Genetic Diseases Flashcards
How common are genetic diseases (%)?
Are pediatric diseases genetic in origin?
67%
Many pediatric diseases are not of genetic origin and they don’t all manifest in infancy and childhood
What’s the difference between hereditary disorders and congenital disorders?
Hereditary disorders are derived from one’s parents and transmitted in gametes through generations
Congenital disorders are present at birth
What are the types of genetic diseases found in genetic disorders?
Single Gene
Multifactorial (multigenic)
Chromosomal
What is single gene disease?
Abnormalities or mutations in the sequence of one gene; highly penetrant & follow classical Mendelian inheritance patterns
What is multifactorial (multigenic) disease?
Caused by the complex interaction of multiple variant (not mutant) forms of genes (polymorphisms) and environmental factors
What is chromosomal disease?
Abnormalities in chromosome structure (breaks) or numerical alternations (missing or extra copies) highly penetrant
What are mutations?
What are the common types of mutations?
Which types of tissues do mutations affect?
Permanent change in DNA
- Point mutation
- Frameshift mutations
- Trinucleotide repeat mutations
Occurs in both germline and somatic tissues
What is a trinucleotide repeat mutation?
Amplification of a sequence of three nucleotides that have Guanine (G) and Cytosine (C)
- Repeated trinucleotide adds a string of glutamines to the protein
What is a frameshift mutaiton?
Insertion or deletion of one or two base pairs alters the reading frame of the DNA strand
What are nonmutation alternations in protein coding genes?
Structural changes:
- Deletions
- Inversions
- Translocations
- Epigenetic Changes: Hypermethylation, Acetylation
What are the alterations in noncoding RNAs?
miRNA- Affect oncogenes or tumor suppressor genes
siRNA
What types of transmission patterns do single gene disorders follow?
What type of inheritance pattern do single gene defects follow?
Autosomal dominant disorders
Autosomal recessive diseases
X-linked disorders
Defects follow Mendelian pattern of inheritance
What are characteristics of autosomal dominant disorders?
Which types of proteins are/ aren’t affected?
Expressed in heterozygous state
Affect male/females equally
Both sexes can transmit the disorder
Enzyme proteins are not affected in autosomal dominant disorders; receptor/ structural proteins are involved
What are characteristics of autosomal recessive disorders?
Which types of proteins are/ aren’t affected?
Occur when both copies of a gene are mutated
Affects male and females equally
Enzyme proteins are involved
What are characteristics of X-linked disorders?
Who is protected and how?
Transmitted by heterozygous females to their sons, who manifest the disease
Female carriers are protected because of random inactivation of one X chromosome
When is the onset of autosomal dominant inheritance?
Which types of mutations does it arise from?
Onset is later than autosomal recessive
Can arise from de novo mutations
What is the typical onset of autosomal recessive inheritance?
What is the percent chance to be affected?
Onset is frequently early in life
25%
How does X-linked recessive inheritance work?
The carrier mother will pass down the gene to her daughter that will have 25% chance of obtaining the gene or being normal while the son will have a 25% chance of being affected or normal
What is X-activation- Lyonization?
What percentage is activated?
How is progeny affected?
Females have one active X chromosome the other X chromosome is inactivated and converted into a Barr Body
After inactivation all the descendants of that cell will have the same chromosome inactivated
12-20% of the inactivated X chromosome will be activated
What are common mutations in genes encoding structural proteins that have effects on the eye?
Are they dominant or recessive?
Marfan Syndrome (Autosomal dominant)
Ehlers Danlos Syndrome (Autosomal dominant and Autosomal recessive)
Which type of Ehler’s Danlos disorder includes both enzymes and proteins?
Ehlers Danlos Syndrome (Autosomal recessive)
Which type of mutation is found in Marfan syndrome?
What are the major tissues affected in Marfans?
How common is this disorder?
How is Marfan’s acquired?
Mutation in FBN1 gene encoding fibrillin
Skeleton, eyes and cardiovascular system are affected
Occurs 1/5000 people thus it is uncommon
70-85% of cases are familial while the rest are sporadic arising from de novo FBN1 mutations in germ cells of parents
How is fibrillin made and what is it used for?
Fibrillin is secreted by fibroblasts and incorporated into microfibrils which provide a scaffold for elastin
Which organ systems are affected from Marfan Syndrome?
Skeletal, Cardiovascular, and Ocular
What are characteristics of the skeletal system being affected in Marfan syndrome?
Tall with long arms and legs
Arachnodactyly
Pigeon Breast Deformity
Deeply depressed sternum
Kyphosis
Scoliosis
Joint Laxity
What are characteristics of the cardiovascular system being affected in Marfan syndrome?
Mitral Valve prolapse
Aortic Aneurysm
Acute Aortic Dissection (Can bleed to death!!)
What are characteristics of the ocular system being affected in Marfan syndrome?
Ectopia lentis (subluxation of the lens) and chorioretinal degeneration- This causes displacement of the lens since the elastin in zonules are affected
What is the result of abnormal fibrillin found in Marfan Syndrome?
Abnormal fibrillin leads to reduced sequestration of TGF-B -> excess TGF-B-> abnormal vascular smooth muscle development and matrix production
Which type of drug can inhibit TGF-B?
Angiotensin II Receptor Blockers which inhibit TGF-B signaling
ie: Losartin have been shown to improve aortic & cardiac function
What are the effects of Marfan Syndrome on the eye?
- Enlargement of the globe due to scleral stretching -> longer axial length = myopia
-Flattened but not thinned cornea
-Dislocation of the lens
What is Ehlers-Danlos syndrome?
How many variants are there of Ehlers?
Which body parts are normally affected?
Which body process is poor due to Ehlers?
What are Ehlers-Danlos clinical features?
- Group of diseases due to defects in collagen synthesis
- Six variants due to distinct mutations
- Skin, ligaments, joints
- Wound healing
- Fragile, hyperextensible skin due to trauma, hypermobile joints, (colon, cornea, large artery- ruptures)
What is an autosomal recessive variant of EDS (Ehlers-Danlos)?
What occurs due to this?
Deficiency of the lysyl hydroxylase enzyme
- The lysyl hydroxylase enzyme is missing and is needed for hydroxylation of lysine residues during collagen synthesis.
- Hydroxylysine is needed for cross-linking of collagen fibers
What are the autosomal dominant variants of EDS (Ehlers-Danlos)?
- What is affected/ symptoms?
Deficiency of type III collagen due to mutations affecting COL3AI gene
- Blood vessels, and bowel wall
Deficient synthesis of type V collagen due to mutations in COL5A1 and COL5A2
- Classical EDS
What are the ocular manifestations of Ehlers- Danlos syndrome?
Eye is 80% collagen
Keratoconus
High myopia
Blue Sclera
Lens Subluxation
Angioid Streaks
Posterior Sytaphloma
Corneal Rupture
What are the mutations in genes encoding receptor proteins or channels?
Which type of mutation is it?
Familial Hypercholesterolemia- Autosomal Dominant
Cystic Fibrosis- Autosomal Recessive
Which type of mutation causes hypercholesterolemia?
Why do patients develop hypercholesteremia?
What do heterozygotes have and what are they at risk of (%) Which disease is formed?
What do homozygotes have and what are they at risk of (%)
- What do they they develop and by what age do they die?
LDLR gene mutations encoding low density lipoprotein receptor (LDL)
Due to impaired transport of LDL into cells
Heterozygotes have elevated serum cholesterol which increases the risk of atherosclerosis (2-3 fold) -> Coronary Artery Disease
Homozygotes have an even greater increase in serum cholesterol (5 fold) -> Ischemic heart disease
-Cutaneous xanthomas and die by 20yo due to myocardial infarction
What is a common deposit of hypercholesterolemia?
How common is this mendelian disorder?
Cholesterol
1/500 thus it is the MOST common
Which type of mutation causes cystic fibrosis?
What is the principal defect?
What does cystic fibrosis result in ?
Autosomal recessive due to CFTR gene mutations encoding the CF transmembrane regulator
Principal defect is chloride ion transport resulting in high salt concentrations in sweat and in viscous luminal secretions in respiratory and GI tracts
CFTR mutations can be severe △F508 resulting in multisystem disease, or mild with limited disease extent and severity
How common is CF?
What is CF known as genetically?
1/3200 live births
Most common lethal genetic disease affecting white population
What are the clinical manifestations of CF?
- Cardiopulmonary complications (most common)
- Pulmonary Infections (resistant pseudomonads)
- Pancreatic insufficiency
- Infertility
- Liver Disease
What is a consistent characteristic of CF?
High level of sodium chloride in the sweat is a consistent and characteristic biochemical abnormality in CF
What is a ring of deposits of cholesterol on the eye called?
What age group is it common in?
Arcus around the limbus
Common for elderly
What does the CFTR channel do?
What follows it?
It transport chloride from the
Ductal lumen -> intersitium tissue
Na follows Cl
What occurs if there is a mutation of the CFTR channel?
Chloride will remain in the duct and there will be more NaCl on the surface in the ductal lumen