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Tay-Sachs Disease
Tay-Sachs disease (TSD) is a fatal genetic disorder, most commonly occurring in children, which result in progressive destruction of the nervous system. “Tay-Sachs is caused by the absence of a vital enzyme called hexosaminidase-A (Hex-A). Without Hex-A, a fatty substance, or lipid, called GM2 ganglioside accumulates abnormally in cells, especially in the nerve cells of the brain. This ongoing accumulation causes progressive damage to the cells (www.genome.gov).” Hex-A is an enzyme that breaks down complex fats called gangliosides found in nervous tissues. As genome.com stated without Hex-A, there is a buildup of ganglioside in the cells of the brain, which causes extreme damage to the cells. Tay Sachs was named after Warren Tay and Bernard Sachs. Tay was a Bristish ophthalmologist who first described the red spot on the retina of the eye that is present in Tay–Sachs disease. Later in Volume V of Ophthalmological Society, he gave a complete description of the clinical symptoms of the disorder. Sachs, a New York neurologist, provided the first description of the cellular changes and the genetic nature of Tay-Sachs disease. Tay-Sachs disease results from defects in a gene on chromosome 15 that codes for production of the enzyme Hex-A. Tay-Sachs is an autosomal recessive genetic disorder, which means that both parents must be a carrier of the disease for their offspring to be at risk. Yet children of parents who are carriers have a 50 percent chance of being carriers themselves. Only when the couple has the same recessive disease allele there is a twenty-five percent chance that the disorder will appear in the child (Teichler-Zallen 162-163). So basically if both parents are carries of the disease and the child inherits the defective Hex-A gene from both parents, then the child will have Tay-Sachs disease.
During Dr. Sachs observation, he noted that most babies with Tay-Sachs disease at that time were of Eastern European Jewish origin. Nowadays, “approximately one in every 27 Jews in the United States is a carrier of the Tay-Sachs disease gene. Non-Jewish French Canadians living near the St. Lawrence River and in the Cajun community of Louisiana also have a higher incidence- about 1 out of 27- of Tay-Sachs. For the general population, about one in 250 people are carriers (www.genome.gov).” The frequency of TSD within the Jewish population is attributed to the "founder effect" in which genetic disorders and mutations within a closely interweaved minority group are continued over generations.
Diagnosis for Tay-Sachs disease can be made a few ways: A simple blood test can identify Tay-Sachs carriers. Blood samples can be analyzed by either enzyme assay or DNA studies. The enzyme assay is a biochemical test that measures the level of Hex-A in a person's blood. Also prenatal tests such as amniocentesis and chorionic villus sampling, where the Hex-A enzyme is measured can identify a Tay-Sachs Carrier (Genes and Human Disease). Amniocentesis involves removing a small amount of amniotic fluid during the sixteenth week of pregnancy. If there is an lack of Hex-A in the fluid, the fetus is affected by TSD, and the couple can choose to have a therapeutic abortion. Another, newer option is chorionic villus sampling (CVS), which is done during the tenth week of pregnancy. This procedure involves removing a small amount of placenta, and test results are returned more quickly than with amniocentesis. Also, if the couple should choose to have an abortion, CVS allows them more privacy and safer abortion. Babies with Classic Tay-Sachs appear normal at birth and typically continue developing normally for the first few months. At around six months of age, development slows. The child slowly stops smiling, turning over and crawling. The child also experiences difficulty in swallowing, breathing and starts losing vision. The child also starts to develop red spots in the back of their eye. By age two, the child usually experiences frequent seizures and has either lost muscle function, mental function, the ability to hear, and as lost all vision. By the age of 3, the child is non responsive to their environment and their central nervous system is damaged so badly that their life cannot go on. Death usually occurs at the age of 5.
Victims of Tay-Sachs disease suffer much before their untimely death. The quality of life for an individual afflicted with Tay-Sachs is very poor. They begin life normally but by six months of age they begin to spiral. Besides for all of the loss of function, one can only imagine the pain involved in being unable to breathe properly and being fed through a feeding tube incorrectly. While these are the only things that come to mind immediately, there are plenty of other pains they endure. There are three existing forms of Tay-Sachs disease: Classic Tay-Sachs, Juvenile Tay-Sachs and Chronic Tay-Sachs. General symptoms for all three forms include: loss of motor skills, muscular weakness, and respiratory decline. Juvenile Tay-Sachs occurs in people with Hex-A mutation in their bloodstream. Early symptoms include lack of coordination, muscle cramps, and muscle weakness. A child may also slurred speech and difficulties swallowing. Children with Juvenile Tay-Sachs develop symptoms of classical Tay-Sachs between the ages of 3-5. The difference between children with juvenile and classical Tay-Sachs is patients with Juvenile Tay-Sachs slowly decline, losing their ability to walk, eat, and communicate. They are also prone to respiratory infection and recurrent bouts of pneumonia while many have seizures. These children usually don’t live longer than 15. Chronic Tay-Sachs occurs between the ages 2 to 5. Yet Chronic Tay-Sachs is very mild, even so that vision, hearing, and mental ability exists. Early symptoms of Chronic Tay-Sachs include clumsiness and muscle weakness in the legs. Once diagnosed, the adult may reflect back on their childhood and notice experiencing symptoms such as speech difficulties and not being athletic. The mental health symptoms may present first. About 40% of affected adults experience mental health symptoms such as bi-polar or psychotic episodes. Over time adults with Chronic Tay-Sachs slowly decline. These adults will need more mobility assistance and many experience speech and swallowing difficulties.
While there is no cure currently available, researchers believe that gene therapy is a way to cure Tay-Sachs. Gene therapy is the modification, insertion, or removal of alleles within a person's cells and biological tissues to treat disease. “The goal of gene therapy is to restore the missing enzyme by introducing the correct genetic code so proper enzyme production can occur” The treatment will involve filling, deep into the brain, engineered viruses that can successfully turn cells in the brain into factories of the Hex-A enzyme that is fatally vague in Tay-Sachs victims. Other possible cures of Tay-Sachs include possible Hex-A Replacement, and Bone Marrow Transplant. “The goal of Hex-A Replacement would be to replace the nonfunctional enzyme, a process similar to insulin injections for diabetes.” However, in previous studies the Hex-A enzyme itself has been thought to be too large to pass through the particular cell layer in the blood vessels that forms the blood–brain barrier in humans.

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