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Published on: March 31, 2019
Altered transmission of HOX and apoptotic SNPs identify a potential common pathway for clubfoot
Audrey R Ester1, Katelyn S Weymouth, Amber Burt
1Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA.
Insights
Genetic factors like HOXA gene variants and insulin-like growth factor binding protein 3 (IGFBP3) may contribute to clubfoot development. Gene interactions involving HOX and apoptotic genes offer a new biologic model for this common birth defect.
Area of Science:
- Genetics
- Developmental Biology
- Orthopedics
Background:
- Clubfoot is a common birth defect affecting limb development, with multifactorial causes that remain poorly understood.
- The HOXA and HOXD gene clusters and insulin-like growth factor binding protein 3 (IGFBP3) are crucial for limb and muscle morphogenesis, making them potential candidates for clubfoot etiology.
Purpose of the Study:
- To investigate the association of single nucleotide polymorphisms (SNPs) in the HOXA, HOXD gene clusters, and IGFBP3 with clubfoot.
- To explore potential gene-gene interactions between these candidate genes and previously identified apoptotic gene variants in clubfoot development.
Main Methods:
- Genotyping of 20 SNPs from HOXA/HOXD clusters and 12 SNPs in IGFBP3 in discovery (multiplex/simplex families) and validation (simplex trios) samples.
- Transmission disequilibrium testing was used to analyze SNP associations.
- Analysis of gene-gene interactions, including those with CASP3 SNPs.
Main Results:
- A specific SNP in the HOXA basal promoter region (rs3801776) showed significant altered transmission in both discovery and validation samples (P = 0.004 and 0.028).
- An SNP in IGFBP3 (rs13223993) also demonstrated altered transmission in the discovery sample (P = 0.003).
- Significant gene-gene interactions were found between HOXA, HOXD, IGFBP3 variants, and SNPs in apoptotic genes, particularly CASP3.
Conclusions:
- Perturbations in HOX genes, specifically HOXA, and IGFBP3 are associated with clubfoot.
- Gene-gene interactions between HOX genes, IGFBP3, and apoptotic pathway genes (like CASP3) suggest a combined role in abnormal muscle and limb development leading to clubfoot.
- This study proposes a biologic model implicating genetic factors in the developmental failure of limb rotation in clubfoot.
Abstract:
Clubfoot is a common birth defect that affects 135,000 newborns each year worldwide. It is characterized by equinus deformity of one or both feet and hypoplastic calf muscles. Despite numerous study approaches, the cause(s) remains poorly understood although a multifactorial etiology is generally accepted. We considered the HOXA and HOXD gene clusters and insulin-like growth factor binding protein 3 (IGFBP3) as candidate genes because of their important roles in limb and muscle morphogenesis. Twenty SNPs from the HOXA and HOXD gene clusters and 12 SNPs in IGFBP3 were genotyped in a sample composed of non-Hispanic white and Hispanic multiplex and simplex families (discovery samples) and a second sample of non-Hispanic white simplex trios (validation sample). Four SNPs (rs6668, rs2428431, rs3801776, and rs3779456) in the HOXA cluster demonstrated altered transmission in the discovery sample, but only rs3801776, located in the HOXA basal promoter region, showed altered transmission in both the discovery and validation samples (P = 0.004 and 0.028). Interestingly, HOXA9 is expressed in muscle during development. An SNP in IGFBP3, rs13223993, also showed altered transmission (P = 0.003) in the discovery sample. Gene-gene interactions were identified between variants in HOXA, HOXD, and IGFBP3 and with previously associated SNPs in mitochondrial-mediated apoptotic genes. The most significant interactions were found between CASP3 SNPS and variants in HOXA, HOXD, and IGFBP3. These results suggest a biologic model for clubfoot in which perturbation of HOX and apoptotic genes together affect muscle and limb development, which may cause the downstream failure of limb rotation into a plantar grade position.
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