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The existence of fetal microchimerism has been demonstrated many years ago. This phenomenon is associated with observation of two or more genetically different populations of cells present in one person. Fetal microchimerism originates naturally during pregnancy, by bidirectional transfer of the cells through placenta from fetus to mother (fetal microchimerism) and from mother to fetus (maternal microchimerism). In some cases fetal cells persisted in mother for decades after pregnancy. In my thesis I showed the presence of fetal microchimerism in tissues of endometrial cancer, breast cancer and ovarian cancer and in control, nonmalignant tissues. I worked with deep-frozen tissues, native tissues and cell cultures created from native tissues. I planed also the analysis of paraffin-embedded tissues; however this type of material showed to be unusable for fetal cells detection. On the contrary, native and deep-frozen tumor and control tissues are suitable for this type of research and fetal microchimerism was observed in part of samples. For detection and amplification of DNA extracted from tissues and cell cultures I used quantitative real-time PCR and SRY gene located on the Y chromosome as a marker of fetal cells. I detected the presence of male fetal cells. Fetal genome was found in both tumor and...

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Η αναζήτηση και επινόηση νέων προσεγγίσεων για την προγεννητική διάγνωση χρωμοσωμικών συνδρόμων, που να συνδυάζουν ταχύτητα, αξιοπιστία και ασφάλεια για την μητέρα και το έμβρυο, είναι πάντοτε επίκαιρη και επιτακτική, ιδιαίτερα στην εποχή μας, όπου η πρόοδος της μοριακής βιολογίας και η αποκρυπτογράφηση του ανθρώπινου γονιδιώματος, προσφέρουν νέα γνώση και εργαλεία για την προσπάθεια αυτή. Στην παρούσα εργασία τυποποιήθηκε η μεθοδολογία της ποσοτικής φθορίζουσας αλυσιδωτής αντίδρασης της πολυμεράσης (Quantitative Fluorescence Polymerase Chain Reaction, QF-PCR) σε συνδυασμό με τη συμβατική PCR για την ανίχνευση ανευπλοειδιών και φύλου σε δείγματα αμνιακών κυττάρων, σε βλαστομερίδια προεμβρύου και κυρίως σε ελεύθερο εμβρυϊκό DNA από την μητρική κυκλοφορία καθώς και σε ούρα της εγκύου, για την καθιέρωση μη επεμβατικής μεθοδολογίας προγεννητικής διάγνωσης. Είναι σαφές από τα αποτελέσματα της παρούσας ερευνητικής εργασίας ότι οι συγκεκριμένες μεθοδολογίες μπορούν να χρησιμοποιηθούν συμπληρωματικά στο συμβατικό χρωμοσωμικό έλεγχο και παράλληλα να αξιοποιηθούν όσον αφορά την ανάλυση του ελεύθερου εμβρυϊκού DNA στο πλάσμα της μητέρας για την ασφαλή διάγνωση του φύλου του εμβρύου στα πρώτα στάδια της κύησης. Επιπλέον, επινοήθηκαν πειράματα προσομοίωσης μητρικού πλάσματος με σκοπό τον προσδιορισμό του ποσοστού του εμβρυϊκού DNA στη μητρική κυκλοφορία σε όλη τη διάρκεια της κύησης. Τα αποτελέσματα έδειξαν ότι στα δείγματα μας το εμβρυϊκό DNA μπορεί να διαχωριστεί από το DNA της μητέρας, ανιχνεύοντας μοναδικά εμβρυϊκά αλληλόμορφα πολυμορφικών περιοχών STR (Short Tandem Repeats) πατρικής προέλευσης με QF-PCR. Αυτά τα αλληλόμορφα χρησιμοποιήθηκαν για τον υπολογισμό του ποσοστού του εμβρυϊκού DNA στο μητρικό πλάσμα. Έτσι βρέθηκε ότι σε φυσιολογικές κυήσεις, το εμβρυϊκό DNA είναι της τάξεως του 7% (διακύμανση 0-20%) του ολικού ελεύθερου DNA στη μητρική κυκλοφορία. Με βάση την ανάλυση των μοντέλων προσομοίωσης προσδιορίσθηκε με QF-PCR ο αριθμός των αντιγράφων των εμβρυϊκών χρωμοσωμάτων συγκρίνοντας τις αναλογίες των αλληλομόρφων δεικτών STR στα χρωμοσώματα 21, 18, 13, Χ και Υ. Τα αποτελέσματα έδειξαν ότι για φυσιολογικά έμβρυα και σε περιπτώσεις όπου το ποσοστό του εμβρυϊκού DNA στο μητρικό πλάσμα είναι ≥15%, ο λόγος των αναλογιών των αλληλομόρφων δύο δεικτών STR σε διαφορετικά χρωμοσώματα προσεγγίζει τη μονάδα. Η ανάλυση δειγμάτων μητρικού πλάσματος από φυσιολογικές κυήσεις και μετά από εμπλουτισμό τους στο ελεύθερο εμβρυϊκό DNA επιβεβαίωσε τα αποτελέσματα των μοντέλων προσομοίωσης. Αντίστοιχα μοντέλα προσομοίωσης δειγμάτων πλάσματος εγκύων με τρισωμικά έμβρυα για το χρωμόσωμα 21 έδειξαν ότι ο λόγος της αναλογίας των αλληλομόρφων ενός δείκτη STR σε ένα αυτοσωμικό χρωμόσωμα (π.χ. 18 ή 13) προς την αναλογία των αλληλομόρφων ενός δείκτη STR στο χρωμόσωμα 21, διαφέρει από τη μονάδα και εξαρτάται από την προέλευση, πατρική ή μητρική, του επιπλέον εμβρυϊκού χρωμοσώματος 21 στο δείγμα (0.5 έναντι 1.3 αντιστοίχως). Τα αποτελέσματα αυτά μπορούν, εφόσον επαληθευθούν σε ικανό αριθμό δειγμάτων να αξιοποιηθούν ως επιπλέον δείκτες προγεννητικού ελέγχου και ενδεχομένως να συμβάλλουν στην τυποποίηση αποτελεσματικής μεθοδολογίας μη επεμβατικής χρωμοσωμικής διάγνωσης. / The quest and devise of new approaches for the prenatal diagnosis of chromosomal syndromes that combine rapid analysis robustness and safety for mother and embryo are always in demand especially in the post-genome era with new tools and methods in our disposition. In the present study, the methodology of quantitative fluorescent polymerase chain reaction (QF-PCR) has been developed and standardized in conjunction with conventional PCR for the detection of aneuploidies and sex in amniotic cells, blastomeres and most importantly in free fetal DNA isolated from maternal peripheral blood and urine, for the establishment of non-invasive methods of prenatal diagnosis. It has become evident that the methodology we have followed can complement conventional prenatal chromosome analysis and in addition can be exploited for the analysis of fetal DNA in maternal plasma for fetal sex determination at the first stages of gestation. Moreover, simulation experiments have been devised in order to determine the percentage of fetal DNA in maternal circulation throughout pregnancy. Our results showed that free fetal DNA can be distinguished from the mother’s DNA in maternal plasma by identifying unique paternally inherited fetal polymorphisms, such as short tandem repeat (STR) alleles, with QF-PCR. These alleles were used to calculate the percentage of fetal DNA in maternal plasma. Fetal DNA was found to be present on an average of 7% (range 0-20%) of the total free DNA in maternal circulation, in normal pregnancies. QF-PCR analysis was also used to determine the copy number of fetal chromosomes by comparing the allelic ratios for chromosomes 21, 18, 13 X and Y. It appears that in informative cases where free fetal DNA is 15% or more and originates from normal embryos, the value of the allelic ratio of a STR marker on one chromosome divided by the value of the allelic ratio of another STR marker on a different chromosome is equal to 1. Analysis of DNA samples isolated from the plasma of pregnant women bearing normal embryos confirmed the results of the simulation models. Comparison of the above data with new analyses simulating DNA from the plasma of pregnant women carrying trisomic for chromosome 21 embryos have shown that the value of the allelic ratio of a STR marker on an autosomal chromosome (e.g. 18 or 13), divided by the allelic ratio of a STR marker on chromosome 21, is different from 1 and it depends on the origin, paternal or maternal, of the extra copy of chromosome 21 in the embryo, with values of 0.5 in paternal compared to 1.3 in maternal trisomies respectively. These results differentiate between normal and trisomic cases and after further evaluation may provide a new indication marker for prenatal diagnosis. In the long term, they may also provide the basis of a non-invasive procedure for early prenatal chromosomal analysis.

Made available in DSpace on 2016-08-17T18:39:41Z (GMT). No. of bitstreams: 1 4098.pdf: 4555828 bytes, checksum: eeec91702a4d283144c291e30559f09c (MD5) Previous issue date: 2011-02-18 / In this paper we proposed and analyzed methodologies using the technology of Cell-Free Fetal Nucleic Acid-Free (cffDNA = Cell Free Fetal DNA) in noninvasive prenatal diagnosis (NIPD). Due to the modern technologies employed and their repercussion among the involved families, we sought to discuss some ethical, social and legal implications. Contrary to the popular belief that the placenta forms an impermeable barrier between mother and child, there is bidirectional traffic between the fetus and mother during pregnancy. Several studies have shown that not only intact cells but also fetal cell-free fetal nucleic acids (cffNA, ie, DNA and RNA) cross the placenta and travels in the mother's bloodstream. Four different applications of analysis technology were identified: cffDNA: a) Prenatal Sex Determination, used in pregnancies under the risk of sexual transmitted diseases and performed through the detection of the Y chromosome b) The diagnosis of certain diseases of a single gene through the detection of paternally inherited mutation c) Fetal Aneuploidy, such as Down syndrome, where chromosomal abnormalities may occur d) identifying the type of fetal blood in pregnancies under the risk of incompatibility, especially RhD. To carry out this work it was used the pre-natal determination of sex in 53 pregnant women at different gestational periods. For that it was proposed and tested methods of DNA extraction, amplification of DNA obtained by PCR (Polymerase Chain Reaction) and a new methodology called LAMP (Loop Mediated Isothermal Amplification) and the analysis of final results. Furthermore, the efficiency of LAMP and PCR was compared by amplifying different segments of the Y chromosome: DSY14 and TSPY. In three cases the samples were discarded because there was no fetal sex confirmation after molecular tests due to loss of contact with pregnant women. In two other cases the results pointed to male fetuses whilst the ultrasound confirmed these fetuses as females due to contamination. Finally it was obtained 28 male samples (58.33%) with amplification of the sequences of the Y chromosome and 20 female samples (41.67%) that did not amplify the sequence of the Y chromosome but only for the control. These results showed that the amplification lamp is more efficient than PCR, in the analysis of DSY14, the limit of detection is 10 pg and 0.1 pg for LAMP and PCR respectively. It was concluded that the amplification using the LAMP method is faster (60 min) and has a high sensitivity and specificity and does not require sophisticated equipment for reaction if compared to the PCR method. These characteristics make this methodology feaseable in laboratories with limited resources. / Neste trabalho propusemos e analisamos metodologias empregadas no uso da tecnologia dos Ácidos Nucléicos Livres de Células Fetais (cffDNA = Cell Free Fetal DNA) no diagnóstico pré-natal não invasivo (DPIN = Non-invasive Prenatal Diagnosis). Dada a modernidade das tecnologias empregadas e a sua repercussão nas famílias envolvidas, procuramos discutir algumas implicações éticas, sociais e legais. Ao contrário da crença popular de que a placenta constitui uma barreira impermeável entre mãe e filho, há tráfego bidirecional entre o feto e a mãe durante a gravidez. Vários estudos têm demonstrado que tanto células fetais intactas e ácidos nucléicos livres de células fetais (cffNA, ou seja, DNA e RNA) atravessam a placenta e circulam na corrente sanguínea materna. Identificamos quatro diferentes aplicações da tecnologia de análise do cffDNA: a) Determinação pré-natal do sexo, utilizada em gestações com risco de uma doença ligada ao sexo e realizada através da detecção do cromossomo masculino Y; b) O diagnóstico de certas doenças de gene único, normalmente através da detecção de mutação herdada paternalmente; c) Aneuploidia fetal, tal como a Síndrome de Down, onde há alterações cromossômicas; d) Detecção do tipo de sangue fetal em gestações com risco de incompatibilidade, sobretudo RhD. Para realizar este trabalho utilizamos a determinação pré-natal do sexo em 53 gestantes em diferentes períodos gestacionais. Para tal, testamos e propusemos metodologias de extração do DNA; amplificação do DNA extraído através da técnica da PCR (Polymerase Chain Reaction) e de uma nova metodologia denominada LAMP (Loop Mediated Isothermal Amplification); e a análise final dos resultados. Além disso, comparamos a eficiência da PCR e LAMP amplificando diferentes segmentos do cromossomo Y: DSY14 e TSPY. Em três casos as amostras foram descartadas porque não houve a confirmação do sexo fetal após os testes moleculares devido à perda de contato com as gestantes. Em outros dois casos os resultados apontaram para fetos masculinos, entretanto, no ultra-som eles foram confirmados como femininos, provavelmente devido a uma contaminção. No final obtivemos 28 amostras (58,33%) masculinas, com a amplificação das sequências do cromossomo Y e 20 amostras (41,67%) femininas que não amplificaram a sequência do cromossomo Y e apenas para o controle. Nossos resultados demonstraram que a amplificação por LAMP é mais eficiente que a PCR na análise de DSY14, sendo que o limite de detecção é de 10 pg e 0,1 pg, para a PCR e o LAMP, respectivamente. Concluímos que a amplificação utilizando a metodologia de LAMP é mais rápida (60 minutos) e apresenta uma alta especificidade, sensibilidade e não requer equipamentos sofisticados para reação, comparada com a técnica da PCR. Tais características viabilizam esta metodologia em laboratórios com poucos recursos.

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.

Prenatal assessment of fetal health is routinely offered throughout pregnancy to ensure that the most effective management can be provided to maintain fetal and maternal well-being. Currently, invasive testing is used for definitive diagnosis of fetal aneuploidy, which is associated with a 1% risk of iatrogenic fetal loss. Developing non-invasive prenatal testing (NIPT) is a key area of research and methods to increase the level of cell-free fetal DNA (cffDNA) within the maternal circulation have been discussed to improve accuracy of such tests. In this study, three strategies; co-amplification at lower denaturation temperature polymerase chain reaction (COLD-PCR), inverse-PCR and Pippin Prep™ gel electrophoresis, were analysed to identify a novel approach to selectively enrich shorter cffDNA fragments from larger maternal cell-free DNA (cfDNA). The sensitivity of droplet digital PCR (ddPCR) against real-time PCR (qPCR) was compared for fetal sex and RHD genotyping. In addition RHD zygosity testing was carried out for non-maternal samples. Consequently, Pippin Prep™ gel electrophoresis was combined with ddPCR analysis for the NIPD of Down Syndrome (DS) in pseudo-maternal samples. The results revealed that the Pippin Prep™ gel electrophoresis enrichment approach successfully demonstrated 2-fold to 5-fold increases in the cffDNA fraction. However, further optimisation assays of COLD-PCR and inverse-PCR using actual maternal samples were required. The spike experiments for DS detection revealed that with the present assay IV overrepresentation of the chromosome 21 target could be significantly detected for samples with ≥15% ‘cffDNA fraction’. In conjunction with the Pippin Prep™ enrichment method, this would have enabled assessment of all 10 maternal samples. Alternatively, fetal sex and RHD genotyping results determined that ddPCR provides a more sensitive platform compared to qPCR approaches, particularly for samples that express low cffDNA fractions (<2%). The ddPCR platform also proved to be a rapid and accurate system for the determination of RHD zygosity. This study highlights that ddPCR could be used as opposed to qPCR for accurate determination of fetal sex and RHD status. While sequencing approaches currently provide the most sensitive platforms for NIPT of fetal aneuploidy, high costs (>£400) prevent universal application. The combination of cffDNA enrichment with ddPCR analysis could provide a cheaper and more widely available platform for NIPD. However, further large scale validation studies using actual maternal samples are required.

This work presents the results ofour research of cell-free nucleic acids (cfNA). The first part shows changes in methylation patterns of immune response genes promoters that are detectable in plasma during the hemodialysis sessions and also differences in methylation between patients and healthy subjects. Alterations include genes that play their role in the regulation of hematopoiesis and these changes are in close relation with the need of anemia therapy. In the other plasma cfNA study we detected miRNA signatures in patients with acute myeloid leukemia at diagnosis (6 highly abundant miRNAs found) and in remission achieved after standard chemotherapy (trend to n01malization, lower levels ofthese miRNAs). Another part of work presents data from the study of potential non-invasive biomarker of bladder cancer. The amounts of cfDNA in urine are higher in patients than in healthy subjects and there were found 5 down-regulated miRNAs. Simultaneously it was established set of 30 miRNAs that are constantly present in urine supematants independently on sex, age and healthy status of subjects. The last part presents analysis ofcell-free fetal DNA. We analyzed differences between a new quantification method - droplet digital PCR and real-time PCR which is used routinely nowadays. Slightly more precise was...