Ilma Floriana Carbone1, Alessandro Conforti2, Silvia Picarelli2, Danila Morano3, Carlo Alviggi2,4, Antonio Farina5,6. 1. Department of Obstetrics and Gynecology, 'L. Mangiagalli' Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 2. Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy. 3. Department of Obstetrics and Gynecology, S. Anna University Hospital, Cona, Ferrara, Italy. 4. Istituto per l'Endocrinologia e l'Oncologia Sperimentale (IEOS), Consiglio Nazionale delle Ricerche, Naples, Italy. 5. Division of Obstetrics and Prenatal Medicine, Department of Medicine and Surgery (DIMEC) Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. antonio.farina@unibo.it. 6. Division of Obstetrics and Gynecology, Department of Medicine and Surgery (DIMEC), University of Bologna, Policlinico Sant'Orsola- Malpighi, Bologna, Italy. antonio.farina@unibo.it.
Abstract
OBJECTIVE: A systematic review was carried out to summarize the available evidence to assess whether circulating nucleic acids in maternal plasma and serum (CNAPS) have the potential to serve as extra and independent markers for the prediction and/or progression monitoring of the most common and severe complications of pregnancy, including preeclampsia, intrauterine growth restriction, preterm delivery, morbidly adherent placenta, gestational diabetes, antiphospholipid syndrome, threatened abortion, intrahepatic cholestasis of pregnancy, and hyperemesis gravidarum. METHOD: A comprehensive literature search of the MEDLINE (PubMed), EMBASE, and ISI Web of Knowledge databases was conducted to identify relevant studies that included amounts of CNAPS in the abovementioned pregnancy complications. RESULTS: Eighty-three studies met the eligibility criteria. The vast majority of studies were conducted on the quantity of total circulating cell free DNA (cfDNA) and cell free fetal DNA (cffDNA), and some were conducted on messenger RNA (mRNA) species. A few studies have instead evaluated the cell free DNA fetal fraction (cfDNAff), but only in a limited number of pregnancy complications. Despite the growing interest and the abundance of the papers available, little information is available for other new CNAPS, including microRNA (miRNA), long noncoding RNA (lncRNA), mitochondrial DNA (mtDNA), and circular RNA. CONCLUSION: Due to the heterogeneity of the populations enrolled, the scarcity of the studies that adjusted the CNAPS values for possible confounding factors, and the difficulty in interpreting the published data, no conclusion regarding the statistical robustness and clinical relevance of the data can be made at present. If assayed at the third trimester, the CNAPS have, however, shown better performance, and could be used in populations already at risk of developing complications as suggested by the presence of other clinical features. Other CNAPS, including miRNA, are under investigation, especially for the screening of gestational diabetes mellitus, but no data about their clinical utility are available. Circulating DNA (cfDNA, cffDNA, and cfDNAff) and mRNA have not been properly evaluated yet, especially in patients asymptomatic early in pregnancy but who developed complications later, perhaps because of the high cost of these techniques and the availability of other predictors of pregnancy complications (biochemical, biophysical, and ultrasound markers). Therefore, from the analysis of the data, the positive predictive value is not available. As regards the new CNAPS, including miRNA, there are still no sufficient data to understand if they can be promising markers for pregnancy complications monitoring and screening, since CNAPS are statistically weak and expensive. It is reasonable to currently conclude that the use of the CNAPS in clinical practice is not recommended.
OBJECTIVE: A systematic review was carried out to summarize the available evidence to assess whether circulating nucleic acids in maternal plasma and serum (CNAPS) have the potential to serve as extra and independent markers for the prediction and/or progression monitoring of the most common and severe complications of pregnancy, including preeclampsia, intrauterine growth restriction, preterm delivery, morbidly adherent placenta, gestational diabetes, antiphospholipid syndrome, threatened abortion, intrahepatic cholestasis of pregnancy, and hyperemesis gravidarum. METHOD: A comprehensive literature search of the MEDLINE (PubMed), EMBASE, and ISI Web of Knowledge databases was conducted to identify relevant studies that included amounts of CNAPS in the abovementioned pregnancy complications. RESULTS: Eighty-three studies met the eligibility criteria. The vast majority of studies were conducted on the quantity of total circulating cell free DNA (cfDNA) and cell free fetal DNA (cffDNA), and some were conducted on messenger RNA (mRNA) species. A few studies have instead evaluated the cell free DNA fetal fraction (cfDNAff), but only in a limited number of pregnancy complications. Despite the growing interest and the abundance of the papers available, little information is available for other new CNAPS, including microRNA (miRNA), long noncoding RNA (lncRNA), mitochondrial DNA (mtDNA), and circular RNA. CONCLUSION: Due to the heterogeneity of the populations enrolled, the scarcity of the studies that adjusted the CNAPS values for possible confounding factors, and the difficulty in interpreting the published data, no conclusion regarding the statistical robustness and clinical relevance of the data can be made at present. If assayed at the third trimester, the CNAPS have, however, shown better performance, and could be used in populations already at risk of developing complications as suggested by the presence of other clinical features. Other CNAPS, including miRNA, are under investigation, especially for the screening of gestational diabetes mellitus, but no data about their clinical utility are available. Circulating DNA (cfDNA, cffDNA, and cfDNAff) and mRNA have not been properly evaluated yet, especially in patients asymptomatic early in pregnancy but who developed complications later, perhaps because of the high cost of these techniques and the availability of other predictors of pregnancy complications (biochemical, biophysical, and ultrasound markers). Therefore, from the analysis of the data, the positive predictive value is not available. As regards the new CNAPS, including miRNA, there are still no sufficient data to understand if they can be promising markers for pregnancy complications monitoring and screening, since CNAPS are statistically weak and expensive. It is reasonable to currently conclude that the use of the CNAPS in clinical practice is not recommended.
Authors: Lorena M Amaral; Valeria C Sandrim; Matthew E Kutcher; Frank T Spradley; Ricardo C Cavalli; Jose E Tanus-Santos; Ana C Palei Journal: Int J Mol Sci Date: 2021-01-08 Impact factor: 6.208
Authors: Luigi Carbone; Federica Cariati; Laura Sarno; Alessandro Conforti; Francesca Bagnulo; Ida Strina; Lucio Pastore; Giuseppe Maria Maruotti; Carlo Alviggi Journal: Genes (Basel) Date: 2020-12-24 Impact factor: 4.096
Authors: Morten Rasmussen; Mitsu Reddy; Rory Nolan; Joan Camunas-Soler; Arkady Khodursky; Nikolai M Scheller; David E Cantonwine; Line Engelbrechtsen; Jia Dai Mi; Arup Dutta; Tiffany Brundage; Farooq Siddiqui; Mainou Thao; Elaine P S Gee; Johnny La; Courtney Baruch-Gravett; Mark K Santillan; Saikat Deb; Shaali M Ame; Said M Ali; Melanie Adkins; Mark A DePristo; Manfred Lee; Eugeni Namsaraev; Dorte Jensen Gybel-Brask; Lillian Skibsted; James A Litch; Donna A Santillan; Sunil Sazawal; Rachel M Tribe; James M Roberts; Maneesh Jain; Estrid Høgdall; Claudia Holzman; Stephen R Quake; Michal A Elovitz; Thomas F McElrath Journal: Nature Date: 2022-01-05 Impact factor: 69.504