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Miller AS, Singh TA. Early diagnosis of androgen insensitivity syndrome with cell-free fetal DNA screening: A case report. Int J Gynaecol Obstet 2024; 164:797-798. [PMID: 37922216 DOI: 10.1002/ijgo.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/05/2023]
Abstract
SynopsisNon‐invasive prenatal testing provides an early opportunity to identify patients with genotype–phenotype sex discordance and can be used to screen for complete androgen insensitivity syndrome.
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Affiliation(s)
- Amitai S Miller
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Tara A Singh
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Obstetrics & Gynecology, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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2
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Wang Y, Yin F, Chai Y, Jin J, Zhang P, Tan Q, Chen Z. Prenatal diagnosis of fetuses with ultrasound anomalies by whole-exome sequencing in Luoyang city, China. Front Genet 2024; 14:1301439. [PMID: 38318287 PMCID: PMC10838985 DOI: 10.3389/fgene.2023.1301439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
Background: There is a great obstacle in prenatal diagnosis of fetal anomalies due to their considerable genetic and clinical heterogeneity. Whole-exome sequencing (WES) has been confirmed as a successful option for genetic diagnosis in pediatrics, but its clinical utility for prenatal diagnosis remains to be limited. Methods: A total of 60 fetuses with abnormal ultrasound findings underwent karyotyping or chromosomal microarray analysis (CMA), and those with negative results were further subjected to WES. The identified variants were classified as pathogenic or likely pathogenic (P/LP) and the variant of uncertain significance (VUS). Pregnancy outcomes were obtained through a telephone follow-up. Results: Twelve (20%, 12/60) fetuses were diagnosed to have chromosomal abnormalities using karyotyping or CMA. Of the remaining 48 cases that underwent WES, P/LP variants were identified in 14 cases (29.2%), giving an additional diagnostic yield of 23.3% (14/60). The most frequently affected organ referred for prenatal WES was the head or neck system (40%), followed by the skeletal system (39.1%). In terms of pathogenic genes, FGFR3 was the most common diagnostic gene in this cohort. For the first time, we discovered five P/LP variants involved in SEC24D, FIG4, CTNNA3, EPG5, and PKD2. In addition, we identified three VUSes that had been reported previously. Outcomes of pregnancy were available for 54 cases, of which 24 cases were terminated. Conclusion: The results confirmed that WES is a powerful tool in prenatal diagnosis, especially for fetuses with ultrasonographic anomalies that cannot be diagnosed using conventional prenatal methods. Additionally, newly identified variants will expand the phenotypic spectrum of monogenic disorders and greatly enrich the prenatal diagnostic database.
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Affiliation(s)
- Yanan Wang
- Department of Genetics and Prenatal Diagnosis, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Fan Yin
- Puluo (Wuhan) Medical Biotechnology Co., LTD., Wuhan, China
| | - Yuqiong Chai
- Department of Genetics and Prenatal Diagnosis, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Jiapei Jin
- Department of Genetics and Prenatal Diagnosis, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Pai Zhang
- Department of Genetics and Prenatal Diagnosis, Luoyang Maternal and Child Health Hospital, Luoyang, China
| | - Qianqian Tan
- Puluo (Wuhan) Medical Biotechnology Co., LTD., Wuhan, China
| | - Zhigang Chen
- Puluo (Wuhan) Medical Biotechnology Co., LTD., Wuhan, China
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3
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Cursino KA, Garcia GM, Barros BA, Mazzola TN, Fabbri-Scallet H, Guaragna MS, Vieira TAP, Mello MPD, Maciel-Guerra AT, Guerra-Junior G. Prenatal Findings in Postnatal Cases of Disorders of Sex Development: Experience from a Tertiary-Specialized Center in Brazil. Fetal Diagn Ther 2023; 51:49-54. [PMID: 37793360 DOI: 10.1159/000534401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION AND OBJECTIVE Prenatal suspicion of disorders/differences of sex development (DSDs) is a relatively new phenomenon. The aim of this study was to review the prenatal findings of DSD cases postnatally diagnosed in our tertiary referral center. METHODS We evaluated 57 DSD cases with sex ambiguity who had undergone prenatal ultrasound with phenotypic sex assessment and/or cell-free fetal DNA (cffDNA) for genotypic sex assessment. RESULTS Prenatal cffDNA had been performed in 32 cases, being positive (suggestive of male genotypic sex) in 26 and negative (suggestive of female genotypic sex) in 6. Five with cffDNA negative had a prenatal ultrasound indicating female external genitalia, in turn, in those with cffDNA positive, only two had a prenatal ultrasound indicating male external genitalia. Our postnatal data showed that when external genitalia were female or poorly virilized, prenatal ultrasound indicated female sex, but in cases of higher degree of virilization, ultrasound showed similar rates of male, female, or undetermined sex. Regarding the karyotype, our data showed those with XY karyotype had positive cffDNA, those with XX karyotype had negative cffDNA, and all five with sex chromosome anomalies had positive cffDNA because they were 45,X/46,XY. We suggested an algorithm to investigate these cases during gestation, including evaluation of uterus, fetal growth, and malformations. CONCLUSION We suggest that the parents should be counseled prenatally by a dedicated multidisciplinary team with experience in DSD management and evaluated as soon as possible after birth.
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Affiliation(s)
- Kleber Andrade Cursino
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Guilherme Mantelato Garcia
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Beatriz Amstalden Barros
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Tais Nitsch Mazzola
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Helena Fabbri-Scallet
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Mara Sanches Guaragna
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Tarsis Antonio Paiva Vieira
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Maricilda Palandi de Mello
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Andrea Trevas Maciel-Guerra
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Gil Guerra-Junior
- Interdisciplinary Group for Studies of Sex Determination and Differentiation (GIEDDS), School of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
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4
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Griffin LB, McCarthy M, Russo ML. Navigation of Prenatal Care With Sex Discordance Between Cell-free DNA and Ultrasound Findings. Clin Obstet Gynecol 2023; 66:616-623. [PMID: 37650671 DOI: 10.1097/grf.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The utilization of cell-free DNA (cfDNA) screening has expanded rapidly across the age spectrum of pregnant persons. With cfDNA's widespread adoption, genetic fetal sex is now often known before a phenotypic assessment on anatomic survey. CfDNA detects sex discordance in 1/1500 to 2000 pregnancies. Upon detection of sex discordance, lab error or other factors should first be assessed. Once other causes have been ruled out, this may indicate an underlying disorder/difference in sex development. A multidisciplinary team should coordinate diagnosis, treatment, and support for the family. This review discusses the diagnostic workup, emphasizing the multidisciplinary counseling and management of disorder/differences in sex development.
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Affiliation(s)
- Laurie B Griffin
- Brown University, Warren Alpert School of Medicine, Providence, Rhode Island
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5
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Benn P, Cuckle H. Overview of Noninvasive Prenatal Testing (NIPT) for the Detection of Fetal Chromosome Abnormalities; Differences in Laboratory Methods and Scope of Testing. Clin Obstet Gynecol 2023; 66:536-556. [PMID: 37650667 DOI: 10.1097/grf.0000000000000803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Although nearly all noninvasive prenatal testing is currently based on analyzing circulating maternal cell-free DNA, the technical methods usedvary considerably. We review the different methods. Based on validation trials and clinical experience, there are mostly relatively small differences in screening performance for trisomies 21, 18, and 13 in singleton pregnancies. Recent reports show low no-call rates for all methods, diminishing its importance when choosing a laboratory. However, method can be an important consideration for twin pregnancies, screening for sex chromosome abnormalities, microdeletion syndromes, triploidy, molar pregnancies, rare autosomal trisomies, and segmental imbalances, and detecting maternal chromosome abnormalities.
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Affiliation(s)
- Peter Benn
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut
| | - Howard Cuckle
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tel Aviv University, Israel
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6
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López Soto Á, Bueno González M, Urbano Reyes M, Carlos Moya Jiménez L, Beltrán Sánchez A, Garví Morcillo J, Velasco Martínez M, Luis Meseguer González J, Martínez Rivero I, García Izquierdo O. Imaging in fetal genital anomalies. Eur J Obstet Gynecol Reprod Biol 2023; 283:13-24. [PMID: 36750003 DOI: 10.1016/j.ejogrb.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Genital anomalies are a heterogeneous group of congenital pathologies that have become increasingly relevant since the Chicago Consensus of 2005. Their postnatal diagnosis has developed significantly in the last two decades, while prenatal diagnosis seems to be underdeveloped, with few protocols available, fragmented scientific literature, and low diagnostic rates. This review aims to examine the current status of this subspecialty from the perspective of prenatal imaging. Indications for the evaluation of fetal genitalia can be divided into medical and non-medical reasons. Medical reasons include sex-linked disorders, detection of other anomalies, relevant family history, or multiple pregnancy. Non-medical reasons include parental request for sex disclosure. Disclosure of fetal sex may be associated with ethical, legal, and medical issues. The main imaging technology used is 2D ultrasound, although there are other complementary techniques such as 3D, MRI, or Color Doppler. Regarding working methodology, several authors have drawn attention to the lack of standardized protocols and guidelines. Most guidelines tend to limit their recommendations to study indications and ethical issues. Technical proposals, measurements, or working methods have not yet been standardized. Fetal sex determination is usually divided into early and late gestation. Early gestation is based on the sagittal sign. Late gestation is based on direct visualization. There are several measurements to describe male and female genitalia, such as penile length, bilabial diameter, or scrotal diameter. Prenatal diagnosis of genital pathologies presents some particularities such as the wide spectrum of phenotypes, the high frequency of associated deformities, or the time of diagnosis. Some of the most frequent pathologies are ambiguous genitalia, fetal sex discordance, hypospadias, micropenis, clitoromegaly, ovarian cysts, hydro(metro)colpos, and cloacal anomalies. Higher-quality studies and direction from scientific societies through the implementation of clinical guidelines are needed.
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Affiliation(s)
- Álvaro López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain.
| | | | - Maribel Urbano Reyes
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
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7
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Maher JY, Gomez-Lobo V, Merke DP. The management of congenital adrenal hyperplasia during preconception, pregnancy, and postpartum. Rev Endocr Metab Disord 2023; 24:71-83. [PMID: 36399318 PMCID: PMC9884653 DOI: 10.1007/s11154-022-09770-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 11/21/2022]
Abstract
Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders of steroidogenesis of the adrenal cortex, most commonly due to 21-hydroxylase deficiency caused by mutations in the CYP21A2 gene. Although women with CAH have decreased fecundity, they are able to conceive; thus, if pregnancy is not desired, contraception options should be offered. If fertility is desired, women with classic CAH should first optimize glucocorticoid treatment, followed by ovulation induction medications and gonadotropins if needed. Due to the possible pregnancy complications and implications on the offspring, preconception genetic testing and counseling with a high-risk obstetrics specialist is recommended. For couples trying to avoid having a child with CAH, care with a reproductive endocrinology and infertility specialist to utilize in vitro fertilization can be offered, with or without preimplantation genetic testing for monogenic disorders. Prenatal screening and diagnosis options during pregnancy include maternal serum cell free-DNA for sex of the baby, and chorionic villus sampling and amniocentesis for diagnosis of CAH. Pregnant women with classic CAH need glucocorticoids to be adjusted during the pregnancy, at the time of delivery, and postpartum, and should be monitored for adrenal crisis. Maternal and fetal risks may include chorioamnionitis, maternal hypertension, gestational diabetes, cesarean section, and small for gestational age infants. This review on CAH due to 21-hydroxylase deficiency highlights reproductive health including genetic transmission, contraception options, glucocorticoid management, fertility treatments, as well as testing, antenatal monitoring, and management during pregnancy, delivery, and postpartum.
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Affiliation(s)
- Jacqueline Yano Maher
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Staff Clinician, 10 Central Drive, Room 8N248, Bethesda, MD, 20892, USA
| | - Veronica Gomez-Lobo
- Director of Pediatric and Adolescent Gynecology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 10 Central Drive, Room 8N248, Bethesda, MD, 20892, USA
| | - Deborah P Merke
- National Institutes of Health Clinical Center and Eunice Kennedy Shriver National Institute of Child Health and Human Development, 10 Central Drive, Room 1-2740, Bethesda, MD, 20892, USA.
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8
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Grati FR, Bestetti I, De Siero D, Malvestiti F, Villa N, Sala E, Crosti F, Parisi V, Nardone AM, Di Giacomo G, Pettinari A, Tortora G, Montaldi A, Calò A, Saccilotto D, Zanchetti S, Celli P, Guerneri S, Silipigni R, Cardarelli L, Lippi E, Cavani S, Malacarne M, Genesio R, Beltrami N, Pittalis MC, Desiderio L, Gentile M, Ficarella R, Recalcati MP, Catusi I, Garzo M, Miele L, Corti C, Ghezzo S, Bertini V, Cambi F, Valetto A, Facchinetti B, Bernardini L, Capalbo A, Balducci F, Pelo E, Minuti B, Pescucci C, Giuliani C, Renieri A, Longo I, Tita R, Castello G, Casalone R, Righi R, Raso B, Civolani A, Muzi MC, di Natale M, Varriale L, Gasperini D, Nuzzi MC, Cellamare A, Casieri P, Busuito R, Ceccarini C, Cesarano C, Privitera O, Melani D, Menozzi C, Falcinelli C, Calabrese O, Battaglia P, Tanzariello A, Stampalija T, Ardisia C, Gasparini P, Benn P, Novelli A. Positive predictive values and outcomes for uninformative cell-free DNA tests: An Italian multicentric Cytogenetic and cytogenomic Audit of diagnOstic testing (ICARO study). Prenat Diagn 2022; 42:1575-1586. [PMID: 36403097 DOI: 10.1002/pd.6271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/10/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To establish the positive predictive values (PPV) of cfDNA testing based on data from a nationwide survey of independent clinical cytogenetics laboratories. METHODS Prenatal diagnostic test results obtained by Italian laboratories between 2013 and March 2020 were compiled for women with positive non-invasive prenatal tests (NIPT), without an NIPT result, and cases where there was sex discordancy between the NIPT and ultrasound. PPV and other summary data were reviewed. RESULTS Diagnostic test results were collected for 1327 women with a positive NIPT. The highest PPVs were for Trisomy (T) 21 (624/671, 93%) and XYY (26/27, 96.3%), while rare autosomal trisomies (9/47, 19.1%) and recurrent microdeletions (8/55, 14.5%) had the lowest PPVs. PPVs for T21, T18, and T13 were significantly higher when diagnostic confirmation was carried out on chorionic villi (97.5%) compared to amniotic fluid (89.5%) (p < 0.001). In 19/139 (13.9%), of no result cases, a cytogenetic abnormality was detected. Follow-up genetic testing provided explanations for 3/6 cases with a fetal sex discordancy between NIPT and ultrasound. CONCLUSIONS NIPT PPVs differ across the conditions screened and the tissues studied in diagnostic testing. This variability, issues associated with fetal sex discordancy, and no results, illustrate the importance of pre- and post-test counselling.
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Affiliation(s)
- Francesca Romana Grati
- R&D, Cytogenetics, Molecular Genetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A, Busto Arsizio, Italy
| | - Ilaria Bestetti
- Laboratorio di Genetica Medica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy.,Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Daria De Siero
- R&D, Cytogenetics, Molecular Genetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A, Busto Arsizio, Italy
| | - Francesca Malvestiti
- R&D, Cytogenetics, Molecular Genetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A, Busto Arsizio, Italy
| | - Nicoletta Villa
- UOS Citogenetica e Genetica Medica - ASST-Monza, Ospedale San Gerardo, Università di Milano-Bicocca, Monza, Italy
| | - Elena Sala
- UOS Citogenetica e Genetica Medica - ASST-Monza, Ospedale San Gerardo, Università di Milano-Bicocca, Monza, Italy
| | - Francesca Crosti
- UOS Citogenetica e Genetica Medica - ASST-Monza, Ospedale San Gerardo, Università di Milano-Bicocca, Monza, Italy
| | - Valentina Parisi
- U.O.C. Laboratorio di Genetica Medica, Ospedale Pediatrico del Bambino Gesù, IRCCS, Roma, Italy
| | - Anna Maria Nardone
- U.O.C. Laboratorio di Genetica Medica, Policlinico Tor Vergata, Roma, Italy
| | | | - Antonella Pettinari
- SOSD Malattie Rare e Citogenetica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | - Giada Tortora
- SOSD Malattie Rare e Citogenetica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
| | | | - Annapaola Calò
- U.O.S. Laboratorio di Genetica, AULSS8 Berica, Vicenza, Italy
| | | | - Sara Zanchetti
- U.O.S. Laboratorio di Genetica, AULSS8 Berica, Vicenza, Italy
| | - Paola Celli
- U.O.S. Laboratorio di Genetica, AULSS8 Berica, Vicenza, Italy
| | - Silvana Guerneri
- Laboratorio di Genetica Medica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Rosamaria Silipigni
- Laboratorio di Genetica Medica, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Laura Cardarelli
- Laboratorio di Genetica medica, Lifebrain, Gruppo Cerba HealthCare, c/o RDI, Rete Diagnostica Italiana, Limena, Italy
| | - Elisabetta Lippi
- Laboratorio di Genetica medica, Lifebrain, Gruppo Cerba HealthCare, c/o RDI, Rete Diagnostica Italiana, Limena, Italy
| | - Simona Cavani
- U.O.C. Laboratorio di Genetica Umana, IRCCS G. Gaslini, Genova, Italy
| | - Michela Malacarne
- U.O.C. Laboratorio di Genetica Umana, IRCCS G. Gaslini, Genova, Italy
| | - Rita Genesio
- DAI medicina di laboratorio e trasfusionale AOU Federico II, Napoli, Italy
| | | | - Maria Carla Pittalis
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Laura Desiderio
- IRCCS Azienda Ospedaliero Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Mattia Gentile
- Dipartimento di Medicina della Riproduzione, UOC Genetica Medica, ASL BARI, Bari, Italy
| | - Romina Ficarella
- Dipartimento di Medicina della Riproduzione, UOC Genetica Medica, ASL BARI, Bari, Italy
| | - Maria Paola Recalcati
- Laboratorio di Citogenetica e Genetica Molecolare, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Ilaria Catusi
- Laboratorio di Citogenetica e Genetica Molecolare, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | - Maria Garzo
- Laboratorio di Citogenetica e Genetica Molecolare, Istituto Auxologico Italiano, IRCCS, Milano, Italy
| | | | | | - Sara Ghezzo
- Laboratorio di Citogenetica - U.O.C. Genetica Medica, Centro Servizi Pievesestina - Laboratorio Unico, AUSL ROMAGNA, Cesena, Italy
| | - Veronica Bertini
- SOD Citogenetica, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Francesca Cambi
- SOD Citogenetica, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Angelo Valetto
- SOD Citogenetica, Azienda Ospedaliero Universitaria Pisana (AOUP), Pisa, Italy
| | - Barbara Facchinetti
- UOSD SMeL 4 Citogenetica e Genetica Medica, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Bernardini
- Medical Genetics Division, IRCCS Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - Anna Capalbo
- Medical Genetics Division, IRCCS Casa Sollievo della Sofferenza Foundation, San Giovanni Rotondo, Italy
| | - Federica Balducci
- TECNOBIOS PRENATALE EUROGENLAB - Gruppo LIFE BRAIN Emilia-Romagna, Bologna, Italy
| | | | | | | | | | - Alessandra Renieri
- Medical Genetics, University of Siena, Siena, Italy.,Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Ilaria Longo
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Rossella Tita
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Giuseppe Castello
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Rosario Casalone
- SSD SMeL Citogenetica e Genetica Medica, ASST dei Settelaghi, Varese, Italy
| | - Rossana Righi
- SSD SMeL Citogenetica e Genetica Medica, ASST dei Settelaghi, Varese, Italy
| | - Barbara Raso
- ASL ROMA 1, Centro S.Anna, Dipartimento dei Laboratori, U.O.S.D. di Genetica medica, Roma, Italy
| | - Alessandro Civolani
- ASL ROMA 1, Centro S.Anna, Dipartimento dei Laboratori, U.O.S.D. di Genetica medica, Roma, Italy
| | - Maria Cristina Muzi
- ASL ROMA 1, Centro S.Anna, Dipartimento dei Laboratori, U.O.S.D. di Genetica medica, Roma, Italy
| | - Manuela di Natale
- ASL ROMA 1, Centro S.Anna, Dipartimento dei Laboratori, U.O.S.D. di Genetica medica, Roma, Italy
| | - Luigia Varriale
- UOSD Diagnostica Alta Complessità, Settore Genetica, Azienda Ospedaliera Ospedali Riuniti Marche Nord-Pesaro, Nord-Pesaro, Italy
| | - Daniela Gasperini
- Laboratorio Genetica e Genomica, Ospedale Microcitemico A.Cao, ARNAS Brotzu Cagliari, Cagliari, Italy
| | - Maria Cristina Nuzzi
- UOC Patologia Clinica - Sezione di Genetica Medica, Ospedale SS. Annunziata Taranto - ASL TARANTO, Taranto, Italy
| | - Angelo Cellamare
- UOC Patologia Clinica - Sezione di Genetica Medica, Ospedale SS. Annunziata Taranto - ASL TARANTO, Taranto, Italy
| | - Paola Casieri
- UOC Patologia Clinica - Sezione di Genetica Medica, Ospedale SS. Annunziata Taranto - ASL TARANTO, Taranto, Italy
| | - Rosa Busuito
- Laboratorio di Genetica Molecolare e Citogenetica - Sezione di Citogenetica, UOC Laboratorio Analisi - ASST Ovest Milanese, Legnano, Italy
| | | | - Carla Cesarano
- U.O.C Genetica Medica, Policlinico Riuniti Foggia, Foggia, Italy
| | - Orsola Privitera
- SOS Genetica e Diagnostica di Laboratorio, Azienda USL Toscana Centro, Presidio Ospedale S. Stefano, Prato, Italy
| | - Daniela Melani
- SOS Genetica e Diagnostica di Laboratorio, Azienda USL Toscana Centro, Presidio Ospedale S. Stefano, Prato, Italy
| | - Cristina Menozzi
- SSD Genetica Medica, Dipartimento Materno Infantile, AOU Policlinico Modena, Modena, Italy
| | - Cristina Falcinelli
- SSD Genetica Medica, Dipartimento Materno Infantile, AOU Policlinico Modena, Modena, Italy
| | - Olga Calabrese
- SSD Genetica Medica, Dipartimento Materno Infantile, AOU Policlinico Modena, Modena, Italy
| | - Paola Battaglia
- Laboratorio di Genetica, UOC Genetica Medica, AUSL Imola, Imola, Italy
| | | | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.,Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Carmela Ardisia
- Genetica Medica IRCCS Ospedale "Burlo Garofolo", Trieste, Italy
| | - Paolo Gasparini
- Genetica Medica IRCCS Ospedale "Burlo Garofolo", Trieste, Italy
| | - Peter Benn
- Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Antonio Novelli
- U.O.C. Laboratorio di Genetica Medica, Ospedale Pediatrico del Bambino Gesù, IRCCS, Roma, Italy
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9
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Sepulveda W, Seiltgens C, Betancourt E, Mangiamarchi M. Fetal Genotype-Phenotype Sex Discordance: A Case of 5-Alpha-Reductase Deficiency. Fetal Pediatr Pathol 2022; 41:794-799. [PMID: 34251982 DOI: 10.1080/15513815.2021.1948645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe the prenatal and postnatal diagnostic workup leading to the diagnosis of 5-alpha-reductase type 2 deficiency (5AR2D) in a case of 46,XY disorder of sex development (DSD). CASE REPORT A first-trimester noninvasive prenatal test (NIPT) on maternal blood revealed a male fetus with a low risk of aneuploidy. However, a female fetus was identified at the second-trimester scan. A repeat sample revealed similar results and ruled out the possibility of both a sample swap or a vanishing twin. At birth, phenotypically female external genitalia were evident, with testes noted in the labioscrotal area. Neonatal blood confirmed a 46,XY complement and a 46,XY DSD genetic panel revealed a 5AR2D. CONCLUSION Our case and others described in the literature demonstrate that fetal sex discordance detected by a combination of NIPT and subsequent ultrasound examination can be associated with several biological conditions, with DSD being the most significant.
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Affiliation(s)
| | | | - Eduardo Betancourt
- Department of Obstetrics and Gynecology, Clinica INDISA, Santiago, Chile
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10
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Burch JL, Stanley TL. A Neonate with Unexpected External Genitalia at Birth. Neoreviews 2022; 23:e653-e657. [PMID: 36047755 DOI: 10.1542/neo.23-9-e653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Juniper Lyra Burch
- Cambridge Health Alliance and Beth Israel Lahey Health Center, Cambridge, MA
| | - Takara L Stanley
- Pediatric Endocrinology, Massachusetts General Hospital for Children, Boston, MA
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11
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Clinical spectrum of female genital malformations in prenatal diagnosis. Arch Gynecol Obstet 2022; 306:1847-1862. [DOI: 10.1007/s00404-022-06441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Introduction
Fetal genital malformations represent a rare and heterogeneous group of congenital malformations of the disorders of sexual development (DSD) spectrum.
Methods
A thorough literature review on the main topics in the prenatal approach towards DSD was conducted.
Results
First, a thorough overview on prenatal characteristics of the most common fetal genital malformations of ovaries, uterus and external genitalia, and second, a standardized approach for differential diagnosis in the presence of direct and indirect prenatal signs of DSDs.
Conclusions
This review is mainly directed towards the aspects of female genital malformations with aspects of male DSD explained as well to aid in the prenatal differential diagnosis.
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12
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Zhytnik L, Peters M, Tilk K, Reimand T, Ilisson P, Kahre T, Murumets Ü, Ehrenberg A, Ustav EL, Tõnisson N, Mölder S, Teder H, Krjutškov K, Salumets A. Prenatal diagnosis of a 46,XY karyotype female fetus with an SRY-associated gonadal dysgenesis, conceived through an intracytoplasmic sperm injection: a case report. BMC Pregnancy Childbirth 2022; 22:105. [PMID: 35123446 PMCID: PMC8818175 DOI: 10.1186/s12884-022-04431-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Abstract
Background Permanent progression of paternal age and development of reproductive medicine lead to increase in number of children conceived with assisted reproductive techniques (ART). Although it is uncertain if ARTs have direct influence on offspring health, advanced paternal age, associated comorbidities and reduced fertility possess significant risks of genetic disorders to the offspring. With a broad implementation of a non-invasive prenatal testing (NIPT), more cases of genetic disorders, including sex discordance are revealed. Among biological causes of sex discordance are disorders of sexual development, majority of which are associated with the SRY gene. Case presentation We report a case of a non-invasive prenatal testing and ultrasound sex discordance in a 46,XY karyotype female fetus with an SRY pathogenic variant, who was conceived through an intracytoplasmic sperm injection (ICSI) due to severe oligozoospermia of the father. Advanced mean age of ICSI patients is associated with risk of de novo mutations and monogenic disorders in the offspring. Additionally, ICSI patients have higher risk to harbour infertility-predisposing mutations, including mutations in the SRY gene. These familial and de novo genetic factors predispose ICSI-conceived children to congenital malformations and might negatively affect reproductive health of ICSI-patients’ offspring. Conclusions Oligozoospermic patients planning assisted reproduction are warranted to undergo genetic counselling and testing for possible inherited and mosaic mutations, and risk factors for de novo mutations.
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13
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O'Connell MA, Atlas G, Ayers K, Sinclair A. Establishing a molecular genetic diagnosis in children with Differences of Sex Development - a clinical approach. Horm Res Paediatr 2021; 96:128-143. [PMID: 34781289 DOI: 10.1159/000520926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Despite distinct underlying aetiologies, the clinical phenotypes and hormonal profiles of children with various differences of sex development (DSD) are often similar, which presents challenges to ascertaining an accurate diagnosis on clinical grounds alone. Associated features and important clinical outcomes can, however, vary significantly in different DSD, thus establishing an accurate molecular diagnosis may have important implications for decision-making and management planning in a given individual. Summary The wider availability of next generation sequencing techniques in recent years has led to recommendations for earlier integration of genetic testing in the diagnostic pathway of children with DSD. This review provides a practical overview of the clinical applications, advantages and limitations of the more commonly available diagnostic genetic tests and outlines a suggested approach to testing. The potential clinical implications of a confirmed genetic diagnosis on subsequent management pathways for individuals with DSD, as well as challenges that remain to be addressed are also outlined. Key messages Despite significant improvements in our understanding of the complex genetic pathways that underlie DSD, an accurate diagnosis still eludes many affected individuals. Establishing a molecular diagnosis provides aetiological certainty, enabling improved information for families and individualised clinical management, including monitoring or prophylactic intervention where higher longer-term health risks exist. A stepwise approach to genomic testing is recommended to afford highest diagnostic yield from available resources. Looking forward, collaborative multicentre prospective studies will be required to assess the true impact of a genetic diagnosis on improving clinical care pathways and health, wellbeing and patient-reported outcomes for individuals with DSD.
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14
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Délot EC, Vilain E. Towards improved genetic diagnosis of human differences of sex development. Nat Rev Genet 2021; 22:588-602. [PMID: 34083777 PMCID: PMC10598994 DOI: 10.1038/s41576-021-00365-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 02/05/2023]
Abstract
Despite being collectively among the most frequent congenital developmental conditions worldwide, differences of sex development (DSD) lack recognition and research funding. As a result, what constitutes optimal management remains uncertain. Identification of the individual conditions under the DSD umbrella is challenging and molecular genetic diagnosis is frequently not achieved, which has psychosocial and health-related repercussions for patients and their families. New genomic approaches have the potential to resolve this impasse through better detection of protein-coding variants and ascertainment of under-recognized aetiology, such as mosaic, structural, non-coding or epigenetic variants. Ultimately, it is hoped that better outcomes data, improved understanding of the molecular causes and greater public awareness will bring an end to the stigma often associated with DSD.
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Affiliation(s)
- Emmanuèle C Délot
- Center for Genetic Medicine Research, Children's Research Institute, Children's National Hospital, Washington, DC, USA
- Department of Genomics and Precision Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Eric Vilain
- Center for Genetic Medicine Research, Children's Research Institute, Children's National Hospital, Washington, DC, USA.
- Department of Genomics and Precision Medicine, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
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15
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Kudze T, Wheeler C. Common pediatric gynecological issues: a review. Curr Opin Obstet Gynecol 2021; 33:350-354. [PMID: 34054101 DOI: 10.1097/gco.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW To provide clinicians with a review of recent research and methods for evaluation of common pediatric gynecology complaints and problems. RECENT FINDINGS The examination and history of a pediatric gynecologic patient involve information gathering in order to limit anxiety for the child and optimize the ability to diagnose and treat her. Child abuse recognition is increasing, and its management requires special expertise. The early management of disorders of sexual development (DSDs) has changed with a focus towards early identification and consideration of delayed surgical management. The multidisciplinary evaluation and management of the pelvic mass in the child involves careful preoperative evaluation to allow for conservative management. SUMMARY Reproductive endocrinology and infertility (REI) providers are often called upon to evaluate children when a pediatric gynecologist is not immediately available. This review highlights valuable information for adult gynecologic providers who may encounter young girls with gynecologic issues in a variety of settings. Having some basic knowledge of the evaluation and management will allow the provider to either manage the child themselves or triage her to the appropriate consultant.
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Affiliation(s)
| | - Carol Wheeler
- Department of Obstetrics and Gynecology
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island in Providence, Rhode Island, USA
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16
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Deng C, Cheung SW, Liu H. Noninvasive prenatal screening for fetal sex chromosome aneuploidies. Expert Rev Mol Diagn 2021; 21:405-415. [PMID: 33787433 DOI: 10.1080/14737159.2021.1911651] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Sex chromosome aneuploidies (SCAs) are among the most common chromosome abnormalities observed in humans. Manifestations include low fertility, infertility, delayed language development, and dysfunction in motor development. Noninvasive prenatal screening (NIPS) based on cell-free fetal DNA from the peripheral blood of pregnant women is increasingly used for the screening of fetal chromosome abnormalities, including screening for fetal gender and fetal sex chromosome aneuploidy. A systematic review of the literature about NIPS for SCAs is needed. AREAS COVERED This review evaluated a vast array of published studies focusing on the clinical significance, detection methods, performance of NIPS for SCAs, and the management of positive SCA results following screening with the aim of facilitating a comprehensive and systematic understanding of NIPS for SCAs. EXPERT COMMENTARY Looking forward, NIPS is expected to become the primary screening test for common aneuploidies as well as other chromosome abnormalities, including some micro-deletions and micro-duplications, with the potential to transition from a screening test to a prenatal diagnosis method. Ultimately, the goal is to provide a safe and accurate method for increasing early diagnosis to improve long-term outcomes for the SCA patients and families by well- informed health care providers.
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Affiliation(s)
- Cechuan Deng
- Medical Genetics Department/Prenatal Diagnostic Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Sau Wai Cheung
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Hongqian Liu
- Medical Genetics Department/Prenatal Diagnostic Center, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
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17
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Balaguer N, Mateu-Brull E, Naja RP, Nagi JB, Milán M. Chromosome Y as a marker for sex discrepancies in patients with organ transplants: a case report. Mol Cytogenet 2021; 14:3. [PMID: 33407713 PMCID: PMC7789569 DOI: 10.1186/s13039-020-00523-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022] Open
Abstract
Background Organ transplantations cause discrepancy in results from cell-free DNA (cfDNA) testing, but scientific literature is scarce. Case A 33-year old gravida underwent cfDNA testing, which showed high levels of Y chromosome (ChrY) in the maternal bloodstream. The ChrY pattern was comparable to an adult male reference. As a result, cfDNA testing was only informative for autosomes. Routine 20-week ultrasound scan showed no structural alterations and the presence of female external genitalia. Post-clinical research revealed that the patient received a bone marrow transplant from a male donor several years before. Fluorescence in situ hybridization showed that 100% of nuclei analysed from the patient’s lymphocytes presented a ChrY. Conclusion This case demonstrates ChrY can be used as a marker to avoid sex discrepancies in certain patients with organ transplants.
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Affiliation(s)
- Nuria Balaguer
- Igenomix Spain Lab S.L.U. Parque tecnológico, Ronda Narciso Monturiol, 11B. Edificios Europark, CP: 46980, Paterna, Valencia, Spain
| | - Emilia Mateu-Brull
- Igenomix Spain Lab S.L.U. Parque tecnológico, Ronda Narciso Monturiol, 11B. Edificios Europark, CP: 46980, Paterna, Valencia, Spain
| | - Roy P Naja
- Igenomix UK Ltd, Surrey Technology Centre, Guildford, UK
| | - Jara B Nagi
- The Centre for Reproductive & Genetic Health, London, UK
| | - Miguel Milán
- Igenomix Spain Lab S.L.U. Parque tecnológico, Ronda Narciso Monturiol, 11B. Edificios Europark, CP: 46980, Paterna, Valencia, Spain.
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