Strategies for prenatal and preimplantation genetic diagnosis in Marfan syndrome (MFS)

Marfan syndrome (MFS) is an autosomal dominant disorder with a prevalence of 2–3 per 10 000 individuals. Symptoms range from skeletal overgrowth, cutaneous striae to ectopia lentis and aortic dilatation leading to dissection. Prenatal diagnosis was until recently mainly performed in familial cases by linkage analysis. However, mutation detection has become available with thorough screening methods. The phenotypic variability observed in MFS makes reproductive options difficult, as molecular diagnosis cannot predict clinical severity of the disease. Data are presented on 15 prenatal and/or preimplantation genetic diagnoses (PGD) in nine families, originating from Belgium, the Netherlands, Spain and France. In four families data from linkage analysis were used, whereas in five other families the causative FBN1 mutation was characterised. Four PGD cycles in two couples led to one ongoing pregnancy. In addition, two amniocenteses and nine chorionic villus (CV) samplings were performed. In five pregnancies an affected fetus was diagnosed. In one of them, the couple chose to continue the pregnancy and an affected child was born, whereas the other four couples decided to terminate the pregnancy. It is expected that the greater availability of mutation testing of the FBN1 gene will increase requests for prenatal diagnosis. PGD appears to be an acceptable alternative for couples facing ethical reproductive dilemmas. Copyright © 2002 John Wiley & Sons, Ltd.     

Pulmonary inflammation induced by office dust and the relation to 1 → 3-β-glucan using different extraction techniques

It is observed that 1?→?3-β-glucan, a major cell wall component of fungi, induces pulmonary inflammation. There is inconsistency in determining the correlation between the levels of glucan measured by current extraction methods and the respiratory inflammation observed in individuals or lab animals exposed to environmental dust samples. The glucan-specific limulus amebocyte lysate (G-LAL) method was used after extraction with dimethyl sulfoxide (DMSO) or sodium hydroxide (NaOH) to analyze the glucan content of office dust samples collected from a water-damaged building. C3HeB/FeJ mice, an endotoxin-sensitive strain, were treated with different dust samples (2.5?mg?kg^?1 body weight) or saline (vehicle control) by pharyngeal aspiration. At 1?day after aspiration, bronchoalveolar lavage (BAL) was performed, and lung inflammation and injury were assessed by measuring: (1) neutrophil (PMN) infiltration, (2) inflammatory cytokine (IL-6, IL-10, MCP-1, IFN-γ, TNF-α, and IL12-p70) levels, and (3) albumin and lactate dehydrogenase in recovered BAL fluid. Both DMSO and NaOH extraction increased the detection of glucan by approximately 20-fold compared to water extraction. However, only the DMSO extraction method showed a statistically significant positive correlation between 1?→?3-β-glucan and albumin levels, total numbers of BAL, polymorphonuclear leukocytes (PMNs) cells recovered, levels of TNF-α, MCP-1, and IL-6. In conclusion, 1?→?3-β-glucan is a potent inflammatory agent in dust samples and DMSO extraction for glucan analysis may prove useful in understanding the impact of environmental contamination by glucans on lung disease.     

大连地区唐氏筛查孕中期妇女羊水中甲状腺激素水平与PBDEs内暴露关系初探

多溴联苯醚(polybrominated diphenyl ethers,PBDEs)是一类常用的溴代阻燃剂,由于使用广泛,已成为普遍存在的环境污染物。研究表明,PBDEs具有内分泌干扰作用,影响甲状腺功能,对胚胎发育、婴幼儿及儿童的健康存在潜在的危害。本研究采集了100例具羊水穿刺指征的孕妇的孕中期羊水样本,采用罗氏全自动电化学发光免疫分析仪测定羊水中促甲状腺激素(TSH)、三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)、甲状腺素(TT4)、游离甲状腺素(FT4)、抗甲状腺过氧化酶抗体(TPOA)和抗甲状腺球蛋白抗体(TGA)的含量,用气相色谱-负化学源-质谱法测定羊水样品中16种PBDEs同系物含量。结果显示,羊水中TSH、TT3、FT3、TT4、FT4中位数分别为0.342μIU·m L-1、0.949 nmol·L-1、1.52 pmol·L-1、11.02 nmol·L-1和3.91pmol·L-1,95%参考区间值分别为0.174~0.872μIU·m L-1、0.835~1.01 nmol·L-1、1.26~2.72 pmol·L-1、9.42~20.68 nmol·L-1和2.16~6.35 pmol·L-1。具有唐氏筛查高风险和甲状腺激素水平低下的羊水样品中共检出6种BDEs(BDE-47、BDE-71、BDE-138、BDE-183、BDE-190、BDE-209),其中BDE-71、183和190在被检羊水样品中均被检出,并且,TSH水平低下的羊水中BDE-190和209负荷水平显著高于正常组。这些结果提示,大连地区孕中期妇女羊水存在PBEDs内暴露,并且PBDEs内暴露可能与羊水的甲状腺激素水平低下、尤其TSH水平升高有关,提示PBDEs暴露可能与胎儿中枢神经系统损伤产生的下丘脑-垂体-甲状腺(HPT)轴功能失调有关。因此,羊水PBDEs内暴露对新生儿出生结局的影响值得进一步关注。     

Astomia-agnathia-holoprosencephaly association. Prenatal diagnosis of a new case

A case of agnathia-astomia-holoprosencephaly with prenatal ultrasound diagnosis at 23 weeks is reported and discussed. This lethal neurocristopathy, well known in mammalians, is rarely observed in humans. Prenatal diagnosis features are intrauterine growth retardation, mandible absence or major hypoplasia, holoprosencephaly, cyclopia or hypotelorism, and in some instances frontal proboscis. This malformation is usually sporadic, but may be genetically determined as an autosomal recessive trait, since two cases in the same sibship have been reported.     

Maternal age and amniocentesis: Should this be lowered to 30 years?

We have reviewed the results of 10000 2nd trimester amniocenteses performed at our centre. Over 80 per cent of these were done only because of maternal age (MA); there were three times as many < 35 year-old women in 1984 compared to 1975. Of women aged 30–34 years at delivery 0·69 per cent were found to have a MA-related chromosome abnormality compared to 0·94 per cent in those aged 35–40 years. Because only about 7 per cent of births occurred to women ⩾ 35 years and 18·6 per cent between 30–34 years, and a practical utilization rate of 50 per cent, we recommend that amniocentesis be made available to women aged ⩾ 30 years. We believe that 27 per cent of Down syndrome (DS) pregnancies could be identified if 50 per cent of pregnant women in this age category availed themselves of the test. With the same utilization rate, about three times as many amniocenteses would be required in California as performed here in 1983.