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Batissoco AC, Cruz DB, Alegria TGP, Kobayashi G, Oiticica J, Soares LE, Passos-Bueno MR, Haddad LA, Mingroni RC. GJB2 c.35del variant up-regulates GJA1 gene expression and affects differentiation of human stem cells. Genet Mol Biol 2024; 47:e20230170. [PMID: 38626573 PMCID: PMC11021044 DOI: 10.1590/1678-4685-gmb-2023-0170] [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: 06/02/2023] [Accepted: 01/17/2024] [Indexed: 04/18/2024] Open
Abstract
Pathogenic DNA alterations in GJB2 are present in nearly half of non-syndromic hearing loss cases with autosomal recessive inheritance. The most frequent variant in GJB2 causing non-syndromic hearing loss is the frameshifting c.35del. GJB2 encodes Cx26, a protein of the connexin family that assembles hemichannels and gap junctions. The expression of paralogous proteins is believed to compensate for the loss of function of specific connexins. As Cx26 has been involved in cell differentiation in distinct tissues, we employed stem cells derived from human exfoliated deciduous teeth (SHEDs), homozygous for the c.35del variant, to assess GJB2 roles in stem cell differentiation and the relationship between its loss of function and the expression of paralogous genes. Primary SHED cultures from patients and control individuals were compared. SHEDs from patients had significantly less GJB2 mRNA and increased amount of GJA1 (Cx43), but not GJB6 (Cx30) or GJB3 (Cx31) mRNA. In addition, they presented higher induced differentiation to adipocytes and osteocytes but lower chondrocyte differentiation. Our results suggest that GJA1 increased expression may be involved in functional compensation for GJB2 loss of function in human stem cells, and it may explain changes in differentiation properties observed in SHEDs with and without the c.35del variant.
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Affiliation(s)
- Ana Carla Batissoco
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas (HC), Laboratório de Investigação Médica de Otorrinolaringologia (LIM32), São Paulo, SP, Brazil
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Dayane Bernardino Cruz
- Universidade de São Paulo (USP), Instituto de Biociências (IB), Centro de Pesquisa Sobre o Genoma Humano e Células-Tronco (HUG-CELL), Departamento de Genética e Biologia Evolutiva, São Paulo, SP, Brazil
| | - Thiago Geronimo Pires Alegria
- Universidade de São Paulo (USP), Instituto de Biociências (IB), Centro de Pesquisa Sobre o Genoma Humano e Células-Tronco (HUG-CELL), Departamento de Genética e Biologia Evolutiva, São Paulo, SP, Brazil
| | - Gerson Kobayashi
- Universidade de São Paulo (USP), Instituto de Biociências (IB), Centro de Pesquisa Sobre o Genoma Humano e Células-Tronco (HUG-CELL), Departamento de Genética e Biologia Evolutiva, São Paulo, SP, Brazil
| | - Jeanne Oiticica
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Hospital das Clínicas (HC), Laboratório de Investigação Médica de Otorrinolaringologia (LIM32), São Paulo, SP, Brazil
- Universidade de São Paulo (USP), Faculdade de Medicina (FM), Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Luis Eduardo Soares
- Universidade de São Paulo (USP), Instituto de Biociências (IB), Centro de Pesquisa Sobre o Genoma Humano e Células-Tronco (HUG-CELL), Departamento de Genética e Biologia Evolutiva, São Paulo, SP, Brazil
| | - Maria Rita Passos-Bueno
- Universidade de São Paulo (USP), Instituto de Biociências (IB), Centro de Pesquisa Sobre o Genoma Humano e Células-Tronco (HUG-CELL), Departamento de Genética e Biologia Evolutiva, São Paulo, SP, Brazil
| | - Luciana Amaral Haddad
- Universidade de São Paulo (USP), Instituto de Biociências (IB), Centro de Pesquisa Sobre o Genoma Humano e Células-Tronco (HUG-CELL), Departamento de Genética e Biologia Evolutiva, São Paulo, SP, Brazil
| | - Regina Célia Mingroni
- Universidade de São Paulo (USP), Instituto de Biociências (IB), Centro de Pesquisa Sobre o Genoma Humano e Células-Tronco (HUG-CELL), Departamento de Genética e Biologia Evolutiva, São Paulo, SP, Brazil
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De Rosa MA, Bernardi MT, Kleppe S, Walz K. Hearing Loss: Genetic Testing, Current Advances and the Situation in Latin America. Genes (Basel) 2024; 15:178. [PMID: 38397168 PMCID: PMC10888486 DOI: 10.3390/genes15020178] [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: 12/27/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
Congenital hearing loss is the most common birth defect, estimated to affect 2-3 in every 1000 births, with ~50-60% of those related to genetic causes. Technological advances enabled the identification of hundreds of genes related to hearing loss (HL), with important implications for patients, their families, and the community. Despite these advances, in Latin America, the population with hearing loss remains underdiagnosed, with most studies focusing on a single locus encompassing the GJB2/GJB6 genes. Here we discuss how current and emerging genetic knowledge has the potential to alter the approach to diagnosis and management of hearing loss, which is the current situation in Latin America, and the barriers that still need to be overcome.
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Affiliation(s)
- Maria Agustina De Rosa
- Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN) CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires C1428EHA, Argentina; (M.A.D.R.); (M.T.B.)
| | - Maria T. Bernardi
- Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN) CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires C1428EHA, Argentina; (M.A.D.R.); (M.T.B.)
| | - Soledad Kleppe
- Department of Clinical Pediatrics, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires C1199ABB, Argentina;
| | - Katherina Walz
- Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN) CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires C1428EHA, Argentina; (M.A.D.R.); (M.T.B.)
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- John T. Macdonald Foundation Department of Human Genetics, Miller School of Medicine, University of Miami, 1501 NW 10th Avenue, BRB-418 (M-860), Miami, FL 33136, USA
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Bertani-Torres W, Lezirovitz K, Alencar-Coutinho D, Pardono E, da Costa SS, Antunes LDN, de Oliveira J, Otto PA, Pingault V, Mingroni-Netto RC. Waardenburg Syndrome: The Contribution of Next-Generation Sequencing to the Identification of Novel Causative Variants. Audiol Res 2023; 14:9-25. [PMID: 38391765 PMCID: PMC10886116 DOI: 10.3390/audiolres14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 02/24/2024] Open
Abstract
Waardenburg syndrome (WS) is characterized by hearing loss and pigmentary abnormalities of the eyes, hair, and skin. The condition is genetically heterogeneous, and is classified into four clinical types differentiated by the presence of dystopia canthorum in type 1 and its absence in type 2. Additionally, limb musculoskeletal abnormalities and Hirschsprung disease differentiate types 3 and 4, respectively. Genes PAX3, MITF, SOX10, KITLG, EDNRB, and EDN3 are already known to be associated with WS. In WS, a certain degree of molecularly undetected patients remains, especially in type 2. This study aims to pinpoint causative variants using different NGS approaches in a cohort of 26 Brazilian probands with possible/probable diagnosis of WS1 (8) or WS2 (18). DNA from the patients was first analyzed by exome sequencing. Seven of these families were submitted to trio analysis. For inconclusive cases, we applied a targeted NGS panel targeting WS/neurocristopathies genes. Causative variants were detected in 20 of the 26 probands analyzed, these being five in PAX3, eight in MITF, two in SOX10, four in EDNRB, and one in ACTG1 (type 2 Baraitser-Winter syndrome, BWS2). In conclusion, in our cohort of patients, the detection rate of the causative variant was 77%, confirming the superior detection power of NGS in genetically heterogeneous diseases.
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Affiliation(s)
- William Bertani-Torres
- Centro de Estudos sobre o Genoma Humano e Células Tronco, Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, Universidade de São Paulo, São Paulo 05508-090, Brazil
- Department of Embryology and Genetics of Malformations, INSERM (Institut National de la Santé et de la Recherche Médicale) UMR (Unité Mixte de Recherche) 1163, Université Paris-Cité and Institut Imagine, 75015 Paris, France
| | - Karina Lezirovitz
- Otorhinolaryngology Lab-LIM 32, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil
| | - Danillo Alencar-Coutinho
- Otorhinolaryngology Lab-LIM 32, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil
| | - Eliete Pardono
- Instituto de Ciências da Saúde, Universidade Paulista UNIP, São Paulo 04026-002, Brazil
- Colégio Miguel de Cervantes, São Paulo 05618-001, Brazil
| | - Silvia Souza da Costa
- Centro de Estudos sobre o Genoma Humano e Células Tronco, Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, Universidade de São Paulo, São Paulo 05508-090, Brazil
| | - Larissa do Nascimento Antunes
- Centro de Estudos sobre o Genoma Humano e Células Tronco, Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, Universidade de São Paulo, São Paulo 05508-090, Brazil
| | - Judite de Oliveira
- Médecine Génomique des Maladies Rares, AP-HP, Hôpital Necker-Enfants Malades, 75015 Paris, France
| | - Paulo Alberto Otto
- Centro de Estudos sobre o Genoma Humano e Células Tronco, Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, Universidade de São Paulo, São Paulo 05508-090, Brazil
| | - Véronique Pingault
- Department of Embryology and Genetics of Malformations, INSERM (Institut National de la Santé et de la Recherche Médicale) UMR (Unité Mixte de Recherche) 1163, Université Paris-Cité and Institut Imagine, 75015 Paris, France
- Médecine Génomique des Maladies Rares, AP-HP, Hôpital Necker-Enfants Malades, 75015 Paris, France
| | - Regina Célia Mingroni-Netto
- Centro de Estudos sobre o Genoma Humano e Células Tronco, Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, Universidade de São Paulo, São Paulo 05508-090, Brazil
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Fehrmann MLA, Huinck WJ, Thijssen MEG, Haer-Wigman L, Yntema HG, Rotteveel LJC, Widdershoven JCC, Goderie T, van Dooren MF, Hoefsloot EH, van der Schroeff MP, Mylanus EAM, Lanting CP, Pennings RJE. Stable long-term outcomes after cochlear implantation in subjects with TMPRSS3 associated hearing loss: a retrospective multicentre study. J Otolaryngol Head Neck Surg 2023; 52:82. [PMID: 38102706 PMCID: PMC10724910 DOI: 10.1186/s40463-023-00680-3] [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: 06/20/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The spiral ganglion hypothesis suggests that pathogenic variants in genes preferentially expressed in the spiral ganglion nerves (SGN), may lead to poor cochlear implant (CI) performance. It was long thought that TMPRSS3 was particularly expressed in the SGNs. However, this is not in line with recent reviews evaluating CI performance in subjects with TMPRSS3-associated sensorineural hearing loss (SNHL) reporting overall beneficial outcomes. These outcomes are, however, based on variable follow-up times of, in general, 1 year or less. Therefore, we aimed to 1. evaluate long-term outcomes after CI implantation of speech recognition in quiet in subjects with TMPRSS3-associated SNHL, and 2. test the spiral ganglion hypothesis using the TMPRSS3-group. METHODS This retrospective, multicentre study evaluated long-term CI performance in a Dutch population with TMPRSS3-associated SNHL. The phoneme scores at 70 dB with CI in the TMPRSS3-group were compared to a control group of fully genotyped cochlear implant users with post-lingual SNHL without genes affecting the SGN, or severe anatomical inner ear malformations. CI-recipients with a phoneme score ≤ 70% at least 1-year post-implantation were considered poor performers and were evaluated in more detail. RESULTS The TMPRSS3 group consisted of 29 subjects (N = 33 ears), and the control group of 62 subjects (N = 67 ears). For the TMPRSS3-group, we found an average phoneme score of 89% after 5 years, which remained stable up to 10 years post-implantation. At both 5 and 10-year follow-up, no difference was found in speech recognition in quiet between both groups (p = 0.830 and p = 0.987, respectively). Despite these overall adequate CI outcomes, six CI recipients had a phoneme score of ≤ 70% and were considered poor performers. The latter was observed in subjects with residual hearing post-implantation or older age at implantation. CONCLUSION Subjects with TMPRSS3-associated SNHL have adequate and stable long-term outcomes after cochlear implantation, equal to the performance of genotyped patient with affected genes not expressed in the SGN. These findings are not in line with the spiral ganglion hypothesis. However, more recent studies showed that TMPRSS3 is mainly expressed in the hair cells with only limited SGN expression. Therefore, we cannot confirm nor refute the spiral ganglion hypothesis.
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Affiliation(s)
- M L A Fehrmann
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - W J Huinck
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - M E G Thijssen
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - L Haer-Wigman
- Department of Clinical Genetics, Radboudumc, Nijmegen, The Netherlands
| | - H G Yntema
- Department of Clinical Genetics, Radboudumc, Nijmegen, The Netherlands
| | - L J C Rotteveel
- Department of Otorhinolaryngology, Leiden UMC, Leiden, The Netherlands
| | - J C C Widdershoven
- Department of Otorhinolaryngology, Maastricht UMC, Maastricht, The Netherlands
| | - T Goderie
- Department of Otorhinolaryngology-Head and Neck Surgery, Ear and Hearing, Amsterdam UMC, Amsterdam, The Netherlands
| | - M F van Dooren
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - E H Hoefsloot
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | | | - E A M Mylanus
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - C P Lanting
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands
| | - R J E Pennings
- Department of Otorhinolaryngology, Radboudumc, Nijmegen, The Netherlands.
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New Insights into the Identity of the DFNA58 Gene. Genes (Basel) 2022; 13:genes13122274. [PMID: 36553541 PMCID: PMC9777997 DOI: 10.3390/genes13122274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Hearing loss is the most common sensory deficit, affecting 466 million people worldwide. The vast and diverse genes involved reflect the complexity of auditory physiology, which requires the use of animal models in order to gain a fuller understanding. Among the loci with a yet-to-be validated gene is the DFNA58, in which ~200 Kb genomic duplication, including three protein-coding genes (PLEK, CNRIP1, and PPP3R1's exon1), was found to segregate with autosomal dominant hearing loss. Through whole genome sequencing, the duplication was found to be in tandem and inserted in an intergenic region, without the disruption of the topological domains. Reanalysis of transcriptomes data studies (zebrafish and mouse), and RT-qPCR analysis of adult zebrafish target organs, in order to access their orthologues expression, highlighted promising results with Cnrip1a, corroborated by zebrafish in situ hybridization and immunofluorescence. Mouse data also suggested Cnrip1 as the best candidate for a relevant role in auditory physiology, and its importance in hearing seems to have remained conserved but the cell type exerting its function might have changed, from hair cells to spiral ganglion neurons.
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Silva VAR, Pauna HF, Lavinsky J, Hyppolito MA, Vianna MF, Leal M, Massuda ET, Hamerschmidt R, Bahmad F, Cal RV, Sampaio ALL, Felix F, Chone CT, Castilho AM. Task force Guideline of Brazilian Society of Otology ‒ hearing loss in children - Part I ‒ Evaluation. Braz J Otorhinolaryngol 2022; 89:159-189. [PMID: 36529647 PMCID: PMC9874360 DOI: 10.1016/j.bjorl.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0 to 18 years. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The evaluation and diagnosis of hearing loss: universal newborn hearing screening, laboratory testing, congenital infections (especially cytomegalovirus), genetic testing and main syndromes, radiologic imaging studies, vestibular assessment of children with hearing loss, auditory neuropathy spectrum disorder, autism spectrum disorder, and noise-induced hearing loss. CONCLUSIONS Every child with suspected hearing loss has the right to diagnosis and appropriate treatment if necessary. This task force considers 5 essential rights: (1) Otolaryngologist consultation; (2) Speech assessment and therapy; (3) Diagnostic tests; (4) Treatment; (5) Ophthalmologist consultation.
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Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil.
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Mariana Leal
- Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia, Recife, PE, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Rogério Hamerschmidt
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Fayez Bahmad
- Universidade de Brasília (UnB), Programa de Pós-Graduação em Ciências da Saúde, Brasília, DF, Brazil; Instituto Brasiliense de Otorrinolaringologia (IBO), Brasília, DF, Brazil
| | - Renato Valério Cal
- Centro Universitário do Estado do Pará (CESUPA), Departamento de Otorrinolaringologia, Belém, PA, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Felippe Felix
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Departamento de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
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Lezirovitz K, Mingroni-Netto RC. Genetic etiology of non-syndromic hearing loss in Latin America. Hum Genet 2021; 141:539-581. [PMID: 34652575 DOI: 10.1007/s00439-021-02354-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/23/2021] [Indexed: 12/16/2022]
Abstract
Latin America comprises all countries from South and Central America, in addition to Mexico. It is characterized by a complex mosaic of regions with heterogeneous genetic profiles regarding the geographical origin of the ancestors and proportions of admixture between the Native American, European and African components. In the first years following the findings of the role of the GJB2/GJB6 genes in the etiology of hearing loss, most scientific investigations about the genetics of hearing loss in Latin America focused on assessing the frequencies of pathogenic variants in these genes. More recently, modern techniques allowed researchers in Latin America to make exciting contributions to the finding of new candidate genes, novel mechanisms of inheritance in previously known genes, and characterize a wide diversity of variants, many of them unique to Latin America. This review aimed to provide a general landscape of the genetic studies about non-syndromic hearing loss in Latin America and their main scientific contributions. It allows the conclusion that, although there are similar contributions of some genes, such as GJB2/GJB6, when compared to European and North American countries, Latin American populations revealed some peculiarities that indicate the need for tailored strategies of screening and diagnosis to specific geographic regions.
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Affiliation(s)
- Karina Lezirovitz
- Laboratório de Otorrinolaringologia/LIM32, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Regina Célia Mingroni-Netto
- Departamento de Genética e Biologia Evolutiva, Centro de Pesquisas sobre o Genoma Humano e Células-Tronco, Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
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