Introduction to Molecular Medicine Second Edition Springer Science+Business Media, LLC Dennis W. Ross Introduction to Molecular Medicine Second Edition With 60 Illustrations Springer Dennis W. Ross, M.D., Ph.D. The School of Medicine Department of Pathology University of North Carolina at Chapel Hill Chapel Hill, NC 27599, USA and Department of Pathology Forsyth Memorial Hospital 3333 Silas Creek Parkway Winston-Salem, NC 27104, USA Library of Congress Cataloging-in-Publication Data Ross, D. W. (Dennis W.) Introduction to molecular medicine I Dennis W. Ross. - 2nd ed. p. cm. Includes bibliographical references and index. ISBN 978-0-387-94468-5 ISBN 978-1-4757-2460-8 (eBook) DOI 10.1007/978-1-4757-2460-8 l. Medical genetics. 2. Molecular biology. 3. Recombinant DNA. 4. Pathology, Molecular. I. Title. [DNLM: l. Genetics, Medical. 2. Molecular Biology. 3. Hereditary Diseases-genetics. 4. Neoplasms-genetics. QZ 50 R823i 1996] RB155.R78 1996 616' .042-dc20 DNLM/DLC 95-36653 Printed on acid-free paper. © 1996 by Springer Science+Business Media New York Originally published by Springer-Verlag New York, Inc. in 1996 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher Springer Science+8usiness Media, LLC. except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereaf ter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production managed by Terry Kornak; manufacturing supervised by Jeffrey Taub. Typeset by Bytheway Typesetting Services, Inc., Norwich, NY.' 9 8 7 6 5 432 1 ISBN 978-0-387-94468-5 SPIN 10495100 Preface to the Second Edition In the four years since the first edition of this book was published, the molecular revolution has continued. DNA has been named by Time maga zine as the Molecule of the Year, a Nobel Prize has been awarded to a young man for the invention of the polymerase chain reaction, and televi sion viewers have learned of the DNA fingerprint. Molecular technology in medicine is increasing. The availability of DNA probes for cancer suscepti bility is stressing our system of insurance, testing our ideas about medical ethics, and teaching us new things about cancer. In this edition, I have added a number of new sections, as well as a new chapter. New examples of molecular medicine have been added to demonstrate current applications of this technology. The basic concepts of molecular biology remain the basis for the first three chapters of the book. The excitement surrounding molec ular medicine that I mentioned in the preface to the first edition continues. It is now tinged with a touch of awe and a little bit of fear at the changes that recombinant DNA technology has brought to our society. v Preface to the First Edition This book describes the discoveries that have created a field called molecu lar medicine. The use of recombinant DNA technology in medical research and most recently in medical practice constitutes a revolutionary tool in our study of disease. Probing the human genome is rapidly becoming as routine as looking at cells under a microscope. The cloning of a new gene is now a common occurrence, newspapers report. Recombinant DNA technology, like the invention of the microscope, shows us a world of detail richer than we might have imagined. This book presents the discoveries, basic scientific concepts, and sense of excitement that surround the revolution in molecular medicine. The scien tific basis of molecular medicine is explained in a simple and direct way. The level of technical detail, however, is sufficient for the reader to appre ciate the power of recombinant DNA technology. This book is clinically oriented throughout. All of the examples and applications are related to medical discoveries and new methods of diagnosis and therapy. A few subjects within molecular medicine are examined in more detail to allow the reader to become aware of the strengths and shortcomings of a molecular approach to disease. I do not hide the incomplete understanding that still surrounds many of the recent discoveries in molecular medicine. I intend to demonstrate the concepts of molecular medicine in this book by showing examples from all branches of medicine. I include, for instance, infectious diseases, genetic disorders, and cancer. However, I am not trying to be comprehensive in examining all areas of molecular medicine. So many discoveries are made each week in this field that it is not yet possible to draw them together in a comprehensive volume. My goal is to help the reader understand what the future may hold as well as the most important current applications. vii viii Preface to the First Edition This book is not a treatise, but an informal guide to a new field. As a guide, I try to communicate excitement, because this is the predominant feeling among people working in the field of molecular medicine. Winston-Salem, NC D.W.R. Acknowledgments Short summaries of some of the material in this book have appeared pre viously in my column "Advances in Science and Pathology," which appears in the Archives oj Pathology and Laboratory Medicine. I would like to thank the editorial staff of the Archives and the American Medical Associa tion for giving me the opportunity to develop my skills in science writing. A number of people have given me valuable suggestions after reviewing draft chapters of this book. I wish to thank them for their time and thought: Susan Atwater, Lanier Ayscue, Phil Carl, Joseph Dudley, Margaret Gulley, Charles Hassell, Edward Highsmith, Roy Hopfer, and William Kaufmann. I must also especially thank Daniel Sinclair, my research technician, for his considerable help on many features of the manuscript including preparing the computer graphics used as illustrations. I also want to thank Sarah Kielar, my secretary, for careful attention to the preparation of the type script. I also wish to acknowledge most gratefully funding from The Blood Cell Fund, which has supported my work in cancer research and education. ix Contents Preface to the Second Edition V Preface to the First Edition VB Acknowledgments IX I. Basics of Molecular Biology 1. Human Genome 3 The Genetic Message • The Genetic Code • Anatomy of a Gene • Physical Organization of the Genome • Gene Maps • Human Genome Project 2. Gene Regulation and Expression 17 Overview • DNA Replication • Gene Expression • Transcription • Translation • Regulation • Antisense Oligonucleotides • Viral Vectors 3. Tools of Recombinant DNA Technology 27 Restriction Enzymes • Southern Blot • Northern and Western Blots • In Situ Hybridization • Labeling Nucleic Acid Probes • Polymerase Chain Reaction • Cloning • Transgenic Animals • Conclusions 4. Cytometry - Cell Analysis 51 Introduction • Cell Division Cycle • Flow Cytometry • Image Cytometry xi xii Contents II. Molecular Approach to Disease 5. Infectious Diseases 63 Introduction • Detection of Microorganisms by DNA Probes • Advantages and Disadvantages of Molecular Detection • Examples of Molecular Diagnostic Applications • Microbial DNA Testing in Development • AIDS • Epidemiology of Infectious Diseases • Antisense Oligonucleotides as Antimicrobial Agents • New Infectious Diseases • Conclusions 6. Genetic Diseases 85 Introduction • Basic Genetics • DNA Fingerprinting • Hemophilia • Cystic Fibrosis • Sickle Cell Anemia • Issues Surrounding Molecular Prenatal Diagnosis • Familial Hypercholesterolemia • Mitochondrial Eve An Aside • Conclusions 7. Immune System and Blood Cells 111 Introduction • Molecular Biology of the Immune System • Hematopoiesis • Bone-Marrow Transplantation • The First Human Gene Transplant • Future Directions 8. Cancer 129 Introduction • Carcinogenesis • DNA Repair • Oncogenes • Tumor Suppressor Genes, Anti-Oncogenes • Colon Cancer: Model of a Multistep Process • Lymphoma, Leukemia • Other Solid Tumors • Future Directions 9. Enviromental Medicine 163 Environmental Pathogens • Molecular Testing of Environmental Pathogens Index 175