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Zakaria H, Kleinfinger P, Lohmann L, Costa JM, Tsatsaris V, Salomon LJ, Jouannic JM, Rosenblatt J, Demain A, Benachi A, El Khattabi L, Vivanti AJ. Performance of cell-free DNA testing for common fetal trisomies in triplet pregnancies. Prenat Diagn 2024; 44:555-561. [PMID: 38448008 DOI: 10.1002/pd.6548] [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: 01/06/2024] [Revised: 02/05/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE In singleton pregnancies, the use of cell-free DNA (cfDNA) analysis as a screening test for common fetal trisomies has spread worldwide though we still lack sufficient data for its use in triplet pregnancies. The objective of this study is to assess the performance of cfDNA testing in detecting fetal aneuploidies in triplet pregnancies as a first-tier test. METHOD We performed a retrospective cohort study including data from pregnant women with a triplet pregnancy who underwent cfDNA testing between May 1, 2017, and January 15, 2020. cfDNA was obtained by massive parallel sequencing (VeriSeq NIPT solution; Illumina®). The objectives of the study were to assess the diagnostic performance of cfDNA testing for trisomy 21 (T21) (primary outcome), trisomy 18 (T18) and 13 (secondary outcomes). RESULTS During the study period, cfDNA testing was performed in 255 women with triplet pregnancy, of which 165 (64.7%) had a neonatal outcome available. Three tests were positive for T21, one of which was confirmed by an antenatal karyotype, and the other was confirmed at birth. The third case did not undergo an invasive procedure and was not confirmed at birth (false positive). In one case, cfDNA testing was positive for T18 and was confirmed by an antenatal karyotype. There were no cases of trisomy 13 in the cohort. The no-call rate was 2.4% at first sampling. Fifty-eight (22.7%) women had embryo reduction, which in 40 (69%) of whom was performed after the cfDNA test result. CONCLUSION cfDNA testing could be offered as primary screening for main fetal aneuploidies in triplet pregnancies after provision of appropriate patient information.
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Affiliation(s)
- Hoda Zakaria
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University, APHP, Clamart, France
| | | | | | | | - Vassilis Tsatsaris
- Division of Obstetrics and Gynecology, "Port Royal" Hospital, Paris Cité University, APHP, Paris, France
| | - Laurent J Salomon
- Division of Obstetrics and Gynecology, "Necker-Enfants Malades" Hospital, Paris Cité University, APHP, Paris, France
| | - Jean-Marie Jouannic
- Division of Fetal Medicine, "Armand Trousseau" Hospital, Sorbonne Paris Nord University, APHP, Paris, France
| | - Jonathan Rosenblatt
- Division of Obstetrics and Gynecology, "Robert Debré" Hospital, Sorbonne Paris Nord University, APHP, Paris, France
| | - Adèle Demain
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University, APHP, Clamart, France
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University, APHP, Clamart, France
| | - Laïla El Khattabi
- Non-Invasive Prenatal Screening laboratory, APHP, Paris Cité University, Hôpital Cochin, Paris, France
- Chromosomal Genomics Unit, Medical Genetics Department, APHP, Sorbonne Paris Nord University, Armand Trousseau and Pitié-Salpêtrière Hospitals, Paris, France
| | - Alexandre J Vivanti
- Division of Obstetrics and Gynecology, "Antoine Béclère" Hospital, Paris Saclay University, APHP, Clamart, France
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Jedraszak G, Jobic F, Receveur A, Bilan F, Gilbert-Dussardier B, Tiffany B, Missirian C, Willems M, Odent S, Lucas J, Dubourg C, Schaefer E, Scheidecker S, Lespinasse J, Goldenberg A, Guerrot AM, Joly-Helas G, Chambon P, Le Caignec C, David A, Coutton C, Satre V, Vieville G, Amblard F, Harbuz R, Sanlaville D, Till M, Vincent-Delorme C, Colson C, Andrieux J, Naudion S, Toutain J, Rooryck C, de Fréminville B, Prieur F, Daire VC, Amram D, Kleinfinger P, Schulze MB, Raabe-Meyer G, Courage C, Lemke J, Stefanou EG, Loretta T, Emmanouil M, Tzeli SK, Sodowska H, Anderson J, Nandini A, Copin H, Garçon L, Liehr T, Morin G. Cat eye syndrome: Clinical, cytogenetics and familial findings in a large cohort of 43 patients highlighting the importance of congenital heart disease and inherited cases. Am J Med Genet A 2024; 194:e63476. [PMID: 37974505 DOI: 10.1002/ajmg.a.63476] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/13/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
Cat Eye Syndrome (CES) is a rare genetic disease caused by the presence of a small supernumerary marker chromosome derived from chromosome 22, which results in a partial tetrasomy of 22p-22q11.21. CES is classically defined by association of iris coloboma, anal atresia, and preauricular tags or pits, with high clinical and genetic heterogeneity. We conducted an international retrospective study of patients carrying genomic gain in the 22q11.21 chromosomal region upstream from LCR22-A identified using FISH, MLPA, and/or array-CGH. We report a cohort of 43 CES cases. We highlight that the clinical triad represents no more than 50% of cases. However, only 16% of CES patients presented with the three signs of the triad and 9% not present any of these three signs. We also highlight the importance of other impairments: cardiac anomalies are one of the major signs of CES (51% of cases), and high frequency of intellectual disability (47%). Ocular motility defects (45%), abdominal malformations (44%), ophthalmologic malformations (35%), and genitourinary tract defects (32%) are other frequent clinical features. We observed that sSMC is the most frequent chromosomal anomaly (91%) and we highlight the high prevalence of mosaic cases (40%) and the unexpectedly high prevalence of parental transmission of sSMC (23%). Most often, the transmitting parent has mild or absent features and carries the mosaic marker at a very low rate (<10%). These data allow us to better delineate the clinical phenotype associated with CES, which must be taken into account in the cytogenetic testing for this syndrome. These findings draw attention to the need for genetic counseling and the risk of recurrence.
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Affiliation(s)
- Guillaume Jedraszak
- Constitutional Genetics Laboratory, University Hospital of Amiens, Amiens, France
- UR4666, University of Picardy Jules Verne, Amiens, France
| | - Florence Jobic
- Clinical Genetics Unit, University Hospital of Amiens, Amiens, France
| | - Aline Receveur
- Constitutional Genetics Laboratory, University Hospital of Amiens, Amiens, France
| | - Frédéric Bilan
- Genetics Laboratory, University Hospital of Poitiers, Poitiers, France
| | | | - Busa Tiffany
- Medical Genetics Unit, University Hospital of Marseille, Marseille, France
| | - Chantal Missirian
- Cytogenetics Laboratory, University Hospital of Marseille, Marseille, France
| | - Marjolaine Willems
- Medical Genetics Laboratory, University Hospital of Montpellier, Montpellier, France
| | - Sylvie Odent
- Medical Genetics Unit, University Hospital of Rennes, Rennes, France
| | - Josette Lucas
- Genetics Laboratory, University Hospital of Rennes, Rennes, France
| | | | - Elise Schaefer
- Clinical Genetics Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | | | - Alice Goldenberg
- Clinical Genetics Unit, University Hospital of Rouen, Rouen, France
| | | | | | - Pascal Chambon
- Cytogenetics Laboratory, University Hospital of Rouen, Rouen, France
| | - Cédric Le Caignec
- Medical Gentics Unit, University Hospital of Toulouse, Toulouse, France
| | - Albert David
- Clinical Genetics Unit, University Hospital of Nantes, Nantes, France
| | - Charles Coutton
- Cytogenetics Laboratory, University Hospital of Grenoble & INSERM U1209 Institute for Advanced Biosciences, University of Grenoble Alpes, Grenoble, France
| | - Véronique Satre
- Cytogenetics Laboratory, University Hospital of Grenoble & INSERM U1209 Institute for Advanced Biosciences, University of Grenoble Alpes, Grenoble, France
| | - Gaëlle Vieville
- Cytogenetics Laboratory, University Hospital of Grenoble, Grenoble, France
| | - Florence Amblard
- Cytogenetics Laboratory, University Hospital of Grenoble, Grenoble, France
| | - Radu Harbuz
- Cytogenetics Laboratory, University Hospital of Grenoble, Grenoble, France
| | | | - Marianne Till
- Cytogenetics Laboratory, University Hospital of Lyon, Bron, France
| | - Catherine Vincent-Delorme
- Catherine Vincent Delorme, Clinical Genetics Unit Guy Fontaine, University Hospital of Lille, Lille, France
| | - Cindy Colson
- Catherine Vincent Delorme, Clinical Genetics Unit Guy Fontaine, University Hospital of Lille, Lille, France
| | - Joris Andrieux
- Molecular Genetics Institute, University hospital of Lille, Lille, France
| | - Sophie Naudion
- Clinical Genetics Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Jérome Toutain
- Clinical Genetics Unit, University Hospital of Bordeaux, Bordeaux, France
| | - Caroline Rooryck
- Medical Genetics Laboratory, University Hospital of Bordeaux, Bordeaux, France
| | | | - Fabienne Prieur
- Medical Genetics Unit, University Hospital of Saint-Etienne, Saint Etienne, France
| | | | - Daniel Amram
- Clinicial Genetics Unit, University Hospital of Creteil, Creteil, France
| | | | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | | | | | - Johannes Lemke
- Institute of Human Genetics, University of Leipzig Medical Center, Leipzig, Germany
| | - Eunice G Stefanou
- Cytogenetics Unit, Laboratory of Medical Genetics, University General Hospital of Patras, Patras, Greece
| | - Thomaidis Loretta
- Developmental Assessment Unit, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Sophia Kitsiou Tzeli
- Department of Medical Genetics, National and Kapodistrian University of Athens, Athens, Greece
| | - Henryka Sodowska
- Niepubliczny Zakład Opieki Zdrowotne "Genom", Ruda Slaska, Poland
| | - Jasen Anderson
- Cytogenetics Department, Sullivan and Nicolaides Pathology, Taringa, Queensland, Australia
| | - Adayapalam Nandini
- Department of Cytogenetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Henri Copin
- Constitutional Genetics Laboratory, University Hospital of Amiens, Amiens, France
| | - Loïc Garçon
- Constitutional Genetics Laboratory, University Hospital of Amiens, Amiens, France
- UR4666, University of Picardy Jules Verne, Amiens, France
| | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany
| | - Gilles Morin
- Clinical Genetics Unit, University Hospital of Amiens, Amiens, France
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Kleinfinger P, Brechard M, Luscan A, Trost D, Boughalem A, Mylene Valduga, Serero DR S, Costa JM, Lohmann L. Case Report: How whole-genome sequencing-based cell-free DNA prenatal testing can help identify a marker mhromosome. Front Genet 2022; 13:926290. [PMID: 36226188 PMCID: PMC9549001 DOI: 10.3389/fgene.2022.926290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/08/2022] [Indexed: 11/30/2022] Open
Abstract
A supernumerary marker chromosome (SMC) is a structurally abnormal chromosome that cannot be characterized by conventional banding cytogenetics. Marker chromosomes are present in 0.075% of prenatal cases. They are associated with variable phenotypes, ranging from normal to severely abnormal, and the prognosis is largely dependent on the results of further cytogenomic analysis. Here, we report the identification and characterization of a marker chromosome following prenatal screening in a 39-year-old pregnant patient. The patient had a normal first trimester ultrasound but was high-risk for fetal chromosome anomalies based on the results of maternal serum parameters. Chorionic villus sampling was performed, and analysis of chorionic villi revealed the presence of two identical marker chromosomes. In the interest of a rapid identification of the markers, we performed noninvasive prenatal testing (NIPT) together with chorionic villus sampling. A pericentromeric 29 Mb duplication of chromosome 20: dup (20) (p13q11.21) was identified and thereafter confirmed by targeted metaphasic FISH. Whole-genome sequencing-based NIPT was instrumental in rapid characterization of the SMCs and allowed us to obviate the need for multiple expensive and time-consuming FISH analyses.
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Mossfield T, Soster E, Menezes M, Agenbag G, Dubois ML, Gekas J, Hardy T, Jurkowska M, Kleinfinger P, Loggenberg K, Marchili P, Sirica R. Multisite assessment of the impact of cell-free DNA-based screening for rare autosomal aneuploidies on pregnancy management and outcomes. Front Genet 2022; 13:975987. [PMID: 36105088 PMCID: PMC9465083 DOI: 10.3389/fgene.2022.975987] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
Cell-free (cf) DNA screening is a noninvasive prenatal screening approach that is typically used to screen for common fetal trisomies, with optional screening for sex chromosomal aneuploidies and fetal sex. Genome-wide cfDNA screening can screen for a wide variety of additional anomalies, including rare autosomal aneuploidies (RAAs) and copy number variants. Here, we describe a multi-cohort, global retrospective study that looked at the clinical outcomes of cases with a high-risk cfDNA screening result for a RAA. Our study cohort included a total of 109 cases from five different sites, with diagnostic outcome information available for 68% (74/109) of patients. Based on confirmatory diagnostic testing, we found a concordance rate of 20.3% for presence of a RAA (15/74) in our study population. Pregnancy outcome was also available for 77% (84/109) of cases in our cohort. Many of the patients experienced adverse pregnancy outcomes, including intrauterine fetal demise, fetal growth restriction, and preterm birth. These adverse outcomes were observed both in patients with fetal or placental confirmation of the presence of a RAA, as well as patients that did not undergo fetal and/or placental diagnostic testing. In addition, we have proposed some suggestions for pregnancy management and counseling considerations for situations where a RAA is noted on a cfDNA screen. In conclusion, our study has shown that genome-wide cfDNA screening for the presence of rare autosomal aneuploidies can be beneficial for both patients and their healthcare practitioners. This can provide a possible explanation for an adverse pregnancy outcome or result in a change in pregnancy management, such as increased monitoring for adverse outcomes.
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Affiliation(s)
| | - Erica Soster
- Labcorp Women’s Health and Genetics, Laboratory Corporation of America, San Diego, CA, United States
| | - Melody Menezes
- Monash IVF Genetics, Monash IVF Group, Richmond, VIC, Australia
| | | | | | - Jean Gekas
- CHU de Quebec Research and Mother and Child Center, Department of Medical Genetics, University Hospital of Quebec, Laval University, Quebec City, QC, Canada
| | - Tristan Hardy
- Monash IVF Genetics, Monash IVF Group, Richmond, VIC, Australia
| | | | | | | | | | - Roberto Sirica
- AMES, Centro Polidiagnostico Strumentale, Srl, Naples, Italy
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5
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Receveur A, Puisney-Dakhli C, Kleinfinger P, Gitz L, Grevoul-Fesquet J, Jouni D, Diot R, Tachdjian G, Petit F. First prenatal case of Kagami-Ogata syndrome associated with a small supernumerary marker chromosome derived from chromosome 15. Taiwan J Obstet Gynecol 2022; 61:382-384. [PMID: 35361407 DOI: 10.1016/j.tjog.2022.02.034] [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] [Accepted: 07/19/2021] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Uniparental disomy (UPD) is one of the common causes of imprinting disorders, which can have an impact on gene expression according to the origin of the parental chromosome. Paternal UPD14 leads to Kagami-Ogata syndrome (KOS), which has a more severe phenotype than maternal UPD14, also called Temple syndrome. Small supernumerary marker chromosomes (SSMCs) are defined as structural chromosomal abnormalities that may be inherited or come from micronucleus-mediated chromothripsis. The association of UPD and SSMC is very rare but not fortuitous and several mechanisms can explain this phenomenon. CASE REPORT We report the first prenatal case of paternal isodisomy for chromosome 14 associated with a de novo SSMC originating from chromosome 15 and revealed by KOS. The mechanism could be a chromothripsis mediated by trisomy rescue. CONCLUSION Regarding this case, in relation to a de novo SSMC, it could be important to extend the research of UPD to other acrocentric chromosomes if ultrasound signs are evocative.
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Affiliation(s)
- Aline Receveur
- Service D'Histologie Embryologie Cytogénétique, APHP.Université Paris Saclay, Antoine Béclère Hospital, 157 Rue de La Porte de Trivaux, 92141, Clamart Cedex, France.
| | - Chloé Puisney-Dakhli
- Service D'Histologie Embryologie Cytogénétique, APHP.Université Paris Saclay, Antoine Béclère Hospital, 157 Rue de La Porte de Trivaux, 92141, Clamart Cedex, France
| | | | - Laurence Gitz
- Service de Gynécologie et Obstétrique, Hôpital Du Sud Francilien, 91 Evry, France
| | | | - Dima Jouni
- Service D'Histologie Embryologie Cytogénétique, APHP.Université Paris Saclay, Antoine Béclère Hospital, 157 Rue de La Porte de Trivaux, 92141, Clamart Cedex, France
| | - Romain Diot
- Service D'Histologie Embryologie Cytogénétique, APHP.Université Paris Saclay, Antoine Béclère Hospital, 157 Rue de La Porte de Trivaux, 92141, Clamart Cedex, France
| | - Gérard Tachdjian
- Service D'Histologie Embryologie Cytogénétique, APHP.Université Paris Saclay, Antoine Béclère Hospital, 157 Rue de La Porte de Trivaux, 92141, Clamart Cedex, France
| | - François Petit
- Laboratoire de Génétique Moléculaire, APHP.Université Paris Saclay, Antoine Béclère Hospital, 157 Rue de La Porte de Trivaux, 92141 Clamart, Cedex, France
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6
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Monier I, Receveur A, Houfflin-Debarge V, Goua V, Castaigne V, Jouannic JM, Mousty E, Saliou AH, Bouchghoul H, Rousseau T, Valat AS, Groussolles M, Fuchs F, Benoist G, Degre S, Massardier J, Tsatsaris V, Kleinfinger P, Zeitlin J, Benachi A. Should prenatal chromosomal microarray analysis be offered for isolated fetal growth restriction? A French multicenter study. Am J Obstet Gynecol 2021; 225:676.e1-676.e15. [PMID: 34058167 DOI: 10.1016/j.ajog.2021.05.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 02/19/2021] [Revised: 05/07/2021] [Accepted: 05/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Compared with standard karyotype, chromosomal microarray analysis improves the detection of genetic anomalies and is thus recommended in many prenatal indications. However, evidence is still lacking on the clinical utility of chromosomal microarray analysis in cases of isolated fetal growth restriction. OBJECTIVE This study aimed to estimate the proportion of copy number variants detected by chromosomal microarray analysis and the incremental yield of chromosomal microarray analysis compared with karyotype in the detection of genetic abnormalities in fetuses with isolated fetal growth restriction. STUDY DESIGN This retrospective study included all singleton fetuses diagnosed with fetal growth restriction and no structural ultrasound anomalies and referred to 13 French fetal medicine centers over 1 year in 2016. Fetal growth restriction was defined as an estimated fetal weight of <tenth percentile for gestational age identified in ultrasound reports. For this analysis, we selected fetuses who underwent invasive genetic testing with karyotype and chromosomal microarray analysis results. Data were obtained from medical records and ultrasound databases and postmortem and placental examination reports in case of spontaneous stillbirths and terminations of pregnancy. Following the American College of Medical Genetics and Genomics guidelines, copy number variants were classified into 5 groups as following: pathogenic, likely pathogenic, variant of unknown significance, likely benign, and benign. RESULTS Of 682 referred fetuses diagnosed with isolated fetal growth restriction, both karyotype and chromosomal microarray analysis were performed in 146 fetuses. Overall, the detection rate of genetic anomalies found by chromosomal microarray analysis was estimated to be 7.5% (11 of 146 [95% confidence interval, 3.3-11.8]), including 10 copy number variants classified as pathogenic and 1 copy number variant classified as likely pathogenic. Among the 139 fetuses with normal karyotype, 5 were detected with pathogenic and likely pathogenic copy number variants, resulting in an incremental yield of 3.6% (95% confidence interval, 0.5-6.6) in chromosomal microarray analysis compared with karyotype. All fetuses detected with pathogenic or likely pathogenic copy number variants resulted in terminations of pregnancy. In addition, 3 fetuses with normal karyotype were detected with a variant of unknown significance (2.1%). Among the 7 fetuses with abnormal karyotype, chromosomal microarray analysis did not detect trisomy 18 mosaicism in all fetuses. CONCLUSION Our study found that compared with karyotype, chromosomal microarray analysis improves the detection of genetic anomalies in fetuses diagnosed with isolated fetal growth restriction. These results support the use of chromosomal microarray analysis in addition to karyotype for isolated fetal growth restriction.
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Affiliation(s)
- Isabelle Monier
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Epidemiology and Statistics Research Center, Université de Paris, Institut national de la santé et de la recherche médicale, Institut national de la recherche agronomique, Paris, France; Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France.
| | - Aline Receveur
- Department of Cytogenetics and Reproductive Biology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France
| | | | - Valérie Goua
- Department of Obstetrics and Gynaecology, Poitiers University Hospital, Poitiers, France
| | - Vanina Castaigne
- Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Jean-Marie Jouannic
- Fetal Medicine Department, Armand-Trousseau Hospital, AP-HP, Sorbonne University, Paris, France
| | - Eve Mousty
- Department of Gynaecology and Obstetrics, Nîmes University Hospital, Nîmes, France
| | - Anne-Hélène Saliou
- Department of Obstetrics and Gynaecology, Brest University Hospital, Brest, France
| | - Hanane Bouchghoul
- Department of Obstetrics and Gynaecology, Bicêtre Hospital, AP-HP, Paris Saclay University, Le Kremlin Bicêtre, France
| | - Thierry Rousseau
- Department of Obstetrics and Gynaecology, Dijon University Hospital, Dijon, France
| | - Anne-Sylvie Valat
- Department of Obstetrics and Gynaecology, Lens Hospital, Lens, France
| | - Marion Groussolles
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, Toulouse University Hospital, Toulouse, France
| | - Florent Fuchs
- Department of Obstetrics and Gynecology, Montpellier University Hospital Center, Montpellier, France
| | - Guillaume Benoist
- Department of Obstetrics and Gynecology, Caen University Hospital Center, Caen, France
| | - Sophie Degre
- Department of Obstetrics and Gynecology, Le Havre University Hospital Center, Le Havre, France
| | - Jérôme Massardier
- Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Bron, France
| | - Vassilis Tsatsaris
- Department of Obstetrics and Gynecology, Cochin Hospital, AP-HP, Paris-Descartes University, Paris, France
| | | | - Jennifer Zeitlin
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Epidemiology and Statistics Research Center, Université de Paris, Institut national de la santé et de la recherche médicale, Institut national de la recherche agronomique, Paris, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynaecology, Antoine Béclère Hospital, AP-HP, Paris Saclay University, Clamart, France
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Gottardi E, Costa JM, Kleinfinger P, Lohmann L, Carrara J, Letourneau A, Demain A, Benachi A, Vivanti AJ. Accuracy of first-trimester cell-free DNA screening for trisomy 21 in twin pregnancy. Ultrasound Obstet Gynecol 2021; 58:327-328. [PMID: 32865843 DOI: 10.1002/uog.23102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 06/11/2023]
Affiliation(s)
- E Gottardi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | | | | | | | - J Carrara
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - A Letourneau
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - A Demain
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - A Benachi
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
| | - A J Vivanti
- Division of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris Saclay University Hospitals, APHP, Clamart, France
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8
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Vivanti AJ, Costa JM, Rosefort A, Kleinfinger P, Lohmann L, Cordier AG, Benachi A. Optimal non-invasive diagnosis of fetal achondroplasia combining ultrasonography with circulating cell-free fetal DNA analysis. Ultrasound Obstet Gynecol 2019; 53:87-94. [PMID: 29380944 DOI: 10.1002/uog.19018] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/27/2017] [Accepted: 01/17/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To assess the performance of non-invasive prenatal testing (NIPT) for achondroplasia using high-resolution melting (HRM) analysis, and to propose an optimal diagnostic strategy combining ultrasound examination and cell-free fetal DNA (cffDNA) analysis. METHODS In this prospective multicenter study, cffDNA was extracted from blood of pregnant women at risk for fetal achondroplasia (owing to paternal achondroplasia, previous affected child or suspected rhizomelic shortening) and of pregnant low-risk controls. The presence of either one of the two main fibroblast growth factor receptor 3 gene (FGFR3) mutations was determined using HRM combined with confirmation by SNaPshot minisequencing. Results were compared with phenotypes obtained using three-dimensional computed tomography or postnatal examination, and/or molecular diagnosis by an invasive procedure. Fetal biometry (head circumference and femur length) was analyzed in order to develop a strategy in which cffDNA analysis for diagnosis of achondroplasia is offered only in selected cases. RESULTS Eighty-six blood samples from women at risk for fetal achondroplasia and 65 from controls were collected. The overall sensitivity and specificity of NIPT were 1.00 (95% CI, 0.87-1.00) and 1.00 (95% CI, 0.96-1.00), respectively. Critical reduction in femur length of affected fetuses could be observed from 26 weeks' gestation. CONCLUSIONS HRM combined with SNaPshot minisequencing is a reliable method for NIPT for achondroplasia. Its implementation in routine clinical care combined with ultrasonography is an efficient strategy for the non-invasive diagnosis of achondroplasia. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- A J Vivanti
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Clamart, France
- Université Paris Sud, Orsay, France
| | - J-M Costa
- Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | - A Rosefort
- Service de Gynécologie-Obstétrique, Hôpital Tenon, AP-HP, Paris, France
| | | | - L Lohmann
- Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | - A-G Cordier
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Clamart, France
- Université Paris Sud, Orsay, France
| | - A Benachi
- Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, AP-HP, Clamart, France
- Université Paris Sud, Orsay, France
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Dabi Y, Guterman S, Jani JC, Letourneau A, Demain A, Kleinfinger P, Lohmann L, Costa JM, Benachi A. Autoimmune disorders but not heparin are associated with cell-free fetal DNA test failure. J Transl Med 2018; 16:335. [PMID: 30509296 PMCID: PMC6276207 DOI: 10.1186/s12967-018-1705-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 09/17/2018] [Accepted: 11/20/2018] [Indexed: 12/18/2022] Open
Abstract
Background Recent studies have suggested a possible association between heparin treatment at the time of cell-free DNA (cfDNA) testing and a non-reportable result. However, these studies lack of proper methodology and had a low level of proof to firmly incriminate heparin. Our objective was to investigate further the relationship between heparin treatment and cfDNA test results. Methods Two complementary approaches were used for the demonstration. First, we conducted a retrospective analysis of a cohort of patients with a singleton pregnancy, screened for aneuploidies by using cfDNA, but with a non-reportable cfDNA result. We included patients between 2013 and 2016 including the patients from the DEPOSA study as controls. CfDNA testing was performed by massive parallel sequencing by using a whole-genome approach. A multiple logistic regression was used to account for the influence of the variables included. Second, we performed in vitro experiments on mimic samples containing increased concentrations of heparin. Results Of 9867 singleton pregnancies tested during the inclusion period, 58 (0.59%) had a non-reportable result and were compared to 295 control patients. Fifteen (25.9%) and 20 (6.8%) patients were treated with heparin in the group with a non-reportable cfDNA result and with a successful assay, respectively. In multivariable analysis, an increased calculated risk at the first-trimester combined screening (OR 28.8 CI 9.76–85.15, p < 0.001), maternal weight (OR 1.03, CI 1.01–1.06, p = 0.01), and the presence of an autoimmune disease (OR 10.38, CI 1.62–66.53, p = 0.01) were the only characteristics associated with a non-reportable result. In vitro experiments showed that heparin had no impact on fetal fraction measurement or the final result, no matter what the dose tested. Conclusions Treatment by heparin had no impact on cfDNA screening test for aneuploidies, while the presence of an autoimmune disorder is an independent predictor of a non-reportable result.
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Affiliation(s)
- Yohann Dabi
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, Université Paris Sud, 154 rue de la Porte de Trivaux, 92140, Clamart, France.
| | - Sarah Guterman
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, Université Paris Sud, 154 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandra Letourneau
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, Université Paris Sud, 154 rue de la Porte de Trivaux, 92140, Clamart, France
| | - Adèle Demain
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, Université Paris Sud, 154 rue de la Porte de Trivaux, 92140, Clamart, France
| | | | - Laurence Lohmann
- Human Genetics Department, Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | - Jean-Marc Costa
- Human Genetics Department, Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, Université Paris Sud, 154 rue de la Porte de Trivaux, 92140, Clamart, France
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Le Conte G, Letourneau A, Jani J, Kleinfinger P, Lohmann L, Costa JM, Benachi A. Cell-free fetal DNA analysis in maternal plasma as screening test for trisomies 21, 18 and 13 in twin pregnancy. Ultrasound Obstet Gynecol 2018; 52:318-324. [PMID: 28833712 DOI: 10.1002/uog.18838] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 03/31/2017] [Revised: 07/11/2017] [Accepted: 08/09/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To evaluate in twin pregnancy the utility of non-invasive prenatal testing using circulating cell-free fetal DNA (cfDNA) in screening for the three main autosomal fetal trisomies. METHODS cfDNA testing was offered to 492 patients with a twin pregnancy without ultrasound anomaly as a first-line screening test or after routine serum screening. Data were collected prospectively and a retrospective analysis was performed. cfDNA analysis was performed by massively parallel sequencing. The fetal-fraction threshold used for test evaluation was 8%. Regression analysis was performed to investigate the effect on the test failure rate of maternal and pregnancy characteristics, and the performance of the test was also reported. RESULTS cfDNA analysis was performed as a first-line test (after the first-trimester scan) in 377 patients and following serum screening in 115. Of the 420 pregnancies for which outcome was available and cfDNA screening was assessed, 78.7% were dichorionic-diamniotic. The test failed on the first attempt in 12 (2.9%) pregnancies, and regression analysis demonstrated that only maternal weight was a significant independent predictor of test failure. A result was subsequently achieved in the 10 cases for which a second sample was obtained. cfDNA analysis identified all three cases of trisomy 21 and the only case of trisomy 18. For trisomy 21, the specificity was 99.8% (95% CI, 98.7-100.0%). When considering pregnancies according to whether they were conceived spontaneously or after assisted reproductive technology, there were no significant differences in terms of maternal weight or no-result rate for cfDNA screening between these two groups. CONCLUSIONS In twin pregnancy without fetal ultrasound abnormality, cfDNA screening for trisomies 21, 18 and 13 had a high success rate and good performance. Therefore, in routine practice, cfDNA analysis could be considered as a first- or second-line screening test. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- G Le Conte
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France
- Université Paris Sud, Kremlin Bicêtre, France
| | - A Letourneau
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France
- Université Paris Sud, Kremlin Bicêtre, France
| | - J Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | - L Lohmann
- Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | - J-M Costa
- Laboratoire CERBA, Saint-Ouen l'Aumône, France
| | - A Benachi
- Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Clamart, France
- Université Paris Sud, Kremlin Bicêtre, France
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Le Conte G, Letourneau A, Jani J, Kleinfinger P, Lohmann L, Costa JM, Benachi A. [Cell-free fetal DNA analysis in maternal plasma as a screening test for trisomy 21 in twin pregnancies]. ACTA ACUST UNITED AC 2018; 46:580-586. [PMID: 29929941 DOI: 10.1016/j.gofs.2018.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 02/15/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To evaluate the performance of noninvasive prenatal testing by cell-free circulating fetal DNA in maternal blood (cfDNA) in screening for trisomies 21 in twin pregnancies. METHODS CfDNA was performed in 492 patients with twin pregnancies without ultrasound anomalies in the first trimester as a first-line screening test or after serum screening. Data were collected prospectively and a retrospective analysis was done. CfDNA was executed by massive parallel technique. The fetal fraction threshold for test evaluation was 8%. Regression analysis was performed to evaluate the effect of different parameters on the test failure rate. Performance of the test was also considered. RESULTS In 377 patients, the test was prescribed first line and in 115 after standard serum screening. Twelve tests (2.9%) have initially failed on the 420 pregnancies with available outcomes and regression analysis found only maternal weight as a significant independent factor of test failure. A second test was performed on 10 patients, all of them had an available result. cfDNA identified all 3 cases of trisomy 21. The sensitivity was 100.0% (95% CI [29.2-100.0%]) and specificity was 99.8% (95% CI [98.7-100.0%]). There was no significant difference between spontaneous pregnancies and those induced by assisted reproductive technologies (ART), in terms of fetal fraction percentage, no-call results for cfDNA screening, maternal weight, or test performance between the two groups. CONCLUSION In twin pregnancies without fetal ultrasound abnormalities, the performance and success rate of the cfDNA are excellent. Therefore, cfDNA could be offered in routine practice as a first-line screening test in this population.
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Affiliation(s)
- G Le Conte
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Sud, 94270 Kremlin-Bicêtre, France.
| | - A Letourneau
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Sud, 94270 Kremlin-Bicêtre, France
| | - J Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, université Libre de Bruxelles, 1020 Brussels, Belgique
| | - P Kleinfinger
- Laboratoire CERBA, 95310 Saint-Ouen-l'Aumône, France
| | - L Lohmann
- Laboratoire CERBA, 95310 Saint-Ouen-l'Aumône, France
| | - J-M Costa
- Laboratoire CERBA, 95310 Saint-Ouen-l'Aumône, France
| | - A Benachi
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Sud, 94270 Kremlin-Bicêtre, France
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12
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Bevilacqua E, Jani JC, Letourneau A, Duiella SF, Kleinfinger P, Lohmann L, Resta S, Cos Sanchez T, Fils JF, Mirra M, Benachi A, Costa JM. Cell-Free DNA Analysis in Maternal Blood: Differences in Estimates between Laboratories with Different Methodologies Using a Propensity Score Approach. Fetal Diagn Ther 2018; 45:302-311. [PMID: 29898450 DOI: 10.1159/000489124] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/11/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the failure rate and performance of cell-free DNA (cfDNA) testing, mainly in terms of detection rates for trisomy 21, performed by 2 laboratories using different analytical methods. METHODS cfDNA testing was performed on 2,870 pregnancies with the HarmonyTM Prenatal Test using the targeted digital analysis of selected regions (DANSR) method, and on 2,635 pregnancies with the "Cerba test" using the genome-wide massively parallel sequencing (GW-MPS) method, with available outcomes. Propensity score analysis was used to match patients between the 2 groups. A comparison of the detection rates for trisomy 21 between the 2 laboratories was made. RESULTS In all, 2,811 patients in the Harmony group and 2,530 patients in the Cerba group had no trisomy 21, 18, or 13. Postmatched comparisons of the patient characteristics indicated a higher no-result rate in the Harmony group (1.30%) than in the Cerba group (0.75%; p = 0.039). All 41 cases of trisomy 21 in the Harmony group and 93 cases in the Cerba group were detected. CONCLUSIONS Both methods of cfDNA testing showed low no-result rates and a comparable performance in detecting trisomy 21; yet GW-MPS had a slightly lower no-result rate than the DANSR method.
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Affiliation(s)
- Elisa Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium,
| | - Alexandra Letourneau
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris-Sud, Clamart, France
| | - Silvia F Duiella
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Serena Resta
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Teresa Cos Sanchez
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Alexandra Benachi
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris-Sud, Clamart, France
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13
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Costa JM, Letourneau A, Favre R, Bidat L, Belaisch-Allart J, Jouannic JM, Quarello E, Senat MV, Broussin B, Tsatsaris V, Demain A, Kleinfinger P, Lohmann L, Agostini H, Bouyer J, Benachi A. Cell-free fetal DNA versus maternal serum screening for trisomy 21 in pregnant women with and without assisted reproduction technology: a prospective interventional study. Genet Med 2018; 20:1346-1353. [DOI: 10.1038/gim.2018.4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/27/2017] [Indexed: 01/17/2023] Open
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14
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Fries N, Salomon LJ, Muller F, Dreux S, Houfflin-Debarge V, Coquel P, Kleinfinger P, Dommergues M. Impact of a shift in nuchal translucency measurements on the detection rate of first-trimester Down syndrome screening: A population-based study. Prenat Diagn 2018; 38:106-109. [PMID: 29231978 DOI: 10.1002/pd.5193] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the distribution of nuchal translucency (NT) measurements following a national policy without credentialing and its impact on first-trimester Down syndrome screening (DSS) detection rate. METHOD All first-trimester DSS data recorded in France (2010-2014) were collected by the laboratories in charge via an Internet database (https://www.bionuqual.org/echo.php). There was no minimal requirement for image quality to allow sonographers to enter the screening process. A subgroup of DSS with complete DS follow-up corresponded to 1614 sonographers. Based on the distribution of maternal age, DS detection rate was calculated and split as a function of the distribution of NT multiple of the median (MoM). RESULTS Four thousand nine hundred forty-three sonographers performed 2,337,372 NT measurements. Median NT expressed in MoM was 0.83. Screenings with complete follow-up consisted of 197,417 screenings, in which DSS detection rates were respectively 70.4%, 70.9%, 79.4%, 87.7%, and 79.5% for the following median NT MoM ranges: <0.7, 0.70 to 0.79, 0.80 to 0.89, 0.90 to 0.99, and >0.99 (trend χ = 12.21; P = .0158). CONCLUSION In France, following a policy of quality assessment without standardized credentialing, the distribution of NT measurements did not fit the expected distribution. Down syndrome detection rate was 10% lower in screenings by sonographers with a median NT < 0.80 MoM.
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Affiliation(s)
- Nicolas Fries
- Collège Français d'Echographie Foetale (CFEF), Montpellier, France
| | - Laurent J Salomon
- Maternité, Hôpital Necker-Enfants Malades, AP-HP, Université Paris-Descartes, Paris, France.,Collège d'Evaluation des Pratiques Professionnelles en Imagerie Médicale (CEPPIM), Paris, France
| | - Françoise Muller
- Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France.,Association des Biologistes Agréés (ABA), Paris, France
| | - Sophie Dreux
- Biochimie-Hormonologie, Hôpital Robert Debré, AP-HP, Paris, France.,Association des Biologistes Agréés (ABA), Paris, France
| | - Véronique Houfflin-Debarge
- Département d'Obstétrique, CHU Lille, Lille, France.,Collège National des Gynécologues Obstétriciens Français (CNGOF), Paris, France
| | - Philippe Coquel
- Collège d'Evaluation des Pratiques Professionnelles en Imagerie Médicale (CEPPIM), Paris, France
| | | | - Marc Dommergues
- Gynécologie-Obstétrique, Hôpital Pitié-Salpétrière AP-HP, Paris, France.,Université Pierre et Marie Curie Paris 6, Paris, France
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15
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Masset H, Hestand MS, Van Esch H, Kleinfinger P, Plaisancié J, Afenjar A, Molignier R, Schluth-Bolard C, Sanlaville D, Vermeesch JR. A Distinct Class of Chromoanagenesis Events Characterized by Focal Copy Number Gains. Hum Mutat 2016; 37:661-8. [DOI: 10.1002/humu.22984] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/24/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Heleen Masset
- Department of Human Genetics; KU Leuven; Leuven Belgium
| | | | | | - Pascale Kleinfinger
- Laboratoire Cerba; Département de Génétique Humaine; Saint-Ouen l'Aumône France
| | - Julie Plaisancié
- Service de Génétique Médicale; Hôpital Purpan; CHU Toulouse France
| | - Alexandra Afenjar
- APHP; Hôpital Armand-Trousseau; Service de Génétique Clinique; Paris France
- APHP; Hôpital Armand-Trousseau; Service de Neuropédiatrie; Paris France
| | - Romain Molignier
- Laboratoire de Biologie Clinique; Clinique Saint Jean Languedoc; Toulouse France
| | - Caroline Schluth-Bolard
- Laboratoire de Cytogénétique Constitutionnelle; Hospices Civils de Lyon; France
- Lyon Neuroscience Research Center; CNRS UMR5292, INSERM U1028, UCBL Lyon France
| | - Damien Sanlaville
- Laboratoire de Cytogénétique Constitutionnelle; Hospices Civils de Lyon; France
- Lyon Neuroscience Research Center; CNRS UMR5292, INSERM U1028, UCBL Lyon France
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Poirsier C, Besseau-Ayasse J, Schluth-Bolard C, Toutain J, Missirian C, Le Caignec C, Bazin A, de Blois MC, Kuentz P, Catty M, Choiset A, Plessis G, Basinko A, Letard P, Flori E, Jimenez M, Valduga M, Landais E, Lallaoui H, Cartault F, Lespinasse J, Martin-Coignard D, Callier P, Pebrel-Richard C, Portnoi MF, Busa T, Receveur A, Amblard F, Yardin C, Harbuz R, Prieur F, Le Meur N, Pipiras E, Kleinfinger P, Vialard F, Doco-Fenzy M. A French multicenter study of over 700 patients with 22q11 deletions diagnosed using FISH or aCGH. Eur J Hum Genet 2015; 24:844-51. [PMID: 26508576 DOI: 10.1038/ejhg.2015.219] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/02/2015] [Accepted: 09/08/2015] [Indexed: 12/31/2022] Open
Abstract
Although 22q11.2 deletion syndrome (22q11.2DS) is the most recurrent human microdeletion syndrome associated with a highly variable phenotype, little is known about the condition's true incidence and the phenotype at diagnosis. We performed a multicenter, retrospective analysis of postnatally diagnosed patients recruited by members of the Association des Cytogénéticiens de Langue Française (the French-Speaking Cytogeneticists Association). Clinical and cytogenetic data on 749 cases diagnosed between 1995 and 2013 were collected by 31 French cytogenetics laboratories. The most frequent reasons for referral of postnatally diagnosed cases were a congenital heart defect (CHD, 48.6%), facial dysmorphism (49.7%) and developmental delay (40.7%). Since 2007 (the year in which array comparative genomic hybridization (aCGH) was introduced for the routine screening of patients with intellectual disability), almost all cases have been diagnosed using FISH (96.1%). Only 15 cases (all with an atypical phenotype) were diagnosed with aCGH; the deletion size ranged from 745 to 2904 kb. The deletion was inherited in 15.0% of cases and was of maternal origin in 85.5% of the latter. This is the largest yet documented cohort of patients with 22q11.2DS (the most commonly diagnosed microdeletion) from the same population. French cytogenetics laboratories diagnosed at least 108 affected patients (including fetuses) per year from among a national population of ∼66 million. As observed for prenatal diagnoses, CHDs were the most frequently detected malformation in postnatal diagnoses. The most common CHD in postnatal diagnoses was an isolated septal defect.
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Affiliation(s)
| | | | | | | | | | - Cédric Le Caignec
- CHU Nantes, Service de Génétique Médicale, Inserm UMR957, Faculté de Médecine, Nantes, France
| | - Anne Bazin
- Laboratoire de Cytogénétique Pasteur-Cerba, Saint-Ouen l'Aumône, France
| | - Marie Christine de Blois
- Service de Cytogénétique, CHU de Necker, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Paul Kuentz
- Service de Cytogénétique, CHU de Besançon, Besançon, France
| | - Marie Catty
- Service de Cytogénétique, Biolille, Lille, France
| | - Agnès Choiset
- Service de Cytogénétique, Hôpital Saint Vincent de Paul, Paris, France
| | - Ghislaine Plessis
- Laboratoire de Cytogénétique Postnatal, CHU Clemenceau, Caen, France
| | - Audrey Basinko
- Service de Cytogénétique et Biologie de la Reproduction, CHRU de Brest, Brest, France
| | | | - Elisabeth Flori
- Service de Cytogénétique, CHU de Strasbourg, Strasbourg, France
| | | | | | | | | | - François Cartault
- Service de Cytogénétique, Hôpital de Saint-Denis, Saint-Denis de la Réunion, France
| | | | | | | | - Céline Pebrel-Richard
- Univ Clermont 1, UFR Médecine, Histologie Embryologie Cytogénétique, Clermont-Ferrand, France.,CHU-Estaing Clermont-Ferrand, Cytogénétique Médicale, Clermont-Ferrand, France.,EA 4677 ERTICA, Univ Clermont 1, UFR Médecine, Clermont-Ferrand, France
| | | | - Tiffany Busa
- Departement de Genétique Medicale, Hopital de la Timone, CHU de Marseille, Marseille, France
| | | | | | | | - Radu Harbuz
- Service de Génétique, CHU de Poitiers, Poitiers, France
| | - Fabienne Prieur
- Service de Cytogénétique, CHU de Saint-Etienne, Saint-Etienne, France
| | - Nathalie Le Meur
- Service de Cytogénétique, Etablissement Français du Sang de Normandie, Rouen, France
| | - Eva Pipiras
- Hôpital Jean Verdier, UF de Cytogénétique, CHU Paris, Paris, France.,Université Paris 13, Sorbonne Paris Cité, INSERM 1141, Paris, France
| | - Pascale Kleinfinger
- Laboratoire de Cytogénétique Pasteur-Cerba, Saint-Ouen l'Aumône, France.,Association des Cytogénéticiens de Langue Française (French-Speaking Cytogeneticists Association), Paris, France
| | - François Vialard
- Service de Cytogénétique, Hôpital Poissy/Saint-Germain-en-Laye, Poissy, France.,Association des Cytogénéticiens de Langue Française (French-Speaking Cytogeneticists Association), Paris, France.,GIG, UVSQ, Versailles, Paris, France
| | - Martine Doco-Fenzy
- Département de Génétique, CHU de Reims, Reims, France.,Association des Cytogénéticiens de Langue Française (French-Speaking Cytogeneticists Association), Paris, France.,EA3801, SFR-CAP Santé, Reims, France
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Landais E, Leroy C, Kleinfinger P, Brunet S, Koubi V, Pietrement C, Poli-Mérol ML, Fiquet C, Souchon PF, Beri M, Jonveaux P, Garnotel R, Gaillard D, Doco-Fenzy M. A pure familial 6q15q21 split duplication associated with obesity and transmitted with partial reduction. Am J Med Genet A 2015; 167:1275-84. [PMID: 25900228 DOI: 10.1002/ajmg.a.36995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/07/2014] [Accepted: 12/29/2014] [Indexed: 01/06/2023]
Abstract
Familial transmission of chromosome 6 duplications is rare. We report on the first observation of a maternally-inherited pure segmental 6q duplication split into two segments, 6q15q16.3 and 6q16.3q21, and associated with obesity. Obesity has previously been correlated to chromosome 6 q-arm deletion but has not yet been assessed in duplications. The aim of this study was to characterize the structure of these intrachromosomal insertional translocations by classic cytogenetic banding, array-CGH, FISH, M-banding and genotyping using microsatellites and SNP array analysis, in a mother and four offspring. The duplicated 6q segments, 9.75 Mb (dup 1) and 7.05 Mb (dup 2) in size in the mother, were inserted distally into two distinct chromosome 6q regions. They were transmitted to four offspring. A son and a daughter inherited the two unbalanced insertions and displayed, like the mother, an abnormal phenotype with facial dysmorphism, intellectual disability, and morbid obesity. Curiously, two daughters with a normal phenotype inherited only the smaller segment, 6q16.3q21. The abnormal phenotype was associated with the larger proximal 6q15q16.3 duplication. We hypothesize a mechanism for this exceptional phenomenon of recurrent reduction and transmission of the duplication during meiosis in a family. We expect the interpretation of our findings to be useful for genetic counseling and for understanding the mechanisms underlying these large segmental 6q duplications and their evolution.
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Affiliation(s)
- Emilie Landais
- CHU-Reims, HMB, Service de Génétique, France.,CHU-Reims, HMB, Plateforme Régionale de Biologie Innovante, France
| | - Camille Leroy
- CHU-Reims, HMB, Service de Génétique, France.,Université de Reims Champagne-Ardenne, UFR de médecine, France
| | | | | | - Valérie Koubi
- Service de génétique Médicale, Laboratoire de génétique moléculaire, CHU Hopital Necker enfants malades, Paris, France
| | | | - Marie-Laurence Poli-Mérol
- Université de Reims Champagne-Ardenne, UFR de médecine, France.,CHU-Reims, American Memorial Hospital, Service de Chirurgie pédiatrique, France
| | - Caroline Fiquet
- CHU-Reims, American Memorial Hospital, Service de Chirurgie pédiatrique, France.,SFR CAP Santé, Reims, EA 3801, France
| | | | - Mylène Beri
- CHU-Nancy, Laboratoire de Génétique Médicale, Nancy Université, France
| | - Philippe Jonveaux
- CHU-Nancy, Laboratoire de Génétique Médicale, Nancy Université, France
| | - Roselyne Garnotel
- CHU-Reims, Laboratoire de Biochimie Médicale et Biologie Moléculaire, CNRS UMR 6198, UFR, Médecine, France
| | - Dominique Gaillard
- CHU-Reims, HMB, Service de Génétique, France.,Université de Reims Champagne-Ardenne, UFR de médecine, France
| | - Martine Doco-Fenzy
- CHU-Reims, HMB, Service de Génétique, France.,SFR CAP Santé, Reims, EA 3801, France
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18
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Plaisancié J, Kleinfinger P, Cances C, Bazin A, Julia S, Trost D, Lohmann L, Vigouroux A. Constitutional chromoanasynthesis: description of a rare chromosomal event in a patient. Eur J Med Genet 2014; 57:567-70. [PMID: 25128687 DOI: 10.1016/j.ejmg.2014.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 04/10/2014] [Accepted: 07/30/2014] [Indexed: 11/24/2022]
Abstract
Structural alterations in chromosomes are a frequent cause of cancers and congenital diseases. Recently, the phenomenon of chromosome crisis, consisting of a set of tens to hundreds of clustered genomic rearrangements, localized in one or a few chromosomes, was described in cancer cells under the term chromothripsis. Better knowledge and recognition of this catastrophic chromosome event has brought to light two distinct entities, chromothripsis and chromoanasynthesis. The complexity of these rearrangements and the original descriptions in tumor cells initially led to the thought that it was an acquired anomaly. In fact, a few patients have been reported with constitutional chromothripsis or chromoanasynthesis. Using microarray we identified a very complex chromosomal rearrangement in a patient who had a cytogenetically visible rearrangement of chromosome 18. The rearrangement contained more than 15 breakpoints localized on a single chromosome. Our patient displayed intellectual disability, behavioral troubles and craniofacial dysmorphism. Interestingly, the succession of duplications and triplications identified in our patient was not clustered on a single chromosomal region but spread over the entire chromosome 18. In the light of this new spectrum of chromosomal rearrangements, this report outlines the main features of these catastrophic events and discusses the underlying mechanism of the complex chromosomal rearrangement identified in our patient, which is strongly evocative of a chromoanasynthesis.
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Affiliation(s)
- Julie Plaisancié
- Service de Génétique Médicale, Hôpital Purpan, CHU Toulouse, France.
| | - Pascale Kleinfinger
- Laboratoire Cerba, Département de Génétique Humaine, Saint-Ouen l'Aumône, France
| | - Claude Cances
- Service de Neuropédiatrie, Hôpital des Enfants, CHU Toulouse, France
| | - Anne Bazin
- Laboratoire Cerba, Département de Génétique Humaine, Saint-Ouen l'Aumône, France
| | - Sophie Julia
- Service de Génétique Médicale, Hôpital Purpan, CHU Toulouse, France
| | - Detlef Trost
- Laboratoire Cerba, Département de Génétique Humaine, Saint-Ouen l'Aumône, France
| | - Laurence Lohmann
- Laboratoire Cerba, Département de Génétique Humaine, Saint-Ouen l'Aumône, France
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19
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Besseau-Ayasse J, Violle-Poirsier C, Bazin A, Gruchy N, Moncla A, Girard F, Till M, Mugneret F, Coussement A, Pelluard F, Jimenez M, Vago P, Portnoï MF, Dupont C, Beneteau C, Amblard F, Valduga M, Bresson JL, Carré-Pigeon F, Le Meur N, Tapia S, Yardin C, Receveur A, Lespinasse J, Pipiras E, Beaujard MP, Teboul P, Brisset S, Catty M, Nowak E, Douet Guilbert N, Lallaoui H, Bouquillon S, Gatinois V, Joly-Helas G, Prieur F, Cartault F, Martin D, Kleinfinger P, Molina Gomes D, Doco-Fenzy M, Vialard F. A French collaborative survey of 272 fetuses with 22q11.2 deletion: ultrasound findings, fetal autopsies and pregnancy outcomes. Prenat Diagn 2014; 34:424-30. [PMID: 24395195 DOI: 10.1002/pd.4321] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 01/02/2014] [Accepted: 01/02/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The 22q11.2 deletion (del22q11.2) is one of the most common microdeletions. We performed a collaborative, retrospective analysis in France of prenatal diagnoses and outcomes of fetuses carrying the del22q11.2. METHODS A total of 272 fetuses were included. Data on prenatal diagnosis, ultrasound findings, pathological features, outcomes and inheritance were analyzed. RESULTS The mean time of prenatal diagnosis was 25.6 ± 6 weeks of gestation. Most of the diagnoses (86.8%) were prompted by abnormal ultrasound findings [heart defects (HDs), in 83.8% of cases]. On fetal autopsy, HDs were again the most common disease feature, but thymus, kidney abnormalities and facial dysmorphism were also described. The deletion was inherited in 27% of cases. Termination of pregnancy (TOP) occurred in 68.9% of cases and did not appear to depend on the inheritance status. However, early diagnosis was associated with a higher TOP rate. CONCLUSION This is the largest cohort of prenatal del22q11.2 diagnoses. As in postnatally diagnosed cases, HDs were the most frequently observed abnormalities. However, thymus and kidney abnormalities and polyhydramnios should also be screened for in the prenatal diagnosis of del22q11.2. Only the time of diagnosis appeared to be strongly associated with the pregnancy outcome: the earlier the diagnosis, the higher the TOP rate.
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Affiliation(s)
- J Besseau-Ayasse
- Cytogenetics Laboratory, Poissy St Germain Hospital, Poissy, France; UFR des Sciences de la Santé, UVSQ, Versailles, France
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20
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Lopez E, Thauvin-Robinet C, Reversade B, Khartoufi NE, Devisme L, Holder M, Ansart-Franquet H, Avila M, Lacombe D, Kleinfinger P, Kaori I, Takanashi JI, Le Merrer M, Martinovic J, Noël C, Shboul M, Ho L, Güven Y, Razavi F, Burglen L, Gigot N, Darmency-Stamboul V, Thevenon J, Aral B, Kayserili H, Huet F, Lyonnet S, Le Caignec C, Franco B, Rivière JB, Faivre L, Attié-Bitach T. C5orf42 is the major gene responsible for OFD syndrome type VI. Hum Genet 2013; 133:367-77. [PMID: 24178751 DOI: 10.1007/s00439-013-1385-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/17/2013] [Indexed: 11/25/2022]
Abstract
Oral-facial-digital syndrome type VI (OFD VI) is a recessive ciliopathy defined by two diagnostic criteria: molar tooth sign (MTS) and one or more of the following: (1) tongue hamartoma (s) and/or additional frenula and/or upper lip notch; (2) mesoaxial polydactyly of one or more hands or feet; (3) hypothalamic hamartoma. Because of the MTS, OFD VI belongs to the "Joubert syndrome related disorders". Its genetic aetiology remains largely unknown although mutations in the TMEM216 gene, responsible for Joubert (JBS2) and Meckel-Gruber (MKS2) syndromes, have been reported in two OFD VI patients. To explore the molecular cause(s) of OFD VI syndrome, we used an exome sequencing strategy in six unrelated families followed by Sanger sequencing. We identified a total of 14 novel mutations in the C5orf42 gene in 9/11 families with positive OFD VI diagnostic criteria including a severe fetal case with microphthalmia, cerebellar hypoplasia, corpus callosum agenesis, polydactyly and skeletal dysplasia. C5orf42 mutations have already been reported in Joubert syndrome confirming that OFD VI and JBS are allelic disorders, thus enhancing our knowledge of the complex, highly heterogeneous nature of ciliopathies.
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Affiliation(s)
- Estelle Lopez
- Equipe d'accueil EA 4271 GAD "Génétique des Anomalies du Développement", IFR Santé STIC, Université de Bourgogne, Dijon, France,
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21
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Schluth C, Gesny R, Borck G, Redon R, Abadie V, Kleinfinger P, Munnich A, Lyonnet S, Colleaux L. New case of interstitial deletion 12(q15-q21.2) in a girl with facial dysmorphism and mental retardation. Am J Med Genet A 2008; 146A:93-6. [PMID: 18076123 DOI: 10.1002/ajmg.a.31869] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Interstitial deletions of the long arm of chromosome 12 are rare rearrangements with only 15 cases reported in the literature. The phenotype may include facial dysmorphism, developmental delay, ectodermal abnormalities, cardiac and renal malformations depending on breakpoints' position. Here, we describe a third case of 12(q15-q21.2) deletion ascertained through CGH-array analyses and provide a 5-year follow-up. The patient presented with pre- and postnatal growth retardation, congenital heart defect, developmental delay, and facial dysmorphism changing with age, underlining the importance of long-term follow-up. We compared this new case with previous observations of 12q deletions in order to propose phenotype-karyotype correlations.
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Affiliation(s)
- Caroline Schluth
- Département de Génétique, Hôpital Necker Enfants Malades, Paris, France
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22
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Le Meur N, Goldenberg A, Michel-Adde C, Drouin-Garraud V, Blaysat G, Marret S, Amara SA, Moirot H, Joly-Hélas G, Mace B, Kleinfinger P, Saugier-Veber P, Frébourg T, Rossi A. Molecular characterization of a 14q deletion in a boy with features of Holt-Oram syndrome. Am J Med Genet A 2005; 134:439-42. [PMID: 15810003 DOI: 10.1002/ajmg.a.30660] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Holt-Oram syndrome, the major "heart-hand" syndrome is defined by the association of radial defects or triphalangeal thumbs and septal heart defects. The transmission is autosomal dominant and the causative gene has been shown to be TBX5, located on 12q24.1, which encodes a transcription factor. Genetic heterogeneity has been suggested by several reports. We identified a 14(q23.3 approximately 24.2q31.1) deletion in a boy presenting severe bilateral asymmetrical radial aplasia, congenital heart defects, and developmental delay. This deletion, whose size could be estimated to be 9.6-13.7 Mb, was shown to be inherited via his mother's interchromosomal insertion. This is the second report of a chromosome 14 interstitial deletion associated with clinical features of Holt-Oram syndrome. These observations suggest the existence of a new "heart-hand" locus on chromosome 14q.
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23
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Lewin P, Kleinfinger P, Bazin A, Mossafa H, Szpiro-Tapia S. Defining the efficiency of fluorescencein situ hybridization on uncultured amniocytes on a retrospective cohort of 27407 prenatal diagnoses. Prenat Diagn 2000. [DOI: 10.1002/(sici)1097-0223(200001)20:1<1::aid-pd739>3.0.co;2-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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24
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Lewin P, Kleinfinger P, Bazin A, Mossafa H, Szpiro-Tapia S. Defining the efficiency of fluorescence in situ hybridization on uncultured amniocytes on a retrospective cohort of 27407 prenatal diagnoses. Prenat Diagn 2000; 20:1-6. [PMID: 10701842] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Rapid prenatal detection of selected numerical chromosomal abnormalities by using fluorescence in situ hybridization (FISH) on uncultured amniotic fluid samples was described six years ago. It allows a very rapid identification of selected aneuploidies. We have indexed the results of our 27407 fetal karyotypes obtained by conventional cytogenetics during the last five years, noting the type of chromosomal abnormality and the reasons for prenatal diagnosis. We have also indexed the chromosomal abnormality regarding the prognosis of the chromosomal aberations to evaluate the real impact of a non-diagnosis. Within the population of bad prognosis abnormalities, the percentage of abnormalities with bad prognosis detectable by FISH is 94.6% for advanced maternal age, 85.3% for ultrasonographic anomalies and 86.4% for positive maternal screening. The use of FISH alone on our cohort is not a suitable method to diagnose the chromosomal abnormalities.
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Affiliation(s)
- P Lewin
- Department of Human Genetics, Pasteur Cerha Laboratory, Cergy Pontoise, France.
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25
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Kleinfinger P, Labelle Y, Melot T, Thomas G, Delattre O, Aurias A. Localization of TEC to 9q22.3-q31 by fluorescence in situ hybridization. Ann Genet 1996; 39:233-5. [PMID: 9037350] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The TEC gene encodes for a novel orphan nuclear receptor. Recently, it has been shown to be involved in the recurrent t(9;22) translocation observed in extraskeletal myxoid chondrosarcoma, in a fusion gene with the EWS gene. We report her on its precise localization on chromosome 9 by fluorescence in situ hybridization.
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Affiliation(s)
- P Kleinfinger
- INSERM U434, Laboratory of Tumor Genetics, Institut Curie, Paris, France
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