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Francisquetti MCC, Gil-da-Silva-Lopes VL, Fett-Conte AC. How are people with orofacial clefts attended in northwest region of São Paulo state, Brazil? Genet Mol Biol 2023; 46:e20230167. [PMID: 38112488 PMCID: PMC10729311 DOI: 10.1590/1678-4685-gmb-2023-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/26/2023] [Indexed: 12/21/2023] Open
Abstract
Characterization of specific birth defects is essential for conducting scientific investigations, care and therapeutic strategies. This article describes demographic, clinical and genetic aspects, risk factors and access to treatment of Brazilian patients with orofacial clefts registered in a specialized collaborative center of the Brazilian Database on Craniofacial Anomalies (BDCA). We interviewed 70 individuals with typical orofacial clefts using a standard instrument from the database and subjected them to genetic testing. The patients were grouped as syndromic and non-syndromic. The majority of individuals were of lower middle class, native ancestry and syndromic. There was a significant difference in the type of clefts regarding gender. There was no significant difference between bilateral and unilateral, between the side affected, right and left, or familial recurrence related to type of oral cleft. The risk factor familial recurrence was significantly higher among non-syndromic cases. Etiological factors were identified or suggested in 62.5% of the syndromic cases. There was a delay in diagnosis and in access to treatment in most cases. We concluded that gender, native ancestry and low family income represent risk factors. Furthermore, the distribution by cleft types and gender is similar to previous studies. The results can guide scientific investigations and care policies.
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Affiliation(s)
- Marina Cristine Cano Francisquetti
- Universidade Estadual Paulista, Instituto de Biociências, Letras e Ciências Exatas, Programa de Pós-Graduação em Biociências, São José do Rio Preto, SP, Brazil
| | | | - Agnes Cristina Fett-Conte
- Faculdade de Medicina de São José do Rio Preto, Departamento de Biologia Molecular, São José do Rio Preto, SP, Brazil
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Diaz Perez KK, Curtis SW, Sanchis-Juan A, Zhao X, Head T, Ho S, Carter B, McHenry T, Bishop MR, Valencia-Ramirez LC, Restrepo C, Hecht JT, Uribe LM, Wehby G, Weinberg SM, Beaty TH, Murray JC, Feingold E, Marazita ML, Cutler DJ, Epstein MP, Brand H, Leslie EJ. Rare variants found in clinical gene panels illuminate the genetic and allelic architecture of orofacial clefting. Genet Med 2023; 25:100918. [PMID: 37330696 PMCID: PMC10592535 DOI: 10.1016/j.gim.2023.100918] [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: 01/18/2023] [Revised: 05/12/2023] [Accepted: 06/10/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE Orofacial clefts (OFCs) are common birth defects including cleft lip, cleft lip and palate, and cleft palate. OFCs have heterogeneous etiologies, complicating clinical diagnostics because it is not always apparent if the cause is Mendelian, environmental, or multifactorial. Sequencing is not currently performed for isolated or sporadic OFCs; therefore, we estimated the diagnostic yield for 418 genes in 841 cases and 294 controls. METHODS We evaluated 418 genes using genome sequencing and curated variants to assess their pathogenicity using American College of Medical Genetics criteria. RESULTS 9.04% of cases and 1.02% of controls had "likely pathogenic" variants (P < .0001), which was almost exclusively driven by heterozygous variants in autosomal genes. Cleft palate (17.6%) and cleft lip and palate (9.09%) cases had the highest yield, whereas cleft lip cases had a 2.80% yield. Out of 39 genes with likely pathogenic variants, 9 genes, including CTNND1 and IRF6, accounted for more than half of the yield (4.64% of cases). Most variants (61.8%) were "variants of uncertain significance", occurring more frequently in cases (P = .004), but no individual gene showed a significant excess of variants of uncertain significance. CONCLUSION These results underscore the etiological heterogeneity of OFCs and suggest sequencing could reduce the diagnostic gap in OFCs.
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Affiliation(s)
| | - Sarah W Curtis
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Alba Sanchis-Juan
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, Department of Neurology and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Xuefang Zhao
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, Department of Neurology and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Taylor Head
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Samantha Ho
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Bridget Carter
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA; Agnes Scott College, Decatur, GA
| | - Toby McHenry
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA
| | - Madison R Bishop
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | | | | | - Jacqueline T Hecht
- Department of Pediatrics, McGovern Medical, School and School of Dentistry, UT Health at Houston, Houston, TX
| | - Lina M Uribe
- Department of Orthodontics, University of Iowa, Iowa City, IA
| | - George Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA
| | - Seth M Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Eleanor Feingold
- Department of Human Genetics, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - Mary L Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh School of Dental Medicine, Pittsburgh, PA; Department of Human Genetics, University of Pittsburgh School of Public Health, Pittsburgh, PA
| | - David J Cutler
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Michael P Epstein
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA
| | - Harrison Brand
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, Department of Neurology and Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Elizabeth J Leslie
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA.
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Kini U. Genetics and orofacial clefts: a clinical perspective. Br Dent J 2023; 234:947-952. [PMID: 37349452 PMCID: PMC10287552 DOI: 10.1038/s41415-023-5994-3] [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: 02/09/2023] [Revised: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023]
Abstract
Orofacial clefts (OFCs) are the most common congenital craniofacial anomaly seen in humans. Most OFCs are sporadic and isolated - these are thought to be multifactorial in origin. Chromosomal and monogenic variants account for the syndromic forms and for some of the non-syndromic inherited forms. This review discusses the importance of genetic testing and the current clinical strategy to deliver a genomics service that is of direct benefit to patients and their families.
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Affiliation(s)
- Usha Kini
- Oxford Centre for Genomic Medicine, Oxford University Hospitals, UK; Spires Cleft Service, Oxford University Hospitals, UK; NDCLS, Radcliffe Department of Medicine, University of Oxford, United Kingdom.
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Zhang Y, Sun F, Yuan K, Du Y, Wu L, Ge Y, Zhang Z, Sun S, Cao W. Ambient temperature and major structural anomalies: A retrospective study of over 2 million newborns. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 882:163613. [PMID: 37087019 DOI: 10.1016/j.scitotenv.2023.163613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/16/2023] [Accepted: 04/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Maternal exposure to ambient heat may be associated with congenital anomalies, but evidence is still limited. OBJECTIVES We aimed to estimate the association between maternal exposure to ambient heat during the 3-12 weeks post-conception (critical window of organogenesis) and risk of total and various diagnostic categories of major structural anomalies among live singleton births in the contiguous United States (US). METHODS We included data on 2,352,529 births with the first day of critical developmental windows falling within months of May through August from 2000 to 2004 across 525 US counties. We used a validated spatial-temporal model to estimate daily county-level population-weighted temperature. We used logistic regression to estimate the association between ambient temperature and risk of diagnostic categories of anomalies during the critical window after adjusting for individual and county-level factors. We conducted subgroup analysis to identify potential susceptible subpopulations. RESULTS A total of 29,188 anomalies (12.4 per 1000 births) were recorded during the study period. Maternal exposure to extreme heat (> 95th percentile) was associated with higher risk of total anomalies, central nervous system anomalies, and other uncategorized anomalies with an odds ratio (OR) of 1.05 (95 % CI: 1.00, 1.11), 1.17 (95 % CI: 1.01, 1.37), and 1.16 (95 % CI: 1.04, 1.29) compared with minimum morbidity temperature, respectively. The associations were homogeneous across subgroups defined by maternal age, maternal race/ethnicity, marital status, educational attainment, and parity, but were more pronounced among mothers residing in more socially vulnerable counties and births with multiple anomalies. CONCLUSIONS Among US live singleton births, maternal exposure to ambient heat may be associated with higher risk of total anomalies, central nervous system anomalies, and other uncategorized anomalies. We suggest additional research is carried out to better understand the relations between maternal heat exposure and congenital anomalies in the presence of global warming.
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Affiliation(s)
- Yangchang Zhang
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Kun Yuan
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Ying Du
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China
| | - Lizhi Wu
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Bin Sheng Road, Binjiang District, Hangzhou 310051, China
| | - Yang Ge
- School of Health Professions, University of Southern Mississippi, Hattiesburg 39402, MS, USA
| | - Zhenyu Zhang
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Shengzhi Sun
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Capital Medical University, Beijing, China; School of Public Health, The Key Laboratory of Environmental Pollution Monitoring and Disease Control, Ministry of Education, Guizhou Medical University, Guiyang 550025, China.
| | - Wangnan Cao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing 100191, China.
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