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Damian BB, Bonetti TCS, Horovitz DDG. Practices and ethical concerns regarding preimplantation diagnosis. Who regulates preimplantation genetic diagnosis in Brazil? Braz J Med Biol Res 2014. [PMID: 25493379 DOI: 10.1590/1414-431x20144083.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Preimplantation genetic diagnosis (PGD) was originally developed to diagnose embryo-related genetic abnormalities for couples who present a high risk of a specific inherited disorder. Because this technology involves embryo selection, the medical, bioethical, and legal implications of the technique have been debated, particularly when it is used to select features that are not related to serious diseases. Although several initiatives have attempted to achieve regulatory harmonization, the diversity of healthcare services available and the presence of cultural differences have hampered attempts to achieve this goal. Thus, in different countries, the provision of PGD and regulatory frameworks reflect the perceptions of scientific groups, legislators, and society regarding this technology. In Brazil, several texts have been analyzed by the National Congress to regulate the use of assisted reproduction technologies. Legislative debates, however, are not conclusive, and limited information has been published on how PGD is specifically regulated. The country requires the development of new regulatory standards to ensure adequate access to this technology and to guarantee its safe practice. This study examined official documents published on PGD regulation in Brazil and demonstrated how little direct oversight of PGD currently exists. It provides relevant information to encourage reflection on a particular regulation model in a Brazilian context, and should serve as part of the basis to enable further reform of the clinical practice of PGD in the country.
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Affiliation(s)
- B B Damian
- Centro de Genética Médica, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - T C S Bonetti
- Departamento de Ginecologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - D D G Horovitz
- Centro de Genética Médica, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Damian BB, Bonetti TCS, Horovitz DDG. Practices and ethical concerns regarding preimplantation diagnosis. Who regulates preimplantation genetic diagnosis in Brazil? ACTA ACUST UNITED AC 2014; 48:25-33. [PMID: 25493379 PMCID: PMC4288489 DOI: 10.1590/1414-431x20144083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023]
Abstract
Preimplantation genetic diagnosis (PGD) was originally developed to diagnose embryo-related genetic abnormalities for couples who present a high risk of a specific inherited disorder. Because this technology involves embryo selection, the medical, bioethical, and legal implications of the technique have been debated, particularly when it is used to select features that are not related to serious diseases. Although several initiatives have attempted to achieve regulatory harmonization, the diversity of healthcare services available and the presence of cultural differences have hampered attempts to achieve this goal. Thus, in different countries, the provision of PGD and regulatory frameworks reflect the perceptions of scientific groups, legislators, and society regarding this technology. In Brazil, several texts have been analyzed by the National Congress to regulate the use of assisted reproduction technologies. Legislative debates, however, are not conclusive, and limited information has been published on how PGD is specifically regulated. The country requires the development of new regulatory standards to ensure adequate access to this technology and to guarantee its safe practice. This study examined official documents published on PGD regulation in Brazil and demonstrated how little direct oversight of PGD currently exists. It provides relevant information to encourage reflection on a particular regulation model in a Brazilian context, and should serve as part of the basis to enable further reform of the clinical practice of PGD in the country.
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Affiliation(s)
- B B Damian
- Centro de Genética Médica, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - T C S Bonetti
- Departamento de Ginecologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil
| | - D D G Horovitz
- Centro de Genética Médica, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
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Schwartz IVD, Pinto LLC, Breda G, Lima L, Ribeiro MG, Mota JG, Acosta AX, Correia P, Horovitz DDG, Porciuncula CGG, Lipinski-Figueiredo E, Fett-Conte AC, Oliveira Sobrinho RP, Norato DYJ, Paula AC, Kim CA, Duarte AR, Boy R, Leistner-Segal S, Burin MG, Giugliani R. Clinical and biochemical studies in mucopolysaccharidosis type II carriers. J Inherit Metab Dis 2009; 32:732-738. [PMID: 19821143 DOI: 10.1007/s10545-009-1275-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 08/18/2009] [Accepted: 08/25/2009] [Indexed: 12/31/2022]
Abstract
The aim of the study was to characterize clinically and biochemically mucopolysaccharidosis type II (MPS II) heterozygotes. Fifty-two women at risk to be a carrier, with a mean age of 34.1 years (range 16-57 years), were evaluated through pedigree analysis, medical history, physical examination, measurement of iduronate sulfatase (IDS) activities in plasma and in leukocytes, quantification of glycosaminoglycans (GAGs) in urine, and analysis of the IDS gene. Eligibility criteria for the study also included being 16 years of age or older and being enrolled in a genetic counselling programme. The pedigree and DNA analyses allowed the identification of 40/52 carriers and 12/52 non-carriers. All women evaluated were clinically healthy, and their levels of urinary GAGs were within normal limits. Median plasma and leukocyte IDS activities found among carriers were significantly lower than the values found for non-carriers; there was, however, an overlap between carriers' and non-carriers' values. Our data suggests that MPS II carriers show lower plasma and leukocyte IDS activities but that this reduction is generally associated neither with changes in levels of urinary GAGs nor with the occurrence of clinical manifestations.
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Affiliation(s)
- I V D Schwartz
- Department of Genetics, UFRGS, Porto Alegre, Brazil.
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.
| | - L L C Pinto
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
- Pediatrics Post Graduation Program, School of Medicine, UFRGS, Porto Alegre, Brazil
| | - G Breda
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - L Lima
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - M G Ribeiro
- Clinical Genetics Service, IPPMG, UFRJ, Rio de Janeiro, Brazil
| | - J G Mota
- Institute of Oncology of the South of Minas Gerais (ISMO), Pouso Alegre, Brazil
| | - A X Acosta
- Department of Pediatrics, School of Medicine of Bahia, UFBA, Salvador, Brazil
| | - P Correia
- Post Graduation Program in Women and Children Health, Fernandes Figueira Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - D D G Horovitz
- Department of Medical Genetics, Fernandes Figueira Institute, FIOCRUZ, Rio de Janeiro, Brazil
| | - C G G Porciuncula
- Clinical Genetics Service, University Hospital, UFAL, Maceió, Brazil
| | | | - A C Fett-Conte
- Department of Molecular Biology, FAMERP, São José do Rio Preto, Brazil
| | | | - D Y J Norato
- Department of Medical Genetics, UNICAMP, Campinas, Brazil
| | - A C Paula
- Genetics Unit, IC-HC-USP, São Paulo, Brazil
| | - C A Kim
- Genetics Unit, IC-HC-USP, São Paulo, Brazil
| | - A R Duarte
- Medical Genetics Service, IMIP, Recife, Brazil
| | - R Boy
- Pediatrics Department, UERJ, Rio de Janeiro, Brazil
| | - S Leistner-Segal
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - M G Burin
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - R Giugliani
- Department of Genetics, UFRGS, Porto Alegre, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
- Pediatrics Post Graduation Program, School of Medicine, UFRGS, Porto Alegre, Brazil
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