Genetic diseases: diagnosis by restriction endonuclease analysis

Prenatal Diagnosis of Hemoglobinopathies: From Fetoscopy to Coelocentesis

Prenatal diagnosis of hemoglobinopathies involves the study of fetal material from blood, amniocytes, trophoblast coelomatic cells and fetal DNA in maternal circulation. Its first application dates back to the 70s and it involves globin chain synthesis analysis on fetal blood. In the 1980s molecular analysis was introduced as well as amniocentesis and chorionic villi sampling under high-resolution ultrasound imaging. The application of direct sequencing and polymerase chain reactionbased methodologies improved the DNA analysis procedures and reduced the sampling age for invasive prenatal diagnosis from 18 to 16–11 weeks allowing fetal genotyping within the first trimester of pregnancy. In the last years, fetal material obtained at 7–8 weeks of gestation by coelocentesis and isolation of fetal cells has provided new platforms on which to develop diagnostic capabilities while non-invasive technologies using fetal DNA in maternal circulation are starting to develop.

The molecular biology of human hereditary central diabetes insipidus

Molecular biology techniques have begun to shed light on the genetic basis of autosomal dominant central DI, but several very basic questions remain to be answered. The disorder was initially presumed to have a developmental, degenerative, or autoimmune basis based on the autopsy findings in the hypothalamus of a limited number of patients. The molecular cloning of the AVP-NP II gene and the clue from the Brattleboro rat that at least this one form of hereditary DI involved an AVP-NP II gene mutation allowed us to focus on this gene in our study of human hereditary DI. Our initial experiments did not show this gene to have a major structural alteration such as a deletion, insertion, or rearrangement, but the approach was not capable of detecting more suitable defects. The linkage studies provided substantial evidence that one particular OT-NP I haplotype was linked to the disease phenotype in each family, and thus, a mutation in the AVP/OT region of chromosome 20 is responsible for this disease. Ito et al. (1991) then identified a single base change in the AVP-NP II gene in affected members of one Japanese family. This change was not detected in unrelated, unaffected persons and thus is a good candidate for the mutation causing the disease in this family. However, there appears to be diversity in the molecular basis of autosomal dominant central DI as affected members of one of our families did not have this particular base change in either AVP-NP II allele and recently another distinct AVP-NP II gene base change has been associated with this disorder. One interesting question still to be addressed is how a mutation in the NP-II coding region of this gene prevents AVP release from the posterior pituitary in the rat or the human disease. Does the disrupted AVP-NP II coding sequence prevent normal processing of the mRNA so that it can not be properly translated into protein? Does the mutated AVP-NP II glycoprotein precursor protein interfere with normal post-translational processing to prevent release of AVP? Is an altered NP II protein not able to protect the AVP from proteolysis within the magnocellular neuron? An even more puzzling question is how a mutation in the gene encoding a hormone is inherited in an autosomal dominant pattern. The Brattleboro rat model follows the a priori expectation of autosomal recessive inheritance: the animal only exhibits a defect in hormone function if both genes encoding the hormone are defective.(ABSTRACT TRUNCATED AT 400 WORDS)

A genetic linkage map of five marker loci in and around the Duchenne muscular dystrophy locus

Linkage analysis of five marker loci in and around the Duchenne muscular dystrophy (DMD) locus, DXS84, DXS206, DXS164, DXS270, and DXS28, was conducted with 499 families. Overall, the best multipoint distances were found to be DXS84-3.7 +/- 0.6 cM-DXS206-1.0 +/- 0.4 cM-DXS164-1.9 +/- 0.6 cM-DXS270-12.0 +/- 1.1 cM-DXS28. A comparison of this linkage map with the established physical map suggests the presence of hot spots for recombination in the DMD locus.

The use of restriction fragment length polymorphisms for prenatal diagnosis: the estimation of diagnosable rate of multiple genetic markers and its use in detecting beta-thalassemia in a Chinese population

As a codominant genetic marker, restriction fragment length polymorphism (RFLP) has been widely applied to the prenatal diagnosis of some genetic diseases. To evaluate the usefulness of the genetic markers in prenatal diagnosis, a parameter, the diagnosable rate or the proportion of diagnosable matings, is estimated when two or more genetic markers are used. The assessment is based on the distribution of haplotypes. By using the data of the distribution of haplotypes of beta-A (normal) and beta-T (beta-thalassemia) chromosomes in a Chinese population and the formula given, it is easy to calculate the different diagnosable rates of all the combinations of seven given genetic markers. The results could help us to find an appropriate combination of genetic markers in prenatal diagnosis and, therefore, makes it possible to obtain a sufficiently high diagnosable value with a limited number of genetic markers.

Carrier detection in the hemophilias

The subject of carrier detection in the hemophilias has received new impetus in the past several years. Treatment complications arising from clotting factor concentrates have become more evident and earlier prenatal diagnosis and new genetic markers for the clotting factor genes have focused interest on this area. Until now, carrier diagnosis has relied upon standard pedigree analysis and clotting factor assays. The results obtained using these methods are probabilistic, and the coagulation tests are unavoidably influenced by the effects of random X chromosome inactivation and the inherent variability of the methods involved. With the cloning and characterization of both factor IX and factor VIII genes, has come the capability of using gene analysis to diagnose the carrier state. This usually involves the detection of restriction fragment length polymorphisms (RFLPs) and their use as linked markers for the defective clotting factor gene. In hemophilia A, the combined use of three intragenic RFLPs and two closely linked, highly polymorphic extragenic markers will make carrier information available to approximately 90% of kindred. In hemophilia B, phenotypic analysis has been complicated by the more heterogeneous expression of the gene defect. To date, five intragenic and one closely linked RFLP have been reported, as well as two protein polymorphisms detectable by monoclonal antibody immunoassays. With the combined use of these genetic markers it is likely that accurate carrier assignment will be available to more than 80% of hemophilia B families.

Evaluation of immunity

Immunodeficiency disease is rapidly increasing in frequency. The AIDS epidemic, the increasing use of transplantation with immunosuppression, the aggressive immunotherapy, the persistent deficiencies after bone marrow transplantation--all contribute to the astronomically increasing numbers of patients with host defense failure. This review has presented my viewpoint as to the approaches which can be utilized by practitioners with varying focal points to provide diagnosis and maximize the potential for a cure today or at least to provide the beginnings of understanding from which will come the cures of tomorrow.

DNA polymorphisms in human population studies: a review

The use of restriction endonucleases and DNA probes to expand the range of informative polymorphisms should be of immense value in the study of human populations. To date, this approach has been only minimally used, but results are available for markers in the major histocompatibility complex and the globin gene clusters. In addition, isolated studies using other probes have been published. The ease of the techniques involved, the rate at which new DNA polymorphisms are being found and the range of information provided should ensure that use of this approach expands rapidly.

Mapping X-linked ophthalmic diseases. Provisional assignment of the locus for choroideremia to Xq13-q24

Choroideremia (McK 30310), an X-linked hereditary retinal dystrophy, causes nyctalopia, progressive visual field loss, and ultimately central blindness in affected males in early adulthood. We have used restriction fragment length polymorphisms from the X-chromosome to localize the region of the mutation for choroideremia in three families with this disorder. One polymorphic marker, DXYS1, located within Xq13-q21, shows no recombination with choroideremia at a LOD score of 5.78. Thus choroideremia maps within 9 centiMorgans of DXYS1 at 90% probability. Another marker, DXS11, located at Xq24-q26, shows no recombination with choroideremia but at a smaller LOD score of 1.54. These results suggest that the locus for choroideremia is distal to DXYS1 and between the two markers in the region Xq13-q24. This information may be useful for antenatal diagnosis, isolation of the mutant gene, and development of a rational therapy for the disorder.

Alpha thalassemia changes erythrocyte heterogeneity in sickle cell disease

Homozygous alpha-thalassemia has the beneficial effect in sickle cell anemia of reducing the hemolytic severity while changing several other hematological parameters. We examined in detail the cellular basis of some of these hematologic alterations. We find that the broad distribution in erythrocyte density and the large proportion of dense cells associated with sickle cell anemia are both reduced with coexisting alpha-thalassemia. Measurements of glycosylated hemoglobin levels as a function of cell density indicate that the accelerated increase in cell density, beyond normal cell aging, in sickle cell anemia is also reduced with alpha-thalassemia. The patients with homozygous alpha-thalassemia and sickle cell disease have slightly lower levels of hemoglobin F than the nonthalassemic sickle cell patients. Examination of hemoglobin F production revealed that the proportion of hemoglobin F containing reticulocytes remained unchanged, as did the proportion of hemoglobin F in cells containing hemoglobin F (F cells). Preferential survival of F cells occurs in sickle cell anemia, with or without alpha-thalassemia, and the slight difference in hemoglobin F levels appear to reflect differences in numbers of circulating F cells. Thus, in sickle cell disease with coexisting alpha-thalassemia, the change in the erythrocyte density profile, possibly due to inhibition of polymerization-related increases in cell density, explains the hematological improvement.

Genetic screening: marvel or menace?

Genetic screening is a systematic search in the population for persons of certain genotypes. The usual purpose is to detect persons who themselves or whose offspring are at risk for genetic diseases or genetically determined susceptibilities to environmental agents. Is genetic screening a marvel about to free us from the scourge of genetic disease or a menace about to invade our privacy and determine who may reproduce? There are three different types of genetic screening. Newborn screening identifies serious genetic disease at birth, permitting prompt treatment to prevent mental and physical retardation. Fetal screening and prenatal diagnosis identify genetic disease in the fetus permitting selective termination of pregnancy and the opportunity to have children free of defects detectable in utero. Carrier screening identifies individuals heterozygous for a gene for a serious recessive disease who may be at risk for affected offspring. The challenge to society is to provide (by way of cost-effective programs) expert services, including genetic counseling and follow-up, to all who may benefit, to ensure confidentiality and freedom of choice, and to avoid misunderstanding and stigmatization. It is recommended that the objective of screening programs should be to maximize the options available to families at risk rather than to reduce the incidence of genetic diseases. Whenever possible, the providers of these services should be the providers of primary health care. Urgently needed are a greater awareness of avoidable genetic diseases on the part of primary care providers and efforts to familiarize the public with the basic concepts of human genetics through the public school system.

Education, consent, and counseling in sickle cell screening programs: report of a survey

In 1980, we surveyed screening facilities to determine the extent of sickle cell screening and to assess compliance with Maryland regulations. Approximately 52,000 persons were screened per year in Maryland by local health departments, hospitals, primary care centers, correctional facilities, and units dedicated entirely to screening. Thirteen thousand persons were screened without informed consent. Many facilities were deficient in providing education and counseling as well as in obtaining informed consent. Units dedicated entirely to screening were most compliant with the state regulations.

Some clinical implications of recombinant DNA technology with emphasis on prenatal diagnosis of hemoglobinopathies

Recombinant DNA technology has made possible remarkable advances in understanding the molecular genetics of human and other eucaryotic cells. This technology also has clinical applications, some of which may soon involve clinical laboratories. Restriction endonucleases and cloned DNA probes permit the direct analysis of cellular DNA to detect sequence abnormalities associated with particular genetic disorders. Use of this approach in the antenatal diagnosis of hemoglobinopathies is now possible on a routine basis. The principles behind the methods are quite general and may be applied to other hereditary diseases once suitable DNA probes become available. The same approach may be used to detect carriers of recessive gene defects and so improve genetic counselling. Other clinically related applications of recombinant DNA technology include the production of antigens for vaccine preparation and of specific human proteins (e.g. interferon and human growth hormone) for therapeutic use, as well as the use of nucleic acid hybridization for identification of microbial pathogens. It seems likely that recombinant DNA technology will, in the future, play an increasingly important role in the diagnosis, prevention and treatment of human disease.

DNA polymorphic loci mapped to human chromosomes 3, 5, 9, 11, 17, 18, and 22

Using the techniques of Southern filter hybridization and somatic cell genetics, seven genomic DNA fragments recognizing DNA polymorphic loci were mapped to specific chromosomes and regions of chromosomes. The seven probes, isolated from human genomic libraries, lacked repetitive sequences and were hybridized to DNA isolated from a set of human-rodent somatic cell hybrids segregating human chromosomes. These probes detected DNA sequences on human chromosomes 3, 5, 9, 11, 17, 18, and 22. These DNA polymorphic sites, which occur in 10% or greater of the population, will serve as markers for linkage studies with known polymorphic loci as well as to establish linkage with disease loci.

The Canadian Rutherford lecture. An evolutionary view of disease in man

It is said that genes propose and experiences dispose. Biological adaptation (to fit with the experiences of life) implies functional and structural homeostasis. Disadaptation (the undoing of fitness, that is, morbidity, disease) occurs when experience overwhelms homeostasis or phenotypic variation undermines it. Human disease has social and cultural contexts, but it is also measurable in the biological dimensions of viability, development, reproduction, and longevity. Heritability is a description of ‘cause’ and, for some classes of disease, heritability is high in modern society relative to the past. Mendelian variation in man is immense; 90% of that occurring in single-copy DNA and associated with disease (selective mutation) is expressed in pre-reproductive life in the universal environment. Neutral (non-selective) mutations also occur in both coding and non-coding DNA regions; when the latter are tightly linked with selective mutations they can be used as markers of risk for disease. Accordingly, molecular genetics and other methods for defining genotype provide ways to anticipate risks to health and to prevent disease. To See a World in a Grain of Sand And a Heaven in a Wild Flower Hold Infinity in the palm of your hand And Eternity in an hour

Oncogenes: clues to carcinogenesis

Recent applications of recombinant DNA techniques in cancer research led to the detection of cellular genes with potential transforming activity, called oncogenes (c-onc). Regularly they seem to be involved in normal cell differentiation and proliferation: a number of oncogene-encoded proteins specifically phosphorylates tyrosine, a key reaction in growth control. Certain human tumors exhibit activated forms of these genes and DNA fragments isolated from these neoplasms transform nonneoplastic cells (transfection assay). Oncogenes were first discovered and defined in a number of retroviruses; these viral oncogenes (v-onc) are thought to have been derived from the cellular oncogenes (c-onc). By integration of the v-onc genes into the host genome acute neoplastic transformation of the cell may occur. Several modes of oncogene activation are discussed that lead either to an increased dosage of gene product or to the formation of an altered gene product. The localization of oncogenes in the human genome near the breakpoints of specific chromosome aberrations involved in various neoplasms like Burkitt lymphoma and several leukemias emphasizes the importance of these genes in carcinogenesis.

Use of repetitive DNA for diagnosis of chromosomal rearrangements

We have used two repeated DNA fragments (3.4 and 2.1 kb) released from Y chromosome DNA by digestion with the restriction endonuclease Hae III to analyze potential Y chromosome/autosome translocations. Two female patients were studied who each had an abnormal chromosome 22 with extra quinacrine fluorescent material on the short arm. The origin of the 22p+ chromosomes was uncertain after standard cytologic examinations. Analysis of one patient's DNA with the Y-specific repeated DNA probes revealed the presence of both the 3.4 and 2.1kb Y-specific fragments. Thus, in this patient, the additional material was from the Y chromosome. Analysis of the second patient's DNA for Y-specific repeated DNA was negative, indicating that the extra chromosomal segment was not from the long arm of the Y chromosome. These two cases demonstrate that repeated DNA can distinguish between similar appearing aberrant chromosomes and may be useful in karyotypic and prenatal diagnosis.

Impact of genetic manipulation on society and medicine

Human beings have been manipulating the genetic characteristics plants and animals since the introduction of agriculture indirect manipulation of human genes occurred with widespread use of public health and medical measures that preserve genes causing disease. The production of biologicals by DNA technology raises few ethical problems. Predictive medicine in which genetic markers (including DNA variants) are used for antenatal and preclinical diagnosis of genetic diseases and susceptibilities poses new questions of confidentiality, private versus societal goals, and self-determination. When normal DNA is used to treat the somatic cells of patients with hemoglobinopathies and other genetic diseases, no new ethical problems arise beyond those presented by an novel theory. In contrast, manipulation of DNA in human fertilized eggs would constitute a qualitative departure from previous therapies since this would affect future generations. In order to be able to make wise decisions on these matters the public must be well informed. Thus, formal and informal education in human biology and genetics must be improved at all levels.