PraenaTest in brief ® PraenaTest® with shortest delivery times Introduction PraenaTest® is a non-invasive molecular genetic prenatal test for fetal trisomy 13, 18 and 21 as well as for gonosomal aneuploidy (Turner, Triple X, Klinefelter and XYY syndrome) using next generation sequencing and zscore calculation following DNA isolation from maternal plasma. Scientific basis The PraenaTest® method centres on the analysis of cellfree DNA (cfDNA) in the pregnant woman’s blood. These small fragments of genetic material are not contained within cells, but circulate freely in the mother’s bloodstream; they include maternal DNA as well as between 2-40% (on average around 10%) fetal DNA (cellfree fetal DNA, or cffDNA). The genetic material stems from dead placental cells, and is continually released into the pregnant woman’s bloodstream. Reasons to perform the PraenaTest® To undergo the PraenaTest®, a pregnant woman must have received explanations and human genetic counseling in accordance with national legislation and has consented to the genetic examination be in the 10th week of pregnancy (gestational week 9+0) or later exhibit one of the following indications for performing the PraenaTest®: • Age 35 years and over at the time of the birth of the child • Prior pregnancy with fetal aneuploidy • Ultrasound anomalies of the fetus • Hereditary risk of fetal aneuploidy • Increased risk of aneuploidy based on screening methods for prenatal risk determination PraenaTest® portfolio and prices WM-1049-EN-002 / Mai 2015 PraenaTest® Option 1 Determination of fetal trisomy 21 EUR 440 PraenaTest® Option 2 EUR 550 Determination of fetal trisomies 21, 18, 13 PraenaTest® Option 3 EUR 660 Determination of fetal trisomies 21, 18, 13 as well as gonosomal aneuploidy Seite 1 von 2 The PraenaTest® result is generally available in 8-10 working days (standard) in 6 working days (express service) The express service is available for all three test options. Gender determination is optional. Gonosomal aneuploidy can be determined for singleton pregnancy only. The ordered PraenaTest® option can be upgraded at any time (e.g. from option 2 to option 3), should the doctor wish to determine more aneuploidies at a later point of time. The patient pays for the difference between the test options plus a handling fee of EUR 95. The prices are incl. VAT and shipping (as of July 2014). Additional costs associated with the medical consultation (examination, education and genetic counseling) are charged separately by the doctor. Diagnostic value of the PraenaTest® Singleton pregnancy: The clinical studies comprised 808 blood samples in total: Sensitivity is 99 %, false positive rate 0,1 % Trisomy 21: Sensitivity 99 % [74/75 cases], false positive rate 0 % Trisomy 18: 14 of 14 cases detected, one sample was false positive Trisomy 13: 8 of 8 cases detected, no sample was false positive Multiple pregnancy: The clinical study comprised 60 blood samples of twin pregnancies and two samples of triplet pregnancies. All positive trisomy 21 cases were correctly classified (1x monochorial, concordant; 5x dichorial, discordant). The other multiple pregnancy specimens yielded unremarkable results. LifeCodexx AG also analyses samples for triplet or other multiple pregnancies. Since the amount of data existing to date is not yet sufficient for a validation, we are preliminarily offering this analysis free of charge as part of our research and development work. Please contact us in such a case. Gonosomal aneuploidy: The PraenaTest® for gonosomal aneuploidy (Turner, Triple X, Klinefelter and XYY syndrome) was tested on a total of 434 specimens from single pregnancies. During this testing, 11 out of 12 affected fetuses, that is 92 %, were correctly determined. Moreover, five discordant, „false positive“ results were obtained. At present, based on the low number of cases examined, LifeCodexx AG will not separately report any sensitivities and specificities for gonosomal aneuploidy. 7. This is followed by sequencing using state-of-the-art analysis equipment (random massively parallel sequencing; rMPS) 8. The sequences are evaluated using the proprietary and CE-marked data analysis software PraenaTest® DAP.plus. 9. The test result is then scientifically interpreted and documented in the result report. Fetal gender determination is optional. If the case of a multiple pregnancy a –male- report means that at least one of the fetuses is male. 10. The result report is faxed and sent by post to the responsible doctor. Limitations of the PraenaTest® Regulatory requirements for NIPT-based aneuploidy testing in Europe In general, the PraenaTest® is not suitable for statements regarding structural chromosomal changes or mosaics. The cellfree fetal DNA examined in the PraenaTest® originates from the trophoblast cells and as such it is only possible to achieve a level of diagnostic certainty close to that attained via direct chorionic villus sampling. Consequently, mosaics or fetoplacental discrepancies in trisomies 21, 18 or 13 are not recognisable. In the event of a fetoplacental discrepancy, this can also mean that the PraenaTest® result is not representative for the unborn child. Undisclosed vanished twins can contribute a sufficient proportion to the total cffDNA fraction to cause discordant NIPT results, being not representative for the continuing singleton pregnancy. PraenaTest® process 1. LifeCodexx AG provides special blood collection tubes to the doctor. 2. After the patient has received genetic counselling and granted consent, the doctor draws 2x10ml venous blood. 3. The blood samples are sent by courier to the LifeCodexx AG diagnostic laboratory in Konstanz, Germany. 4. Laboratory work begins by isolating the blood plasma. 5. Next, the cell-free genetic material (cfDNA) is extracted from the plasma. The cfDNA is not further separated into maternal and fetal DNA – further analysis is always performed using the mixture of maternal and fetal cell-free DNA. For the analysis to be successful, the mixture must contain more than 4% fetal cell-free DNA mixed in with the maternal DNA. Should fetal DNA comprise less than 4% of the cell-free DNA mixture, it is recommended that new blood samples be taken later on in the pregnancy. 6. The recovered DNA is present in only minute quantities; after determining its percentage of fetal DNA, a so-called genomic library is generated and reproduced so that it can be analysed. Seite 2 von 2 NIPT-based aneuploidy tests for trisomy 21 fall under the European Union Directive on In-Vitro-Diagnostics 98/79/EG (List B, Appendix II, IVD products), and under the corresponding national laws. This means: The data analysis pipeline must be CE-marked under the supervision of a Notified Body. The company offering the test must have a comprehensive quality assurance system in place (EN ISO 13485).
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