Evaluation of the clinical usefulness of isolation of fetal DNA from the maternal circulation.
OBJECTIVE
To assess the reliability of isolating free fetal DNA from maternal usefulness.


METHODS
Fetal DNA was isolated from plasma or serum that was either collected prospectively or from archived samples collected for the purposes of second trimester screening.


METHODS
Prospective samples were collected from patients undergoing prenatal diagnostic procedures (n = 24). A second group of samples from Rhesus negative women (n = 28) were assayed in which blood had originally been collected for maternal triple serum screening. DNA was extracted from all samples and assayed for the presence of the beta-globin gene, sex-determing region Y (SRY) gene and Rh gene. All DNA sample handling and extraction was carried out by a single operator, and polymerase chain reaction (PCR) was carried out using previously published PCR primers and appropriate controls. The accuracy of results was assessed relative to the karyotype in the case of the SRY gene or cord blood phenotype in the case of the Rh gene.


RESULTS
The SRY PCR results were compared to fetal cell karyotypes obtained from invasive diagnostic testing, 21 out of the 24 samples were correctly 'sexed'. The RhD PCR results were compared to fetal cord blood samples at the time of delivery, and showed both false positive and false negative results. Two RhD negative babies were genotyped as RhD positive, despite repeat analysis.


CONCLUSIONS
It is possible to isolate fetal DNA from maternal serum. It is a potentially clinically useful technique in our laboratory and can be used to detect male fetuses, and Rh negative fetuses. To be useful in clinical practice, it is necessary to safeguard against contamination at the time of sample handling, and to use the optimal range of primers available to cover the polymorphisms present within the RhD gene. Although not robust enough yet to be used with diagnostic certainty in our hands, immense improvements in technique, probes and real-time PCR equipment make this type of diagnosis a reality in the near future.
Siva
Sashi C
SC
Department Fetal-Maternal Medicine, Royal North Shore Hospital University of Sydney, St Leonards, North South Wales, Sydney, Australia. sashi_siva@yahoo.com
Johnson
Sylvia I
SI
McCracken
Sharon A
SA
Morris
Jonathan M
JM
D041322:Chromosomes, Human, Y; D004247:DNA / Q000097:blood*; D005260:Female; D005333:Fetus; D006801:Humans; D008297:Male; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012204:Rh-Hr Blood-Group System / Q000032:analysis; D012732:Sex Determination Analysis; D013048:Specimen Handling
D012204:Rh-Hr Blood-Group System; D004247:DNA