Circulating trophoblast cell clusters for early detection of placenta accreta spectrum disorders

Placenta accreta spectrum (PAS) is a high-risk obstetrical condition associated with significant morbidity and mortality. Current clinical screening modalities for PAS are not always conclusive. Here, we report a nanostructure-embedded microchip that efficiently enriches both single and clustered circulating trophoblasts (cTBs) from maternal blood for detecting PAS. We discover a uniquely high prevalence of cTB-clusters in PAS and subsequently optimize the device to preserve the intactness of these clusters. Our feasibility study on the enumeration of cTBs and cTB-clusters from 168 pregnant women demonstrates excellent diagnostic performance for distinguishing PAS from non-PAS. A logistic regression model is constructed using a training cohort and then cross-validated and tested using an independent cohort. The combined cTB assay achieves an Area Under ROC Curve of 0.942 (throughout gestation) and 0.924 (early gestation) for distinguishing PAS from non-PAS. Our assay holds the potential to improve current diagnostic modalities for the early detection of PAS.

Automated summary

A newly developed microchip technology enables efficient enrichment of circulating trophoblasts from maternal blood for early detection of placenta accreta spectrum (PAS). The researchers identified a high prevalence of circulating trophoblast clusters in PAS patients and constructed a diagnostic model with excellent performance in distinguishing PAS. The combined trophoblast assay shows potential to improve current diagnostic methods for the early detection of PAS.