<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">AJAC</journal-id><journal-title-group><journal-title>American Journal of Analytical Chemistry</journal-title></journal-title-group><issn pub-type="epub">2156-8251</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/ajac.2014.54031</article-id><article-id pub-id-type="publisher-id">AJAC-43711</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Chemistry&amp;Materials Science</subject></subj-group></article-categories><title-group><article-title>
 
 
  Unusual Detection of Lathosterol in Amniotic Fluids Investigated for the Determination of Cholesterol and 7-Dehydrocholesterol for Suspected Smith-Lemli-Opitz Syndrome
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>eniero</surname><given-names>Gambaro</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Fiorenza</surname><given-names>Farè</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Andrea</surname><given-names>Barlocco</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Federico</surname><given-names>Maggi</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Giuseppe</surname><given-names>Simoni</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Lucia</surname><given-names>Dell’Acqua</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Chiara</surname><given-names>Rusconi</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Gabriella</surname><given-names>Roda</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><addr-line>Dipartimento di Scienze Farmaceutiche “Pietro Pratesi”, University of Milan, Milan, Italy</addr-line></aff><aff id="aff2"><addr-line>Laboratorio TOMA srl, Busto Arsizio, Italy</addr-line></aff><author-notes><corresp id="cor1">* E-mail:<email>gabriella.roda@unimi.it(GR)</email>;</corresp></author-notes><pub-date pub-type="epub"><day>06</day><month>03</month><year>2014</year></pub-date><volume>05</volume><issue>04</issue><fpage>249</fpage><lpage>257</lpage><history><date date-type="received"><day>28</day>	<month>January</month>	<year>2014</year></date><date date-type="rev-recd"><day>2</day>	<month>March</month>	<year>2014</year>	</date><date date-type="accepted"><day>10</day>	<month>March</month>	<year>2014</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  The Smith-Lemli-Opitz syndrome (SLOS), is an autosomal recessive disorder caused by a 7-dehydrocholesterol reductase deficiency, which is characterized by abnormally elevated amniotic fluid 7-DHC (7-dehydrocholesterol) concentrations. A GC/FID (gas-chromatography with a flame ionization detector) and GC/MS (gas-chromatography with a mass detector) method was optimized for the detection of cholesterol and 7-DHC in amniotic fluids. The quantitative determination of cholesterol in 39 control amniotic fluids evidenced that between the fourth and fifth month of pregnancy the levels of this analyte are quite constant, the concentration of total and free cholesterol being respectively 10.3 μg&#183;mL
  <sup>﹣1</sup> (SD = &#177;3.6) and 1.7 μg&#183;mL
  <sup>﹣1</sup> (SD = &#177;0.91), while the analysis of 60 amniotic fluids potentially related to SLOS, showed a higher variability of cholesterol levels. Moreover, in 13 samples an analyte which did not correspond either to cholesterol or to 7-DHC was detected. A GC/MS investigation allowed us to identify this compound as lathosterol, a precursor of cholesterol in the biosynthetic pathway.
 
</p></abstract><kwd-group><kwd>Lathosterol; Cholesterol; SLO Syndrome; Amniotic Fluid; GC/FID; GC/MS</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Cholesterol is an essential lipid which is a precursor for many sterol-based compounds and is involved in the regulation of the precise pattering of embryonic structures [<xref ref-type="bibr" rid="scirp.43711-ref1">1</xref>] . Thus, a defeat in its availability during pregnancy has severe consequences to the fetus, interfering in its regular development [<xref ref-type="bibr" rid="scirp.43711-ref2">2</xref>] .</p><p>Cholesterol is produced from lanosterol through a complex biosynthetic pathway involving several multienzymatic reactions, including demethylations, isomerization, desaturation, and double-bond reductions. Several polimalformative disorders [<xref ref-type="bibr" rid="scirp.43711-ref3">3</xref>] -[<xref ref-type="bibr" rid="scirp.43711-ref6">6</xref>] have been identified, deriving from enzyme defects in cholesterol biosynthesis [<xref ref-type="bibr" rid="scirp.43711-ref7">7</xref>] [<xref ref-type="bibr" rid="scirp.43711-ref8">8</xref>] . In particular the Smith-Lemli-Opitz syndrome (SLOS), is an autosomal recessive disorder affecting 1:20000 individuals, characterized by a recognizable pattern of minor facial anomalies, limb abnormalities and multiple congenital anomalies including pseudohermaphroditism in males, neonatal hypotonia, mental retardation and failure to thrive [<xref ref-type="bibr" rid="scirp.43711-ref9">9</xref>] -[<xref ref-type="bibr" rid="scirp.43711-ref12">12</xref>] . This disease, caused by a 7-dehydrocholesterol reductase deficiency, is characterized by high blood levels of specific metabolites of postsqualene cholesterol biosynthesis [<xref ref-type="bibr" rid="scirp.43711-ref13">13</xref>] . A clinical suspicion of SLOS is usually confirmed by a marked increase of 7-dehydrocholesterol (7-DHC) in plasma or tissues, accompanied by decreased levels of cholesterol, which is consistent with a 7-dehydrocholesterol reductase deficiency [<xref ref-type="bibr" rid="scirp.43711-ref14">14</xref>] . The determination of serum cholesterol and 7-DHC by GC/MS is the method of choice for SLOS diagnosis [<xref ref-type="bibr" rid="scirp.43711-ref15">15</xref>] , even if other analytical approaches have been described [<xref ref-type="bibr" rid="scirp.43711-ref16">16</xref>] -[<xref ref-type="bibr" rid="scirp.43711-ref18">18</xref>] figure 1. This method was also applied to the prenatal diagnosis for the determination of sterols in amniotic fluid [<xref ref-type="bibr" rid="scirp.43711-ref15">15</xref>] [<xref ref-type="bibr" rid="scirp.43711-ref19">19</xref>] -[<xref ref-type="bibr" rid="scirp.43711-ref26">26</xref>] . It was demonstrated that abnormally elevated amniotic fluid 7-DHC concentrations are an accurate predictor of fetal SLOS [<xref ref-type="bibr" rid="scirp.43711-ref27">27</xref>] [<xref ref-type="bibr" rid="scirp.43711-ref28">28</xref>] . In this paper, we describe the results obtained for the determination of free cholesterol, total cholesterol and its derivatives in 39 amniotic fluids without genetic alterations, considered as control fluids and in 60 amniotic fluids withdrawn from pregnant women, showing a fetal growth retardation potentially related to SLOS, in order to confirm the correlation between this pathology and the sterol levels in amniotic fluid.</p><p>The fetal growth retardation were divided into three classes: an overt intra uterine growth retardation (IUGR), a smaller fetus respect to the gestational age (SGA) and cases in which further biomedical studies were necessary (ACC).</p><p>In the case of the amniotic fluids related to fetal growth retardations only the quantitative determination of total cholesterol was carried out, in fact it was not possible to determine its free portion because of the small amount of amniotic fluid available after the routine cytogenetic investigations.</p><p>In the screening phase the determinations were carried out by means of the GC/FID technique, which allows a fast and accurate quali-quantitative detection of the analytes of interest; the fluids which presented altered concentration values of sterols were further investigated by GC/MS, a technique able to detect compounds structurally related to cholesterol, belonging to its biosynthetic pathway.</p></sec><sec id="s2"><title>2. Experimental</title><sec id="s2_1"><title>2.1. Materials</title><p>All reagents and solvents were of analytical-reagent grade. Cholesterol, 7-DHC, lathosterol and stigmasterol were purchased from Sigma (St. Louis, MO), cyclohexane was obtained from J.T. Baker (Phillipsburg, NJ), ethanol from Carlo Erba (Milano), KOH and pyridine from Merck (Darmstadt), 0.9% NaCl solution from Baxter (Trieste).</p><p>Derivatization reagents were N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) with 1% trimethylchlorosilano (TMCS) (Supelco inc., Bellafonte).</p></sec></sec></body><back><ref-list><title>References</title><ref id="scirp.43711-ref1"><label>1</label><mixed-citation publication-type="other" xlink:type="simple">Gofflot, F., Hars, G., Illien, F., Chevy, F., Wolf, C., Picard, J.J. and Roux, C. (2003) Molecular Mechanisms Underlying Limb Anomalies Associated with Cholesterol Deficiency during Gestation: Implications of Hedgehog Signalling. Human Molecular Genetics, 12, 1187-1198. http://dx.doi.org/10.1093/hmg/ddg129</mixed-citation></ref><ref id="scirp.43711-ref2"><label>2</label><mixed-citation publication-type="other" xlink:type="simple">Cardoso, M.L., Balreira, A., Martins, E., Nunes, L., Cabral, A., Marques, M., Lima, M., Reis, M., Marques, J.S., Medeira, A., Cordeiro, I., et al. (2005) Molecular Studies in Portuguese Patients with Smith-Lemli-Opitz Syndrome and Report of Three New Mutations in DHCR7. Molecular Genetics and Metabolism, 85, 228-235. http://dx.doi.org/10.1016/j.ymgme.2005.02.009</mixed-citation></ref><ref id="scirp.43711-ref3"><label>3</label><mixed-citation publication-type="other" xlink:type="simple">Kelley, R.I. and Hernan, G.E. (2001) Inborn Errors of Sterol Biosynthesis. Annual Review of Genomics and Human Genetics, 2, 299-341. http://dx.doi.org/10.1146/annurev.genom.2.1.299</mixed-citation></ref><ref id="scirp.43711-ref4"><label>4</label><mixed-citation publication-type="other" xlink:type="simple">Krakowiak, P.A., Wassif, C.A., Kratz, L., Cozma, D., Ková?ová, M., Harris, G., Grinberg, A., Yang, Y., Hunter, A.G.W., Tsokos, M., Kelley, R.I. and Porter, F.D. (2003) Lathosterolosis: An Inborn Error of Human and Murine Cholesterol Synthesis Due to Lathosterol 5-Desaturase Deficiency. Human Molecular Genetics, 12, 1631-1641. http://dx.doi.org/10.1093/hmg/ddg172 </mixed-citation></ref><ref id="scirp.43711-ref5"><label>5</label><mixed-citation publication-type="other" xlink:type="simple">Chevy, F., Humbert, L. and Wolf, C. (2005) Sterol Profiling of Amniotic Fluid: A Routine Method for the Detection of Distal Cholesterol Synthesis Deficit. Prenatal Diagnosis, 25, 1000-1006. http://dx.doi.org/10.1002/pd.1254</mixed-citation></ref><ref id="scirp.43711-ref6"><label>6</label><mixed-citation publication-type="other" xlink:type="simple">Brunetti-Pierri, N., Corso, G., Rossi, M., Ferrari, P., Balli, F., Rivasi, F., Annunziata, I., Ballabio, A., Dello Russo, A., Andria, G. and Parenti, G. (2002) Lathosterolosis, a Novel Multiple-Malformation/Mental Retardation Syndrome Due to Deficiency of 3-Hydroxysteroid-5-Desaturase. The American Journal of Human Genetics, 71, 952-958. http://dx.doi.org/10.1086/342668</mixed-citation></ref><ref id="scirp.43711-ref7"><label>7</label><mixed-citation publication-type="other" xlink:type="simple">Clayton, P.T. (1998) Disorders of Cholesterol Biosynthesis. Archives of Diseases in Childhood, 78, 185-189. http://dx.doi.org/10.1136/adc.78.2.185</mixed-citation></ref><ref id="scirp.43711-ref8"><label>8</label><mixed-citation publication-type="other" xlink:type="simple">Porter, F.D. (2003) Human Malformation Syndromes Due to Inborn Errors of Cholesterol Synthesis. Current Opinion in Pediatrics, 15, 607-613. http://dx.doi.org/10.1097/00008480-200312000-00011</mixed-citation></ref><ref id="scirp.43711-ref9"><label>9</label><mixed-citation publication-type="other" xlink:type="simple">Irons, M., Elias, E.R., Salen, G., Tint, G.S. and Batta, A. (1993) Defective Cholesterol Biosynthesis in Smith-Lemli-Opitz Syndrome. Lancet, 341, 1414. http://dx.doi.org/10.1016/0140-6736(93)90983-N</mixed-citation></ref><ref id="scirp.43711-ref10"><label>10</label><mixed-citation publication-type="other" xlink:type="simple">Tint, G.S., Irons, M., Elias, E.R., Batta, A.K., Frieden, R., Chen, T.S. and Salen, G. (1994) Defective Cholesterol Biosynthesis Associated with the Smith-Lemli-Opitz Syndrome. The New England Journal of Medicine, 330, 107-113. http://dx.doi.org/10.1056/NEJM199401133300205</mixed-citation></ref><ref id="scirp.43711-ref11"><label>11</label><mixed-citation publication-type="journal" xlink:type="simple"><name name-style="western"><surname>Tint</surname><given-names> G.S.</given-names></name>,<name name-style="western"><surname> Seller</surname><given-names> M.</given-names></name>,<name name-style="western"><surname> Hughes-Benzie</surname><given-names> R.</given-names></name>,<name name-style="western"><surname> Batta</surname><given-names> A.K.</given-names></name>,<name name-style="western"><surname> Shefer</surname><given-names> S.</given-names></name>,<name name-style="western"><surname> Genest</surname><given-names> D.</given-names></name>,<name name-style="western"><surname> Irons</surname><given-names> M.</given-names></name>,<name name-style="western"><surname> Elias</surname><given-names> E. and Salen</given-names></name>,<name name-style="western"><surname> G. </surname><given-names>  </given-names></name>,<etal>et al</etal>. (<year>1995</year>)<article-title>Markedly Increased Tissue Concentrations of 7-Dehydrocholesterol Combined with Low Levels of Cholesterol Are Characteristic of the Smith-Lemli-Opitz Syndrome</article-title><source> Journal of Lipid Research</source><volume> 36</volume>,<fpage> 89</fpage>-<lpage>95</lpage>.<pub-id pub-id-type="doi"></pub-id></mixed-citation></ref><ref id="scirp.43711-ref12"><label>12</label><mixed-citation publication-type="journal" xlink:type="simple"><name name-style="western"><surname>Salen</surname><given-names> G.</given-names></name>,<name name-style="western"><surname> Shefer</surname><given-names> S.</given-names></name>,<name name-style="western"><surname> Batta</surname><given-names> A.K.</given-names></name>,<name name-style="western"><surname> Tint</surname><given-names> G.S.</given-names></name>,<name name-style="western"><surname> Xu</surname><given-names> G.</given-names></name>,<name name-style="western"><surname> Honda</surname><given-names> A.</given-names></name>,<name name-style="western"><surname> Irons</surname><given-names> M. and Elias</given-names></name>,<name name-style="western"><surname> E. </surname><given-names>  </given-names></name>,<etal>et al</etal>. (<year>1996</year>)<article-title>Abnormal Cholesterol Biosynthesis in the Smith-Lemli-Opitz Syndrome</article-title><source> Journal of Lipid Research</source><volume> 37</volume>,<fpage> 1169</fpage>-<lpage>1180</lpage>.<pub-id pub-id-type="doi"></pub-id></mixed-citation></ref><ref id="scirp.43711-ref13"><label>13</label><mixed-citation publication-type="other" xlink:type="simple">Griffiths, W.J., Wang, Y., Karu, K., Samuel, E., McDonnel, S., Hornshaw, M. and Shackleton, C. (2008) Potential of Sterol Analysis by Liquid Chromatography-Tandem Mass Spectrometry for the Prenatal Diagnosis of Smith-Lemli-Opitz Syndrome. Clinical Chemistry, 54, 1317-1324. http://dx.doi.org/10.1373/clinchem.2007.100644</mixed-citation></ref><ref id="scirp.43711-ref14"><label>14</label><mixed-citation publication-type="other" xlink:type="simple">Amaral, C., Gallardo, E., Rodrigues, R., Pinto Leite, R., Quelhas, D., Tomaz, C. and Cardoso, M.L. (2010) Quantitative Analysis of Five Sterols in Amniotic Fluid by GC-MS: Application to the Diagnosis of Cholesterol Biosynthesis Defects. Journal of Chromatography B, 878, 2130-2136. http://dx.doi.org/10.1016/j.jchromb.2010.06.010</mixed-citation></ref><ref id="scirp.43711-ref15"><label>15</label><mixed-citation publication-type="other" xlink:type="simple">Kelley, R.I. (1995) Diagnosis of Smith-Lemli-Opitz Syndrome by Gas Chromatography/Mass Spectrometry of 7-Dehydrocholesterol in Plasma, Amniotic Fluid and Cultured Skin Fibroblasts. Clinical Chimica Acta, 236, 45-58. http://dx.doi.org/10.1016/0009-8981(95)06038-4</mixed-citation></ref><ref id="scirp.43711-ref16"><label>16</label><mixed-citation publication-type="other" xlink:type="simple">Zimmerman, P.A., Hercules, D.M. and Naylor, E.W. (1997) Direct Analysis of Filter Paper Blood Specimens for Identification of Smith-Lemli-Opitz Syndrome Using Time-of-Flight Secondary Ion Mass-Spectrometry. American Journal of Medical Genetics, 68, 300-304. http://dx.doi.org/10.1002/(SICI)1096-8628(19970131)68:3&lt;300::AID-AJMG10&gt;3.0.CO;2-X</mixed-citation></ref><ref id="scirp.43711-ref17"><label>17</label><mixed-citation publication-type="journal" xlink:type="simple"><name name-style="western"><surname>Seedorf</surname><given-names> U.</given-names></name>,<name name-style="western"><surname> Fobker</surname><given-names> M.</given-names></name>,<name name-style="western"><surname> Voss</surname><given-names> R.</given-names></name>,<name name-style="western"><surname> Meyer</surname><given-names> K.</given-names></name>,<name name-style="western"><surname> Kannenberg</surname><given-names> F.</given-names></name>,<name name-style="western"><surname> Meschede</surname><given-names> D.</given-names></name>,<name name-style="western"><surname> et al. </surname><given-names>  </given-names></name>,<etal>et al</etal>. (<year>1995</year>)<article-title>Smith-Lemli-Opitz Syndrome Diagnosed by Using Time-of-Flight Secondary-Ion Mass Spectrometry</article-title><source> Clinical Chemistry</source><volume> 41</volume>,<fpage> 548</fpage>-<lpage>552</lpage>.<pub-id pub-id-type="doi"></pub-id></mixed-citation></ref><ref id="scirp.43711-ref18"><label>18</label><mixed-citation publication-type="journal" xlink:type="simple"><name name-style="western"><surname>Johnson</surname><given-names> D.W.</given-names></name>,<name name-style="western"><surname> ten Brink</surname><given-names> H.J. and Jackobs</given-names></name>,<name name-style="western"><surname> C. </surname><given-names>  </given-names></name>,<etal>et al</etal>. (<year>2001</year>)<article-title>A Rapid Screening Procedure for Cholesteroland Dehydrocholesterol by Electrospray Ionization Tandem Mass Spectrometry</article-title><source> Journal of Lipid Research</source><volume> 42</volume>,<fpage> 1699</fpage>-<lpage>1705</lpage>.<pub-id pub-id-type="doi"></pub-id></mixed-citation></ref><ref id="scirp.43711-ref19"><label>19</label><mixed-citation publication-type="other" xlink:type="simple">Rossiter, J.P., Hofman, K.J. and Kelley, R.I. (1995) Prenatal Diagnosis by Quantification of Cholesterol Precursors in Amniotic Fluid. American Journal of Medical Genetics, 56, 272-275. http://dx.doi.org/10.1002/ajmg.1320560307</mixed-citation></ref><ref id="scirp.43711-ref20"><label>20</label><mixed-citation publication-type="other" xlink:type="simple">Abuelo, D.N., Tint, G.S., Kelley, R., Batta, A.K., Shefer, S. and Salen, G. (1995) Prenatal Detection of the Cholesterol Biosynthetic Defect in the Smith-Lemli-Opitz Syndrome by the Analysis of Amniotic Fluid Sterols. American Journal of Medical Genetics, 56, 281-285. http://dx.doi.org/10.1002/ajmg.1320560309</mixed-citation></ref><ref id="scirp.43711-ref21"><label>21</label><mixed-citation publication-type="other" xlink:type="simple">Dallaire, L., Mitchell, G., Giguère, R., Lefebvre, F., Melan?on, S.B. and Lambert, M. (1995) Prenatal Diagnosis of Smith-Lemli-Opitz Syndrome Is Possible by Measurement of 7-Dehydrocholesterol in Amniotic Fluid. Prenatal Diagnosis, 15, 855-858. http://dx.doi.org/10.1002/pd.1970150911 </mixed-citation></ref><ref id="scirp.43711-ref22"><label>22</label><mixed-citation publication-type="other" xlink:type="simple">Chevy, F., Humbert, L. and Wolf, C. (2005) Sterol Profiling of Amniotic Fluid: A Routine Method for the Detection of Distal Cholesterol Synthesis Deficit. Prenatal Diagnosis, 25, 1000-1006. http://dx.doi.org/10.1002/pd.1254</mixed-citation></ref><ref id="scirp.43711-ref23"><label>23</label><mixed-citation publication-type="other" xlink:type="simple">Linck, L.M., Hayflick, S.J., Lin, D.S., Battaile, K.P., Ginat, T., Burlingame, S., Gibson, K.M., Honda, M., Honda, A., Salen, G., Tint, G.S., Connor, W.E. and Steiner, R.D. (2000) Fetal Demise with Smith-Lemli-Opitz Syndrome Confirmed by Tissue Sterol Analysis and the Absence of Measurable 7-Dehydrocholesterol Δ7-Reductase Activity in Chorionic Villi. Prenatal Diagnosis, 20, 238-240. http://dx.doi.org/10.1002/(SICI)1097-0223(200003)20:3&lt;238::AID-PD792&gt;3.0.CO;2-W</mixed-citation></ref><ref id="scirp.43711-ref24"><label>24</label><mixed-citation publication-type="other" xlink:type="simple">McGaughran, J.M., Clayton, P.T., Mills, K.A., Rimmer, S., Moore, L. and Donnai, D. (1995) Prenatal Diagnosis of Smith-Lemli-Opitz Syndrome. American Journal of Medical Genetics, 56, 269-271. http://dx.doi.org/10.1002/ajmg.1320560306</mixed-citation></ref><ref id="scirp.43711-ref25"><label>25</label><mixed-citation publication-type="other" xlink:type="simple">Dallaire, L., Mitchell, G., Giguère, R., Lefebvre, F., Melan?on, S.B. and Lambert, M. (1995) Prenatal Diagnosis of Smith-Lemli-Opitz Syndrome Is Possible by Measurement of 7-Dehydrocholesterol. Prenatal Diagnosis, 15, 855-858. http://dx.doi.org/10.1002/pd.1970150911 </mixed-citation></ref><ref id="scirp.43711-ref26"><label>26</label><mixed-citation publication-type="other" xlink:type="simple">Abuelo, D.N., Tint, G.S., Kelley, R., Batta, A.K., Shefer, S. and Salen, G. (1995) Prenatal Detection of the Cholesterol Biosynthetic Defect in the Smith-Lemli-Opitz Syndrome by the Analysis of Amniotic Fluid Sterols. American Journal of Medical Genetics, 56, 281-285. http://dx.doi.org/10.1002/ajmg.1320560309</mixed-citation></ref><ref id="scirp.43711-ref27"><label>27</label><mixed-citation publication-type="other" xlink:type="simple">Tint, G.S., Abuelo, D., Till, M., Cordier, M.P., Batta, A.K., Shefer, S., Honda, A., Honda, M., Xu, G., Irons, M., Elias, E.R. and Salen, G. (1998) Fetal Smith-Lemli-Opitz Syndrome Can Be Detected Accurately and Reliably by Measuring Amniotic Fluid Dehydrocholesterols. Prenatal Diagnosis, 18, 651-658. http://dx.doi.org/10.1002/(SICI)1097-0223(199807)18:7&lt;651::AID-PD316&gt;3.0.CO;2-V</mixed-citation></ref><ref id="scirp.43711-ref28"><label>28</label><mixed-citation publication-type="other" xlink:type="simple">Sharp, P., Haan, E., Fletcher, J.M., Khong, T.Y. and Carey, W.F. (1997) First-Trimester Diagnosis of Smith-Lemli-Opitz Syndrome. Prenatal Diagnosis, 17, 355-361. http://dx.doi.org/10.1002/(SICI)1097-0223(199704)17:4&lt;355::AID-PD78&gt;3.0.CO;2-M</mixed-citation></ref></ref-list></back></article>