Monogenic diseases Flashcards

Segregation analysis; Modes of inheritance; Risk assessment; Genetic sceening; Epigenetics and genomic imprinting; Mitochondrial disorders; Obesity

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1
Q

What are the 5 main purposes for familial segregation analysis?

A
Identify genetic diseases running in the family
Identify inheritance patterns
Aid diagnosis
Assist in management of condition
Identify relatives at risk of disease
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2
Q

What is the segregation pattern of an autosomal dominant disease? Give an example

A
At least one parent affected
M or F can be affected
Vertical transmission
e.g. Huntington's disease
-cell death in basal ganglia
-instable CAG triplet repeats
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3
Q

What is the segregation pattern of an autosomal recessive disease? Give an example

A
No affected parent
Transmitted by M or F
M or F affected
Usually no family history
e.g. Cystic fibrosis
-Mutation in the CFTR gene on Ch7 
-disrupts salt/water regulation = thick mucus
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4
Q

What is the segregation pattern of an X linked recessive disease? Give an example

A
No affected parents
Transmitted by F
Only M affected
rarely f affected
e.g. haemophilia
-Blood clotting disorder
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5
Q

What are 3 variations of genetic heterogeneity?

A

Same gene, different mutations, different symptoms
e.g. Cystic fibrosis and CAVD
Same disease, different genes
e.g. Haemophilia A/B
Same disease, different genes, different inheritance
e.g. different forms of epidermolysis bullosa

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6
Q

Define incomplete penetrance

A

Symptoms not always present in an individual with a disease-causing condition

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7
Q

Define variable expressivity

A

Disease severity may vary between individuals with the same disease-causing mutation

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8
Q

Define epistasis

A

Interaction between disease gene mutations and other modifier genes that can affect phenotype

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9
Q

What is the mechanism of dominance and what are its implications for therapy?

A
Mutations = toxic protein
Effects of mutated gene mask the normal copy
Treatment 
-switch off mutant gene 
-neutralise toxic protein effects
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10
Q

What is the mechanism of recessivity and what are its implications for therapy?

A

Mutations = absence of functional protein
Treatment = restore activity of missing protein
-Replace gene/protein/affected tissue

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11
Q

What is the mechanism of co-dominance and what are its implications for therapy?

A

Mutations affect both mutated and normal genes apparent in people with both
e.g. sickle cell trait

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12
Q

Define genomic imprinting

A

One copy of gene is methylated and will not be transcribed

If deletion in an active gene, causes disease as no transcription occurs

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13
Q

What are the causes and symptoms of Prader-Willi syndrome?

A
Caused by loss of paternal chromosome 15
Symptoms:
-Hyperphagia = obesity
-Mental impairment
-Behavioural problems
-Short stature, small hands and feel
-Delayed/incomplete puberty
-Infertility
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14
Q

How can the symptoms of Prader-Willi be managed?

A

Diet restriction
Exercise to increase muscle mass
Growth hormones for short stature
Hormone replacement at puberty

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15
Q

What are the causes and symptoms of Angelman syndrome?

A
Caused by loss of maternal chromosome 15
Symptoms:
-Developmental delay
-Movement disorders
-Behavioural uniqueness
-Microcephaly
-Seizures
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16
Q

How can the symptoms of Angelman be managed?

A

Anticonvulsant drugs
Physo
Communication therapy

17
Q

How are mitochondrial disorders inherited?

A

Via females through oocytes
Both M and F affected
Variable phenotype due to heteroplasmy

18
Q

What is MELAS, its symptoms and its diagnosis?

A

Mitochondrial Encephalopathy Lactic Acidosis and Stroke like episodes
Progressive, ultimately fatal
Muscle weakness, vomiting, seizures, headache, hemiparesis, dementia
Diagnosed by muscle biopsy

19
Q

What is LHON, its symptoms and its diagnosis?

A

Leber’s Hereditary Optic Neuropathy
Bilateral, painless loss of central vision and optic atrophy
Degeneration of retinal ganglion cells
Most patients eventually blind
Diagnosed by blood test and opthamlmology findings

20
Q

What are two inborn errors of metabolism currently included in the UK national neonatal screening progammes?

A

Phenylketonuria (PKU)

MCAD deficiency

21
Q

What are the clinical features of PKU?

A

Blond hair, blue eyes - no melanin
Eczema
Must odour

22
Q

What is the treatment available for PKU?

A

Early detection is key
Remove phenylalanine from diet and monitor levels
Protein supplements
Strict diet in pregnancy

23
Q

What are the clinical features of MCAD deficiency?

A

Mutation in ACADM gene causes disorder in fatty acid oxidisation
Presents in infancy with episodic hypoketotic hypoglycaemia, vomiting, coma, etc
Fasting or metabolic stress causes impaired fatty acid oxidisation

24
Q

What is the treatment available for MCADD?

A

Avoid fasting

Nutritional supplements @ times of increased stress

25
Q

What defects in the leptin-melanocortin pathway lead to three forms of obesity?

A
Insenstivity to leptin = always hungry
MC4R 
PCSK1
POMC
MRAP2
all affect appetite regulation