Understanding Monogenic Diabetes: Causes and Types

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1. Introduction – monogenic diabetes results from mutations in a single gene. 20 genes have been linked to monogenic diabetes. A mutation in any one of these gene can cause a child or adult to develop monogenic diabetes. If an individual has a mutated gene then this mutation may be passed from parents to their children or may spontaneously occur in an individual. there are two main forms of monogenic diabetes –
1. MODY (Maturity onset diabetes of the young) – most commonly caused by mutations in two genes- GCK gene and HNF1A gene.HNF1A genes encoding the enzyme glucokinase (GCK is a key regulatory enzyme in the beta cell, and also called as pancreatic glucose sensor). HNF1A gene encodes the nuclear transcription factors hepatocyte nuclear …show more content…

Isoforms of HNF1A and HNF4A do have an ability to moderate MODY phenotype-

RNA processing helps to generate isoforms of many genes, these isoforms are basically mRNA that are derived from the same locus but they are different in their transcription start site, protein coding DNA sequence. Regulated expression of these isoforms have a functional role, particularly in those tissues with high expression (for example the pancreas). mutations that affect only certain isoforms of HNF1A lead to different influences on beta-cell dysfunction and diabetic phenotype.
RNA processing helps us to determine the age of patients with clinical symptoms. In HNF1A gene , we can directly relate mutation position to the age of patient like Patients with a mutation in exon 9 or 10 of HNF4A present at a median age of 40. And if mutation is in exons 2–8, that affects all isoforms median age of onset for patients is 28.

2. RNA Processing helps us in discovering new areas to screen for mutations …show more content…

With the understanding of surveillance pathway we can explain mechanism causing the disease :-
MODY is a disease, where only one allele is mutated, it had been proposed that the clinical phenotype of MODY be caused by two reasons. First one is by haploinsufficiency and second one is by a dominant-negative effect of the mutated protein upon the wild-type protein.
MODY is most likely a disease of haploinsufficiency. Clues for this haploinsufficiency came from the patients with similar phenotype HNF1A MODY due to loss-of-function mutations (for example promoter or dimerization domain mutations). Furthermore the demonstration that NMD results in the destruction of several transcripts having PTCs, and because of NMD sometime whole gene gets deleted and this whole HNF1A gene deletions may cause MODY, RCAD caused by HNF1B mutations is also likely to be a disease of haplo insufficiency as whole gene deletions of HNF1B have been documented.

In a diabetic family with an IPF-1 frame shift mutation a protein has been shown to be generated as a result of translation re initiation. And this translation re initiation was shown to exert a dominant-negative effect on the activation of transcription by the wild-type protein. Despite

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