Prenatal diagnosis of classical phenylketonuria by linked restriction fragment length polymorphism analysis

Since the isolation of a recombinant containing a cDNA sequence for human phenylalanine hydroxylase (hPH) (Woo et al., 1983; Speer et al., 1986) prenatal diagnosis by linked restriction fragment length polymorphism (RFLPs) has become possible for families in which phenylketonuria (PKU) occurs (Lidsky et al., 1985a). We describe here the application of a Hind III three-allele RFLP in a single family, which allowed the prenatal diagnosis of an affected fetus.     

Prenatal diagnosis of Duchenne muscular dystrophy by restriction fragment length polymorphism analysis with pERT 87 intragenomic deoxyribonucleic acid probes.

Prenatal diagnosis of DMD was performed with three intragenic genomic probes and chorionic villus sampling. A total of 8 unrelated families with at least one DMD were analysed. DNA was extracted from peripheral white blood cells for carrier testings (50 individuals). For prenatal detection, it was extracted from chorionic villi obtained by chorionic villus sampling at 9 menstrual weeks. DNA was digested with an appropriate restriction enzyme followed by overnight electrophoresis in 1% agarose gels. DNA was transferred from the gel to nylon membrane according to the protocol of an alkaline transfer method. The pERT 87 probes were labeled by nick translation. The membranes were hybridized overnight after prehybridization. After washing, the membranes were exposed to X-ray films to make autoradiograms for restriction fragment length polymorphism analysis. Fetal sex was determined by a rapid screening test with a Y chromosome-specific repeat sequence. Out of 8 fetuses, 4 were males and 4 were females. All of 4 male fetuses were determined to be unaffected. Out of 4 female fetuses, 3 were diagnosed as non-carriers, and the carrier status of the remaining one was not able to be determined because her mother was not informative for all testings.     

Factors responsible for multiple pregnancies after ovarian stimulation and intrauterine insemination with gonadotropins

Purpose: The present study was undertaken in order to analyze possible factors that could be responsible for multiple pregnancies in normoovulatory women undergoing superovulation with gonadotropins and intrauterine artificial insemination. Methods: We retrospectively analyzed several clinical parameters in patients that achieved gestation with this treatment. Patients were divided into two groups depending on sperm origin (husband and donor sperm). Furthermore, they were subclassified as follows: (a) cycles resulting in single pregnancies (n=366), (b) cycles ending in multiple pregnancies (n=126), and (c) a control group composed of unsuccessful cycles (n=366). Results: In cycles employing husband's sperm, the age, number of cycles necessary to reach pregnancy, serum estradiol (E₂) levels, and number of follicles were significantly (P<0.05) different in multiple pregnancies compared to single or nonpregnant cycles. In donor insemination, women with multiple pregnancies were significantly younger than nonpregnant patients. There was a significant increase in the number of follicles developed (P<0.00001) and serum E₂ levels on the day of hCG (P<0.05) in multiple compared to single pregnancies and unsuccessful cycles. The number of motile sperm in the insemination specimen was not different among the established groups. When both types of treatments were grouped, pregnant patients were significantly (P<0.00001) younger than women with failed cycles. In addition, multifetal pregnancies were significantly (P<0.05) more frequent in women <30 years old. E₂ production was significantly (P<0.00008) higher in twin and multifetal pregnancies than in single or nonpregnant cycles. Follicular development was also significantly (P<0.00001) higher in twin and multifetal pregnancies compared to failed cycles. Conclusions: The results suggest that young women (<30 years) who develop more than six follicles with E₂ >1000 pg/ml when stimulated with gonadotropins are at higher risk of multiple gestation. These data may be helpful in preventing this undesired complication of assisted reproduction techniques.     

Restriction fragment length polymorphism analysis to study the genetic origin of complete hydatidiform mole.

To determine the genetic origin of the complete hydatidiform mole, 20 abnormal pregnancies were studied with restriction fragment length polymorphism with five genomic probes: EJ 6.6, beta-globin gene, 3'alpha-hypervariable region, J-Bir, and St14. In the 12 cases of molar pregnancy, pure paternal origin was proved in 11 cases, but both maternal and paternal inheritance were shown in only one case. In the cases with pure paternal origin, all of the restriction fragment length polymorphisms were homozygous, although those of the fathers were heterozygous at 15 loci. In the four cases that mimicked hydatidiform mole but were diagnosed as hydropic change of villi, both paternal and maternal inheritance were noted. In the four pregnancies with blighted ovum, both paternal and maternal inheritance were shown in three cases; and in one case with a balanced translocation between chromosomes 13 and 14, only paternal inheritance was noted. This study showed that most of the complete hydatidiform moles were caused by fertilization of an empty egg by a duplicated haploid sperm, but rare exceptions may exist.     

Detection of polyomavirus JC genotype from transplant patients by capillary electrophoresis: comparison to fragment length polymorphism analysis.

BACKGROUND/PURPOSE: Among the genotypes of human polyomavirus JC (JCV) reported in Taiwan, CY, TW1, TW2 and TW3 are the most commonly correlated with human diseases. JCV is usually detected using nucleotide sequencing and restriction fragment length polymorphism (RFLP) analysis. The aim of this study was to detect the rate of positivity and genotype of the JCV genome in urine by RFLP or capillary electrophoresis (CE) in renal transplant patients and healthy volunteers. METHODS: We compared CE analysis to the methods of nucleotide sequencing and RFLP analysis for detection of JCV viruria among 60 renal transplant patients and 50 unrelated healthy controls. Genotyping of the positive PCR products was performed using CE and RFLP analysis simultaneously. RESULTS: The urine JCV-positive rate was significantly higher in renal transplant patients than in healthy volunteers (40% [24/60] vs. 20% [10/50]; p=0.0238). In addition, multiple genotypes of JCV could be detected by CE, but only one genotype could be detected by RFLP. In our study, 20% (2/10) of urine JCV-positive samples from healthy volunteers had two different genotypes. In renal transplant patients 66% (16/24) of JCV-positive samples had two different genotypes and 12% (3/24) had three different genotypes. CONCLUSION: In comparison with RFLP, CE can detect multiple genotypes in urine JCV-positive samples and requires only 1/200 of the volume of specimen required for RFLP analysis. The CE method has sensitivity and specificity suitable for use in the clinical laboratory, and identifies more genotypes than RFLP analysis.     

雌激素受体基因限制性片段长度多态性与子宫内膜异位症

目的 探讨雌激素受体(ER)基因限制性片段长度多态性(RFLP)与子宫内膜异位症发病的关系。方法 经手术证实的Ⅰ-Ⅳ期子宫内膜异位症患者50例为实验组,随机选择年龄相当的正常妇女50例为对照组,分别提取外周血白细胞DNA,经PCR扩增,PvuⅡ限制性内切酶酶切,琼脂糖电泳观察结果。结果PP、Pp及pp 3种基因型在子宫内膜异位症组出现例数为6、22和22例,而在对照组分别为10,23和17例,两组差异无显著性(P>0.05);等位基因P与p出现频率差异也无显著性(P>0.05)。结论 ER基因型和等位基因频率可能与子宫内膜异位症发病及疾病严重程度无关。     

Avoidance of multiple pregnancies after ovulation induction by supernumerary preovulatory follicular reduction

OBJECTIVE: To evaluate the effect of supernumerary preovulatory follicular reduction as an approach to avoid multiple pregnancies in ovulation induction or superovulation cycles. DESIGN: Retrospective study. SETTING: Tertiary referral center. PATIENT(S): In 26 cycles, 24 patients underwent ovulation induction or superovulation with either clomiphene citrate or hMG. INTERVENTION(S): Selective follicle aspiration was performed before hCG administration. MAIN OUTCOME MEASURE(S): Clinical pregnancy rate and numbers of multiple pregnancies. RESULT(S): A mean number of 4.5 follicles with a diameter > or =15 mm and a mean number of 4.5 follicles with a diameter < or =14 mm were observed before hCG administration. A mean number of 2.3 follicles with a diameter > or =15 mm and a mean number of 1.8 follicles with a diameter < or =14 mm were aspirated before the hCG administration. Seven singleton pregnancies (26.9% per cycle) ensued from the treatment. CONCLUSION(S): Aspiration of supernumerary follicles after ovulation induction or superovulation seems to be a valid approach to avoid multiple pregnancies without affecting pregnancy rate.     

Fatal disruption of a splenorenal shunt after multiple pregnancies

A 39-year-old woman underwent a distal splenorenal shunt operation for bleeding esophageal varices due to liver cirrhosis. Following the operation she had 7 pregnancies at almost yearly intervals. At the term of the last pregnancy a disruption of the anastomotic site caused a fatal hemorrhage. The outcome of postshunt pregnancies as reviewed in the literature is usually favorable, but numerous pregnancies in these circumstances may carry a considerable risk.     

辅助生殖后中孕期多胎妊娠减胎相关问题

辅助生育技术增加多胎妊娠,通过限制胚胎移植数目及取消卵巢高反应周期,高数目多胎妊娠的风险在减少。因多胎妊娠母儿风险增加,有些情况下选择性中期妊娠减胎术是必要的。减胎术一般保留至2个胎儿,减胎后妊娠成功率随初始胎儿数的增加而降低。绒毛膜性的确定对于围产期管理至关重要。中期妊娠减胎术的手术方法根据绒毛膜性不同而选择药物注射或脐带血管闭塞法。辅助生殖技术也增加单绒毛膜双胎的发生。当单绒毛膜双胎发生血管吻合异常和胎盘共享不均时,可能导致不良结局,为复杂性双胎。多胎妊娠减胎可优化孕妇和留存胎儿的健康状况,但少数可能发生整个妊娠丢失。应正确把握减胎指征,尊重孕妇和家属的知情选择。     

The association of antiphospholipid antibodies with pregnancies complicated by fetal growth restriction

The association of antiphospholipid antibodies with fetal growth restriction is often cited, but the published evidence for this is based on few patients and comes primarily from patient histories, not study groups. In this prospective study, we evaluated a subgroup of our population with fetuses whose estimated weights at ultrasound were at or below the tenth percentile for gestational age. Plasma and serum testing was performed to determine the presence of antiphospholipid antibodies, specifically lupus anticoagulant and anticardiolipin antibodies, respectively. From March 1990 through March 1991, 55 women were followed for suspected fetal growth restriction. Intensive monitoring of the fetal condition and modification of the mother's activity were recommended, resulting in 100% compliance. Despite this, 37 newborns were confirmed by birth weight to be at or below the tenth percentile, and all were below the 45th percentile. Fifteen of 55 women (27%) were positive for anticardiolipin antibodies, as were nine of 37 (24%) with correctly diagnosed fetal growth restriction. Five of 15 women whose newborns had ponderal indexes below the tenth percentile tested positive for anticardiolipin antibodies. None of the women had a positive lupus anticoagulant test. The prevalence of anticardiolipin antibodies in this study group was significantly higher than in our general population. We conclude that there is a statistically significant association between the presence of circulating maternal anticardiolipin antibodies and fetal growth restriction.     

Genetic analysis of familial and multiple malignancies of endometrial cancer.

The presence of the positive replication errors (RER) phenotype in familial and multiple primary malignancies of endometrial cancer, and its association with a poor prognosis was examined. We analyzed 40 endometrial cancers for RER. Eight endometrial cancers with the RER(+) phenotype at multiple microsatellite loci were detected. The presence of the RER(+) phenotype was higher than in non-familial malignancies. None of the eight cases with the RER(+) phenotype involved multiple primary malignancies; however these patients had shorter survival times. In this study, we suggest that RER examination in endometrial cancer may be useful for establishing a diagnosis of a familial malignancy, and for predicting a poor prognosis.     

Altered potassium channel expression in the human placental vasculature of pregnancies complicated by fetal growth restriction.

OBJECTIVE: Decreased activity of "oxygen-sensitive" potassium (K) channels reduces hypoxia-induced contraction of pulmonary vascular tissue. "Oxygen-sensitive" channels are present in the fetoplacental vasculature, where vascular resistance is thought to increase in fetal growth restriction (FGR). We assessed placental gene expression of K(V)2.1, K(V)9.3 and K(IR)6.1, three "oxygen-sensitive" K channels in normal pregnancy and FGR. METHODS: Biopsies were obtained from 12 normal pregnancies and 12 pregnancies complicated by FGR. Chorionic plate arteries and veins were dissected from the biopsies and a sample of placental tissue comprising chorionic plate and villus tissue was also collected. All samples were processed and analyzed using "real time" quantitative RT-PCR. RESULTS: K(V)2.1 and K(V)9.3 gene expression, in veins and placental homogenate, respectively, were increased in FGR. K(IR)6.1 gene expression was comparable in normal pregnancy and FGR samples. CONCLUSIONS: The gene expression of two voltage-gated K channels thought to be important for altered vascular reactivity following changes in oxygenation is increased in FGR.     

Transvaginal embryo aspiration--a safe method for selective reduction in multiple pregnancies.

OBJECTIVE: To evaluate pregnancy outcome after transvaginal selective embryo aspiration and to compare the results with those reported previously with other techniques for selective abortion. DESIGN: Retrospective case series. SETTING: University-based in vitro fertilization (IVF) program. PATIENTS: Nineteen women with multiple pregnancy who conceived after ovulation induction or IVF/gamete intrafallopian transfer. INTERVENTION: Transvaginal ultrasound-guided aspiration of the embryo(s) was performed at 7 to 8 weeks of gestation. MAIN OUTCOME MEASURES: Early and late complications related to the procedure, outcome of pregnancy, and birth weight. RESULTS: In 18 cases, the initial number of embryos (3 to 7) was reduced to two. In 1 case, the number of embryos was reduced from 4 to 3. None of the remaining fetuses vanished after the procedure. One patient delivered at 25 weeks and all other patients delivered healthy, viable infants (a pregnancy loss rate of 5.3%). CONCLUSIONS: Transvaginal embryo aspiration in early gestation appears to be a simple and relatively safe procedure for selective termination in patients with high-order multiple pregnancy. The cumulative loss rate of selective termination procedures previously reported by others is three times higher than the loss encountered in our series. This earlier procedure may be more acceptable to patients from emotional and religious points of view.     

Matrix metalloproteinase release from placental explants of pregnancies complicated by intrauterine growth restriction

OBJECTIVE: There is evidence of impaired placental development in intrauterine growth restriction (IUGR). Matrix metalloproteinases (MMPs) are extracellular matrix-degrading enzymes that are released by placental cells during tissue remodeling processes. We hypothesized 1) that release of MMP-2 and -9 is decreased and/or release of tissue inhibitors of metalloproteinases (TIMPs) is increased from placental explants in pregnancies complicated by IUGR and 2) that oxygen levels affect such release. METHODS: Placental villous explants from normal (n = 7) and IUGR (n = 7) pregnancies were cultured at high (20%) and low (3%) oxygen levels for 24 hours. Supernatants were analyzed for MMP-2 and MMP-9 by zymography and for TIMP-1 and -2 by western blot analysis. RESULTS:: At 20% oxygen there was significantly reduced MMP-2 (P < .05) and TIMP-1 (P < .01) release and a trend for decreased MMP-9 release (P = .07) in explants from IUGR pregnancies compared with normal pregnancies; however, there were no differences at 3% oxygen. TIMP-2 was below detectable levels in all samples. Although MMP-2 and TIMP-1 release was significantly reduced at 3% compared with 20% oxygen in explants from both normal (P < .001; P < .05) and IUGR (P < .05) pregnancies, MMP-2 release changed less in IUGR compared with normal explant cultures. There were no significant effects of oxygen on MMP-9 release. CONCLUSION: Placental explants from IUGR pregnancies demonstrated reduced MMP-2, MMP-9, and TIMP-1 release compared with explants from normal pregnancies at high (20%) but not low (3%) oxygen.     

Restriction fragment length polymorphism study of families with congenital adrenal hyperplasia due to 21-hydroxylase deficiency in Taiwan

Congenital adrenal hyperplasia (CAH) is a heterogeneous group of hereditary diseases characterized by deficient adrenal cortisol synthesis. Most CAH is due to 21-hydroxylase (C21) deficiency. Genomic DNA from several families with 21-hydroxylase deficiency and normal controls was analyzed by the Southern blot hybridization technique. The restriction fragment length polymorphism (RFLP) patterns using several endonucleases, such as Taq I, Eco RI and Pvu II, at the C21 gene locus showed a very low frequency of variability in normals and most of the patients with CAH. One proband with CAH lacked the characteristic 3.7 kb Taq I fragment probed with C21 cDNA. This may be due to gene conversion and/or deletion events in the functional C21 gene locus. On the other hand, genes closely linked to the C21 locus such as C4 and HLA-DR are highly polymorphic. Using these flanking genes as probes, it is easy to perform linkage analysis and identify the inheritance trait. Prenatal diagnosis will be possible in these affected families when an additional pregnancy is expected.     

An image analysis technique for the investigation of variations in placental morphology in pregnancies complicated by preeclampsia with and without intrauterine growth restriction

OBJECTIVE: The purpose of this study was to use visual image analysis to observe changes in the morphology and composition of placental villi in pregnancies complicated by preeclampsia (PE) and intrauterine growth restriction (IUGR). METHODS: Placental biopsies from nine normal pregnancies, five cases of PE, five cases of IUGR, and five cases of PE with IUGR (PE x IUGR) were randomly sampled. Formalin-fixed, wax-embedded sections were stained with hematoxylin and eosin (H&E) and subjected to image analysis. The placental areas occupied by villi, syncytiotrophoblast, and syncytial cytoplasm and nuclei were quantified. RESULTS: Significantly smaller placentas were obtained from growth-restricted pregnancies. PE, with and without IUGR, had no effect on the total area occupied by villi or intervillous space. IUGR alone showed a real and consistent reduction in villous area (56.0 +/- 2.4% vs 43.6 +/- 3.3%, P <.03). While the ratio of syncytial to villous areas were noticeably reduced in all cases of PE (0.38 +/- 0.03 vs 0.24 +/- 0.07, P <.05), this ratio remained unchanging in IUGR. Birth weight was positively correlated to both placental size and total villous area occupied. Moreover, increasingly positive relationships were recorded between both syncytiotrophoblast area and syncytiotrophoblast cytoplasm and birth weight (P <.01 and P <.001, respectively). CONCLUSION: These measurements point to impoverished villus development in idiopathic IUGR. The observed changes in PE with IUGR were more akin to PE without growth restriction than IUGR alone. This suggests that idiopathic IUGR and IUGR in PE have a separate etiology, idiopathic IUGR arising through a reduction in villous area alone, and IUGR in PE caused by changes in syncytiotrophoblast quantity, more specifically the amount of syncytiotrophoblast cytoplasm.     

Outcome of subsequent pregnancies following antibiotic therapy after primary or multiple spontaneous abortions

The course of the subsequent pregnancy and the maternal and fetal complications were evaluated in 254 couples who were seen in an infertility clinic after primary or multiple spontaneous abortions. The 100 couples who were treated with antibiotics after pregnancy loss showed a significantly better chance of achieving a subsequent pregnancy. The outcome of pregnancy was significantly better in the antibiotic treated group and the rate of spontaneous abortion recurrence was significantly lower (10 versus 38 per cent). The number of maternal complications was significantly less in the treated group--premature rupture of membranes, three (4 per cent) versus 30 (46 per cent), and postpartum fever, three (4 per cent) versus 23 (35 per cent), respectively. The untreated group experienced a significantly lower percentage of vaginal delivery (56 versus 69 per cent) (p less than 0.001). In the antibiotic treated group, there were significantly lower rates of fetal complications, including fetal distress, meconium, respiratory distress syndrome, neonatal infection and hyperbilirubinemia. The mean birth weight of infants in the antibiotic treated group was significantly higher (3,529 versus 3,090 grams; p less than 0.001). Prematurity and postdatism were significantly less frequent in the antibiotic treated group, and the corresponding Apgar scores were significantly better. We, thus, postulate that certain spontaneous abortions may be caused by bacteria present in the genital tract at the time of conception. These bacteria may have an adverse effect on the course of pregnancy and result in increased maternal and fetal complications.