Submitted by admin tede (tede@pucgoias.edu.br) on 2017-11-10T16:06:34Z No. of bitstreams: 1 KELLER GABRIEL MARTINS.pdf: 1151760 bytes, checksum: 3a640f73b5ee5ea85d89f69f6ccd9aa9 (MD5) / Made available in DSpace on 2017-11-10T16:06:34Z (GMT). No. of bitstreams: 1 KELLER GABRIEL MARTINS.pdf: 1151760 bytes, checksum: 3a640f73b5ee5ea85d89f69f6ccd9aa9 (MD5) Previous issue date: 2017-08-04 / The determination of fetal sex using maternal plasma is a noninvasive prenatal diagnostic test (NIPDT), offered to pregnant women, especially those with an increased risk of having children with conditions X-linked inheritance. Because it is a non-invasive technique, it presents a greater advantage over other methods of invasive prenatal diagnosis such as amniocentesis, cordocentesis and biopsy of chorionic villi. The use of cell free fetal DNA (cffDNA) in maternal plasma has become a promising alternative for the diagnosis of noninvasive and early sex determination. The porpuse this study is to conduct a qualitative test in pregnant women with gestational age ranging from 6 to 20 weeks using the noninvasive prenatal test for the early sex determination of fetal by the real time PCR technique. Twenty-one healthy pregnant women, over 18 years of age, single gestation and attended at the Gynecology and Obstetrics Clinic of the Unigen Laboratory belonging to the Private Health Care Network of the City of Goiânia-GO were selected. After venous blood collection, plasma was separated and frozen (-20 ° C). The material to be analyzed followed the laboratory of the company Qiagen® located in São Paulo, SP, where DNA extraction and purification were performed using fully automated equipment (QIAcube®, with the QIAamp® DNA Micro kit, using the protocol "Purification of viral nucleic acids from large body-fluid samples", according to the manufacturer's specifications), and then the quantitative PCR technique (Rotor-Gene® Qiagen) was run for specific Y-sequence amplification. Of the 21 pregnant women selected, two participants aborted and were excluded from the study. The results showed that, in the 19 cases analyzed, comparing the results of qPCR with fetal sex determined by ultrasonography (USG), 7/19 (36.8%) pregnancies with positive results for the Y chromosome (determining the male sex) and 11/19 (57.9%) pregnancies with a negative result for the Y chromosome (determining the female sex) and only one gestation (5.3%) presented false-negative results for males. The analysis of the concordance index, between the results of the qPCR and the USG, found a concordance of 0.89. These results confirmed a good sensitivity and specificity of the method for the gestation period studied (mean of 12 weeks), indicating that this procedure should be used in the medical routine as an auxiliary tool in cases where fetal sexing becomes necessary for health fetal and/or decreased parents anxiety. / A determinação do sexo fetal utilizando o plasma materno é um teste de diagnóstico pré-natal não invasivo (DPIN), oferecido as gestantes, principalmente para aquelas com risco aumentado de terem crianças com doenças ligadas ao sexo. Por se tratar de uma técnica não invasiva, apresenta-se com maior vantagem sobre outros métodos de diagnóstico pré-natal invasivos como a amniocentese, cordocentese e a biópsia de vilosidades coriônicas. O diagnóstico pré-natal (DPN) tem sido importante no acompanhamento de gestações com anormalidades fetais, além de permitir um planejamento mais adequado para o parto e de cuidados neonatais específicos. Dessa forma, o DPN tem sido estabelecido na prática obstétrica moderna e integra um conjunto de procedimentos para identificar uma anormalidade no feto durante a gravidez. Diversas pesquisas têm buscado a utilização de novas tecnologias para o diagnóstico pré-natal não invasivo (DPNI). O uso de DNA fetal livre (cffDNA) no plasma materno passou a ser uma alternativa promissora para diagnóstico do sexo não invasivo e precoce. O objetivo do presente trabalho é realizar um estudo qualitativo em pacientes gestantes, com idade gestacional variando de 6 a 20 semanas utilizando o teste pré-natal não invasivo para a determinação precoce do sexo fetal pela técnica de qPCR. Foram selecionadas 21 gestantes saudáveis, maiores de 18 anos e gestação única e atendidas em clínica de ginecologia e obstetrícia do Centro de Diagnóstico Clínico UNIGEN pertencente à Rede Privada de Atendimento à Saúde da Cidade de Goiânia-GO. Após a coleta de sangue venoso, houve a separação e o congelamento do plasma (-20°C). O material a ser analisado seguiu para o laboratório da empresa Qiagen® localizado em São Paulo-SP, onde foram realizadas a extração e purificação do DNA utilizando equipamento automatizado (QIAcube®, com o kit QIAamp® DNA Micro, empregando-se o protocolo “Purification of viral nucleic acids from large body-fluid samples”, conforme especificações do fabricante), e em seguida foi ralizada a técnica de PCR quantitativa (Rotor-Gene® Qiagen) para amplificação de sequência Y específica. Das 21 gestantes selecionadas, duas participantes abortaram, sendo dessa forma excluídas do estudo. Os resultados revelaram que dos 19 casos analisados, ao comparar os resultados da qPCR com o sexo fetal determinado pela ultrassonografia (USG), 7/19 (36,8%) gestações com resultados positivos para o cromossomo Y (determinando o sexo Masculino) e 11/19 (57,9%) gestações com resultado negativo para o cromossomo Y (determinando o sexo Feminino) e apenas uma gestação (5,3%) apresentou resultado falso-negativo para o sexo masculino. A análise do índice de concordância, entre os resultados da qPCR com a USG foi de 0,89. Esses resultados confirmaram uma boa sensibilidade e especificidade do método para o período de gestação estudado (média de 12 semanas), indicando que este procedimento deve ser utilizado na rotina médica como ferramenta auxiliar nos casos onde a sexagem fetal torna-se necessária para tratamento fetal e/ou diminuição da ansiedade dos pais.

La place du Dépistage Prénatal Non Invasif (DPNI) n’est pas encore clairement définie dans le dépistage prénatal de la trisomie 21 en France. Nos objectifs étaient d’évaluer la compréhension, les connaissances, et l’attitude de professionnels de santé et de patientes concernant le DPNI.Une étude prospective multicentrique par questionnaire auprès de patientes enceintes et de professionnels de santé a été menée dans différents hôpitaux français entre février 2014 et juillet 2015.Sur les 260 questionnaires recueillis chez les professionnels, le score moyen de connaissances était 5,38±2,83(sur 10)et 92,7%(n=241) avaient une attitude favorable face au DPNI. En analyse multivariée, les facteurs associés à un bon niveau de connaissances étaient la profession de gynécologue ou de conseiller en génétique, l’âge<30 ans, le fait de travailler à l’hôpital ou en cabinet et le fait de suivre>50 grossesses par an.Sur les 380 questionnaires de patientes, le score moyen de connaissances était faible 2,20±1,88(sur 10) et 89,9%(n=328) avaient une attitude favorable face au DPNI. En analyse multivariée, les facteurs associés à un bon niveau de connaissances chez les patientes étaient l’âge maternel et le fait de consulter en secteur privé.Le niveau de connaissances des professionnels et des patientes sur le DPNI est faible. La plupart des patientes ne peuvent pas formuler de consentement éclairé. Toutefois, la plupart des professionnels et des patientes sont très en faveur de ce test. La généralisation du DPNI dans le dépistage de la trisomie 21 implique un important programme de formation des professionnels afin qu'ils délivrent une information prénatale de qualité et non directive. / The place of Non Invasive Prenatal Testing(NIPT) is not clearly established for prenatal screening for Down syndrome in France. Our objectives were to assess the understanding, knowledge of, and attitudes towards NIPT in French patients and healthcare providers.A prospective multicenter study was performed in several French hospital centers between February 2014 and July 2015. A survey was administered to pregnant patients and to healthcare professionals.A total of 260 questionnaires were completed by healthcare providers. The average knowledge score was 5,38±2,83(out of a possible 10). In multivariate analysis, the characteristics associated with satisfactory knowledge were: profession as obstetrician or genetic counsellor, age<30 years, working in hospital or in doctor’s office, more than 50 pregnancies followed per year. Among professionals, 92,7%n=241) had a favorable attitude towards NIPT.We collected 380 questionnaires from pregnant women. The average knowledge score was very low: 2,20±1,88(out of 10). In multivariate analysis, the two significant characteristics associated with satisfactory knowledge was maternal age and having prenatal care in private practice. Among patients, 89,9%(n=328) had a favorable attitude towards NIPT.The level of knowledge of NIPT of healthcare professionals and patients is low. Many patients can not provide informed consent. However most professionals and patients are in favor of the use of this test. The input of NIPT in prenatal screening for trisomy 21 requires a considerable teaching program for healthcare providers so they can give balanced pretest information and non-directive counselling.

L’objectif principal de ce projet de recherche doctorale est la mise au point d’approches méthodologiques fiables et reproductibles permettant la caractérisation génétique de cellules rares circulantes isolées par la méthode de filtration ISET® (Rarecells®, France). La première application développée consiste en la détection des mutations du gène suppresseur de tumeur VHL (Von Hippel Lindau) dans les cellules rares circulantes (CRC) uniques isolées du sang de 30 patients atteints de carcinome rénal à cellules claires (CRCC), et réalisée comparativement à l’analyse cytopathologique. L’étude génétique a également été conduite en parallèle dans les 30 tissus tumoraux correspondants. Les résultats ont mis en lumière une potentielle complémentarité de l’approche de génétique moléculaire sur cellules uniques avec l’analyse cytomorphologique de référence et suggèrent que combiner ces approches permettrait d’obtenir une plus grande sensibilité de détection des cellules cancéreuses circulantes chez les patients atteints de CRCC. Une deuxième application a consisté en le développement d’une approche innovante pour le diagnostic prénatal non-invasif des maladies génétiques récessives par analyse de cellules trophoblastiques rares collectées au niveau du col de l’utérus. Enfin, des développements supplémentaires ont permis d’optimiser les analyses de séquençage à haut débit et de les appliquer à des CRC individuelles isolées par ISET®. Cette nouvelle approche, associée à l’isolement de CRC non fixées, est en mesure de fournir des données génétiques élargies à l’exome entier pour des applications à la fois en oncologie prédictive et en diagnostic prénatal non invasif. / The aim of this doctoral research project is the development of reliable and reproducible methodological approaches enabling the genetic characterization of circulating rare cells (CRC) isolated by ISET® filtration (Rarecells®, France). The first application developed consists in detecting mutations of the VHL (Von Hippel Lindau) tumor suppressor gene in single CRC isolated from the blood of 30 patients patients with clear cell renal cell carcinoma (ccRCC), assessed according to the results obtained by cytopathological analysis. In parallel, genetic analysis of VHL mutations was conducted in the corresponding tumor tissues. Results revealed a potential complementarity of the molecular genetic approach targeted to single cells with the reference method of cytopathological analysis and suggested that combining both strategies could improve the sensitivity of circulating cancer cells’ detection in patients with ccRCC. A second application consisted in the development of an innovative approach for non-invasive prenatal diagnosis of recessive genetic diseases by analysis of rare trophoblastic cells collected from the cervix. Finally, further developments allowed to optimize high-throughput sequencing analyses and to apply them to single CRC isolated by ISET®. This approach, combined with the isolation of living CRC, enabled us to obtain broader genetic data from the whole exome and should foster innovative applications to both predictive oncology and non-invasive prenatal diagnosis.