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Murugesu S, Jones BP, Serhal P, Ben-Nagi J. Successful preimplantation genetic testing for fibrodysplasia ossificans progressiva: a case report. J Med Case Rep 2024; 18:227. [PMID: 38664849 PMCID: PMC11046953 DOI: 10.1186/s13256-024-04504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/10/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE OF THE STUDY Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant condition that leads to significant disability and morbidity, characterised by the formation of heterotopic hard tissues within connective tissues. The condition has an incidence of approximately one per two million people worldwide. There is no known single effective treatment available for FOP. We report the world's first case of a healthy infant born following in vitro fertilisation (IVF) and preimplantation genetic testing for monogenic disorder (PGT-M) using Karyomapping for FOP. CASE PRESENTATION A 30-year-old Caucasian female with FOP presented with her partner seeking IVF with PGT-M to achieve a healthy pregnancy with an embryo unaffected by FOP. METHODS The couple underwent IVF and PGT-M using Karyomapping as the testing method. A multi-disciplinary team approach was utilised in planning this case, considering the additional risks of oocyte retrieval, pregnancy and childbirth in women with FOP. MAIN FINDINGS The oocyte retrieval was covered with a 5-day course of prednisolone to reduce the risk of a localised inflammatory reaction, which could result in subsequent heterotopic ossification. This was subsequently weaned down with reducing doses every two days. The patient underwent uncomplicated oocyte retrieval, yielding 12 mature oocytes. Following intracytoplasmic sperm injection (ICSI), ten zygotes having two pro-nuclei were cultured, and six underwent trophoectoderm biopsy and vitrification 5-6 days after retrieval. PGT-M via Karyomapping revealed four out of six (66.7%) of blastocysts were not carriers of the maternal high-risk FOP allele. In total, the patient had three separate embryo transfers. Pregnancy was achieved following the third frozen embryo transfer, which went to 37 weeks' gestation, and delivered by Caesarean section. The baby was born in excellent condition and is unaffected by FOP. CONCLUSION IVF/ICSI and PGT-M using Karyomapping was successfully implemented to identify embryos carrying the high-risk FOP allele resulting in a healthy livebirth.
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Affiliation(s)
- Sughashini Murugesu
- Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London, W12 0HS, UK.
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK.
| | - Benjamin P Jones
- Queen Charlotte's and Chelsea Hospital, Imperial College NHS Trust, Du Cane Road, London, W12 0HS, UK
- Department of Surgery and Cancer, Imperial College London, London, W12 0NN, UK
| | - Paul Serhal
- Centre for Reproductive and Genetic Health, 230-232 Great Portland Street, London, W1W 5QS, UK
| | - Jara Ben-Nagi
- Centre for Reproductive and Genetic Health, 230-232 Great Portland Street, London, W1W 5QS, UK
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Ni H, Tang S, Zhang Y. A fibrodysplasia ossificans progressiva patient with a rare missense mutation in ACVR1 detected on 18F-FDG PET/CT. Joint Bone Spine 2024; 91:105682. [PMID: 38159793 DOI: 10.1016/j.jbspin.2023.105682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/03/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an exceedingly rare human genetic disorder characterized by the progressive and incapacitating formation of ectopic bone outside the skeleton. We report a case of FOP patient with mutations within the ACVR1 gene (c.982G>A; p.G328R). 18F-FDG positron emission tomography/computed tomography (PET/CT) was carried out for disease assessment. Previous studies have shown increased FDG uptake in regions of heterotopic ossification (HO) in FOP. However, in our study, the PET/CT features demonstrate that active ossificans exhibit increased 18F-FDG uptake, whereas end-stage ossifications do not. Collectively, 18F-FDG PET/CT emerges as a prospective approach to evaluate medication efficacy in the early stages, directing early intervention and pharmacological management of FOP before ossifications formation.
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Affiliation(s)
- Haopeng Ni
- Department of Nuclear Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, 310000 Hangzhou, Zhejiang, China
| | - Songhan Tang
- Department of Nuclear Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, 310000 Hangzhou, Zhejiang, China
| | - Ying Zhang
- Department of Nuclear Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, 310000 Hangzhou, Zhejiang, China.
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Ahn TY, Han JB, Bae JY, Woo SH. Superior mesenteric artery syndrome in a patient with fibrodysplasia ossificans progressiva. Bone Rep 2023; 19:101702. [PMID: 37520933 PMCID: PMC10382279 DOI: 10.1016/j.bonr.2023.101702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
An 18-year-old boy with fibrodysplasia ossificans progressiva lost weight at an accelerated rate due to gastrointestinal symptoms, resulting in a weight loss of 36 kg in 1 year. His first outpatient abdominal computed tomography (CT) result was unremarkable. Since the patient had biliary vomiting during hospitalization, his CT was reexamined, and the superior mesenteric artery syndrome diagnosis was confirmed. Thus, clinicians must consider superior mesenteric artery syndrome when presented with weight loss.
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Affiliation(s)
- Tae Young Ahn
- Department of Orthopedic Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan 49241, Republic of Korea
| | - Jung Bum Han
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
| | - Jung Yun Bae
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
| | - Seung Hun Woo
- Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan 50612, Republic of Korea
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Ohte S, Yamazaki H, Takahashi O, Rotinsulu H, Wewengkang DS, Sumilat DA, Abdjul DB, Maarisit W, Kapojos MM, Zhang H, Hayashi F, Namikoshi M, Katagiri T, Tomoda H, Uchida R. Inhibitory effects of sesquiterpene lactones from the Indonesian marine sponge Lamellodysidea cf. herbacea on bone morphogenetic protein-induced osteoblastic differentiation. Bioorg Med Chem Lett 2021; 35:127783. [PMID: 33422607 DOI: 10.1016/j.bmcl.2021.127783] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/22/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022]
Abstract
A new unique sesquiterpene lactone, bicyclolamellolactone A (1), was isolated together with two known monocyclofarnesol-type sesquiterpenes, lamellolactones A (2) and B (3), from the Indonesian marine sponge Lamellodysidea sp. (cf. L. herbacea). The planar structure of 1 was assigned based on its spectroscopic data (1D and 2D NMR, HRESIMS, UV, and IR spectra). The relative and absolute configuration of 1 was determined by comparison of its calculated and experimental electronic circular dichroism spectra in combination with NOESY correlations. Compounds 1-3 inhibited bone morphogenic protein (BMP)-induced alkaline phosphatase activity in mutant BMP receptor-carrying C2C12 cells with IC50 values of 51, 4.6, and 20 μM, respectively.
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Affiliation(s)
- Satoshi Ohte
- Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan.
| | - Hiroyuki Yamazaki
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
| | - Ohgi Takahashi
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
| | - Henki Rotinsulu
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan; Faculty of Mathematic and Natural Sciences, Sam Ratulangi University, Kampus Bahu, Manado 95115, Indonesia
| | - Defny S Wewengkang
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan; Faculty of Mathematic and Natural Sciences, Sam Ratulangi University, Kampus Bahu, Manado 95115, Indonesia
| | - Deiske A Sumilat
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan; Faculty of Fisheries and Marine Science, Sam Ratulangi University, Kampus Bahu, Manado 95115, Indonesia
| | - Delfly B Abdjul
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan; North Sulawesi Research and Development Agency, 17 Agustus Street, Manado 95117, Indonesia
| | - Wilmar Maarisit
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan; Faculty of Mathematics and Natural Sciences, Christian University of Indonesia, Tomohon 95362, Indonesia
| | - Magie M Kapojos
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan; Faculty of Nursing, University of Pembangunan Indonesia, Bahu, Manado 95115, Indonesia
| | - Huiping Zhang
- NMR Science and Development Division, RIKEN SPring-8 Center, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045, Japan
| | - Fumiaki Hayashi
- NMR Science and Development Division, RIKEN SPring-8 Center, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045, Japan
| | - Michio Namikoshi
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan
| | - Takenobu Katagiri
- Division of Biomedical Sciences, Research Center for Genomic Medicine, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama 350-1241, Japan
| | - Hiroshi Tomoda
- Graduate School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Ryuji Uchida
- Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Sendai 981-8558, Japan.
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Abstract
Fibrodysplasia ossificans progressiva (FOP) is a rare human skeletal disease caused by constitutively activating mutations in the gene ACVR1, which encodes a type I BMP/TGFβ family member receptor. FOP is characterized by progressive heterotopic ossification (HO) of fibrous tissues, including skeletal muscle, tendons, and ligaments, as well as malformation of the big toes, vertebral fusions, and osteochondromas. Surgical interventions in patients often result in enhanced HO, which can exacerbate rather than improve diagnostic outcomes. As a result of these difficulties, a variety of animal models are needed to study human FOP. Here we describe the methods for creating and characterizing zebrafish conditionally expressing Acvr1lQ204D, the first adult zebrafish model for FOP.
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Affiliation(s)
- Melissa LaBonty
- Program in Cell, Molecular, and Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA.,Department of Orthodontics, Division of Craniofacial and Molecular Genetics, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Pamela C Yelick
- Program in Cell, Molecular, and Developmental Biology, Sackler School of Graduate Biomedical Sciences, Tufts University School of Medicine, Boston, MA, USA. .,Department of Orthodontics, Division of Craniofacial and Molecular Genetics, Tufts University School of Dental Medicine, Boston, MA, USA.
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Tian S, Zhu J, Lu Y. Difficult diagnosis and genetic analysis of fibrodysplasia ossificans progressiva: a case report. BMC Med Genet 2018; 19:30. [PMID: 29482508 PMCID: PMC5828422 DOI: 10.1186/s12881-018-0543-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 02/15/2018] [Indexed: 01/21/2023]
Abstract
Background Fibrodysplasia ossificans progressiva (FOP), an ultra-rare and disabling genetic disorder of skeletal malformations and progressive heterotopic ossification, is caused by heterozygous activating mutations in activin A receptor, type I/activin-like kinase 2 (ACVR1/ALK2). The rarity of the disease makes it common to make a misdiagnosis and cause mismanagement. Case presentation We reported a case of a sixteen-year-old male patient who had suffered from pain and swelling in the biopsy site for two months. His physical examination presented serious stiffness and multiple bony masses in the body, with his bilateral halluces characterized by hallux valgus deformity and macrodactyly. Imaging examinations showed widespread heterotopic ossification. All laboratory blood tests were normal except for the one on alkaline phosphatase. A de novo heterozygous mutation (c.617G > A; p.R206H) were found in the ACVR1/ALK2 using gene sequencing. Conclusion Even though FOP is a rare disorder of genetic origin, which is generally misdiagnosed, the genetic analysis could provide definitive confirmation of the disease. Awareness of such an important approach can help clinicians to avoid the commonly practiced misdiagnosis and mismanagement of the rare disease.
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Affiliation(s)
- Shengjie Tian
- Department of Emergency Traumatic Surgery, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China
| | - Jianhua Zhu
- Department of Emergency Traumatic Surgery, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China.
| | - Yaogang Lu
- Department of Emergency Traumatic Surgery, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China
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Abstract
Fibrodysplasia ossificans progressive (FOP) is an extremely rare autosomal dominant disorder characterized by congenital malformations of the great toes and progressive heterotopic ossification that can induce a disabling second skeleton. Spontaneously occurring flare-ups can cause inflammatory soft tissue to swell, followed by progressive and disabling heterotopic endochondral ossification. FOP is very rare, with an estimated incidence of one case per two million individuals. There is no definitive treatment for FOP, but the longevity of patients with FOP can be extended by early diagnosis and appropriate prevention of flares-up. Some promising treatment strategies and targets have recently been reported. The current review describes the classical phenotype and genotype of FOP, useful methods of diagnosing the condition, therapeutic approaches and commonly used drugs, and experimental models used to study this disease.
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Affiliation(s)
- Zijuan Qi
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Science, Ji'nan, China
- Key Laboratory for Rare Disease Research of Shandong Province, Key Laboratory for Biotech Drugs of the Ministry of Health, Shandong Medical Biotechnological Center, Shandong Academy of Medical Sciences, Ji'nan, China
| | - Jing Luan
- Key Laboratory for Rare Disease Research of Shandong Province, Key Laboratory for Biotech Drugs of the Ministry of Health, Shandong Medical Biotechnological Center, Shandong Academy of Medical Sciences, Ji'nan, China
| | - Xiaoyan Zhou
- Key Laboratory for Rare Disease Research of Shandong Province, Key Laboratory for Biotech Drugs of the Ministry of Health, Shandong Medical Biotechnological Center, Shandong Academy of Medical Sciences, Ji'nan, China
| | - Yazhou Cui
- Key Laboratory for Rare Disease Research of Shandong Province, Key Laboratory for Biotech Drugs of the Ministry of Health, Shandong Medical Biotechnological Center, Shandong Academy of Medical Sciences, Ji'nan, China
| | - Jinxiang Han
- Key Laboratory for Rare Disease Research of Shandong Province, Key Laboratory for Biotech Drugs of the Ministry of Health, Shandong Medical Biotechnological Center, Shandong Academy of Medical Sciences, Ji'nan, China
- Address correspondence to: Dr. Jinxiang Han, Key Laboratory for Rare Disease Research of Shandong Province, Key Laboratory for Biotech Drugs of the Ministry of Health, Shandong Medical Biotechnological Center, Shandong Academy of Medical Sciences, Ji'nan, Shandong 250062, China. E-mail:
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Bertamino M, Severino M, Schiaffino MC, Garrè ML, Bocciardi R, Ravazzolo R, Rossi A, Di Rocco M. New insights into central nervous system involvement in FOP: Case report and review of the literature. Am J Med Genet A 2015; 167A:2817-21. [PMID: 26239063 DOI: 10.1002/ajmg.a.37271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/13/2015] [Indexed: 12/29/2022]
Abstract
Fibrodyspasia ossificans progressiva is an autosomal dominant disease due to activating mutations in activin receptor type IA and characterized by progressive heterotopic ossification. Recently, the same non-synonymous heterozygous somatic mutations of ACVR1 have been identified in brain biopsies or autopsy of 24-27% of patients with a rare cerebral tumor, the diffuse intrinsic pontine glioma. We report the first case of a patient with FOP with incidental findings of an abnormal soft tissue mass surrounding the brainstem and causing obstructive hydrocephalus, associated with bilateral dentate lesions. Clinico-radiological course during 10 years of follow-up was consistent with a benign lesion, excluding an oncogenic role of ACVR1 mutations.
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Affiliation(s)
- Marta Bertamino
- Department of Medicine and Surgery, University of Genoa, Genoa, Italy
| | | | | | | | - Renata Bocciardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,G. Gaslini Institute, Laboratory of Molecular Genetics Genoa, Italy 7 Giannina Gaslini Institute, Rare Diseases, Pediatric, Genoa, Italy
| | - Roberto Ravazzolo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,G. Gaslini Institute, Laboratory of Molecular Genetics Genoa, Italy 7 Giannina Gaslini Institute, Rare Diseases, Pediatric, Genoa, Italy
| | - Andrea Rossi
- Giannina Gaslini Institute, Unit of Neuroradiology, Genoa, Italy
| | - Maja Di Rocco
- Giannina Gaslini Institute, Rare Diseases, Pediatric, Genoa, Italy
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Agarwal S, Loder SJ, Brownley C, Eboda O, Peterson JR, Hayano S, Wu B, Zhao B, Kaartinen V, Wong VC, Mishina Y, Levi B. BMP signaling mediated by constitutively active Activin type 1 receptor (ACVR1) results in ectopic bone formation localized to distal extremity joints. Dev Biol 2015; 400:202-9. [PMID: 25722188 DOI: 10.1016/j.ydbio.2015.02.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/11/2015] [Accepted: 02/15/2015] [Indexed: 10/24/2022]
Abstract
BMP signaling mediated by ACVR1 plays a critical role for development of multiple structures including the cardiovascular and skeletal systems. While deficient ACVR1 signaling impairs normal embryonic development, hyperactive ACVR1 function (R206H in humans and Q207D mutation in mice, ca-ACVR1) results in formation of heterotopic ossification (HO). We developed a mouse line, which conditionally expresses ca-ACVR1 with Nfatc1-Cre(+) transgene. Mutant mice developed ectopic cartilage and bone at the distal joints of the extremities including the interphalangeal joints and hind limb ankles as early as P4 in the absence of trauma or exogenous bone morphogenetic protein (BMP) administration. Micro-CT showed that even at later time points (up to P40), cartilage and bone development persisted at the affected joints most prominently in the ankle. Interestingly, this phenotype was not present in areas of bone outside of the joints - tibia are normal in mutants and littermate controls away from the ankle. These findings demonstrate that this model may allow for further studies of heterotopic ossification, which does not require the use of stem cells, direct trauma or activation with exogenous Cre gene administration.
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Affiliation(s)
- Shailesh Agarwal
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, USA
| | - Shawn J Loder
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, USA
| | - Cameron Brownley
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, USA
| | - Oluwatobi Eboda
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, USA
| | - Jonathan R Peterson
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, USA
| | - Satoru Hayano
- University of Michigan, School of Dentistry, Department of Biologic and Materials Sciences, Ann Arbor, MI, USA
| | - Bingrou Wu
- Albert Einstein College of Medicine, Department of Genetics, Bronx, New York, USA
| | - Bin Zhao
- Albert Einstein College of Medicine, Department of Genetics, Bronx, New York, USA
| | - Vesa Kaartinen
- University of Michigan, School of Dentistry, Department of Biologic and Materials Sciences, Ann Arbor, MI, USA
| | - Victor C Wong
- Johns Hopkins University, Department of Plastic Surgery, Baltimore, MD, USA
| | - Yuji Mishina
- University of Michigan, School of Dentistry, Department of Biologic and Materials Sciences, Ann Arbor, MI, USA.
| | - Benjamin Levi
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, USA.
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