[Early prognostic of ASD: A challenge]

Autism Spectrum Disorders (ASD) are born in the womb generated by intrauterine genetic or environmental insult. ASD diagnostic is made at the age of 3-5 years in Europe and in the US. Relying on this, we have tested the hypothesis of identifying already at birth babies who might be diagnosed later with ASD, thereby facilitating an early use of psychoeducative techniques to attenuate the severity of the symptoms. Here, we discuss the various approaches that have been used to enable an early diagnosis. We have ourselves used an approach based on a "without a priori" machine learning analysis of all maternity biological and ultrasound data available in French maternities (around 116) in utero and after birth. This program made it possible to identify at birth almost all (96%) of babies who will be later neurotypical and around half of those who will be diagnosed with ASD. Some of the parameters allowing this identification were largely unexpected with no known links with ASD. This approach will enable an early identification of babies at risk, but also might be used to diagnose ASD later on, and perhaps could help to get a better understanding of the heterogeneity of ASD.

Machine learning analysis of pregnancy data enables early identification of a subpopulation of newborns with ASD

To identify newborns at risk of developing ASD and to detect ASD biomarkers early after birth, we compared retrospectively ultrasound and biological measurements of babies diagnosed later with ASD or neurotypical (NT) that are collected routinely during pregnancy and birth. We used a supervised machine learning algorithm with a cross-validation technique to classify NT and ASD babies and performed various statistical tests. With a minimization of the false positive rate, 96% of NT and 41% of ASD babies were identified with a positive predictive value of 77%. We identified the following biomarkers related to ASD: sex, maternal familial history of auto-immune diseases, maternal immunization to CMV, IgG CMV level, timing of fetal rotation on head, femur length in the 3rd trimester, white blood cell count in the 3rd trimester, fetal heart rate during labor, newborn feeding and temperature difference between birth and one day after. Furthermore, statistical models revealed that a subpopulation of 38% of babies at risk of ASD had significantly larger fetal head circumference than age-matched NT ones, suggesting an in utero origin of the reported bigger brains of toddlers with ASD. Our results suggest that pregnancy follow-up measurements might provide an early prognosis of ASD enabling pre-symptomatic behavioral interventions to attenuate efficiently ASD developmental sequels.

Interest of human papillomavirus DNA quantification and genotyping in paired cervical and urine samples to detect cervical lesions

BACKGROUND

Cervical cancer is caused by persistent infection with high-risk human papillomavirus (HR-HPV). Conventional human papillomavirus (HPV) testing requires cervical sampling. However, vaginal and urine self-sampling methods are more acceptable for patients and result in increased participation when they are available in screening programs. In this context, we have developed a non-invasive screening method via the detection of HPV DNA in urine samples.

PURPOSE

To compare HPV viral loads and genotypes in paired cervical and urine samples, and to assess correlation between virological and cytological results in women seeking gynecological consultation.

METHODS

Paired urine and cervical specimens were collected and analyzed from 230 of 245 women participating in the previously described prospective PapU study. HPV DNA detection and quantification were performed using a real-time PCR method with short fragment PCR primers. Genotyping was carried out using the INNO-LiPA HPV genotyping assay.

RESULTS

The prevalence of HPV in the 230 paired urine and cervical smear samples was 42 and 49 %, respectively. Overall agreement for HPV positivity and negativity between the paired samples was 90 % (κ = 0.80). High HPV viral load in both cervical and urine samples was associated with cytological abnormalities. HPV-positive women were mostly infected with HR-HPV types. The agreement between high- and low-risk HPV (LR-HPV) detection in both samples was 97 % (κ = 0.95 for HR-HPV and κ = 0.97 for LR-HPV).

CONCLUSIONS

High concordance rates for HPV-DNA quantification and high/low-risk HPV genotyping in paired urine/cervical samples suggest that urinary HPV DNA testing could be useful for cervical lesion screening.

[Evaluation of accuracy of three assays for human papillomavirus detection and typing: Hybrid Capture 2, HPV Consensus kit and Amplicor HPV]

BACKGROUND

Detection of high-risk human papillomavirus has proved its usefulness in complement of abnormal cervical scrape result. The Hybrid Capture 2 (HC2, Digene) test has proven its efficiency. We have compared this test with HPV Consensus kit (HPVC, Argène) and Amplicor HPV test (AHPV, RocheDiagnostics) on a panel of 88 samples with low HC2 ratios or discordant results between HC2 and cervical scrape.

MATERIAL AND METHODS

Cervical samples were tested in parallel by the three methods using a nested amplification of L1 region as reference.

RESULTS

Eighty-six samples were suitable for analysis. Results of HC2 and AHPV tests were closely related. The use of a "generic" probe in the HPVC test was responsible for undetermined results, which were not clinically relevant.

CONCLUSION

Despite the low viral load of the samples chosen, the hybridization (HC2) and PCR (AHPV or HPVC) methods gave comparable results, with false positive and false negative results for all tests, but a 75% concordance and a high sensibility to detect HPV infection. However, a complementary study on a larger population with ASCUS diagnosis and biopsy under colposcopy would be necessary to valid these assays for a clinical indication.

[Hybrid Capture 2 vs HPV Consensus kit: comparison of 2 assays for human papillomavirus detection and typing]

BACKGROUND

Many laboratories use the DNA Hybrid Capture 2 HPV-high risk assay (Digene) to detect and type oncogenic HPV. The aim of this work was to compare this assay with a new HPV genotyping assay: HPV Consensus kit (Argène). Actually, this assay is not commercially available.

MATERIALS AND METHODS

Ninety-four cervical samples were tested with both the routine assay Hybrid Capture 2 and the HPV Consensus kit. Discordant results were analysed by amplification with a nested PCR and sequencing of amplified products.

RESULTS

Only 81 results could be analysed concerning the oncogenic risk. The overall concordance was 92,6%. But we find 13 "generic" results with the HPV Consensus kit, the generic probe including high risk and low risk genotypes.

CONCLUSION

HPV Consensus kit results showed a better detection sensitivity for this assay than Hybrid Capture 2 assay. Nevertheless, "generic" results give no information about the oncogenic risk of the HPV detected in a sample.

[Uterine Doppler study for pre-implantation prognosis of the embryo]

To assess if a simple US criteria was present allowing pre- and post-implantation evaluation of the quality of the embryo. Measurement of the pulsatility index (PI) of the uterine arteries in association with evaluation of the type of curves was useful for follow-up. PI correlates with the number of follicules, the number of cells at Day 2, and the likelihood of pregnancy whereas the type of curve directly correlates with the appearance of the oocytes and embryo before the transfer. These results should be confirmed by larger studies but they could lead to early detection and a treatment of these abnormalities of vascularization.