Population-based trends in prenatal screening and diagnosis for aneuploidy: a retrospective analysis of 38 years of state-wide data.

OBJECTIVE: To analyse population-based trends over the entire history of prenatal testing for aneuploidy. DESIGN: Retrospective analysis of state-wide data sets. SETTING: Australian state of Victoria with ~70 000 annual births. POPULATION: All pregnant women undergoing invasive prenatal testing at <25 weeks' gestation from 1976 to 2013. METHODS: Analysis of three state-wide data sets: (1) Prenatal diagnosis data set of 119 404 amniocenteses and chorionic villus samplings from 1976 to 2013; (2) central serum screening laboratory data set from 1996 to 2013; (3) government birth statistics from 1976 to 2013. MAIN OUTCOME MEASURES: Annual numbers and uptake rates of invasive prenatal tests and serum screening, indications for invasive prenatal testing, prenatal diagnoses of aneuploidy, diagnostic yield of invasive tests. RESULTS: Annual numbers of invasive prenatal tests climbed steadily from 1976, then declined from 2000. In 2013, the number of invasive prenatal tests was the lowest in 25 years, while the number of trisomy 21 diagnoses was the highest ever recorded. Annual uptake of serum screening climbed from 1.6 to 83% over 1996-2013. Results from 2013 showed a high diagnostic yield (15.8%) for a low rate of invasive testing (3.4% of births). Over four decades, the number of invasive procedures performed for each diagnosis of major chromosome abnormality declined from 100 to six. CONCLUSIONS: This study demonstrates historic reductions in the proportion of women undergoing invasive testing and dramatic improvements in diagnostic yield. Monitoring the impact of new prenatal technologies on this progress remains an important research priority. TWEETABLE ABSTRACT: Invasive prenatal testing has reached historic lows due to dramatic improvements in Down syndrome screening.

Small heat shock protein alteration provides a mechanism to reduce mesangial cell contractility in diabetes and oxidative stress.

BACKGROUND: Small heat shock proteins are expressed in many tissues and are proposed to regulate actin filament dynamics when dissociated into small aggregates and phosphorylated in a p38 mitogen-activated protein kinase (p38MAPK)-dependent manner. METHODS: p38MAPK activity and small heat shock protein-25 (Hsp25) were determined in glomeruli from rats with experimental diabetes induced by streptozotocin administration and in isolated glomeruli exposed to a free radical stress. Contractile responsiveness of mesangial cells was determined by the serum-induced contraction of cell-embedded type I collagen gels. RESULTS: In experimental diabetes, there is an activation of p38MAPK, a decrease in the size of Hsp25 molecular aggregates, from large to small homo-oligomers, and an increase in the phosphorylation of Hsp25. In control glomeruli, a free radical stress, H2O2, activated p38MAPK and increased Hsp25 in a concentration-dependent manner. Additionally, H2O2 decreased the contractility of cultured mesangial cells concomitant with an increase in Hsp25 phosphorylation and a reduction in Hsp25 aggregate size. These effects were significantly reduced by SB202190, an imidazole-derivative cell-permeable inhibitor of p38MAPK. CONCLUSIONS: It has been proposed that the generation of oxygen-derived free radicals in diabetes may be linked causally to a loss of glomerular contractile reactivity and thus hyperfiltration in the early stages of diabetes mellitus. This study provides a mechanism for alteration of mesangial cell contractile responsiveness through phosphorylation of Hsp25 and may be a mechanism underlying abnormalities in glomerular hemodynamics in diabetes and in the presence of free radical stress.

Extracellular matrix components cooperate to activate phosphatidyl inositol-4-phosphate 5-kinase.

Interaction of mesangial cells with extracellular matrix proteins can provide a means to modify cellular anchorage and traction through an interaction of integrins with activation of the actin cytoskeleton. We investigated intracellular signalling of matrix components fibronectin and laminin in mesangial cells in monolayer and 3-dimensional configurations to show a fibronectin-dependent activation of phosphatidylinositol-4-phosphate 5-kinase (up to threefold), which is augmented by a laminin-dependent increase in phospholipase D activity. Functional responsiveness to fibronectin and laminin addition was seen in the contraction of free-floating 3-dimensional mesangial cell-embedded collagen gels, a well-defined system reflecting coupling of extracellular matrix-cell events to activation of the actin cytoskeleton. Activation of phosphatidylinositol-4-phosphate 5-kinase and contraction of mesangial cell-embedded collagen gels in response to fibronectin and laminin were inhibited by pretreatment of mesangial cells with lovastatin and restored by isoprenoid augmentation with geranylgeraniol, supporting a role for the ras-related protein Rho in this process.