Circulating mRNA in Maternal Plasma at the Second Trimester of Pregnancy: A Possible Screening Tool for Cardiac Conotrun
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ORIGINAL RESEARCH ARTICLE
Circulating mRNA in Maternal Plasma at the Second Trimester of Pregnancy: A Possible Screening Tool for Cardiac Conotruncal and Left Ventricular Outflow Tract Abnormalities Elena Contro1 • Lara Stefani2 • Silvia Berto2 • Cristina Lapucci2 • Diego Arcelli1 Daniela Prandstraller3 • Antonella Perolo1 • Nicola Rizzo1 • Antonio Farina1
•
Published online: 25 July 2017 Ó Springer International Publishing AG 2017
Abstract Objective Maternal plasma is a source of circulating placental nucleic acids. This study was designed to detect aberrantly expressed placental mRNA genes circulating in the maternal plasma of pregnancies affected with fetal conotruncal anomalies (CNTRA) and left-ventricular outflow tract (LVOT) obstruction in the second trimester of pregnancy. Methods This was a retrospective monocentric study conducted from 1 Jan 2016 to 31 Dec 2016. NanoString technology was used to identify aberrantly expressed genes, comparing 36 women carrying a fetus with CNTRA or LVOT obstruction to 42 controls at 19–24 weeks of gestation. The genes with differential expression were subsequently tested using real-time polymerase chain reaction. Linear discriminant analysis was used to combine all the mRNA species with discriminant ability for CNTRA and LVOT obstruction. A multivariable receiver operating characteristic (ROC) curve having the estimated discriminant score as an explanatory variable was generated for the
two affected groups versus controls. Results Three genes with differential expression, namely MAPK1, IQGAP1 and Visfatin were found. The ROC curves yielded detection rates of 60 and 62.5% at a falsepositive rate of 5% for CNTRA and LVOT, respectively. Conclusions These data suggested that molecular screening of CNTRA and LVOT obstruction in the second trimester is feasible. Prospective studies are needed to test the discriminant ability of these genes and to calculate the predictive positive value in the general population.
Key Points Fetal echocardiography is the only effective screening tool for congenital heart defects, but in some countries it is only avalable in tertiary referral centres. A non-invasive molecular screening method for congenital heart defects, based on circulating mRNAs, would improve the detection rate of these malformations and would properly identify the higher-risk pregnancies.
Electronic supplementary material The online version of this article (doi:10.1007/s40291-017-0295-7) contains supplementary material, which is available to authorized users. & Antonio Farina [email protected] 1
Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant’Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
2
Synlab Italia Srl, Castenedolo, Brescia, Italy
3
Pediatric Cardiology and Adult Congenital Unit, Sant’OrsolaMalpighi Hospital, Bologna, Italy
This preliminary work presents a possible screening method for conotruncal and left-ventricular outflow tract abnormalities, based on the differential expression of MAPK1,
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