Συμβολή στη μοριακή προγεννητική διάγνωση ανευπλοειδιών και φύλου με χρήση μεθόδων αλυσιδωτής αντίδρασης πολυμεράσης

Abstract

The quest and devise of new approaches for the prenatal diagnosis of chromosomal syndromes that combine rapid analysis robustness and safety for mother and embryo are always in demand especially in the post-genome era with new tools and methods in our disposition. In the present study, the methodology of quantitative fluorescent polymerase chain reaction (QF-PCR) has been developed and standardized in conjunction with conventional PCR for the detection of aneuploidies and sex in amniotic cells, blastomeres and most importantly in free fetal DNA isolated from maternal peripheral blood and urine, for the establishment of non-invasive methods of prenatal diagnosis. It has become evident that the methodology we have followed can complement conventional prenatal chromosome analysis and in addition can be exploited for the analysis of fetal DNA in maternal plasma for fetal sex determination at the first stages of gestation. Moreover, simulation experiments have been devised in order to determine the percentage of fetal DNA in maternal circulation throughout pregnancy. Our results showed that free fetal DNA can be distinguished from the mother’s DNA in maternal plasma by identifying unique paternally inherited fetal polymorphisms, such as short tandem repeat (STR) alleles, with QF-PCR. These alleles were used to calculate the percentage of fetal DNA in maternal plasma. Fetal DNA was found to be present on an average of 7% (range 0-20%) of the total free DNA in maternal circulation, in normal pregnancies. QF-PCR analysis was also used to determine the copy number of fetal chromosomes by comparing the allelic ratios for chromosomes 21, 18, 13 X and Y. It appears that in informative cases where free fetal DNA is 15% or more and originates from normal embryos, the value of the allelic ratio of a STR marker on one chromosome divided by the value of the allelic ratio of another STR marker on a different chromosome is equal to 1. Analysis of DNA samples isolated from the plasma of pregnant women bearing normal embryos confirmed the results of the simulation models. Comparison of the above data with new analyses simulating DNA from the plasma of pregnant women carrying trisomic for chromosome 21 embryos have shown that the value of the allelic ratio of a STR marker on an autosomal chromosome (e.g. 18 or 13), divided by the allelic ratio of a STR marker on chromosome 21, is different from 1 and it depends on the origin, paternal or maternal, of the extra copy of chromosome 21 in the embryo, with values of 0.5 in paternal compared to 1.3 in maternal trisomies respectively. These results differentiate between normal and trisomic cases and after further evaluation may provide a new indication marker for prenatal diagnosis. In the long term, they may also provide the basis of a non-invasive procedure for early prenatal chromosomal analysis.