REVIEWS Genomic disorders: Structural characteristics of the human genome predis- pose to rearrangements that result in human disease structural features of the traits. The gene is still the key in mediating the pheno- type, but is altered almost coincidentally by the rearrangement. I will refer to such conditions that result genome can lead to DNA from genome architecture as genomic disorders. Genomic disorders are caused by an alteration of the genome that might lead to the complete loss or gain of rearrangements and a gene(s) sensitive to a dosage effect or, alternatively, might disrupt the structural integrity of a gene. This human disease traits mechanism is in sharp contrast to the classical mecha- nism for genetic disease, by which an abnormal pheno- type is primarily a result of point mutation. Genome JAMES R. LUPSKI (
[email protected]) alterations can occur through many mechanisms, one of which is homologous recombination during meiosis Molecular medicine began with Pauling’s seminal work, between region-specific, low-copy repeated sequences. which recognized sickle-cell anemia as a molecular These homologous recombination events result in disease, and with Ingram’s demonstration of a specific a type of DNA rearrangement that is a function of the chemical difference between the hemoglobins of normal orientation of the repeated sequences that act as and sickled human red blood cells. During the four 1 substrates for homologous recombination . Recom- decades that followed, investigations have focused on the bination between direct repeats can lead to deletion gene – how mutations specifically alter DNA and how these and/or duplication of the genetic material between the changes affect the structure and expression of encoded repeats, while recombination between inverted repeats proteins.