I. The Emerging Role of Genetics and Genomics in Medicine
A. Genetics is the study of inheritance of characteristics.
B. Genes are sequences of nucleotides of the nucleic acid DNA.
C. Genes are part of structures called chromosomes.
D. A gene’s nucleotide sequence tells a cell how to link a certain sequence of amino acids together to construct a specific protein molecule.
E. A genome is the complete set of genetic instructions in a human cell.
F. Somatic cells have two sets of chromosomes.
G. Diploid means having two sets of chromosomes or 46 chromosomes.
H. Sex cells have one set of chromosomes.
I. Haploid means having one set of chromosomes or 23 chromosomes.
J. Genomics is the study of the human body in terms of multiple, interacting genes.
K. Proteonomics focuses on the spectrum of proteins that specific cell types produce.
L. Environmental factors that affect how genes are expressed are chemical, physical, social, and biological.
II. Modes of Inheritance
A. Introduction
1. The probability that a certain trait will occur in the offspring of two individuals can be determined by knowing how genes are distributed in meiosis and the combinations in which they can come together at fertilization.
B. Chromosomes and Genes Come in Pairs
1. Karyotypes are chromosome charts that display the 23 chromosome pairs in size order.
2. Autosomes are chromosome pairs 1 through 22 and do not carry genes that determine sex.
3. Sex chromosomes are chromosome pair 23 and determine sex.
4. Most chromosomes contain hundreds of thousands of genes.
5. Alleles are variant forms of genes that differ in DNA sequence.
6. Homozygous alleles are identical.
7. Heterozygous alleles are different.
8. Genotype is the particular combination of genes in a person’s genome.
9. Phenotype is the appearance or health condition of the individual that develops as a result of the ways the genes are expressed.
10. A wild type allele is associated with the most common or normal phenotype.
11. A mutant allele is a change from the wild type.
C. Dominant and Recessive Inheritance
1. A dominant allele is one that masks that of another allele.
2. A recessive allele is one that is masked by a dominant allele.
3. An autosomal gene is located on a nonsex chromosome.
4. An X-linked gene is located on an X chromosome.
5. A Y-linked gene is located on a Y chromosome.
6. Mode of inheritance refers to whether a trait is dominant or recessive, autosomal or carried on a sex chromosome.
7. An autosomal condition is equally likely to affect either sex.
8. X-linked characteristics affect males much more than females.
9. Recessive conditions can skip a generation because a person most likely inherits a recessive condition from two healthy parents who are each heterozygotes.
10. Dominant conditions do not skip generations because a person who inherits the condition has at least one affected parent.
11. The disease cystic fibrosis is an example of an autosomal recessive disorder.
12. If both parents are heterozygotes for the trait that causes cystic fibrosis, there is a 25% chance that their offspring will be homozygous dominant, a 50% chance their offspring will be heterozygous, and a 25% chance their offspring will be homozygous recessive.
13. A Punnett square is a table used to predict the probabilities of particular genotypes occurring in offspring.
14. A pedigree is a diagram that depicts family relationships and genotypes and phenotypes when they are known.
15. An example of an autosomal dominant disorder is
D. Different Dominance Relationships
1. Incomplete dominance is a type of inheritance in which the heterozygous phenotype is intermediate between that of either homozygote.
2. An example of a trait inherited through incomplete dominance is familial hypercholesterolemia.
3. Codominant means different alleles are both expressed in a heterozygote.
4. The genotypes of individuals with the following blood types are:
type A – IAIA or IAi
type B – IBIB or IBi
type AB - IAIB
type O - ii
III. Gene Expression
A. Introduction
1. The same allele combination can produce different phenotypes because of the influences of nutrition, toxins, illnesses or the activities of other genes.
2. A major goal of genomics is to identify and understand the interactions of alleles, nutrition, environmental factors, illnesses, and activities of other genes.
B. Penetrance and Expressivity
1. Completely penetrant means that everyone who inherits it has some symptoms.
2. Incompletely penetrant means some individuals with it do not express the associated phenotype.
3. A phenotype is variably expressive if the symptoms vary in intensity in different people.
C. Pleiotropy
1. Pleiotropy is a single genetic disorder that can produce several symptoms.
2. An example of a disease that exhibits pleiotropy is Marfan syndrome.
D. Genetic Heterogeneity
1. Genetic heterogeneity is when the same phenotype may result from the actions of different genes.
2. An example of a condition that exhibits genetic heterogeneity is hereditary deafness.
IV. Complex Traits
A. Polygenic means the traits are determined by more than one gene.
B. Variations in height are due to multiple genes.
C. Variations in skin color are due to three or more genes with two alleles each.
D. Variations in eye color are due to multiple genes; four have been found so far.
E. Multifactorial traits are traits molded by one or more genes plus the environment.
F. Examples of multifactorial traits are height, skin color, and certain illnesses.
V. Matters of Sex
A. Introduction
1. A human female is termed homogametic because she has two of the same type of sex chromosome.
2. A human male is termed heterogametic because his two sex chromosomes are different.
B. Sex Determination
1. A male is conceived when a sperm containing a Y chromosome fertilizes an egg (which has an X chromosome).
2. A female is conceived when a sperm containing an X chromosome fertilizes an egg.
3. The gene responsible for being male is the SRY gene.
C. Sex Chromosomes and Their Genes
1. The X chromosome has more than 1500 genes.
2. The Y chromosome has 231 protein-encoding genes.
3. The three groups of Y-linked genes are genes at the tips of the Y chromosome that have counterparts on the X chromosome, genes that are very similar in DNA sequence to certain genes on the X chromosome and genes that are unique to the Y chromosome.
4. Y-linked genes are transmitted from father to sons.
5. Any gene on the X chromosome of a male is expressed in his phenotype because he has no second allele on a second X chromosome to mask its expression.
6. An allele on an X chromosome of a female may or may not be expressed because it depends on whether it is dominant or recessive and upon the nature of the allele on the second X chromosome.
7. The male is said to be hemizygous for X-linked traits because he has half the number of genes on the X chromosome that the female has.
8. Examples of X-linked recessive traits are red-green color blindness and hemophilia.
9. If a mother is heterozygous for a particular X-linked gene, her son has a 50% chance of inheriting either allele from her.
10. X-linked genes are passed on from mother to son.
11. A daughter can inherit an X-linked disorder only if her father is affected and her mother is a carrier.
D. Gender Effects and Phenotypes
1. A sex-linked trait is one that affects a structure or function of the body that is present in only males or only females.
2. Sex-influenced inheritance is a type of inheritance in which an allele is dominant in one sex but recessive in another.
3. A heterozygous male is bald and a heterozygous female is not bald because the baldness allele is dominant in males but recessive in females.
4. Genomic imprinting is an effect in which the expression of a disorder differs depending upon which parent transmits the disease-causing gene.
VII. Chromosome Disorders
A. Polyploidy
1. Polyploidy is the condition of having an extra set of chromosomes.
2. Polyploidy results from formation of a diploid gamete.
3. The fate of a polyploid human is death as an embryo, fetus or rarely as a young child.
B. Aneuploidy
1. Aneuploid means a condition of missing a chromosome or having an extra one.
2. Euploid means a normal chromosome number.
3. Anueploidy results from nondisjunction.
4. Nondisjunction is meiotic error in which a chromosomal pair fails to separate, producing a sperm or egg that has two copies of a particular chromosome or none.
5. Autosomal aneuploidy often results in mental retardation.
5. Trisomy is the condition of having one extra chromosome.
6. Monosomy is the condition of missing one chromosome.
7. Translocation is a type of aberration in which one copy of a chromosome exchanges parts with a different chromosome.
8. Trisomy 21 is known as Down syndrome.
9. Other common autosomal trisomies are trisomy 13 and trisomy 18.
10. Turner syndrome results from missing one X chromosome in a girl.
11. Klinefelter syndrome results from having an extra X chromosome in a boy.
12. Jacobs syndrome results from having an extra Y chromosome in a boy.
C. Prenatal Tests
1. An ultrasound can detect growth rate, head size, and size and location of organs.
2. Maternal serum markers can detect an underdeveloped fetal liver that may indicate an increased risk of trisomy.
3. Amniocentesis is a procedure in which a needle is inserted into the amniotic sac to draw amniotic fluid and it can detect chromosomal abnormalities.
4. Chorionic villus sampling is the removing of chorionic villus cells and it can detect chromosomal abnormalities.
5. Fetal cell sorting is a process that samples only maternal blood and it can detect genetic abnormalities of the fetus.
VIII. Gene Therapy
A. Introduction
1. Functions of gene therapy are to alter, replace, silence or augment a gene’s function to improve or prevent symptoms.
2. Gene therapy operates at the gene level.
B. Two Approaches to Gene Therapy
1. Two types of gene therapy are heritable gene therapy and nonheritable gene therapy.
2. Heritable gene therapy is the type that introduces the genetic change into a sperm, egg or fertilized egg, which corrects each cell of the resulting individual.
3. Heritable gene therapy is most commonly performed in plants and non-human animals.
4. Nonheritable gene therapy is the type that targets only affected cells and therefore cannot be transmitted to the next generation.
5. A nonheritable gene therapy for cystic fibrosis is an aerosol containing a virus that has had its pathogenic genes removed and a functional human CFTR gene added.
C. Gene Therapy Targets
1. Introduction
a. Some methods used to introduce therapeutic genes into cells include the use of viruses, liposomes, and naked preparations of DNA.
b. The challenge in nonheritable gene therapy is to target sufficient numbers of affected cells for a long enough time to exert a noticeable effect.
2. Bone Marrow
a. Bone marrow tissue includes the precursors of all mature blood cells types.
b. Many gene therapy targets might be reached by bone marrow because stem cells in bone marrow can also travel to other sites, such as muscle, liver, and the brain.
3. Skin
a. In the laboratory, skin cells grow well.
b. Skin grafts can be used to secrete therapeutic proteins into a person’s system.
4. Muscle
a. The reasons muscle tissue is a good target for gene therapy are because it comprises about half of the body’s mass, is easily accessible, and is near a blood supply.
b. A challenge with muscle is to correct enough muscle cells to alleviate symptoms.
5. Endothelium
a. Endothelium is a tissue that forms capillaries and lines the interiors of other blood vessels.
b. Endothelium can be altered to secrete a substance directly into the bloodstream.
6. Liver
a. The liver controls many bodily functions and it can regenerate.
b. Liver cells that are genetically altered can relieve cholesterol buildup.
7. Lungs
a. An aerosol can directly reach respiratory tube lining cells, making it unnecessary to remove cells, alter them, and reimplant them.
b. A form of gene therapy used to treat emphysema is inhalation of alpha-1-antitrypsin.
8. Nerve Tissue
a. Gene therapy of neurons is not feasible because these cells do not divide.
b. Routes of nerve cell gene therapy could include altering neuroglial cells or sending in a valuable gene attached to the herpes simplex virus, which remains in nerve cells after infections.
D. Genomics and a New View of Anatomy and Physiology
1. Today, human genetics and genomics have shifted focus to normal variations as well as conditions molded by interactions among genes and environmental factors.
2. Physiology is not only being dissected at the cellular level, but at the level of chemical signals that enable cells to interact to form tissues, and tissues to form organs.
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