Genome, Epigenome and Inheritance Flashcards

1
Q

What is the structure of DNA

A

Double stranded helix from two anti-parallel strands
Phosphodiester backbone
Pentose sugar - purines (A and G) and pyramidine (T and C)

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2
Q

What is the structure of chromatin

A

Nucleosomes - Histone octamer’s
2A, 2B,3 and 4
H1 binds with linker DNA (DNA between nucleosomes)
The nucleotides and H1 stack to form solenoids

Euchromatin and heterochromatin form depending on how tightly bound they are (loose and tight respectively)

Also related: trithorax and polycomb proteins which impact euchromatin and heterchromatin formation

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3
Q

What are the functions of centromeres

A

They keep the sister chromatids together
They attach to microtubules doing cell division
They are rich in heterochromatin - and are normally highly repetitive sequence of CAG

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4
Q

What are the functions of telomeres

A

They have a specific six base repeated sequence that protects chromosomes from being degraded TTAGGG

They are repaired by telomerase but this is only active in certain cell types - inappropriate activation can lead to cancer

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5
Q

Describe and explain the functional units of a gene

A

Exons - codes for amino acids (except the 5’ and 3’ UTR)
UTR - contains regulatory elements important for the control of protein synthesis
Introns - non-coding sections of genes between exons
Promoter - 5’ of gene containing important regulatory elements for transcription some genes include transcription factors which combined promoters and other motifs
Enhancer - TF binding site to enhance RNA pol recruitment
Silencer - TF binding site to inhibit RNA pol recruitment

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6
Q

Define the genome

A

The genome is the entire set of DNA/chromosomes in the human body nuclear and mitochondrial

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7
Q

Define the exome

A

The set of genes which have coding functions

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8
Q

Define the epigenome

A

The chemical changes to the DNA and histone proteins which can be passed on to offspring

It alters chromatin structure recruits histone modifiers, represses transcription, enables differential gene expression

It is established as a genome wide pattern at fertilisation

It responds to environmental cues cellular and extracellular

Non-mendelian

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9
Q

What is differential gene expression

A

The processes that determine which genes are actively transcribed and translated into mRNA and proteins in a cell and under what conditions

In time - temporal
Development i.e. embryo versus adult
In response to hormones, infection and other signals

Spatially
Different tissues/cells expressed different genes e.g. brain versus liver

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10
Q

Overview of transcription

A

Transcription factors find the DNA and promote or repress transcription

RNA polymerase unwinds dsDNA separating the sense and antisense strand. It then recruits nucleotides to the antisense strand.

Sense strand = contains the same sequence as mRNA (5’ to 3’)
Antisense strand = template to generate mRNA (3’ to 5’)

Modifications of mRNA then follow…

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11
Q

Describe the modifications of mRNA

A

Capping - adding of altered/methylated guanosine

Protects 5’ from extension and degradation stabilises the molecule
Facilitates transport into the cytoplasm
Enhances translation

Polyadenylation - adding of 50-250 I adenosines by polyadenylation polymerase

Protects the 3’ end from degradation

Splicing - removal of introns and joining together of exons via the spliceosome, which cleaves the 5’ site which loops onto 3’ site , following which the in the loop is cleaved off

This is directed by sequences at the exon-intron boundaries and those within the intron

Alternative/differential slicing helps to develop a different isoforms of protein using different tissues and/or different stages of development

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12
Q

Overview of translation

A

Translation occurs in the cytoplasm, facilitated by ribosomes (rRNA) and tRNA

Not all components are translated, such as the polyA tail, and the UTR regions

There are important sites in the UTR which give signals in translation
Start codon (AUG) and stop codon (UAA/UAG/UGA)
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13
Q

Define synonymous mutations

A

These are also known as silent mutations, where the base change does not result in an amino acid change

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14
Q

Define non-synonymous mutations (missense and nonsense)

A

Missense - amino acid substitution
Depends on
Physiochemical similarity between the two amino acid
Functional role of the specific domain of the protein
Phylogenetic conservation of original amino acid amongst diver species

Nonsense - stop codon
If it appears any on it may be subject to nonsense mediated decay
However, there could be a truncated mRNA/protein - impact depends on where it occurs

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15
Q

Define indel mutations (frame shift and non-frame shift)

A

These are insertions or deletions

This includes unequal crossover during meiosis, resulting in loss in one chromosome, and gain in another - or due to polymerase slippage.

Generally in-frame mutations do not cause a huge problem
Some diseases such as expansion disorders can cause a disease phenotype

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16
Q

What are the effects of variance in non-coding regions

A

Promoter region variants – affects gene expression

Terminator sequence variance – affect the correct termination and polyadenylation of mRNA

Spicing variance – lead to creation or deletion of the spice donor/acceptor or branch site
This can lead to incorrect incorporation of introns, or exon skipping
It can be exonic or intronic

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17
Q

What is loss/gain of function and dominant negative

A

Loss of function
Reduced activity/decreased stability – hypomorph
Complete loss of gene product – null allele/amorph

Gain of function
Increases levels of gene expression and/or new function for protein products

Dominant negative
Mutant allele produces gene product that interferes with the correct role

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18
Q

Examples of loss of function diseases

A

Recessive
Sickle-cell anaemia, phenylketonuria, cystic fibrosis, gauchers disease, haemochromatosis

Dominant (haploinsufficiency)
MonoMac syndrome 1 lack of GATA2 = monocytes and B cell deficiencies
CHARGE syndrome, Marfan syndrome, Ehlers-Danlos syndrome

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19
Q

Examples of gain of function diseases

A
Dominant
Achondroplasia – gain of function mutation in FGFR3 leads to decrease bone mass by altered regulation of osteoblast/class activity
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20
Q

What are dominant negative diseases

A

Mutations in transcription factors removes activation domain but still binds DNA = can’t trigger transcription

Mutation in proteins that function as a dimer, but may lack functional domains = can dimerise with WT but the dimer is non-functional
Can occur in sodium channels

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21
Q

What happens when you fail to regulate gene expression

A

Metabolic disease
Cellshape/motility – metastasis
Cell differentiation – congenital disorders
Cell proliferation – cancer

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22
Q

What is the main mechanism of gene expression regulation

A

It is mainly regulated at the level of transcription it can be transcribed to different levels
Abundant such as housekeeping genes EG glycolytic enzymes
Rare
None – tissue-specific e.g. globin, non-existent in some highly transcribed in others

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23
Q

State some gene control elements

A

Transcription factor binding regions including -
Promoter
Regulatory elements
Enhancers
Silences
(Specificity is derived from specific transcription factors which only target a specific gene or family of genes)

Post-translational gene regulation

Small non-coding RNA

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24
Q

Describe control of gene expression through promoters

A

Promoters have recognition sequences responsible for recruiting RNA polymerase and transcription factors

A key sequence is the TATA box - this recruits the general transcription factor TATA box binding factor

Transcriptional activators recruit RNA polymerase
Transcriptional represses prevent transcription by RNA polymerase

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25
Describe control of gene expression through regulatory elements
These can act as transcription factors to allow recruitment of general transcription factors and RNA polymerase to the TATA box Example the oestrogen response element This binds to the oestrogen receptor and forms a complex that acts as a transcription factor allowing recruitment to be TATA box (Explored further in mice models)
26
Describe control of gene expression through enhancers
These are sequences of DNA that act to enhance the recruitment of RNA polymerase to a promoter They contain DNA sequences that are strong binding site for transcription factors
27
Describe the control of gene expression through silencers
These are sequences of DNA that are adjacent to transcription, acting to inhibit RNA polymerase (5’, 3’ or intronic) They may be able to mask the activity of an enhancer Direct interaction with a general transcription factors Bind sites to prevent RNA polymerase being recruited by them and other transcription factors binding
28
Describe post-transcriptional gene regulation
Polyadenylation Capping Splicing Translation - 5’ UTR determines how efficiently the ribosome initiates translation RNA stability - conferred by the 3’ UTR, and impacted by miRNA
29
Describe Beta Thalassaemia as an example of disease caused by a fault in control of gene expression
A group of genetic diseases caused by insufficient expression of β-globin Most types of beta thalassaemia the protein is structurally normal There are multiple forms of the disease Causal mutations TATA box point mutation = failure to recruit RNA polymerase Splice site point mutation = truncated mRNA
30
Function of Trithorax and Polycomb proteins
Trithroax - maintain expression Polycomb - prevent expression
31
What is the difference between general and specific transcription factors
General - bind generally to promoters to then enhance a cascade of TF activation Specific - recruit RNA polymerase to genes that need to be transcribed, targeting only a specific gene or gene family thus deriving specificity
32
What is the significance of alternative splicing
Alternative/differential slicing helps to develop a different isoforms of protein using different tissues and/or different stages of development
33
What is the structure and function of miRNA's
Structure - ssRNA Function - post-transcriptional regulation Binds to complementary sequences Strong binding = rapid degradation Weaker binding = some degradation Occurs in cytoplasm
34
Definite epigenetics
The study of heritable changes in gene expression not due to changes in the DNA sequence Heritable can be defined on the cellular or organism level i.e. changes inherited by subsequent generations of cells or organisms
35
Examples of epigenetic phenomena
Cell differentiation and memory - includes trithorax and polycomb proteins to drive expression to maintain cellular identity Genomic imprinting - e.g. Rainbow and copycat, where the clone looked different due to the removal of imprinting Development plasticity and the environment - polyphenism (distinct phenotypes elicited by environment e.g. sex determination in clown fish or temperature changing alligator) Transgenerational epigenetics Diseases with epigenetic basis or contribution
36
How are induced pluripotent cells and nuclear reprogramming evidence of epigenetic phenomena
4 TF's can be used to remove the epigenetic mechanisms from a somatic cell that cause cell differentiation thus leading pluripotency
37
List 3 epigenetic mechanisms
These mechanisms interact with TF's to regulate gene-expression patterns inherited from cell to cell DNA methylation Post-translational modification of histone proteins Small and non-coding RNA The patterns underlie embryonic development, differentiation and cell identity
38
Describe mechanisms of epigenetic regulation
Regulatory elements - influencing gene transcription Altering chromatin structure Trithorax protein = heterochromatin into euchromatin (H3K4me3) Polycomb protein = euchromatin into heterochromatin (H3K27me3) Chromatin remodelling is important in establishing and maintaining cellular identity
39
Describe nucleosome modifications
``` Methylation Acetylation Phosphorylation Ubiquitination Other ``` Typically end terminal tail modifications Different combinations = different effects
40
Describe writers, erasers and readers
Writers - enzymes that add epigenetic marks to histones or DNA E.g. histone methyltransferase or DNA methyltransferase Erasers - enzymes that remove these marks E.g. histone demethylase Readers - proteins/protein domains that can recognise these marks through which they are recruited to DNA and introduce further modifications E.g. remodel chromatin, recruit other writers or erasers These are critical for normal development and mutations result in disease A singular protein may have multiple functions, e.g. have a reader domain, and writing activity
41
Describe the involvement of CpG dinucleotides
Only cytosine residues are methylated during DNA methylation Cytosines found in CpG pairs tend to be most methylated Methyl CpG recruits specific readers e.g. methyl-binding proteins (MBP/MeCP) These protein recruit additional enzymatic proteins complexes that compact DNA - heterochromatin formation and gene repression *DNA methylation does not always lead to heterochromatin, but it is the most common effect
42
How do we detect epigenetic modification (epigenomics) with ChIP-seq NGS
ChIP-seq (chromatin immunoprecipitation) Proteins are crosslinked to DNA, isolated and then sonicated into fragments They are then incubated with antibodies for a specific histone modification e.g. H3Ly27me3 The Ab/chromatin complexes are isolated, and then the Ab removed DNA is then used in NGS
43
How is epigenetics involved in X-inactivation
X-inactivation is regulated by the locus Xic Xic encodes the ncRNA module Xist Xist coats the X chromosome in cis, and recruits modifying enzymes like polycomb = heterochromatin, compaction (Barr body) and gene repression
44
Describe involvement of epigenetics in CHARGE syndrome
AD condition affecting multiple body systems, 60-90% of cases caused by CHD7 mutation CHD7 is an ATP-dependent chromatin remodelling factor - moves nucleosomes around/removes histones
45
Describe involvement of epigenetics in cancer
DNA hypermethylation = oncogenic mechanism Histone deacetylase = switch tumour suppressor genes off *HDAC Inhibitors = tested for cancer treatment to reactive TS genes
46
What factors influence DNA methylation
Aging Diet - intake of methyl groups via folate Environment - Arsenic exposure = hypomethylation of RAS Cadmium exposure = inactivation of DNMT1 thus global hypomethylation
47
Link methylation and anxiety
Rat study - methylation in the brain and anxiety Low licking grooming of offspring - increased methylation, less resilient to anxiety High licking/grooming of offspring - decreased methylation , more resilient to anxiety Monozygotic twins study Significant discordance in several diseases e.g. cancer, schizophrenia
48
Describe the mendelian modes of inheritance
AR - homozygote V compound heterozygote (trans/cis) AD X-linked recessive/dominant Y-linked
49
What is variable expressivity
Variation severity/symptoms of disorder between individuals with same mutn
50
What is incomplete/reduced penetrance
Percentage of individuals who carry the mutation V develop symptoms of the disorder Influenced by modifier genes, environment, lifestyle, other non-genetic biological factors (e.g. hormones) Many dominant disorders show age-dependant penetrance E.g. cancers, Huntington's disease, polycystic kidney disease
51
What is sex-influences/limited inheritance
Over-representation of condition in one sex due to other biological factors related to sex e.g. hormones E.g. homozygous females with AR hemochromatosis much less likely than males to show symptoms because of 'rescue effect' of menstruation
52
What is pleiotropy
Mutn in one gene affects multiple organs/systems or leading to different presentations There may be no apparent relationship between the various symptoms Often seen when the gene is involved in early development
53
What is mosaicism
Somatic - some normal and some abnormal, doesn't affect sperm/eggs Arises in early embryogenesis, only in some tissues/cells Germ-line - some normal and some abnormal cell, affects sperm/eggs Mutation present in variable proportion of gametes - easy to test from sperm Children are not mosaics for that mutation Can infer this from pedigree if multiple children get a seemingly 'de novo' mosaicism
54
What is phenocopy, genocopy, heterogeneity
Phenocopy - same phenotype arising due to non-genetic reasons Genocopy/Heterogeneity- same disorder arises due to mutn in different genetic loci Locus heterogeneity- when the same disorder can be caused by mutations in different genes .e.g. AR Retinitis pigmentation Allelic/mutational heterogeneity - when different mutations in the same gene cause one condition e.g. cystic fibrosis
55
Describe X-linked Recessive inheritance
X-linked genes never passed from father to son - ALL daughters of affected males are obligate carriers Children of carrier females have a 50% chance of inheriting the mutant allele Skewed X inactivation means that some woman will still manifest symptoms in cells where the healthy X is inactivated (manifesting carrier)
56
What is anticipation
Disease occurs earlier and/or with greater severity in subsequent generation Typically occurs in repeat expansion disorders e.g.. myotonic dystrophy Harmful protein gets bigger and may even impede transcription of other proteins due to its size There is a tendency for repeat section to increase further due to slippage
57
What is uniparental disomy
Occurs when an individual has inherited both homologous chromosomes from a single parent - due to non-disjunction - including trisomic rescue NDJ Meiosis I = heterodisomy = 2 different chromosomes from one parent NDJ Meiosis II = isodisomy = 2 same chromosomes from one parent Trismic rescue When parent 2 is involved, the cell gets 3 chromosomes, but parent 2's chromosome is kicked out
58
Describe UPD disorders
X-linked disorders can be passed from affected father to son Occurs if NDJ happens in meiosis I, leading to XY in one chromosome - upon fertilisation, this becomes XXY. This could revert back to fathers XY by trismic rescue Child of a couple can have an autosomal recessive disorder, despite only one parent being a carrier It can result in imprinting disorders, such as Prader-willi or Angelman syndrome
59
Describe the complexities of mitochondrial inheritance
Maternal inheritance only Every cell has many different mitochondria If all are the same = homoplasmy If there is a mixture = heteroplasmy, can vary in percentage Higher percentage = greater likelihood of disease manifestation IMPORTANT - here are mitochondrial disease that are due to mutation in nuclear DNA, can show mendelian inheritance
60
Explain and give examples for monogenic, digeneic, polygenic and multifactorial disorders
Monogenic - 1 gene -cystic fibrosis, DMD Digenic - 2 genes - ? Polygenic - multiple genes, often multifactorial Multifactorial - polygenic + environmental factors - schizophrenia
61
What is a quantitative trait
A measurable phenotype that depends on the cumulative actions of many genes and the environment Continuous V discontinuous
62
What is susceptibility
Environment needed to trigger disease phenotype, threshold effect Most multifactorial disorders have a threshold Discontinuous traits follow distribution but phenotype is determined by threshold
63
What methods are used to investigate monogenic disease
Whole exome sequencing Linkage analysis Auto-zygosity mapping
64
What methods are used to investigate multifactorial disease
GWAS Case-control
65
What is an imprinted gene
The process by which one parental allele is preferentially silence according to its parental origin More than half of the imprinted genes are involved in pre and post-natal growth There are imprinting control regions which regulate pattern of expression e.g. methylation
66
Explain how chromosome rearrangement can lead to imprinting disorders
If a gene is deleted/duplicated - then there will be in imbalance between paternal and maternal patterns One will be lost
67
Explain how aberrant methylation patterns (epimutation) can lead to imprinting disorders
Imbalance in methylation patterns can mean overactivation or underactivation
68
Explain how uniparental disomy can lead to imprinting disorders
There may be double paternal or double maternal patterns = imbalance
69
What is the conflict hypothesis
Paternally expressed genes promote growth, maternal expressed genes supress growth During gametogenesis, the epigenetic markings are erased, and re-established It is established according to gender - maternal epigenome is applied to oocytes, paternal to sperm
70
Describe Prader-Willi syndrome
Defect in chr15q11.2 - increased maternal gene effect Deletions - no paternal genes (only suppression) - 75% Maternal UPD - both maternal genes (only suppression) - 25% Epigenetic defect - paternal IC hypermethylated (only suppression) - 1% ``` Clinical features Moderate to severe learning difficulties, average IQ = 60 Better at visual-spatial problems 80% have behavioural problems Hypogonadotropic hypogonadism ```
71
Describe Angelman syndrome
Defect in chr15q11.2 - increased paternal gene effect Deletions - no maternal gene (no suppression) - 70% Paternal UPD - two paternal genes (no suppression) - 2-5% Epigenetic defects - maternal IC hypomethylated (no suppressors) - 2-5% Mutations in UBE3A so it's not expressed/non-functional - 20% Clinical features in all patients: Severe cognitive impairment, receptive and non-verbal skills better than verbal, ataxia or tremulousness of gait Behavioural uniqueness - frequent laughter/smiling, happy disposition, short attention span, easily excitable Other clinical features - microcephaly, seizures, sleep disturbance
72
What and how can we detect PW deletions
PML probe binds both Chr.15 at the critical region and another region Normally it binds SNRPN (critical region) and PML (normal) Control - 2 PML detected Deletion = only 1 SNRPN
73
What is the transcriptome
Complete set of transcripts (RNA) expressed in a sample/tissue at specific point of time Tissue specificity Changes in response to stimuli/disease
74
What post-transcriptional modifications enhance complexity in our genes
Enhancing complexity encoded in our genes: Variation in genome, epigenome, proteolytic cleavage of protein, phosphorylation, acetylation Proteome and metabolome - quantitative mass spectrometry is used for analysis Genomics, transcriptomics, epigenomics - next generation sequencing is used for analysis
75
What does alternative splicing achieve
Alternative splicing >90% of human genes - tissue specific/developmental variants Inclusion or exclusions of exons Increased/decreased UTR Intron retention - used to increase or decrease expression of a protein
76
Describe splicing mechanisms
Recognition of splice sites > intron removal Components - several cis and trans acting elements Spliceosome complex (trans-acting element) - Work with the cis elements below and other splicing repressors/activators Donor and acceptor sites - these are evolutionarily conserved For 98.7% of splice sites - 5' Donor = GT (GU), 3' Acceptor = AG (canonical pair) - Most frequent non-canonical pair = GC/AG (0.56%) and AT/AC (0.09%), Donor site mutation more prevalent than acceptor 1.5:1 Branch point, polypyrimidine tract - Highly degenerated and are recognised with the donor and acceptor sites by spliceosome Enhancer and silencer splicing sequences
77
Describe aberrant splicing
Aberrant splicing (9% of all mutations) Splice site mutations Splicing factor-binding mutations Intronic variants Closer to donor/acceptor splice regions Deep intronic variants - within middle of introns Synonymous variants Exonic - usually these type of variants are investigated by looking at the protein itself, not splicing and are usually ignored as they usually don't affect the protein Need to test splicing changes via testing the RNA in a patient
78
Describe splicing mutations
Canonical splice site splicing mutation - whole exon skipping Canonical splice site variants - usage of cryptic/pseudo or intronic splice site thus inclusion of intron, or exon fragment skipping Deep intronic variants - inclusion of cryptic/pseudoexons SNV in exons - create new splice site, thus losing an exon fragment Splicing mutations in Disease: Different splice mutations in LMNA cause distinct disease Exonic splice enhancer mutation - exon skipping
79
Describe the splicing mutation disease within the LMNA gene
Different splice mutations within the LMNA gene causes different distinct diseases LMNA proteins are found in the nucleus and important in maintaining nuclear shape Mutations Limb girdle muscular dystrophy 18 (LGMD18) - mutant 5' ss (c.1608+5G>C) Retention of intron 9 = premature stop codon Familial partial lipodystrophy type 2 (FPLD2) - mutant 5'ss (c.1488+5G>C) Retention of intron 8 = 8 premature stop codon Hutchinson-Gilford progeria syndrome - alternative 5'ss (c.1824C>T) Within exon = activates cryptic ss = exon 11 150bp deletion ``` Dilated cardiomyopathy (DCM) - alternative 3'ss (c.640-10A>G) Exon 4 5' extension = protein +3AA (non-frameshift) ```
80
Describe the methods for functional testing of predicted splice variants
Reverse-transcriptase PCR (RT-PCR) RNA from patient fibroblasts or PBMCs (or other biopsied tissue) Oligo-DT (random primers) anneal to RNA Specifically used as they anneal to the poly-A tail of mRNA Reverse transcriptase forms cDNA, followed by PCR Problem of nonsense mediated decay (NMD) Can be inhibited by treating cells with puromycin Minigene assay Cells or tissues not available Introduce variant into healthy cells using genome-editing (e.g CRISPR-Cas9). Test with RT-PCR
81
Describe the use of RT-PCR in beta thalassemia and leigh syndrome
Beta Thalassemia >200 known mutations in HBB including splice mutations Example - deep intronic variant results in intronic retention RT-PCR enables visualisation of the larger fragment via electrophoresis Leigh Syndrome - MRPS34 Donor mutation activated a cryptic ss leading to partial deletion and frame shift mutation One acceptor site mutation lead to 2 different aberrant transcripts These transcripts are distributed differently in tissues This makes validation of splice site mutations as they are tissue specific and may not be detected in all tissues SS mutations aren't 100% effective as they’ll be heterogenous in different tissues/not be included in some
82
Describe when the minigene assay is use to analyse RNA
Used when there aren't any cells or tissue samples available to extract RNA Requires cloning of DNA fragment into expression vector This is introduced into cell cultures Expressed transcript is then analysed
83
Discuss why WES and WGS is not ideal in analysing RNA
Yield - 25-75% depending on cohort Splice variants underrepresented Deep intronic variants not detected in whole-exome sequencing Detecting by genome-sequencing by prioritisation/prediction is difficult Large number of variants across the species, it is difficult to determine what is pathogenic Only donor and acceptor site mutations simple to predict, as they're highly conserved Solution = directly interrogate the transcriptome
84
Describe transcriptome analysis
RNA-sequencing via NGS (RNA-Seq) allows the entire transcriptome to be analysed in a single run Investigate - specific cell, tissue, or organism at a given developmental stage or physiological condition Long reads of protein-coding mRNA and non-coding RNA such as rRNA, tRNA, small non-coding RNA and large-intergenic non-coding RNA Used to identify genetic variants and their effects Altered expression levels Aberrant splicing Gene fusions
85
Describe RNA sequencing library prep
Purify RNA e.g. mRNA = polyA selection > fragmentation > random priming Reverse transcribe into cDNA > ENDREPAIR, phosphorylation, A-tailing > adaptors ligated > PCR amplified > sequenced on illumina
86
Describe the use of RNAseq in routine diagnostics
It is in the early stages but used in Cancer – gene fusions Inherited diseases e.g. Neurofibromatosis 1 (NF1) regulatory splicing RNA-seq in Mendelian disorder AR condition where patients already has WES/WGS but molecular diagnosis not made Muscles and skin biopsies were not originally taken, which is why they didn't get tested RNA-seq allowed the molecular diagnosis to diagnose those who were missed in WGS/WES RNA-seq in mitochondrial disorders Fibroblast used, all patients screened with WGS Detected 3 different types of abnormalities depending on what mutation was present ``` Aberrant expression (typically low expression) Mutation likely causes NMD due to frameshift/premature stop ``` Aberrant splicing Inclusion of cryptic exons, exon skipping, exon truncation, exon extension, intron retention Mono-allelic expression Genetic Splicing/premature stop codons leading to NMD thus only the other allele works The other allele could have a missense, thus only faulty protein expressed Promoter or regulatory mutations Large deletions e.g. TAR syndrome Epigenetic mechanisms Therapy Antisense oligonucleotide (AON) therapy can be used to treat splicing diseases It can block sections of DNA to induce splicing/skipping