1
|
Allen SK, Chandler NJ, Kinning E, Harrison V, Brothwell SLC, Vijay S, Castleman J, Cilliers D. Diagnosis of inborn errors of metabolism through prenatal exome sequencing with targeted analysis for fetal structural anomalies. Prenat Diagn 2024; 44:432-442. [PMID: 38063435 DOI: 10.1002/pd.6476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/09/2023] [Accepted: 11/20/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVES The value of prenatal exome sequencing (pES) for fetuses with structural anomalies is widely reported. In England, testing is conducted through trio exome sequencing and analysis of a gene panel. Over a 30-month period testing of 921 pregnancies resulted in a genetic diagnosis in 32.8% of cases (302/921). Here we review cases diagnosed with an inborn error of metabolism. METHODS Diagnoses of inborn errors of metabolism (IEM) were classified according to the ICIMD classification system. Genetic diagnoses were assessed against Human Phenotype Ontology terms, gestation of scan findings and literature evidence. RESULTS 35/302 diagnoses (11.6%) represented IEM. Almost half affected metabolism of complex macromolecules and organelles (n = 16), including congenital disorders of glycosylation (n = 8), peroxisome biogenesis disorders (n = 4), and lysosomal storage disorders (n = 4). There were eight disorders of lipid metabolism and transport, the majority being genes in the cholesterol biosynthesis pathway, eight disorders of intermediary metabolism, of which seven were defects in "energy" processes, and two diagnoses of alkaline phosphatase deficiency. CONCLUSIONS Review of pES diagnoses and ultrasound scan findings is key to understanding genotype-phenotype correlations. IEM are genetically heterogeneous and may present with variable scan findings, which makes an individual diagnosis difficult to suspect. Diagnosis during pregnancy is particularly important for many IEM with respect to prognosis and early neonatal management.
Collapse
Affiliation(s)
- Stephanie K Allen
- West Midlands Regional Genetics Laboratory, Central and South Genomic Laboratory Hub, Birmingham, UK
| | - Natalie J Chandler
- North Thames Genomic Laboratory Hub, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Esther Kinning
- West Midlands Regional Clinical Genetics Service, Birmingham Women's and Children's Foundation Trust, Birmingham, UK
| | - Victoria Harrison
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Shona L C Brothwell
- Department of Inherited Metabolic Diseases, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Suresh Vijay
- Department of Inherited Metabolic Diseases, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - James Castleman
- Fetal Medicine Department, Birmingham Women's and Children's Foundation Trust, Birmingham, UK
| | - Deirdre Cilliers
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
2
|
Wall E, Petley E, Mone F, Doyle S, Hartles-Spencer L, Allen SK, Castleman J, Marton T, Williams D. Molecular autopsy for fetal structural anomaly: diagnostic and clinical utility of multidisciplinary team approach. Ultrasound Obstet Gynecol 2024. [PMID: 38517166 DOI: 10.1002/uog.27647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES In the West Midlands Regional Genetic Service, cases of perinatal death with a possible genetic diagnosis are evaluated by the Perinatal Pathology Genetic Multidisciplinary Team (MDT). The MDT assessed autopsy findings and considered genomic assessments. The objective of this retrospective service evaluation was to determine the clinical utility of the MDT. This is the first evaluation since the introduction of whole genome and whole exome sequencing in routine clinical care. METHOD The outcomes for all the perinatal MDT cases from January 2021 to December 2021 were examined. All cases received a full or partial post-mortem examination (PM) and a chromosomal microarray. Demographics, phenotype, MDT recommendations, genetic testing, diagnoses, outcomes, impact of PM and impact of genetic testing were collected from patient case notes. RESULTS One hundred and twenty-three cases were discussed at the MDT meeting in 2021. Genetic evaluation was recommended in 84 cases and accepted in 64 cases. A range of genetic tests were requested according to indication and availability. Thirty diagnoses were identified in 29 cases from 26 unrelated families. The diagnostic yield was 24% (29/123) of all cases or 45% (29/64) of the cases with a suspected genetic diagnosis who underwent genetic testing. PM examination added clinically actionable phenotype data in 79% of cases. A genetic diagnosis enabled accurate counselling of recurrence risk and provision of appropriate follow-up, including prenatal testing and preimplantation diagnosis for patients with inherited conditions. CONCLUSIONS Genomic testing was a clinically useful addition to (but not a substitute for) PM examination in perinatal cases associated with structural anomalies. The MDT model helped assess cases and plan appropriate follow-up. Expedited whole genome sequencing or panel-agnostic analysis were most appropriate for heterogeneous presentations. This broad approach can also expand prenatal phenotypes and detect novel disease genes and should be a priority for future research. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- E Wall
- West Midlands Clinical Genetics Service, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK
| | - E Petley
- West Midlands Clinical Genetics Service, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK
| | - F Mone
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - S Doyle
- Perinatal Genomics Service, National Maternity Hospital, Holles St., Dublin, Ireland
| | - L Hartles-Spencer
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - S K Allen
- West Midlands Regional Genetics Laboratory, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - J Castleman
- West Midlands Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - T Marton
- West Midlands Perinatal Pathology Department, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Department of Obstetrics and Gynaecology, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - D Williams
- West Midlands Clinical Genetics Service, Birmingham Women's and Children's NHS Foundation Trust, Edgbaston, UK
| |
Collapse
|
3
|
Liu B, Malone S, Knight T, Turvey-Haigh L, Castleman J, Morris RK, Al-Sakini N, Bradlow W, Thorne S, Steeds RP, Hudsmith LE, Moody WE. Utility of Exercise Stress Echocardiography for Prepregnancy Risk Stratification in Women With Left Heart Obstruction. Can J Cardiol 2024; 40:125-127. [PMID: 37722624 DOI: 10.1016/j.cjca.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 09/20/2023] Open
Affiliation(s)
- Boyang Liu
- University of Birmingham, Birmingham, United Kingdom; University Hospital Birmingham, Birmingham, United Kingdom.
| | - Sean Malone
- University Hospital Birmingham, Birmingham, United Kingdom
| | - Tamlyn Knight
- University Hospital Birmingham, Birmingham, United Kingdom
| | | | - James Castleman
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | - R Katie Morris
- University Hospital Birmingham, Birmingham, United Kingdom; Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
| | | | | | - Sara Thorne
- Toronto General Hospital and University Health Network, Toronto, Ontario, Canada
| | - Richard P Steeds
- University of Birmingham, Birmingham, United Kingdom; University Hospital Birmingham, Birmingham, United Kingdom
| | | | - William E Moody
- University of Birmingham, Birmingham, United Kingdom; University Hospital Birmingham, Birmingham, United Kingdom
| |
Collapse
|
4
|
Kilby MD, Castleman J, Allen S, Doyle S, Williams DK. Prenatal diagnosis of PORCN-related developmental syndrome in a fetus: A novel phenotype. Prenat Diagn 2023; 43:1472-1476. [PMID: 37698465 DOI: 10.1002/pd.6438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023]
Abstract
We report a case of a female fetus born to an unrelated couple with a complex fetal phenotype of a pleural effusion, a cardiac malformation, and syndactyly of the toes. Prenatal exome sequencing identified a variant of uncertain significance in the PORCN gene that was upgraded to likely pathogenic following postnatal clinical examination. The phenotype described in cases with variants in the PORCN gene is often associated with findings that cannot be prospectively diagnosed by ultrasonography. This is the first report of a prenatal phenotype involving a fetal effusion associated with variants in the PORCN gene, with skeletal findings identified later in gestation on ultrasonography. The diagnosis was confirmed on neonatal examination.
Collapse
Affiliation(s)
- Mark D Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Birmingham, UK
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Medical Research Group, Illumina, Cambridge, UK
| | - James Castleman
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation Trust, Birmingham, UK
| | - Stephanie Allen
- West Midlands Regional Genetics Laboratory, Central and South Genomic Laboratory Hub, Birmingham, UK
| | - Samantha Doyle
- Perinatal Genomics Service, The National Maternity Hospital, Dublin, Ireland
| | - Denise K Williams
- West Midlands Regional Clinical Genetics Service, Birmingham Women's and Children's Foundation Trust, Birmingham, UK
| |
Collapse
|
5
|
Ormesher L, Vause S, Higson S, Roberts A, Clarke B, Curtis S, Ordonez V, Ansari F, Everett TR, Hordern C, Mackillop L, Stern V, Bonnett T, Reid A, Wallace S, Oyekan E, Douglas H, Cauldwell M, Reddy M, Palmer K, Simpson M, Brennand J, Minns L, Freeman L, Murray S, Mary N, Castleman J, Morris KR, Haslett E, Cassidy C, Johnstone ED, Myers JE. Prevalence of pre-eclampsia and adverse pregnancy outcomes in women with pre-existing cardiomyopathy: a multi-centre retrospective cohort study. Sci Rep 2023; 13:153. [PMID: 36599871 DOI: 10.1038/s41598-022-26606-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/16/2022] [Indexed: 01/05/2023] Open
Abstract
Pre-eclampsia is associated with postnatal cardiac dysfunction; however, the nature of this relationship remains uncertain. This multicentre retrospective cohort study aimed to determine the prevalence of pre-eclampsia in women with pre-existing cardiac dysfunction (left ventricular ejection fraction < 55%) and explore the relationship between pregnancy outcome and pre-pregnancy cardiac phenotype. In this cohort of 282 pregnancies, pre-eclampsia prevalence was not significantly increased (4.6% [95% C.I 2.2-7.0%] vs. population prevalence of 4.6% [95% C.I. 2.7-8.2], p = 0.99); 12/13 women had concurrent obstetric/medical risk factors for pre-eclampsia. The prevalence of preterm pre-eclampsia (< 37 weeks) and fetal growth restriction (FGR) was increased (1.8% vs. 0.7%, p = 0.03; 15.2% vs. 5.5%, p < 0.001, respectively). Neither systolic nor diastolic function correlated with pregnancy outcome. Antenatal ß blockers (n = 116) were associated with lower birthweight Z score (adjusted difference - 0.31 [95% C.I. - 0.61 to - 0.01], p = 0.04). To conclude, this study demonstrated a modest increase in preterm pre-eclampsia and significant increase in FGR in women with pre-existing cardiac dysfunction. Our results do not necessarily support a causal relationship between cardiac dysfunction and pre-eclampsia, especially given the population's background risk status. The mechanism underpinning the relationship between cardiac dysfunction and FGR merits further research but could be influenced by concomitant ß blocker use.
Collapse
Affiliation(s)
- Laura Ormesher
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, Manchester, UK. .,Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Sarah Vause
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Suzanne Higson
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Anna Roberts
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Bernard Clarke
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | | | | | | | | | - Claire Hordern
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Lucy Mackillop
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Victoria Stern
- Academic Unit of Developmental and Reproductive Medicine, University of Sheffield, Sheffield, UK
| | - Tessa Bonnett
- Academic Unit of Developmental and Reproductive Medicine, University of Sheffield, Sheffield, UK
| | - Alice Reid
- Department of Obstetrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Suzanne Wallace
- Department of Obstetrics, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ebruba Oyekan
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Maya Reddy
- Monash Women's, Monash Health, Monash University, Melbourne, Australia
| | - Kirsten Palmer
- Monash Women's, Monash Health, Monash University, Melbourne, Australia
| | - Maggie Simpson
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, UK
| | - Janet Brennand
- Scottish Adult Congenital Cardiac Service, Golden Jubilee National Hospital, Glasgow, UK.,Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Laura Minns
- Department of Cardiology, Norfolk& Norwich University Hospital Foundation Trust, Norwich, UK
| | - Leisa Freeman
- Department of Cardiology, Norfolk& Norwich University Hospital Foundation Trust, Norwich, UK
| | - Sarah Murray
- Royal Infirmary of Edinburgh, NHS Lothian University Hospitals Division, Edinburgh, UK
| | - Nirmala Mary
- Royal Infirmary of Edinburgh, NHS Lothian University Hospitals Division, Edinburgh, UK
| | - James Castleman
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Katie R Morris
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | - Edward D Johnstone
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, Manchester, UK.,Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jenny E Myers
- Maternal & Fetal Health Research Centre, Division of Developmental Biology and Medicine, University of Manchester, Manchester, UK.,Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
6
|
Lodge F, Castleman J, Fox C, Morris R, Ram C, Clift P, Hudsmith L. Cardiac function in pregnant women with a Fontan circulation following live birth. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Fontan circuits are used to palliate congenital heart disease where patients have a single functioning ventricle. The venous return to the heart is redirected to the pulmonary arteries through the use of a conduit, bypassing the heart. Many females with Fontan circuits are now reaching child-bearing age and some desire pregnancy. However, pregnancy in women with Fontan circuits is associated with high complication rates.
Purpose
We compared postnatal cardiac function in women with a Fontan circulation with pre-pregnancy cardiovascular investigations.
Methods
Data were collected from case notes of all women with a Fontan circulation giving birth after 24 weeks of gestation at Birmingham Women's Hospital between 1997 and 2019.
Results
18 women with a median age of 29±6 years were followed up for 8.0±9 years. There were 21 live births at a median gestation of 32±5 weeks, of which 81% were caesarean sections. Three infants (14%) were born before 30 weeks' gestation and only two (10%) at term. Significant dyspnoea complicated 19% of pregnancies and postpartum haemorrhage occurred in 24%.
Pre-pregnancy cardiac magnetic resonance (CMR) data were available for 11 women and post-pregnancy for 14. Post-pregnancy scans were performed a median of 1.5±4.8 years after birth. Ejection fraction was 63.6±5% at baseline and tended to reduce following pregnancy (median −5.0±8%, n=7). Pre-pregnancy peak oxygen consumption (VO2max) was 73±14% of predicted on cardiopulmonary exercise testing. Median change in VO2max was −8±22% post-pregnancy (n=4). There was no change New York Heart Association (NYHA) class or resting saturations after pregnancy.
Conclusions
Preterm delivery and maternal bleeding were prevalent in this cohort. Exercise capacity was moderately impaired and saturations were typically low. Pregnancy does not seem to have longer term impact on oxygen saturations or NYHA class. Larger series are needed to confirm whether pregnancy is detrimental to postpartum systolic function. CMR can give comprehensive assessment of cardiac function before and after pregnancy and provide data to inform the crucial pre-pregnancy counselling for Fontan patients of child-bearing age.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- F Lodge
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - J Castleman
- Sandwell and West Birmingham Hospitals NHS Trust, Department of Maternity and Perinatal Medicine, Birmingham, United Kingdom
| | - C Fox
- Birmingham Women's Hospital, Birmingham, United Kingdom
| | - R.K Morris
- University of Birmingham, Birmingham, United Kingdom
| | - C Ram
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - P Clift
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - L Hudsmith
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| |
Collapse
|
7
|
Castleman J, Hodgetts V, Moore J, Molloy M, Ganapathy R. 118: An evaluation of the role of investigations for women with second trimester miscarriage. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
8
|
|
9
|
Loharikar A, Briere E, Schwensohn C, Weninger S, Wagendorf J, Scheftel J, Garvey A, Warren K, Villamil E, Rudroff JA, Kurkjian K, Levine S, Colby K, Morrison B, May A, Anderson S, Daly E, Marsden-Haug N, Erdman MM, Gomez T, Rhorer A, Castleman J, Adams JK, Theobald L, Lafon P, Trees E, Mitchell J, Sotir MJ, Behravesh CB. Four Multistate Outbreaks of Human Salmonella Infections Associated with Live Poultry Contact, United States, 2009. Zoonoses Public Health 2012; 59:347-54. [DOI: 10.1111/j.1863-2378.2012.01461.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
10
|
Elfrink VL, Davis LS, Fitzwater E, Castleman J, Burley J, Gorney-Moreno MJ, Sullivan J, Nichols B, Hall D, Queen K, Johnson S, Martin A. A comparison of teaching strategies for integrating information technology into clinical nursing education. Nurse Educ 2000; 25:136-44. [PMID: 11111570 DOI: 10.1097/00006223-200005000-00014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
As health care becomes more information-intensive and diverse, there is a need to integrate information technology (IT) into clinical education. Little is known, however, about how to design instructional strategies for integrating information technology into clinical nursing education. This article outlines the instructional strategies used by faculty in five nursing programs who taught students to use a point-of-care information technology system. The article also reports students' computer acceptance and summarizes IT clinical teaching recommendations.
Collapse
|
11
|
Abstract
This article examines the positive and negative aspects of working with a documentation and information management system from the unique perspective of a practicing home care nurse who was also a student. Aspects of the nightingale tracker technology that are comparable with others used in home care, experiences of field testing, and the nurse's observations can help home care nurses see how this technology can benefit their practice.
Collapse
Affiliation(s)
- K Pearce
- University of Florida, Gainesville, USA
| | | | | |
Collapse
|
12
|
Lam KW, Dekker PT, Castleman J, Yam LT. Studies of intracellular distribution of acid phosphatase 5 in the spleen cells of leukemic reticuloendotheliosis by isopycnic gradient centrifugation. Clin Chim Acta 1976; 70:289-95. [PMID: 954212 DOI: 10.1016/0009-8981(76)90431-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A fresh spleen sample obtained from a patient with leukemic reticuloendotheliosis was homogenized and subjected to centrifugation on a sucrose density gradient. A major portion of acid phosphatase band 5 was observed in the lysosome, confirming that the elevated phosphatase activity in the neoplastic spleen is a lysosomal enzyme. However, a significant amount of brand 5 was also observed in the microsome. The microsomal and lysosomal enzymes have different affinity to CM-cellulose. The relationship between lysosomal and microsomal enzymes has not been established.
Collapse
|