For the first time, researchers have determined virtually the entire
genome of a fetus using only a blood sample from the pregnant woman and a
saliva specimen from the father.
The accomplishment heralds an era in which parents might find it easier
to know the complete DNA blueprint of a child months before it is born.
That would allow thousands of genetic diseases to be detected
prenatally. But the ability to know so much about an unborn child is
likely to raise serious ethical considerations as well. It could
increase abortions for reasons that have little to do with medical
issues and more to do with parental preferences for traits in children.
“It’s an extraordinary piece of technology, really quite remarkable,” said Peter Benn, professor of genetics
and developmental biology at the University of Connecticut, who was not
involved in the work. “What I see in this paper is a glance into the
future.”
The paper, published Wednesday in the journal Science Translational
Medicine, was written by genome scientists at the University of
Washington. They took advantage of new high-speed DNA sequencing and
some statistical and computational acrobatics to deduce the DNA sequence
of the fetus with about 98 percent accuracy.
The process is not practical, affordable or accurate enough for use now,
experts said. The University of Washington researchers estimated that
it would cost $20,000 to $50,000 to do one fetal genome today.
But the cost of DNA sequencing is falling at a blistering pace, and
accuracy is improving as well. The researchers estimated that the
procedure could be widely available in three to five years. Others said
it would take somewhat longer.
It is already possible to determine the DNA sequence of a fetus by acquiring fetal cells through amniocentesis or chorionic villus sampling, which involves testing the placental tissue. But these procedures are invasive and carry a slight risk of inducing a miscarriage.
For couples worried about passing on a genetic disease, it is also
possible to use in vitro fertilization and have an embryo genetically
tested before implantation into the womb.
But the technique described in the paper would not require complete
cells from the fetus and would make such DNA testing easier and less
risky.
“If this sort of thing is ever to be used on a widespread basis, I think
it necessarily has to be noninvasive,” said Jay Shendure, associate
professor of genome sciences at the University of Washington, who
supervised the research team.
The genome was determined from blood samples taken 18.5 weeks into the pregnancy,
although the researchers said the technique could probably be applied
in the first trimester, as early as or even earlier than some invasive
techniques.
The technique takes advantage of the discovery in the 1990s that
fragments of DNA from the fetus can be found in a pregnant woman’s blood
plasma, probably the result of fetal cells dying and breaking apart.
These fragments can be genetically analyzed, providing that the fetal
DNA fragments can be distinguished from the far more numerous fragments
that come from the mother herself.
The analysis of fetal DNA fragments found in a pregnant woman’s blood is
already used in new commercially available tests of the fetus’s gender,
its paternity and whether it has Down syndrome. But reconstructing an entire genome from DNA fragments is much more difficult.
Such information would allow detection of so-called Mendelian disorders, like cystic fibrosis, Tay-Sachs disease and Marfan syndrome, which are caused by mutations in a single gene.
More than 3,000 such diseases collectively occur in about 1 percent of
births. The mutations can be inherited from the parents or they can
arise spontaneously in the fetus.
Researchers led by Dennis Lo at the Chinese University of Hong Kong
first showed in 2010 that reconstructing a fetal genome would be
possible. Other work toward this goal has been done by Stephen Quake and
colleagues at Stanford University.
But Dr. Lo’s team used a maternal sample obtained invasively. And it
could determine only the inherited mutations, not the spontaneous ones.
The University of Washington researchers, using an approach partly
developed by a graduate student, Jacob O. Kitzman, did not need an
invasive test. And they were able to detect 39 of 44 such spontaneous
mutations, though with a huge number of false positives.
“This will be a step toward having a better and better prenatal diagnosis
that detects more and more at a reliable cost,” said Dr. Arthur L.
Beaudet, chairman of molecular and human genetics at Baylor College of
Medicine in Houston.
Dr. Beaudet, who was not involved in the work, said that spontaneous mutations account for about 10 percent of cases of mental retardation and other learning disabilities.
The ability to sequence an entire fetal genome is likely to raise
numerous issues. “There are some scenarios that are extremely
troubling,” said Marcy Darnovsky, associate executive director of the
Center for Genetics and Society, a public interest group in Berkeley,
Calif. The tests will spur questions on “who deserves to be born,” she
said.
Use of the approach could lead to an increase in abortions because some
parents might terminate the pregnancy if the fetus was found to have a
genetic disease. But it is also possible that parents may be tempted to
terminate if the fetus lacked a favorable trait like athletic prowess.
“You could start doing things more toward the direction of positive
selection,” said Dr. Stephen A. Brown, associate professor of obstetrics
and gynecology at the University of Vermont.
Moreover, a full fetal genome sequence would turn up numerous mutations
for which information is lacking as to whether they cause disease,
posing a dilemma for expectant parents and their doctors.
“Our capacity to generate data is outstripping our ability to interpret
it in ways that are useful to physicians and patients,” the University
of Washington researchers wrote their paper. “That is, although the
noninvasive prediction of a fetal genome may be technically feasible,
its interpretation — even for known Mendelian disorders — will remain a
major challenge.”
The researchers sequenced the genomes of the mother and father. They
then sequenced nearly three billion DNA fragments from the mother’s
blood. The samples, obtained from a tissue bank, were from unknown
donors.
Since people have two copies of each chromosome, they have two versions
of each gene. Only one version is passed to the baby.
Determining which version at any given spot in the father’s genome was
passed to the fetus was fairly straightforward, since any fragments of
DNA in the mother’s blood containing a sequence unique to the father had
to have come from the fetus.
Determining which of two variants at a given location — call them A and B
— the fetus inherited from the mother was more difficult. If the fetus
inherited version A, then fragments containing A (which could come from
either the fetus or the mother) would outnumber fragments containing B
(which could come only from the mother). But since there are relatively
few fetal fragments, the difference would be small and hard to detect.
The researchers used an approach they developed to figure out which
variations in the mother’s genome were likely to be passed to the baby
together. That made the problem more tractable than trying to make a
call individually at three million locations in the genome.
After it was determined what the fetus inherited from the mother and
father, what was left in the fetus’s DNA was considered a possible
spontaneous mutation. There were initially 25 million such candidates,
though statistical approaches narrowed that to 3,800. That still vastly
exceeded the such spontaneous mutations found after the baby was born
and its cord blood sequenced. Having so many false positive findings of spontaneous mutations could worry parents and doctors.
“There’s definitely plenty of room for improvement,” Professor Shendure
said. But, he added, “This is not science fiction anymore.”
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