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UTSW school of medicine 2009 genetics class

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Question
Answer
What is Q-banding?   Stain with quinacrine mustard (fluorescent). Bright Q bands correspond to dark G bands. Detects heteromorphisms of satellite repeats.  
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What is G-banding?   Giemsa black stain most commonly used in karyotyping  
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What is R-banding?   Heat the DNA before staining to improve resolution of bands. Reversed banding patterns.  
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Metacentric Chromosome   arms are approximately equal length  
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Submetacentric Chromosome   Centromere is off-center  
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Acrocentric chromosome   Centromere near one end (13, 14, 15, 21, 22)  
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Telocentric chromosome   only one arm (occurs sometimes w/chromosome rearrangements)  
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What is C banding?   Stains centromere and constitutive heterochromatin only  
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What is SKY?   Spectral karyotyping (uses 24 different colored fluorescent probes simultaneously)  
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Heteroploid   any chromosome number other than 46  
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Euploid   Exact multiple of 23 chromosomes  
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Aneuploid   Any chromosome number that is not a multiple of 23. Usually caused by nondisjunction.  
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Triploidy & Tetraploidy   Embryonic Lethal, results from failure of complete cleavage of the zygote at an early stage  
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Isochromosome   one arm is missing & the other is duplicated (haploinsufficiency of one arm and partial trisomy of the other). e.g. i(Xq)  
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Paracentric Inversion vs. Pericentric Inversion   Para = 2 breaks occur in one arm to one side of the centromere, usually no change in phenotype. Peri = 2 breaks occur in one arm around the centromere, can lead to duplication and deficiency during meiosis.  
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Balanced Reciprocal Translocation   Reciprocal exchange of broken-off segments between 2 different chromosomes. Very common, risk of abnormal progeny. Forms quadrivalent during meiosis.  
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Robertsonian Translocation   2 acrocentric chromosomes fuse near the centromere and lose short arms. (all acrocentric short arms contain repeats of ribosomal genes, so usually not deleterious). Risk of unbalanced progeny.  
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Isodisomy vs. Heterodisomy   (= uniparental disomy), Isodisomy = 2 identical chromosomes from same parent, Heterodisomy = 2 nonidentical chromosomes from same parent  
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Mole   When sperm fertilizes egg w/out nucleus. Develops into disorganized mass, can cause choriocarcinoma.  
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Ovarian Teratoma   46, XX containing only maternal chromosomes. Paternal --> extraembryonic devel. and maternal --> fetal devel.  
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Supernumerary chromosome derived from a paracentromeric region   Typically has clinical repercussions  
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Name the potential causes of Down Syndrome:   1. Trisomy 21, 2. Robertsonian Translocation (46 chromosomes), 3. 21q21q Translocation (isochromosome origin), 4. Mosaic Down Syndrome, 5. Partial Trisomy 21  
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Marker Chromosome   Supernumerary chromosome, very small, risk of clinical disorder depend on genes in marker  
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What are the 3 genetic disorders showing complete trisomy of an autonomic chromosome?   21 (Down Syndrome), 18, and 13  
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47 XXY   Klinefelter syndrome (male). More X's = still Klinefelter, but more severe phenotype. paternal nondisjunction of meiosis 1.  
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45 X   Turner syndrome (female), very uncommon (1/4000) short, webbed neck, cardiovascular abnormalities, normal intelligence  
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What is the region of the sex chromosomes that undergoes recombination?   Pseudoautosomal. When recombination extends beyond this region, XX males and XY females can occur.  
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X inactivation   X inactivation center at proximal Xq and XIST gene (only expressed from inactive X). X inactivation is usually random, but a damaged X is always inactivated.  
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47 XYY   normal male phenotype (paternal nondisjunction at meiosis). slightly lower IQ, greater risk of ADHD & hyperactivity. paternal nondisjunction of meiosis 2.  
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47 XXX   Trisomy X. Lower IQ, learning disabilities. 48XXXX & 49 XXXXX are more severe.  
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Segmental Aneusomy   microdeletions producing haploinsufficiency for key genes  
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What is the cell cycle in which most chromosome analysis is conducted?   Metaphase  
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Name the 6 common indications for chromosome evaluation:   1. Problems with early growth and development, 2. stillbirth and neonatal death, 3. fertility problems, 4. family history, 5. Neoplasia, 6. Pregnancy in woman of advanced age  
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Which cell types are used in cell culture for FISH analysis?   Leukocytes & Lymphoblastoids (peripheral blood), fibroblasts (skin biopsy), bone marrow, fetal amniocytes or chorionic villus biopsy  
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What are 3 identifying features of each chromosome?   1. position of the centromere, 2. banding pattern, 3. size  
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What are the chromosomal features & types of genetic testing available for fragile X?   1. expose cells to chemicals that inhibit DNA synthesis, or 2. detect expansion of the CGG repeat in the FMR1 gene  
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What are the 3 types of FISH probes?   1. Locus-specific probes (look for presence/absence of particular genes), 2. repetitive DNA probes (detect satellite DNA/centromeres/telomeres), 3. whole chromosome probes (bind segmentally along length of chromosome: painting)  
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What are the limitations of microarray CGH?   Measures relative copy number of DNA sequences, but not whether they have been translocated/rearranged  
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What is the incidence of...(1) sex chromosome aneuploidy, (2) autosomal aneuploidy, (3) structural abnormalities ?   (1) sex chromosome aneuploidy 1/350 male -- 1/550 female, (2) autosomal aneuploidy 1/700, (3) structural abnormalities 1/375. TOTAL = 1/150  
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What are the chromosomal abnormalities leading to spontaneous abortion?   1. Autosomal trisoym (0.52), 2. Autosomal monosomy (<0.01), 3. Triploidy (0.16), 4. Tetraploidy (0.06)  
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Describe the difference between Prader Willi & Angelman Syndrome:   Prader Willi = lacking chromosome 15 from FATHER, Angelman = lacking lacking chromosome 15 from MOTHER  
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What are the clinical features of Trisomy 18, 13, and 21 (besides mental retardation)?   Down Syndrome = loose neck skin, protruding tongue, heart disease. Patau Syndrome (Trisomy 13) = cleft palate, microcephaly, clenched hands, rocker-bottom feet, polydactyly. Trisomy 18 = cleft palate, clenched hands, receding jaw.  
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Name two cytogenetic mechanisms for mosaicism:   mitotic event: 1. nondisjunction in an early postzygotic mitotic division, 2. trisomy of zygote that is lost in an early postzygotic division  
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What is the mechanism of XX males and XY females?   SRY gene in sex determining region of Y chromosome (P11.3) is located right next to pseudoautosomal region  
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What is the difference between recombination and sister chromatid exchange?   Meiosis recombination = exchange of different codes, Mitosis sister chromatid exchange = exchange of identical genetic code  
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How can autosomal dominant be distinguished from X-linked dominant and pseudoautosomal dominant mutations?   X-linked dominant cannot be passed from father to son (son have an autosomal dominant-like pattern if recombination transfers X-linked genes to the Y chromosome (mostly female transmission with a few male)  
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What is anticipation?   When a disease phenotype is expressed at earlier and earlier ages as it is passed from generation to generation. Common in unstable repeat expansion diseases.  
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Fragile X Syndrome   fragile site on the q arm fails to condense during mitosis. 50% penetrance in females. Caused by an unstable repeat expansion.  
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Mitochondrial genetic bottleneck   # mitochondria in the oocyte is severely reduced before being exponentially multiplied. This can allow a mutant mitochondrial DNA to dominate the gamete.  
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Mitochondrial DNA mutations   each mitochondrion has multiple copies of DNA, but mutations can be propogated amongst daughter cells, and eventually produce homozygous cells. Inheritance is only from the mother.  
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Obligate Heterozygote   Phenotypically normal, but on the basis of pedigree must contain the mutant allele  
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Compound Heterozygote   2 different mutant alleles of the same gene are present (no normal allele)  
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What is the transmission pattern for X-linked recessive mutations?   Generally restricted to males (but not all males), rarely seen among females.  
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Locus Heterogeneity   Same disease phenotype caused by mutation of different genes  
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Name 3 autosomal dominant diseases   Familial Hypercholesteremia (incomplete), Achondroplasia (incomplete), Huntington Disease  
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What is incompletely dominant inheritance?   More severe clinical outcome when homozygote vs. heterozygote in autosomal dominant disease.  
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Differentiate Consanguinity from Inbreeding:   Inbreeding = isolated population that tends to choose partners from within population. Consanguinity = 2 partners inherit a mutant allele from a single distant common ancestor  
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pleiotropy   multiple, often seemingly unrelated, clinical disorders related to a single mutation  
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Name 2 X-linked recessive disorders:   Hemophilia A, Androgen Insensitivity Syndrome  
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Relative Risk Ratio (RRR)   Prevalence of disease in relatives of an affected person/Prevalence in general population  
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Difference in the likelihood of relatives of diseased individuals to report a genetic condition vs. relatives of normal individuals:   Ascertainment Bias  
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Greater likelihood to know of other family members experiencing the same condition in diseased vs. control groups (due to knowledge of the disease):   Recall Bias  
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Qualitative vs. Quantitative trait:   Quantitative = follows Gaussian distribution in population (e.g. large tonsils), Qualitative = present/absent in disease state (e.g. fibroxanthoma)  
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Situations in which monozygotic twins do not have identical genotypes:   1. somatic rearrangements in T-cell receptor & IgG, 2. X-chromosome inactivation  
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Volunteer-Based vs. Population-Based Ascertainment   Volunteer-Based = one twin signs on, then recruits other twin. Population-Based = twins sign up for study and their health is subsequently assessed.  
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Heritability (h^2)   0 if genes contribute nothing to the phenotypic variance. 1 if genes contribute 100%. = (Variance in DZ - Variance in MZ pairs)/(Variance in DZ pairs)  
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Multigenic trait disorders   e.g. digenic inheritance in Retinitis Pigmentosa, e.g. Idiopathic Cerebral Vein Thrombosis (2 genetic, 1 environmental factor), 3. Hirschprung Disease, 4. Type 1 Diabetes, 5. Alzheimer's  
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Which inheritance pattern shows linear, diagonal, or horizontal inheritance?   Linear = autosomal dominant, Diagonal = X-linked recessive, Horizontal = autosomal recessive  
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Sarcoma   Tumor arises in mesenchyme (bone/muscle/connective/nervous system)  
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Carcinoma   Tumor originates in epithelial tissue (intestine/bronchi/mammary)  
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Gatekeeper Tumor Suppressor Genes   Control cell growth (regulate checkpoint transitions = gates)  
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Caretaker Tumor Suppressor Genes   Protect the integrity of the genome (prevent propogation of mutations)  
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What is the mechanism of oncogenesis for ABL?   Cytoplasmic Tyrosine Kinase, causing Chronic Myelogenous Leukemia. BCR-ABL protein has constitutive tyrosine kinase activity. (bone marrow leukocyte stem cells)  
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What is the mechanism of oncogenesis for CMYC?   Transcription factor causing Burkitt Lymphoma. MYC gene translocates from 8q to 14q -> unregulated gene expression (B-cells)  
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What is the mechanism of oncogenesis for BCL2?   Antiapoptotic mitochondrial protein causing Chronic Lymphocytic Leukemia (Bcells). BCL2 translocated from 18q to 14q -> unregulated expression via heavy chain promoter.  
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What is the mechanism of oncogenesis for telomerase?   Not a primary oncogenic factor, but likely plays a role in maintenance of the cancerous cell proliferation  
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2-hit hypothesis for cancer   genotypic heterozygous for one mutation undergoes second somatic mutation to knock out function of the other allele, OR epigenetic changes shut down other allele  
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Loss of heterozygosity (LOH)   When tumor cells contain two identical mutant alleles at an oncogene locus instead of heterozygous alleles.  
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Mechanisms for LOH   1. Interstitial deletion (allele loss), 2. Mitotic recombination (allele loss), 3. Mitotic nondisjunction (chromosome loss), 4. Mitotic nondisjunction + duplication (chromosome loss + new copy of chromosome w/mutant gene)  
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What is the difference between genome, chromosome, and gene mutations?   Genome Mutations = change in # chromosomes, Chromosome Mutations = change structure of single chromsome, Gene Mutation = change in individual gene  
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What are the consequences of missense mutations?   one codon is replaced with another -> altered protein funtion or altered rate of transcription  
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What are the consequences of Chain Termination Mutations?   nonsense mutations (inserted/deleted stop codon) -> unstable mRNA leading to decay or unstable protein leading to degradation.  
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What are the consequences of RNA Processing Mutations?   Alternative RNA splicing sites generated  
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Mutation Hotspot   Single NT mutations can be transitions (pyrimidine for pyrimidine & purine for purine), or transversions. Hotspots = spontaneous deamination of methylated CpG -> thymidine. Very common mutation.  
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mechanism for large deletions/insertions   LINE RNA is reverse transcribed into DNA, and can insert randomly into the genome  
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c.365g>a   cDNA mutation in which a guanine was mutated into an adenine at position 365  
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g.IVS365+2T>A   genomic DNA mutation in which the invariant T of the GT 5' splice donor site has been mutated to an A, adjacent to an intervening sequence (used when gene sequence not fully known)  
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g.IVS365-1G>C   genomic DNA mutation in which the highly conserved G of the 3' AG splice acceptor site is mutated to C.  
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m.365_369delACAC   deletion of 4 nucleotides of mitochondrial DNA beginning at position 365  
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m.365_369insACAC   insertion of 4 nucleotides of mitochondrial DNA beginning at position 365  
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Glu365X   nonsense mutation substituting a stop codon for Glutamate 365  
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dynamic mutation   variable repeat mutations that accumulate over multiple generations of cells/people  
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Calculating Mutation Rate   Take # affected individuals from a large n of an autosomal dominant mutation. Mutation rate = # affected/(2 alleles x n)  
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Mutation Rate   # new mutations/locus/generation (typically in the range of 10^-4 to 10^-6)  
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Genetic Polymorphism   mutation found in >1% of a population  
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short tandem repeat polymorphisms (STRP's)   microsatellites = repeats of 2-5 NT's, multiple repeat lengths (alleles) in the population, readily genotyped. 5-25 copies.  
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variable number tandem repeats (VNTR's)   minisatellites = repeats of 10-100 NT's. Thousands of copies.  
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Copy Number Polymorphism   Repeated segments of DNA, tested by array comparative genome hybridization  
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Rh   + have antigen RhD, - lack antigen. (-) mothers w/(+) fetuses make Ab's that attack fetal blood = hemolytic disease. Greater risk for subsequent pregnancies. Treatment = Rh antibodies (RhoGam) to mother to reduce exposure to fetal antigens.  
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HLA genes   human leukocyte antigen genes, class I (A, B, C) and II (DP, DQ, DR) encode proteins that present antigens to the lymphocytes. chromosome 6p, part of MHC, order = class II, then III, then I.  
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HLA inheritance   clustered on single choromosomal segment 6p (HLA Haplotype), so inherited in entirety from a single chromosome from each parent. Linkage Disequilibrium.  
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Ankylosing Spondilitis   autoimmune disease of the spine, caused by HLA B27 polymorphism  
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Linkage Disequilibrium   Occurence of specific combinations of alleles @ linked loci more frequently than predicted. Due to low recombination & closely located genes of a common function.  
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SNP   2 alleles only corresponding to 2 different bases @ particular site. Occur 1/1000 base pairs.  
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Assumptions in calculating mutation rate:   1. ascertained cases due to new mutation, 2. full penetration, 3. all new mutations are carried to term, 4. Only 1 mutation can cause the disease  
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Stratification   Different subpopulations do not interbreed. Increases frequency of autosomal recessive & dominant disease, only minor effect on X-linked disease.  
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Assortative Mating   positive = people choose mates with similar characteristics to themselves (including disease). Increases frequency of autosomal recessive disease.  
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Consanguinity and Inbreeding   Consanguinity increases frequency of autosomal recessive disease.  
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Linkage Analysis   Compares inheritance of particular stretches of DNA with disease incidence within a family tree  
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Association Analysis   Compare frequency of a particular allele between diseased individuals and controls from the same population  
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=genes located on the same chromosome   syntenic  
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recombination frequency (theta)   between 0 (no recombination)and 1/2 (independent assortment) (proportion, not percentage)  
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phase   knowing which alleles are syntenic in the case of an AaBb individual. On same chromosome homologue = in coupling (cis), on different homologues = in repulsion (trans)  
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LOD score (logarithm of the odds)   (Z) statistical measure of accuracy per n for recombination events. = [log(10) (likelihood if linked/likelihood if unlinked)]. higher Z = better estimate of theta max. LOD > +3 = odds better than 1000:1 for linkage.  
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linkage equilibrium   Equilibrium = frequency of allele within a haplotype is the same as the frequency of the allele within the whole population.  
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linkage disequilibrium   Disequilibrium = genes surrounding disease allele inherited at higher than expected rates.  
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D'   measure of linkage disequilibrium. 0 = equilibrium, up to 1 = intense disequilibrium.  
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Ancestry Informative Markers   SNP's that distinguish different ethnicities  
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LD blocks   clusters of SNPs in high linkage disequilibrium  
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Disease Odds Ratio   odds of an allele carrier developing a disease = (# diseased allele carriers/# nondiseased carriers)/(# diseased noncarriers/# undiseased noncarriers)  
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Relative Risk Ratio   measures strength of an odds ratio: (# diseased carriers/all allele carriers)/(# diseased noncarriers/all noncarriers)  
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Limitations of Association Studies   1. in population stratification, it may be that a particular alleles is associated with a higher risk of disease because multiple alleles are associated with the stratified group (consanguinity), 2. linkage disequilibrium  
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tag SNP's   minimum set of SNP alleles necessary for defining a haplotype in a LD block  
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What's the best method for mapping short genetic distances?   linkage disequilibrium (D')  
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How do you calculate the number of possible haplotypes with complete linkage equilibrium?   2^n (where n = # SNP's)  
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Contiguous Gene Syndrome   poly-phenotypic disorder caused by deletion of contiguous genes along a chromosome.  
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balanced translocation meiotic assortment   adjacent 1 (1 of each type of of centromere), adjacent 2 (2 of one type of centromere), alternate = normal/balanced  
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pseudohermaphrodite vs. hermaphrodite   pseudohermaphrodite = internal sex organs match karyotype. true hermaphrodite = both testes and ovaries are present.  
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Indications for Prenatal Diagnosis by Invasive Testing   1. Older women, 2. previous child w/ aneuploidy, 3. structural chromosomal abnormality in parent, 4. family history of single-gene disorder, 5. relatives w/neural tube defect, 6. family history of X-linked disorder, 7. + maternal serum/ultrasound screen  
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Amniocentesis   1. invasive, 2. 2nd trimester 15-16 weeks, 3. amniotic fluid contains fetal cells & urine, 4. test AFP, metabolites, chromosomes, enzyme activity, DNA sequencing  
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alpha fetoprotein as indicator   immunoassay in maternal serum (MSAFP) or amniotic fluid (AFAFP). high [AFP] indicates anencephaly, spina bifida. (also blood in AF, death, twins, overestimated age  
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chorionic villus sampling   1. invasive biopsy (tertiary villi), 2. 1st trimester (early advantage) 10-12 weeks, 3. cells derived from fetus, 4. test chromosomes, enzyme activity, DNA sequencing (NOTE: too early for AFP, some mosaicism ambiguity)  
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MSAFP   catches Down Syndrome (1st trimester) & neural tube defects (2nd trimester)  
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1st trimester MSAFP screening   11-13 weeks, measures PAPP-A (low in Down Syndrome) & hCG (high in Down syndrome but low in trisomy 13 & 18)  
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ultrasonography   2nd trimester & later, look for edema of fetal neck (trisomy marker), other physical abnormalities, growth rate  
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2nd trimester MSAFP screening   AFP, hCG, estriol (triple screen). sometimes also inhibin A. All low in all trisomies (except hCG high in Down S)  
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types of mosaicism   true = detected in multiple colonies from multiple primary cultures, pseudo = seen only in single cell or derived from single primary culture (usually false positive)  
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if unexpected adverse findings from prenatal chromsomes analysis   karyotype the parents (especially for balanced vs. unbalanced structural rearrangements, and for uniparental disomy in region containing imprinted genes)  
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Prenatal disease treatment & prevention   termination of pregnancy, metabolic disorder treatment, glucocorticoids for CAH, relief of bladder obstruction, bone marrow transplantation  
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preimplantation genetic diagnosis   in vitro fertilization, single blasttomere tested (8-16 cells), DNA analysis for single disorder, only conducted if parents/other child has a disorder  
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Genetic screening   public health initiative to identify individuals at increased risk for genetic disease. screen all members of a large population, regardless of family history.  
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clinical validity vs. utility   validity = predictive of disease, utility = will cause change to treatment  
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sensitivity vs. specificity   sensitivity = fraction individuals w/disease who have the tested-for genotype, specificity = fraction of individuals w/out disease who do not have the tested-for genotype  
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positive predictive value   = % chance of developing the disease given a particular genotype, OR % of people with a genotype that actually have the disease  
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heterozygote screening   when a high frequency of carriers (e.g. Ashkenazi jews & Tay-Sachs), inexpensive tests, genetic counseling & prenatal diagnosis available,  
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gene flow   slow diffusion of genes across large populations  
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genetic drift   in small populations, random effects cause a change in allele frequeny  
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nondirective counseling   patients provided with information, but are not told what to do regarding testing & managment options  
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conditional probabilities   depend on whether the individual in question is a carrier  
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What are the odds of 13 successive male births? What are the odds of 13 successive births of a single-sex?   1. (1/2)^13, 2. 2*(1/2)^13  
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How are genetic vs. allelic diseases treated?   genetic = treat symptoms, identify risk for family. allelic = replace defective protein/minimize consequences, genetic counseling, carrier testing, prenatal diagnosis. increasing protein expression only works when mutant protein is partially functional.  
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Diversion Therapy   use of alternative metabolic pathways to reduce concentration of a harmful metabolite.  
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Treatment of Enzymopathies   Improve enzyme folding (2-3% improvement, but enough to restore homeostasis). Doesn't work when protein 100% dysfunctional.  
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small molecules therapy for skipping over mutant stop codons   nonsense mutation = 11% of defects in human genome. experimental therapy, as yet not fully tested.  
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ERT (enzyme replacement therapy)   1. proteins can be chemically modified (e.g. PEG) to improve pharmacotherapy, 2. intracellular enzymes can be administered extracellularly if substrate is in equilibrium w/extracellular fluid, 3. don't cross BBB, expensive  
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best candidates for ERT   CNS not involved, only alternative therapies are high risk, human enzyme available in abundance, biology very well understood  
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How are enzymes for Gaucher's Disease targeted to particular cell types & organelles?   modification of the carbohydrates normally decorating the glycoprotein enzyme: terminal sugars are removed & core alpha mannosyl residues target macrophages (then delivered to lysosomes intracellularly)  
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What gene expression targeted treatments are appropriate for sickle cell anemia?   DNA hypomethylation increases expression of fetal Hb  
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Nuclear Transplantation   = nuclear cloning, transfer of diploid nucleus from adult donor somatic cell into an oocyte cytoplasm  
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Therapeutic cloning   uses embryonic stem cells generated by nuclear trnsplantation to form mature differentiated cell types in culture, for transplantation into the donor w/no immune rejection  
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reproductive cloning   reimplanting an embryo obtained by nuclear trnsplantation into the uterus of a surrogate mother -> clone of donor human  
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What are some examples of genetic disorders treated by hematopoietic stem cell transplantation?   cancer, severe combined immunodeficiency (e.g. beta-thalassemia). Transplanted stem cells release enzymes that are taken up by native cells containing the k/o mutation. Brain perivascular microglia come from marrow. homozygous normal best.  
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source of hematopoietic stem cells   bone marrow, placental cord blood (more tolerable for histoincompatibility, widely available, risk of graft-vs.-host disease is reduced)  
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what are the essential requirements of gene therapy for an inherited disorder?   1. known gene identity, 2. cDNA clone, 3. known disease pathophysiology, 4. good risk-to-benefit ratio, 5. low consequences of over/underexpression, 6. target cell w/ long half-life or replicative, 7. successful animal studies, 8. governmental oversight  
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ex vivo vs. in vivo gene therapy   ex vivo = gene injected into cells in vitro that are then introduced into the body. in vivo = gene introduced directly into the patient via viruses  
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episome   circular viral DNA containing a normal copy of a gene to replace a mutant allele. good for long-lived cells  
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Uses for gene therapy   1. replace mutant gene, 2. inactivate dominant allele, 3. administer pharmacotherapy in vivo  
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ex vivo vs. in vivo gene therapy    
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retrovirus DNA transfer   = RNA viruses, incapable of replication, non-cytotoxic, up to 8kb DNA, low copy number inserted. Usually target cell must undergo mitosis, but Lentiviruses (eg. HIV) work in non-dividing cells.  
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adeno-associated viruses in DNA transfer   no adverse effects in humans, infect all cells. Inserts only up to 5 b.  
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adenoviruses in DNA transfer   easy to produce (high titer), infect all cells, inserts of 30 to 35 kb. Associated w/death due to immune reaction.  
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nonviral vectors for DNA transfer   naked DNA, DNA in liposomes, protein-DNA conjugates (where protein binds receptor for transport, etc.), artificial chromosomes.  
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limited success of nonviral vectors   DNA tends to be degraded by lysosomes, remaining DNA mostly does not enter the nucleus, inefficient delivery  
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