The contingent use of cell-free fetal DNA for prenatal screening of trisomies 21, 18, 13 in pregnant women within a national health service: A budget impact analysis.

OBJECTIVE: Non-invasive prenatal testing (NIPT) based on cell-free fetal DNA (cffDNA) is highly accurate in the detection of common fetal autosomal trisomies. Aim of this project was to investigate short-term costs and clinical outcomes of the contingent use of cffDNA for prenatal screening of trisomies 21, 18, 13 within a national health service (NHS). METHODS: An economic analysis was developed from the perspective of the Italian NHS to compare two possible scenarios for managing pregnant women: women managed according to the Standard of Care screening (SoC) vs a cffDNA scenario, where Harmony Prenatal Test was introduced as a second line screening choice for women with an "at risk" result from SoC screening. RESULTS: The introduction of cffDNA as a second line screening test, conditional to a risk ≥ 1:1,000 from SoC screening, showed a 3% increase in the detection of trisomies, with a 71% decrease in the number of invasive tests performed. Total short-term costs (pregnancy management until childbirth) decreased by € 19 million (from € 84.5 to 65.5 million). CONCLUSION: The adoption of the Harmony Prenatal Test in women resulting at risk from SoC screening, implied a greater number of trisomies detection, together with a reduction of the healthcare costs.

Re-purposing bridging flocculation for on-site, rapid, qualitative DNA detection in resource-poor settings.

Developing molecular diagnostics in resource-poor settings is challenging. As such, we purpose-built a novel bridging flocculation assay for qualitative evaluation of isothermally amplified DNA by naked eye. The flocculation assay was dependent on pH, DNA polymer amounts and lengths. The method was first applied to the rapid and sensitive detection of important plant pathogens and subsequently extended to other pathogens across the animal kingdom to demonstrate the wide applications of our approach.

Towards practical, high-capacity, low-maintenance information storage in synthesized DNA.

Digital production, transmission and storage have revolutionized how we access and use information but have also made archiving an increasingly complex task that requires active, continuing maintenance of digital media. This challenge has focused some interest on DNA as an attractive target for information storage because of its capacity for high-density information encoding, longevity under easily achieved conditions and proven track record as an information bearer. Previous DNA-based information storage approaches have encoded only trivial amounts of information or were not amenable to scaling-up, and used no robust error-correction and lacked examination of their cost-efficiency for large-scale information archival. Here we describe a scalable method that can reliably store more information than has been handled before. We encoded computer files totalling 739 kilobytes of hard-disk storage and with an estimated Shannon information of 5.2 × 10(6) bits into a DNA code, synthesized this DNA, sequenced it and reconstructed the original files with 100% accuracy. Theoretical analysis indicates that our DNA-based storage scheme could be scaled far beyond current global information volumes and offers a realistic technology for large-scale, long-term and infrequently accessed digital archiving. In fact, current trends in technological advances are reducing DNA synthesis costs at a pace that should make our scheme cost-effective for sub-50-year archiving within a decade.

Bodies of science and law: forensic DNA profiling, biological bodies, and biopower.

How is jurisdiction transferred from an individual's biological body to agents of power such as the police, public prosecutors, and the judiciary, and what happens to these biological bodies when transformed from private into public objects? These questions are examined by analysing bodies situated at the intersection of science and law. More specifically, the transformation of 'private bodies' into 'public bodies' is analysed by going into the details of forensic DNA profiling in the Dutch jurisdiction. It will be argued that various 'forensic genetic practices' enact different forensic genetic bodies'. These enacted forensic genetic bodies are connected with various infringements of civil rights, which become articulated in exploring these forensic genetic bodies''normative registers'.

A comparison of ARA and DNA data for microbial source tracking based on source-classification models developed using classification trees.

The literature on microbial source tracking (MST) suggests that DNA analysis of fecal samples leads to more reliable determinations of bacterial sources of surface water contamination than antibiotic resistance analysis (ARA). Our goal is to determine whether the increased reliability, if any, in library-based MST developed with DNA data is sufficient to justify its higher cost, where the bacteria source predictions are used in TMDL surface water management programs. We describe an application of classification trees for MST applied to ARA and DNA data from samples collected in the Potomac River Watershed in Maryland. Conclusions concerning the comparison of ARA and DNA data, although preliminary at the current time, suggest that the added cost of obtaining DNA data in comparison to the cost of ARA data may not be justified, where MST is applied in TMDL surface water management programs.

Sharing the benefits of genetic resources: from biodiversity to human genetics.

Benefit sharing aims to achieve an equitable exchange between the granting of access to a genetic resource and the provision of compensation. The Convention on Biological Diversity (CBD), adopted at the 1992 Earth Summit in Rio de Janeiro, is the only international legal instrument setting out obligations for sharing the benefits derived from the use of biodiversity. The CBD excludes human genetic resources from its scope, however, this article considers whether it should be expanded to include those resources, so as to enable research subjects to claim a share of the benefits to be negotiated on a case-by-case basis. Our conclusion on this question is: 'No, the CBD should not be expanded to include human genetic resources.' There are essential differences between human and non-human genetic resources, and, in the context of research on humans, an essentially fair exchange model is already available between the health care industry and research subjects. Those who contribute to research should receive benefits in the form of accessible new health care products and services, suitable for local health needs and linked to economic prosperity (e.g. jobs). When this exchange model does not apply, as is often the case in developing countries, individually negotiated benefit sharing agreements between researchers and research subjects should not be used as 'window dressing'. Instead, national governments should focus their finances on the best economic investment they could make; the investment in population health and health research as outlined by the World Health Organization's Commission on Macroeconomics and Health; whilst international barriers to such spending need to be removed.

"What's my DNA worth, anyway?": a response to the commercialization of individuals' DNA information.

Extensive enthusiasm surrounds the potential for human DNA information to sustain and enhance the pharmaceutical industry's profitability. Nevertheless, persons whose health makes their DNA of commercial interest are routinely expected simply to give their DNA and the information in it to pharmaceutical or genomics companies or their academic intermediaries, voluntarily and without compensation. This state of affairs is increasingly recognized as paradoxical, but it is favored by conventional bioethical opinion. Given that most DNA information is now collected for commercial purposes and is worth considerably more than is generally imagined, bioethical objections to compensation of individuals for their DNA information are inappropriate. This paper suggests approaches by which individuals and representative governments and patient interest groups can negotiate compensation. Appreciable attitudinal change is required if those individuals personally involved are to be included fairly in the commercialization of human DNA information. Ultimately, however, such change is necessary if commercial genetic research is to respect human dignity and human rights.

Clinical trials, genetic add-ons, and the question of benefit-sharing.

Discussion of benefit-sharing has become common in the sphere of human genetic research. Roughly, this term means that individuals or organisations who could reap financial rewards from research into human genetics have some obligation to share the benefits of this research, perhaps with the people who made the research possible in the first place, or with humankind more broadly. This idea has met with some acceptance, finding its way into policy recommendations and statements of several prominent groups. However, the issue of benefit-sharing is generally raised in the context of large-scale population-based genetic studies. Other sources of human DNA are often ignored. In particular, little attention has been paid to the increasingly common practice of collecting genetic samples as add-ons to clinical drug trials. Generally such trials do not specify a use for these samples, which are collected for purposes of potential future research. We argue that if a case for benefit-sharing can be made for genetic studies in general, it can be made for add-on studies as well. We suggest some ways in which benefit-sharing might be implemented for genetic add-on studies.

Sensitive and efficient detection of RB1 gene mutations enhances care for families with retinoblastoma.

Timely molecular diagnosis of RB1 mutations enables earlier treatment, lower risk, and better health outcomes for patients with retinoblastoma; empowers families to make informed family-planning decisions; and costs less than conventional surveillance. However, complexity has hindered clinical implementation of molecular diagnosis. The majority of RB1 mutations are unique and distributed throughout the RB1 gene, with no real hot spots. We devised a sensitive and efficient strategy to identify RB1 mutations that combines quantitative multiplex polymerase chain reaction (QM-PCR), double-exon sequencing, and promoter-targeted methylation-sensitive PCR. Optimization of test order by stochastic dynamic programming and the development of allele-specific PCR for four recurrent point mutations decreased the estimated turnaround time to <3 wk and decreased direct costs by one-third. The multistep method reported here detected 89% (199/224) of mutations in bilaterally affected probands and both mutant alleles in 84% (112/134) of tumors from unilaterally affected probands. For 23 of 27 exons and the promoter region, QM-PCR was a highly accurate measure of deletions and insertions (accuracy 95%). By revealing those family members who did not carry the mutation found in the related proband, molecular analysis enabled 97 at-risk children from 20 representative families to avoid 313 surveillance examinations under anesthetic and 852 clinic visits. The average savings in direct costs from clinical examinations avoided by children in these families substantially exceeded the cost of molecular testing. Moreover, health care savings continue to accrue, as children in succeeding generations avoid unnecessary repeated anaesthetics and examinations.

A scalable high-throughput chemical synthesizer.

A machine that employs a novel reagent delivery technique for biomolecular synthesis has been developed. This machine separates the addressing of individual synthesis sites from the actual process of reagent delivery by using masks placed over the sites. Because of this separation, this machine is both cost-effective and scalable, and thus the time required to synthesize 384 or 1536 unique biomolecules is very nearly the same. Importantly, the mask design allows scaling of the number of synthesis sites without the addition of new valving. Physical and biological comparisons between DNA made on a commercially available synthesizer and this unit show that it produces DNA of similar quality.

Pending resolution: the question of who owns DNA.

With the emergence of the Human Genome Project and its private counterparts, the U.S. Patent and Trademark Office has begun receiving applications for the patenting of genes and genetic sequences. Earlier patent decisions regarding similar scientific advances limited patents to organisms "made by the hand of man," which would seem to remove discovered genes from patent protection. But many applicants have been successful in attaining patents for genes based on their ability to demonstrate the ultimate utility of the gene, for instance in medicine. One controversy regarding genomic patenting, however, is that patents apparently have been granted for mere gene fragments devoid of much demonstrable utility. Furthermore, critics fear that gene patenting will retard research by squelching scientists' ability to share findings freely.

Who "owns" cells and tissues?

Opposition to 'ownership' of cells and tissues often depends on arguments about the special or sacred nature of human bodies and other living things. Such arguments are not very helpful in dealing with the patenting of DNA fragments. Two arguments undergird support for patenting: the notion that an author has a 'right' to an invention resulting from his/her labor, and the utilitarian argument that patents are needed to support medical inventiveness. The labor theory of ownership rights is subject to critique, thought it may still have enduring value. The more important argument is that deriving from the common good. If patents on DNA are supported on the basis of their contributions to the common good, then they can also be limited based on considerations of the common good.