Pathogenic mutations Essay

Critically comparison and contrast, a non-cancerous familial disease, which is caused by a individual cistron ( monogenetic ) defect ( e.g. thalassaemia or cystic fibrosis, Huntington’s chorea ) to a common non-cancerous disease ( e.g. Alzheimer’s or Parkinson’s ) that has a multigenic constituent ( more than one cistron can do or predispose persons to the same disease ) . Your reply should cover the undermentioned points: a ) Identify the cistron, in the instance of the chosen monogenetic disease or several ( at least 3 ) of the cistrons involved in doing or predisposing persons to enduring from your chosen common multigenic upset B ) The infective mutants involved that cause or predispose to these diseases c ) How do these mutants affect the proteins and downstream tracts involved in these diseases? vitamin D ) What therapies have been devised to handle or potentially handle these diseases?

A lower limit of 5 recent documents ( the bulk from 2005-2009 ) must be used. Because these inquiries are non individualised for separate pupils, you should take peculiar attention to guarantee that your reply is wholly your ain work: of course it is imperative that you do non conspire in any manner with fellow pupils in fixing your reply, to avoid ‘academic deceit’ . Finally, entry size is non purely determined for these inquiries ; instead, concision is valued: but around 3 sides of A4 ( including diagrams and bibliography ) are likely to be the lower limit required to make justness to these inquiries.

Human genotype is the most outstanding determiner of human pathogenesis. Thus the function of human cistron on the patterned advance and development of human disease can non be neglected. A herediatery upset might be monogenetic which occurs due to mutant in a individual specific gene.For case reaping hook cell disease, thalassaemia, Cystic fibrosis are the illustrations of monogenetic upset which are caused due to desert in a peculiar familial mutant. In contrast, in some familial upsets, mutant occurs in more than one cistron doing the same disease. Therefore Alzheimer’s disease and prkinson’s disease which are caused due to involvement of more than one cistron can be termed as multigenic diseases.

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Sickle Cell Disease ( SCD )

Introduction:

Sickle Cell Disease which is a monogenetic heamoglobinopathy doing the Red Blood Cells ( RBC ) to organize an unnatural reaping hook shape.This procedure is called sickling which finally consequences in the loss of flexibleness in RBC and other infective consequencs. The factor involved behind the sickling of RBC is the mutant of Beta Globin cistron located in chromosome 11. This upset is prevailing in people who originated from tropical and sub tropical parts where malaria is /was common. About one 3rd autochthonal pople of Sub- Saharan Africa bear this mutated Beta globin cistron. Sickle cell disease consequences into decreased life anticipation with mean life of male and female being 42 old ages and 48 old ages severally in affected males and females severally. ( Platt OS, et Al, 1994 )

Pathophysiology:

A point mutant in the ?-globin cistron of chromosome 11, which consequences in the permutation of hydrophilic glutamic acid to by hydrophobic valine at the 6th place gives rise to mutated beta hematohiston bomber unit.When two mutated beta hematohiston fractional monetary units bind to two wild type alpha sub units, formation of a an abberent hemoglobin called HbS takes topographic point. Bing benign in nature, this mutant does non do any evident effects on the secondary, third, or quaternate construction of hemoglobin in conditions of normal O concentration. However, this HbS has a inclination to polymerise in low-oxygen tenseness and causes polymerization of the hemoglobin. In this procedure, the hydrophobic residues of the valine at place 6 of the beta concatenation of HbS associates with the hydrophobic spot, doing the hemoglobin molecules to aggregate and organize hempen precipitates. The perennial episodes of polymerisation and sickling causes lasting malformation on the form of RBC and decreased snap. When these deformed and stiff RBCs base on balls through the capillaries, they get occluded at that place due to decreased snap. Thus the adhesion of unnatural ruddy blood cell ( RBC ) to the endothelium has been proposed as the likely initiating event of vasoocclusion, however the fluctuations in the endothelium activation province may modulate the unpredictable happening of the major complications. ( Hebbel RP, 1997 ) Inflammation is the major catalytic agent for this procedure. ( Kaul DK, Hebbel RP,2000 ) . This procedure finally consequences in ischemia.

The anaemia in reaping hook cell disease is caused by haemolysis due to the devastation of the RBCs inside the lien. The rapid devastation rate of RBC exceeds the rate of refilling rate of bone marrow. Unlike healthy ruddy blood cells typically sickle cells survive merely for 10-20 days.Though the peripheral devastation of sickled RBCs have been considered to be outstanding characteristic of reaping hook cell disease, possible part of uneffective erythropoiesis to the pathophysiology of this haemoglobinopathy is besides point to be considered. ( Catherine J. Wu et al,2005 ) .

Treatment:

Dietary cyanate or derived functions can be used on the intervention of reaping hook cell disease. Painful crisis due to vaso-occlusion can be managed by anodynes, opoid administration.Children born with sicle cell disease are given 1 milligrams dosage of folic acid per twenty-four hours throughout the life. As a addendum they are accompanied by a dosage of penicillin excessively, till the age of five old ages in order to safe guard from infections. In adults patients with acute thorax hurting due to vaso-occlusion, O supplementation, and blood transfusion can give alleviation. Bone marrow organ transplant has been found to be effectual in kids. ( Walters MC, Patience M, Leisenring W, et al. , 1996 )

Hydroxyurea is the first sanctioned drug for the intervention of reaping hook cell anaemia which had successfully decreased the badness of onslaughts in a survey done by Charache et Al in 1995. “To day of the month, hydroxyurea ( HU ) is the lone drug known to cut down the frequence of vasoocclusive crises, acute thorax syndromes ( ACSs ) , and transfusion requirements” . ( Malika Benkerrou et Al, 2002 ) . The possible mechanism of action of hydroxyurea has been believed to be the reactivation of foetal heamoglobin in topographic point of HbS. Neverthless the long term usage of this drug as a chemotheraupetic agent has shown some hazards. ( Platt OS, 2008 ) .

Gene therapy is the most fresh and most promising technique for intervention of monogenetic upset like reaping hook cell disease.

Alzheimer’s disease ( AD )

Alzheimer ‘s disease ( AD ) , was named after German head-shrinker Alois Alzheimer who foremost described it in 1906 as a incurable, neurodegenerative disease by and large diagnosed in people more than 65 old ages of age. ( Brookmeyer R, Gray S, Kawas C, 1998 ) . The study of September 2009 shows that figure of patients enduring from Alzheimer’s disease worldwide is more than 35 million. This prevalence has been expected to make up to 107 million by 2050. ( Brookmeyer, R et al,2007 ) .
Alzheimer ‘s disease is a type of a protein misfolding disease ( proteopathy ) , caused by accretion of abnormally folded amyloid-beta and tau proteins in the encephalon. Hence it is besides called a tauopathy due to unnatural collection of the tau protein in encephalon.

The clinical image of AD is variable, nevertheless the common characteristic is progressive dislocation of memory and cognitive maps like concluding. ( Nussbaum et al 2004 ) . Confusion, crossness, linguistic communication dislocation, aggression and long term memory loss are some of the symptoms that appear as the disease becomes more terrible. ( Waldemar G, et Al. 2007 ) ( Tabert MH et Al 2005 ) .This finally leads to loss of organic structure maps and decease. Most of the AD sick persons, are expected to last for around seven old ages after acquiring diagnosed.. ( Molsa PK, Marttila RJ, Rinne UK, 1986. ) .However, less than 3 % sick persons remain alive even after 14 old ages of diagnosing. ( Molsa PK, Marttila RJ, Rinne UK 1995 )

Geneticss:

Ad is chiefly a sporadic disease and merely 0.1 per centum instances are familial which onst before the age of 65. Neverthless there are some cistrons that act as a hazard factor. ( hundred Blennow K, de Leon MJ, Zetterberg H ( July 2006 ) . “ Alzheimer ‘s disease ” . Lancet 368 ( 9533 ) : 387-403 ) . Most of the familial autosomal dominant AD are due to mutant in one of the undermentioned cistrons: 1 ) APP ( Amyloid precursor protein ) cistron 2 ) presenilin1 and 3 ) Presinilin 2 ( Consuming SC, Rosenberg RN ( March 2008 ) .

“ Genome-wide association surveies in Alzheimer disease ” . Arch Neurol 65 ( 3 ) : 329-34 ) . Most of the mutant in APP or Presenilin gives rise to the production of AB42 ( Amyloid beta 42 ) which is the major portion of senile plaques that are seen in AD.

Apolipoprotein E ( APOE ) another familial factor associated with AD. APOE is really a common aminoacid involved in cholesterin conveyance. However it is besides detected in both plaques and neurofibraillary tangles associated with AD.Studies have shown that at least 40 to 80 per centum persons with AD possess at least one APOE 4 allelomorph. ( Mahley RW, Weisgraber KH, Huang Y ( April 2006 ) . “ Apolipoprotein E4: a causative factor and curative mark in neuropathology, including Alzheimer ‘s disease ” . Proc. Natl. Acad. Sci. U.S.A. 103 ( 15 ) : 5644-51 )

Pathophysiology

Though the exact cause of oncoming of AD has non yet been revealed, some theories has been put frontward. They are:

I ) Cholinergic hypothesis

two ) Amyloid Hypothesis and

three ) Tau Hypothesis.

The cholinergic hypothesis says that impaired synthesis of a neurotransmitter called acetylcholine is responsible for the oncoming of AD. ( Francis PT, Palmer AM, Snape M, Wilcock GK, 1999 ) . However this hypothesis was refuted by the grounds that medicines intended to handle acetylcholine lack could non bring forth assuring consequences.

Starchlike hypothesis holds the impression that deposition of starchlike beta protein ( ABP ) derived from starchlike beta precursor protein ( APP ) is the chief footing of the AD. ( Hardy J, Allsop D,1991 ) ( Mudher A, Lovestone S, 2002 ) . This APP is encoded by APP cistron located on chromosome 21.

Harmonizing to this hypothesis, the plaques of AD are made up of little peptides, 39-43 amino acids in length, called beta-amyloid ( besides written as A-beta or A? ) . Beta-amyloid is a fragment from a larger protein called amyloid precursor protein ( APP ) , a transmembrane protein that penetrates through the nerve cell ‘s membrane. APP is critical to neuron growing, endurance and post-injury fix. [ 55 ] [ 56 ] In Alzheimer ‘s disease, an unknown procedure causes APP to be divided into smaller fragments by enzymes throughproteolysis. [ 57 ] One of these fragments gives rise to filaments of beta-amyloid, which form bunchs that sedimentation outside nerve cells in heavy formations known as senile plaques. [ 12 ] [ 58 ]

These filaments disrupt the cell’s calcioum ion homeostasis. This procedure finally consequences in programmed cell decease or programmed cell death. ( Yankner BA, Duffy LK, Kirschner DA ( October 1990 ) . “ Neurotrophic and neurotoxic effects of starchlike beta protein: reversal by tachykinin neuropeptides ” . Science ( diary ) 250 ( 4978 ) : 279-82. )

In 2004, Tau hypothsis for AD emerged when starchlike hypothesis was challenged by the fact that amyloid plaques do non correlate with the neuron loss. ^ Schmitz C, Rutten BP, Pielen A, et Al. ( April 2004 ) . “ Hippocampal neuron loss exceeds starchlike plaque burden in a transgenic mouse theoretical account of Alzheimer ‘s diseaseTau hypothesis emphasize that when hyperphosphorylated Tau braces with other yarn of Tau, formation of a neurofibrillary tangle takes topographic point inside the nervus cell organic structures. Goedert M, Spillantini MG, Crowther RA ( July 1991 ) . “ Tau proteins and neurofibrillary devolution ” . Brain Pathol 1 ( 4 ) : 279-86. doi:10.1111/j.1750-3639.1991.tb00671.x
As we know every nerve cell has a cytoskeleton, partially made up of constructions called microtubules. These microtubules act like paths, steering foods and molecules from the organic structure of the cell to the terminals of the axon and back. The Tau hypothesis says that tau protein stabilizes the microtubules when phosphorylated and undergoes chemical alterations, going hyperphosphorylated. It so begins to partner off with other togss, making neurofibrillary tangles and disintegrate the nerve cell ‘s conveyance system. ( Hernandez F, Avila J ( September 2007 ) . “ Tauopathies ” . Cell. Mol. Life Sci. 64 ( 17 ) : 2219-33 ) .

As a consequence, biochemical communicating Michigans between theneurons taking to decease of cell.

Therapy/Management

Since there is no remedy available for Alzheimer ‘s disease ; merely diagnostic intervention can be given to the sick persons. The intervention can be divided into pharmaceutical, psychosocial and caregiving.

Pharmaceutical

1. Acetylcholinesterase inhibitors are used to cut down the rate of acetylcholine broken down.
2. Glutamate which is a utile excitant neurotransmitter of the nervous system.
3. Memantine ( trade name names Akatinol, Axura, Ebixa/Abixa, Memox and Namenda ) , [ 142 ] is a noncompetitive NMDA receptor adversary
4. Antipsychotic drugs can be used to cut down aggression and psychosis in Alzheimer ‘s patients with behavioral jobs


Psychosocial intercessions

Psychosocial intercession is complementary to pharmaceutical intervention in AD patients. Especially dementedness is managed by psychosocial intercession.

Caregiving

Since AD renders people incapable of carry throughing their ain demands, caregiving is really indispensable.

Mentions:

Platt OS, et Al, 1994. Mortality in reaping hook cell disease. Life anticipation and hazard factors for early decease. N. Engl. J. Med. 330 ( 23 ) : 1639-44.

Catherine J. Wu et Al, 2005. Red Cell: Evidence for uneffective erythropoiesis in terrible reaping hook cell disease, Blood | 2005-11106: | 3639 – 3645

Charache S, et al,1995. “ Effect of hydroxyurea on the frequence of painful crises in reaping hook cell anaemia. Research workers of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia ” . N. Engl. J. Med. 332 ( 20 ) : 1317-22

Hebbel RP, 1997. Adhesive interactions of reaping hook red blood cells with endothelium. J Clin Invest. ; 99:2561-2564

Kaul DK, Hebbel RP,2000. Hypoxia/reoxygenation causes inflammatory response in transgenic reaping hook mice but non in normal mice. J Clin Invest.106:411-420

Bruno walters MC, Patience M, Leisenring W, et al. , 1996. Bone marrow organ transplant for reaping hook cell disease. N. Engl. J. Med. 335 ( 6 ) : 369-76

Malika Benkerrou et Al, 2002. Clinical OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS: Hydroxyurea corrects the dysregulated L-selectin look and increased H2O2 production of polymorphonuclear neutrophils from patients with sickle cell anaemia
Blood.0499: 2297 – 2303

Platt OS, 2008. “ Hydroxyurea for the intervention of reaping hook cell anaemia ” . N. Engl. J. Med. 358 ( 13 ) : 1362-9

Brookmeyer R, Gray S, Kawas C, 1998. “ Projections of Alzheimer ‘s disease in the United States and the public wellness impact of detaining disease oncoming ” . Am J Public Health 88 ( 9 ) : 1337-42

Brookmeyer, R et al,2007. “ Forecasting the planetary load of Alzheimer’s disease ” . Alzheimer ‘s and Dementia 3 ( 3 ) : 186-91

Nussbaum et al,2004. Thompson and Thompson Genetics in medical specialty. 6th edition, revised.Pennsylvania: Saunders

Waldemar G et Al. 2007. “ Recommendations for the diagnosing and direction of Alzheimer ‘s disease and other upsets associated with dementedness: EFNS guideline ” . Eur J Neurol 14 ( 1 ) : e1-26. doi:10.1111/j.1468-1331.2006.01605.x

Tabert MH et Al 2005. “ A 10-item odor designation graduated table related to hazard for Alzheimer ‘s disease ” . Ann. Neurol. 58 ( 1 ) : 155-160.doi:10.1002/ana.20533. PMID 15984022.

Molsa PK, Marttila RJ, Rinne UK, 1986. “ Survival and cause of decease in Alzheimer ‘s disease and multi-infarct dementedness ” . Acta Neurol Scand 74 ( 2 ) : 103-7

degree Celsiuss Molsa PK, Marttila RJ, Rinne UK 1995 ) . “ Long-run endurance and forecasters of mortality in Alzheimer ‘s disease and multi-infarct dementedness ” . ActaNeurol Scand 91 ( 3 ) : 159-64

Van Broeck B, Van Broeckhoven C, Kumar-Singh S,2007. “ Current penetrations into molecular mechanisms of Alzheimer disease and their deductions for curative attacks ” . Neurodegener Dis 4 ( 5 ) : 349-65

Francis PT, Palmer AM, Snape M, Wilcock GK, 1999. “ The cholinergic hypothesis of Alzheimer ‘s disease: a reappraisal of advancement ” . J. Neurol. Neurosurg. Psychiatr. 66 ( 2 ) : 137-47

Hardy J, Allsop D,1991. “ Starchlike deposition as the cardinal event in the aetiology of Alzheimer ‘s disease ” . Trends Pharmacol. Sci. 12 ( 10 ) : 383-88. doi:10.1016/0165-6147 ( 91 ) 90609-V. PMID 1763432.

Mudher A, Lovestone S, 2002. “ Alzheimer ‘s disease-do tauists and Baptist Churchs eventually agitate custodies? ” . Trends Neurosci. 25 ( 1 ) : 22-26. doi:10.1016/S0166-2236 ( 00 ) 02031-2. PMID 11801334

degree Celsiuss Blennow K, de Leon MJ, Zetterberg H ( July 2006 ) . “ Alzheimer ‘s disease ” . Lancet 368 ( 9533 ) : 387-403

Consuming SC, Rosenberg RN ( March 2008 ) . “ Genome-wide association surveies in Alzheimer disease ” . Arch Neurol 65 ( 3 ) : 329-34

Mahley RW, Weisgraber KH, Huang Y ( April 2006 ) . “ Apolipoprotein E4: a causative factor and curative mark in neuropathology, including Alzheimer ‘s disease ” . Proc. Natl. Acad. Sci. U.S.A. 103 ( 15 ) : 5644-51

Yankner BA, Duffy LK, Kirschner DA ( October 1990 ) . “ Neurotrophic and neurotoxic effects of starchlike beta protein: reversal by tachykinin neuropeptides ” . Science ( diary ) 250 ( 4978 ) : 279-82.

Schmitz C, Rutten BP, Pielen A, et Al. ( April 2004 ) . “ Hippocampal neuron loss exceeds starchlike plaque burden in a transgenic mouse theoretical account of Alzheimer ‘s disease ” . Am J Pathol 164 ( 4 ) : 1495-1502. PMID 15039236.

^ Goedert M, Spillantini MG, Crowther RA ( July 1991 ) . “ Tau proteins and neurofibrillary devolution ” . Brain Pathol 1 ( 4 ) : 279-86. doi:10.1111/j.1750-3639.1991.tb00671.x. PMID 1669718.

^ Iqbal K, Alonso Adel C, Chen S, et Al. ( January 2005 ) . “ Tau pathology in Alzheimer disease and other tauopathies ” . Biochim Biophys Acta 1739 ( 2-3 ) : 198-210. doi:10.1016/j.bbadis.2004.09.008. PMID 15615638.

^ Chun W, Johnson GV ( 2007 ) . “ The function of tau phosphorylation and cleavage in neural cell decease ” . Front Biosci 12: 733-56.
Hernandez F, Avila J ( September 2007 ) . “ Tauopathies ” . Cell. Mol. Life Sci. 64 ( 17 ) : 2219-33. doi:10.1007/s00018-007-7220-x. PMID 17604998.

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