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Salami AY, Agbara KS, Moulot OM, Ehua AM, Opaleye TO, Adesina AO, Bankole R. Van Der Woude Syndrome: A Case Series at Chu D' Treichville, Abidjan, Cote D' Ivoire. J West Afr Coll Surg 2023; 13:56-58. [PMID: 37538203 PMCID: PMC10395858 DOI: 10.4103/jwas.jwas_20_23] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/12/2023] [Indexed: 08/05/2023]
Abstract
Background Van der Woude syndrome (VWS), characterised mainly by lower lip pits and orofacial cleft (OFC), is the most common syndrome associated with an OFC. It is inherited as an autosomal dominant, high penetrance disorder with variable phenotypic expression and caused by the genetic mutation of the interferon regulatory factor 6 gene (IRF6). This study showcases the syndrome's variable phenotypic expressivity in six cases seen at Chu d' Treichvile, Abidjan, and Cote d'Ivoire. Materials and Methods A review of six cases at the above-named hospital. Data collected include age at presentation, gender, type of cleft, presence or absence of lip pits, and family history of VWS. Results Six cases of VWS were reviewed with an age range from 2 to 39 years and a male-to-female ratio of 1:2. Three of the patients had a bilateral cleft lip, one case of unilateral cleft lip and palate, another single case of cleft palate only while the sixth patient has no cleft deformity. All the patients have bilateral lower lip pits except one with a single median pit on the lower lip. There is a family history of VWS in three of the patients. Conclusion Our study demonstrates the variable expressivity of VWS as different forms of lower lip pits and OFC. The presence of lower lip pits should be a signal for examination of family members to identify other cases and those likely to have cleft babies. Genetic mapping to detect mutation of IRF6 genes will be of tremendous aid in the effective diagnosis of VWS.
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Affiliation(s)
- Ajibola Yussuf Salami
- Dental department, Randle General Hospital, Surulere, Lagos State Health Service Commission, Lagos, Nigeria
| | - Kouame Soroboua Agbara
- Department of Paediatric Surgery, University Teaching Hospital (Centre Hospitalier Universitaire) Treichville, Abidjan, Cote d’ ivoire
| | - Olivier Martial Moulot
- Department of Paediatric Surgery, University Teaching Hospital (Centre Hospitalier Universitaire) Treichville, Abidjan, Cote d’ ivoire
| | - Adjoba Manuela Ehua
- Department of Paediatric Surgery, University Teaching Hospital (Centre Hospitalier Universitaire) Treichville, Abidjan, Cote d’ ivoire
| | - Taofiq Olamide Opaleye
- Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital Ikeja, Lagos, Nigeria
| | - Adewale Oluwafemi Adesina
- Department of Oral and Maxillofacial Surgery, Lagos State University College of Medicine, Lagos State University Teaching Hospital Ikeja, Lagos, Nigeria
| | - Rouma Bankole
- Department of Paediatric Surgery, University Teaching Hospital (Centre Hospitalier Universitaire) Treichville, Abidjan, Cote d’ ivoire
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Naicker T, Alade A, Adeleke C, Mossey PA, Awotoye WA, Busch T, Li M, Olotu J, Aldous C, Butali A. Novel IRF6 variant in orofacial cleft patients from Durban, South Africa. Mol Genet Genomic Med 2023; 11:e2138. [PMID: 36811272 PMCID: PMC10178789 DOI: 10.1002/mgg3.2138] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/22/2022] [Accepted: 01/10/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND To date, there are over 320 variants identified in the IRF6 gene that cause Van der Woude syndrome or popliteal pterygium syndrome. We sequenced this gene in a South African orofacial cleft cohort to identify the causal IRF6 variants in our population. METHOD Saliva samples from 100 patients with syndromic and non-syndromic CL ± P were collected. Patients were recruited from the cleft clinics at two public, tertiary hospitals in Durban, South Africa (SA), namely Inkosi Albert Luthuli Central Hospital (IALCH) and KwaZulu-Natal Children's Hospital (KZNCH). We prospectively sequenced the exons of IRF6 in 100 orofacial cleft cases, and where possible, we also sequenced the parents of the individuals to determine the segregation pattern. RESULTS Two variants were identified; one novel (p.Cys114Tyr) and one known (p.Arg84His) missense variant in IRF6 gene were identified. The patient with the p.Cys114Tyr variant was non-syndromic with no clinical VWS phenotype expected of individuals with IRF6 coding variants, and the patient with the p.Arg84His had phenotypic features of popliteal pterygium syndrome. The p.Arg84His variant segregated in the family, with the father also being affected. CONCLUSIONS This study provides evidence that IRF6 variants are found in the South African population. Genetic counselling is essential for affected families, particularly in the absence of a known clinical phenotype since it helps with the plans for future pregnancies.
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Affiliation(s)
- Thirona Naicker
- Genetics, Department of PaediatricsUniversity of KwaZulu‐NatalDurbanSouth Africa
- Smile Train PartnerNew YorkNew YorkUSA
| | - Azeez Alade
- Department of Oral Pathology, Radiology and Medicine, College of DentistryUniversity of IowaIowa CityIowaUSA
| | - Chinyere Adeleke
- Department of Oral Pathology, Radiology and Medicine, College of DentistryUniversity of IowaIowa CityIowaUSA
| | - Peter A. Mossey
- Department of OrthodonticsUniversity of DundeeDundeeUK
- Smile Train Global Medical Advisory BoardUSA
| | - Waheed A. Awotoye
- Department of Oral Pathology, Radiology and Medicine, College of DentistryUniversity of IowaIowa CityIowaUSA
| | - Tamara Busch
- Department of Oral Pathology, Radiology and Medicine, College of DentistryUniversity of IowaIowa CityIowaUSA
| | - Mary Li
- Department of Oral Pathology, Radiology and Medicine, College of DentistryUniversity of IowaIowa CityIowaUSA
| | - Joy Olotu
- Department of AnatomyUniversity of Port HarcourtPort HarcourtNigeria
| | - Colleen Aldous
- School of Clinical MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, College of DentistryUniversity of IowaIowa CityIowaUSA
- Smile Train Research and Innovation Advisory CouncilUSA
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Slavec L, Geršak K, Eberlinc A, Hovnik T, Lovrečić L, Mlinarič-Raščan I, Karas Kuželički N. A Comprehensive Genetic Analysis of Slovenian Families with Multiple Cases of Orofacial Clefts Reveals Novel Variants in the Genes IRF6, GRHL3, and TBX22. Int J Mol Sci 2023; 24:ijms24054262. [PMID: 36901693 PMCID: PMC10002089 DOI: 10.3390/ijms24054262] [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: 11/25/2022] [Revised: 01/13/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Although the aetiology of non-syndromic orofacial clefts (nsOFCs) is usually multifactorial, syndromic OFCs (syOFCs) are often caused by single mutations in known genes. Some syndromes, e.g., Van der Woude syndrome (VWS1; VWS2) and X-linked cleft palate with or without ankyloglossia (CPX), show only minor clinical signs in addition to OFC and are sometimes difficult to differentiate from nsOFCs. We recruited 34 Slovenian multi-case families with apparent nsOFCs (isolated OFCs or OFCs with minor additional facial signs). First, we examined IRF6, GRHL3, and TBX22 by Sanger or whole exome sequencing to identify VWS and CPX families. Next, we examined 72 additional nsOFC genes in the remaining families. Variant validation and co-segregation analysis were performed for each identified variant using Sanger sequencing, real-time quantitative PCR and microarray-based comparative genomic hybridization. We identified six disease-causing variants (three novel) in IRF6, GRHL3, and TBX22 in 21% of families with apparent nsOFCs, suggesting that our sequencing approach is useful for distinguishing syOFCs from nsOFCs. The novel variants, a frameshift variant in exon 7 of IRF6, a splice-altering variant in GRHL3, and a deletion of the coding exons of TBX22, indicate VWS1, VWS2, and CPX, respectively. We also identified five rare variants in nsOFC genes in families without VWS or CPX, but they could not be conclusively linked to nsOFC.
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Affiliation(s)
- Lara Slavec
- Research Unit, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Ksenija Geršak
- Research Unit, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Andreja Eberlinc
- Department of Maxillofacial and Oral Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Tinka Hovnik
- Clinical Institute for Special Laboratory Diagnostics, University Children’s Hospital, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Luca Lovrečić
- Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Clinical Institute of Genomic Medicine, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Irena Mlinarič-Raščan
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Nataša Karas Kuželički
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
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Schierz IAM, Amoroso S, Antona V, Giuffrè M, Piro E, Serra G, Corsello G. Novel de novo missense mutation in the interferon regulatory factor 6 gene in an Italian infant with IRF6-related disorder. Ital J Pediatr 2022; 48:132. [PMID: 35906647 PMCID: PMC9338470 DOI: 10.1186/s13052-022-01330-6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Congenital maxillomandibular syngnathia is a rare craniofacial anomaly leading to difficulties in feeding, breathing and ability to thrive. The fusion may consist of soft tissue union (synechiae) to hard tissue union. Isolated cases of maxillomandibular fusion are extremely rare, it is most often syndromic in etiology. Case presentation Clinical management of a female newborn with oromaxillofacial abnormities (synechiae, cleft palate, craniofacial dysmorphisms, dental anomaly) and extraoral malformations (skinfold overlying the nails of both halluces, syndactyly, abnormal external genitalia) is presented. The associated malformations addressed to molecular genetic investigations revealing an interferon regulatory factor 6 (IRF6)-related disorder (van der Woude syndrome/popliteal pterygium syndrome). A novel de novo heterozygous mutation in exon 4 of IRF6 gene on chromosome 1q32.2, precisely c.262A > G (p.Asn88Asp), was found. Similarities are discussed with known asparagine missense mutations in the same codon, which may alter IRF6 gene function by reduced DNA-binding ability. A concomitant maternal Xp11.22 duplication involving two microRNA genes could contribute to possible epigenetic effects. Conclusions Our reported case carrying a novel mutation can contribute to expand understandings of molecular mechanisms underlying synechiae and orofacial clefting and to correct diagnosing of incomplete or overlapping features in IRF6-related disorders. Additional multidisciplinary evaluations to establish the phenotypical extent of the IRF6-related disorder and to address family counseling should not only be focused on the surgical corrections of syngnathia and cleft palate, but also involve comprehensive otolaryngologic, audiologic, logopedic, dental, orthopedic, urological and psychological evaluations.
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Affiliation(s)
- Ingrid Anne Mandy Schierz
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy.
| | - Salvatore Amoroso
- Pediatric Surgery Unit, Children's Hospital, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Vincenzo Antona
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | - Ettore Piro
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | - Gregorio Serra
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University Hospital "P. Giaccone", Via Alfonso Giordano n. 3, 90127, Palermo, Italy
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5
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Nahas LD, Alzamel O, Dali MY, Alsawah R, Hamsho A, Sulman R, Alzamel M, Omar A. Distribution and risk factors of cleft lip and palate on patients from a sample of Damascus hospitals - A case-control study. Heliyon 2021; 7:e07957. [PMID: 34541358 PMCID: PMC8436068 DOI: 10.1016/j.heliyon.2021.e07957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/23/2021] [Accepted: 09/03/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE This case-control study was conducted to determine the distribution of cleft lip and/or palate, its association with family history, syndromes and serous otitis media (SOM), and its relation with several risk factors. METHODS The case group comprised of 133 children born with cleft lip and/or palate, and the control was 133 non-cleft children born full-term. Data was collected including age, gender, origin and risk factors for cleft lip and palate from patients' files, interviewing supervising doctors, and the patient. Data was then filled out into Excel and underwent statistical analysis using the Goodness of Fit Test and Chi-Square to determine the significance of the results. RESULTS Cleft lip and/or palate (CL/P) was slightly higher among males (51.9%). Combined cleft lip and palate (CLP) was the most common presentation (42.1%). Cleft lips (CL) were mostly complete cleft (51,5%) incomplete cleft comprised (41.1%), In the sample 35.4% of the cases were bilateral, 32.3% were right unilateral, 28.3% were left unilateral and 4% were median cleft. Cleft palate (CP) was mostly complete (46.6%) there were incomplete clefts (40%), and the remainder were submucosal (13.4%). Isolated CL and combined CLP were higher in males (51.6%, 62.5% respectively). Both isolated CP and Tessier anomaly were more common in females (64.7% and 58.3% respectively). consanguineous marriages accounted for 36.1% of cases. 21.8% of the sample had a first-degree relative and 24.8% had a second degree relative born with CL/P. There were only 7 cases (0.05%) of syndromic CL/P: Down's (4), Pierre Robin's (2), and Van der Woude Syndrome (1). A relationship was found between CL/P and the risk factors: taking anticonvulsants (without specifying the drug) (p = 0.025, OR = 10.73 C.I. 95%), taking retinoic acid (p-value = 0.049, OR = 4.75 C.I. 95%), not consuming folic acid (p-value = 0.00, OR = 28.23 C.I. 95%), and smoking cigarettes (p-value = 0.046, OR = 2.00 C.I. 95%). There was no relationship with maternal alcohol consumption or maternal diabetes (p-values = 0.652 and 0.210, respectively). SOM was present in 63.2% of patients with CL/P and were mostly isolated CP. CONCLUSION CL/P was only slightly higher among males. The most common condition was CLP. There was higher incidence of CL/P among second-degree relatives than first degree. Down's, Pierre Robin's, and Van der Woude Syndromes may be associated with CL/P. Taking anticonvulsants, taking retinoic acid, not consuming folic acid, and smoking cigarettes all have a role in the incidence of CL/P. More than half of the sample had an associated SOM.
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Affiliation(s)
- Louei Darjazini Nahas
- Department of Surgery Division of Otorhinolaryngology, Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Omar Alzamel
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | | | - Rama Alsawah
- Faculty of Medicine, Syrian Private University, Damascus, Syria
- Resident at Internal Medicine Department, Damascus University, Damascus, Syria
| | - Ahmad Hamsho
- Faculty of Medicine, Syrian Private University, Damascus, Syria
- Department of Otorhinolaryngology, Damascus, Syria
| | - Rafi Sulman
- Department of Otorhinolaryngology, Damascus, Syria
| | - Mohamad Alzamel
- Faculty of Medicine, Syrian Private University, Damascus, Syria
- Department of Otorhinolaryngology, Damascus, Syria
| | - Abdullah Omar
- Faculty of Medicine, Syrian Private University, Damascus, Syria
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Ghassibe-Sabbagh M, El Hajj J, Al Saneh M, El Baba N, Abou Issa J, Al Haddad M, El Atat O, Sabbagh J, Abou Chebel N, El-Sibai M. Altered regulation of cell migration in IRF6-mutated orofacial cleft patients-derived primary cells reveals a novel role of Rho GTPases in cleft/lip palate development. Cells Dev 2021; 166:203674. [PMID: 33994351 DOI: 10.1016/j.cdev.2021.203674] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/22/2021] [Accepted: 03/10/2021] [Indexed: 11/30/2022]
Abstract
Orofacial clefts are the most common congenital craniofacial birth defects. They occur from a failure in cell proliferation and fusion of neural crest cells of the lip buds and/or palatal shelves. In this study, we investigate the genetic basis and molecular mechanisms in primary cells derived from a cleft and lip palate patient presenting van der Woude syndrome (VWS). Since mutations in the integrin genes are widely correlated with VWS, Interferon Regulatory Factor 6 (IRF6) screening was conducted in a cohort of 200 participants presenting with orofacial anomalies. Primary fibroblastic cells derived from the upper right gingiva and palatal regions were isolated and two cellular populations from two participants were obtained: a control with no cleft phenotype and a patient with a cleft phenotype typical of van der Woude syndrome (VWS). IRF6 targeted sequencing revealed mutations in two distinct families. Our results showed no alteration in the viability of the CLP/VWS patient cells, suggesting the phenotype associate with the disease is not secondary to a defect in cell proliferation. We did however detect a significant decrease in the migratory ability of the CLP with Van der Woude syndrome (CLP/VWS) patient cells, which could account for the phenotype. When compared to normal cells, patient cells showed a lack of polarization, which would account for their lack of mobility. Patient cells showed protrusions all around the cells and a lack of defined leading edge. This was reflected with actin staining, WAVE2 and Arp2 around the cell, and correlated with an increase in Rac1 activation. Consistently with the increase in Rac1 activation, patient cells showed a loss in the maturation of focal adhesions needed for contractility, which also accounts for the lack in cell migration. Our findings give increased understanding of the molecular mechanisms of VWS and expands the knowledge of van der Woude syndrome (VWS) occurrence by providing a strong molecular evidence that CLP with Van der Woude syndrome (CLP/VWS) phenotype is caused by a defect in normal physiological processes of cells.
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Affiliation(s)
- Michella Ghassibe-Sabbagh
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
| | - Joelle El Hajj
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
| | - Mounir Al Saneh
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
| | - Nada El Baba
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
| | - Jamil Abou Issa
- School of Medicine, Lebanese American University, Beirut, Lebanon.
| | - Maria Al Haddad
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
| | - Oula El Atat
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
| | - Joseph Sabbagh
- Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon
| | - Naji Abou Chebel
- Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
| | - Mirvat El-Sibai
- Department of Natural Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon.
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Degen M, Girousi E, Feldmann J, Parisi L, La Scala GC, Schnyder I, Schaller A, Katsaros C. A Novel Van der Woude Syndrome-Causing IRF6 Variant Is Subject to Incomplete Non-sense-Mediated mRNA Decay Affecting the Phenotype of Keratinocytes. Front Cell Dev Biol 2020; 8:583115. [PMID: 33117810 PMCID: PMC7552806 DOI: 10.3389/fcell.2020.583115] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/03/2020] [Indexed: 01/02/2023] Open
Abstract
Van der Woude syndrome (VWS) is a genetic syndrome that leads to typical phenotypic traits, including lower lip pits and cleft lip/palate (CLP). The majority of VWS-affected patients harbor a pathogenic variant in the gene encoding for the transcription factor interferon regulatory factor 6 (IRF6), a crucial regulator of orofacial development, epidermal differentiation and tissue repair. However, most of the underlying mechanisms leading from pathogenic IRF6 gene variants to phenotypes observed in VWS remain poorly understood and elusive. The availability of one VWS individual within our cohort of CLP patients allowed us to identify a novel VWS-causing IRF6 variant and to functionally characterize it. Using VWS patient-derived keratinocytes, we reveal that most of the mutated IRF6_VWS transcripts are subject to a non-sense-mediated mRNA decay mechanism, resulting in IRF6 haploinsufficiency. While moderate levels of IRF6_VWS remain detectable in the VWS keratinocytes, our data illustrate that the IRF6_VWS protein, which lacks part of its protein-binding domain and its whole C-terminus, is noticeably less stable than its wild-type counterpart. Still, it maintains transcription factor function. As we report and characterize a so far undescribed VWS-causing IRF6 variant, our results shed light on the physiological as well as pathological role of IRF6 in keratinocytes. This acquired knowledge is essential for a better understanding of the molecular mechanisms leading to VWS and CLP.
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Affiliation(s)
- Martin Degen
- Laboratory for Oral Molecular Biology, Dental Research Center, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Eleftheria Girousi
- Laboratory for Oral Molecular Biology, Dental Research Center, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Julia Feldmann
- Laboratory for Oral Molecular Biology, Dental Research Center, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Ludovica Parisi
- Laboratory for Oral Molecular Biology, Dental Research Center, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
| | - Giorgio C La Scala
- Division of Pediatric Surgery, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Isabelle Schnyder
- University Clinic for Pediatric Surgery, Bern University Hospital, Bern, Switzerland
| | - André Schaller
- Division of Human Genetics, Bern University Hospital, Bern, Switzerland
| | - Christos Katsaros
- Laboratory for Oral Molecular Biology, Dental Research Center, Department of Orthodontics and Dentofacial Orthopedics, University of Bern, Bern, Switzerland
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8
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Sylvester B, Brindopke F, Suzuki A, Giron M, Auslander A, Maas RL, Tsai B, Gao H, Magee W, Cox TC, Sanchez-Lara PA. A Synonymous Exonic Splice Silencer Variant in IRF6 as a Novel and Cryptic Cause of Non-Syndromic Cleft Lip and Palate. Genes (Basel) 2020; 11:genes11080903. [PMID: 32784565 PMCID: PMC7465030 DOI: 10.3390/genes11080903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/28/2020] [Accepted: 08/04/2020] [Indexed: 12/31/2022] Open
Abstract
Missense, nonsense, splice site and regulatory region variants in interferon regulatory factor 6 (IRF6) have been shown to contribute to both syndromic and non-syndromic forms of cleft lip and/or palate (CL/P). We report the diagnostic evaluation of a complex multigeneration family of Honduran ancestry with a pedigree structure consistent with autosomal-dominant inheritance with both incomplete penetrance and variable expressivity. The proband's grandmother bore children with two partners and CL/P segregates on both sides of each lineage. Through whole-exome sequencing of five members of the family, we identified a single shared synonymous variant, located in the middle of exon 7 of IRF6 (p.Ser307Ser; g.209963979 G>A; c.921C>T). The variant was shown to segregate in the seven affected individuals and through three unaffected obligate carriers, spanning both sides of this pedigree. This variant is very rare, only being found in three (all of Latino ancestry) of 251,352 alleles in the gnomAD database. While the variant did not create a splice acceptor/donor site, in silico analysis predicted it to impact an exonic splice silencer element and the binding of major splice regulatory factors. In vitro splice assays supported this by revealing multiple abnormal splicing events, estimated to impact >60% of allelic transcripts. Sequencing of the alternate splice products demonstrated the unmasking of a cryptic splice site six nucleotides 5' of the variant, as well as variable utilization of cryptic splice sites in intron 6. The ectopic expression of different splice regulatory proteins altered the proportion of abnormal splicing events seen in the splice assay, although the alteration was dependent on the splice factor. Importantly, each alternatively spliced mRNA is predicted to result in a frame shift and prematurely truncated IRF6 protein. This is the first study to identify a synonymous variant as a likely cause of NS-CL/P and highlights the care that should be taken by laboratories when considering and interpreting variants.
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Affiliation(s)
- Beau Sylvester
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (B.S.); (A.A.); (W.M.III)
| | | | - Akiko Suzuki
- Department of Oral & Craniofacial Sciences, University of Missouri-Kansas City School of Dentistry, Kansas City, MO 64108, USA; (A.S.); (T.C.C.)
| | - Melissa Giron
- Operación Sonrisa Honduras, Tegucigalpa 11101, Honduras;
| | - Allyn Auslander
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (B.S.); (A.A.); (W.M.III)
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 90033, USA
| | - Richard L. Maas
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Becky Tsai
- Fulgent Genetics, Temple City, CA 91780, USA; (B.T.); (H.G.)
| | - Hanlin Gao
- Fulgent Genetics, Temple City, CA 91780, USA; (B.T.); (H.G.)
| | - William Magee
- Division of Plastic and Maxillofacial Surgery, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA; (B.S.); (A.A.); (W.M.III)
| | - Timothy C. Cox
- Department of Oral & Craniofacial Sciences, University of Missouri-Kansas City School of Dentistry, Kansas City, MO 64108, USA; (A.S.); (T.C.C.)
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO 64108, USA
| | - Pedro A. Sanchez-Lara
- Department of Pediatrics, Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, CA 90048, USA
- Correspondence: ; Tel.: +1-(310)-423-4461
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9
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Alade AA, Buxo‐Martinez CJ, Mossey PA, Gowans LJ, Eshete MA, Adeyemo WL, Naicker T, Awotoye WA, Adeleke C, Busch T, Toraño AM, Bello CA, Soto M, Soto M, Ledesma R, Marquez M, Cordero JF, Lopez‐Del Valle LM, Salcedo MI, Debs N, Li M, Petrin A, Olotu J, Aldous C, Olutayo J, Ogunlewe MO, Abate F, Hailu T, Muhammed I, Gravem P, Deribew M, Gesses M, Hassan M, Pape J, Adeniyan OA, Obiri‐Yeboah S, Arthur FK, Oti AA, Olatosi O, Miller SE, Donkor P, Dunnwald MM, Marazita ML, Adeyemo AA, Murray JC, Butali A. Non-random distribution of deleterious mutations in the DNA and protein-binding domains of IRF6 are associated with Van Der Woude syndrome. Mol Genet Genomic Med 2020; 8:e1355. [PMID: 32558391 PMCID: PMC7434609 DOI: 10.1002/mgg3.1355] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/03/2020] [Accepted: 05/19/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The development of the face occurs during the early days of intrauterine life by the formation of facial processes from the first Pharyngeal arch. Derangement in these well-organized fusion events results in Orofacial clefts (OFC). Van der Woude syndrome (VWS) is one of the most common causes of syndromic cleft lip and/or palate accounting for 2% of all cases. Mutations in the IRF6 gene account for 70% of cases with the majority of these mutations located in the DNA-binding (exon 3, 4) or protein-binding domains (exon 7-9). The current study was designed to update the list of IRF6 variants reported for VWS by compiling all the published mutations from 2013 to date as well as including the previously unreported VWS cases from Africa and Puerto Rico. METHODS We used PubMed with the search terms; "Van der Woude syndrome," "Popliteal pterygium syndrome," "IRF6," and "Orofacial cleft" to identify eligible studies. We compiled the CADD score for all the mutations to determine the percentage of deleterious variants. RESULTS Twenty-one new mutations were identified from nine papers. The majority of these mutations were in exon 4. Mutations in exon 3 and 4 had CADD scores between 20 and 30 and mutations in exon 7-9 had CADD scores between 30 and 40. The presence of higher CADD scores in the protein-binding domain (exon 7-9) further confirms the crucial role played by this domain in the function of IRF6. In the new cases, we identified five IRF6 mutations, three novel missense mutations (p.Phe36Tyr, p.Lys109Thr, and p.Gln438Leu), and two previously reported nonsense mutations (p.Ser424*and p.Arg250*). CONCLUSION Mutations in the protein and DNA-binding domains of IRF6 ranked among the top 0.1% and 1% most deleterious genetic mutations, respectively. Overall, these findings expand the range of VWS mutations and are important for diagnostic and counseling purposes.
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Affiliation(s)
- Azeez A. Alade
- Department of Oral Pathology, Radiology and MedicineCollege of DentistryUniversity of IowaIowa CityIAUSA
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIAUSA
- Department of EpidemiologyCollege of Public HealthUniversity of IowaIowa CityIAUSA
| | - Carmen J. Buxo‐Martinez
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Peter A. Mossey
- Department of OrthodonticsUniversity of DundeeDundeeUnited Kingdom
| | - Lord J.J. Gowans
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | - Wasiu L. Adeyemo
- Department of Oral and Maxillofacial SurgeryUniversity of LagosLagosNigeria
| | - Thirona Naicker
- School of clinical medicineKwaZulu‐Natal UniversityDurbanSouth Africa
| | - Waheed A. Awotoye
- Department of Oral Pathology, Radiology and MedicineCollege of DentistryUniversity of IowaIowa CityIAUSA
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIAUSA
| | - Chinyere Adeleke
- Department of Oral Pathology, Radiology and MedicineCollege of DentistryUniversity of IowaIowa CityIAUSA
| | - Tamara Busch
- Department of Oral Pathology, Radiology and MedicineCollege of DentistryUniversity of IowaIowa CityIAUSA
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIAUSA
| | - Ada M. Toraño
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Carolina A. Bello
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Mairim Soto
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Marilyn Soto
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Ricardo Ledesma
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Myrellis Marquez
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Jose F. Cordero
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Lydia M. Lopez‐Del Valle
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Maria I. Salcedo
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Natalio Debs
- Dental and Craniofacial Genomics CoreUniversity of Puerto Rico School of Dental MedicineSan JuanPuerto Rico
| | - Mary Li
- Department of Oral Pathology, Radiology and MedicineCollege of DentistryUniversity of IowaIowa CityIAUSA
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIAUSA
| | - Aline Petrin
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIAUSA
| | - Joy Olotu
- Department of AnatomyUniversity of Port HarcourtPort HarcourtNigeria
| | - Colleen Aldous
- School of clinical medicineKwaZulu‐Natal UniversityDurbanSouth Africa
| | - James Olutayo
- Department of Oral and Maxillofacial SurgeryUniversity of LagosLagosNigeria
| | - Modupe O. Ogunlewe
- Department of Oral and Maxillofacial SurgeryUniversity of LagosLagosNigeria
| | - Fekir Abate
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Taye Hailu
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Ibrahim Muhammed
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Paul Gravem
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Milliard Deribew
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Mulualem Gesses
- School of Public HealthAddis Ababa UniversityAddis AbabaEthiopia
| | - Mohaned Hassan
- Department of Oral Pathology, Radiology and MedicineCollege of DentistryUniversity of IowaIowa CityIAUSA
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIAUSA
| | - John Pape
- Department of Oral Pathology, Radiology and MedicineCollege of DentistryUniversity of IowaIowa CityIAUSA
| | - Oluwole A. Adeniyan
- NHS Foundation Trust, (Queens Hospital, Burton‐On‐Trent)StaffordshireUnited Kingdom
| | - Solomon Obiri‐Yeboah
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Fareed K.N. Arthur
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Alexander A. Oti
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | - Sara E. Miller
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIAUSA
| | - Peter Donkor
- Komfo Anokye Teaching Hospital and Kwame Nkrumah University of Science and TechnologyKumasiGhana
| | | | - Mary L. Marazita
- Oral BiologyHuman GeneticsUniversity of PittsburghPittsburghPAUSA
| | | | | | - Azeez Butali
- Department of Oral Pathology, Radiology and MedicineCollege of DentistryUniversity of IowaIowa CityIAUSA
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIAUSA
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10
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Yu Y, Wan Y, Qin C, Yue H, Bian Z, He M. Novel IRF6 mutations in Chinese Han families with Van der Woude syndrome. Mol Genet Genomic Med 2020; 8:e1196. [PMID: 32108996 PMCID: PMC7216816 DOI: 10.1002/mgg3.1196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/02/2020] [Accepted: 02/14/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Interferon Regulatory Factor 6 (IRF6) gene encodes a member of the IRF family of transcription factors. Mutations in IRF6 cause Van der Woude Syndrome (VWS), which is the most common malformation of syndromic orofacial clefts in humans. METHODS Here, we performed sequencing studies of six families with VWS in the Chinese Han population. The entire IRF6-coding region and the exon-intron boundaries including exons 3-8 and part of exon 9 were screened among all the collected family members by Sanger sequencing. RESULTS We found a novel splice site variant c.175-6T>A, two novel missense variants (p.Lys66Arg and p.Pro107Thr), in addition with a previously reported missense variant (p.Leu87Phe), which were all located in and nearby exon 4 of IRF6. Meanwhile, a novel frameshift variant p.G257Vfs*46 in exon 7 of IRF6 was also detected. All the mutations presented to be co-segregated in each family. CONCLUSION Our study has advanced the understanding of the genetic architecture of VWS and provides the basis for genetic counseling, antenatal diagnosis, and gene therapy of high risk groups.
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Affiliation(s)
- Yanqin Yu
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yatao Wan
- Key Laboratory of Analytical Chemistry for Biology and Medicine (Ministry of Education), College of Chemistry and Molecular Sciences, State Key Laboratory of Virology, Wuhan University, Wuhan, China
| | - Chuanqi Qin
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Haitang Yue
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Zhuan Bian
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Miao He
- State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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11
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Rhea L, Canady FJ, Le M, Reeb T, Canady JW, Kacmarynski DSF, Avvari R, Biggs LC, Dunnwald M. Interferon regulatory factor 6 is required for proper wound healing in vivo. Dev Dyn 2019; 249:509-522. [PMID: 31724286 DOI: 10.1002/dvdy.134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/20/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Van der Woude syndrome (VWS) is the most common form of syndromic orofacial cleft caused predominantly by mutations in Interferon Regulatory Factor 6 (IRF6). We previously reported that individuals with VWS have increased risk of wound healing complications following cleft repair compared with individuals with nonsyndromic orofacial clefts (nonsyndromic cleft lip and palate-NSCLP). In vitro, absence of IRF6 leads to impaired keratinocyte migration and embryonic wound healing. However, there is currently no data on tissue repair in adult animals and cells with reduced levels of IRF6 like in VWS. RESULTS Excisional wounds of Irf6+/- and wild-type animals were analyzed 4 and 7 days post-wounding. Although all wounds were reepithelialized after 7 days, the epidermal and wound volume of repaired wounds was larger in Irf6+/- . These data were supported by increased keratinocyte proliferation in the neoformed epidermis and a less mature granulation tissue with increased cytokine levels. This effect was not cell autonomous, as Irf6+/- neonatal keratinocytes in vitro did not exhibit defects in scratch wound closure or proliferation. Keratinocytes from individuals with VWS also migrated similarly to keratinocytes from NSCLP individuals. CONCLUSIONS These data support a role for IRF6 in wound healing by regulating keratinocyte proliferation, granulation tissue maturation, and cytokine levels.
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Affiliation(s)
- Lindsey Rhea
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa
| | | | - Marc Le
- Department of Pediatrics, The University of Iowa, Iowa City, Iowa
| | - Tanner Reeb
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa.,Interdisciplinary Graduate Program in Genetics, The University of Iowa, Iowa City, Iowa
| | - John W Canady
- Department of Otolaryngology, Head and Neck Surgery, The University of Iowa, Iowa City, Iowa.,Department of Surgery, The University of Iowa, Iowa City, Iowa
| | - Deborah S F Kacmarynski
- Department of Pediatrics, The University of Iowa, Iowa City, Iowa.,Department of Otolaryngology, Head and Neck Surgery, The University of Iowa, Iowa City, Iowa
| | - Rishika Avvari
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa
| | - Leah C Biggs
- Department of Pediatrics, The University of Iowa, Iowa City, Iowa
| | - Martine Dunnwald
- Department of Anatomy and Cell Biology, The University of Iowa, Iowa City, Iowa.,Interdisciplinary Graduate Program in Genetics, The University of Iowa, Iowa City, Iowa
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12
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Du XY, Li XY, Wu B, Xie C, Tian WD. [Clinical and genetic features of Chinese kindreds with Van der Woude syndrome caused by interferon regulatory factor 6 mutation]. Hua Xi Kou Qiang Yi Xue Za Zhi 2018; 36:623-627. [PMID: 30593107 DOI: 10.7518/hxkq.2018.06.008] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to investigate the clinical phenotype and genetic characteristics of Chinese families with Van der Woude syndrome (VWS). METHODS Clinical manifestations between 14 families and within each family were recorded. Possible inheritance modes and pathogenic genes were analyzed. Phenotypic distribution and gene frequencies were calculated. RESULTS Of the pedigrees investigated, an autosomal dominant inheritance pattern was suggested. All patients had typical symptoms. The pathogenic gene was interferon regulatory factor 6 (IRF6). Phenotypic distribution frequencies were as follows: lip pits (91.9%), cleft lip and/or palate (73.0%), and hyperdontia (8.1%). There were significant differences in clinical phenotypes among individuals of different families and individuals of the same family. CONCLUSIONS VWS in a Chinese population was dominantly inherited with high penetrance and variable expressivity. The pathogenic gene was IRF6. VWS in a Chinese population was genotyped as VWS1.
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Affiliation(s)
- Xin-Ya Du
- Dept. of Stomotology, The People's Hospital of Longhua, Shenzhen 518000, China
| | - Xiao-Yu Li
- Dept. of Stomotology, The People's Hospital of Longhua, Shenzhen 518000, China
| | - Bin Wu
- Dept. of Stomotology, The People's Hospital of Longhua, Shenzhen 518000, China
| | - Chun Xie
- Dept. of Stomotology, The People's Hospital of Longhua, Shenzhen 518000, China
| | - Wei-Dong Tian
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Trauma and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China;National Engineering Laboratory for Oral Regenerative Medicine, Sichuan University, Chengdu 610041, China
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13
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Peralta-Mamani M, Terrero-Pérez Á, Dalben G, Rubira CMF, Honório HM, Rubira-Bullen IF. Treatment of lower lip pits in Van der Woude syndrome: a systematic review. Int J Oral Maxillofac Surg 2017; 47:421-427. [PMID: 29089202 DOI: 10.1016/j.ijom.2017.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/27/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 11/25/2022]
Abstract
The presence of lower lip pits in individuals with Van der Woude syndrome (VWS) may cause discomfort due to saliva secretion. Furthermore, one of the main complaints in relation to lip pits is poor aesthetics, which often affects quality of life. The aim of this systematic review was to identify the best technique for the surgical removal of lower lip pits in terms of aesthetic and functional characteristics. A search of the PubMed, Embase, Web of Science, Science Direct, and Scopus databases was performed on December 27, 2016, which retrieved 88 records without duplicates. Among these papers, three ultimately met all eligibility criteria. The three studies included a total of 61 individuals, with follow-up ranging from 6 months to 10 years and sample collection from 10 to 24 years. The findings demonstrated that the outcome of surgical removal of lower lip pits was better with the use of vertical wedge excision, inverted-T lip reduction, Mutaf-Goldstein technique and modified simple excision than with simple excision. Simple excision may result in postoperative complications, such as mucocele and pit recurrence.
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Affiliation(s)
- M Peralta-Mamani
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - Á Terrero-Pérez
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - G Dalben
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - C M F Rubira
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - H M Honório
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
| | - I F Rubira-Bullen
- Department of Stomatology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil.
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14
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Bertin H, Diallo-Hornez G, Isidor B, Mercier J. Surgical management of lower lip pits in Van der Woude syndrome. J Stomatol Oral Maxillofac Surg 2017; 119:67-70. [PMID: 28893716 DOI: 10.1016/j.jormas.2017.09.003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/16/2017] [Accepted: 09/03/2017] [Indexed: 11/16/2022]
Abstract
Van der Woude syndrome (VDWS) is characterized by the presence of lower lip pits which may be of concern to patients due to aesthetic considerations. By presenting three clinical cases, we provide an overview of the surgical techniques currently available to treat labial pits. Fusiform excision with dissection of the entire pit is still the most commonly used procedure and it generally yields good functional and aesthetic outcomes. The split-lip advancement technique and the inverted T-lip reduction nonetheless represent good surgical alternatives. Proper management of the lower pits that occur with VDWS requires thorough knowledge of the available surgical procedures.
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Affiliation(s)
- H Bertin
- Oral and maxillofacial surgery, Nantes university hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - G Diallo-Hornez
- Oral and maxillofacial surgery, Nantes university hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - B Isidor
- Pediatric genetic unit, Nantes university hospital, 44093 Nantes, France
| | - J Mercier
- Oral and maxillofacial surgery, Nantes university hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
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15
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Richardson S, Khandeparker RV. Van der Woude syndrome presenting as a single median lower lip pit with associated dental, orofacial and limb deformities: a rare case report. J Korean Assoc Oral Maxillofac Surg 2017; 43:267-271. [PMID: 28875142 PMCID: PMC5583202 DOI: 10.5125/jkaoms.2017.43.4.267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/07/2016] [Accepted: 02/20/2016] [Indexed: 11/19/2022] Open
Abstract
Although it is a rare developmental malformation, van der Woude syndrome is the most common form of syndromic orofacial clefting, accounting for approximately 2% of all cleft cases. The lower lip pits with or without a cleft lip or palate is characteristic of the syndrome. Findings, such as hypodontia, limb deformities, popliteal webs, ankylogossia, ankyloblepheron, and genitourinary and cardiovascular abnormalities, are rarely associated with the syndrome. This paper reports a rare case of van der Woude syndrome in a 10-year-old male patient with a single median lower lip pit and a repaired bilateral cleft lip and cleft palate that were associated with microstomia, hypodontia, and clubbing of the left foot with syndactyly of the second to fifth lesser toes of the same foot.
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16
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Kousa YA, Roushangar R, Patel N, Walter A, Marangoni P, Krumlauf R, Klein OD, Schutte BC. IRF6 and SPRY4 Signaling Interact in Periderm Development. J Dent Res 2017; 96:1306-1313. [PMID: 28732181 DOI: 10.1177/0022034517719870] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rare mutations in IRF6 and GRHL3 cause Van der Woude syndrome, an autosomal dominant orofacial clefting disorder. Common variants in IRF6 and GRHL3 also contribute risk for isolated orofacial clefting. Similarly, variants within genes that encode receptor tyrosine kinase (RTK) signaling components, including members of the FGF pathway, EPHA3 and SPRY2, also contribute risk for isolated orofacial clefting. In the mouse, loss of Irf6 or perturbation of Fgf signaling leads to abnormal oral epithelial adhesions and cleft palate. Oral adhesions can result from a disruption of periderm formation. Here, we find that IRF6 and SPRY4 signaling interact in periderm function. We crossed Irf6 heterozygous ( Irf6+/-) mice with transgenic mice that express Spry4 in the basal epithelial layer ( TgKRT14::Spry4). While embryos with either of these mutations can have abnormal oral adhesions, using a new quantitative assay, we observed a nonadditive effect of abnormal oral epithelial adhesions in the most severely affected double mutant embryos ( Irf6+/-;TgKRT14::Spry4). At the molecular level, the sites of abnormal oral adhesions maintained periderm-like cells that express keratin 6, but we observed abnormal expression of GRHL3. Together, these data suggest that Irf6 and RTK signaling interact in regulating periderm differentiation and function, as well as provide a rationale to screen for epistatic interactions between variants in IRF6 and RTK signaling pathway genes in human orofacial clefting populations.
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Affiliation(s)
- Y A Kousa
- 1 Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, USA
| | - R Roushangar
- 1 Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, MI, USA
| | - N Patel
- 2 Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
| | - A Walter
- 2 Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
| | - P Marangoni
- 3 Departments of Orofacial Sciences and Pediatrics and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - R Krumlauf
- 4 Stowers Institute for Medical Research, Kansas City, MO, USA.,5 Department of Anatomy and Cell Biology, University of Kansas Medical Center, Kansas City, KS, USA
| | - O D Klein
- 3 Departments of Orofacial Sciences and Pediatrics and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - B C Schutte
- 2 Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA.,6 Departments of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
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17
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Abstract
BACKGROUND Mutations in IRF6, CHUK (IKKA), and RIPK4 can lead to a disease spectrum that includes cutaneous, limb, and craniofacial malformations. Loss of these alleles in the mouse leads to perinatal lethality and severe cutaneous, limb, and craniofacial defects also. Genetic rescue in the mouse has been shown for Ikka and Ripk4. RESULTS Here, we show partial genetic rescue of Irf6 knockout embryos using the KRT14 promoter to drive Irf6 expression in the basal epithelium. In contrast to Irf6 knockout embryos, rescue embryos survive the immediate perinatal period. Macroscopic examination reveals rescue of skin adhesions between the axial and appendicular skeleton. Unexpectedly, KRT14-driven Irf6 expression does not completely rescue orofacial clefting and adhesions between the palate and tongue, suggesting the importance of cell-autonomous IRF6 expression in periderm. Like knockout embryos, Irf6 rescue embryos also have persistent esophageal adhesions, which likely contribute to postnatal demise. CONCLUSIONS Together, these data suggest that targeted expression of IRF6 can significantly reduce disease severity, but that a minimum level of Irf6 in both periderm and basal epithelial cells is necessary for orofacial development. Therefore, homologous human and mouse phenotypes are observed for IRF6, IKKA, and RIPK4. In this work, we show that altering the expression level of IRF6 dramatically modified this phenotype in utero. Developmental Dynamics 246:670-681, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Youssef A Kousa
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan.,Pediatric Residency Program, Children's National Health System, Washington, DC
| | - Dina Moussa
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan
| | - Brian C Schutte
- Department of Biochemistry and Molecular Biology, Michigan State University, East Lansing, Michigan.,Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan.,Department of Pediatrics and Human Development, Michigan State University, East Lansing, Michigan
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18
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Los E, Baines H, Guttmann-Bauman I. Concurrent Van der Woude syndrome and Turner syndrome: A case report. SAGE Open Med Case Rep 2017; 5:2050313X16687916. [PMID: 28228961 PMCID: PMC5308529 DOI: 10.1177/2050313x16687916] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 12/13/2016] [Indexed: 11/15/2022] Open
Abstract
Most cases of Van der Woude syndrome are caused by a mutation to interferon regulatory factor 6 on chromosome 1. Turner syndrome is caused by complete or partial absence of the second sex chromosome in girls. We describe a unique case of the two syndromes occurring concurrently though apparently independently in a girl with Van der Woude syndrome diagnosed at birth and Turner syndrome at 14 years 9 months. Short stature was initially misattributed to Van der Woude syndrome and pituitary insufficiency associated with clefts before correctly diagnosing Turner syndrome. We discuss the prevalence of delayed diagnosis of Turner syndrome, the rarity of reports of concurrent autosomal chromosome mutation and sex chromosome deletion, as well as the need to consider the diagnosis of Turner syndrome in all girls with short stature regardless of prior medical history.
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Affiliation(s)
- Evan Los
- Pediatric Endocrinology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hayley Baines
- Pediatric Endocrinology, Oregon Health & Science University, Portland, OR, USA
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Gowans LJJ, Busch TD, Mossey PA, Eshete MA, Adeyemo WL, Aregbesola B, Donkor P, Arthur FKN, Agbenorku P, Olutayo J, Twumasi P, Braimah R, Oti AA, Plange-Rhule G, Obiri-Yeboah S, Abate F, Hoyte-Williams PE, Hailu T, Murray JC, Butali A. The prevalence, penetrance, and expressivity of etiologic IRF6 variants in orofacial clefts patients from sub-Saharan Africa. Mol Genet Genomic Med 2017; 5:164-171. [PMID: 28361103 PMCID: PMC5370218 DOI: 10.1002/mgg3.273] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/16/2016] [Accepted: 12/08/2016] [Indexed: 01/08/2023] Open
Abstract
Background Orofacial clefts are congenital malformations of the orofacial region, with a global incidence of one per 700 live births. Interferon Regulatory Factor 6 (IRF6) (OMIM:607199) gene has been associated with the etiology of both syndromic and nonsyndromic orofacial clefts. The aim of this study was to show evidence of potentially pathogenic variants in IRF6 in orofacial clefts cohorts from Africa. Methods We carried out Sanger Sequencing on DNA from 184 patients with nonsyndromic orofacial clefts and 80 individuals with multiple congenital anomalies that presented with orofacial clefts. We sequenced all the nine exons of IRF6 as well as the 5′ and 3′ untranslated regions. In our analyses pipeline, we used various bioinformatics tools to detect and describe the potentially etiologic variants. Results We observed that potentially etiologic exonic and splice site variants were nonrandomly distributed among the nine exons of IRF6, with 92% of these variants occurring in exons 4 and 7. Novel variants were also observed in both nonsyndromic orofacial clefts (p.Glu69Lys, p.Asn185Thr, c.175‐2A>C and c.1060+26C>T) and multiple congenital anomalies (p.Gly65Val, p.Lys320Asn and c.379+1G>T) patients. Our data also show evidence of compound heterozygotes that may modify phenotypes that emanate from IRF6 variants. Conclusions This study demonstrates that exons 4 and 7 of IRF6 are mutational ‘hotspots’ in our cohort and that IRF6 mutants‐induced orofacial clefts may be prevalent in the Africa population, however, with variable penetrance and expressivity. These observations are relevant for detection of high‐risk families as well as genetic counseling. In conclusion, we have shown that there may be a need to combine both molecular and clinical evidence in the grouping of orofacial clefts into syndromic and nonsyndromic forms.
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Affiliation(s)
- Lord Jephthah Joojo Gowans
- Department of Biochemistry and BiotechnologyKwame Nkrumah University of Science and Technology (KNUST)KumasiGhana; Cleft ClinicKomfo Anokye Teaching HospitalKumasiGhana; Department of PaediatricsUniversity of IowaIowa CityIowa; Department of Oral PathologyRadiology and MedicineUniversity of IowaIowa CityIowa
| | - Tamara D Busch
- Department of Oral Pathology Radiology and Medicine University of Iowa Iowa City Iowa
| | - Peter A Mossey
- Department of Orthodontics University of Dundee Dundee Scotland
| | | | | | | | - Peter Donkor
- Cleft ClinicKomfo Anokye Teaching HospitalKumasiGhana; Department of SurgerySchool of Medical SciencesKNUSTKumasiGhana
| | - Fareed K N Arthur
- Department of Biochemistry and Biotechnology Kwame Nkrumah University of Science and Technology (KNUST) Kumasi Ghana
| | - Pius Agbenorku
- Cleft ClinicKomfo Anokye Teaching HospitalKumasiGhana; Department of SurgerySchool of Medical SciencesKNUSTKumasiGhana
| | - James Olutayo
- College of Medicine University of Lagos Lagos Nigeria
| | - Peter Twumasi
- Department of Biochemistry and Biotechnology Kwame Nkrumah University of Science and Technology (KNUST) Kumasi Ghana
| | - Rahman Braimah
- Obafemi Awolowo University Teaching Hospital Ile-Ife Nigeria
| | - Alexander A Oti
- Cleft ClinicKomfo Anokye Teaching HospitalKumasiGhana; Department of SurgerySchool of Medical SciencesKNUSTKumasiGhana
| | | | - Solomon Obiri-Yeboah
- Cleft ClinicKomfo Anokye Teaching HospitalKumasiGhana; Department of SurgerySchool of Medical SciencesKNUSTKumasiGhana
| | | | | | - Taye Hailu
- Addis Ababa University Addis Ababa Ethiopia
| | | | - Azeez Butali
- Department of Oral Pathology Radiology and Medicine University of Iowa Iowa City Iowa
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20
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Tehranchi A, Behnia H, Nadjmi N, Yassaee VR, Ravesh Z, Mina M. Multidisciplinary management of a patient with van der Woude syndrome: A case report. Int J Surg Case Rep 2016; 30:142-147. [PMID: 28012331 PMCID: PMC5192017 DOI: 10.1016/j.ijscr.2016.11.032] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 11/11/2022] Open
Abstract
We described the orthodontic treatment of a girl diagnosed with VWS. Multidisciplinary techniques resulted in satisfactory outcomes. Genetic testing determined a known putative splice site mutation.
Introduction Van der Woude syndrome (VWS) is the most frequent form of syndromic cleft lip and palate (SCLP) accounting for 2% of all patients with CLP. Case presentation We describe the orthodontic treatment of a girl diagnosed with VWS referred by her family dentist for her cosmetic concerns. Discussion Comprehensive orthodontic treatment, secondary bone graft, distraction osteogenesis (for a deficient maxilla), secondary palatoplasty and excision of lower lip pits, as well as orthodontic and prosthetic procedures may provide a satisfactory outcome. Genetic testing showed a known putative splice site mutation (c.174 + 1 G/A) as the prime cause of VWS in our patient and her family. Conclusion SCLP has significant effects on facial aesthetics and the psychosocial status. Parents should be assessed and counseled appropriately. This condition is treatable in the absence of life threatening systemic anomalies. An interdisciplinary team approach is advocated.
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Affiliation(s)
- Azita Tehranchi
- Preventive Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Orthodontic Department, Dental School, Tehran, Iran.
| | - Hossein Behnia
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Dental School, Tehran, Iran.
| | - Nasser Nadjmi
- University of Antwerp (UA), Belgium; The Team for Cleft and Craniofacial Anomalies, Oral and Maxillofacial Surgery, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium.
| | - Vahid Reza Yassaee
- Genomic Research Center, Aarabi St., Yaman Ave., Evin, Velenjak, Shahid Beheshti University of Medical Sciences, Tehran, 1966645643, Iran; Dept. of Medical Genetic, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 1966645643, Iran.
| | - Zeinab Ravesh
- Genomic Research Center, Aarabi St., Yaman Ave., Evin, Velenjak, Shahid Beheshti University of Medical Sciences, Tehran, 1966645643, Iran.
| | - Morteza Mina
- North Khorasan University of Medical Sciences, Bojnurd, Iran.
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21
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Wójcicki P, Koźlik MJ, Wójcicka K. Genetic Factors in Selected Complex Congenital Malformations with Cleft Defect. ADV CLIN EXP MED 2016; 25:977-987. [PMID: 28028964 DOI: 10.17219/acem/61911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/15/2015] [Revised: 12/19/2015] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
Cleft lips, alveolar ridges and palates are among the most common birth defects. There are over 500 different complex genetic disorders that include cleft defects. The most common related defects include abnormalities of the skeleton, skull, cardiovascular and nervous system. The occurrence of a cleft results from the interplay of multiple genes and environmental factors. Several thousand different mutations responsible for these syndromes have been discovered, whereas there are still numerous phenotypic cases of unknown genetic origin. The aim of this study was to present various clinical aspects and the latest discoveries with regard to genetic research in complex malformations, such as Van der Woude syndrome, popliteal pterygium syndrome, EEC syndrome, Pierre Robin sequence, various forms of Stickler syndrome, and Treacher Collins syndrome. These complex syndromes have different incidences, and most of them also have allelic variants with characteristic severities that differ even among close relatives. Easier access to genetic counseling and the lower cost of DNA testing in recent years can lead to new findings on the causes of such syndromes.
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Affiliation(s)
- Piotr Wójcicki
- Department of Plastic Surgery, Wroclaw Medical University, Polanica-Zdrój, Poland
| | - Maciej J Koźlik
- Department of Plastic Surgery, Wroclaw Medical University, Polanica-Zdrój, Poland
| | - Karolina Wójcicka
- Department of Plastic Surgery, Specialist Medical Center, Polanica-Zdrój, Poland
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22
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Affiliation(s)
- Stephanie J Drew
- Hofstra School of Medicine, Hempstead, New York, USA; Stony Brook University Medical Center, 101 Nicolls Road, Stony Brook, NY 11794, USA; Private Practice, The New York Center for Orthognathic and Maxillofacial Surgery, 474 Montauk Highway, West Islip, NY 11795, USA.
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23
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Busche A, Hehr U, Sieg P, Gillessen-Kaesbach G. Van der Woude and Popliteal Pterygium Syndromes: Broad intrafamilial variability in a three generation family with mutation in IRF6. Am J Med Genet A 2016; 170:2404-7. [PMID: 27286731 DOI: 10.1002/ajmg.a.37791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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: 02/05/2016] [Accepted: 05/30/2016] [Indexed: 11/11/2022]
Abstract
Patients with Van der Woude syndrome typically present with cleft lip, cleft lip and palate, or with cleft palate only. In contrast to non-syndromic cleft lip and/or palate, Van der Woude syndrome typically is characterized by bilateral, paramedian lower-lip pits. Popliteal pterygium syndrome shares features with Van der Woude syndrome, but, in addition, is characterized by a popliteal pterygium, genital anomalies, cutaneous syndactyly of the fingers and the toes, and a characteristic pyramidal fold of skin overlying the nail of the hallux. In some patients oral synechiae or eyelid synechiae are present. Van der Woude Syndrome and Popliteal pterygium syndrome are autosomal dominantly inherited disorders caused by heterozygous mutations in IRF6. We present a three generation family with tremendous intrafamilial phenotypic variability. The newborn index patient had a diagnosis of Popliteal pterygium syndrome. The mother presented with a classic Van der Woude Syndrome, while the maternal grandfather had Van der Woude Syndrome as well as minor signs of Popliteal pterygium syndrome. In all three affecteds the known pathogenic mutation c.265A>G, p.Lys89Glu in IRF6 was identified. While inter- as well as intra-familial variability has been described in IRF6-related disorders, the occurrence of a typical Van der Woude Syndrome without any other anomalies as well as a diagnosis of Popliteal pterygium syndrome in the same family is rare. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Andreas Busche
- Institut für Humangenetik, Westfälische Wilhelms-Universität Münster, Münster, Germany.,Institut für Humangenetik, Universität zu Lübeck, Lübeck, Germany
| | - Ute Hehr
- Zentrum für Humangenetik und Institut für Humangenetik, Universität Regensburg, Regensburg, Germany
| | - Peter Sieg
- Klinik für Kiefer- und Gesichtschirurgie, Universität zu Lübeck, Lübeck, Germany
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24
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Tan EC, Lim HW, Lim ECP, Lee ST. A Novel Interferon Regulatory Factor 6 Mutation in an Asian Family With Van der Woude Syndrome. Cleft Palate Craniofac J 2016; 54:442-445. [PMID: 27243668 DOI: 10.1597/15-327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Van der Woude syndrome (VWS) is a rare autosomal dominant genetic disorder characterized by orofacial clefting and lip pits. Mutations in the transcription factor interferon regulatory factor 6 gene (IRF6) have been identified in individuals with VWS. We performed direct sequencing of the gene for molecular investigation of a proband with Bangladeshi-Malay ancestry. A novel transition mutation (c.113T>C), which resulted in an amino acid substitution (p.Ile38Thr) in the deoxyribonucleic acid-binding domain was detected. Testing of family members showed that the mutation segregated with the VWS phenotype for members of her immediate family. Although there is some phenotypic variability, all of the affected members are of the female gender.
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25
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Abstract
Orofacial clefting is a common birth defect with significant morbidity. A panoply of candidate genes have been discovered through synergy of animal models and human genetics. Among these, variants in interferon regulatory factor 6 (IRF6) cause syndromic orofacial clefting and contribute risk toward isolated cleft lip and palate (1/700 live births). Rare variants in IRF6 can lead to Van der Woude syndrome (1/35,000 live births) and popliteal pterygium syndrome (1/300,000 live births). Furthermore, IRF6 regulates GRHL3 and rare variants in this downstream target can also lead to Van der Woude syndrome. In addition, a common variant (rs642961) in the IRF6 locus is found in 30% of the world's population and contributes risk for isolated orofacial clefting. Biochemical studies revealed that rs642961 abrogates one of four AP-2alpha binding sites. Like IRF6 and GRHL3, rare variants in TFAP2A can also lead to syndromic orofacial clefting with lip pits (branchio-oculo-facial syndrome). The literature suggests that AP-2alpha, IRF6 and GRHL3 are part of a pathway that is essential for lip and palate development. In addition to updating the pathways, players and pursuits, this review will highlight some of the current questions in the study of orofacial clefting.
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Affiliation(s)
- Youssef A Kousa
- Biochemistry and Molecular Biology Department, Michigan State University, East Lansing, Michigan
| | - Brian C Schutte
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan
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26
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Affiliation(s)
| | - Sunday Ajike
- Department of Maxillofacial Surgery, Ahmadu Bello University, Zaria, Nigeria
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27
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Reardon JB, Brustowicz KA, Marrinan EM, Mulliken JB, Padwa BL. Anatomic Severity, Midfacial Growth, and Speech Outcomes in Van der Woude/Popliteal Pterygium Syndromes Compared to Nonsyndromic Cleft Lip/Palate. Cleft Palate Craniofac J 2014; 52:676-81. [PMID: 25210863 DOI: 10.1597/14-132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To summarize the clinical characteristics and surgical and speech outcomes for patients with Van der Woude/popliteal pterygium syndromes (VWS/PPS) and to compare them with a historic cohort of patients with nonsyndromic cleft lip/cleft palate (CL/P). DESIGN Retrospective chart review. SETTING Tertiary care center. PATIENTS All patients with VWS/PPS seen at Boston Children's Hospital from 1979 to 2012: 28 patients with VWS (n = 21)/PPS (n = 7) whose mean age was 17.3 ± 10.4 years, including 18 females (64%) and 10 males (36%); 18 patients (64%) had a family history of VWS/PPS. MAIN OUTCOME MEASURES Cleft type, operative procedures, speech, and midfacial growth. Data were compared with historic cohorts of patients with nonsyndromic CL/P treated at one tertiary care center. RESULTS There were 24 patients (86%) with CP±L, Veau types I (n = 4, 17%), II (n = 4, 17%), III (n = 5, 21%), and IV (n = 11, 46%). Nine patients (38%) had palatal fistula after palatoplasty. Fourteen of 23 (61%) patients with CL/P age 5 years or older had midfacial retrusion, and 10 (43%) required a pharyngeal flap for velopharyngeal insufficiency. Fisher's exact test demonstrated higher frequencies of Veau type IV CP±L (P = .0016), bilateral CL±P (P = .0001), and complete CL±P (P < .0001) in VWS/PPS compared with nonsyndromic patients. Incidences of midfacial retrusion (P = .0001), palatal fistula (P < .0001), and need for pharyngeal flap (P = .0014) were significantly greater in patients with VWS/PPS. CONCLUSIONS Patients with VWS/PPS have more severe forms of labiopalatal clefting and higher incidences of midfacial retrusion, palatal fistula, and velopharyngeal insufficiency following primary repair as compared with nonsyndromic CL/P.
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Abstract
The Van der Woude syndrome is a rare autosomal dominant developmental malformation usually associated with lower lip pits, cleft lip and palate. These congenital lip pits appear, clinically, as a malformation in the vermilion border of the lip, with or without excretion. Obligate carriers of this dominant mutation may have lip pits alone, cleft(s) alone, clefts and pits or neither. Here, we present a case report of a 10 year-old male patient with Van der Woude syndrome and a brief literature on its treatment modalities.
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Affiliation(s)
- Bhavna Kaul
- Department of Pedodontics and Preventive Dentistry, Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir, India
| | - Nanika Mahajan
- Department of Pedodontics and Preventive Dentistry, Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir, India
| | - Rakesh Gupta
- Department of Pedodontics and Preventive Dentistry, Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir, India
| | - Bhanu Kotwal
- Department of Pedodontics and Preventive Dentistry, Indira Gandhi Government Dental College and Hospital, Jammu, Jammu and Kashmir, India
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Butali A, Mossey PA, Adeyemo WL, Eshete MA, Gaines LA, Even D, Braimah RO, Aregbesola BS, Rigdon JV, Emeka CI, James O, Ogunlewe MO, Ladeinde AL, Abate F, Hailu T, Mohammed I, Gravem PE, Deribew M, Gesses M, Adeyemo AA, Murray JC. Novel IRF6 mutations in families with Van Der Woude syndrome and popliteal pterygium syndrome from sub-Saharan Africa. Mol Genet Genomic Med 2014; 2:254-60. [PMID: 24936515 PMCID: PMC4049366 DOI: 10.1002/mgg3.66] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/18/2013] [Accepted: 12/19/2013] [Indexed: 12/23/2022] Open
Abstract
Orofacial clefts (OFC) are complex genetic traits that are often classified as syndromic or nonsyndromic clefts. Currently, there are over 500 types of syndromic clefts in the Online Mendelian Inheritance in Man (OMIM) database, of which Van der Woude syndrome (VWS) is one of the most common (accounting for 2% of all OFC). Popliteal pterygium syndrome (PPS) is considered to be a more severe form of VWS. Mutations in the IRF6 gene have been reported worldwide to cause VWS and PPS. Here, we report studies of families with VWS and PPS in sub-Saharan Africa. We screened the DNA of eight families with VWS and one family with PPS from Nigeria and Ethiopia by Sanger sequencing of the most commonly affected exons in IRF6 (exons 3, 4, 7, and 9). For the VWS families, we found a novel nonsense variant in exon 4 (p.Lys66X), a novel splice-site variant in exon 4 (p.Pro126Pro), a novel missense variant in exon 4 (p.Phe230Leu), a previously reported splice-site variant in exon 7 that changes the acceptor splice site, and a known missense variant in exon 7 (p.Leu251Pro). A previously known missense variant was found in exon 4 (p.Arg84His) in the PPS family. All the mutations segregate in the families. Our data confirm the presence of IRF6-related VWS and PPS in sub-Saharan Africa and highlights the importance of screening for novel mutations in known genes when studying diverse global populations. This is important for counseling and prenatal diagnosis for high-risk families.
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Affiliation(s)
- Azeez Butali
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa Iowa City, Iowa
| | - Peter A Mossey
- Department of Orthodontics, University of Dundee Dundee, Scotland
| | | | | | - LauRen A Gaines
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa Iowa City, Iowa
| | - Dee Even
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa Iowa City, Iowa
| | | | | | - Jennifer V Rigdon
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa Iowa City, Iowa
| | | | - Olutayo James
- College of Medicine, University of Lagos Lagos, Nigeria
| | | | | | - Fikre Abate
- Addis Ababa University Addis Ababa, Ethiopia
| | - Taye Hailu
- Addis Ababa University Addis Ababa, Ethiopia
| | | | | | | | | | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health Bethesda, Maryland
| | - Jeffrey C Murray
- Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa Iowa City, Iowa
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30
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David-Paloyo FP, Yang X, Lin JL, Wong FH, Wu-Chou YH, Lo LJ. Lower lip pits: van der woude or kabuki syndrome? Cleft Palate Craniofac J 2013; 51:729-34. [PMID: 24088119 DOI: 10.1597/12-258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Kabuki syndrome (KS) is a multiple congenital anomaly/mental retardation syndrome with characteristic facial features. Despite more than 350 documented cases and recent correlation of MLL2 mutations as a genetic cause, its full clinical spectrum is still being defined. This report describes two patients who were initially diagnosed with Van der Woude syndrome (VWS) based on the presence of lower lip pits. However, this finding can occur with KS, albeit infrequently. For patients with lower lip pits, a thorough evaluation should be made to distinguish between VWS and KS, as there are differences in long-term prognosis.
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31
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Tan EC, Lim EC, Lee ST. De novo 2.3 Mb microdeletion of 1q32.2 involving the Van der Woude Syndrome locus. Mol Cytogenet 2013; 6:31. [PMID: 23915469 DOI: 10.1186/1755-8166-6-31] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 06/04/2013] [Indexed: 11/29/2022] Open
Abstract
Background Van der Woude syndrome is the most common among syndromes which include cleft lip and/or cleft palate as one of the presentations. It is usually caused by mutations in the interferon regulatory factor 6 (IRF6) gene. Case presentation We previously reported on a patient with suspected deletion of the IRF6 gene. Using the Affymetrix Human SNP 6.0 Array, the interstitial deletion has been confirmed and found to be approximately 2.327–2.334 Mb within the 1q32.2 region. Although several known genes were deleted, the patient has no other phenotype apart from the orofacial presentations typical of VWS. The same deletion was not present in either parent and his two siblings were also phenotypically normal. Conclusions Other than IRF6, the genes which are deleted in this patient appear to be insensitive to copy number and haploinsufficiency. We compared the deletion in this patient with another case which was also mapped by high resolution array but had additional phenotypic features.
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32
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Abstract
This article presents the case of a patient with Van der Woude syndrome treated with orthodontic and orthopedic intervention in the mixed dentition stage. The patient had a bilateral cleft of the lip and alveolus accompanied by lip pits on the lower lip. Intra-orally, there was bilateral anterior and posterior cross-bite with a collapsed maxilla. The maxillary transverse deficiency was managed with orthopedic expansion and the second phase of treatment involved secondary alveolar bone grafting followed by retention with functional regulator-3. The mild maxillary retrognathia and deficient lip support was managed with dental compensation.
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Affiliation(s)
- Sonahita Agarwal
- Department of Orthodontics and Dentofacial Orthopedics, Mahatma Gandhi Dental College, Jaipur, India
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33
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Malik S, Wilcox ER, Naz S. Novel lip pit phenotypes and mutations of IRF6 in Van der Woude syndrome patients from Pakistan. Clin Genet 2013; 85:487-91. [PMID: 23713753 DOI: 10.1111/cge.12207] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 03/09/2013] [Revised: 05/23/2013] [Indexed: 11/29/2022]
Abstract
The role of interferon regulatory factor 6 (IRF6) gene mutations in causing Van der Woude syndrome (VWS) and poplyteal pterygium syndrome has been described in different populations worldwide. The former is one of the major syndromes of cleft lip and/or cleft palate (CL/P) with the distinct phenotype of presence of pits with or without sinuses on the lower lip. We identified seven probands with VWS from Punjab province of Pakistan and recognized two previously unreported lip pit phenotypes. The mutational analysis of IRF6 in this cohort revealed four novel and two previously reported mutations. The newly identified mutations include three frameshifts (c.635delG; c.21_33del13; c.627delC) and one transition mutation (c.2T>C) affecting the first codon of IRF6. Together with a past epidemiological study on VWS in Pakistan, the frequency of this syndrome among CL/P individuals from Punjab was calculated to be 1.17%.
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Affiliation(s)
- S Malik
- School of Biological Sciences; Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
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34
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Abbo O, Vaysse F, Bieth E, Galinier P. [ Van der Woude syndrome: An unrecognised clinical entity]. ANN CHIR PLAST ESTH 2014; 59:81-4. [PMID: 22014507 DOI: 10.1016/j.anplas.2011.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 09/18/2011] [Indexed: 11/20/2022]
Abstract
Van der Woude syndrome is known to be the first syndromic cause of oral cleft. Apart clefts the cardinal signs are lower lip pits and hypodontia. IRF6 gene mutations have been recently identified as potential cause in this syndrome which permits to better understand its phenotype heterogeneity. Based on a literature review, we tried to cover the different aspects of this syndrome with an emphasis on genetic counselling and surgical correction of lip pits.
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