1
|
Barel D, Marom D, Ponger P, Kurolap A, Bar-Shira A, Kaplan-Ber I, Mory A, Abramovich B, Yaron Y, Drory V, Baris Feldman H. Genetic diagnosis and detection rates using C9orf72 repeat expansion and a multi-gene panel in amyotrophic lateral sclerosis. J Neurol 2024:10.1007/s00415-024-12368-3. [PMID: 38625400 DOI: 10.1007/s00415-024-12368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/17/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder. It is mostly sporadic, with the C9orf72 repeat expansion being the most common genetic cause. While the prevalence of C9orf72-ALS in patients from different populations has been studied, data regarding the yield of C9orf72 compared to an ALS gene panel testing is limited.We aimed to explore the application of C9orf72 versus a gene panel in the general Israeli population. A total of 140 ALS patients attended our Neurogenetics Clinic throughout 2018-2023. Disease onset was between ages 60 and 69 years for most patients (34%); however, a quarter had an early-onset disease (< 50 years). Overall, 119 patients (85%) were genetically evaluated: 116 (97%) were tested for the C9orf72 repeat expansion and 64 (54%) underwent gene panel testing. The C9orf72 repeat expansion had a prevalence of 21% among Ashkenazi Jewish patients compared to 5.7% in non-Ashkenazi patients, while the gene panel had a higher yield in non-Ashkenazi patients with 14% disease-causing variants compared to 5.7% in Ashkenazi Jews. Among early-onset ALS patients, panel testing was positive in 12% compared to 2.9% for C9orf72.We suggest a testing strategy for the Israeli ALS patients: C9orf72 should be the first-tier test in Ashkenazi Jewish patients, while a gene panel should be considered as the first step in non-Ashkenazi and early-onset patients. Tiered testing has important implications for patient management, including prognosis, ongoing clinical trials, and prevention in future generations. Similar studies should be implemented worldwide to uncover the diverse ALS genetic architecture and facilitate tailored care.
Collapse
Affiliation(s)
- Dalit Barel
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Daphna Marom
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Penina Ponger
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Bar-Shira
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Idit Kaplan-Ber
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adi Mory
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yuval Yaron
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vivian Drory
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
- Faculty of Medical and Health Sciences, School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
2
|
Blayney GV, Laffan E, Jacob PA, Baptiste CD, Gabriel H, Sparks TN, Yaron Y, Norton ME, Diderich K, Wang Y, Chong K, Chitayat D, Saini N, Aggarwal S, Pauta M, Borrell A, Gilmore K, Chandler NJ, Allen S, Vora N, Noor A, Monaghan C, Kilby MD, Wapner RJ, Chitty LS, Mone F. Monogenic conditions and central nervous system anomalies: A prospective study, systematic review and meta-analysis. Prenat Diagn 2024; 44:422-431. [PMID: 38054560 PMCID: PMC11044826 DOI: 10.1002/pd.6466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/16/2023] [Accepted: 10/27/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Determine the incremental diagnostic yield of prenatal exome sequencing (pES) over chromosome microarray (CMA) or G-banding karyotype in fetuses with central nervous system (CNS) abnormalities. METHODS Data were collected via electronic searches from January 2010 to April 2022 in MEDLINE, Cochrane, Web of Science and EMBASE. The NHS England prenatal exome cohort was also included. Incremental yield was calculated as a pooled value using a random-effects model. RESULTS Thirty studies were included (n = 1583 cases). The incremental yield with pES for any CNS anomaly was 32% [95%CI 27%-36%; I2 = 72%]. Subgroup analysis revealed apparent incremental yields in; (a) isolated CNS anomalies; 27% [95%CI 19%-34%; I2 = 74%]; (b) single CNS anomaly; 16% [95% CI 10%-23%; I2 = 41%]; (c) more than one CNS anomaly; 31% [95% Cl 21%-40%; I2 = 56%]; and (d) the anatomical subtype with the most optimal yield was Type 1 malformation of cortical development, related to abnormal cell proliferation or apoptosis, incorporating microcephalies, megalencephalies and dysplasia; 40% (22%-57%; I2 = 68%). The commonest syndromes in isolated cases were Lissencephaly 3 and X-linked hydrocephalus. CONCLUSIONS Prenatal exome sequencing provides a high incremental diagnostic yield in fetuses with CNS abnormalities with optimal yields in cases with multiple CNS anomalies, particularly those affecting the midline, posterior fossa and cortex.
Collapse
Affiliation(s)
- Gillian V. Blayney
- Fetal Medicine Department, Royal Jubilee Maternity Service, Belfast Health and Social Care Trust, Belfast, UK
| | - Eoghan Laffan
- Department of Radiology, Children’ Health Ireland at Crumlin, Dublin, Ireland
| | | | | | | | - Teresa N. Sparks
- Department of Obstetrics, Gynaecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mary E. Norton
- Department of Obstetrics, Gynaecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Karin Diderich
- Department of Clinical Genetics, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Yiming Wang
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karen Chong
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Chitayat
- Division of Clinical and Metabolic Genetics, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- The Prenatal Diagnosis and Medical Genetics Program, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Neelam Saini
- Department of Medical Genetics, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Shagun Aggarwal
- Department of Medical Genetics, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Montse Pauta
- Insitut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), BCNatal, Barcelona, Spain
| | - Antoni Borrell
- Insitut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), BCNatal, Barcelona, Spain
| | - Kelly Gilmore
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Stephanie Allen
- West Midlands Regional Genetics Laboratory, South and Central Genomic Laboratory Hub, Birmingham, UK
| | - Neeta Vora
- Department of Obstetrics and Gynaecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Abdul Noor
- Division of Diagnostic Medical Genetics, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Caitriona Monaghan
- Fetal Medicine Department, Royal Jubilee Maternity Service, Belfast Health and Social Care Trust, Belfast, UK
| | - Mark D. Kilby
- Institute of Metabolism and Systems Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
- Fetal Medicine Centre, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, UK
| | | | - Lyn S. Chitty
- North Thames Genomic Laboratory Hub, NHS Foundation Trust, London, UK
- Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - Fionnuala Mone
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| |
Collapse
|
3
|
Michaelson-Cohen R, Salzer LS, Brabbing-Goldstein D, Yaron Y, Reches A, Yonath H, Regev M, Shani H, Altarescu G, Segel R, Sukenik-Halevy R, Daum H, Harel T, Meiner V, Basel-Salmon L, Sagi-Dain L, Maya I. Exploring the factors affecting classification and reporting of uncertain prenatal microarray findings, using a "virtual fetus" model-a pilot study. Prenat Diagn 2024; 44:511-518. [PMID: 38353311 DOI: 10.1002/pd.6535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/12/2024] [Accepted: 02/01/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Significant discrepancy exists between laboratories in classification and reporting of copy number variants (CNVs). Studies exploring factors affecting prenatal CNV management are rare. Our "virtual fetus" pilot study examines these factors. METHOD Ten prenatally diagnosed CNVs of uncertain significance (VUS) > 1Mb, encompassing OMIM-morbid genes, inherited from healthy parents, were classified by 15 MD geneticists from laboratory, prenatal, and preimplantation genetic testing (PGT) units. Geneticists addressed factors affecting classification, obligation to report, and recommendation for invasive testing or PGT. RESULTS CNVs were classified likely benign (10.7%), VUS (74.7%), likely pathogenic (8.7%), or pathogenic (6.0%). Classification discrepancy was higher for losses versus gains. Classifying pathogenic/likely pathogenic was more common for losses (adjusted odds ratio [aOR] 10.9, 95% CI 1.55-76.9), and geneticists specializing in gynecology (aOR 4.9, 95% CI 1.03-23.3). 84.0% of respondents would report CNVs, depending on classification and family phenotype. Invasive testing in pregnancies was recommended for 29.3% of CNVs, depending on the classification and geneticist's specialization. PGT was recommended for 32.4%, depending on classification, experience years, and family's phenotype (38.0% for patients undergoing in vitro fertilization irrespectively, 26.7% otherwise). CONCLUSION Factors affecting CNV classification/reporting are mainly dosage, family phenotype, geneticist specialization and experience. Understanding factors from our pilot study may facilitate developing an algorithm for clinical consensus and optimal management.
Collapse
Affiliation(s)
- Rachel Michaelson-Cohen
- Faculty of Medicine, Medical Genetics Institute, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liat Sheelo Salzer
- Sackler Faculty of Medicine, Raphael Recanati Genetics Institute, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Dana Brabbing-Goldstein
- Sackler Faculty of Medicine, Raphael Recanati Genetics Institute, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Yaron
- Sackler Faculty of Medicine, The Genetics Institute and Genomics Center, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Adi Reches
- Sackler Faculty of Medicine, The Genetics Institute and Genomics Center, Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Hagith Yonath
- Sackler Faculty of Medicine, Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Miriam Regev
- Sackler Faculty of Medicine, Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Shani
- Sackler Faculty of Medicine, Danek Gertner Institute of Human Genetics, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Gheona Altarescu
- Faculty of Medicine, Medical Genetics Institute, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Reeval Segel
- Faculty of Medicine, Medical Genetics Institute, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rivka Sukenik-Halevy
- Genetics Institute, Meir Medical Center, Sackler School of Medicine, Tel Aviv University, Kfar Saba, Central, Israel
| | - Hagit Daum
- Department of Genetics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamar Harel
- Department of Genetics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Vardiella Meiner
- Department of Genetics, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lina Basel-Salmon
- Sackler Faculty of Medicine, Raphael Recanati Genetics Institute, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Idit Maya
- Sackler Faculty of Medicine, Raphael Recanati Genetics Institute, Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Mustafa HJ, Barbera JP, Sambatur EV, Pagani G, Yaron Y, Baptiste CD, Wapner RJ, Brewer CJ, Khalil A. Diagnostic yield of exome sequencing in prenatal agenesis of corpus callosum: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2024; 63:312-320. [PMID: 37519216 DOI: 10.1002/uog.27440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/25/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To determine the incremental diagnostic yield of exome sequencing (ES) after negative chromosomal microarray analysis (CMA) in cases of prenatally diagnosed agenesis of the corpus callosum (ACC) and to identify the associated genes and variants. METHODS A systematic search was performed to identify relevant studies published up until June 2022 using four databases: PubMed, SCOPUS, Web of Science and The Cochrane Library. Studies in English reporting on the diagnostic yield of ES following negative CMA in prenatally diagnosed partial or complete ACC were included. Authors of cohort studies were contacted for individual participant data and extended cohorts were provided for two of them. The increase in diagnostic yield with ES for pathogenic/likely pathogenic (P/LP) variants was assessed in all cases of ACC, isolated ACC, ACC with other cranial anomalies and ACC with extracranial anomalies. To identify all reported genetic variants, the systematic review included all ACC cases; however, for the meta-analysis, only studies with ≥ three ACC cases were included. Meta-analysis of proportions was employed using a random-effects model. Quality assessment of the included studies was performed using modified Standards for Reporting of Diagnostic Accuracy criteria. RESULTS A total of 28 studies, encompassing 288 prenatally diagnosed ACC cases that underwent ES following negative CMA, met the inclusion criteria of the systematic review. We classified 116 genetic variants in 83 genes associated with prenatal ACC with a full phenotypic description. There were 15 studies, encompassing 268 cases, that reported on ≥ three ACC cases and were included in the meta-analysis. Of all the included cases, 43% had a P/LP variant on ES. The highest yield was for ACC with extracranial anomalies (55% (95% CI, 35-73%)), followed by ACC with other cranial anomalies (43% (95% CI, 30-57%)) and isolated ACC (32% (95% CI, 18-51%)). CONCLUSIONS ES demonstrated an incremental diagnostic yield in cases of prenatally diagnosed ACC following negative CMA. While the greatest diagnostic yield was observed in ACC with extracranial anomalies and ACC with other central nervous system anomalies, ES should also be considered in cases of isolated ACC. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- H J Mustafa
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children and Indiana University Health Fetal Center, Indianapolis, IN, USA
| | - J P Barbera
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - E V Sambatur
- Research Division, Houston Center for Maternal Fetal Medicine, Houston, TX, USA
| | - G Pagani
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Y Yaron
- Prenatal Genetic Diagnosis Unit, Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C D Baptiste
- Obstetrics and Gynecology, Reproductive Genetics, Columbia University Medical Center, New York, NY, USA
| | - R J Wapner
- Obstetrics and Gynecology, Reproductive Genetics, Columbia University Medical Center, New York, NY, USA
| | - C J Brewer
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|
5
|
Brabbing-Goldstein D, Basel-Salmon L, Yaron Y. Reply. Ultrasound Obstet Gynecol 2024; 63:428-430. [PMID: 38426869 DOI: 10.1002/uog.27597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 03/02/2024]
Affiliation(s)
- D Brabbing-Goldstein
- Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Ultrasound Unit, Helen Schneider Women's Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - L Basel-Salmon
- Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Yaron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
6
|
Brabbing-Goldstein D, Kozlova D, Bazak L, Basel-Salmon L, Gilboa Y, Marciano-Levi I, Zahra J, Kanengisser-Pines B, Botvinik A, Kurolap A, Birnbaum R, Yaron Y. Unique prenatal manifestations of biallelic NDUFAF5 variants: expansion of phenotype. Ultrasound Obstet Gynecol 2024; 63:392-398. [PMID: 37718619 DOI: 10.1002/uog.27482] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/20/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE Mitochondrial complex-I deficiency, nuclear type 16, is a rare autosomal recessive disorder caused by biallelic pathogenic variants in NDUFAF5 (C20orf7) (OMIM 618238). The aim of this study was to describe a severe early prenatal manifestation of this disorder, which was previously considered to occur only postnatally. METHODS This was a multicenter retrospective case series including five fetuses from three non-related families, which shared common sonographic abnormalities, including brain cysts, corpus callosal malformations, non-immune hydrops fetalis and growth restriction. Genetic evaluation included chromosomal microarray analysis and exome sequencing. Two fetuses from the same family were also available for pathology examination, including electron microscopy. RESULTS Chromosomal microarray analysis revealed no chromosomal abnormality in any of the tested cases. Trio exome sequencing demonstrated that three affected fetuses from three unrelated families were compound heterozygous or homozygous for likely pathogenic variants in NDUFAF5. No other causative variants were detected. The association between NDUFAF5 variants and fetal malformations was further confirmed by segregation analysis. Histological evaluation of fetal tissues and electron microscopy of the skeletal muscle, liver, proximal tubules and heart demonstrated changes that resembled postmortem findings in patients with mitochondrial depletion disorders as well as previously undescribed findings. CONCLUSIONS Mitochondrial complex-I deficiency and specifically biallelic mutations in NDUFAF5 have a role in abnormal fetal development, presenting with severe congenital malformations. Mitochondrial complex-I disorders should be considered in the differential diagnosis of corpus callosal malformations and brain cysts, especially when associated with extracranial abnormalities, such as fetal growth restriction and non-immune hydrops fetalis. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- D Brabbing-Goldstein
- Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Ultrasound Unit, Helen Schneider Women's Hospital, Rabin Medical Center, Petah Tikva, Israel
| | - D Kozlova
- Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - L Bazak
- Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
| | - L Basel-Salmon
- Raphael Recanati Genetic Institute, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Gilboa
- Ultrasound Unit, Helen Schneider Women's Hospital, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Marciano-Levi
- Department of Pathology, Rabin Medical Center, Petah Tikva, Israel
| | - J Zahra
- Genetics Institute, Soroka Medical Center, Beer Sheva, Israel
| | | | - A Botvinik
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Kurolap
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - R Birnbaum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Y Yaron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
7
|
Hourvitz N, Kurolap A, Mory A, Haratz KK, Kidron D, Malinger G, Baris Feldman H, Yaron Y. SMARCC1 is a susceptibility gene for congenital hydrocephalus with an autosomal dominant inheritance mode and incomplete penetrance. Prenat Diagn 2023; 43:1374-1377. [PMID: 37639281 DOI: 10.1002/pd.6426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
A Jewish couple of mixed origin was referred for genetic counseling following termination of pregnancy at 18 weeks of gestation due to severe ventriculomegaly with aqueduct stenosis. Trio exome sequencing revealed a loss-of-function heterozygous variant in the SMARCC1 gene inherited from an unaffected mother. The SMARCC1 gene is associated with embryonic neurodevelopmental processes. Recent studies have linked perturbations of the gene with autosomal dominant congenital hydrocephalus, albeit with reduced penetrance. However, these studies were not referenced in the SMARCC1 OMIM record (*601732) and the gene was not considered, at the time, an OMIM morbid gene. Following our case and appeal, SMARCC1 is now considered a susceptibility gene for hydrocephalus. This allowed us to reclassify the variant as likely pathogenic and empowered the couple to make informed reproductive choices.
Collapse
Affiliation(s)
- Noa Hourvitz
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adi Mory
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Karina Krajden Haratz
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dvora Kidron
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gustavo Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity and Hospital for Women's Health, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Yaron
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Mustafa HJ, Sambatur EV, Barbera JP, Pagani G, Yaron Y, Baptiste CD, Wapner RJ, Khalil A. Diagnostic yield with exome sequencing in prenatal severe bilateral ventriculomegaly: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101048. [PMID: 37311485 DOI: 10.1016/j.ajogmf.2023.101048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to determine the incremental diagnostic yield of prenatal exome sequencing after negative chromosomal microarray analysis results in prenatally diagnosed bilateral severe ventriculomegaly or hydrocephalus; another objective was to categorize the associated genes and variants. DATA SOURCES A systematic search was performed to identify relevant studies published until June 2022 using 4 databases (Cochrane Library, Web of Science, Scopus, and MEDLINE). STUDY ELIGIBILITY CRITERIA Studies in English reporting on the diagnostic yield of exome sequencing following negative chromosomal microarray analysis results in cases of prenatally diagnosed bilateral severe ventriculomegaly were included. METHODS Authors of cohort studies were contacted for individual participant data, and 2 studies provided their extended cohort data. The incremental diagnostic yield of exome sequencing was assessed for pathogenic/likely pathogenic findings in cases of: (1) all severe ventriculomegaly; (2) isolated severe ventriculomegaly (as the only cranial anomaly); (3) severe ventriculomegaly with other cranial anomalies; and (4) nonisolated severe ventriculomegaly (with extracranial anomalies). To be able to identify all reported genetic associations, the systematic review portion was not limited to any minimal severe ventriculomegaly case numbers; however, for the synthetic meta-analysis, we included studies with ≥3 severe ventriculomegaly cases. Meta-analysis of proportions was done using a random-effects model. Quality assessment of the included studies was performed using the modified STARD (Standards for Reporting of Diagnostic Accuracy Studies) criteria. RESULTS A total of 28 studies had 1988 prenatal exome sequencing analyses performed following negative chromosomal microarray analysis results for various prenatal phenotypes; this included 138 cases with prenatal bilateral severe ventriculomegaly. We categorized 59 genetic variants in 47 genes associated with prenatal severe ventriculomegaly along with their full phenotypic description. There were 13 studies reporting on ≥3 severe ventriculomegaly cases, encompassing 117 severe ventriculomegaly cases that were included in the synthetic analysis. Of all the included cases, 45% (95% confidence interval, 30-60) had positive pathogenic/likely pathogenic exome sequencing results. The highest yield was for nonisolated cases (presence of extracranial anomalies; 54%; 95% confidence interval, 38-69), followed by severe ventriculomegaly with other cranial anomalies (38%; 95% confidence interval, 22-57) and isolated severe ventriculomegaly (35%; 95% confidence interval, 18-58). CONCLUSION There is an apparent incremental diagnostic yield of prenatal exome sequencing following negative chromosomal microarray analysis results in bilateral severe ventriculomegaly. Although the greatest yield was found in cases of nonisolated severe ventriculomegaly, consideration should also be given to performing exome sequencing in cases of isolated severe ventriculomegaly as the only brain anomaly identified on prenatal imaging.
Collapse
Affiliation(s)
- Hiba J Mustafa
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, IN (Dr Mustafa); Fetal Center at Riley Children's Health, Indiana University Health, Indianapolis, IN (Dr Mustafa).
| | - Enaja V Sambatur
- Research Division, Houston Center for Maternal Fetal Medicine, Houston, TX (Ms Sambatur)
| | - Julie P Barbera
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Ms Barbera)
| | - Giorgio Pagani
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy (Dr Pagani)
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Yaron); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Yaron)
| | - Caitlin D Baptiste
- Division of Women's Genetics, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Drs Baptiste and Wapner)
| | - Ronald J Wapner
- Division of Women's Genetics, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Drs Baptiste and Wapner)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom (Dr Khalil); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom (Dr Khalil)
| |
Collapse
|
9
|
Calame DG, Guo T, Wang C, Garrett L, Jolly A, Dawood M, Kurolap A, Henig NZ, Fatih JM, Herman I, Du H, Mitani T, Becker L, Rathkolb B, Gerlini R, Seisenberger C, Marschall S, Hunter JV, Gerard A, Heidlebaugh A, Challman T, Spillmann RC, Jhangiani SN, Coban-Akdemir Z, Lalani S, Liu L, Revah-Politi A, Iglesias A, Guzman E, Baugh E, Boddaert N, Rondeau S, Ormieres C, Barcia G, Tan QKG, Thiffault I, Pastinen T, Sheikh K, Biliciler S, Mei D, Melani F, Shashi V, Yaron Y, Steele M, Wakeling E, Østergaard E, Nazaryan-Petersen L, Millan F, Santiago-Sim T, Thevenon J, Bruel AL, Thauvin-Robinet C, Popp D, Platzer K, Gawlinski P, Wiszniewski W, Marafi D, Pehlivan D, Posey JE, Gibbs RA, Gailus-Durner V, Guerrini R, Fuchs H, Hrabě de Angelis M, Hölter SM, Cheung HH, Gu S, Lupski JR. Monoallelic variation in DHX9, the gene encoding the DExH-box helicase DHX9, underlies neurodevelopment disorders and Charcot-Marie-Tooth disease. Am J Hum Genet 2023; 110:1394-1413. [PMID: 37467750 PMCID: PMC10432148 DOI: 10.1016/j.ajhg.2023.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/21/2023] Open
Abstract
DExD/H-box RNA helicases (DDX/DHX) are encoded by a large paralogous gene family; in a subset of these human helicase genes, pathogenic variation causes neurodevelopmental disorder (NDD) traits and cancer. DHX9 encodes a BRCA1-interacting nuclear helicase regulating transcription, R-loops, and homologous recombination and exhibits the highest mutational constraint of all DDX/DHX paralogs but remains unassociated with disease traits in OMIM. Using exome sequencing and family-based rare-variant analyses, we identified 20 individuals with de novo, ultra-rare, heterozygous missense or loss-of-function (LoF) DHX9 variant alleles. Phenotypes ranged from NDDs to the distal symmetric polyneuropathy axonal Charcot-Marie-Tooth disease (CMT2). Quantitative Human Phenotype Ontology (HPO) analysis demonstrated genotype-phenotype correlations with LoF variants causing mild NDD phenotypes and nuclear localization signal (NLS) missense variants causing severe NDD. We investigated DHX9 variant-associated cellular phenotypes in human cell lines. Whereas wild-type DHX9 was restricted to the nucleus, NLS missense variants abnormally accumulated in the cytoplasm. Fibroblasts from an individual with an NLS variant also showed abnormal cytoplasmic DHX9 accumulation. CMT2-associated missense variants caused aberrant nucleolar DHX9 accumulation, a phenomenon previously associated with cellular stress. Two NDD-associated variants, p.Gly411Glu and p.Arg761Gln, altered DHX9 ATPase activity. The severe NDD-associated variant p.Arg141Gln did not affect DHX9 localization but instead increased R-loop levels and double-stranded DNA breaks. Dhx9-/- mice exhibited hypoactivity in novel environments, tremor, and sensorineural hearing loss. All together, these results establish DHX9 as a critical regulator of mammalian neurodevelopment and neuronal homeostasis.
Collapse
Affiliation(s)
- Daniel G Calame
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Tianyu Guo
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chen Wang
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lillian Garrett
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Angad Jolly
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Moez Dawood
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Alina Kurolap
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noa Zunz Henig
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jawid M Fatih
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Isabella Herman
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Boys Town National Research Hospital, Boys Town, NE, USA
| | - Haowei Du
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Tadahiro Mitani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lore Becker
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Birgit Rathkolb
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Molecular Animal Breeding and Biotechnology, Gene Center, Ludwig-Maximilians University Munich, Munich, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Raffaele Gerlini
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Claudia Seisenberger
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Susan Marschall
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jill V Hunter
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA; E.B. Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Amanda Gerard
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Thomas Challman
- Autism & Developmental Medicine Institute, Geisinger, Danville, PA, USA
| | - Rebecca C Spillmann
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Shalini N Jhangiani
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Zeynep Coban-Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Seema Lalani
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lingxiao Liu
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anya Revah-Politi
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, USA; Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY, USA
| | - Alejandro Iglesias
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Edwin Guzman
- Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Evan Baugh
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, 75015 Paris, France
| | - Sophie Rondeau
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Clothide Ormieres
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Giulia Barcia
- Service de Médecine Génomique des Maladies Rares - APHP, Hôpital Necker Enfants Malades, Université de Paris, Paris, France
| | - Queenie K G Tan
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Isabelle Thiffault
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA
| | - Tomi Pastinen
- Genomic Medicine Center, Children's Mercy Hospital, Kansas City, MO, USA; University of Missouri Kansas City School of Medicine, Kansas City, MO, USA
| | - Kazim Sheikh
- Department of Neurology, UT Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Suur Biliciler
- Department of Neurology, UT Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Davide Mei
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Federico Melani
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Vandana Shashi
- Department of Pediatrics, Duke University Medical Center, Duke University, Durham, NC, USA
| | - Yuval Yaron
- Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mary Steele
- Lifetime Neurodevelopmental Care, San Francisco, CA, USA
| | - Emma Wakeling
- North East Thames Regional Genetic Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Elsebet Østergaard
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lusine Nazaryan-Petersen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Julien Thevenon
- Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs de l'Interrégion Est, Fédération Hospitalo-Universitaire Médecine TRANSLationnelle et Anomalies du Développement, Centre Hospitalier Universitaire Dijon, Equipe Genetics of Developmental Anomalies-INSERM UMR 1231, Dijon, France
| | - Ange-Line Bruel
- Functional Unit for Diagnostic Innovation in Rare Diseases, FHU-TRANSLAD, Dijon Bourgogne University Hospital, Dijon, France; INSERM UMR1231 GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France
| | - Christel Thauvin-Robinet
- INSERM UMR1231 GAD "Génétique des Anomalies du Développement," FHU-TRANSLAD, University of Burgundy, Dijon, France; Department of Genetics and Reference Center for Development Disorders and Intellectual Disabilities, Dijon Bourgogne University Hospital, Dijon, France
| | - Denny Popp
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Konrad Platzer
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Pawel Gawlinski
- Institute of Mother and Child, Kasprzaka 17a, 02-211 Warsaw, Poland
| | - Wojciech Wiszniewski
- Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road L103, Portland, OR, USA
| | - Dana Marafi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Davut Pehlivan
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jennifer E Posey
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Richard A Gibbs
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Valerie Gailus-Durner
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Renzo Guerrini
- Neuroscience Department, Meyer Children's Hospital IRCCS, Florence, Italy; University of Florence, Florence, Italy
| | - Helmut Fuchs
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Hrabě de Angelis
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; Chair of Experimental Genetics, TUM School of Life Sciences, Technische Universität München, Alte Akademie 8, 85354 Freising, Germany
| | - Sabine M Hölter
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Institute of Developmental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Technische Universität München, Freising-Weihenstephan, Germany
| | - Hoi-Hung Cheung
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shen Gu
- School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China; Key Laboratory for Regenerative Medicine, Ministry of Education, School of Biomedical Sciences, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong SAR, China; Kunming Institute of Zoology Chinese Academy of Sciences, the Chinese University of Hong Kong Joint Laboratory of Bioresources and Molecular Research of Common Diseases, Hong Kong SAR, China.
| | - James R Lupski
- Texas Children's Hospital, Houston, TX, USA; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA; Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
| |
Collapse
|
10
|
Van den Veyver IB, Yaron Y, Deans ZC. International Society for Prenatal Diagnosis 2022 debate 3-Fetal genome sequencing should be offered to all pregnant patients. Prenat Diagn 2023; 43:428-434. [PMID: 36221164 PMCID: PMC10108654 DOI: 10.1002/pd.6247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
Abstract
Prenatal trio exome sequencing (ES) has become integrated into the care for pregnant women when the fetus has structural anomalies. Details regarding optimizing indications for prenatal exome sequencing, its detection rates with different categories of fetal anomalies, and principles of interpretation of pathogenicity of sequence variants are still under investigation. However, there is now growing consensus about its benefits for finding the cause of fetal structural anomalies. What is not established, is whether exome or genome sequencing (GS) has a place in the care of all pregnant women. This report is a summary of the debate on this topic at the 26th International Conference on Prenatal Diagnosis and Therapy. Both expert debaters considered the advantages and disadvantages. Advantages include the ability to diagnose serious childhood conditions without a prenatally observable phenotype, which creates the potential of early treatments. Disadvantages include difficulties with variant classification, counseling complexities, healthcare cost, and the burden on healthcare systems and families, in particular with the discovery of adult-onset disorders or variants of uncertain significance. Although both debaters weighed the balance of these conflicting arguments differently, they agreed that more research is needed to further explore the clinical utility and ethical aspects of GS for all pregnant women.
Collapse
Affiliation(s)
- Ignatia B. Van den Veyver
- Departments of Obstetrics and Gynecology and Molecular and Human Genetics, Baylor College of Medicine, and Texas Children’s Hospital, Houston, TX 77030, USA
| | - Yuval Yaron
- Director, Prenatal Genetic Diagnosis Unit, Institute of Genetics and Genomics, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zandra C Deans
- GenQA, Department of Laboratory Medicine, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, EH14 6SA, UK
| |
Collapse
|
11
|
Einhorn Y, Einhorn M, Kurolap A, Steinberg D, Mory A, Bazak L, Paperna T, Grinshpun-Cohen J, Basel-Salmon L, Weiss K, Singer A, Yaron Y, Baris Feldman H. Community data-driven approach to identify pathogenic founder variants for pan-ethnic carrier screening panels. Hum Genomics 2023; 17:30. [PMID: 36978159 PMCID: PMC10044388 DOI: 10.1186/s40246-023-00472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The American College of Medical Genetics and Genomics (ACMG) recently published new tier-based carrier screening recommendations. While many pan-ethnic genetic disorders are well established, some genes carry pathogenic founder variants (PFVs) that are unique to specific ethnic groups. We aimed to demonstrate a community data-driven approach to creating a pan-ethnic carrier screening panel that meets the ACMG recommendations. METHODS Exome sequencing data from 3061 Israeli individuals were analyzed. Machine learning determined ancestries. Frequencies of candidate pathogenic/likely pathogenic (P/LP) variants based on ClinVar and Franklin were calculated for each subpopulation based on the Franklin community platform and compared with existing screening panels. Candidate PFVs were manually curated through community members and the literature. RESULTS The samples were automatically assigned to 13 ancestries. The largest number of samples was classified as Ashkenazi Jewish (n = 1011), followed by Muslim Arabs (n = 613). We detected one tier-2 and seven tier-3 variants that were not included in existing carrier screening panels for Ashkenazi Jewish or Muslim Arab ancestries. Five of these P/LP variants were supported by evidence from the Franklin community. Twenty additional variants were detected that are potentially pathogenic tier-2 or tier-3. CONCLUSIONS The community data-driven and sharing approaches facilitate generating inclusive and equitable ethnically based carrier screening panels. This approach identified new PFVs missing from currently available panels and highlighted variants that may require reclassification.
Collapse
Affiliation(s)
| | | | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
| | | | - Adi Mory
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
| | - Lily Bazak
- Beilinson Hospital, Rabin Medical Center, Recanati Genetics Institute, Petah Tikva, Israel
| | - Tamar Paperna
- Rambam Health Care Campus, The Genetics Institute, Haifa, Israel
| | | | - Lina Basel-Salmon
- Beilinson Hospital, Rabin Medical Center, Recanati Genetics Institute, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karin Weiss
- Rambam Health Care Campus, The Genetics Institute, Haifa, Israel
- The Ruth and Bruce Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Amihood Singer
- Community Genetic Services, Ministry of Health, Tel Aviv, Israel
| | - Yuval Yaron
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
12
|
Mustafa HJ, Sambatur E, Heydari MH, Yaron Y, Baptiste C, Khalil A, Wapner R, Al-Kouatly HB. Prenatal agenesis of corpus callosum and diagnostic yield with exome sequencing, systematic review and metanalysis. Am J Obstet Gynecol 2023. [DOI: 10.1016/j.ajog.2022.11.563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
13
|
Yaron Y, Krajden Haratz K. Reply. Ultrasound Obstet Gynecol 2023; 61:120-121. [PMID: 36594736 DOI: 10.1002/uog.26122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 05/27/2023]
Affiliation(s)
- Y Yaron
- Prenatal Genetic Diagnosis Unit, Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Krajden Haratz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Obstetric Ultrasound, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
14
|
Kurolap A, Mory A, Simchoni S, Krajden Haratz K, Malinger G, Birnbaum R, Baris Feldman H, Yaron Y. Upgrading an intronic TMEM67 variant of unknown significance to likely pathogenic through RNA studies and community data sharing. Prenat Diagn 2022; 42:1484-1487. [PMID: 36221156 PMCID: PMC9828675 DOI: 10.1002/pd.6248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023]
Abstract
FETAL PHENOTYPE A couple of Ashkenazi Jewish descent was referred for an early anatomy scan at 14 + 2 weeks of gestation following a previous pregnancy termination due to posterior encephalocele and enlarged kidneys. The index pregnancy was also positive for several fetal abnormalities, including enlarged kidneys with cystic dysplasia and abnormal cerebellar morphology highly suggestive of Joubert syndrome. GENETIC DIAGNOSTIC TEST PERFORMED, RESULT, AND INTERPRETATION Trio exome sequencing revealed compound heterozygosity for variants in the TMEM67 gene: a known pathogenic maternally inherited variant found in trans with a paternal intronic variant of unknown significance. RNA analysis revealed that the intronic variant creates a cryptic acceptor splice site in intron 12, leading to the insertion of 22 bp and causing a frameshift with a premature stop codon. This analysis enabled the reclassification of the intronic variant to likely pathogenic. IMPLICATIONS AND NOVELTY This information empowered the couple to make informed reproductive choices and opt for preimplantation genetic testing (PGT) for future pregnancies.
Collapse
Affiliation(s)
- Alina Kurolap
- The Genetics Institute and Genomics CenterTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Adi Mory
- The Genetics Institute and Genomics CenterTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Sharon Simchoni
- The Genetics Institute and Genomics CenterTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Karina Krajden Haratz
- Division of Ultrasound in Obstetrics and GynecologyLis Maternity and Hospital for Women's HealthTel Aviv Sourasky Medical CenterTel AvivIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Gustavo Malinger
- Division of Ultrasound in Obstetrics and GynecologyLis Maternity and Hospital for Women's HealthTel Aviv Sourasky Medical CenterTel AvivIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Roee Birnbaum
- Division of Ultrasound in Obstetrics and GynecologyLis Maternity and Hospital for Women's HealthTel Aviv Sourasky Medical CenterTel AvivIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics CenterTel Aviv Sourasky Medical CenterTel AvivIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Yuval Yaron
- The Genetics Institute and Genomics CenterTel Aviv Sourasky Medical CenterTel AvivIsrael,Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| |
Collapse
|
15
|
Sagi-Dain L, Weisz B, Krajden KH, Singer A, Yaron Y, Maymon R. Methodological drawbacks in the alleged association between foetal sonographic anomalies and autism. Brain 2022; 145:e90-e91. [PMID: 35802022 DOI: 10.1093/brain/awac246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 07/03/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lena Sagi-Dain
- 1Genetics Institute, Obstetrics and Gynecology department, Carmel Medical Center, affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Boaz Weisz
- Diagnostic Ultrasound Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karina Haratz Krajden
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Ultrasound in Obstetrics & Gynecology, Lis Maternity and Women's Hospital, Tel Aviv Sourasky Medical Center, Israel
| | - Amihood Singer
- Community Genetics, Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Yuval Yaron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ron Maymon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Obstetrics and Gynecology department, Shamir Medical Center, Zerifin, Israel
| |
Collapse
|
16
|
Yaron Y, Ofen Glassner V, Mory A, Zunz Henig N, Kurolap A, Bar Shira A, Brabbing Goldstein D, Marom D, Ben Sira L, Baris Feldman H, Malinger G, Krajden Haratz K, Reches A. Exome sequencing as first-tier test for fetuses with severe central nervous system structural anomalies. Ultrasound Obstet Gynecol 2022; 60:59-67. [PMID: 35229910 PMCID: PMC9328397 DOI: 10.1002/uog.24885] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Prenatally detected central nervous system (CNS) anomalies present a diagnostic challenge. In this study, we compared the diagnostic yield of exome sequencing (ES) and chromosomal microarray analysis (CMA) in fetuses with a major CNS anomaly. METHODS This was a retrospective study of 114 cases referred for genetic evaluation following termination of pregnancy (TOP) due to a major CNS anomaly detected on prenatal ultrasound. All fetuses were first analyzed by CMA. All CMA-negative cases were offered ES. CMA-positive cases were reanalyzed using ES to assess its ability to detect copy-number variants (CNVs). RESULTS CMA identified a pathogenic or likely pathogenic (P/LP) CNV in 11/114 (10%) cases. Eighty-six CMA-negative cases were analyzed using ES, which detected P/LP sequence variants in 38/86 (44%). Among recurrent cases (i.e. cases with a previously affected pregnancy), the incidence of P/LP sequence variants was non-significantly higher compared with non-recurrent ones (12/19 (63%) vs 26/67 (39%); P = 0.06). Among the 38 cases with an ES diagnosis, 20 (53%) were inherited and carried a significant risk of recurrence. Reanalysis of 10 CMA-positive cases by ES demonstrated that the bioinformatics pipeline used for sequence variant analysis also detected all P/LP CNVs, as well as three previously known non-causative CNVs. CONCLUSIONS In our study, ES provided a high diagnostic yield (> 50%) in fetuses with severe CNS structural anomalies, which may have been partly due to the highly selected case series that included post-TOP cases from a specialist referral center. These data suggest that ES may be considered as a first-tier test for the prenatal diagnosis of major fetal CNS anomalies, detecting both P/LP sequence variants and CNVs. This is of particular importance given the time constraints of an ongoing pregnancy and the risk of recurrence in future pregnancies. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- Y. Yaron
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - V. Ofen Glassner
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
| | - A. Mory
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
| | - N. Zunz Henig
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
| | - A. Kurolap
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
| | - A. Bar Shira
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
| | - D. Brabbing Goldstein
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
- Division of Obstetric Ultrasound, Lis Maternity HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - D. Marom
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - L. Ben Sira
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Radiology DepartmentTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - H. Baris Feldman
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - G. Malinger
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Division of Obstetric Ultrasound, Lis Maternity HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - K. Krajden Haratz
- Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
- Division of Obstetric Ultrasound, Lis Maternity HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - A. Reches
- Prenatal Genetic Diagnosis UnitGenetics Institute, Tel Aviv Sourasky Medical CenterTel AvivIsrael
- Division of Obstetric Ultrasound, Lis Maternity HospitalTel Aviv Sourasky Medical CenterTel AvivIsrael
| |
Collapse
|
17
|
Cuckle H, Benn P, Yaron Y. A Founding Father of Reproductive Genetics: Eugene Pergament (1933-2022). Prenat Diagn 2022; 42:959-961. [PMID: 35621153 DOI: 10.1002/pd.6187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A Founding Father of Reproductive Genetics: Eugene Pergament (1933-2022) This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Howard Cuckle
- Columbia University Medical Center, Obstetrics and Gynecology, New York, New York, US
| | - Peter Benn
- University of Connecticut Health Center, Department of Genetics and Genome Sciences, Farmington, Connecticut, US
| | - Yuval Yaron
- Tel Aviv Sourasky Medical Center, Prenatal Diagnosis Unit, Genetic Institute, 6 Weizmann Street, Tel Aviv, Israel
| |
Collapse
|
18
|
Reytan S, Henig NZ, Yinon Y, Avnet H, Kurolap A, Yaron Y, Feldman HB. Non-immune hydrops fetalis caused by PIEZO1 compound heterozygous deletions detected only by exome sequencing. Prenat Diagn 2022; 42:890-893. [PMID: 35393661 DOI: 10.1002/pd.6142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/20/2022] [Accepted: 03/28/2022] [Indexed: 11/06/2022]
Abstract
This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Sivan Reytan
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Noa Zunz Henig
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yoav Yinon
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagai Avnet
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yuval Yaron
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
19
|
Einhorn Y, Einhorn M, Yaron Y, Steinberg D, Henig NZ, Mory A, Bazak L, Tsur E, Weiss K, Paperna T, Grinshpun-Cohen J, Singer A, Basel-Salmon L, Feldman HB. eP345: Community data-driven approach for generating cross-ethnic population carrier screening panel. Genet Med 2022. [DOI: 10.1016/j.gim.2022.01.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
20
|
Cleper R, Reches A, Shapira D, Simchoni S, Reisman L, Ben-Sira L, Yaron Y, Wolman I, Malinger G, Brabbing-Goldstein D, Ben-Shachar S. Improving renal phenotype and evolving extra-renal features of 17q12 deletion encompassing the HNF1B gene. Transl Pediatr 2021; 10:3130-3139. [PMID: 35070826 PMCID: PMC8753471 DOI: 10.21037/tp-21-386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/01/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND HNF1B deletion/intragenic mutations are the most commonly identified genetic cause of congenital anomalies of the kidney and urinary tract (CAKUT) suggested by fetal ultrasound findings such as: parenchymal hyperechogenicity, overt cystic changes or gross morphological urinary system (UT) abnormalities. The postnatal evolution of these 17q12 deletions encompassing the HNF1B gene-associated findings has not been assessed in depth. METHODS In this observational study, we present postnatal follow-up findings in 5 of 6 cases (one pregnancy was terminated on parental request) of fetal-onset cystic/hyperechogenic kidneys eventually diagnosed with 17q12 microdeletion encompassing the HNF1B gene between 2009 and 2017. RESULTS Complete normalization of kidney parenchymal abnormalities and of depressed neonatal renal function was observed in 4/5 and 5/5 patients within 2-4.9 years and 1.5-8 months, respectively. All 5 patients had preserved normal renal function at 3-11 years of follow-up. The evolving later-onset renal features included: hypomagnesemia, hyperuricemia, urinary tract infection (UTI), and bilateral grade 3-4 vesicoureteral reflux and bladder diverticula in 3, 3, 2, and 1 patient, respectively. HNF1B gene deletion-associated extra-renal manifestations with delayed presentation were global developmental delay/autistic spectrum disorder (ASD), rolandic-type seizures, overweight, and borderline fasting hyperglycemia observed in 1-2 patients each. Family history was positive for small-size or asymptomatic cystic kidneys with normal function, diabetes mellitus, seizures, and mental/psychiatric problems in 3/6 cases. CONCLUSIONS Fetal-onset HNF1B deletion-associated kidneys' parenchymal abnormalities confirmed postnatally with initially depressed renal function might undergo complete resolution within several years and few months, respectively. However, later-onset urinary tract, metabolic, and neurodevelopmental features of this mutation might appear over years. Therefore, genetic molecular evaluation/diagnosis and continuous follow-up for evolving features are mandatory in affected children.
Collapse
Affiliation(s)
- Roxana Cleper
- Pediatric Nephrology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Reches
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dana Shapira
- Pediatric Nephrology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Simchoni
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lewis Reisman
- Pediatric Nephrology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Liat Ben-Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Radiology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yuval Yaron
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Igal Wolman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gustavo Malinger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dana Brabbing-Goldstein
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Shay Ben-Shachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
21
|
Yaron Y, Borrell A. Reply: cfDNA testing in recurrent pregnancy loss: a new step in the right way but still raw for the clinical area. Hum Reprod 2021; 36:829-830. [PMID: 33378533 DOI: 10.1093/humrep/deaa360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Antoni Borrell
- BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| |
Collapse
|
22
|
Peng S, Bhatt S, Borrell A, Yaron Y. Economic impact of using maternal plasma cell-free DNA testing to guide further workup in recurrent pregnancy loss. Prenat Diagn 2021; 41:1215-1221. [PMID: 34002411 PMCID: PMC8518071 DOI: 10.1002/pd.5972] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/24/2020] [Revised: 03/02/2021] [Accepted: 05/08/2021] [Indexed: 11/15/2022]
Abstract
Objective We have previously demonstrated that maternal‐plasma cell‐free DNA (cfDNA)‐testing can detect chromosomal anomalies in recurrent pregnancy loss (RPL) with 81.8% sensitivity and 90.3% specificity. Here we assess whether this is cost effective in guiding further workup in RPLs. Method A decision‐analytic model was developed to compare the cost of various RPL management pathways: (1) current American Society for Reproductive Medicine (ASRM) RPL workup; (2) microarray or karyotyping analysis of products of conception (POCs) and RPL workup only for euploid cases; and (3) cfDNA testing and RPL workup only for euploid cases. Sample accessibility, failure rates, and sensitivity were specified for each test. Costs of sample collection, genetic tests, and RPL workup were considered. Analysis outcomes included detection rate of chromosomal anomaly and cost per patient tested. Results In comparison to existing cytogenetic testing on POCs, cfDNA testing pathway allowed for better sample accessibility with a lower cost per patient. In addition, using cfDNA to guide further workup significantly increases the number of causative fetal chromosome anomalies detected, reducing the number of patients undergoing unnecessary workup resulting in an overall cost savings. Conclusion Our study showed that inclusion of cfDNA testing is a cost‐effective approach to guide RPL workup.
What is already known about this topic?
Chromosomal anomalies account for 50%–70% of early pregnancy loss (EPL) and even in recurrent pregnancy loss (RPL) random aneuploidy is the single most common etiology, accounting for >50% of cases. In a previous study we have shown that maternal‐plasma genome‐wide cell‐free DNA (cfDNA)‐based testing can reliably detect chromosomal anomalies in random EPL and RPL with a sensitivity of 81.8% and a specificity of 90.3%. We therefore suggested cfDNA‐based testing serve to guide further management in cases of RPL: if cfDNA in the second and subsequent RPL demonstrates aneuploidy, no further action is taken; if an unbalanced rearrangement is found, parental karyotyping is recommended; if no abnormality is detected, the recommended RPL workup is performed.
What does this study add?
In this study we demonstrate that using cfDNA to guide further workup in RPL is a cost‐effective approach. We share our algorithm to facilitate local cost‐effectiveness analysis based on prevailing billing schemes, either based on national health systems or private payor systems.
Collapse
Affiliation(s)
- Siyang Peng
- Illumina Inc., San Diego, CA, United States of America
| | - Sucheta Bhatt
- Illumina Inc., San Diego, CA, United States of America
| | - Antoni Borrell
- BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
23
|
Yaron Y, Pauta M, Badenas C, Soler A, Borobio V, Illanes C, Paz-Y-Miño F, Martinez-Portilla R, Borrell A. Maternal plasma genome-wide cell-free DNA can detect fetal aneuploidy in early and recurrent pregnancy loss and can be used to direct further workup. Hum Reprod 2021; 35:1222-1229. [PMID: 32386059 PMCID: PMC7259365 DOI: 10.1093/humrep/deaa073] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 03/15/2020] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Can maternal plasma cell-free DNA (cfDNA) detect chromosomal anomalies in early pregnancy loss (EPL) and recurrent pregnancy loss (RPL)? SUMMARY ANSWER Genome-wide cfDNA testing can serve as an alternative to cytogenetic analysis in products of conception (POCs) in RPLs and can guide further management. WHAT IS KNOWN ALREADY Random chromosomal anomalies are the single most common cause for EPL and RPL. Cytogenetic analysis in POCs may be used to direct management in RPL because the detection of random chromosomal anomalies can eliminate further unwarranted testing. STUDY DESIGN, SIZE, DURATION This was a prospective diagnostic test study from March 2018 to January 2019 of 109 patients experiencing pregnancy loss before 14 weeks gestation at a tertiary-care academic medical center. PARTICIPANTS/MATERIALS, SETTING, METHODS Blood samples were drawn for genome-wide cfDNA testing prior to chorionic villous sampling for cytogenetic analysis of POCs with both short-term cultures (STCs) and long-term cultures (LTCs). Final analysis included 86 patients with non-mosaic cytogenetic results in POCs and available cfDNA results. Aneuploidy detection rates by cfDNA testing and POC cytogenetic analysis were compared. The first 50 samples served as the Training Set to establish pregnancy loss-specific log-likelihood ratio (LLR) thresholds using receiver-operator characteristic (ROC)-like analyses. These were then used for the entire cohort. MAIN RESULTS AND THE ROLE OF CHANCE Seventy-eight samples (71.5%) had results available from both STC and LTC; 12 samples (11%) had a result from STC only, and 7 samples (6.4%) had a result from LTC only. A chromosomal anomaly was detected in 55/86 (64%). The rates of chromosomal anomalies were 61, 72, 73 and 44% in patients undergoing their first, second, third and ≥4th pregnancy losses, respectively. The median cfDNA fetal fraction was 5%. With standard LLR thresholds used for noninvasive prenatal screening, the sensitivity of cfDNA in detecting aneuploidy was 55% (30/55) and with a specificity of 100% (31/31). Using pregnancy loss-specific LLR thresholds, the sensitivity of cfDNA in detecting aneuploidy was 82% (45/55), with a specificity of 90% (28/31). The positive and negative likelihood ratios were 8.46 and 0.20, respectively. Fetal sex was correctly assigned in all cases. LIMITATIONS, REASONS FOR CAUTION Cases with a false-positive result by cfDNA analysis would not receive the indicated RPL workup. Specificity could be improved by using a fetal fraction (FF) cutoff of 4%, but this would result in exclusion of more than a quarter of cases. WIDER IMPLICATIONS OF THE FINDINGS cfDNA-based testing can serve as an alternative to POC cytogenetic analysis and can guide further RPL management: if cfDNA demonstrates aneuploidy, no further action is taken and if no abnormality is detected, the recommended RPL workup is performed. STUDY FUNDING/COMPETING INTEREST(S) Cell-free DNA testing was funded by Illumina, Inc., San Diego, CA. Y.Y. is a member of Illumina’s Clinical Expert Panel and has received travel grants. A.B. has received travel grants from Illumina. All authors have no competing interest to declare.
Collapse
Affiliation(s)
- Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Sourasky Medical Center, Tel Aviv, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Montse Pauta
- Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Celia Badenas
- Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Anna Soler
- Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Virginia Borobio
- Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Carmen Illanes
- Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain
| | - Fernanda Paz-Y-Miño
- Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain
| | | | - Antoni Borrell
- Department of Maternal-Fetal Medicine, BCNatal, Hospital Clinic, Barcelona, Catalonia, Spain.,BCNatal, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| |
Collapse
|
24
|
Brabbing-Goldstein D, Yaron Y, Reches A. Familial Beckwith-Wiedemann syndrome: Prenatal manifestation and a possible expansion of the phenotype. Eur J Med Genet 2021; 64:104137. [PMID: 33421606 DOI: 10.1016/j.ejmg.2021.104137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 10/19/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022]
Abstract
We describe a case of Beckwith-Wiedemann syndrome (BWS) demonstrating pre- and post-natal intra-familial variability. Our first encounter with the family occurred in the 1990s following the birth of 3 affected offspring. The first two pregnancies presented with exomphalos and elevated second trimester maternal serum alpha-fetoprotein (msAFP, 3.43 and 4.01 MOM, respectively) as well as elevated maternal human chorionic gonadotrophin (mhCG, 4.33 and 8.8 MOM, respectively). The diagnosis of BWS was confirmed postnatally in both cases. The third ongoing pregnancy presented only with elevated mhCG (7.09 MOM) and no malformation. Nonetheless BWS was suspected. The diagnosis was confirmed postnatally with clinical manifestations including macroglossia and cleft palate. Two affected female siblings were also diagnosed with Mullerian agenesis in adulthood. Suspecting a common genetic etiology, sequencing of the CDKN1C gene revealed a maternally inherited, likely pathogenic variant (NM_000076.2: c.367_385del; p.(Ala123Serfs*143)) causative of BWS. Chromosomal microarray and whole exome sequencing did not reveal any other pathogenic variant that would explain the Mullerian agenesis. One of the affected females underwent successful preimplantation genetic testing (PGT) with a surrogate and gave birth to a healthy female. To the best of our knowledge, this is the first report of Mullerian agenesis as a possible rare expansion of the BWS phenotype. In addition, this case highlights the potential role of abnormal second trimester biochemical markers (msAFP, mHCG) as possible indicators of BWS, especially in familial cases.
Collapse
Affiliation(s)
- Dana Brabbing-Goldstein
- Genetic Institute at Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv, Israel.
| | - Yuval Yaron
- Genetic Institute at Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Reches
- Genetic Institute at Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv, Israel
| |
Collapse
|
25
|
Palomaki GE, Chiu RWK, Pertile MD, Sistermans EA, Yaron Y, Vermeesch JR, Vora NL, Best RG, Wilkins-Haug L. International Society for Prenatal Diagnosis Position Statement: cell free (cf)DNA screening for Down syndrome in multiple pregnancies. Prenat Diagn 2020; 41:1222-1232. [PMID: 33016373 DOI: 10.1002/pd.5832] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Women & Infants Hospital and the Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - Rossa W K Chiu
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mark D Pertile
- Victorian Clinical Genetics Services (VCGS), Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Erik A Sistermans
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Medical Center, Faculty of Medicine Tel Aviv University, Tel Aviv, Israel
| | | | - Neeta L Vora
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert G Best
- University of South Carolina SOM Greenville, Greenville, South Carolina, USA
| | - Louise Wilkins-Haug
- Division of Maternal Fetal Medicine and Reproductive Genetics, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
26
|
Benachi A, Caffrey J, Calda P, Carreras E, Jani JC, Kilby MD, Klein HG, Rizzo G, Yaron Y. Understanding attitudes and behaviors towards cell-free DNA-based noninvasive prenatal testing (NIPT): A survey of European health-care providers. Eur J Med Genet 2020; 63:103616. [PMID: 30654154 DOI: 10.1016/j.ejmg.2019.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/25/2018] [Accepted: 01/12/2019] [Indexed: 02/07/2023]
Abstract
Cell-free DNA-based noninvasive prenatal testing (cfDNA) is a relatively new screening tool that analyzes cfDNA circulating in maternal plasma to screen for aneuploidies. Since its introduction, cfDNA has been rapidly adopted by health care providers (HCPs). This rapid adoption, as well as progressive developments in the technology, requires professional societies to continuously update their guidelines to indicate the broadening scope both in terms of test indications and patient populations for whom it has become the appropriate primary test. CfDNA testing, initially applied to high-risk patients, is now largely considered an option for all patients. For HCPs, the rapid introduction of cfDNA into clinical practice has come with the requirement to stay up-to-date and accurately informed. We performed a survey to understand the current practices and views of European HCPs on the use of cfDNA. European HCPs were surveyed on several topics such as familiarity with cfDNA-based noninvasive prenatal testing (NIPT), current usage, patient counseling, test menu expansion, and future perspectives. The results of this survey demonstrate increasing usage and awareness of cfDNA-based NIPT in five European countries (UK, France, Germany, Spain and Italy). Major barriers to implementation include cost and a lack of physician education on NIPT.
Collapse
Affiliation(s)
- Alexandra Benachi
- Service de Gynécologie-Obstétrique. AP-HP, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France
| | | | - Pavel Calda
- Fetal Medicine Center. First Medical Faculty, Charles University and General Teaching Hospital, Prague, Czech Republic
| | - Elena Carreras
- Department of Obstetrics, Hospital Universitari, Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mark D Kilby
- Centre for Women's & Newborn Health, Institute of Metabolism & Systems Research, University of Birmingham and Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Birmingham, UK
| | - Hanns-Georg Klein
- Center for Human Genetics and Laboratory Diagnostics, Dr. Klein, Dr. Rost & Colleagues, Martinsried, Germany
| | - Giuseppe Rizzo
- Università di Roma Tor Vergata, Department of Maternal ad Fetal Medicine, Ospedale Cristo Re, Rome, Italy; The First I.M. Sechenov Moscow State Medical University, Department of Obstetrics and Gynecology, Moscow, Russia
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Medical Center, Tel Aviv, Israel.
| |
Collapse
|
27
|
Shoham G, Levy-Toledano R, Leong M, Weissman A, Yaron Y, Shoham Z. Oncofertility: insights from IVF specialists-a worldwide web-based survey analysis. J Assist Reprod Genet 2019; 36:1013-1021. [PMID: 30788661 DOI: 10.1007/s10815-019-01419-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This research sought to understand IVF-physicians' knowledge of, experience with, and attitudes toward fertility preservation for cancer patients. METHODS A 35-question, self-report survey request was emailed to IVF providers who were registered on the IVF-Worldwide.com network (3826 clinics). Physicians submitted responses on the IVF-Worldwide.com website. Survey results were reported as a proportion of the responding clinics. RESULTS Survey responses were completed by 321 (8.4%) globally distributed IVF clinics, representing 299,800 IVF cycles. Of these clinics, 86.6% (278) performed fertility preservation, treating approximately 6300 patients annually. However, 18.4% of the centers reported that patients sought advice independently, without an oncologist's referral. Ovarian tissue cryopreservation was performed by 37.7% of the clinics, yet 52.6% considered the procedure experimental. IVM was performed by 16.5% of responding clinics. A majority (63.6%) of the clinics selected treatment protocols based on each patient's malignancy. Most respondents (76.3%) disagreed that fertility preservation was not yet successful enough to make it an available option. However, 44.2% believed that pregnancy rates following oocyte cryopreservation could not be determined because not enough oocyte cryopreservation patients had completed embryo transfer. CONCLUSIONS Most clinics performed fertility preservation, tailoring protocols to each patient's disease and condition. Almost 20% of patients sought advice independently, indicating that more effort is needed to encourage oncologists to refer patients. Most survey respondents believed that data was not yet available on either live birth outcomes or the best protocol for each disease. Therefore, long-term study must continue, with the establishment of interim milestones and an outcome-tracking registry.
Collapse
Affiliation(s)
- Gon Shoham
- Sackler Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv, 69978, Tel Aviv, Israel. .,School of Electrical Engineering, Wolfson Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.
| | | | - Milton Leong
- IVF Clinic, The Women's Clinic, 12/F, Central Tower, 28 Queen's Road Central, Central, Hong Kong
| | - Ariel Weissman
- Sackler Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv, 69978, Tel Aviv, Israel.,IVF Unit, Department of Obstetrics & Gynecology, Edith Wolfson Medical Center, Ha-Lokhamim St 62, 5822012, Holon, Israel
| | - Yuval Yaron
- Sackler Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv, 69978, Tel Aviv, Israel.,Prenatal Genetic Diagnosis Unit, Genetics Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Blvd., Tel Aviv, Israel
| | - Zeev Shoham
- The Reproductive Medicine and IVF Unit, Kaplan Medical Center, 76100, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Ein Kerem, P.O. Box 12271, 9112102, Jerusalem, Israel
| |
Collapse
|
28
|
Reches A, Hiersch L, Simchoni S, Barel D, Greenberg R, Ben Sira L, Malinger G, Yaron Y. Whole-exome sequencing in fetuses with central nervous system abnormalities. J Perinatol 2018; 38:1301-1308. [PMID: 30108342 DOI: 10.1038/s41372-018-0199-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/03/2018] [Accepted: 07/09/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We describe our experience with whole-exome sequencing (WES) in fetuses with central nervous system (CNS) abnormalities following a normal chromosomal microarray result. METHODS During the study period (2014-2017) 7 cases (9 fetuses) with prenatally diagnosed CNS abnormality, whose chromosomal microarray analysis was negative, were offered whole-exome sequencing analysis. RESULTS A pathogenic or a likely pathogenic variant was found in 5 cases including a previously described, likely pathogenic de novo TUBA1A variant (Case #1); a previously described homozygous VRK1 variant (Case #2); an X-linked ARX variant (Case #3); a likely pathogenic heterozygous variant in the TUBB3 gene (Case #5). Finally, in two fetuses of the same couple (Case #6), a compound heterozygous state was detected, consisting of the NPHP1 gene deletion and a sequence variant of uncertain significance. Two additional cases had normal WES results. CONCLUSION Whole-exome sequencing may improve prenatal diagnosis in fetuses with CNS abnormalities.
Collapse
Affiliation(s)
- Adi Reches
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Liran Hiersch
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel. .,Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
| | - Sharon Simchoni
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Dalit Barel
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Rotem Greenberg
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Liat Ben Sira
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.,Radiology Department, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Gustavo Malinger
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| |
Collapse
|
29
|
Grati FR, Gallazzi G, Branca L, Maggi F, Simoni G, Yaron Y. Response: how PGS/PGT-A laboratories succeeded in losing all credibility. Reprod Biomed Online 2018; 37:246. [PMID: 30075842 DOI: 10.1016/j.rbmo.2018.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Francesca Romana Grati
- Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A., Busto Arsizio VA, Italy.
| | - Gloria Gallazzi
- Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A., Busto Arsizio VA, Italy
| | - Lara Branca
- Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A., Busto Arsizio VA, Italy
| | - Federico Maggi
- Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A., Busto Arsizio VA, Italy
| | - Giuseppe Simoni
- Cytogenetics and Medical Genetics Unit, TOMA Advanced Biomedical Assays S.p.A., Busto Arsizio VA, Italy
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
30
|
Grati FR, Gallazzi G, Branca L, Maggi F, Simoni G, Yaron Y. Response: scoring of mosaic embryos after preimplantation genetic testing – the rollercoaster ride between fear, hope and embryo wastage. Reprod Biomed Online 2018; 37:122. [DOI: 10.1016/j.rbmo.2018.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/19/2018] [Indexed: 10/17/2022]
|
31
|
Grati FR, Gallazzi G, Branca L, Maggi F, Simoni G, Yaron Y. An evidence-based scoring system for prioritizing mosaic aneuploid embryos following preimplantation genetic screening. Reprod Biomed Online 2018; 36:442-449. [DOI: 10.1016/j.rbmo.2018.01.005] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 12/29/2022]
|
32
|
Svirsky R, Brabbing-Goldstein D, Rozovski U, Kapusta L, Reches A, Yaron Y. The genetic and clinical outcome of isolated fetal muscular ventricular septal defect (VSD). J Matern Fetal Neonatal Med 2018; 32:2837-2841. [DOI: 10.1080/14767058.2018.1449829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Ran Svirsky
- Prenatal Genetic Diagnosis Unit & Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Obstetrics And Gynecology, Assaf Harofe Medical Center, Zrifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Brabbing-Goldstein
- Prenatal Genetic Diagnosis Unit & Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Uri Rozovski
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Davidoff Cancer Center, Institute of Hematology, Beilinson Hospital, Tel Aviv, Israel
| | - Livia Kapusta
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Children’s Heart Center, Amalia Children’s Hospital, Radboud University Medical Centre, Nijmegen, The Netherlands
- Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Reches
- Prenatal Genetic Diagnosis Unit & Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit & Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
33
|
Brabbing-Goldstein D, Reches A, Svirsky R, Bar-Shira A, Yaron Y. Dilemmas in genetic counseling for low-penetrance neuro-susceptibility loci detected on prenatal chromosomal microarray analysis. Am J Obstet Gynecol 2018; 218:247.e1-247.e12. [PMID: 29146387 DOI: 10.1016/j.ajog.2017.11.559] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/14/2017] [Accepted: 11/06/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chromosomal microarray analysis is standard of care in fetuses with malformations, detecting clinically significant copy number variants in 5-7% of cases over conventional karyotyping. However, it also detects variants of uncertain significance in 1.6-4.2% of the cases, some of which are low-penetrance neuro-susceptibility loci. The interpretation of these variants in pregnancy is particularly challenging because the significance is often unclear and the clinical implications may be difficult to predict. OBJECTIVE The purpose of this study was to describe counseling dilemmas regarding low-penetrance neuro-susceptibility loci that are detected by prenatal chromosomal microarray analysis. STUDY DESIGN During the study period (January 2014 to December 2015), 700 prenatal chromosomal microarray analyses were performed. Cases were categorized as "indicated" (n=375) if there were abnormal sonographic findings or suggestive medical history and "patient choice" (n=325) in the presence of a structurally normal fetus with no other particular indication. The laboratory reported on copy number variants ≥400 Kb in size in loci known to be associated with genetic syndromes and ≥1 Mb in other areas of genome. Results were classified as gross aneuploidy, copy number variants, and normal. Copy number variants were categorized according to the American College of Medical Genetics standards and guidelines: pathogenic, variants of uncertain significance, or benign. Variants of uncertain significance were further subdivided into categories of likely pathogenic, variants of uncertain significance with no subclassification, and likely benign. Statistical analysis was performed with the use of Chi square test and Fisher's exact test to compare intergroup differences in incidence of the different result categories and demographic data. RESULTS Patient choice cases became more prevalent with time (35.5% in the beginning of the study, compared with 48.4% at the end of the study period). Clinically significant copy number variants were found in 14 of 375 (3.7%) of indicated cases vs only 2 of 325 (0.6%) of patient choice cases (P=.009). All "likely benign" variants consisted of low-penetrance neuro-susceptibility loci. The incidence thereof was similar between the indicated and patient choice groups (3.7% vs 3.4%; P=.85). In the indicated group, some variants of uncertain significance may have contributed to the abnormal anatomic findings. Conversely, in the patient choice group, the finding of low-penetrance neuro-susceptibility loci was often unexpected and confounding for prospective parents. CONCLUSION Prenatal chromosomal microarray analysis added clinically significant information in both groups. However, it also detected low-penetrance neuro-susceptibility loci in approximately 3.5% of the cases. This fact should be conveyed during pretest counseling to allow patients to make informed choices, particularly when chromosomal microarray is to be performed for patient choice.
Collapse
|
34
|
Schlumberger M, Elisei R, Müller S, Schöffski P, Brose M, Shah M, Licitra L, Krajewska J, Kreissl MC, Niederle B, Cohen EEW, Wirth L, Ali H, Clary DO, Yaron Y, Mangeshkar M, Ball D, Nelkin B, Sherman S. Overall survival analysis of EXAM, a phase III trial of cabozantinib in patients with radiographically progressive medullary thyroid carcinoma. Ann Oncol 2017; 28:2813-2819. [PMID: 29045520 PMCID: PMC5834040 DOI: 10.1093/annonc/mdx479] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Primary analysis of the double-blind, phase III Efficacy of XL184 (Cabozantinib) in Advanced Medullary Thyroid Cancer (EXAM) trial demonstrated significant improvement in progression-free survival with cabozantinib versus placebo in patients with progressive medullary thyroid cancer (MTC). Final analysis of overall survival (OS), a key secondary endpoint, was carried out after long-term follow-up. PATIENTS AND METHODS EXAM compared cabozantinib with placebo in 330 patients with documented radiographic progression of metastatic MTC. Patients were randomized (2:1) to cabozantinib (140 mg/day) or placebo. Final OS and updated safety data are reported. RESULTS Minimum follow-up was 42 months. Kaplan-Meier analysis showed a 5.5-month increase in median OS with cabozantinib versus placebo (26.6 versus 21.1 months) although the difference did not reach statistical significance [stratified hazard ratio (HR), 0.85; 95% confidence interval (CI), 0.64-1.12; P = 0.24]. In an exploratory assessment of OS, progression-free survival, and objective response rate, cabozantinib appeared to have a larger treatment effect in patients with RET M918T mutation-positive tumors compared with patients not harboring this mutation. For patients with RET M918T-positive disease, median OS was 44.3 months for cabozantinib versus 18.9 months for placebo [HR, 0.60; 95% CI, 0.38-0.94; P = 0.03 (not adjusted for multiple subgroup analyses)], with corresponding values of 20.2 versus 21.5 months (HR, 1.12; 95% CI, 0.70-1.82; P = 0.63) in the RET M918T-negative subgroup. Median treatment duration was 10.8 months with cabozantinib and 3.4 months with placebo. The safety profile for cabozantinib remained consistent with that of the primary analysis. CONCLUSION The secondary end point was not met in this final OS analysis from the trial of cabozantinib in patients with metastatic, radiographically progressive MTC. A statistically nonsignificant increase in OS was observed for cabozantinib compared with placebo. Exploratory analyses suggest that patients with RET M918T-positive tumors may experience a greater treatment benefit with cabozantinib. TRIAL REGISTRATION NUMBER NCT00704730.
Collapse
Affiliation(s)
- M Schlumberger
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy and University Paris-Saclay, Villejuif, France.
| | - R Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Müller
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - P Schöffski
- Department of General Medical Oncology, KU Leuven, Leuven; Laboratory of Experimental Oncology at the University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - M Brose
- Department of Otorhinolaryngology: Head and Neck Surgery, Abramson Cancer Center of the University of Pennsylvania, Philadelphia
| | - M Shah
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - L Licitra
- IRCCS Foundation, National Cancer Institute, Milan; University of Milan, Milan, Italy
| | - J Krajewska
- Maria Skłodowska-Curie Memorial Institute - Cancer Center Gliwice Branch, Gliwice, Poland
| | - M C Kreissl
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - B Niederle
- Division of Surgical Endocrinology, Medical University of Vienna, Vienna, Austria
| | - E E W Cohen
- University of California San Diego Moores Cancer Center, La Jolla
| | - L Wirth
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston
| | - H Ali
- Henry Ford Health System, Detroit
| | | | - Y Yaron
- Exelixis, Inc, South San Francisco
| | | | - D Ball
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore
| | - B Nelkin
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore
| | - S Sherman
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, USA
| |
Collapse
|
35
|
Grande M, Stergiotou I, Pauta M, Marquès B, Badenas C, Soler A, Yaron Y, Borrell A. Parental Origin of the Retained X Chromosome in Monosomy X Miscarriages and Ongoing Pregnancies. Fetal Diagn Ther 2017; 45:118-124. [DOI: 10.1159/000480499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/22/2017] [Indexed: 11/19/2022]
|
36
|
Weissman A, Shoham G, Shoham Z, Fishel S, Leong M, Yaron Y. Preimplantation genetic screening: results of a worldwide web-based survey. Reprod Biomed Online 2017; 35:693-700. [PMID: 28988928 DOI: 10.1016/j.rbmo.2017.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 12/12/2022]
Abstract
Our objective was to evaluate and characterize the extent and patterns of worldwide usage of preimplantation genetic screening (PGS) among the assisted reproductive technique community. A prospective, web-based questionnaire with questions relating to practices of, and views on, PGS was directed to users and non-users of PGS. A total of 386 IVF units from 70 countries conducting 342,600 IVF cycles annually responded to the survey. A total of 77% of respondents routinely carry out PGS in their clinics for a variety of indications: advanced maternal age (27%), recurrent implantation failure (32%) and recurrent pregnancy loss (31%). Few (6%) offer PGS to all their patients. In most cycles (72%), trophectoderm biopsy is carried out and either array-comparative genomic hybridization (59%) or next-generation sequencing (16%) are used for genetic analysis. Only 30% of respondents regard PGS as clearly evidenced-based, and most (84%) believe that more randomized controlled trials are needed to support the use of PGS. Despite ongoing debate and lack of robust evidence, most respondents support the use of PGS, and believe that it may aid in transferring only euploid embryos, thereby reducing miscarriage rates and multiple pregnancies, increasing live birth rates and reducing the risk of aneuploid pregnancies and births.
Collapse
Affiliation(s)
- Ariel Weissman
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, 62 Halochamim Street, Holon, 5822012, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 6997801, Israel.
| | - Gon Shoham
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 6997801, Israel
| | - Zeev Shoham
- IVF Unit, Kaplan Hospital, Rehovot, 7661041, Israel; Hadassah Medical School, Affiliated to the Hebrew University, Jerusalem, Israel
| | - Simon Fishel
- CARE Fertility Group, John Webster House, 6 Lawrence Drive, Nottingham Business Park, Nottingham, NG14 5GU, UK
| | - Milton Leong
- The IVF Clinic, 13/F Central Tower, 28 Queens Road Central, Hong Kong, China
| | - Yuval Yaron
- IVF Unit, Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, 62 Halochamim Street, Holon, 5822012, Israel; Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel
| |
Collapse
|
37
|
Svirsky R, Reches A, Brabbing-Goldstein D, Bar-Shira A, Yaron Y. Cover Image, Volume 37, Issue 8. Prenat Diagn 2017. [DOI: 10.1002/pd.4899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
38
|
Svirsky R, Reches A, Brabbing-Goldstein D, Bar-Shira A, Yaron Y. Association of aberrant right subclavian artery with abnormal karyotype and microarray results. Prenat Diagn 2017; 37:808-811. [DOI: 10.1002/pd.5092] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/26/2017] [Accepted: 06/11/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Ran Svirsky
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Adi Reches
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Dana Brabbing-Goldstein
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Anat Bar-Shira
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit & Genetic Institute; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
39
|
Malcov M, Gold V, Peleg S, Frumkin T, Azem F, Amit A, Ben-Yosef D, Yaron Y, Reches A, Barda S, Kleiman SE, Yogev L, Hauser R. Improving preimplantation genetic diagnosis (PGD) reliability by selection of sperm donor with the most informative haplotype. Reprod Biol Endocrinol 2017; 15:31. [PMID: 28446182 PMCID: PMC5405512 DOI: 10.1186/s12958-017-0247-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study is aimed to describe a novel strategy that increases the accuracy and reliability of PGD in patients using sperm donation by pre-selecting the donor whose haplotype does not overlap the carrier's one. METHODS A panel of 4-9 informative polymorphic markers, flanking the mutation in carriers of autosomal dominant/X-linked disorders, was tested in DNA of sperm donors before PGD. Whenever the lengths of donors' repeats overlapped those of the women, additional donors' DNA samples were analyzed. The donor that demonstrated the minimal overlapping with the patient was selected for IVF. RESULTS In 8 out of 17 carriers the markers of the initially chosen donors overlapped the patients' alleles and 2-8 additional sperm donors for each patient were haplotyped. The selection of additional sperm donors increased the number of informative markers and reduced misdiagnosis risk from 6.00% ± 7.48 to 0.48% ±0.68. The PGD results were confirmed and no misdiagnosis was detected. CONCLUSIONS Our study demonstrates that pre-selecting a sperm donor whose haplotype has minimal overlapping with the female's haplotype, is critical for reducing the misdiagnosis risk and ensuring a reliable PGD. This strategy may contribute to prevent the transmission of affected IVF-PGD embryos using a simple and economical procedure. TRIAL REGISTRATION All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. DNA testing of donors was approved by the institutional Helsinki committee (registration number 319-08TLV, 2008). The present study was approved by the institutional Helsinki committee (registration number 0385-13TLV, 2013).
Collapse
Affiliation(s)
- Mira Malcov
- 0000 0004 1937 0546grid.12136.37Wolfe PGD-Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Veronica Gold
- 0000 0004 1937 0546grid.12136.37Wolfe PGD-Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Peleg
- 0000 0004 1937 0546grid.12136.37Wolfe PGD-Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tsvia Frumkin
- 0000 0004 1937 0546grid.12136.37Wolfe PGD-Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- 0000 0004 1937 0546grid.12136.37Wolfe PGD-Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ami Amit
- 0000 0004 1937 0546grid.12136.37Wolfe PGD-Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dalit Ben-Yosef
- 0000 0004 1937 0546grid.12136.37Wolfe PGD-Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Yaron
- 0000 0004 1937 0546grid.12136.37Prenatal Diagnosis Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Reches
- 0000 0004 1937 0546grid.12136.37Wolfe PGD-Stem Cell Lab, Racine IVF Unit Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- 0000 0004 1937 0546grid.12136.37Prenatal Diagnosis Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimi Barda
- 0000 0004 1937 0546grid.12136.37The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906 Israel
| | - Sandra E. Kleiman
- 0000 0004 1937 0546grid.12136.37The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906 Israel
| | - Leah Yogev
- 0000 0004 1937 0546grid.12136.37The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906 Israel
| | - Ron Hauser
- 0000 0004 1937 0546grid.12136.37The Institute for the Study of Fertility, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, 6423906 Israel
| |
Collapse
|
40
|
Artieri CG, Haverty C, Evans EA, Goldberg JD, Haque IS, Yaron Y, Muzzey D. Noninvasive prenatal screening at low fetal fraction: comparing whole-genome sequencing and single-nucleotide polymorphism methods. Prenat Diagn 2017; 37:482-490. [PMID: 28317136 DOI: 10.1002/pd.5036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/15/2017] [Accepted: 03/14/2017] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Performance of noninvasive prenatal screening (NIPS) methodologies when applied to low fetal fraction samples is not well established. The single-nucleotide polymorphism (SNP) method fails samples below a predetermined fetal fraction threshold, whereas some laboratories employing the whole-genome sequencing (WGS) method report aneuploidy calls for all samples. Here, the performance of the two methods was compared to determine which approach actually detects more fetal aneuploidies. METHODS Computational models were parameterized with up-to-date published data and used to compare the performance of the two methods at calling common fetal trisomies (T21, T18, T13) at low fetal fractions. Furthermore, clinical experience data were reviewed to determine aneuploidy detection rates based on compliance with recent invasive screening recommendations. RESULTS The SNP method's performance is dependent on the origin of the trisomy, and is lowest for the most common trisomies (maternal M1 nondisjunction). Consequently, the SNP method cannot maintain acceptable performance at fetal fractions below ~3%. In contrast, the WGS method maintains high specificity independent of fetal fraction and has >80% sensitivity for trisomies in low fetal fraction samples. CONCLUSION The WGS method will detect more aneuploidies below the fetal fraction threshold at which many labs issue a no-call result, avoiding unnecessary invasive procedures. © 2017 Counsyl Inc. Prenatal Diagnosis published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | | | - Eric A Evans
- Counsyl Inc., South San Francisco, California, USA
| | | | - Imran S Haque
- Counsyl Inc., South San Francisco, California, USA.,Freenome, South San Francisco, California, USA
| | - Yuval Yaron
- Genetic Institute, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine Tel Aviv University, Israel
| | - Dale Muzzey
- Counsyl Inc., South San Francisco, California, USA
| |
Collapse
|
41
|
Weissman A, Shoham G, Shoham Z, Fishel S, Leong M, Yaron Y. Chromosomal mosaicism detected during preimplantation genetic screening: results of a worldwide Web-based survey. Fertil Steril 2017; 107:1092-1097. [PMID: 28433368 DOI: 10.1016/j.fertnstert.2017.02.119] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/12/2017] [Accepted: 02/27/2017] [Indexed: 11/24/2022]
Abstract
Embryonic mosaicism, the presence of more than one distinct cell line within an embryo, has recently become the focus of growing attention and controversy in the context of preimplantation genetic screening (PGS). To evaluate the extent of mosaic aneuploidy in clinical practice and to gain insight on the practices and views regarding this issue, we conducted a survey using a prospective, 20-item Web-based questionnaire with questions related to practices and views regarding mosaicism in PGS. A total of 102 in vitro fertilization (IVF) units from 32 countries that performed 108,900 IVF cycles annually responded to the survey. More than half responded that embryonic mosaic aneuploidy is reported by the laboratory, but 31.9% stated that samples are reported as euploid or aneuploid only. If mosaic aneuploidy is reported, 46% stated that it was present in ≤10% of the embryos. More than two-thirds were of the opinion that next-generation sequencing is required to reliably detect mosaicism. Among centers performing PGS, 47.9% consider embryonic mosaicism when detected in >20% of the cells, and nearly two-thirds believe that mosaic aneuploid embryos should be stored for potential therapeutic use after extensive and appropriate counseling. In summary, mosaicism has always existed in preimplantation embryos, and new technologies can now detect its presence with higher resolution. More studies are needed before definite conclusions can be drawn.
Collapse
Affiliation(s)
- Ariel Weissman
- IVF Unit, Department of Obstetrics & Gynaecology, Edith Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gon Shoham
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zeev Shoham
- Reproductive Medicine Unit, Kaplan Medicine Center, Rehovot, Israel; Hadassah Medical School, Affiliated to the Hebrew University, Jerusalem, Israel
| | - Simon Fishel
- CARE Fertility Group, John Webster House, Nottingham, United Kingdom
| | | | - Yuval Yaron
- IVF Unit, Department of Obstetrics & Gynaecology, Edith Wolfson Medical Center, Holon, Israel; Prenatal Genetic Diagnosis Unit, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
42
|
Griffin DK, Fishel S, Gordon T, Yaron Y, Grifo J, Hourvitz A, Rechitsky S, Elson J, Blazek J, Fiorentino F, Treff N, Munne S, Leong M, Schmutzler A, Vereczkey A, Ghobara T, Nánássy L, Large M, Hamamah S, Anderson R, Gianaroli L, Wells D. Continuing to deliver: the evidence base for pre-implantation genetic screening. BMJ 2017; 356:j752. [PMID: 28196796 DOI: 10.1136/bmj.j752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Yuval Yaron
- Unit for Prenatal Genetic Diagnosis, Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Jamie Grifo
- New York University (NYU) Langone Fertility Center, New York, NY, USA
| | - Ariel Hourvitz
- Reproduction Laboratory, Sackler School of Medicine, Tel Aviv, Israel
| | | | | | | | | | - Nathan Treff
- Reproductive Medicine Associates of New Jersey, USA
| | | | | | | | | | - Tarek Ghobara
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - László Nánássy
- Versys Clinics Human Reproduction Institute, Budapest, Hungary
| | | | | | - Robert Anderson
- Southern California Center for Reproductive Medicine, Newport Beach, CA, USA
| | | | - Dagan Wells
- Preimplantation Genetic Diagnosis Laboratory, University of Oxford, NIHR Biomedical Research Centre, Oxford, UK
| |
Collapse
|
43
|
Goldstein M, Svirsky R, Reches A, Yaron Y. Does the number of previous miscarriages influence the incidence of chromosomal aberrations in spontaneous pregnancy loss? J Matern Fetal Neonatal Med 2017; 30:2956-2960. [PMID: 27923289 DOI: 10.1080/14767058.2016.1269317] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Chromosomal aberrations are a common cause for miscarriage. The purpose of this study was to evaluate factors that influence the frequency of chromosomal abnormalities in miscarriages and provide clinicians with a guideline for management of such cases. METHODS The study included 170 women who experienced pregnancy loss between the 2004 and 2014. Cytogenetic analysis of products of conception (POC) was routinely performed. RESULTS Successful cytogenetic analysis was achieved in 144 cases (84%). Of these, 78 cases (54%) had a chromosomal aberration. The incidence of chromosomal aberrations was not statistically significant among patients with 1, 2, 3, 4 or ≥5 previous miscarriages (33.3%, 57.4%, 48.6%, 65.2%, and 59.1%, respectively, p = 0.227). The F/M ratio was similar in normal and abnormal POC karyotypes (1.2:1 and 1.3:1, respectively, p = 0.7). CONCLUSION Contrary to previous assumptions we did not find correlation between number of previous spontaneous miscarriages a women experienced and chromosomal aberration in her current miscarriage.
Collapse
Affiliation(s)
- Myriam Goldstein
- a Prenatal Genetic Diagnosis Unit and Genetic Institute, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Ran Svirsky
- a Prenatal Genetic Diagnosis Unit and Genetic Institute, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Israel.,c Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center , Zerifin, Israel
| | - Adi Reches
- a Prenatal Genetic Diagnosis Unit and Genetic Institute, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Yuval Yaron
- a Prenatal Genetic Diagnosis Unit and Genetic Institute, Tel Aviv Sourasky Medical Center , Tel Aviv , Israel.,b Sackler Faculty of Medicine, Tel Aviv University , Israel
| |
Collapse
|
44
|
Hiersch L, Reches A, Simchoni S, Barel D, Greenberg R, Yaron Y. 257: The added value of whole exome sequencing (WES) in fetuses with structural abnormalities. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Brabbing-Goldstein D, Reches A, Shira AB, Yaron Y. 160: Chromosomal microarray for patient choice disadvantage may outweigh benefit. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
46
|
Yaron Y, Hyett J, Langlois S. Current controversies in prenatal diagnosis 2: for those women screened by NIPT using cell free DNA, maternal serum markers are obsolete. Prenat Diagn 2016; 36:1167-1171. [PMID: 27747900 DOI: 10.1002/pd.4944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Yuval Yaron
- Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Jon Hyett
- Royal Prince Alfred Hospital Sydney, University of Sydney, Sydney, NSW, Australia
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, Canada
| |
Collapse
|
47
|
Oepkes D, Bartha JL, Schmid M, Yaron Y. Benefits of contingent screening vs primary screening by cell-free DNA testing: think again. Ultrasound Obstet Gynecol 2016; 47:542-545. [PMID: 26415101 DOI: 10.1002/uog.15758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 06/05/2023]
Affiliation(s)
- D Oepkes
- Leiden University Medical Centre, Department of Obstetrics, Leiden, The Netherlands
| | - J L Bartha
- University Hospital La Paz, Madrid, Spain
| | - M Schmid
- Medical University of Vienna, Vienna, Austria
| | - Y Yaron
- Genetic Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
48
|
Yaron Y. The implications of non-invasive prenatal testing failures: a review of an under-discussed phenomenon. Prenat Diagn 2016; 36:391-6. [DOI: 10.1002/pd.4804] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/08/2016] [Accepted: 02/29/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Yuval Yaron
- Genetic Institute, Tel Aviv Sourasky Medical Center; Tel Aviv University; Tel Aviv Israel
| |
Collapse
|
49
|
Yablonski-Peretz T, Paluch-Shimon S, Gutman LS, Kaplan Y, Dvir A, Barnes-Kedar I, Kadouri L, Semenisty V, Efrat N, Neiman V, Glasser Y, Michaelson-Cohen R, Katz L, Kaufman B, Golan T, Reish O, Hubert A, Safra T, Yaron Y, Friedman E. Screening for germline mutations in breast/ovarian cancer susceptibility genes in high-risk families in Israel. Breast Cancer Res Treat 2015; 155:133-8. [DOI: 10.1007/s10549-015-3662-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
|
50
|
Benn P, Borrell A, Chiu RWK, Cuckle H, Dugoff L, Faas B, Gross S, Huang T, Johnson J, Maymon R, Norton M, Odibo A, Schielen P, Spencer K, Wright D, Yaron Y. Position statement from the Chromosome Abnormality Screening Committee on behalf of the Board of the International Society for Prenatal Diagnosis. Prenat Diagn 2015; 35:725-34. [DOI: 10.1002/pd.4608] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 04/24/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Peter Benn
- Department of Genetics and Genome Sciences; University of Connecticut Health Center; Farmington CT USA
| | - Antoni Borrell
- Prenatal Diagnosis Unit, Institute of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Maternitat Campus; University of Barcelona Medical School; Catalonia Spain
| | - Rossa W. K. Chiu
- Department of Chemical Pathology; The Chinese University of Hong Kong, Prince of Wales Hospital; Hong Kong
| | - Howard Cuckle
- Department of Obstetrics and Gynecology; Columbia University Medical Center; New York NY USA
| | - Lorraine Dugoff
- Department of Obstetrics and Gynecology; University of Pennsylvania; Philadelphia PA USA
| | - Brigitte Faas
- Department of Human Genetics; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Susan Gross
- Department of Obstetrics and Gynecology; Albert Einstein College of Medicine; New York NY USA
| | - Tianhua Huang
- Genetics Program; North York General Hospital; Toronto ON Canada
| | - Joann Johnson
- Department of Obstetrics and Gynecology; University of Calgary; Calgary AB Canada
| | - Ron Maymon
- Department of Obstetrics and Gynecology, Assaf Harofe Medical Center, Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Mary Norton
- Department of Obstetrics and Gynecology; Stanford University School of Medicine; Stanford CA USA
| | - Anthony Odibo
- Department of Obstetrics and Gynecology; University of South Florida; Tampa FL USA
| | - Peter Schielen
- Laboratory for Infectious Diseases and Perinatal Screening; National Institute for Public Health and the Environment (RIVM); Bilthoven The Netherlands
| | - Kevin Spencer
- Prenatal Screening Unit, Clinical Biochemistry Department; Barking Havering & Redbridge University Hospitals, King George Hospital; Goodmayes UK
| | - Dave Wright
- Department of Statistics; University of Exeter; Exeter UK
| | - Yuval Yaron
- Prenatal Diagnosis Unit, Genetic Institute; Sourasky Medical Center; Tel Aviv Israel
| |
Collapse
|