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Tuesday, October 07, 2008

A Safer Test for Down Syndrome

A noninvasive technique screens maternal blood for fetal DNA.

By Anna Davison

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Trio of chromosomes: People with Down syndrome have three copies of chromosome 21, rather than the standard two.
Credit: Phanie / Photo Researchers, Inc

Ever since the discovery that a pregnant woman's blood contains traces of her baby's DNA, researchers have been looking for ways to screen that DNA for genetic abnormalities. A new test developed by Stephen Quake and his colleagues at Stanford University takes us one step closer to a noninvasive blood test to diagnose disorders like Down syndrome in a fetus.

The new test uses powerful DNA sequencing techniques to amplify short fragments of a baby's DNA from its mother's blood, and to map the chromosomes. The method reveals the extra copies of chromosomes--aneuploidy--characteristic of certain genetic disorders, including Down syndrome, in which there are three copies of chromosome 21 rather than two.

"Now we're getting closer to the time when there will be not a screening test but a definitive noninvasive test," says Joe Leigh Simpson of Florida International University. Simpson wasn't involved in Quake's work.

The test picked up all nine cases of Down syndrome among 18 women in a study reported today in the Proceedings of the National Academy of Sciences. It also detected two cases of Edward syndrome, in which there is an extra copy of chromosome 18, and one instance of Patau syndrome, characterized by three copies of chromosome 13.

"This is very exciting," says Farideh Bischoff, a cytogeneticist with Biocept, a biotech company based in San Diego. "It's powerful." Bischoff wasn't involved in Quake's work.

Currently, the gold standard for prenatal diagnosis of Down syndrome is amniocentesis, "which requires a big needle to be stuck into the mom right next to the baby" to extract a sample of amniotic fluid, explains Quake, who is also an investigator for the Howard Hughes Medical Institute. There's an attendant risk of miscarriage, infection, or damage to the fetus. A diagnosis may also be made by chorionic villus sampling, which uses tissue from the placenta but has a higher risk of miscarriage than amniocentesis. The samples of amniotic fluid or placenta are examined to see if the fetus has three copies of chromosome 21.

Quake's technique takes advantage of the fact that small amounts of DNA from a fetus circulate in its mother's blood. Some DNA is within intact fetal cells, but about a decade ago, researchers discovered that a pregnant woman's blood also carries free-floating fetal DNA. Unlike intact cells, cell-free fetal DNA doesn't linger from one pregnancy to another. It's also more abundant than that from intact cells, but still rare enough to make it difficult to detect.

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Comments

  • People with Down syndrome are human beings...
    antibody on 10/07/2008 at 9:31 AM
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    As a father of a wonderful 9 year old son who happens to have Down syndrome, I was appalled by the statement "A first-trimester test for Down syndrome would be preferable, so that parents have more time to decide if they wish to terminate the pregnancy..." 

    Why is there the automatic assumption that parents would want to destroy their child just because he or she has a disability?  Are we that uncivilized? Or are we just ignorant of the wonderful qualities exhibited by people with this disability?

    Rather than spending all this money and brain power on how to detect birth defects earlier, why don't we instead focus on discovering what causes birth defects in the first place.  Those resources could also be used to develop better therapies and treatments for those among us who have disabilities.

    This weekend in every major metro area around the US friends and families are conducting various "Buddy Walks" to raise awareness of what Down syndrome really is. I challenge everyone on this forum to go spend a couple of hours educating yourself on all of the positive aspects of this disability. (Google: DS Buddy Walk and your area)
    Rate this comment: 12345
    • Re: People with Down syndrome are human beings...
      phoenix on 10/07/2008 at 11:37 AM
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      It would seem to be a more ethical approach than that of infanticide, where deformed or sickly newborns were simply left somewhere to die, which was a fairly common practice in some parts of Africa and other remote sections of the world right up until the middle of the 20th century. And many of those individuals deemed unworthy by the standards of Hitlers third reich, standards which were developed largely from the observations of Sir Francis Galton, the so called father of Eugenics, were sterilized so that they would not be able to reproduce. The option of terminating such a pregnancy, which you feel is unworthy of society even to contemplate, just might save a hopelessly deformed child from being brought into a world that would treat it as just another Elephant Man sideshow. 
      Rate this comment: 12345
    • Re: People with Down syndrome are human beings...
      Biologist on 10/08/2008 at 4:08 AM
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      antibody, the key phrase here is "parents have more time to decide if they wish to terminate the pregnancy". Emphasis is on the parents making this decision for themselves. There is absolutely no assumption that the parents would want to destroy their child. They have the choice of whether to take this test or not. When they receive the result, they then have the choice of what to do with that result.
      I work in this area, and routinely sign out results which parents use to make these choices, but when my wife was pregnant, we decided we would not terminate the pregnancy if Down syndrome was picked up on screening. It's all about choices.
      Rate this comment: 12345
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