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Fortin O, Mulkey SB, Fraser JL. Advancing fetal diagnosis and prognostication using comprehensive prenatal phenotyping and genetic testing. Pediatr Res 2024:10.1038/s41390-024-03343-9. [PMID: 38937640 DOI: 10.1038/s41390-024-03343-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/14/2024] [Accepted: 06/04/2024] [Indexed: 06/29/2024]
Abstract
Prenatal diagnoses of congenital malformations have increased significantly in recent years with use of high-resolution prenatal imaging. Despite more precise radiological diagnoses, discussions with expectant parents remain challenging because congenital malformations are associated with a wide spectrum of outcomes. Comprehensive prenatal genetic testing has become an essential tool that improves the accuracy of prognostication. Testing strategies include chromosomal microarray, exome sequencing, and genome sequencing. The diagnostic yield varies depending on the specific malformations, severity of the abnormalities, and multi-organ involvement. The utility of prenatal genetic diagnosis includes increased diagnostic clarity for clinicians and families, informed pregnancy decision-making, neonatal care planning, and reproductive planning. Turnaround time for results of comprehensive genetic testing remains a barrier, especially for parents that are decision-making, although this has improved over time. Uncertainty inherent to many genetic testing results is a challenge. Appropriate genetic counseling is essential for parents to understand the diagnosis and prognosis and to make informed decisions. Recent research has investigated the yield of exome or genome sequencing in structurally normal fetuses, both with non-invasive screening methods and invasive diagnostic testing; the prenatal diagnostic community must evaluate and analyze the significant ethical considerations associated with this practice prior to generalizing its use. IMPACT: Reviews available genetic testing options during the prenatal period in detail. Discusses the impact of prenatal genetic testing on care using case-based examples. Consolidates the current literature on the yield of genetic testing for prenatal diagnosis of congenital malformations.
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Affiliation(s)
- Olivier Fortin
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
| | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA
- Department of Neurology and Rehabilitation Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jamie L Fraser
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington, DC, USA.
- Rare Disease Institute, Children's National Hospital, Washington, DC, USA.
- Center for Genetic Medicine Research, Children's National Hospital, Washington, DC, USA.
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Favier M, Dard R, Gorincour G, Tessier A, Motte-Signoret E, Duvillier C, Racine C, Faivre L, Thauvin-Robinet C, Mau-Them FT. Discovery of pathogenic variants in EFEMP2 and RAG1 and undetectable fetal phenotype: A challenge of prenatal exome sequencing. Prenat Diagn 2024. [PMID: 38923535 DOI: 10.1002/pd.6629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Exome sequencing in prenatal context confronts with pathogenic variants associated with phenotypes that are not detectable prenatally. MATERIALS AND METHODS A consanguineous couple was referred at 24 weeks of gestation for prenatal genetic investigations after ultrasonography findings including decreased fetal movements, hypoplastic male external genitalia, retrognathia, prefrontal edema, anomalies of the great vessels with pulmonary atresia and dilated tortuous aorta. RESULT Prenatal trio exome sequencing identified two homozygous likely pathogenic variants, i.e. a missense in EFEMP2 involved in cutis laxa and a nonsense in RAG1 involved in several types of severe combined immunodeficiency. DISCUSSION The fetal ultrasonographic phenotype was partially compatible with previously reported prenatal presentations secondary to EFEMP2 biallelic variants, but prenatal presentations have never been reported for RAG1 related disorders because the RAG1 phenotype is undetectable during pregnancy. CONCLUSION Both EFEMP2 and RAG1 variants were disclosed to the couple because the EFEMP2 variant was considered causative for the fetal ultrasonographic phenotype and the RAG1 variant was considered a finding of strong interest for genetic counselling and monitoring of future pregnancies following the American College of Medical Genetics and Genomics recommendations about the discovery of incidental findings in fetal exome sequencing in prenatal diagnosis.
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Affiliation(s)
- Maud Favier
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- SoFFoet - Société Française de Foetopathologie, Paris, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes Malformatifs, FHU-TRANSLAD, Dijon, France
| | - Rodolph Dard
- Centre Pluridisciplinaire de diagnostic Prénatal, Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Guillaume Gorincour
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, Marseille, France
| | - Aude Tessier
- SoFFoet - Société Française de Foetopathologie, Paris, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes Malformatifs, FHU-TRANSLAD, Dijon, France
- Centre Pluridisciplinaire de diagnostic Prénatal, Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Emmanuelle Motte-Signoret
- Unité de Réanimation Néonatale, Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Clemence Duvillier
- Centre Pluridisciplinaire de diagnostic Prénatal, Centre Hospitalier Intercommunal Poissy/Saint-Germain-en-Laye, Poissy, France
| | - Caroline Racine
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- SoFFoet - Société Française de Foetopathologie, Paris, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes Malformatifs, FHU-TRANSLAD, Dijon, France
| | - Laurence Faivre
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- SoFFoet - Société Française de Foetopathologie, Paris, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes Malformatifs, FHU-TRANSLAD, Dijon, France
| | - Christel Thauvin-Robinet
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- SoFFoet - Société Française de Foetopathologie, Paris, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes Malformatifs, FHU-TRANSLAD, Dijon, France
| | - Frédéric Tran Mau-Them
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- SoFFoet - Société Française de Foetopathologie, Paris, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes Malformatifs, FHU-TRANSLAD, Dijon, France
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Margiotti K, Fabiani M, Cima A, Libotte F, Mesoraca A, Giorlandino C. Prenatal Diagnosis by Trio Clinical Exome Sequencing: Single Center Experience. Curr Issues Mol Biol 2024; 46:3209-3217. [PMID: 38666931 PMCID: PMC11048976 DOI: 10.3390/cimb46040201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Fetal anomalies, characterized by structural or functional abnormalities occurring during intrauterine life, pose a significant medical challenge, with a notable prevalence, affecting approximately 2-3% of live births and 20% of spontaneous miscarriages. This study aims to identify the genetic cause of ultrasound anomalies through clinical exome sequencing (CES) analysis. The focus is on utilizing CES analysis in a trio setting, involving the fetuses and both parents. To achieve this objective, prenatal trio clinical exome sequencing was conducted in 51 fetuseses exhibiting ultrasound anomalies with previously negative results from chromosomal microarray (CMA) analysis. The study revealed pathogenic variants in 24% of the analyzed cases (12 out of 51). It is worth noting that the findings include de novo variants in 50% of cases and the transmission of causative variants from asymptomatic parents in 50% of cases. Trio clinical exome sequencing stands out as a crucial tool in advancing prenatal diagnostics, surpassing the effectiveness of relying solely on chromosomal microarray analysis. This underscores its potential to become a routine diagnostic standard in prenatal care, particularly for cases involving ultrasound anomalies.
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Affiliation(s)
- Katia Margiotti
- Human Genetics Lab, Altamedica Main Centre, Viale Liegi 45, 00198 Rome, Italy; (M.F.); (A.C.); (F.L.); (A.M.); (C.G.)
| | - Marco Fabiani
- Human Genetics Lab, Altamedica Main Centre, Viale Liegi 45, 00198 Rome, Italy; (M.F.); (A.C.); (F.L.); (A.M.); (C.G.)
| | - Antonella Cima
- Human Genetics Lab, Altamedica Main Centre, Viale Liegi 45, 00198 Rome, Italy; (M.F.); (A.C.); (F.L.); (A.M.); (C.G.)
| | - Francesco Libotte
- Human Genetics Lab, Altamedica Main Centre, Viale Liegi 45, 00198 Rome, Italy; (M.F.); (A.C.); (F.L.); (A.M.); (C.G.)
| | - Alvaro Mesoraca
- Human Genetics Lab, Altamedica Main Centre, Viale Liegi 45, 00198 Rome, Italy; (M.F.); (A.C.); (F.L.); (A.M.); (C.G.)
| | - Claudio Giorlandino
- Human Genetics Lab, Altamedica Main Centre, Viale Liegi 45, 00198 Rome, Italy; (M.F.); (A.C.); (F.L.); (A.M.); (C.G.)
- Fetal-Maternal Medical Centre, Altamedica Viale Liegi 45, 00198 Rome, Italy
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Favier M, Delanne J, Gorincour G, Faivre L, Racine C, Philippe C, Duffourd Y, Vitobello A, Rousseau T, Martz O, Tarris G, Oualiken C, Thauvin-Robinet C, Mau-Them FT. Early prenatal diagnosis of causative homozygous variants in ASCC1 in a fetus with cystic hygroma and additional homozygous variants of unknown significance associated with a neurological phenotype not visible in early gestation: Dual diagnosis or not? Prenat Diagn 2024; 44:352-356. [PMID: 38342957 DOI: 10.1002/pd.6519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 02/13/2024]
Abstract
A consanguineous couple was referred at 10 weeks of gestation (WG) for prenatal genetic investigations due to isolated cystic hygroma. Prenatal trio exome sequencing identified causative homozygous truncating variants in ASCC1 previously implicated in spinal muscular atrophy with congenital bone fractures. Prenatal manifestations in ASCC1 can usually include hydramnios, fetal hypo-/akinesia, arthrogryposis, contractures and limb deformities, hydrops fetalis and cystic hygroma. An additional truncating variant was identified in CSPP1 associated with Joubert syndrome. Presentations in CSPP1 include cerebellar and brainstem malformations with vermis hypoplasia and molar tooth sign, difficult to visualize in early gestation. A second pregnancy was marked by the recurrence of isolated increased nuchal translucency at 10 + 2 WG. Sanger prenatal diagnosis targeted on ASCC1 and CSPP1 variants showed the presence of the homozygous familial ASCC1 variant. In this case, prenatal exome sequencing analysis is subject to a partial ASCC1 phenotype and an undetectable CSPP1 phenotype at 10 weeks of gestation. As CSPP1 contribution is unclear or speculative to a potentially later in pregnancy or postnatal phenotype, it is mentioned as a variant of uncertain significance. The detection of pathogenic or likely pathogenic variants involved in severe disorders but without phenotype-genotype correlation because the pregnancy is in the early stages or due to prenatally undetectable phenotypes, will encourage the clinical community to define future practices in molecular prenatal reporting.
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Affiliation(s)
- Maud Favier
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- SoFFoet - Société Française de Foetopathologie, Paris, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Julian Delanne
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
- Centre Pluridisciplinaire de Diagnostic Prénatal, CHU Dijon Bourgogne, Dijon, France
| | - Guillaume Gorincour
- Institut Méditerranéen d'Imagerie Médicale Appliquée à la Gynécologie, la Grossesse et l'Enfance (IMAGE 2), Marseille, France
| | - Laurence Faivre
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Caroline Racine
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
- Centre Pluridisciplinaire de Diagnostic Prénatal, CHU Dijon Bourgogne, Dijon, France
| | - Christophe Philippe
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
- Laboratoire de Génétique, CHR Metz Thionville, Hôpital Mercy, Metz, France
| | - Yannis Duffourd
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Antonio Vitobello
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
| | - Thierry Rousseau
- Centre Pluridisciplinaire de Diagnostic Prénatal, CHU Dijon Bourgogne, Dijon, France
| | - Olivia Martz
- Centre Pluridisciplinaire de Diagnostic Prénatal, CHU Dijon Bourgogne, Dijon, France
| | - Georges Tarris
- UMR1098, Service de Pathologie, Université Bourgogne-Franche Comté, Dijon, France
| | - Camélia Oualiken
- UMR1098, Service de Pathologie, Université Bourgogne-Franche Comté, Dijon, France
| | - Christel Thauvin-Robinet
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
- Centre Pluridisciplinaire de Diagnostic Prénatal, CHU Dijon Bourgogne, Dijon, France
| | - Frédéric Tran Mau-Them
- Inserm UMR1231 - GAD, Université Bourgogne Franche-Comté, Dijon, France
- Centre de Référence Maladies Rares Anomalies du développement et Syndromes malformatifs, FHU-TRANSLAD, CHU Dijon Bourgogne, Dijon, France
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