Essential Endocrinology and Diabetes. Richard I. G. Holt

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amplified and turned into many replica proteins. Specific proteins define the particular phenotype of a cell‐type (e.g. a thyroid cell that synthesizes thyroid hormone rather than the complement of proteins that, for instance, might lead to a beating cardiomyocyte). More commonplace proteins carry out basic functions such as the metabolic processes common to all cells. Proteins on the cell surface act as receptors that initiate intracellular signalling, which in turn is reliant on proteins that function as enzymes. Eventually, this signalling cascade reaches the nucleus and the proteins within it, called transcription factors. These latter proteins bind or release themselves from areas of DNA around genes to determine whether a gene is expressed (i.e. mRNA is transcribed) or silenced.

       A molecule of deoxyribose (a five‐carbon sugar) is linked covalently to one of two types of nitrogenous bases:Purine – adenine (A) or guanine (G)Pyrimidine – thymine (T) or cytosine (C)The base plus the sugar is termed a ‘nucleoside’, e.g. adenosine

       The addition of a phosphate group to a nucleoside creates a nucleotide. E.g. adenosine mono‐, di‐ or tri‐phosphate (according to how many phosphate groups have been added)

       Phosphodiester bonds polymerize the nucleotides into a single strand of DNA

       Two strands, running in opposite directions, 5 prime (5′; upstream) to 3′ (downstream) assemble as a double helix:Hydrogen bonds form between the strands, between the base pairs A–T and G–C

       ∼3 billion base pairs comprise the human genome

      Several chromosomal abnormalities can result in endocrine disorders. During meiosis, if a chromosome fails to separate properly from its partner or if migration is delayed, a gamete might result that lacks a chromosome or has too many. Turner syndrome (45,XO) occurs when one sex chromosome is missing while in Klinefelter syndrome (47,XXY) there is an extra one. Similarly, breakages and rejoining across or within chromosomes produce unusual ‘derivative’ chromosomes or ones with duplicated or deleted regions (see Figure 4.4). These events can disrupt gene function, e.g. deletion causing congenital loss of a hormone. Duplication can be equally significant. For instance, on the X chromosome, duplication of a region that includes the dosage‐sensitive sex reversal, adrenal hypoplasia critical region gene 1 (DAX1, also called NR0B1) overrides normal male development in the 46,XY embryonic gonad to result in an ovarian pathway.

      Gene transcription and its regulation

      Schematic illustration of cell division. Prior to mitosis and meiosis, the cell undergoes a period of DNA synthesis so that the normal diploid status of DNA (2n) temporarily becomes 4n. (a) The stages of mitosis result in each daughter cell containing diploid 2n quantities of DNA. Schematic illustration of cell division. Prior to mitosis and meiosis, the cell undergoes a period of DNA synthesis so that the normal diploid status of DNA (2n) temporarily becomes 4n. (b, opposite) Meiosis is split into two stages, each of which comprises prophase, prometaphase, metaphase, anaphase and telophase. During prophase of meiosis I, the maternally and paternally derived chromosomes align to allow crossing over, a critical aspect of genetic diversity ensuring that each of the final haploid cells is genetically different from the parent cell.

Schematic illustration of a gene, transcription and translation. In this example, the gene comprises three exons with enhancer elements in the 5′ and 3′ flanking regions and a silencer element upstream of the promoter.

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