ALD is an X-linked recessive disorder which is secondary to a mutation in the ABCD1 gene (Xq28) and results neurological effects. The choice method for X-linked ALD-PGD is sexing. But fifty of female embryos are carriers and fifty percent of the discarded male embryos are unaffected diminishing the pool of embryos suitable for transfer. The aim of this work was to increase the reliability of PGD for X-linked ALD and to improve our ability to respond in a fast and safe way thanks to the availability of enough quality DNA obtained by MDA from a single cell for multiple PCR analyses. The MDA product was used for polymerase chain reaction (PCR) analysis of informative markers, used in the PGD–ALD program. A couple which wife carries a causative mutation 676 A > C in the ABCD1 gene that causes X-linked ALD. The affected wife was heterozygous at the DXS1073 and DXS9901 locus. To identify the sex chromosomes X22 informativity test were performed. MDA was used to amplify the whole-genome directly from a single cell. Segregation studies of the family were performed and showed that the ABCD1 extragenic and sex chromosome markers were informative. The development of a MDA–PGD protocol for ALD allowed for the diagnosis of five embryos. The amplification efficiency for DXS1073, DXS9901 and X22 was 12/15, 15/15 and 15/15, respectively. In addition, only ADO in DXS1073 was reported. Four embryos were determined to carry the non-affected haplotype, two embryos were affected, and one could not be diagnosed. Two healthy embryos were transferred 48 hours after culture, resulting in a singleton ongoing pregnancy and the birth of a healthy child. Sex selection for the PGD of X-linked ALD, using standard PCR procedures, has several disadvantages: (1) half of the male embryos could be healthy and will not be replaced, (2) the replacement of carrier female embryos cannot be avoided. This, has led to the fact that, the couples who wish to undergo PGD will rather decide on a specific DNA diagnosis rather than a simple sexing. The availability of enough DNA, thanks to the MDA reaction, allows different target amplification avoiding multiplex optimization protocol, resulting in a very accurate diagnosis. MDA would become a universal first step in PGD. The method we report for the diagnosis of X-linked ALD should be applicable to most patients carrying ALD as long as they were informative for the markers.
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