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Yıl:2004; Cilt: 42; Sayı: 4>> Özet
TAM METİN
Yeni Symposium; 2004;42(4):154-157
Âilesinde veya İlk Çocuğunda Otistik Bozukluk Öyküsü Olan Çiftlerde Çocuk Sâhibi Olma: Tavsiyeler ve Son Genetik Çalışmalar
N Güvendeğer
Dr. Behçet Uz Çocuk Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastânesi
Yaygın Gelişimsel Bozukluklar’ın (YGB) içerisinde en sık görüleni Otistik Bozukluk’tur
(OB). Kalıtsal geçiş özelliği nedeniyle, âilesinde veya birinci çocuğunda OB öyküsü olan
ebeveynler için genetik danışmanlığın rolü çok önemlidir. Otizmin genel popülasyondaki
prevalansı 1/1000, erkek/kız oranı 4/1’dir. Otistik bireye sâhip âilelerde, tekrar otistik birey
görülme sıklığı, genel popülasyon prevalansından 45 kez fazladır. Etkilenmiş çocukların
kardeşlerinde otizm görülme sıklığı %2-8’dir. Çalışmalar, otizmin nedenleri arasında çoğul
genetik faktörlerin rol oynadığını göstermektedir. Çoğul genler arasındaki etkileşimler, “idiyopatik
otizme” yol açar. Otizme sebep olabilecek belirgin bir prenatal veya perinatal sebep
ise bulunmamıştır. Yapılan kromozom çalışmaları, kromozom 15q11-13’ün babadan
gelen dublikasyonunun otizm ile ilgili olabileceğini göstermiştir. Diğer çalışmalarda ise, kromozom
7q31-q33, 17q11-q12, 7q22-31, 2q32’nin otizm ile ilişkisi olabileceği ileri sürülmüştür.
Ayrıca, serotonin taşıyıcı geninin varyant alellerinin, diğer genler ve çevresel faktörlerle
etkileşime girip, otistik hastalarda yüksek serotonin düzeylerine yol açtığı saptanmıştır.
Ek olarak, otizmin mitokondrial aspartat/glutamat taşıyıcısını (AGC1) kodlayan SLC25A12
geniyle de ilişkisi araştırılmıştır.
Sonuç olarak, otizme kesin sebep olacak genler henüz tam saptanmamıştır. OB, sağaltım
şeması açısından, birey, âile ve toplum adına, ağır derecede maddî ve mânevî yük getiren
bir durum olduğu için, âilesinde veya birinci çocuğunda otistik birey bulunan çiftlerde, çocuk
sâhibi olma kararı aşamasında âile ve genetik danışmanlığının rolü son derece önemlidir.
Having A New Child in Couples Who Have Autistic Disorder in the First Child or A Family History of Autism: Latest Genetical Studies and Suggestions
Autistic Disorder is the most common type seen among Pervasive Developmental Disorders
(PDD). Since all the studies suggest a genetic transmission for Autistic Disorder (AD),
genetic counseling plays a very important role for couples who have an autistic individual
in their families and for couples whose first born children are diagnosed as autistic.
Prevalence of AD in the general population is estimated to be 1/1000; male/ female ratio
is estimated to be 4/1. Recurrence risk in families with autistic subjects is 45 times greater
than the prevalence in the general population. The recurrence rate in siblings of affected
children is approximately 2% to 8%. Studies suggest that multiple genetic factors play role
in the etiology of AD and results of the studies rule out X-linkage as the prevailing type
of inheritance. The interactions between these multiple genes cause “idiopathic autism”
but that epigenetic factors and exposure to other environmental factors, may contribute to
autism-related traits. A specific perinatal or prenatal factor has not been identified in the
etiology of Autistic Disorder.
It has been suggested that paternal duplication of chromosome 15q11-13 may cause AD.
Other chromosomes, which are suggested to be related with autism are, 7q31-q33, 17q11-
q12, 7q22-31, 2q32. Additionally, it has been examined that, specific serotonin transporter
gene variants, modulate transporter reuptake function, so that they possibly influence the
occurrence of hyperserotonemia in autistic patients. Also, SLC25A12 gene, encoding mitochondrial aspartate/glutamate carrier and its association and linkage with autism has been
studied.
Specific genes related with AD have not been identified yet. Since treating and handling
an autistic child cause hard economical and social obligations for the families, genetic and
family counseling play a very important role in couples who are under risk and planning to
have a new child. In that case, parents who wish to have more children must be informed
that their statistical risk of having an autistic child is increased.

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