; 146:165-8. [PMID: 19632756 DOI: 10.1016/j.ejogrb.2009.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 04/26/2009] [Accepted: 06/15/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This research was designed to analyze the presence of fetal female DNA, expressed in copy number, in the plasma of the pregnant woman with preeclampsia-complicated pregnancy. STUDY DESIGN Twenty-four pregnant women with female fetuses identified by means of ultrasound scanning were enrolled in this pilot study. The study group consisted of 12 pregnant women with symptoms of preeclampsia, with 12 healthy women, matched for gestational age, as controls. RESULTS Mean DNA number of genomic equivalents per reaction in the group was 201 geq/PCR (from 44.9 to 375) and increased over time after onset of PE, which was the reason for pregnancy termination. In the group of women with preeclampsia, a notably higher DNA copy number in comparison to the control group was noted (p=0.0003 U Mann-Whitney test). CONCLUSIONS The pilot study presented in this work confirms that also in the case of preeclampsia-complicated pregnancy with female fetuses it is possible to implement the method of fetal DNA quantification. Use of the presented methods confirms that in severe preeclampsia-complicated pregnancies an increase of the number of DNA genomic equivalents per reaction in comparison to the control group is observed. Due to the small study group further research on the described issue is vital, but this study proves that it is also feasible among women carrying female fetuses.
Collapse
Affiliation(s)
- Engel Karina
- Department of Feto-Maternal Medicine, Pomeranian Medical University, 1 Unii Lubelskiej Street, 71-252 Szczecin, Poland
| | | | | | | | | | | |
Collapse
|
23
|
Wang XD, Wang BL, Ye SL, Liao YQ, Wang LF, He ZM. Non-invasive foetal RHD genotyping via real-time PCR of foetal DNA from Chinese RhD-negative maternal plasma. Eur J Clin Invest 2009; 39:607-17. [PMID: 19545247 DOI: 10.1111/j.1365-2362.2009.02148.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A majority of studies predicting the foetal RhD blood group in free foetal DNA from RhD-negative maternal plasma have been conducted in Caucasian populations, whereas limited data have been accumulated for Asian populations. In this study, we assessed the feasibility of prenatal genotyping of RHD in RhD-negative Chinese pregnant women. MATERIALS AND METHODS Cell-free plasma DNA was extracted from 78 RhD-negative Chinese women carrying a singleton foetus (gestation between 14 and 40 weeks). Foetal DNA was confirmed by testing SRY or nine different polymorphic STR loci in the maternal plasma and buffy coat. Foetal RHD exons 5, 7 and 10 and intron 4 were successfully amplified with RQ-PCR. The RHD1227A allele was examined in all RhD-positive individuals. The foetal RHD genotyping results were compared with the infant cord blood serological analysis. RESULTS Among the 78 specimens, RHD genotyping results of 70 cases were in complete concordance with serological results from foetal umbilical cord blood. Sixty of these cases were identified as RhD-positive, and 10 cases were typed as RhD-negative. In addition, five cases were 'false-positives', while three cases were considered inconclusive. The detection rate was 89.7% (70/78). In four of the five 'false-positive' cases, the RhDel phenotype was assessed by detecting the RHD1227A allele. Thus, this method yielded a 94.9% (74/78) accuracy rate. CONCLUSIONS The correct foetal RhD phenotype may be accurately predicted from RhD-negative maternal plasma in Chinese subjects. The RHD1227A allele proved to be an important genetic marker in the RhDel Chinese population.
Collapse
Affiliation(s)
- X D Wang
- Cancer Research Institute, Xiangya Medical School, Central South University, Changsha, China
| | | | | | | | | | | |
Collapse
|
24
|
Abstract
After the revolutionary detection of ffDNA (free fetal DNA) in maternal circulation by real-time PCR in 1997 and advances in molecular techniques, NIPD (non-invasive prenatal diagnosis) is now a clinical reality. Non-invasive diagnosis using ffDNA has been implemented, allowing the detection of paternally inherited alleles, sex-linked conditions and some single-gene disorders and is a viable indicator of predisposition to certain obstetric complications [e.g. PET (pre-eclampsia)]. To date, the major use of ffDNA genotyping in the clinic has been for the non-invasive detection of the pregnancies that are at risk of HDFN (haemolytic disease of the fetus and newborn). This has seen numerous clinical services arising across Europe and many large-scale NIPD genotyping studies taking place using maternal plasma. Because of the interest in performing NIPD and the speed at which the research in this area was developing, the SAFE (Special Non-Invasive Advances in Fetal and Neonatal Evaluation) NoE (Network of Excellence) was founded. The SAFE project was set up to implement routine, cost-effective NIPD and neonatal screening through the creation of long-term partnerships within and beyond the European Community and has played a major role in the standardization of non-invasive RHD genotyping. Other research using ffDNA has focused on the amount of ffDNA present in the maternal circulation, with a view to pre-empting various complications of pregnancy. One of the key areas of interest in the non-invasive arena is the prenatal detection of aneuploid pregnancies, particularly Down's syndrome. Owing to the high maternal DNA background, detection of ffDNA from maternal plasma is very difficult; consequently, research in this area is now more focused on ffRNA to produce new biomarkers.
Collapse
|
25
|
Banzola I, Kaufmann I, Lapaire O, Hahn S, Holzgreve W, Rusterholz C. Isolation of serum nucleic acids for fetal DNA analysis: comparison of manual and automated extraction methods. Prenat Diagn 2009; 28:1227-31. [PMID: 19039825 DOI: 10.1002/pd.2154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To investigate the performance of an automated system for the extraction of cell-free DNA of maternal and fetal origin from stored serum samples for subsequent quantitative real-time polymerase chain reaction (PCR) analysis. METHODS Thirty-two maternal blood samples between the early second trimester and term were obtained. Cell-free DNA was extracted from replicate stored sera using a column-based manual isolation procedure and with an automated system, the MagNA Pure LC Instrument. Real-time quantitative PCR for the ubiquitous glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and male-specific DYS14 loci was performed. RESULTS The extraction yields for both total and fetal DNA and the quality of the purified nucleic acids were similar for the automated system or the manual procedure. However, the number of false-negative results in samples collected early in pregnancy was reduced with the automated extraction. Furthermore, the extraction rate by the automated system was highly reproducible over time. CONCLUSIONS We validated the use of an automated extraction system for the isolation of fetal DNA from stored serum. This procedure might be exploited in the future for high-throughput non-invasive fetal gene analysis of archived serum samples.
Collapse
Affiliation(s)
- Irina Banzola
- Laboratory for Prenatal Medicine and Gynecologic Oncology, Department of Biomedicine, University Hospital, Basel, Switzerland
| | | | | | | | | | | |
Collapse
|
26
|
Daniels G, Finning K, Martin P, Massey E. Noninvasive prenatal diagnosis of fetal blood group phenotypes: current practice and future prospects. Prenat Diagn 2009; 29:101-7. [DOI: 10.1002/pd.2172] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
27
|
Geifman-Holtzman O, Ober Berman J. Prenatal diagnosis: update on invasive versus noninvasive fetal diagnostic testing from maternal blood. Expert Rev Mol Diagn 2009; 8:727-51. [PMID: 18999924 DOI: 10.1586/14737159.8.6.727] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The modern obstetrics care includes noninvasive prenatal diagnosis testing such as first trimester screening performed between 11 and 14 weeks' gestation and second trimester screening performed between 15 and 20 weeks. In these screening tests, biochemical markers are measured in the maternal blood with or without ultrasound for fetal nuchal translucency with reported accuracy of up to 90%. Invasive procedures, including amniocentesis or chorionic villi sampling, are used to achieve over 99% accuracy. During these procedures direct fetal material is examined and, therefore, these tests are highly accurate with the caveat of a small risk for pregnancy loss. Much research now focuses on other noninvasive highly accurate and risk-free tests that will identify fetal material in the maternal blood. Fetal cells and fetal DNA/RNA provide fetal information but are hard to find in an overwhelming background of maternal cells and in the absence of specific fetal cell markers. The most experience has been accumulated with fetal rhesus and fetal sex determination from maternal blood, with an accuracy of up to 100% by using gene sequences that are absent from maternal blood. Although not clinically applicable yet, fetal cells, fetal DNA/RNA and fetal proteomics in combination with cutting edge technology are described to prenatally diagnose aneuploidies and single-gene disorders.
Collapse
Affiliation(s)
- Ossie Geifman-Holtzman
- Division of Reproductive Genetics and Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA.
| | | |
Collapse
|
28
|
Freeman K, Szczepura A, Osipenko L. Non-invasive fetal RHD genotyping tests: a systematic review of the quality of reporting of diagnostic accuracy in published studies. Eur J Obstet Gynecol Reprod Biol 2008; 142:91-8. [PMID: 19081172 DOI: 10.1016/j.ejogrb.2008.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 10/08/2008] [Accepted: 10/17/2008] [Indexed: 11/29/2022]
Abstract
Articles reporting the diagnostic accuracy of non-invasive prenatal diagnostic (NIPD) tests for RHD genotyping using fetal material extracted from maternal blood have been published steadily for over a decade. Health care providers in Europe have started to use this technology for management of the small number of sensitised pregnancies (ca. 220-600 per annum in the Netherlands, Germany, France and the UK). Scientists and clinicians are also advocating widespread implementation for the far larger number of non-sensitised RhD-negative pregnancies (ca. 34,000-125,000 per annum in the same countries). Large-scale, prospective trials are only now underway. Estimates of the technical performance of these tests are currently based on results from small-scale studies, together with formal meta-analysis. The issue of early assessment of test performance is one faced by many new genetic tests. As part of a wider study we have investigated the quality of reporting of diagnostic accuracy in publications and produced guidelines for future studies. A systematic search of the literature identified 27 papers which met predefined inclusion criteria. All 27 papers were, first, assessed against an international quality (STARD) checklist for reporting of diagnostic accuracy and, second, against our own in-house NIPD proforma to assess the implications of the quality of reporting specifically for the RhD NIPD test. Authors were found to generally present an optimistic view of NIPD, bearing in mind weaknesses identified in reporting and conduct of their studies and the analysis of results, as evidenced by the low STARD scores. The NIPD proforma identified that specific biases were potentially introduced through selective population sampling and/or failure to report the make-up of the population tested, omission of inconclusive results, inconsistencies in the handling of repeat results on a sample, and lack of adequate controls. These factors would inevitably affect the validity of diagnostic accuracy as reported in individual publications, as well as any subsequent meta-analyses. Together, published reports to date may provide a biased picture of the actual potential of NIPD testing for fetal RHD genotyping. Generalisation of the available evidence on diagnostic accuracy, especially to large-scale implementation of NIPD testing of non-sensitised women, will also require that decision makers consider further aspects such as test reliability and cost of routine testing in clinical practice. It is recommended that all studies of diagnostic accuracy of NIPD tests adhere to the STARD quality checklist in order to improve reporting, thereby, minimising bias and increasing the comparability of studies. Researchers should also consider specific shortcomings for NIPD and avoid selective participant sampling; report population characteristics; report handling of replicate sampling as well as their failure rates; and include controls for genotypes tested in the study. Furthermore, meta-analyses should consider the quality, as well as the sample size, of NIPD studies in their analysis. Larger trials, required to produce results that are valid and meaningful for clinical practice, must also adhere to these reporting standards.
Collapse
Affiliation(s)
- Karoline Freeman
- Warwick Medical School, Warwick University, Gibbet Hill Road, Coventry CV4 7AL, UK.
| | | | | |
Collapse
|
29
|
Grill S, Banzola I, Li Y, Rekhviashvili T, Legler TJ, Müller SP, Zhong XY, Hahn S, Holzgreve W. High throughput non-invasive determination of foetal Rhesus D status using automated extraction of cell-free foetal DNA in maternal plasma and mass spectrometry. Arch Gynecol Obstet 2008; 279:533-7. [PMID: 18751991 DOI: 10.1007/s00404-008-0774-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 08/14/2008] [Indexed: 01/19/2023]
Abstract
PURPOSE To examine the potential high throughput capability and efficiency of an automated DNA extraction system in combination with mass spectrometry for the non-invasive determination of the foetal Rhesus D status. METHODS A total of 178 maternal plasma samples from RHD-negative pregnant women were examined, from which DNA was extracted using the automated Roche MagNA Pure system. Presence of the foetal RHD gene was detected by PCR for RHD exon 7 and subsequent analysis using the Sequenom MassArray mass spectrometric system. RESULTS We determined that as little as 15 pg of RHD-positive genomic DNA could be detected in a background of 585 pg of RHD-negative genomic DNA. The analysis of the clinical samples yielded a sensitivity and specificity of 96.1 and 96.1%, respectively. CONCLUSION Our study indicated that automated DNA extraction in combination with mass spectrometry permits the determination of foetal Rhesus D genotype with an accuracy comparable to the current approaches using real-time PCR.
Collapse
Affiliation(s)
- Simon Grill
- Department Biomedicine, University Women's Hospital, Basel, Switzerland
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Geifman-Holtzman O, Grotegut CA, Gaughan JP, Holtzman EJ, Floro C, Hernandez E. Noninvasive fetal RhCE genotyping from maternal blood. BJOG 2008; 116:144-51. [DOI: 10.1111/j.1471-0528.2008.01744.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
31
|
Abstract
RhD blood group incompatibility between a pregnant woman and her fetus can result in maternal alloimmunization and consequent haemolytic disease of the newborn (HDN) in subsequent pregnancies. The D-negative blood group is found in 15% of whites, 3-5% of black Africans, and is rare in Asians. Recent technological advances in non-invasive prenatal determination of the fetal RHD status using cell-free fetal DNA (cffDNA) have opened new avenues for the management of D-negative pregnant women. In this review applications for the high risk women, as well as potential for routine screening will be discussed. The use of non-invasive prenatal diagnosis and the management of other blood incompatibilities will also be discussed.
Collapse
|
32
|
Finning K, Martin P, Summers J, Daniels G. Fetal genotyping for the K (Kell) and Rh C, c, and E blood groups on cell-free fetal DNA in maternal plasma. Transfusion 2008; 47:2126-33. [PMID: 17958542 DOI: 10.1111/j.1537-2995.2007.01437.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND When a pregnant woman has an antibody with the potential to cause hemolytic disease of the fetus and newborn, it is beneficial to determine whether her fetus has the corresponding antigen to assess risk. In many countries this is now done routinely for RhD, by testing cell-free fetal DNA in the maternal plasma. Similar tests for K, C, c, and E are reported. STUDY DESIGN AND METHODS Real-time quantitative polymerase chain reaction incorporating an allele-specific primer was developed for detecting the K allele of KEL and the C, c, and E alleles of RHCE. These methods were used to test DNA isolated from plasma of pregnant women with antibodies to K, C, c, or E. Accuracy of the tests was determined by comparing results with serologic tests performed on cord red blood cells (RBCs) after delivery or by molecular genotyping on DNA obtained from fetal cells. RESULTS The K test incorporated an allele-specific primer with two locked nucleic acids and a mismatch. In 70 tests, including 27 K+ fetuses, only one false-negative and no false-positive results were obtained. The C, c, and E tests, performed on 13, 44, and 46 samples, respectively, gave rise to no false results. CONCLUSION Reliable methods have been developed for predicting fetal K, C, c, and E phenotypes, by testing fetal DNA in the plasma samples of pregnant women whose RBCs lack the corresponding antigens. These methods are now being used routinely in a diagnostic service in the United Kingdom.
Collapse
Affiliation(s)
- Kirstin Finning
- International Blood Group Reference Laboratory, NHSBT, Bristol, UK
| | | | | | | |
Collapse
|
33
|
Orzińska A, Guz K, Brojer E, Żupańska B. Preliminary results of fetal Rhc examination in plasma of pregnant women with anti-c. Prenat Diagn 2008; 28:335-7. [DOI: 10.1002/pd.1977] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
34
|
Abstract
BACKGROUND Molecular methods for blood group genotyping became available more than 10 years ago as one major aspect of immunogenetics. Since then, the clinical applications have been expanded and refined. Their implementation varies considerably among different health-care systems, notably between North America and Europe. STUDY DESIGN This summary is based on studies published mostly during the last 3 years and on workshop reports from the German and Swiss transfusion societies. It represents an edited transcript of the author's presentation given at the Workshop on Molecular Methods in Immunohematology organized by the Food and Drug Administration (FDA) in Bethesda on September 25, 2006. RESULTS Current applications of blood group genotyping in Germany, Switzerland, and Austria are detailed: weak D testing in patients and pregnant women; blood group genotyping in perinatal care, in patients who received a transfusion, and in patients with immunohematologic problems; RHD genotyping in donors for DEL and D(+/-) chimera; and RHD zygosity testing. CONCLUSION Since around 2000, molecular tests for blood groups have been widely offered as a routine service. Many samples are shipped to reference laboratories in the German-speaking countries with the specific request for such testing. The advent of Conformité Européenne (CE)-labeled test kits renders it technically and legally possible, within the specifications of the CE-certification process for in vitro diagnostic devices in the European Union, to replace several blood group serology tasks by genotyping.
Collapse
Affiliation(s)
- Willy A Flegel
- Institute of Transfusion Medicine, University Hospital Ulm, Germany.
| |
Collapse
|
35
|
Abstract
Determination of predicted blood group phenotype by determination of genotype has been performed since the 1990s. This evolved due to the rapid accrual of information surrounding the molecular basis of blood group antigen expression, which started in 1990 with ABO and RH systems and has now resulted in the molecular description of 28 of the 29 blood groups. Blood group genotyping is currently performed mostly for fetal blood group incompatibility and for assessment of multi-transfused patients. Both of these clinical scenarios are either dangerous or technically difficult, respectively to define serologically. With the simultaneous development of mass scale genotyping platforms it has now permitted the application of them to blood group genotype determination. In this paper, I describe some recently published work that has demonstrated that mass scale genotyping approaches are feasible. These approaches may lead to more effective management of blood stocks and patient cross-matching by reducing the dependence on serology during the time critical pre-transfusion phase. It is most probable that large scale studies, perhaps involving many European Union and North American based blood suppliers, may drive the introduction of this technology and convince red cell serologists that this approach may allow their work to be more focussed.
Collapse
Affiliation(s)
- Neil D Avent
- Centre for Research in Biomedicine, Bristol Genomics Research Institute, Faculty of Applied Sciences, University of the West of England, Bristol, United Kingdom.
| |
Collapse
|
36
|
Clausen FB, Krog GR, Rieneck K, Dziegiel MH. Improvement in fetal DNA extraction from maternal plasma. Evaluation of the NucliSens Magnetic Extraction system and the QIAamp DSP Virus Kit in comparison with the QIAamp DNA Blood Mini Kit. Prenat Diagn 2007; 27:6-10. [PMID: 17154236 DOI: 10.1002/pd.1605] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Prenatal diagnostic assays have been developed using free fetal DNA circulating in the maternal blood of pregnant women. Efficient DNA extraction is crucial for a robust analysis. To improve fetal DNA yield, we tested two manual extraction methods--the NucliSens Magnetic Extraction (NMAG) system and the QIAamp DSP Virus Kit (QDSP)--against our current standard method, the widely used QIAamp DNA Blood Mini Kit (QDNA). METHODS The fetal DNA yield of the two extraction systems was evaluated using the RHD exon 7 as target in DNA extracts of 75 plasma samples from pregnant RhD-negative women, known to have given birth to RhD-positive infanto. The total DNA yield was evaluated in 23 samples, targeting GAPDH. RESULTS The fetal DNA yield was improved by a mean factor of 1.7 using the NMAG system, and improved by a mean factor of 1.5 using the QDSP. The total DNA yield was improved by a mean factor of 2.3 using the NMAG system, and by a mean factor of 1.3 using the QDSP. CONCLUSION Both extraction systems tested were superior to our standard with regard to DNA yield. This improvement may have a great impact on the success of genotyping in early pregnancy.
Collapse
|
37
|
Geifman-Holtzman O, Grotegut CA, Gaughan JP. Diagnostic accuracy of noninvasive fetal Rh genotyping from maternal blood--a meta-analysis. Am J Obstet Gynecol 2006; 195:1163-73. [PMID: 17000250 DOI: 10.1016/j.ajog.2006.07.033] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 06/02/2006] [Accepted: 07/27/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the reported diagnostic accuracy, the validity, and the current limitations of fetal Rh genotyping from peripheral maternal blood based on the existing English-written publications. STUDY DESIGN A search of the English literature describing fetal RhD determination from maternal blood was conducted. From each study, we determined the number of samples tested, fetal RhD genotype, the source of the fetal DNA (maternal plasma, serum, or fetal cells), gestational age, and confirmation of fetal Rh type. The presence of alloimmunization and exclusions of tested samples were noted. For the meta-analysis we calculated composite estimates using 2 random effects models, weighted GLM and Bayesian. Sensitivity, specificity, positive and negative predictive values were calculated. RESULTS We identified 37 English-written publications that included 44 protocols reporting noninvasive Rh genotyping using fetal DNA obtained from maternal blood on a total of 3261 samples. A total of 183 (183/3261, 5.6%) samples were excluded from the meta-analysis. The overall diagnostic accuracy after exclusions was 94.8%. The gestational ages ranged between 8 and 42 weeks gestation. Maternal serum and plasma were found to be the best source for accurate diagnosis of fetal RhD type in 394/410 (96.1%) and 2293/2377 (96.5%), respectively. There were 719/783 (91.8%) alloimmunized patients that were correctly diagnosed. There were 16 studies that reported 100% diagnostic accuracy in their fetal RhD genotyping. CONCLUSION The diagnostic accuracy of noninvasive fetal Rh determination using maternal peripheral blood is 94.8%. Its use can be applicable to Rh prophylaxis and to the management of Rh alloimmunized pregnancies. Improvements of the technique and further study of structure and rearrangements of the RhD gene may improve accuracy of testing and enable large-scale, risk-free fetal RhD genotyping using maternal blood.
Collapse
Affiliation(s)
- Ossie Geifman-Holtzman
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University School of Medicine, Philadelphia, PA, USA.
| | | | | |
Collapse
|
38
|
Di Simone N, Lai M, Rumi C, Riccardi P, D'Asta M, Leone G, Mancuso S, Caruso A. Non-Invasive Detection of Fetal Rhesus D Status: A Comparison between Polymerase Chain Reaction and Flow Cytometry. Fetal Diagn Ther 2006; 21:404-9. [PMID: 16912487 DOI: 10.1159/000093880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 09/05/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A non-invasive prenatal determination of the fetal RhD status might be useful for the management of pregnancies in RhD-negative women whose partners are RhD positive. METHODS Maternal peripheral blood of 32 RhD-negative women (17-24 weeks of gestation) was collected, and circulating fetal cells were enriched by CD71 mini-magnetic activated cell sorting. The RhD status of the fetuses was assessed using multiparametric flow cytometry, and results were compared to those of reverse transcriptase (RT)-polymerase chain reaction (PCR), or PCR, which acted as control. Flow-cytometric study of fetal cells employed monoclonal antibodies directed against CD71, glycophorin A (GPA) and RhD antigens. RESULTS The median percentage of CD71- and RhD-positive cells was 0.83% (range 0.14-6.44%), and that of CD71 and GPA-positive cells was 10.07% (range 0.52-45.84%). Flow-cytometric analysis correlated with RT-PCR results of RNA obtained from whole maternal blood. In 1 case, an incorrect result was due to the failure of the amplification of the specific RhD band on RNA extracted from the CD71-positive fraction. In two instances, we observed false-positive results for RhD in PCR of DNA obtained from maternal plasma. CONCLUSION Based on our results, flow-cytometric analysis might be proposed as a clinical tool for the non-invasive prenatal determination of the fetal RhD status independently of fetal gender.
Collapse
Affiliation(s)
- Nicoletta Di Simone
- Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Shao CP, Xiong W, Zhou YY. Multiple isoforms excluding normal RhD mRNA detected in Rh blood group Del phenotype with RHD 1227A allele. Transfus Apher Sci 2006; 34:145-52. [PMID: 16510313 DOI: 10.1016/j.transci.2005.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 09/16/2005] [Accepted: 10/31/2005] [Indexed: 11/23/2022]
Abstract
The RhD mRNA was analyzed in both Rh-positive and D(el) phenotypes with RHD 1227A allele through sequencing. As a result, five and six transcripts were detected in Rh-positive and D(el), respectively. Four of them have identical sequences between Rh-positive and D(el). Those are the transcripts with exon 9, exons 8 and 9, exons 7 and 9, and exons 7-9 spliced out compared normal RhD mRNA that was detected in Rh-positive but not in D(el) individuals. Unexpectedly, two additional transcripts were found in D(el) individuals. Its exon 9 or exons 8-9 were spliced out, but interestingly both possess a 170 bp segment of sequence from intron 7 of RHD. We may conclude that a normal RhD protein does not exist in a D(el) individual with RHD 1227A allele since the exon 9 was always spliced out due to the silent mutation at the end of exon 9. The transcripts without exon 9 was also detected in the normal Rh-positive individual and further confirmed by a specific reverse-transcription PCR (RT-PCR) system.
Collapse
Affiliation(s)
- Chao-Peng Shao
- Shenzhen Blood Center and Shenzhen Institute of Blood Transfusion Medicine, Meigang South Street, Nigang West Road, Futian, Shenzhen 518035, PR China
| | | | | |
Collapse
|
40
|
Lo YMD. Recent developments in fetal nucleic acids in maternal plasma: implications to noninvasive prenatal fetal blood group genotyping. Transfus Clin Biol 2006; 13:50-2. [PMID: 16563836 DOI: 10.1016/j.tracli.2006.02.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The discovery of circulating cell-free fetal DNA in maternal plasma has opened up new possibilities for noninvasive prenatal diagnosis. Fetal DNA in maternal plasma has been used for the noninvasive prenatal determination of the RhD status of fetuses carried by RhD-negative pregnant women. In such analysis, the possible need of an internal control for the presence of detectable amounts of fetal DNA in a particular maternal plasma sample has been actively discussed. Recently, the development of a robust method for discriminating single nucleotide differences in plasma DNA using single allele base extension reaction (SABER) followed by matrix-assisted laser-desorption and ionization time-of-flight mass spectrometry (MALDI-TOF MS) has opened up the possibilities of using a panel of single nucleotide polymorphisms as such a positive control. A second approach is the recent successful development of fetal epigenetic markers which can be developed into universal fetal DNA markers. These developments hold promise to allow the eventual widespread utilization of maternal plasma DNA analysis for the noninvasive prenatal diagnosis of blood group mismatches between the mother and fetus.
Collapse
Affiliation(s)
- Y M D Lo
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
| |
Collapse
|
41
|
Abstract
BACKGROUND The RH genes RHD and RHCE encode two proteins that represent the clinically most important blood group system defined by the sequences of red cell membrane proteins. In the last five years the field has been moving from defining the underlying molecular genetics to applying the molecular genetics in clinical practice. MATERIALS AND METHODS The state of the current knowledge is briefly summarized using recent reviews and original work since 2000. RESULTS The RHD and RHCE genes are strongly homologous and located closely adjacent at the human chromosomal position 1p36.11. Part of the genetic complexity is explained by the clustered orientation of both genes with their tail ends facing each other. The SMP1 gene is located interspersed between both RH genes. Using additional genetic features of the RH gene locus, RHCE was shown to represent the ancestral RH position, while RHD is the duplicated gene. More than 150 alleles have been defined for RHD alone. They were classified based on antigenic and clinical properties into phenotypes like partial D, weak D and DEL. Among the D negative phenotype a large variety of non-functional alleles were found. The frequencies of these distinct alleles vary widely among human populations, which has consequences for clinical practice. CONCLUSION Rhesus is a model system for the correlation of genotype and phenotype, facilitating the understanding of underlying genetic mechanisms in clustered genes. With regard to clinical practice, the genetic diagnostics of blood group antigens will advance the cost-effective development of transfusion medicine.
Collapse
Affiliation(s)
- W A Flegel
- Institut für Klinische Transfusionsmedizin und Immungenetik Ulm, Abteilung Transfusionsmedizin, Universitätsklinikum Ulm, Ulm, Germany.
| |
Collapse
|
42
|
Traeger-Synodinos J. Real-time PCR for prenatal and preimplantation genetic diagnosis of monogenic diseases. Mol Aspects Med 2006; 27:176-91. [PMID: 16430951 DOI: 10.1016/j.mam.2005.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The provision of prenatal diagnosis requires the highest standards in laboratory practice to ensure an accurate result. In preimplantation genetic diagnosis protocols additionally have to address the need to achieve an accurate result from 1 to 2 cells within a limited time. Emerging protocols of "non-invasive" prenatal diagnosis, which are based on analysis of free fetal DNA in the circulation of the pregnant mother, also have to achieve a result from a limited quantity of fetal DNA against a high background of maternal free DNA. Real-time PCR uses fluorescent probes or dyes and dedicated instruments to monitor the accumulation of amplicons produced throughout the progress of a PCR reaction. Real-time PCR can be used for quantitative or qualitative evaluation of PCR products and is ideally suited for analysis of nucleotide sequence variations (point mutations) and gene dosage changes (locus deletions or insertions/duplications) that cause human monogenic diseases. Real-time PCR offers a means for more rapid and potentially higher throughput assays, without compromising accuracy and has several advantages over end-point PCR analysis, including the elimination of post-PCR processing steps and a wide dynamic range of detection with a high degree of sensitivity. This review will focus on real-time PCR protocols that are suitable for genotyping monogenic diseases with particular emphasis on applications to prenatal diagnosis, non-invasive prenatal diagnosis and preimplantation genetic diagnosis.
Collapse
Affiliation(s)
- Joanne Traeger-Synodinos
- Department of Medical Genetics, National and Kapodistrian University of Athens, St. Sophia's Children's Hospital, Athens 11527, Greece.
| |
Collapse
|
43
|
Wu YY, Csako G. Rapid and/or high-throughput genotyping for human red blood cell, platelet and leukocyte antigens, and forensic applications. Clin Chim Acta 2006; 363:165-76. [PMID: 16154123 DOI: 10.1016/j.cccn.2005.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 07/08/2005] [Accepted: 07/11/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Traditionally, transfusion medicine, platelet and human leukocyte antigen (HLA) typing, and forensic medicine relied on serologic studies. METHODS In recent years, molecular testing on nucleic acids has been increasingly applied to these areas. Although conventional molecular diagnostic methods such as PCR-sequence-specific priming, PCR-restriction fragment-length polymorphism, PCR-single-strand conformation polymorphism, sequence-based typing, and DNA fingerprinting have been shown to perform well, their use is limited by long turnaround times, high cost, labor-intensiveness, the need for special technical skills, and/or the high risk of amplicon contamination. With advance of fast and/or high-throughput methods and platforms that often combine amplification and detection, a new era of molecular genotyping is emerging in these fields dominated by serology for a century. As new targets, short tandem repeats, mitochondrial DNA and Y-chromosome sequences were introduced for forensic applications. This article reviews the current status of the application of rapid and/or high-throughput genotyping methods to these areas. RESULTS The results are already promising with real-time PCR, pyrosequencing, microarrays, and mass spectrometry and show high concordance rates with classic serologic and earlier manual molecular diagnostic methods. Exploration of other emerging methodologies will likely further enhance the diagnostic utility of molecular testing in these areas.
Collapse
Affiliation(s)
- Yan Yun Wu
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06510-3202, USA.
| | | |
Collapse
|
44
|
Hromadnikova I, Vechetova L, Vesela K, Benesova B, Doucha J, Kulovany E, Vlk R. Non-invasive fetal RHD exon 7 and exon 10 genotyping using real-time PCR testing of fetal DNA in maternal plasma. Fetal Diagn Ther 2005; 20:275-80. [PMID: 15980640 DOI: 10.1159/000085085] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 04/07/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this prospective study, we assessed the feasibility of foetal RHD genotyping by analysis of DNA extracted from plasma samples of Rhesus (Rh) D-negative pregnant women using real-time PCR and primers and probes targeted toward exon 7 and 10 of RHD gene. METHODS We analysed 24 RhD-negative pregnant woman and 4 patients with weak D phenotypes at a gestational age ranging from 11th to 38th week of gestation and correlated the results with serological analysis of cord blood after the delivery. RESULTS Non-invasive prenatal foetal RHD exon 7 genotyping analyses of maternal plasma samples was in complete concordance with the serological analysis of cord blood in all 24 RhD-negative pregnant women delivering 12 RhD-positive and 12 RhD-negative newborns. RHD exon-10-specific PCR amplicons were not detected in 2 out of 12 studied plasma samples from women bearing RhD-positive foetus, despite the positive amplification in RHD exon 7 region observed in all cases. In 1 case red cell serology of cord blood revealed that the mother had D-C-E-c+e+ C(w)- and the infant D+C-E-c+e+ C(w)+ phenotypes. RhD exon 10 real-time PCR analysis of cord blood was also negative. These findings may reflect that DC(w)- paternally inherited haplotype probably possesses no RHD exon 10. In another case no cord blood sample has been available for additional studies. The specificity of both RHD exon 7 and 10 systems approached 100% since no RhD-positive signals were detected in women currently pregnant with RhD-negative foetus (n = 8). Using real-time PCR and DNA isolated from maternal plasma, we easily differentiated pregnant woman whose RBCs had a weak D phenotype (n = 4) from truly RhD-negative patients since the threshold cycle (C(T)) for RHD exon 10 or 7 amplicons reached nearly the same value like C(T) for control beta-globin gene amplicons detecting the total DNA present in maternal plasma. However in these cases foetal RhD status cannot be determined. CONCLUSION Prediction offoetal RhD status from maternal plasma is highly accurate and enables implementation into clinical routine. We suggest that safe non-invasive prenatal foetal RHD genotyping using maternal plasma should involve the amplification of at least two RHD-specific products.
Collapse
Affiliation(s)
- Ilona Hromadnikova
- 2nd Clinic of Paediatrics, 2nd Medical Faculty, Charles University, University Hospital Motol, Prague, Czech Republic.
| | | | | | | | | | | | | |
Collapse
|
45
|
Brojer E, Zupanska B, Guz K, Orziñska A, Kaliñska A. Noninvasive determination of fetal RHD status by examination of cell-free DNA in maternal plasma. Transfusion 2005; 45:1473-80. [PMID: 16131380 DOI: 10.1111/j.1537-2995.2005.00559.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cell-free fetal DNA in maternal plasma opens the way for routine risk-free diagnosis of fetal D status of D- mothers. The focus was on accuracy of RHD typing and confirmation of fetal DNA in maternal plasma while RHD was not detected. STUDY DESIGN AND METHODS Plasma DNA was extracted (by manual and/or automatic method) from 255 D- pregnant women and amplified in exons 7 and 10 and intron 4 of RHD gene with real-time polymerase chain reaction. The presence of fetal DNA was confirmed by testing SRY and, when negative, by one of 11 different polymorphisms found in the father but not in the mother. The results were compared with the D status of the newborns. RESULTS After exclusion of 25 cases (10%) because of material shortage, in 230 cases (90%) available for complete study, the predictive value of the procedure of fetal RHD testing (RHD genotyping plus confirmation of fetal DNA) was 99.6 percent. SRY detection confirmed fetal DNA presence in maternal plasma in all boys, whereas the detection of various polymorphisms in all girls but one. CONCLUSIONS Fetal RHD genotyping from maternal plasma may be used with confidence, although additional polymorphisms for confirmation of fetal DNA should be included for 100 percent predictive value (instead of 99.6%).
Collapse
Affiliation(s)
- E Brojer
- Department of Immunohematology and Immunology of Transfusion Medicine, Institute of Hematology and Blood Transfusion, 5th Chocimska Street, 00-957 Warsaw, Poland.
| | | | | | | | | |
Collapse
|
46
|
Hromadnikova I, Vechetova L, Vesela K, Benesova B, Doucha J, Vlk R. Non-invasive fetal RHD and RHCE genotyping using real-time PCR testing of maternal plasma in RhD-negative pregnancies. J Histochem Cytochem 2005; 53:301-5. [PMID: 15750007 DOI: 10.1369/jhc.4a6372.2005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We assessed the feasibility of fetal RHD and RHCE genotyping by analysis of DNA extracted from plasma samples of RhD-negative pregnant women using real-time PCR and primers and probes targeted toward RHD and RHCE genes. We analyzed 45 pregnant women in the 11th to 40th weeks of pregnancy and correlated the results with serological analysis of cord blood after delivery. Non-invasive prenatal fetal RHD exon 7, RHD exon 10, RHCE exon 2 (C allele), and RHCE exon 5 (E allele) genotyping analysis of maternal plasma samples was correctly performed in 45 out of 45 RhD-negative pregnant women delivering 24 RhD-, 17 RhC-, and 7 RhE-positive newborns. Detection of fetal RHD and the C and E alleles of RHCE gene from maternal plasma is highly accurate and enables implementation into clinical routine. We recommend performing fetal RHD and RHCE genotyping together with fetal sex determination in alloimmunized D-negative pregnancies at risk of hemolytic disease of the newborn. In case of D-negative fetus, amplification of another paternally inherited allele (SRY and/or RhC and/or RhE positivity) proves the presence of fetal DNA in maternal circulation.
Collapse
Affiliation(s)
- Ilona Hromadnikova
- Clinic of Paediatrics, 2nd Medical Faculty, University Hospital Motol, V Uvalu 84, 150 18 Prague 5, Czech Republic.
| | | | | | | | | | | |
Collapse
|
47
|
Rouillac-Le Sciellour C, Puillandre P, Gillot R, Baulard C, Métral S, Le Van Kim C, Cartron JP, Colin Y, Brossard Y. Large-scale pre-diagnosis study of fetal RHD genotyping by PCR on plasma DNA from RhD-negative pregnant women. ACTA ACUST UNITED AC 2005; 8:23-31. [PMID: 15230639 DOI: 10.1007/bf03260044] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The routine prenatal determination of fetal RhD blood group would be very useful in the management of pregnancies in RhD-negative women, as up to 40% of these pregnancies bear a RhD-negative fetus. The fetal DNA present in maternal plasma offers an opportunity for risk-free prenatal diagnosis. AIM This study focused on the feasibility and accuracy of large-scale RhD fetal diagnosis in non-immunized and anti-D immunized RhD-negative women. METHODS Plasma DNA was extracted from 893 RhD-negative pregnant women and amplified in exons 7 and 10 of the RHD gene using conventional and real-time PCR. The results were then compared with the RHD fetal genotype determined on amniotic cells and/or the RhD phenotype of the red blood cells of the infants at birth. RESULTS After exclusion of 42 samples from women exhibiting a nonfunctional or rearranged RHD gene, fetal RhD status was predicted with a 99.5% accuracy. A strategy is also proposed to avoid the small number of false-positive and -negative results. CONCLUSION Fetal RHD genotyping from maternal plasma DNA in different clinical situations may be used with confidence.
Collapse
|
48
|
Hromadnikova I, Vesela K, Benesova B, Nekovarova K, Duskova D, Vlk R, Spalova I, Gerychova R, Hakenova A, Rosenbaumova Z, Vlasin P, Vlachova A, Palasek V, Roznakova E, Calda P. Non-invasive fetal RHD and RHCE genotyping from maternal plasma in alloimmunized pregnancies. Prenat Diagn 2005; 25:1079-83. [PMID: 16231295 DOI: 10.1002/pd.1282] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In this prospective study, we assessed the feasibility of fetal RH genotyping by analysis of DNA extracted from maternal plasma samples of alloimmunized pregnant women using real-time PCR and primers and probes targeted toward RHD (exon 7 and exon 10) and RHCE (intron 2 and exon 5) genes. METHODS We analysed 23 alloimmunized pregnant women (16 anti-D, 5 anti-D + C, 2 anti-E) at risk of haemolytic disease of the newborn (HDN) within 11th and 37th week of pregnancy and correlated the results with serological analysis of cord blood. RESULTS AND CONCLUSION Detection of the presence of the RHD gene, the C and/or E alleles of the RHCE gene in maternal plasma samples is highly accurate and enables implementation in a clinical diagnostic algorithm for following pregnancies at risk for HDN. The absence of RHD gene, the C and/or E alleles of RHCE gene in the current pregnancy excludes the risk of HDN caused by anti-D, anti-C and/or anti-E alloantibodies and the performance of invasive fetal-blood sampling.
Collapse
Affiliation(s)
- I Hromadnikova
- Cell Biology Laboratory, Paediatric Clinic, 2nd Medical Faculty, Charles University, University Hospital Motol, Prague, Czech Republic.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Clausen FB, Krog GR, Rieneck K, Nielsen LK, Lundquist R, Finning K, Dickmeiss E, Hedegaard M, Dziegiel MH. Reliable test for prenatal prediction of fetal RhD type using maternal plasma from RhD negative women. Prenat Diagn 2005; 25:1040-4. [PMID: 16231312 DOI: 10.1002/pd.1248] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The objective of this study was to establish a reliable test for prenatal prediction of fetal RhD type using maternal plasma from RhD negative women. This test is needed for future prenatal Rh prophylaxis. METHODS A novel real-time PCR-based assay targeting RHD exon 7 combined with a published assay for RHD exon 10 were used to determine the fetal RHD status in DNA extracted from plasma, sampled from 56 pregnant RhD negative women in 15th-36th week of gestation. Thirty-eight samples were from ongoing pregnancies of Danish women and 21 samples from 18 pregnant women were stored anonymized samples from the International Blood Group Reference Laboratory, Bristol, United Kingdom. Prediction of fetal RhD type was compared with the serological result obtained after birth. RESULTS The prediction of the fetal RhD type was in 100% concordance with the serological RhD type from the 16th week of gestation. One sample from the 15th week of gestation was inconclusive. The number of copies of fetal RHD DNA was found to increase with gestational age. Low levels of DNA were found to follow the Poisson distribution (p = 1.0000). CONCLUSION Our set-up was very reliable for determination of fetal RhD genotype, and thus will be of value in prenatal Rh prophylaxis and in the management of immunized women.
Collapse
|
50
|
Daniels G, Finning K, Martin P, Soothill P. Fetal blood group genotyping from DNA from maternal plasma: an important advance in the management and prevention of haemolytic disease of the fetus and newborn. Vox Sang 2004; 87:225-32. [PMID: 15585017 DOI: 10.1111/j.1423-0410.2004.00569.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The cloning of blood group genes and subsequent identification of the molecular bases of blood group polymorphisms has made it possible to predict blood group phenotypes from DNA with a reasonable degree of accuracy. The major application of this technology, which has now become the standard of care, is the determination of a fetal RHD genotype in women with anti-D, to assess whether the fetus is at risk of haemolytic disease of the fetus and newborn (HDFN). Initially, the procurement of fetal DNA required the invasive procedures of amniocentesis or chorionic villus sampling. Since the discovery of fetal DNA in maternal plasma in 1997, the technology of detecting an RHD gene in this very small quantity of fetal DNA has developed rapidly, so that non-invasive fetal D typing can now be provided as a diagnostic service for D-negative pregnant women with anti-D. Within a few years, it is probable that fetuses of all D-negative pregnant women will be tested for RHD, to establish whether the mother requires antenatal anti-D immunoglobulin prophylaxis.
Collapse
Affiliation(s)
- G Daniels
- International Blood Group Reference Laboratory, Bristol Institute for Transfusion Sciences, National Blood Service, Bristol, UK.
| | | | | | | |
Collapse
|