Diseases Sex Linked and Sex Influenced

There are thousands of cases of sex linked and sex influenced diseases worldwide. These diseases can range from a social inconvenience, to a fatal ailment. In sex linked diseases, like Muscular Dystrophy, hemophilia and color blindness, only males are affected. When a man infected with a sex linked disease has children, all his sons are normal, but all of his daughters are carriers. When a carrier woman and an uninfected man have children, half of the sons are normal, and half of the sons are affected; half of the daughters are carriers and half of the daughters are normal. Only males are affected because the sex linked diseases affect the X chromosome. Males have one X chromosome and one Y chromosome, so they need to use that X, whether it is flawed or not. Females on the other hand, have two X chromosomes, so if one is defective, they can use their second X chromosome. Duchenne¹s Muscular Dystrophy(DMD) is defined as ³a genetic disease characterized by defective muscle cells that can not produce a p rotein called dystrophin² (Science News 380). In patients of hemophilia, there is a deficiency of a protein needed for blood clotting, causing this hereditary bleeding disorder. In red/green color blindness, the broadest form of color blindness that affects six percent of the population, the cones in the retina that receive green light do not function properly. Unlike sex linked diseases, sex influenced diseases are not reserved solely for the male. However, the diseases occur in males much more frequently than in females. This is because sex influenced diseases occur from imbalances in testosterone, much more highly concentrated in males. Baldness and gout are two diseases that are a result of these hormonal imbalances. Baldness is defined as the lack or loss of hair. Permanent baldness strikes on a hereditary basis because the hormonal imbalances tend to be passed from generation to generation. Gout is a hereditary metabolic disorder that involves recurrent acute attacks of severe inflammation of joi nts. Sex linked diseases are born when sex genes, that compose two of the 46 chromosomes, are mutated by an error in copying genes in reproduction. One of these sex linked diseases is Duchenne¹s Muscular Dystrophy. DMD is a disease that has rightfully been gaining some headlines recently, as the disease is taking the lives of young children. Several cures have been brought up recently in the medical society, but none have paid any dividends. According to the Muscular Dystrophy Association, one in every 2500 boys are infected with muscular dystrophy. The defective gene is found at the top of the X chromosome. This gene is the largest known to exist. In patients of DMD, this gene is either missing or severely mutilated. The symptoms of DMD are fatal. By age eleven, the victims weaken fast. Normally, muscle deterioration begins in the lower legs and then moves up the body of the patient. Generally, victims are in their early twenties when they die from either heart failure or diaphragm failure.(The dia phragm is the muscle that makes breathing possible.) One mother of a Duchenne¹s Muscular Dystrophy patient says succinctly, ³Eventually these kids get bedridden and then they die.²(Grady 87) It is imperative to find a cure for Duchenne¹s Muscular Dystrophy so we can save the lives of thousands of innocent children. One of the major researchers working on a cure for DMD is Dr. Peter K. Law of the Cell Therapy Research Foundation. Law has been in the field for over twenty years and has made many discoveries. In 1972, Law¹s doctoral thesis proved that dystrophic muscle cells have abnormal cell membranes. This showed that the disease was caused by a muscle defect, not a nerve defect as was previously thought. Since it was clear that it was a muscle defect, Law tried to transplant both whole and minced muscle into mice. The minced muscle proved to be too damaged to operate, and the whole muscle was so large that it died before an adequate blood and nerve supply was developed. At this point, since the whole muscle was too large but was the only feasible solution, he decided to transplant whole muscles of a baby mouse into an adult mouse. This muscle was not damaged, because it was not minced, and it was not too large, because the baby muscle is considerably smaller than an adult muscle. Not only did the mouse survive, but normal function was restored to diseased adult muscle. Since the transplantation of muscle in mice was so successful, Dr. Law tried to find something along those lines that would work in a human. He found a solution; myoblasts. A myoblast is a mature muscle cell. It is a long thin fiber that can be more than an inch long. Unlike cells of other types, myoblasts have over 200 nuclei. When they are damaged, the myoblasts call upon a reservoir of satellite cells; small immature cells that nestle inside the muscle fiber¹s outer sheath. Satellite cells are the key to muscle repair and regeneration.The satellites leave the fiber, divide and then flatten into spindle shaped forms- the myoblasts. Myoblasts repair muscle cells by fusing with the injured cell and they share their nuclei with the injured cell¹s nuclei. When these two myoblasts fuse completely, new cells are formed. In 1970 Law thought of a procedure that would fuse healthy myoblasts with the dystrophic one, hoping that the resulting hybrid would have some function. However, Law had to perfect this procedure. One of the main problems was that when the healthy myoblast cells were fused, the immune system would treat them as alien and attack them. According to Law, another thing they had to do was ³... to design and perfect a culture medium to mass-produce myoblasts and weed out other cells.²(Grady 90) Law explains yet another problem encountered,³If you cram too many cells in the same spot, they might not survive.²(Grady 90) While Law was working on his myoblast experiments, another door was opened by the discovery of the exact gene that caused the dystrophy. Many scientists thought that this gene therapy, rather than Law¹s cell therapy, was the future. But Law dismissed gene therapy saying, ³To me, in reality, that science will not work in our lifetime. First you must make a normal copy of the defective gene, which is enormous, and somehow insert it into a small virus to carry it into the host. Then you must hope that the virus will attack the right cell in the body, get through the cell membrane, break into the nucleus, and splice itself into place inside the cell¹s DNA. And then you expect that cell to function as normal? Are you kidding me?²(Grady 91-92) Law also made it clear that in gene therapy you have to replace the exact right nucleus in the exact right gene. In cell therapy, it doesn¹t matter which is the exactly right one that needs replacement because all of the cells are being replaced. Just two years after he wrote off the gene therapy, in 1988,when the problems were weeded out, Law injected healthy myoblasts into 19 dystrophic mice. The results of these tests were encouraging; 11 mice fared extremely well, 3 showed moderate improvement and 5 rejected the myoblasts. Another encouraging fact was that the life span was increased from nine months to nineteen months in the mice that fared extremely well. With the success in the mice, Law decided to launch phase I of his human experiments . Each of three boys received four injections of myoblasts from either their brother¹s body or their father¹s body. In two of the boys, these injections, which were given in the foot, were matched in the other foot by placebo saline solutions so nobody except Law¹s assistant would know which foot the real injections were placed. At the end of the experiment, all three boys said that they felt that one foot was stronger than the other. The foot that felt stronger was the same foot that was injected with the myoblasts in all three cases, and all three feelings of greater strength were backed up by muscle strength tests administered by Law. Although the results of Phase I seemed ideal, Law received some criticism from his peers. They said that he rushed too quickly into the human experiments without gaining complete assurance that it would work to perfection. Some scientists were concerned that the myoblast injection would have side-effects. The criticism was not publicized to a wide extent, and it went virtually unnoticed after Law made a statement in which he said, ³We have to move the research forward as quickly as possible. These are dying children. We have no time to lose.²(Grady 88) In May 1991, after Phase I was considered to be a success, Law lunched Phase II. As of July 24, 1992 Law had treated the major leg muscle of 32 boys, ages 6 to 14. For this process, Law removes an eraser-sized piece of muscle from either the patients father or brother. Then, he grows the muscle in the lab until he has 5 million myoblasts. At the time of treatment, the patients go under general anesthesia for 10 minutes, and receive 48 injections of myoblasts in 22 muscle groups. All patients take cyclosporin, an immune system suppressive for six months to prevent the boys from rejecting the myoblasts. The muscle strength of each patient is recorded 3 months before treatment, at the time of treatment, and three months after treatment. This test was also successful. Muscle strength was reported to improve in 43% of the muscles by an average of 41% when compared to muscle strength before treatment. 38% of the muscles stopped deteriorating after treatment and 19% completely failed to respond. However, as in Phase I, Law¹s success was accompanied with criticism. The major problem his peers had was that there were no controls. Says Robert H. Brown Jr. of Massachusetts General Hospital in Boston during one meeting session, ³I am astonished that you haven¹t controlled for cyclosporin.(Thompson 473) Law counters, ³We have a perfect control, strength before and after transfer on the same muscle.²(Thompson 473) Law also says that the upper body of the patient acts as a control. Law says that another reason he does not use controls is because the saline solution is shown to speed up deterioration, and that would not be ethically correct. His opposition, however says that since he only had two patients with the placebo solution, so those results could not be verified. Another thing that was criticized was the use of muscle strength to measure the effectiveness. The three major components of the criticism is that the children may not be using full exertion, that when you get older your strength gets greater, and third, how do you know dystrophin produced this strength; what about the cyclosporin? The work done by Peter Law has been exemplary. He has found a method for prolonging the life of young DMD patients. Although the way Law went about his trials were controversial, moving as fast as possible is imperative because thousands of children are having their ability to walk, and eventually their lives taken away by this disease. If Law had waited, it may have been too late. Although there is a large controversy concerning Peter Law, the Muscular Dystrophy Association should support him and encourage him to perfect a cure for this disease. Another sex linked diseases that is similar to DMD in makeup, not in symptoms is hemophilia. In hemophiliacs, a protein that clots blood is missing or abnormal due to a gene mutation that was formed in the duplication of sex genes. The protein missing in hemophilia victims is antihemophilic globulin (AHG). Like in all sex linked diseases, only males can show symptoms, and females are the only carriers. The father of a hemophiliac may or may not be infected, but the mother must be a carrier. A hemophiliac has received his mother¹s bad X chromosome and his father¹s Y. The same couple can also have a normal son who received his mother¹s good X and his father¹s Y. If the couple has daughters she can receive her father¹s X and her mother¹s bad X, or mother¹s good X. So, the chance of a hemophiliac boy being born when the mother is a carrier is one in four. Therefore the incidence of hemophilia is familial, as in the Russian royal family. In hemophiliacs ,the tendency to bleed becomes noticeable at a young age and leads to severe anemia or even death. Hemophiliacs often have large bruises and soft tissue of the skin from incidents as small as lightly bumping into something. This bruising is much like the bruising of the elderly. Not only will bruises form, but bleeding will often occur for no reason in the mouth, nose and gastrointestinal tract. Once the victim grows out of childhood, hemorrhages in knees , ankles, elbows and other joints occur frequently. These hemorrhages result in swelling which impairs the victim¹s function. Hemophilia patients are generally advised to refrain from physical activity . When hemorrhages occur, local application such as thrombin are applied that serve as a blood clotting mechanism, or blood is transfused. A third type of a sex linked disease caused by a defective chromosome is color blindness. Red/green color blindness, the most common type that affects six percent of the population, is caused by defective green cones in the retina. People with red-green color deficiency see blue and orange very clear and bright. Other colors, although different from the colors that normal people see, are always the same to them and suit most victims fine because they have nothing to compare the colors they see to(USA Today 16). Like hemophilia, Duchenne¹s Muscular Dystrophy and all sex linked diseases, only males suffer the symptoms, and the females are the carriers. Although color blindness is a disease that affects thousands of people, it is not a life-threatening disease. Most color blind people do not suffer, because they do not know that the color should be different. Few problems, like traffic lights, hinder color blind people, and as Cynthia Bradford, an opthamologist at the University of Oklahoma Health Science s Center says, ³With many people, you might not even know they¹re color blind­unless they tell you²(USA Today 16) Unlike sex linked diseases, sex influenced diseases do not affect one sex solely. Baldness, the lack or loss of hair, is caused by an imbalance of testosterone. Since it is caused by testosterone, much more concentrated in males, sex influenced diseases are much more common in males.This imbalance causes the destruction of hair follicles which causes the baldness to be permanent. The largest type of baldness is male-pattern baldness that affects forty percent of some male populations(Norton 2:826). Male-pattern baldness is hereditary, and varies in degree from generation to generation. Ironically, people with male pattern baldness have a higher percentage of body hair than most, and those Aborigines with male pattern baldness generally have bald calves as well. Although this disease is not life-threatening, baldness is a social problem. Almost every other man is a victim, and those who do suffer the disease are prejudiced. Solutions, not cures to baldness to exist. The first obvious option is the wi g. Secondly, hair transplants are becoming more and more frequent, and topical solutions such as minoxidil have helped to prevent further balding in many cases, and reinitiate hair growth in a much smaller percent of users. The important thing to remember about sex influenced diseases is that they are hereditary, but only to the extent of the amount of testosterone produced. The genes tell the offspring the amount and concentration of testosterone, not whether or not to lose hair. If the amounts of testosterone relayed are not normal, baldness may occur. A second sex influenced disease is gout. Gout is the ³hereditary metabolic disorder that is characterized by recurrent acute attacks of severe inflammation in one or more of the extremities²(Norton 5:392). This inflammation is caused by an excess deposition of uric acid in and about the joints. Like baldness, this condition strikes men predominantly, but can also be found in women. The exact cause of gout is not yet known, however, it is logical to believe that it is caused by the same hormonal imbalances as baldness, and that is why it is classified as a sex influenced disease. Gout is inborn, however the symptoms do not occur until middle age. Before the attacks, small amount of uric acid build up in the joints. All joints, especially the big toe, are susceptible. Symptoms such as heat, redness of the skin, and extreme tenderness and pain accompany the affected joints. Numerous gout attacks can cause knobby bumps on the affected joints. Acute cases of gout may come and go in a matter of a week fo r no apparent reason. Some circumstances , however, inhibit the symptoms of gout. These circumstances include: emotional upset, diuresis, surgery, trauma, and the administration of certain drugs. Cochicine is the classic treatment for gout, but new medicines have surfaced recently. Sex linked and sex influenced diseases are a problem that hurts our society. Although many of the diseases are just an inconvenience, others are fatal. There is no fathomable way of preventing any of these diseases, unless genes can be altered. The only medicine to treat theses diseases acts as a suppressant, not as an end to the diseases¹s life. Hopefully, cures can be found to save the lives of young, innocent people who are affected with hemophilia, Duchenne¹s Muscular Dystrophy and other fatal diseases.