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Abstract
Remarkable changes are occurring in the diagnosis and management of individuals with hemophilia A. Genetic testing, including next-generation sequencing, enables family planning, carrier testing, and prenatal diagnosis. Musculoskeletal ultrasound examination facilitates the early detection of acute bleeds and joint disease in clinic, enabling more rapid bleed resolution and treatment planning. Novel therapies offer simpler weekly or monthly administration, some by subcutaneous injection, with better compliance and quality of life, as well as fewer bleeds. Gene therapy provides a 1-time phenotypic "cure" that is cost effective, but may be complicated by waning levels, vector immune responses, and hepatotoxicity.
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Comegna M, Maruotti GM, Sarno L, Cernera G, Gelzo M, Guida M, Zullo F, Zarrilli F, Castaldo G. Prenatal Diagnosis of Cystic Fibrosis and Hemophilia: Incidental Findings and Weak Points. Diagnostics (Basel) 2019; 10:diagnostics10010007. [PMID: 31877800 PMCID: PMC7168058 DOI: 10.3390/diagnostics10010007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/16/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022] Open
Abstract
Because of the progression of genetics and genomics, the demand for prenatal diagnosis (PD) for inherited genetic diseases has increased. However, several incidental findings may emerge during PD, like misattributed paternity, the evidence of disease in a parent, and the possible misinterpretation of the results because of complex alleles or de novo mutations that have several implications. In a retrospective observational study on all the couples referred to our Medical School (1993–2018) for PD of genetic inherited diseases (n = 1502), we selected the cases of PD for cystic fibrosis (CF, n = 239) and hemophilia A and B (HA, HB, n = 47), revising all incidental findings previously mentioned. We found one case in which a technical error led to PD of carrier in two siblings that were born affected by CF, four cases of misattributed paternity, eight cases of asymptomatic parents revealed as affected by CF transmembrane regulator (CFTR)-related disorders, a case of a novel complex allele that could have caused the diagnosis of CF in a carrier fetus, and a case of a de novo mutation in a mother (already a carrier) that caused hemophilia in a child that PD had revealed as healthy. We present these conditions as clinical cases and discuss the technical, clinical, ethical, and legal aspects to be considered.
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Affiliation(s)
- Marika Comegna
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.C.); (G.C.); (M.G.); (G.C.)
- CEINGE-Advanced Biotechnology, Via G. Salvatore 486, 80145 Naples, Italy
| | - Giuseppe Maria Maruotti
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy (L.S.); (M.G.)
| | - Laura Sarno
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy (L.S.); (M.G.)
| | - Gustavo Cernera
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.C.); (G.C.); (M.G.); (G.C.)
- CEINGE-Advanced Biotechnology, Via G. Salvatore 486, 80145 Naples, Italy
| | - Monica Gelzo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.C.); (G.C.); (M.G.); (G.C.)
- CEINGE-Advanced Biotechnology, Via G. Salvatore 486, 80145 Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy (L.S.); (M.G.)
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy (L.S.); (M.G.)
| | - Federica Zarrilli
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.C.); (G.C.); (M.G.); (G.C.)
- CEINGE-Advanced Biotechnology, Via G. Salvatore 486, 80145 Naples, Italy
- Correspondence:
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Via S. Pansini 5, 80131 Naples, Italy; (M.C.); (G.C.); (M.G.); (G.C.)
- CEINGE-Advanced Biotechnology, Via G. Salvatore 486, 80145 Naples, Italy
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Shanbhag S, Ghosh K, Shetty S. Somatic mosaicism in a severe haemophilia B family detected by allele specific PCR: An alert to the genetic diagnostic laboratories. Thromb Res 2017; 158:138-139. [DOI: 10.1016/j.thromres.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/24/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
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Maruotti GM, Frisso G, Calcagno G, Fortunato G, Castaldo G, Martinelli P, Sacchetti L, Salvatore F. Prenatal diagnosis of inherited diseases: 20 years’ experience of an Italian Regional Reference Centre. Clin Chem Lab Med 2013; 51:2211-7. [DOI: 10.1515/cclm-2013-0194] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/08/2013] [Indexed: 11/15/2022]
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