One-year evaluation of a neonatal screening program for cystic fibrosis in Switzerland

BACKGROUND From January 2011 onward, the Swiss newborn screening (NBS) program has included a test for cystic fibrosis (CF). In this study, we evaluate the first year of implementation of the CF-NBS program. METHODS The CF-NBS program consists of testing in two steps: a heel prick sample is drawn (= Guthrie test) for measurement of immunoreactive trypsinogen (IRT) and for DNA screening. All children with a positive screening test are referred to a CF center for further diagnostic testing (sweat test and genetic analysis). After assessment in the CF center, the parents are given a questionnaire. All the results of the screening process and the parent questionnaires were centrally collected and evaluated. RESULTS In 2011, 83 198 neonates were screened, 84 of whom (0.1%) had a positive screening result and were referred to a CF center. 30 of these 84 infants were finally diagnosed with CF (positive predictive value: 35.7%). There was an additional infant with CF and meconium ileus whose IRT value was normal. The 31 diagnosed children with CF correspond to an incidence of 1 : 2683. The average time from birth to genetically confirmed diagnosis was 34 days (range: 13-135). 91% of the parents were satisfied that their child had undergone screening. All infants receiving a diagnosis of CF went on to receive further professional care in a CF center. CONCLUSION The suggested procedure for CF-NBS has been found effective in practice; there were no major problems with its implementation. It reached high acceptance among physicians and parents.

Genetics of recurrent airway obstruction (RAO)

Recurrent airway obstruction (RAO) is a multifactorial and polygenic disease. Affected horses are typically 7 years of age or older and show exercise intolerance, increased breathing effort, coughing, airway neutrophilia, mucus accumulation and hyperreactivity as well as cholinergic bronchospasm. The environmental factors responsible are predominantly allergens and irritants in haydust, but the immunological mechanisms underlying RAO are still unclear. Several studies have demonstrated a familiar predisposition for RAO and it is now proven that the disease has a genetic basis. In offspring, the risk of developing RAO is 3-fold increased when one parent is affected and increases to almost 5-fold when both parents have RAO. Segregation analysis in two high-prevalence families demonstrated a high heritability and a complex inheritance with several major genes. A whole genomescan showed chromosome-wide significant linkage of seven chromosomal regions with RAO. Of the microsatellites, which were located near atopy candidate genes, those in a region of chromosome 13 harboring the IL4R gene were strongly associated with the RAO phenotype in the offspring of one RAO-affected stallion. Furthermore, IgE-levels are influenced by hereditary factors in the horse, and we have evidence that RAO-affected offspring of the same stallion have increased levels of specific IgE against moldspore allergens. The identification of genetic markers and ultimately of the responsible genes will not only allow for an improved prophylaxis, i.e. early identification of susceptible individuals and avoidance of high-risk matings, but also improve our ability to find new therapeutic targets and to optimize existing treatments.

Hereditäre Thrombozytopathie beim Simmental Rind.

Der Wiederkäuerklinik oder dem Institut für Genetik der Universität Bern wurden zwi-schen 2012 und 2014 insgesamt 5 Rinder der Rasse Simmental vorgestellt, die je-weils nicht sistierende Blutungen nach Trauma zeigten. Alle betroffenen Tiere waren homozygote Träger für die seit 2007 bekannte RASGRP2 Mutation. Die verfügbaren Eltern wurden als heterozygote Anlageträger genotypisiert, was somit einen rezessi-ven Erbgang bestätigt. Drei erkrankte Tiere sind an den Folgen der unstillbaren Blu-tungen verstorben. Ein Tier konnte stabilisiert werden und wurde einen Monat nach der Entlassung aus der Klinik geschlachtet. Bei einem weiteren Fall wurden wieder-holt andauernde Blutungen sowie mehrmals Hämatome festgestellt und nach der genetischen Analyse wurde das Rind euthanasiert. Die Genotypisierung einer Stich-probe von 145 Stieren, die im Jahr 2013 in der Schweiz in der künstlichen Besamung zum Einsatz kamen, zeigte, dass 10% der getesteten Stiere in der Schweiz Anlage-träger für die assoziierte Mutation sind. Diese Stiere werden mit TP carrier gekenn-zeichnet und sollten zukünftig nicht mehr unkontrolliert eingesetzt werden. Die Zuchtverantwortlichen in der Schweiz nutzen heute den Gentest systematisch zur Selektion von anlagefreien Stieren.