Trophoblast retrieval and isolation from the cervix (TRIC) for noninvasive prenatal screening at 5 to 20 weeks of gestation.

OBJECTIVE: To use trophoblast cells accumulating in the endocervical canal at the beginning of pregnancy for noninvasive prenatal testing.
DESIGN: Prospective, double-blinded test for fetal gender.
SETTING: Academic medical center. PATIENT(S): Fifty-six women with singleton pregnancies at gestational age 5-20 weeks. INTERVENTION(S): Isolation of fetal cells from resident maternal cells in endocervical specimens using anti-human leukocyte antigen G coupled to magnetic nanoparticles; cell phenotyping immunofluorescently with a panel of trophoblast subtype-specific proteins; DNA integrity assessment with terminal dUTP nick-end labeling (TUNEL); and polymerase chain reaction (PCR) and fluorescent in situ hybridization (FISH) to detect sex chromosomes in individual cells. MAIN OUTCOME MEASURE(S): Trophoblast phenotype, TUNEL index, and percentage male cells. RESULT(S): The women were given a routine Papanicolaou test; fetal genders were verified from medical records. Recovery after immunomagnetic isolation averaged 746±59 cells across gestational age, with 99% expressing chorionic gonadotropin, whereas the depleted cell fraction expressed none. The isolated cells had an extravillous trophoblast phenotype and intact nuclear DNA (>95%). Fetal gender was determined in 20 specimens without error by PCR. The FISH analysis of isolated cells from male specimens validated their fetal origin. CONCLUSION(S): Noninvasive prenatal testing is feasible beginning at a gestational age of 5 weeks.