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Sibbett S, Oh J, Carrougher G, Muffley L, Ashford N, Pacleb M, Mandell S, Schneider J, Wolf S, Stewart B, Gibran NS. Establishing a Collaborative Genomic Repository for Adult Burn Survivors: A Burn Model System Feasibility Study. EUROPEAN BURN JOURNAL 2024; 5:389-398. [PMID: 39727910 DOI: 10.3390/ebj5040034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 10/24/2024] [Accepted: 11/01/2024] [Indexed: 12/28/2024]
Abstract
In this study, we aimed to integrate a genetic repository with an existing longitudinal national burn database. We set out two primary objectives, namely (1) to develop standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing multicenter database; and (2) to demonstrate the feasibility of correlating genetic variation to functional outcomes in a pilot study, using the catechol-O-methyltransferase (COMT) gene. Dubbed the worrier/warrior gene, COMT variants have been associated with varying phenotypes of post-traumatic stress, wellbeing, and resilience. Between August 2018 and July 2020, COMT variants were identified for 111 participants from three sites and correlated with their outcome data. We found no association between COMT variants and functional outcomes, likely due to the inadequate sample size. We also asked all potential participants why they consented to or refused genetic analysis. A thematic analysis of responses revealed altruism and personal interest/enthusiasm in the study as top reasons for consenting. Privacy concerns were the most common reason for refusal. In conclusion, we successfully developed standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing database, and we demonstrated the feasibility of conducting a multicenter collaborative study using a centralized lab location.
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Affiliation(s)
- Stephen Sibbett
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | - Jamie Oh
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | | | - Lara Muffley
- Department of Genome Sciences, University of Washington, Seattle, WA 98195, USA
| | - Nathaniel Ashford
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | - Maiya Pacleb
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | - Samuel Mandell
- Parkland Regional Burn Center, Department of Surgery, University of Texas Southwestern, Dallas, TX 75235, USA
| | - Jeffrey Schneider
- Rehabilitation Outcomes Center at Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02129, USA
| | - Steven Wolf
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
| | - Nicole S Gibran
- Department of Surgery, University of Washington, Seattle, WA 98195, USA
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Ongom PO, Ajibade YA, Mohammed SB, Dieng I, Fatokun C, Boukar O. HybridQC: A SNP-Based Quality Control Application for Rapid Hybridity Verification in Diploid Plants. Genes (Basel) 2024; 15:1252. [PMID: 39457376 PMCID: PMC11507623 DOI: 10.3390/genes15101252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/19/2024] [Accepted: 09/23/2024] [Indexed: 10/28/2024] Open
Abstract
Background/Objectives: Hybridity authentication is an important component of quality assurance and control (QA/QC) in breeding programs. Here, we introduce HybridQC v1.0, a QA/QC software program specially designed for parental purity and hybridity determination. HybridQC rapidly detects molecular marker polymorphism between parents of a cross and utilizes only the informative markers for hybridity authentication. Methods: HybridQC is written in Python and designed with a graphical user interface (GUI) compatible with Windows operating systems. We demonstrated the QA/QC analysis workflow and functionality of HybridQC using Kompetitive allele-specific PCR (KASP) SNP genotype data for cowpea (Vigna unguiculata). Its performance was validated in other crop data, including sorghum (Sorghum bicolor) and maize (Zea mays). Results: The application efficiently analyzed low-density SNP data from multiple cowpea bi-parental crosses embedded in a single Microsoft Excel file. HybridQC is optimized for the auto-generation of key summary statistics and visualization patterns for marker polymorphism, parental heterozygosity, non-parental alleles, missing data, and F1 hybridity. An added graphical interface correctly depicted marker efficiency and the proportions of true F1 versus self-fertilized progenies in the data sets used. The output of HybridQC was consistent with the results of manual hybridity discernment in sorghum and maize data sets. Conclusions: This application uses QA/QC SNP markers to rapidly verify true F1 progeny. It eliminates the extensive time often required to manually curate and process QA/QC data. This tool will enhance the optimization efforts in breeding programs, contributing to increased genetic gain.
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Affiliation(s)
- Patrick Obia Ongom
- International Institute of Tropical Agriculture (IITA), Kano 713103, Nigeria; (Y.A.A.); (S.B.M.); (O.B.)
| | - Yakub Adebare Ajibade
- International Institute of Tropical Agriculture (IITA), Kano 713103, Nigeria; (Y.A.A.); (S.B.M.); (O.B.)
| | - Saba Baba Mohammed
- International Institute of Tropical Agriculture (IITA), Kano 713103, Nigeria; (Y.A.A.); (S.B.M.); (O.B.)
| | - Ibnou Dieng
- International Institute of Tropical Agriculture (IITA), Ibadan 200001, Nigeria; (I.D.); (C.F.)
| | - Christian Fatokun
- International Institute of Tropical Agriculture (IITA), Ibadan 200001, Nigeria; (I.D.); (C.F.)
| | - Ousmane Boukar
- International Institute of Tropical Agriculture (IITA), Kano 713103, Nigeria; (Y.A.A.); (S.B.M.); (O.B.)
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3
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Gao C, Iles M, Larvin H, Bishop DT, Bunce D, Ide M, Sun F, Pavitt S, Wu J, Kang J. Genome-wide association studies on periodontitis: A systematic review. PLoS One 2024; 19:e0306983. [PMID: 39240858 PMCID: PMC11379206 DOI: 10.1371/journal.pone.0306983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/26/2024] [Indexed: 09/08/2024] Open
Abstract
OBJECTIVES This study aims to systematically review the existing literature and critically appraise the evidence of genome-wide association studies (GWAS) on periodontitis. This study also aims to synthesise the findings of genetic risk variants of periodontitis from included GWAS. METHODS A systematic search was conducted on PubMed, GWAS Catalog, MEDLINE, GLOBAL HEALTH and EMBASE via Ovid for GWAS on periodontitis. Only studies exploring single-nucleotide polymorphisms(SNPs) associated with periodontitis were eligible for inclusion. The quality of the GWAS was assessed using the Q-genie tool. Information such as study population, ethnicity, genomic data source, phenotypic characteristics(definition of periodontitis), and GWAS methods(quality control, analysis stages) were extracted. SNPs that reached conventional or suggestive GWAS significance level(5e-8 or 5e-06) were extracted and synthesized. RESULTS A total of 15 good-quality GWAS on periodontitis were included (Q-genie scores ranged from 38-50). There were huge heterogeneities among studies. There were 11 identified risk SNPs (rs242016, rs242014, rs10491972, rs242002, rs2978951, rs2738058, rs4284742, rs729876, rs149133391, rs1537415, rs12461706) at conventional GWAS significant level (p<5x10-8), and 41 at suggestive level (p<5x10-6), but no common SNPs were found between studies. Three SNPs (rs4284742 [G], rs11084095 [A], rs12461706 [T]) from three large studies were from the same gene region-SIGLEC5. CONCLUSION GWAS of periodontitis showed high heterogeneity of methodology used and provided limited SNPs statistics, making identifying reliable risk SNPs challenging. A clear guidance in dental research with requirement of expectation to make GWAS statistics available to other investigators are needed.
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Affiliation(s)
- Chenyi Gao
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Mark Iles
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Harriet Larvin
- Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | - David Timothy Bishop
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - David Bunce
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Mark Ide
- Centre for Host Microbial Interactions, Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, United Kingdom
| | - Fanyiwen Sun
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Susan Pavitt
- School of Dentistry, University of Leeds, Leeds, United Kingdom
| | - Jianhua Wu
- Wolfson Institute of Population Health, Queen Mary, University of London, London, United Kingdom
| | - Jing Kang
- Oral Clinical Research Unit, Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, United Kingdom
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4
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Bonilla DA, Orozco CA, Forero DA, Odriozola A. Techniques, procedures, and applications in host genetic analysis. ADVANCES IN GENETICS 2024; 111:1-79. [PMID: 38908897 DOI: 10.1016/bs.adgen.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
This chapter overviews genetic techniques' fundamentals and methodological features, including different approaches, analyses, and applications that have contributed to advancing health and disease. The aim is to describe laboratory methodologies and analyses employed to understand the genetic landscape of different biological contexts, from conventional techniques to cutting-edge technologies. Besides describing detailed aspects of the polymerase chain reaction (PCR) and derived types as one of the principles for many novel techniques, we also discuss microarray analysis, next-generation sequencing, and genome editing technologies such as transcription activator-like effector nucleases (TALENs) and the clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated (Cas) systems. These techniques study several phenotypes, ranging from autoimmune disorders to viral diseases. The significance of integrating diverse genetic methodologies and tools to understand host genetics comprehensively and addressing the ethical, legal, and social implications (ELSI) associated with using genetic information is highlighted. Overall, the methods, procedures, and applications in host genetic analysis provided in this chapter furnish researchers and practitioners with a roadmap for navigating the dynamic landscape of host-genome interactions.
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Affiliation(s)
- Diego A Bonilla
- Hologenomiks Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain; Research Division, Dynamical Business & Science Society-DBSS International SAS, Bogotá, Colombia.
| | - Carlos A Orozco
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá, Colombia
| | - Diego A Forero
- School of Health and Sport Sciences, Fundación Universitaria del Área Andina, Bogotá, Colombia
| | - Adrián Odriozola
- Hologenomiks Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain
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5
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Nibali L, Divaris K, Lu EMC. The promise and challenges of genomics-informed periodontal disease diagnoses. Periodontol 2000 2024; 95:194-202. [PMID: 39072804 DOI: 10.1111/prd.12587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/16/2024] [Accepted: 06/07/2024] [Indexed: 07/30/2024]
Abstract
Recent advances in human genomics and the advent of molecular medicine have catapulted our ability to characterize human and health and disease. Scientists and healthcare practitioners can now leverage information on genetic variation and gene expression at the tissue or even individual cell level, and an enormous potential exists to refine diagnostic categories, assess risk in unaffected individuals, and optimize disease management among those affected. This review investigates the progress made in the domains of molecular medicine and genomics as they relate to periodontology. The review summarizes the current evidence of association between genomics and periodontal diseases, including the current state of knowledge that approximately a third of the population variance of periodontitis may be attributable to genetic variation and the management of several monogenic forms of the disease can be augmented by knowledge of the underlying genetic cause. Finally, the paper discusses the potential utility of polygenic risk scores and genetic testing for periodontitis diagnosis now and in the future, in light of applications that currently exist in other areas of medicine and healthcare.
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Affiliation(s)
- Luigi Nibali
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Kimon Divaris
- Department of Pediatric Dentistry and Dental Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily Ming-Chieh Lu
- Periodontology Unit, Centre for Host Microbiome Interactions, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
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6
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Sahana G, Cai Z, Sanchez MP, Bouwman AC, Boichard D. Invited review: Good practices in genome-wide association studies to identify candidate sequence variants in dairy cattle. J Dairy Sci 2023:S0022-0302(23)00357-0. [PMID: 37349208 DOI: 10.3168/jds.2022-22694] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/01/2023] [Indexed: 06/24/2023]
Abstract
Genotype data from dairy cattle selection programs have greatly facilitated GWAS to identify variants related to economic traits. Results can enhance the accuracy of genomic prediction, analyze more complex models that go beyond additive effects, elucidate the genetic architecture of a trait, and finally, decipher the underlying biology of traits. The entire process, comprising data generation, quality control, statistical analyses, interpretation of association results, and linking results to biology should be designed and executed to minimize the generation of false-positive and false-negative associations and misleading links to biological processes. This review aims to provide general guidelines for data analysis that address data quality control, association tests, adjustment for population stratification, and significance evaluation to improve the reliability of conclusions. We also provide guidance on post-GWAS strategy and the interpretation of results. These guidelines are tailored to dairy cattle, which are characterized by long-range linkage disequilibrium, large half-sib families, and routinely collected phenotypes, requiring different approaches than those applied in human GWAS. We discuss common limitations and challenges that have been overlooked in the analysis and interpretation of GWAS to identify candidate sequence variants in dairy cattle.
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Affiliation(s)
- G Sahana
- Aarhus University, Center for Quantitative Genetic and Genomics, 8830 Tjele, Denmark.
| | - Z Cai
- Aarhus University, Center for Quantitative Genetic and Genomics, 8830 Tjele, Denmark
| | - M P Sanchez
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, 78350 Jouy-en-Josas, France
| | - A C Bouwman
- Wageningen University & Research, Animal Breeding and Genomics, 6700 AH Wageningen, the Netherlands
| | - D Boichard
- Université Paris-Saclay, INRAE, AgroParisTech, GABI, 78350 Jouy-en-Josas, France
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7
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Divaris K, Haworth S, Shaffer J, Anttonen V, Beck J, Furuichi Y, Holtfreter B, Jönsson D, Kocher T, Levy S, Magnusson P, McNeil D, Michaëlsson K, North K, Palotie U, Papapanou P, Pussinen P, Porteous D, Reis K, Salminen A, Schaefer A, Sudo T, Sun Y, Suominen A, Tamahara T, Weinberg S, Lundberg P, Marazita M, Johansson I. Phenotype Harmonization in the GLIDE2 Oral Health Genomics Consortium. J Dent Res 2022; 101:1408-1416. [PMID: 36000800 PMCID: PMC9516613 DOI: 10.1177/00220345221109775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Genetic risk factors play important roles in the etiology of oral, dental, and craniofacial diseases. Identifying the relevant risk loci and understanding their molecular biology could highlight new prevention and management avenues. Our current understanding of oral health genomics suggests that dental caries and periodontitis are polygenic diseases, and very large sample sizes and informative phenotypic measures are required to discover signals and adequately map associations across the human genome. In this article, we introduce the second wave of the Gene-Lifestyle Interactions and Dental Endpoints consortium (GLIDE2) and discuss relevant data analytics challenges, opportunities, and applications. In this phase, the consortium comprises a diverse, multiethnic sample of over 700,000 participants from 21 studies contributing clinical data on dental caries experience and periodontitis. We outline the methodological challenges of combining data from heterogeneous populations, as well as the data reduction problem in resolving detailed clinical examination records into tractable phenotypes, and describe a strategy that addresses this. Specifically, we propose a 3-tiered phenotyping approach aimed at leveraging both the large sample size in the consortium and the detailed clinical information available in some studies, wherein binary, severity-encompassing, and "precision," data-driven clinical traits are employed. As an illustration of the use of data-driven traits across multiple cohorts, we present an application of dental caries experience data harmonization in 8 participating studies (N = 55,143) using previously developed permanent dentition tooth surface-level dental caries pattern traits. We demonstrate that these clinical patterns are transferable across multiple cohorts, have similar relative contributions within each study, and thus are prime targets for genetic interrogation in the expanded and diverse multiethnic sample of GLIDE2. We anticipate that results from GLIDE2 will decisively advance the knowledge base of mechanisms at play in oral, dental, and craniofacial health and disease and further catalyze international collaboration and data and resource sharing in genomics research.
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Affiliation(s)
- K. Divaris
- Division of Pediatric and Public
Health, Adams School of Dentistry, University of North Carolina at Chapel Hill,
Chapel Hill, NC, USA
- Department of Epidemiology, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill, Chapel
Hill, NC, USA
| | - S. Haworth
- Medical Research Council Integrative
Epidemiology United, Department of Population Health Sciences, Bristol Medical
School, University of Bristol, Bristol, UK
- Bristol Dental School, University of
Bristol, Bristol, UK
| | - J.R. Shaffer
- Department of Human Genetics, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - V. Anttonen
- Research Unit of Oral Health Sciences,
Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center, Oulu
University Hospital and University of Oulu, Oulu, Finland
| | - J.D. Beck
- Division of Comprehensive Oral
Health–Periodontology, Adams School of Dentistry, University of North Carolina at
Chapel Hill, Chapel Hill, NC, USA
| | - Y. Furuichi
- Division of Endodontology and
Periodontology, Department of Oral Rehabilitation, Graduate School of Dentistry,
Health Sciences University of Hokkaido, Hokkaido, Japan
| | - B. Holtfreter
- Department of Restorative Dentistry,
Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University
Medicine Greifswald, Greifswald, Germany
| | - D. Jönsson
- Public Dental Service of Skåne, Lund,
Sweden
- Hypertension and Cardiovascular
Disease, Department of Clinical Sciences in Malmö, Lund University, Malmö,
Sweden
- Faculty of Odontology, Malmö
University, Malmö, Sweden
| | - T. Kocher
- Department of Restorative Dentistry,
Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University
Medicine Greifswald, Greifswald, Germany
| | - S.M. Levy
- Department of Preventive and
Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA,
USA
| | - P.K.E. Magnusson
- Department of Medical Epidemiology
and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - D.W. McNeil
- Center for Oral Health Research in
Appalachia, Appalachia, NY, USA
- Department of Psychology, West
Virginia University, Morgantown, WV, USA
- Department of Dental Public Health
& Professional Practice, West Virginia University, Morgantown, WV, USA
| | - K. Michaëlsson
- Department of Surgical Sciences, Unit
of Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - K.E. North
- Department of Epidemiology, Gillings
School of Global Public Health, University of North Carolina at Chapel Hill, Chapel
Hill, NC, USA
- Carolina Population Center,
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - U. Palotie
- Oral and Maxillofacial Diseases,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - P.N. Papapanou
- Division of Periodontics, Section of
Oral, Diagnostic and Rehabilitation Sciences, Columbia University, College of Dental
Medicine, New York, NY, USA
| | - P.J. Pussinen
- Oral and Maxillofacial Diseases,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute of Dentistry, School on
Medicine, University of Eastern Finland, Kuopio, Finland
| | - D. Porteous
- Centre for Genomic and Experimental
Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh,
UK
| | - K. Reis
- Institute of Genomics, University of
Tartu, Tartu, Estonia
| | - A. Salminen
- Oral and Maxillofacial Diseases,
University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - A.S. Schaefer
- Department of Periodontology, Oral
Medicine and Oral Surgery, Institute for Dental and Craniofacial Sciences,
Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - T. Sudo
- Institute of Education, Tokyo Medical
and Dental University, Tokyo, Japan
| | - Y.Q. Sun
- Center for Oral Health Services and
Research Mid-Norway (TkMidt), Trondheim, Norway
- Department of Clinical and Molecular
Medicine, NTNU, Norwegian University of Science and Technology, Trondheim,
Norway
| | - A.L. Suominen
- Institute of Dentistry, School on
Medicine, University of Eastern Finland, Kuopio, Finland
- Institute of Dentistry, School on
Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Oral and Maxillofacial
Diseases, Kuopio University Hospital, Kuopio, Finland
- Public Health Evaluation and
Projection Unit, Finnish Institute for Health and Welfare (THL), Helsinki,
Finland
| | - T. Tamahara
- Department of Community Medical
Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai,
Japan
| | - S.M. Weinberg
- Department of Human Genetics, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - P. Lundberg
- Department of Odontology, Section of
Molecular Periodontology, Umeå University, Umeå, Sweden
| | - M.L. Marazita
- Department of Human Genetics, Graduate
School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Center for Craniofacial and Dental
Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine,
University of Pittsburgh, Pittsburgh, PA, USA
| | - I. Johansson
- Department of Odontology, Section of
Cariology, Umeå University, Umeå, Sweden
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8
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Examining Barriers and Opportunities of Conducting Genome-Wide Association Studies in Developing Countries. CURR EPIDEMIOL REP 2022. [DOI: 10.1007/s40471-022-00303-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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9
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Silva DNDA, Monajemzadeh S, Pirih FQ. Systems Biology in Periodontitis. FRONTIERS IN DENTAL MEDICINE 2022. [DOI: 10.3389/fdmed.2022.853133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Systems biology is a promising scientific discipline that allows an integrated investigation of host factors, microbial composition, biomarkers, immune response and inflammatory mediators in many conditions such as chronic diseases, cancer, neurological disorders, and periodontitis. This concept utilizes genetic decoding, bioinformatic, flux-balance analysis in a comprehensive approach. The aim of this review is to better understand the current literature on systems biology and identify a clear applicability of it to periodontitis. We will mostly focus on the association between this condition and topics such as genomics, transcriptomics, proteomics, metabolomics, as well as contextualize delivery systems for periodontitis treatment, biomarker detection in oral fluids and associated systemic conditions.
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10
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Muneeb M, Henschel A. Eye-color and Type-2 diabetes phenotype prediction from genotype data using deep learning methods. BMC Bioinformatics 2021; 22:198. [PMID: 33874881 PMCID: PMC8056510 DOI: 10.1186/s12859-021-04077-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
Background Genotype–phenotype predictions are of great importance in genetics. These predictions can help to find genetic mutations causing variations in human beings. There are many approaches for finding the association which can be broadly categorized into two classes, statistical techniques, and machine learning. Statistical techniques are good for finding the actual SNPs causing variation where Machine Learning techniques are good where we just want to classify the people into different categories. In this article, we examined the Eye-color and Type-2 diabetes phenotype. The proposed technique is a hybrid approach consisting of some parts from statistical techniques and remaining from Machine learning. Results The main dataset for Eye-color phenotype consists of 806 people. 404 people have Blue-Green eyes where 402 people have Brown eyes. After preprocessing we generated 8 different datasets, containing different numbers of SNPs, using the mutation difference and thresholding at individual SNP. We calculated three types of mutation at each SNP no mutation, partial mutation, and full mutation. After that data is transformed for machine learning algorithms. We used about 9 classifiers, RandomForest, Extreme Gradient boosting, ANN, LSTM, GRU, BILSTM, 1DCNN, ensembles of ANN, and ensembles of LSTM which gave the best accuracy of 0.91, 0.9286, 0.945, 0.94, 0.94, 0.92, 0.95, and 0.96% respectively. Stacked ensembles of LSTM outperformed other algorithms for 1560 SNPs with an overall accuracy of 0.96, AUC = 0.98 for brown eyes, and AUC = 0.97 for Blue-Green eyes. The main dataset for Type-2 diabetes consists of 107 people where 30 people are classified as cases and 74 people as controls. We used different linear threshold to find the optimal number of SNPs for classification. The final model gave an accuracy of 0.97%. Conclusion Genotype–phenotype predictions are very useful especially in forensic. These predictions can help to identify SNP variant association with traits and diseases. Given more datasets, machine learning model predictions can be increased. Moreover, the non-linearity in the Machine learning model and the combination of SNPs Mutations while training the model increases the prediction. We considered binary classification problems but the proposed approach can be extended to multi-class classification.
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Affiliation(s)
- Muhammad Muneeb
- Department of Electrical Engineering and Computer Science, Center for Biotechnology Khalifa University, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Andreas Henschel
- Department of Electrical Engineering and Computer Science, Center for Biotechnology Khalifa University, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates.
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11
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Divaris K, Slade GD, Ferreira Zandona AG, Preisser JS, Ginnis J, Simancas-Pallares MA, Agler CS, Shrestha P, Karhade DS, Ribeiro ADA, Cho H, Gu Y, Meyer BD, Joshi AR, Azcarate-Peril MA, Basta PV, Wu D, North KE. Cohort Profile: ZOE 2.0-A Community-Based Genetic Epidemiologic Study of Early Childhood Oral Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8056. [PMID: 33139633 PMCID: PMC7663650 DOI: 10.3390/ijerph17218056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
Early childhood caries (ECC) is an aggressive form of dental caries occurring in the first five years of life. Despite its prevalence and consequences, little progress has been made in its prevention and even less is known about individuals' susceptibility or genomic risk factors. The genome-wide association study (GWAS) of ECC ("ZOE 2.0") is a community-based, multi-ethnic, cross-sectional, genetic epidemiologic study seeking to address this knowledge gap. This paper describes the study's design, the cohort's demographic profile, data domains, and key oral health outcomes. Between 2016 and 2019, the study enrolled 8059 3-5-year-old children attending public preschools in North Carolina, United States. Participants resided in 86 of the state's 100 counties and racial/ethnic minorities predominated-for example, 48% (n = 3872) were African American, 22% white, and 20% (n = 1611) were Hispanic/Latino. Seventy-nine percent (n = 6404) of participants underwent clinical dental examinations yielding ECC outcome measures-ECC (defined at the established caries lesion threshold) prevalence was 54% and the mean number of decayed, missing, filled surfaces due to caries was eight. Nearly all (98%) examined children provided sufficient DNA from saliva for genotyping. The cohort's community-based nature and rich data offer excellent opportunities for addressing important clinical, epidemiologic, and biological questions in early childhood.
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Affiliation(s)
- Kimon Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (P.V.B.); (K.E.N.)
| | - Gary D. Slade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Andrea G. Ferreira Zandona
- Department of Comprehensive Dentistry, School of Dental Medicine, Tufts University, Boston, MA 02111, USA;
| | - John S. Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (J.S.P.); (H.C.); (Y.G.); (D.W.)
| | - Jeannie Ginnis
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Miguel A. Simancas-Pallares
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Cary S. Agler
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Poojan Shrestha
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (P.V.B.); (K.E.N.)
| | - Deepti S. Karhade
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA; (G.D.S.); (J.G.); (M.A.S.-P.); (C.S.A.); (P.S.); (D.S.K.)
| | - Apoena de Aguiar Ribeiro
- Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA;
| | - Hunyong Cho
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (J.S.P.); (H.C.); (Y.G.); (D.W.)
| | - Yu Gu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (J.S.P.); (H.C.); (Y.G.); (D.W.)
| | - Beau D. Meyer
- Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA;
| | - Ashwini R. Joshi
- Division of Surgery, School of Medicine, University of North Carolina-Chapel Hill, NC 27599-7050, USA;
| | - M. Andrea Azcarate-Peril
- Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, and UNC Microbiome Core, Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, NC 27599-7555, USA;
| | - Patricia V. Basta
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (P.V.B.); (K.E.N.)
| | - Di Wu
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (J.S.P.); (H.C.); (Y.G.); (D.W.)
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina-Chapel Hill, NC 27599-7450, USA
| | - Kari E. North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC 27599-7400, USA; (P.V.B.); (K.E.N.)
- Carolina Center for Genome Sciences, University of North Carolina-Chapel Hill, NC 27514, USA
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Comparison of DNA Extracted from Pediatric Saliva, Gingival Crevicular Fluid and Site-Specific Biofilm Samples. Methods Protoc 2020; 3:mps3030048. [PMID: 32660039 PMCID: PMC7565886 DOI: 10.3390/mps3030048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/04/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
(1) Introduction: Due to the non-invasive nature of saliva, many methods have been used to isolate and collect DNA from saliva samples for microbial screening. Many oral microbes also inhabit the oral biofilm, which may represent significantly different microbial constituents that may contribute to oral health and disease, including caries and periodontal disorders. Moreover, the biofilm may vary within the same patient at different sites. Few studies have evaluated the comparison between DNA isolated from saliva and DNA from site-specific biofilm, with virtually no studies addressing this analysis among pediatric patients. (2) Methods: An existing repository of paper point derived biofilm, gingival crevicular fluid (GCF), and unstimulated saliva samples previously collected from pediatric patients (n = 47) was identified. DNA was isolated from biofilm sites (tongue, upper buccal molar, mandibular lingual incisor), and GCF and saliva were used for quantitative DNA comparison using a phenol:chloroform extraction. A quantitative and qualitative analysis was performed using the NanoDrop 2000 spectrophotometer using absorbance readings at A230 nm, A260 nm and A280 nm. (3) Results: These data demonstrated the successful isolation of DNA from all of the patient samples, with the highest concentrations observed among unstimulated saliva (4264.1 ng/μL) and the lowest derived from GCF (1771.5 ng/μL). No differences were observed between males and females or minorities and non-minority patients. In addition, comparison of the overall concentrations of DNA obtained from adult samples was slightly higher than, but not significantly different from, the concentrations obtained from pediatric samples (p = 0.2827). A real-time quantitative qPCR screening revealed that all of the samples evaluated harbored bacterial and human DNA of sufficient quantity and quality for a molecular screening greater than the limit of detection (ΔRn = 0.01). (4) Conclusions: Many methods are currently available to provide the sampling and screening of saliva and specific sites within the oral cavity, but the validation and comparison of simple and low-cost methods, that include paper point sampling and unstimulated saliva collection, may suggest these methods and protocols provide sufficient DNA quality and quantity for molecular screening and other comparison applications. In addition, although heterogeneity will be a constant and consistent feature between patient samples, standardized methods that provide similar and consistent DNA from various oral sites may provide needed consistency for screening and molecular analysis.
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13
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Divaris K, Joshi A. The building blocks of precision oral health in early childhood: the ZOE 2.0 study. J Public Health Dent 2020; 80 Suppl 1:S31-S36. [PMID: 30566750 PMCID: PMC6584604 DOI: 10.1111/jphd.12303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
Abstract
Improving children's oral health is a long-standing area of priority and sustained efforts by many stakeholders. Despite these efforts, dental caries, particularly early childhood caries (ECC), persists as a clinical and dental public health problem with multilevel consequences. Despite recent successes in the non-restorative management of dental caries, remarkably little has been done in the domain of ECC prevention. There is promise and expectation that meaningful improvements in early childhood oral health and ECC prevention can be made via the advent of precision medicine in the oral health domain. We posit that precision dentistry, including genomic influences, may be best examined in the context of well-characterized communities (versus convenience clinical samples) and the impact of contextual factors including geography and social disadvantage may be explainable via mechanistic (i.e., biological) research. This notion is aligned with the population approach in precision medicine, which calls for the latter to be predictive, preventive, personalized, and participatory. The article highlights research directions that must be developed for precision dentistry and precision dental public health to be realized. In this context, we describe the rationale, activities, and early insights gained from the ZOE 2.0 study - a large-scale, community-based, genetic epidemiologic study of early childhood oral health. We anticipate that this long-term research program will illuminate foundational domains for the advancement of precision dentistry and precision dental public health. Ultimately, this new knowledge can help catalyze the development of effective preventive and therapeutic modalities via actions at the policy, community, family, and person level.
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Affiliation(s)
- Kimon Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashwini Joshi
- Department of Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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14
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Agler CS, Divaris K. Sources of bias in genomics research of oral and dental traits. COMMUNITY DENTAL HEALTH 2020; 37:102-106. [PMID: 32031351 PMCID: PMC7316399 DOI: 10.1922/cdh_specialissue_divaris05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Evidence regarding the genomic basis of oral/dental traits and diseases is a fundamental pillar of the emerging notion of precision health. During the last decade, technological advances have improved the feasibility and affordability of conducting genome-wide association studies (GWAS) and studying the associations of emanating data with both common and rare oral conditions. Most evidence thus far emanates from GWAS of dental caries and periodontal disease that have tested the associations of several million single nucleotide polymorphisms (SNPs) with typically binary, health vs. disease phenotypes. GWAS offer advantages over the previous candidate-gene studies, mainly owing to their agnostic (i.e., unbiased, or hypothesis-free) nature. Nevertheless, GWAS are prone to virtually all sources of random and systematic error. Here, we review common sources of bias in genomics research with focus on GWAS including: type I and II errors, population stratification and heterogeneity, selection bias, adjustment for heritable covariates, appropriate reference panels for imputation, and gene annotation. We argue that valid and precise phenotype measurement is a key requirement, as GWAS sample sizes and thus statistical power increase. Finally, we stress that the lack of diversity of populations with phenotypes and genotypes is a major limitation for the generalizability and ultimate translation of the emerging genomics evidence-base into oral health promotion for all.
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Affiliation(s)
- Cary S Agler
- Adams School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
| | - Kimon Divaris
- Adams School of Dentistry, University of North Carolina Chapel Hill, Chapel Hill, NC, United States
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15
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Biologically Defined or Biologically Informed Traits Are More Heritable Than Clinically Defined Ones: The Case of Oral and Dental Phenotypes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1197:179-189. [PMID: 31732942 DOI: 10.1007/978-3-030-28524-1_13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The genetic basis of oral health has long been theorized, but little information exists on the heritable variance in common oral and dental disease traits explained by the human genome. We sought to add to the evidence base of heritability of oral and dental traits using high-density genotype data in a well-characterized community-based cohort of middle-age adults. We used genome-wide association (GWAS) data combined with clinical and biomarker information in the Dental Atherosclerosis Risk In Communities (ARIC) cohort. Genotypes comprised SNPs directly typed on the Affymetrix Genome-Wide Human SNP Array 6.0 chip with minor allele frequency of >5% (n = 656,292) or were imputed using HapMap II-CEU (n = 2,104,905). We investigated 30 traits including "global" [e.g., number of natural teeth (NT) and incident tooth loss], clinically defined (e.g., dental caries via the DMFS index, periodontitis via the CDC/AAP and WW17 classifications), and biologically informed (e.g., subgingival pathogen colonization and "complex" traits). Heritability (i.e., variance explained; h2) was calculated using Visscher's Genome-wide Complex Trait Analysis (GCTA), using a random-effects mixed linear model and restricted maximum likelihood (REML) regression adjusting for ancestry (10 principal components), age, and sex. Heritability estimates were modest for clinical traits-NT = 0.11 (se = 0.07), severe chronic periodontitis (CDC/AAP) = 0.22 (se = 0.19), WW17 Stage 4 vs. 1/2 = 0.15 (se = 0.11). "High gingival index" and "high red complex colonization" had h2 > 0.50, while a periodontal complex trait defined by high IL-1β GCF expression and Aggregatibacter actinomycetemcomitans subgingival colonization had the highest h2 = 0.72 (se = 0.32). Our results indicate that all GWAS SNPs explain modest levels of the observed variance in clinical oral and dental measures. Subgingival bacterial colonization and complex phenotypes encompassing both bacterial colonization and local inflammatory response had the highest heritability, suggesting that these biologically informed traits capture aspects of the disease process and are promising targets for genomics investigations, according to the notion of precision oral health.
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16
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Ginnis J, Ferreira Zandoná AG, Slade GD, Cantrell J, Antonio ME, Pahel BT, Meyer BD, Shrestha P, Simancas-Pallares MA, Joshi AR, Divaris K. Measurement of Early Childhood Oral Health for Research Purposes: Dental Caries Experience and Developmental Defects of the Enamel in the Primary Dentition. Methods Mol Biol 2019; 1922:511-523. [PMID: 30838597 PMCID: PMC6642073 DOI: 10.1007/978-1-4939-9012-2_39] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Epidemiological investigations of early childhood oral health rely upon the collection of high-quality clinical measures of health and disease. However, ascertainment of valid and accurate clinical measures presents unique challenges among young, preschool-age children. The paper presents a clinical research protocol for the conduct of oral epidemiological examinations among children, implemented in ZOE 2.0, a large-scale population-based genetic epidemiologic study of early childhood caries (ECC). The protocol has been developed for the collection of information on tooth surface-level dental caries experience and tooth-level developmental defects of the enamel in the primary dentition. Dental caries experience is recorded using visual criteria modified from the International Caries Detection and Assessment System (ICDAS), and measurement of developmental defects is based upon the modified Clarkson and O'Mullane Developmental Defects of the Enamel Index. After a dental prophylaxis (toothbrushing among all children and flossing as needed), children's teeth are examined by trained and calibrated examiners in community locations, using portable dental equipment, compressed air, and uniform artificial light and magnification conditions. Data are entered directly onto a computer using a custom Microsoft Access-based data entry application. The ZOE 2.0 clinical protocol has been implemented successfully for the conduct of over 6000 research examinations to date, contributing phenotype data to downstream genomics and other "omics" studies of ECC and DDE, as well as traditional clinical and epidemiologic dental research.
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Affiliation(s)
- Jeannie Ginnis
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Andrea G Ferreira Zandoná
- Department of Comprehensive Dentistry, Tufts University School of Dental Medicine, Tufts University, Boston, MA, USA
| | - Gary D Slade
- Department of Dental Ecology, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - John Cantrell
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Mikafui E Antonio
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Bhavna T Pahel
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Beau D Meyer
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Poojan Shrestha
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Miguel A Simancas-Pallares
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Ashwini R Joshi
- Oral and Craniofacial Health Sciences, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Kimon Divaris
- Department of Pediatric Dentistry, UNC School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
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