RESUMEN
BACKGROUND: Orofacial cleft (OFC) is the most prevalent craniofacial birth defect. Genes involved in one-carbon, folate and vitamin B12 metabolisms have been associated with OFC but no study performed a concomitant assessment on genes involved in these three pathways. OBJECTIVE: We looked for potential genetic variants associated with OFC using an exhaustive gene panel of one-carbon metabolism. METHODS: We performed a case-control discovery study on children with OFC (236 cases, 145 controls) and their related mothers (186 cases, 127 controls). We performed a replication study on the top significant genetic variant in an independent group from Belgium (248 cases, 225 controls). RESULTS: In the discovery study on 'mothers', the CBS locus reached array-wide significance (p=9.13×10-6; Bonferroni p=4.77×10-3; OR 0.47 (0.33 to 0.66)) among the 519 haplotypes tested for their association with OFC risk. Within the CBS haplotype block (rs2124459, rs6586282, rs4920037, rs234705, rs234709), the rs2124459 was the most significantly associated with a reduced risk of OFC (p=1.77×10-4; Bonferroni p=2.00×10-2; OR 0.53 (0.38 to 0.74), minor allele). The rs2124459 was associated with a reduced risk of cleft palate (CP) (p=6.78×10-5; Bonferroni p=7.80×10-3; OR 0.40 (0.25 to 0.63)). In the 'children' group, the rs2124459 was associated with a reduced risk of CP (p=0.02; OR 0.61 (0.40 to 0.93), minor allele). The association between rs2124459 and reduced risk of CP was replicated in an independent children population from Belgium (p=0.02; OR 0.64 (0.44 to 0.93), minor allele). CONCLUSIONS: The CBS rs2124459 was associated with a reduced risk of CP in both French and Belgian populations. These results highlight the prominent involvement of the vitamin B6-dependent transsulfuration pathway of homocysteine in OFC risk and the interest for evaluating vitamin B6 status in further population studies.
Asunto(s)
Labio Leporino/genética , Fisura del Paladar/genética , Cistationina betasintasa/genética , Predisposición Genética a la Enfermedad , Polimorfismo de Nucleótido Simple , Adulto , Bélgica , Estudios de Casos y Controles , Niño , Preescolar , Labio Leporino/complicaciones , Labio Leporino/metabolismo , Fisura del Paladar/complicaciones , Fisura del Paladar/metabolismo , Femenino , Francia , Estudios de Asociación Genética , Haplotipos , Humanos , Lactante , MasculinoRESUMEN
Orbito-facial number 4 clefts are the rarest craniofacial clefts and only a few cases have been reported. We report a case of a complete bilateral Tessier number 4 cleft, and our approach to surgical correction. We analyse the patient's treatment plan over a 26-year follow-up period. We comment on the age at which the first surgical procedure is commonly performed with or without a primary bone graft, as well as the use of the facial plasty technique with interdigitating Z-plasty flaps and rotation-transposition flaps. Closure of the cleft can constitute an emergency when the patient's globe is exposed.