Developing computational methods and workflows for targeted and whole-genome sequencing based non-invasive prenatal testing
Date
2022-05-06
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Abstract
Loote sõeluuring võimaldab avastada lootel esinevaid arenguhäireid ja sagedasemaid kromosoomhaiguseid, nagu näiteks Down’i, Edwards’i ja Patau sündroom. Varajane teave lootel esineva kromosoomhaiguse kohta võimaldab langetada informeeritud otsust raseduse jätkamise osas ning aitab tulevasi vanemaid paremini ette valmistada.
Tavapärane loote sõeluuring sisaldab loote ultraheli uuringut ja vereseerumi analüüsi, mille abil tuvastatakse enamik kromosoomhaigusega loodetest. Lõpliku diagnoosi saamiseks suunatakse kõrge riski saanud patsient edasi invasiivsele protseduurile. Eelnimetatud sõeluuringute puuduseks on arvestatav valepositiivsete hulk, mistõttu enamik positiivse testitulemuse saanud patsientidest kannab täiesti tervet loodet. Sõeluuringule järgnev invasiivne protseduur on neil juhtudel ebavajalik, põhjustab rasedatele asjatut stressi ning sellega võib kaasneda suurenenud oht raseduse katkemiseks.
Antud doktoritöö keskseks teemaks on mitte-invasiivne sünnieelne testimine (NIPT), mis põhineb ema veres leiduva loote päritolu rakuvaba DNA analüüsil. Võrreldes eelmainitud traditsionaalsete sõeluuringu meetoditega, on NIPT oluliselt sensitiivsem ja spetsiifilisem sagedamini esinevate kromosoomihäirete avastamiseks.
Doktoritöö raames arendati välja TAC-seq põhine analüüsi töövoog, mida rakendati 21. kromosoom trisoomia tuvastamiseks. Lisaks töötati välja NIPT analüüsiraamistik, mis kasutab erinevaid masinõppe metoodikaid loote trisoomia määramiseks rakuvaba DNA-st. Niisamuti viidi Eesti rasedate kohordil läbi NIPT metoodika validatsiooni uuring, milles rakendati ülegenoomsel sekveneerimisel põhinevat töövoogu sagedamate loote kromosoomihäirete määramiseks.
Üldiselt on nii suunatud kui ka ülegenoomsel NIPT meetoditel muutnud rasedate sõeluuring varasemast veel täpsemaks. Kui suunatud sekveneerimise suureks eeliseks on kulutõhusus, siis ülegenoomne lähenemine tuvastab valimatult kõikvõimalikke geneetilisi aberratsioone üle kogu genoomi.
Fetal screening allows to detect congenital anomalies and more frequent chromosomal abnormalities, such as Down, Edwards and Patau syndrome. Early information about a fetus’s possible health problem allows to make an informed decision about the continuation of the pregnancy and better prepare the future parents. Conventional screening includes an ultrasound and blood serum analysis by way of which most of the fetal chromosomal abnormalities are detected. For a final diagnosis, the patients who are deemed to have a high risk for fetal chromosomal aberrations are referred to an invasive procedure. The disadvantage of the aforementioned screening method is a considerable number of false positive results, which is why most of the patients who receive a positive result are actually carrying a fully healthy fetus. The invasive procedure that follows the screening is unnecessary for those patients, causes them undue stress and this may also lead to a higher risk of miscarriage. The focal point of this doctoral thesis is non-invasive prenatal testing (NIPT), which is based on the analysis of cell-free DNA (cfDNA) of fetal origin that is found in maternal blood. In comparison to the above-mentioned conventional screening methods, NIPT is considerably more sensitive and specific for detecting the most common chromosomal abnormalities. In the framework of the thesis, TAC-seq based analysis workflow was developed and used to detect chromosome 21 trisomy. In addition, NIPT analysis framework, which uses different machine learning methods, was developed for determining fetal trisomies from cfDNA sample. Also, a validation study of NIPT was carried out on pregnant women in Estonian cohort using a whole-genome sequencing based workflow. In general, both targeted and whole-genome sequencing based NIPT methods have made prenatal screening of fetal aneuplodies even more accurate than before. While cost-effectiveness is a major advantage of the targeted sequencing based approach, the whole-genome sequencing based NIPT possibly detects all kinds of genetic aberrations across the genome.
Fetal screening allows to detect congenital anomalies and more frequent chromosomal abnormalities, such as Down, Edwards and Patau syndrome. Early information about a fetus’s possible health problem allows to make an informed decision about the continuation of the pregnancy and better prepare the future parents. Conventional screening includes an ultrasound and blood serum analysis by way of which most of the fetal chromosomal abnormalities are detected. For a final diagnosis, the patients who are deemed to have a high risk for fetal chromosomal aberrations are referred to an invasive procedure. The disadvantage of the aforementioned screening method is a considerable number of false positive results, which is why most of the patients who receive a positive result are actually carrying a fully healthy fetus. The invasive procedure that follows the screening is unnecessary for those patients, causes them undue stress and this may also lead to a higher risk of miscarriage. The focal point of this doctoral thesis is non-invasive prenatal testing (NIPT), which is based on the analysis of cell-free DNA (cfDNA) of fetal origin that is found in maternal blood. In comparison to the above-mentioned conventional screening methods, NIPT is considerably more sensitive and specific for detecting the most common chromosomal abnormalities. In the framework of the thesis, TAC-seq based analysis workflow was developed and used to detect chromosome 21 trisomy. In addition, NIPT analysis framework, which uses different machine learning methods, was developed for determining fetal trisomies from cfDNA sample. Also, a validation study of NIPT was carried out on pregnant women in Estonian cohort using a whole-genome sequencing based workflow. In general, both targeted and whole-genome sequencing based NIPT methods have made prenatal screening of fetal aneuplodies even more accurate than before. While cost-effectiveness is a major advantage of the targeted sequencing based approach, the whole-genome sequencing based NIPT possibly detects all kinds of genetic aberrations across the genome.
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Keywords
prenatal screening, antenatal diagnosis, chromosomal anomalies, trisomy