Chromosome disorders

Parkinson’s disease is the second most common neurodegenerative disorder. The pathological hallmark of the disease is degeneration of midbrain dopaminergic neurons. Genetic association studies have linked 13 human chromosomal loci to Parkinson’s disease. Identification of gene(s), as part of the etiology of Parkinson’s disease, within the large number of genes residing in these loci can be achieved through several approaches, including screening methods, and considering appropriate criteria.

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Đây là một thử nghiệm máu. Dùng trong việc định bệnh myeloproliferative neoplasm (MPN) (cũng gọi là myeloprolif. disorders) Năm 2005, các investigators tìm thấy V617F mutation ở pseudokinase domain của Janus kinase 2 gene (cho nên viết tắt JAK2). Gene này ở chromosome 9p (Lancet 2005; 365:1054-1061) (NewEnglJnlMed 2005;352:17791790) (Nature 2005;434:1144-1148) Lab sẽ báo cáo như sau : (1) negative for JAK2 mutation (2) Positive for JAK2 mutation (3) below the lab cut off for positivity....

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The etiology of PV is unknown. Although nonrandom chromosome abnormalities such as 20q, trisomy 8, and especially 9p, have been documented in up to 30% of untreated PV patients, unlike CML no consistent cytogenetic abnormality has been associated with the disorder. However, a mutation in the autoinhibitory, pseudokinase domain of the tyrosine kinase JAK2—which replaces valine with phenylalanine (V617F), causing constitutive activation of the kinase— appears to have a central role in the pathogenesis of PV.

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While most autosomal dominant inherited cancer syndromes are due to mutations in tumor-suppressor genes (Table 79-1), there are a few interesting exceptions. Multiple endocrine neoplasia type II, a dominant disorder characterized by pituitary adenomas, medullary carcinoma of the thyroid, and (in some pedigrees) pheochromocytoma, is due to gain-of-function mutations in the protooncogene RET on chromosome 10. Similarly, gain-of-function mutations in the tyrosine kinase domain of the MET oncogene lead to hereditary papillary renal carcinoma.

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Harrison's Internal Medicine Chapter 64. The Practice of Genetics in Clinical Medicine Implications of Molecular Genetics for Internal Medicine The field of medical genetics has traditionally focused on chromosomal abnormalities (Chap. 63) and Mendelian disorders (Chap. 62). However, there is genetic susceptibility to many common adult-onset diseases, including atherosclerosis, cardiac disorders, asthma, hypertension, autoimmune diseases, diabetes mellitus, macular degeneration, Alzheimer's disease, psychiatric disorders, and many forms of cancer.

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Deletions involving the long arm of chromosome 22 (22q11) are the most common microdeletions identified to date, present in ~1/3000 newborns. VCF syndrome, the most commonly associated syndrome, consists of learning disabilities or mild mental retardation, palatal defects, a hypoplastic aloe nasi and long nose, and congenital heart defects (conotruncal defect).

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Microdeletion Syndromes The term contiguous gene syndrome refers to genetic disorders that mimic a combination of single-gene disorders. They result from the deletion of a small number of tightly clustered genes. Because some are too small to be detected cytogenetically, they are termed microdeletions. The application of molecular techniques has led to the identification of at least 18 of these microdeletion syndromes (Table 63-4). Some of the more common ones include the Wilms' tumor–aniridia complex (WAGR), Miller Dieker syndrome (MDS), and velocardiofacial (VCF) syndrome.

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Maternal Age and Trisomy The association between increasing maternal age and trisomy is the most important etiologic factor in congenital chromosomal disorders. Among women under the age of 25, ~2% of all clinically recognized pregnancies are trisomic; by the age of 36, however, this figure increases to 10% and by the age of 42, to 33% (Fig. 63-5). This association between maternal age and trisomy is exerted without respect to race, geography, or socioeconomic factors and likely affects segregation of all chromosomes.

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Chromosome segregation in meiosis. A. In meiosis I, each of the 23 pairs of chromosomes finds its "partner," or homologue, and exchanges genetic material (recombines) with it. At metaphase, each homologous pair aligns on the equatorial plate; at anaphase, each member of the homologous pair segregates from its partner. Thus, at the end of meiosis I, each daughter cell contains 23 chromosomes, with each chromosome consisting of two sister chromatids. B. In meiosis II, each chromosome aligns on the metaphase plate, and at anaphase, each of the two sister chromatids divides from the other.

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Cytogenetic Testing in Prenatal Diagnosis The vast majority of prenatal diagnostic studies are performed to rule out a chromosomal abnormality, but cells may also be propagated for biochemical studies or molecular analyses of DNA. Three procedures are used to obtain samples for prenatal diagnosis: amniocentesis, chorionic villus sampling (CVS), and fetal blood sampling. Amniocentesis is the most common procedure and is routinely performed at 15–17 weeks of gestation.

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Applications of FISH The majority of FISH applications involve hybridization of one or two probes of interest as an adjunctive procedure to conventional chromosomal banding techniques. In this regard, FISH can be utilized to identify specific chromosomes, characterize de novo duplications or deletions, and clarify subtle chromosomal rearrangements. Its greatest utilization, however, is in the detection of microdeletions (see below). Though conventional cytogenetic studies can detect some microdeletions, initial detection and/or confirmation with FISH is essential.

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Molecular Cytogenetics The introduction of FISH methodologies in the late 1980s revolutionized the field of cytogenetics. In principle, FISH is similar to other DNA-DNA hybridization methodologies. The probe is labeled with a hapten, such as biotin or digoxigenin, to allow detection with a fluorophore (e.g., FITC or rhodamine). After the hybridization step, the specimen is counter-stained and the preparations are visualized with a fluorescence microscope.

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