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  • Estudios en restos abortivos

    ESTUDIOS GENÉTICOS EN RESTOS ABORTIVOS

    ¿Qué importancia tienen las alteraciones genéticas en la pérdida del embarazo?

    Se estima que entre un 10-15% de los embarazos terminan en un aborto espontáneo, porcentaje que aumenta con la edad materna. Estas pérdidas gestacionales se deben normalmente a factores fetales y maternos, sin embargo, en un 50% de los casos, los abortos que se producen durante el primer trimestre de gestación son originados por alteraciones genéticas y anomalías cromosómicas en el embrión.

    Algunas de estas alteraciones pueden ser adquiridas de los propios progenitores, comprometiéndose, por lo tanto, futuras gestaciones. Por ello, el análisis genético de restos abortivos es de gran importancia para determinar la causa de la pérdida del embarazo, permitiendo a la pareja, determinar cuál es el motivo de los abortos y minimizar así los riesgos en un próximo embarazo. Además, a aquellas mujeres o parejas que van a someterse a técnicas de reproducción asistida, les permite obtener asesoramiento genético adecuado de cara a futuros tratamientos de reproducción asistida y conseguir, así, un embarazo evolutivo. Este tipo de estudio se puede realizar cuando una mujer sufre una pérdida gestacional de causa desconocida, y especialmente, en aquellas parejas que sufren abortos espontáneos reiterados.

    ¿Qué técnicas se utilizan para el estudio genético de restos abortivos?

    Las técnicas que se emplean normalmente para la detección de posibles alteraciones genéticas en restos abortivos son principalmente la técnica FISH (Hibridación In Situ Fluorescente) y la Citogenética convencional para la obtención del Cariotipo

    El FISH permite analizar si existen alteraciones en alguno de los cromosomas, detectando la presencia o ausencia de una única región cromosómica. En cambio, el cariotipo permite visualizar todos los cromosomas y comprobar si existen alteraciones numéricas o estructurales en alguno de los 46 cromosomas que forman cada una de las células del feto. Sin embargo, tiene como desventaja que requiere de un cultivo de células que suele durar 15 días aproximadamente, además de existir la posibilidad de que no se produzca crecimiento celular o de que exista contaminación materna, ya que esta técnica no diferencia células maternas de fetales. Esta técnica precisa de células vivas, por lo que hasta en un 40% de los casos no es posible su realizacion.

    Actualmente, existen técnicas de mayor resolución que el cariotipo convencional, como el array CGH, la secuenciación de nueva generación (NGS) y el array genómico CMA (chromosomal microarray), técnicas de screening cromosómico completo que permiten detectar alteraciones de menor tamaño y que no precisan de cultivos celulares. Estas técnicas son mucho más sensibles y eficientes que el cariotipo convencional y permiten alcanzar niveles de diagnóstico superiores, haciendo posible detectar anomalías cromosómicas que serían imperceptibles en el análisis cromosómico convencional.

    Estas técnicas analizan el genoma completo en busca de ganancias o pérdidas de material genético, permitiendo identificar duplicaciones o ausencias de pequeñas regiones cromosómicas que el cariotipo no alcanza a detectar. Sin embargo, dichas metodologías, además de tener un elevado coste, también tienen sus limitaciones. Por un lado, el array de CGH no permite detectar alteraciones cromosómicas balanceadas (traslocaciones o inversiones), polimorfismos, ni poliploidías, mientras que el CMA, aunque tampoco detecte traslocaciones balanceadas, sí detecta polimorfismos, además de reordenamientos crípticos y deleciones terminales.

    ¿Qué ofrecemos?

    Desde Omicaslab, ofrecemos la posibilidad de realizar estudios genéticos en restos abortivos con cualquiera de estas técnicas: cariotipo, FISH, array CGH, NGS y CMA, adecuando la selección de cada técnica a los requerimientos de cada mujer y cada pareja. De esta manera, conseguimos aumentar las posibilidades de detectar cuál es la causa subyacente de los fenómenos abortivos, minimizando la posibilidad de que se repitan en futuras gestaciones.

  • Estudio de DNA fetal en sangre materna en embarazo detenido

    ESTUDIO DE DNA FETAL EN SANGRE MATERNA EN EMBARAZO DETENIDO

    ¿Qué importancia tienen las alteraciones genéticas y cromosómicas en la pérdida del embarazo?

    El aborto espontáneo es la complicación más frecuente del embarazo temprano. Se estima que entre un 10-15% de los embarazos terminan en un aborto espontáneo, principalmente durante las 13 primeras semanas del embarazo. Estas pérdidas gestacionales se deben normalmente a factores fetales y maternos, sin embargo, en un 50% de los casos, los abortos que se producen durante el primer trimestre de gestación son originados por alteraciones genéticas y anomalías cromosómicas en el embrión. De este porcentaje, las alteraciones numéricas (trisomías, monosomías, poliploidías, etc) están involucradas en un 96% de los casos. Por ello, analizando anomalías cromosómicas en casos de abortos espontáneos, es posible identificar la causa de la detención del embarazo en un porcentaje superior al 90%.

    ¿Qué ofrecemos?

    Desde OmicasLab, ofrecemos una prueba que proporciona respuestas sobre la posible causa de pérdida del embarazo, detectando si fue debida a la presencia de anomalías cromosómicas en el feto. Se trata de un ensayo de screening no invasivo en plasma materno que detecta aneuploidías cromosómicas y CNVs (variaciones en el número de copias) en el feto, cuando la gesta se ha detenido espontáneamente, con el fin de identificar una causa cromosómica responsable. Esta prueba resulta útil en la detección no invasiva de aneuploidías a partir de las 7 semanas de gestación y dentro de las 2-3 semanas de detenido el embarazo en forma espontánea. Para ello, gracias al empleo de secuenciacion de nueva generación, analiza los fragmentos de ADN fetal que fueron liberados del trofoblasto placentario, y que aún circulan libremente en la sangre materna, siendo posible identificar si existían anomalías cromosómicas que provocaran la pérdida del embarazo.

    Entre las anomalías más prevalentes que esta prueba es capaz de detectar se encuentran, entre otras:

    Trisomías

    • Trisomía 21 (Síndrome de Down)

    • Trisomía 18 (Síndrome de Edwards)

    • Trisomía 13 (Síndrome de Patau)

    • Trisomía 7, 9, 14, 15, 16, 22: son las trisomías más frecuentes causantes de la perdida de embarazo. Estas trisomías pueden afectar a todas las células del organismo, en cuyo caso se denomina trisomía pura, o ser un mosaicismo en el que algunas células presentan la dotación cromosómica normal y otras no. El 92% de los fetos con estas trisomías puras fallecen entre los 4 y 9 meses del embarazo, produciéndose un aborto espontáneo

    Aneuploidías cromosómicas sexuales

    • Síndrome de Turner (45, X0)
    • Síndrome de Klinefelter (47, XXY)
    • Trisomía del cromosoma X (47, XXX)
    • Síndrome de Jacobs o Disomía del Y (47, XYY)

    Características del test y aplicaciones

    • Para detección no invasiva de aneuploidías en gesta detenida en forma espontánea

    • Especialmente útil en pacientes con abortos recurrentes

    • Indicada a partir de las 7 semanas de gestación y durante todo el embarazo

    • A realizar dentro de las 2-3 semanas de detenido el embarazo en forma espontánea

    • Identifica aneuploidías en todos los cromosomas

    • Determina el sexo fetal

    • Detecta variante en número de copias (CNV) patogénicas

    • Útil en embarazos únicos, gemelares, ovodonación y FIV

  • Test genético prenatal en sangre materna

    TEST GENÉTICO PRENATAL EN SANGRE MATERNA 

    Fundamentos del estudio

    Las anomalías cromosómicas son causantes de una elevada proporción de abortos espontáneos y enfermedades infantiles, contribuyendo también al desarrollo de procesos malignos tanto en la edad infantil como adulta. Estas alteraciones son la primera causa de pérdidas embrionarias y fetales del primer trimestre, presentando aproximadamente el 50% de los abortos espontáneos alguna alteración cromosómica del tipo trisomía, poliploidía o monosomía, entre otras.

    El riesgo de que el feto presente anomalías cromosómicas aumenta a medida que aumenta la edad gestacional de la madre, creciendo drásticamente después de los 35 años. Por todo ello, el diagnóstico prenatal temprano de anomalías cromosómicas es una herramienta esencial y necesaria en el control prenatal actual.
    Para este propósito, surge el Test Prenatal No invasivo (NIPT según sus siglas en inglés), un ensayo de screening que proporciona respuestas sobre la posible presencia de anomalías cromosómicas fetales sin riesgo para la madre ni el feto.

    Esta prueba analiza los fragmentos de ADN fetal liberados del trofoblasto placentario, y que circulan libremente en la sangre materna, siendo posible identificar qué individuos están en riesgo y para cuáles se recomienda una investigación adicional mediante técnicas diagnósticas invasivas como amniocentesis o la biopsia de vellosidades coriónicas.

    Este estudio determina el posible riesgo del feto de presentar trisomías, es decir, alteraciones que ocurren cuando un individuo presenta un cromosoma adicional en comparación con el par cromosómico habitual, aneuploidías cromosómicas sexuales (variaciones en el número de cromosomas X e Y), opcionalmente, el sexo fetal, así como también en forma incidental, puede detectar aneuploidías menos frecuentes, en cromosomas 7, 9, 14, 15, 16 y 22, algunas de ellas asociadas a pérdidas de embarazo y retardo intrauterino de crecimiento
    Esta prueba es adecuada para todas las mujeres embarazadas ya que evita los riesgos asociados a las pruebas de diagnóstico invasivas, y se puede realizar desde la 9ª semana de embarazo en adelante.

    Metodología: NGS Next Generation Sequencing

    Tras la extracción de una muestra de sangre de la madre, esta prueba analiza los fragmentos de ADN fetal que son liberados y circulan libremente en la sangre materna. A continuación, el test permite el análisis del ADN fetal mediante Secuencia Masiva Paralela, haciendo posible la detección de:

    Trisomías
    – Trisomía 21 (Síndrome de Down)
    – Trisomía 18 (Síndrome de Edwards)
    – Trisomía 12 (Síndrome de Patau)

    Aneuploidías cromosómicas sexuales
    – Síndrome de Turner (45,X)
    – Síndrome de Klinefelter (47, XXY)
    – Trisomía del cromosoma X (47, XXX)
    – Síndrome de Jacobs o Disomía del Y (47, XYY)

    Sexo fetal

    Hallazgos incidentales: aneuploidías de cromosomas 7, 9, 14, 15, 16 y 22
    Esta prueba es capaz de proporcionar respuestas incluso si la fracción fetal está entre el 3 y el 4%, lo que reduce el número de pruebas invasivas innecesarias evitando el riesgo tanto fetal como materno.

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