Abstract
Understanding the causes of variation in clinical manifestations of disease should allow for design of new or improved therapeutic strategies to treat the disease. If variation is caused by genetic differences between individuals, identifying the genes involved should present therapeutic targets, either in the proteins encoded by those genes or the pathways in which they function. The technology to identify and genotype the millions of variants present in the human genome has evolved rapidly over the past two decades. Originally only a small number of polymorphisms in a small number of subjects could be studied realistically, but speed and scope have increased nearly as dramatically as cost has decreased, making it feasible to determine genotypes of hundreds of thousands of polymorphisms in thousands of subjects. The use of such genetic technology has been applied to cystic fibrosis (CF) to identify genetic variation that alters the outcome of this single gene disorder. Candidate gene strategies to identify these variants, referred to as “modifier genes,” has yielded several genes that act in pathways known to be important in CF and for these the clinical implications are relatively clear. More recently, whole-genome surveys that probe hundreds of thousands of variants have been carried out and have identified genes and chromosomal regions for which a role in CF is not at all clear. Identification of these genes is exciting, as it provides the possibility for new areas of therapeutic development.
Highlights
Only a small number of polymorphisms in a small number of subjects could be studied realistically, but speed and scope have increased nearly as dramatically as cost has decreased, making it feasible to determine genotypes of hundreds of thousands of polymorphisms in thousands of subjects. The use of such genetic technology has been applied to cystic fibrosis (CF) to identify genetic variation that alters the outcome of this single gene disorder
Several studies agree that mannose-binding lectin (MBL) low expression alleles associate with lung function (Gabolde et al, 1999; Davies et al, 2004; Yarden et al, 2004; Trevisiol et al, 2005; Choi et al, 2006; Buranawuti et al, 2007; Dorfman et al, 2008), but there is no consensus as to whether this effect is only seen in patients colonized with P. aeruginosa, and whether a heterozygous genotype is sufficient to cause such impairment
The discovery of genetic modifiers may help account for the broad spectrum of disease severity observed in patients, especially those with the same CFTR genotype
Summary
Reviewed by: Burkhard Tümmler, Medizinische Hochschule Hannover, Germany Sabina Gallati, University of Bern, Switzerland. Only a small number of polymorphisms in a small number of subjects could be studied realistically, but speed and scope have increased nearly as dramatically as cost has decreased, making it feasible to determine genotypes of hundreds of thousands of polymorphisms in thousands of subjects The use of such genetic technology has been applied to cystic fibrosis (CF) to identify genetic variation that alters the outcome of this single gene disorder. Many reports of correlations between CFTR genotype and clinical phenotype exist
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