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.
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