Chapter 5 Genes, Environment, and Common Diseases Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. Disease in Populations Incidence rate Number of new cases of a disease reported during a specific period (typically 1 year) divided by the number of individuals in the population Prevalence rate Proportion of the population affected by a disease at a specific point in time Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Risk Factors Relative risk Incidence rate of a disease among individuals exposed to a risk factor divided by the incidence rate of a disease among individuals not exposed to a risk factor Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Multifactorial Inheritance Polygenic Multifactorial trait Variation in traits caused by the effects of multiple genes Variation in traits caused by genetic and environmental or lifestyle factors Quantitative traits Traits that are measured on a continuous numeric scale Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Multifactorial Inheritance Threshold model Liability distribution Threshold of liability Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Multifactorial Inheritance Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Multifactorial Inheritance Characteristics of multifactorial disorders Result from hereditary and environmental factors Hereditary component is polygenic • Individual involved genes follow mendelian principles • Many genes act together to influence the expressed trait Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Multifactorial Inheritance Concordance and discordance Concordance • Expression of the disease in two related family members Discordance • Expression of the disease in one family member but not a second Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Multifactorial Inheritance Twin studies and concordance Genetic conditions • Monozygotic (MZ) twins: 100% concordance • Dizygotic (DZ) twins: less than 100% and similar to that among other siblings Environmental conditions • Equal concordance rates among MZ and DZ twins Multifactorial conditions • MZ twins with greater concordance than DZ twins, but rates are not 100% Adoption studies Gene-environment-lifestyle interaction Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Recurrence Risks Recurrence risks of multifactorial diseases can change substantially because gene frequencies as well as environment and lifestyle factors can differ among populations Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Recurrence Risks Recurrence risk becomes higher if more than one family member is affected If the expression of the disease in the proband is more severe, recurrence risk is higher Recurrence risk is higher if the proband is of the less commonly affected sex Recurrence risk for the disease usually decreases rapidly in remotely related relatives Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Nature and Nurture Nature Genetics Nurture Environment-lifestyle Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Nature and Nurture Twin studies Monozygotic (identical) Dizygotic (fraternal) Concordant trait • Both members of a twin pair share a trait Discordant trait • A twin pair does not share a trait Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Nature and Nurture Adoption studies Children born to parents who have a disease but are then subsequently adopted by parents lacking the disease are studied for the recurrence of the disease Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Genetics of Common Diseases Congenital malformations Congenital diseases are present at birth or shortly after birth Most congenital diseases are multifactorial Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Adult Multifactorial Diseases Coronary heart disease Potential mycocardial infarction caused by atherosclerosis Risk increases if: • There are more affected relatives • Affected relatives are female rather than male • Age of onset is younger than 55 years Autosomal dominant familial hypercholesterolemia, high-fat diet, lack of exercise, smoking, and obesity Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Familial Hypercholesterolemia Autosomal dominant 1 in 500 is heterozygous for FH gene; 1 in 1 million is homozygous for the trait Serum cholesterol 300 to 400 mg/dl in heterozygote; 600 to 1200 mg/dl in homozygote Cholesterol deposits in arteries and skin (xanthomas) Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Familial Hypercholesterolemia Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Hypertension Risk factor for heart disease, stroke, and kidney disease 20% to 40% of blood pressure variations are genetic; this means that 60% to 80% are environmental Causes of hypertension Sodium intake, lack of exercise, stress, obesity, smoking, and high-fat intake Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Breast Cancer Affects 12% of American women who live to 85 If a woman has a first-degree relative with breast cancer, her risk doubles Recurrence risk increases if age of onset in the affected relative is early and if the cancer is bilateral An autosomal dominant form (5%) has been linked to chromosomes 13 and 17 Other genes are implicated Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Colorectal Cancer 1 in 20 Americans will develop colorectal cancer Second only to lung cancer Risk factors Genetics High-fat and low-fiber diet are contributors Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Diabetes Leading cause of blindness, heart disease, and kidney failure Two major types Type 1 (insulin-dependent diabetes mellitus) Type 2 (non–insulin-dependent diabetes mellitus) Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Type 1 Diabetes Autoimmune destruction of insulin-producing beta cells in the pancreas T cell activation and autoantibody production Onset before 40 years of age Higher incidence with offspring of diabetic fathers Recurrence risk 0.55 MZ twin concordance rate 1% to 6% sibling recurrence Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Type 2 Diabetes 80% to 90% of all diabetes cases Neither HLA nor autoantibodies commonly seen in type 2 Person has insulin resistance or diminished insulin production Risk factors High carbohydrate diet and obesity Recurrence risk 0.90 MZ twin concordance rate 10% to 15% sibling recurrence Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Obesity Body mass index >30 Obesity is a substantial risk factor for heart disease, stroke, and type 2 diabetes Adoptive studies BMI = W/H2 (weight in kg and height in meters) Body weights of adopted individuals correlated significantly with their natural parents’ body weights Twin studies Higher concordance in MZ twins than DZ twins Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Alzheimer Disease Progressive dementia and loss of memory Formation of amyloid plaques and neurofibrillary tangles in the brain Risk of developing AD doubles in individuals who have an affected first-degree relative Mutations in any of three genes that affect amyloid-beta deposition Presenilin 1 (PS1) Presenilin 2 (PS2) Amyloid-beta precursor protein gene (APP) Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Alcoholism Risk is 3 to 5 times higher in individuals with an alcoholic parent Adoption studies Offspring of nonalcoholic parents, when reared by alcoholic parents, did not have an increased risk Twin studies Concordance rates • MZ: >60% • DZ: <30% Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Psychiatric Disorders Schizophrenia Severe emotional disorder characterized by delusions, hallucinations, and bizarre, withdrawn, or inappropriate behavior Recurrence risk among the offspring of one affected parent is 10 times higher than the general population Twin and adoption studies indicate that genetic factors are likely to be involved Bipolar affective disorder Genetics Minimal environmental influence Mosby items and derived items © 2010, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. 28