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.

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