{"id":7286,"date":"2024-02-17T10:13:15","date_gmt":"2024-02-17T10:13:15","guid":{"rendered":"https:\/\/neuropediatoolkit.org\/?p=7286"},"modified":"2026-06-22T20:07:03","modified_gmt":"2026-06-22T20:07:03","slug":"exoma-clinico-first-tier","status":"publish","type":"post","link":"https:\/\/neuropediatoolkit.org\/en\/exoma-clinico-first-tier\/","title":{"rendered":"Clinical exome, first tier?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">La evoluci\u00f3n tecnol\u00f3gica en gen\u00f3mica tiene una velocidad muy r\u00e1pida y las gu\u00edas cl\u00ednicas se quedan obsoletas respecto a la pr\u00e1ctica cl\u00ednica habitual, de forma que los profesionales frecuentemente nos encontramos con preguntas dif\u00edciles de responder. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Mucho ha llovido desde las gu\u00edas de la AAN de 2003, en las que se propuso como primer escal\u00f3n para el estudio del retraso global del desarrollo y los trastornos del espectro del autismo la utilizaci\u00f3n del cariotipo y el X-fragil, actualmente retiradas <span class=\"zp-InText-zp-ID--19955111-USAKSNND--wp7286 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{19955111:USAKSNND}', 'format': '(%a%, %d%, %p%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>, tras la revisi\u00f3n realizada en 2011 por los mismos autores <span class=\"zp-InText-zp-ID--19955111-W37ZUI82--wp7286 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{19955111:W37ZUI82}', 'format': '(%a%, %d%, %p%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Las gu\u00edas de 2012 de la academia americana de pediatr\u00eda, introdujeron por primera vez el uso sistem\u00e1tico del aCGH <span class=\"zp-InText-zp-ID--19955111-KP9ZKQPJ--wp7286 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{19955111:KP9ZKQPJ}', 'format': '(%a%, %d%, %p%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>. Una consecuencia no inesperada, ha sido la progresiva decadencia de las t\u00e9cnicas de citogen\u00e9tica tradicionales (cariotipo), hasta el punto de que se est\u00e1 perdiendo el \u00abknow how\u00bb, y el n\u00famero de profesionales capaces de realizar la t\u00e9cnica est\u00e1 en riesgo de extinci\u00f3n.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Desde entonces, la aparici\u00f3n de los estudios de secuenciaci\u00f3n del exoma ha significado una revoluci\u00f3n desde el punto de vista del incremento de la rentabilidad diagn\u00f3stica (diagnostic yield). En particular, la aparici\u00f3n de sistemas bioinform\u00e1ticos de detecci\u00f3n de CNV a partir de los datos obtenidos en la secuenciaci\u00f3n del exoma, ha permitido cuestionar seriamente la utilidad de realizar un aCGH previo. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">En las \u00faltimas gu\u00edas de la ACMG de 2021, se ha analizado si el exoma deber\u00eda ser el 1\u00ba escal\u00f3n en el estudio diagn\u00f3stico de los pacientes con malformaciones cong\u00e9nitas m\u00faltiples y discapacidad intelectual, proponiendo un cambio en el paradigma actual. <span class=\"zp-InText-zp-ID--19955111-UXTQ6ZNU--wp7286 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{19955111:UXTQ6ZNU}', 'format': '(%a%, %d%, %p%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">No obstante, continua existiendo discusi\u00f3n en el campo respecto a cu\u00e1l debe ser la actual secuencia de decisiones desde el punto de vista de la pr\u00e1ctica cl\u00ednica, cuestionandose t\u00edmidamente si realmente es rentable continuar realizando X-fragil a toda la poblaci\u00f3n, dada la disminuci\u00f3n de prevalencia identificada en las \u00faltimas d\u00e9cadas <span class=\"zp-InText-zp-ID--19955111-KJWQRLHH--wp7286 zp-InText-Citation loading\" rel=\"{ 'pages': 'np', 'items': '{19955111:KJWQRLHH}', 'format': '(%a%, %d%, %p%)', 'brackets': '', 'etal': '', 'separator': '', 'and': '' }\"><\/span>. <\/p>\n\n\n\n<div id='zp-InTextBib-zotpress-50976dd802fddbd2cb1534b16f155714' class='zp-Zotpress zp-Zotpress-InTextBib wp-block-group zp-Post-7286'>\r\n\t\t<span class=\"ZP_ITEM_KEY ZP_ATTR\">{19955111:USAKSNND};{19955111:W37ZUI82};{19955111:KP9ZKQPJ};{19955111:UXTQ6ZNU};{19955111:KJWQRLHH}<\/span>\r\n\t\t<span class=\"ZP_STYLE ZP_ATTR\">vancouver<\/span>\r\n\t\t<span class=\"ZP_SORTBY ZP_ATTR\">default<\/span>\r\n\t\t<span class=\"ZP_ORDER ZP_ATTR\">asc<\/span>\r\n\t\t<span class=\"ZP_TITLE ZP_ATTR\"><\/span>\r\n\t\t<span 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The Lancet Neurology. 2006;5(9):780\u201390.<\/div>\n   <\/div>\n<\/div>\n\t\t\t\t<\/div><!-- .zp-Entry .zpSearchResultsItem --><\/div><!-- .zp-zp-SEO-Content -->\n<\/div><!-- .zp-List --><\/div><!--.zp-Zotpress-->\n\n\n","protected":false},"excerpt":{"rendered":"<p>Technological evolution in genomics has a very fast speed and clinical guidelines become obsolete with respect to usual clinical practice, so that professionals frequently find themselves with questions that are difficult to answer. Much has happened since the 2003 AAN guidelines, in which it was proposed as the first step... <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/neuropediatoolkit.org\/en\/exoma-clinico-first-tier\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> \"Clinical exome, first tier?\"<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":7292,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"categories":[10],"tags":[],"class_list":["post-7286","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-neurogenetica","entry"],"_links":{"self":[{"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts\/7286","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/comments?post=7286"}],"version-history":[{"count":8,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts\/7286\/revisions"}],"predecessor-version":[{"id":8408,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts\/7286\/revisions\/8408"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/media\/7292"}],"wp:attachment":[{"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/media?parent=7286"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/categories?post=7286"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/tags?post=7286"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}