Maternal serum Down syndrome screening: Free β-protein is a more effective marker than human chorionic gonadotropin

Macri, James N.; Kasturi, Ramana V.; Krantz, David; Cook, Edward J.; Moore, Norman D.; Young, J.; Romero, Kathleen; Larsen, John W.

doi:10.1016/0002-9378(90)90700-h

Cited by 202 publications

(86 citation statements)

References 5 publications

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“…The highest level of detection efficiency [up to 80% for trisomy 21 in early gestational weeks (less than 17 weeks)] has been achieved by combining maternal age and the biochemical markers AFP and Free-d (hCG). 4 This latest observation has been confirmed by several independent studies. S • IO .…”

supporting

confidence: 75%

Dual Analyte Immunoassay—a New Approach to Neural Tube Defect and Down's Syndrome Screening

Macri¹,

Spencer

Anderson³

1992

Ann Clin Biochem

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SUMMARY. A microtiter plate based Dual Analyte enzymeimmunoassay method for the simultaneous measurement of o-fetoprotein (AFP) and Free-d human chorionic gonadotrophin (hCG) was evaluated. This rapid assay, which has application in both Neural Tube Defect screening and Down's screening, shows good precision with between assay coefficients of variation between 5 and 7· 5OJo for AFP and 3' 7 to 5·8% for Free-{3(hCG). Correlation with single analyte procedures is good, with correlation coefficients being greater than O'91 in both cases. Clinical discrimination in detecting both types of abnormalities is not compromised by this new simultaneous Dual Analyte assay. We conclude that the Dual Analyte approach, which combines analytes achieving the highest known detection efficiency, will bring about improvements in the efficiency of screening, reduce costs and improve report turnaround, all leading to better quality of patient care. Additional key phrases: alphafetoprotein; Free beta human chorionic gonadotrophin; simultaneous enzymeimmunoassay; clinical evaluationThe use of maternal serum o-fetoprotein (AFP) quantitation in prenatal screening of unselected pregnant populations for structural malformations (anencephaly and spina bifida) was introduced in the mid 1970s and is now a routine part of obstetric care in many parts of the world. The subsequent observation that lowered AFP levels during the second trimester of pregnancy could be associated with fetal chromosomal trisomies added a new dimension (albeit a mediocre 20% detection rate) to an evolving screening protocol. I The search for additional markers to improve Down's syndrome detection efficiency ensued.Currently a variety of protocols including combinations of two or more analytes have been proposed.v" Recent evidence documents little or no utility for maternal serum unconjugated oestriol. 5-9 Maternal serum quantitation of intact human chorionic gonadotrophin (hCG), however, can independently identify approximately 40% of cases of Down's syndrome and, in combination with maternal age and the biochemical marker AFP, approximately 50-60% of cases of Down's Correspondence: Mr K Spencer. 390 syndrome. However, in a recent side by side comparison study," the marker Free-d (hCG) has been shown to independently identify a substantially greater number of cases of Down's syndrome than total hCG. The highest level of detection efficiency [up to 80% for trisomy 21 in early gestational weeks (less than 17 weeks)] has been achieved by combining maternal age and the biochemical markers AFP and Free-d (hCG).4 This latest observation has been confirmed by several independent studies. S • IO . ! 1The concept of using multiple markers to detect congenital disorders is a relatively new methodology requiring high level statistical computations and computer support. Additionally, linking the evaluation of both AFP and Free-d (hCG) in a single maternal serum sample raises the intriguing prospect of being able to measure both analytes simultaneously. This prospect.is enhanced i...

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supporting

confidence: 75%

Dual Analyte Immunoassay—a New Approach to Neural Tube Defect and Down's Syndrome Screening

Macri¹,

Spencer

Anderson³

1992

Ann Clin Biochem

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“…The suppression of HIV-1 replication by hCG has indeed been demonstrated (7). The concentration of hCG used in our studies is pharmacologically achievable and is quite safe, as indicated by the presence of 5000 mIU/ml to over 100,000 mIU/ml in normal maternal sera during the second trimester (58). During pregnancy, hCG may play a role in suppression of cell-mediated allogeneic reactions.…”

Section: Fig 8 Hcg Inhibits Tnf-induced Jnk (A) and Mek (B) Activatmentioning

confidence: 86%

Human Chorionic Gonadotropin Suppresses Activation of Nuclear Transcription Factor-κB and Activator Protein-1 Induced by Tumor Necrosis Factor

Manna

Mukhopadhyay

Aggarwal

2000

Journal of Biological Chemistry

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“…The most optimal cut-off risk for the screening was calculated to be 1 in 250 (Baumgarten, 1985). During the early 1990s, the triple test was adjusted by the replacement of hCG with the free beta subunit of hCG (fβ-hCG) (Macri et al, 1990, Ryall et al, 1992. Moreover, in 1996, inhibin-A was found to contribute to the current triple test (Wald et al, 1996) and with the addition of inhibin-A the 'quadruple test' was conceived.…”

Section: Prenatal Screening For Down Syndromementioning

confidence: 99%

Innovations in Down Syndrome Screening

Koster¹,

Vries²,

Visser³

et al. 2011

Prenatal Diagnosis and Screening for Down Syndrome

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Maternal serum Down syndrome screening: Free β-protein is a more effective marker than human chorionic gonadotropin

Cited by 202 publications

References 5 publications

Dual Analyte Immunoassay—a New Approach to Neural Tube Defect and Down's Syndrome Screening

Dual Analyte Immunoassay—a New Approach to Neural Tube Defect and Down's Syndrome Screening

Human Chorionic Gonadotropin Suppresses Activation of Nuclear Transcription Factor-κB and Activator Protein-1 Induced by Tumor Necrosis Factor

Innovations in Down Syndrome Screening

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