Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA; Center for Developmental Biology & Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA 98101, USA; Division of Basic Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, Seattle, WA 98195, USA; Center for Developmental Biology & Regenerative Medicine, Seattle Children's Research Institute, Seattle, WA 98101, USA; Department of Anatomy & Developmental Biology, Monash University, Clayton, VIC 3800, Australia.
Am J Hum Genet. 2018 Jun 7;102(6):1143-1157. doi: 10.1016/j.ajhg.2018.04.009. Epub 2018 May 24.
Non-syndromic cleft lip with or without cleft palate (NS-CL/P) is one of the most common human birth defects and is generally considered a complex trait. Despite numerous loci identified by genome-wide association studies, the effect sizes of common variants are relatively small, with much of the presumed genetic contribution remaining elusive. We report exome-sequencing results in 209 people from 72 multi-affected families with pedigree structures consistent with autosomal-dominant inheritance and variable penetrance. Herein, pathogenic variants are described in four genes encoding components of the p120-catenin complex (CTNND1, PLEKHA7, PLEKHA5) and an epithelial splicing regulator (ESRP2), in addition to the known CL/P-associated gene, CDH1, which encodes E-cadherin. The findings were also validated in a second cohort of 497 people with NS-CL/P, comprising small families and singletons with pathogenic variants in these genes identified in 14% of multi-affected families and 2% of the replication cohort of smaller families. Enriched expression of each gene/protein in human and mouse embryonic oro-palatal epithelia, demonstration of functional impact of CTNND1 and ESRP2 variants, and recapitulation of the CL/P spectrum in Ctnnd1 knockout mice support a causative role in CL/P pathogenesis. These data show that primary defects in regulators of epithelial cell adhesion are the most significant contributors to NS-CL/P identified to date and that inherited and de novo single gene variants explain a substantial proportion of NS-CL/P.
非综合征性唇裂伴或不伴腭裂(NS-CL/P)是最常见的人类出生缺陷之一,通常被认为是一种复杂的特征。尽管全基因组关联研究已经确定了许多位点,但常见变异的效应大小相对较小,而假定的遗传贡献仍难以捉摸。我们报告了 209 名来自 72 个多发病家族的外显子组测序结果,这些家族的系谱结构与常染色体显性遗传和可变外显率一致。在此,我们描述了四个编码 p120-连环蛋白复合物(CTNND1、PLEKHA7、PLEKHA5)和一个上皮剪接调节因子(ESRP2)组成部分的基因以及已知的 CL/P 相关基因 CDH1 中的致病性变异,该基因编码 E-钙黏蛋白。这些发现还在由 497 名患有 NS-CL/P 的人组成的第二个队列中得到了验证,该队列包括具有致病性变异的小家族和单身者,这些基因在 14%的多发病家族和 2%的较小家族的复制队列中被鉴定。每个基因/蛋白质在人源和鼠源胚胎口-腭上皮中的富集表达、CTNND1 和 ESRP2 变异的功能影响的证明以及 Ctnnd1 敲除小鼠中 CL/P 谱的重现,都支持它们在 CL/P 发病机制中的因果作用。这些数据表明,上皮细胞黏附调节剂的主要缺陷是迄今为止 NS-CL/P 中最重要的致病因素,并且遗传和新生单基因变异解释了 NS-CL/P 的很大一部分。
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