TOPIC 11 - genetics Flashcards
what are the common factors in diseases caused more by genetics?
- rare
- genetics simple
- unifactorial
- high recurrence rate
what are the common factors in diseases caused by more by environment?
- common
- genetics complex
- multifactorial
- low recurrence rate
what are fully penetrant conditions?
environmental factors have no effect, mutations cause all problems
- usually due to single gene defect
what are low penetrance conditions?
genes have a small influence part, in addition to other genetic and environmental factors, in determining disease susceptibility
- usually due to multifactorial genes
give an example of multifactorial condition
MS- multiple sceleorsis
where genetic factors play a major part in determining susceptibility, but each individual factor has a very low penetrance
what are the 5 classifications of genetic disorders?
- multifactorial
- single gene
- chromosomal- chromosomes being lost and inserted onto other chromosomes
- mitochondrial (inheritance)
- somatic mutations (cancer)
what is a single gene/monogenic Mendelian disorder
mutations in single genes (often causing loss of function)
- dominant/recessive pedigree patterns (Mendelian inheritance)
- can affect structural proteins, enzymes, receptors, transcription factors
what are multifactorial diseases
variants in genes causing alteration of function and the effect of the environment
- “environmental” influences (eg. drugs, infections) + genetic predisposition = susceptibility to a disease
- variants in genes cause alteration of function
- one organ system affected
what are ‘variants’ in genes
2 or more types of forms in genetic variant in polygenic inheritance
- can change phenotypes and cause 2 different types of functions
what are chromosomal disorders?
- lots of info is gained or lost
= chromosomal imbalance causes alteration in gene dosage
-thousands of genes may be involved
multiple organ systems affected at multiple stages in gestation. - usually de novo (trisomies, deletions, duplications)
- in rare cases, can be inherited (translocations)
what is down syndrome/ trisomy 21
- too much gene dosage for chromosome 21
- a syndrome so collection of features
what are the phenotypes for people with down syndrome
- round face
- protruding tongue
- upslanting palpebral fissures
- epicanthic folds
- developmental delay
what are the ultrasound features of someone with trisomy 21
- short femurs
- nuchal translucency
- echogenic bowel
- choroid plexus cyst
- sandal gap, single palmar crease
what are micro deletions in chromosomes
- chromosomal abnormality
- chromosomal region is lost
how are microdeltions in chromosomes detected
too small to be observed microscopically
•identified by use of specific molecular cytogenetic techniques
what is DiGeorge syndrome
•DiGeorge syndrome- microdeletion of chromosome 22 : small mouth, prominent nose, congenital heart defects
what causes Williams-Beuren syndrome-WBS
microdeletion (about 26 genes from the long arm of chromosome 7)
what are the phenotypic traits of WBS
bright eyes stellate irides wide mouth upturned nose long philtrum flattened nasal bridge
what are the personality traits and congenital malformations of WBS
heart defects (heart murmurs, supravalvular aortic stenosis), typical facies overly sociable ("cocktail party" type personality)
what are single gene disorders also known as
mendelian genetics
what is a dominant single gene disorder
heterozygous with one copy of alterd gene are affected
what is a recessive single gene disorder
homozygous with 2 copies of altered gene are affected
what is a X linked single gene disorder
males with one copy of altered gene on X chromosome affected
what kind of disorders pose a high risk to relatives?
single gene disorders
how do single gene disorders occur
spontaneously or from family inheritance
-some isolated cases due to new dominant mutations
what are symptoms of huntingtons disease
- Ataxia- inability to have voluntary movement or motion
- advanced stages = involuntary movements of head and face
NB- loss of degenerative tissue in white matter
what are the 2 diseases associated with Cholesterol deposition in patients heterozygous for familial hypercholesterolemia
- Tendon xanthomata,(deposition of yellow bodies with lipids and cholesterol in them)
- corneal arcus
what kind if disease is CF
autosomal recessive condition
what is required for CF patients
frequent hospital admissions/monitoring
physiotherapy
constant medications
how is CF treated
treatment with enzymes and nebulisers
how do we test for Duchenne muscular dystrophy
- do biopsy
- use brown stain- Gomori trichrome stain
- Normal muscle shows a regular architecture of cells with dystrophin (brown stain) on all the outer membranes
- if no brown staining= muscular dystrophy
what is autosomal dominant inheritance?
heterozygous with one copy of mutated gene are affected
-onset usually later on in life
what is autosomal recessive inheritence
homozygotes with 2 copies of mutated gene are effected
-loss of function, more severe, present early on,eg.CF
what is X linked inheritence
males with one copy of mutated gene on X chromosome are affected
what is mitochondrial inheritance?
Mutations in mitochondrial genome
During fertilisation all from oocyte = maternal disease
what do mitochondrial diseases cause in general
Mutations- defects in energy usage or productions
present in brain or eyes early on
what is Leber hereditary optic neuropathy
-caused by mitochondrial disfunction
-reduction in vision
(eyes are susceptible tissue and vunerable to environment and genetic changes)
In an autosomal recessive disorder, what is the chance that healthy sister is carrier if brother has disease?
2/3
what happens in dominantly inherited familial cancer syndromes?
both alleles of a gene become inactivated in a particular somatic cell leading to loss of control of growth and unchecked cell proliferation
are cancers usually sporadic or familial
sporadic
in multifactorial inheritance does the effect of each gene have a major impact?
no- effect of each gene is small as effects are polygenic (+ environment)
how many organ systems are affected in multifactorial inheritance?
one organ system
what Q are asked in clinical genetics?
- What? - establishing the diagnosis- often initial diagnosis and then another diagnosis to confirm
- How/Why?- determining the mode of inheritance
- Again? - calculating the risk-will this happen to another child
- Choices? - discussing the options, treatment? Therapeutic intervention? Prognosis?
how do you make a diagnosis in clinical genetics
-History
-Family- happened in family before
-Medical- make medical diagnosis
-Examination
-Investigations- testing hypothesis
-Chromosomes- testing chromosomes
-DNA
Biochemical- )cheap)
in pedigree diagrams what is the symbol for a male
square
in pedigree diagrams what is the symbol for a female
circle
in pedigree diagrams what is the symbol for an unaffected individual
empty sqaure/circle
in pedigree diagrams what is the symbol for a affected individual
filled in symbol
in pedigree diagrams what is the symbol for a dead person
diagonal line through symbol
in pedigree diagrams what is the symbol for a miscarrge
triangle
what extra info could you use on a pedigree diagram
• record names, dates of birth, and maiden names
what kind of inheritance disorders are miscarriages and still births more common in
chromosomal abnormalities
what is consanguinity
being related
in pedigree diagrams what is the symbol for a person whos sex is unkown
diamond
in pedigree diagrams why would you draw a double line
union of consanguineous couple
in pedigree diagrams what is the symbol for stillborn of unknown sex
diamond with ‘SB’ written by the side
in pedigree diagrams what is the symbol for a spontaoues abortion
triangle
in pedigree diagrams what is the symbol for a theraputic abortion
triangle with a line through it
what is Genetic heterogeneity
- deafness
- AD/AR/X linked/mitochondrial= many genes mutated giving rise to same consequence- deafness
what does penetrance means in terms of disease
how severe it is in individual (eg. different severities of huntingtons disease)
what does variable expressivity mean in terms of disease
how expressive it is
(eg. different expresivities of neurofibromatosis)
when the phenotype is expressed
what is NF ,neurofibromatosis
Mutations in NF1
in germ line= huge range symptoms
in somatic cells= cancer
how do we diagnose NF type 1
checking for the characteristic symptoms of the condition
2 or more of the following symptoms:
-six or more café au lait spots/pigmentation spots or (coffee-coloured skin patches) that are larger than 5mm in children, or 15mm in adults
- freckles under the arms or around the groin
- two or more neurofibromas (bumps on or under the skin), or one plexiform neurofibroma (a neurofibroma that develops where multiple branches of nerves come together)
- a tumour on the optic nerve (an optic glioma), which rarely causes symptoms or affects sight
t-wo or more tiny brown spots in the iris (the coloured part of the eye). These are known as Lisch nodules
- bone defects, such as bowing of the lower leg
- a family history of NF1
do we get a wide range of phenotypes with polygenic disorders
range of phenotypes associated with certain disease
some genes can cause more or less expressivity
same gene defect and can get different phenotypes
what are symptoms of huntingtons disease?
- Early signs and symptoms: irritability, depression, small involuntary movements, poor coordination, and trouble learning new information or making decisions
- involuntary jerking or twitching movements known as chorea- movements more pronounced as disease progresses
- changes in personality and a decline in thinking and reasoning abilities
when does huntingtons disease begin to show?
30-40s
usually live about 15 to 20 years after signs and symptoms begin
what happens in the genome with HT disease when its inherited
altered HTT gene is passed from one generation to the next, the size of the CAG trinucleotide repeat often increases in size. A larger number of repeats is usually associated with an earlier onset of signs and symptoms. This phenomenon is called anticipation
what is gentic councelling
process of communication and education which addresses concerns relating to the development and/or transmission of a hereditary disorder
what do we (as doctors) consider and talk about in genetic councelling
•non-directive •non-judgemental •bereavement choices and options •carrier testing •presymptomatic diagnosis •prenatal diagnosis •risk calculations (Mendelian, empirical or Bayesian?)
why might screening of the whole population be justifiable?
- if intervention available e.g. PKU (5 – 10 live births per year)
- if early diagnosis reduces morbidity or mortality e.g. FH