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Genes Contributing in Cleft Lip and Cleft Palate
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Journal of International Dental and Medical Research ISSN 1309-100X Genes Contributing in Cleft Lip and Cleft Palate Stella Lesmana, and Elza Ibrahim Auerkari

Genes Contributing in Cleft Lip and Cleft Palate: A Literature Review

Stella Lesmana1, Elza Ibrahim Auerkari2*

1. DDS, Pediatric Dentistry Postgraduate Programme, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia.
2. Prof. DDS, M.Biomed, PhD, For. Odont. Department of Oral Biology, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia.


Failure of the palatal shelves with the primary palate or with each other results in cleft palate,
with varying degrees of disability. Orofacial clefts are common birth defects of complex etiology
involving the interplay of genetic predisposition and enviromental exposures. Both genetic and
environmental factors playing an important and influential role.Ethnic and sex differences in the
prevalence of orofacial clefting provide further support of a genetic component to these disorders.
The researches in genetics subject have shown several genes that cause orofacial cleft, it can
be the single gene disorder or aletration of the chromosome.
Review (J Int Dent Med Res 2016; 9: (Special Issue), pp. 441-448)
Keywords: Cleft palate, cleft lip, genetic, gene, chromosome.
Received date: 28 September 2016 Accept date: 29 October 2016

Introduction and to varying degrees suffer from disturbances

in the normal facial and dental development.4
Orofacial clefts represents a large Children with these disorders require surgical
proportion of birth defects and have a intervention, starting from the first year of their
multifactorial cause with the worldwide frequency life and potentially for many years afterwards,
is 1 in 700 live births.1,2 There are many possible plus also requiring nutritional, dental, speech,
etiologies including single-gene disorders, medical, and behavioral follow-up assistance.1
chromosome aberrations, exposure to teratogens, The disorder has a complex inheritance
and sporadic conditions of unknown cause.2 Both pattern with no clear mode of inheritance and
genetic and environmental factors playing an reduced penetrance, with a positive family
important and influential role. Primary evidence historty for clefting in approxmately one third of
for a genetic role has been available for some patients. To date, 13 genome-wide scans for non
years; the sibling risk for cleft lip and palate is syndromic cleft lip wirth or without cleft palate
approximately 30 times higher than that for the (NSCL/P) have been carried out; a meta-analysis
normal population prevalence.3 has been performed on the 6 published and 7
Orofacial clefts can be subdivided into ongoing genome scans, revealing multiple loci.
these that affect the lip and palate and those that Many mouse mutants with isolated clefts have
impact the palate only.1 Approximately 30% of all also been described where the specific gene has
clefts are associated with one of more than 400 been identified. These genes have also
described syndromes, while the remaining 70% contributed to the set of candidates that have
are isolated defects.2 The clinical manifestations been considered for genetic studies.1 This
of these defects are diverse, ranging from literature review is about alteration of some
isolated clefts of the lip to complete bilateral genes that cause orofacial cleft.
clefts of the lip, alveolus and palate.3 Children
with cleft lip and palate can face problems during LITERATURE REVIEW
feeding, show speech and hearing difficulties, Etiology of Cleft
Oral-facial clefts are common birth
*Corresponding author: defects of complex etiology involving the
Prof. Elza Ibrahim Auerkari interplay of genetic predisposition and
Department of Oral Biology, Faculty of Dentistry, 5
enviromental exposures. Most orofacial clefts
Universitas Indonesia, Jakarta, Indonesia.
Salemba Raya 4, Jakarta 10430, Indonesia. are caused by the interaction between genetic
E-mail: and environmental factors. Genetic factors create
suspectibility for clefts, and when environmental
Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 441
Journal of International Dental and Medical Research ISSN 1309-100X Genes Contributing in Cleft Lip and Cleft Palate Stella Lesmana, and Elza Ibrahim Auerkari

factors interact with a genetically suspectible chromosomes 13, 18, and 21 associated with
genotype, a cleft develops during an early stage cleft lip with or without palate were described, as
of development.4 The study of cleft lip and palate well as partial deletions and duplications of other
is further complicated by the fact that a chromosomes. These findings suggest that there
combination of genetic and enviromental factors may be several genomic regions containing loci
contributes to its etiology.6 which, in excess or in insufficiency, may lead to
Most orofacial clefts are believed to be cleft lip with or without palate.7
nonsyndromic, with the rarer syndromic cases Cleft lip with or without palate can be
resulting from factors such as chromosomal caused by both exogenous and genetic factors.
abnormalities, characterized Mendelian single- However, the precise aetiology and pathogenesis
gene syndroms and teratogenic effects. The high remain obscure. Some environmental factors are
rates of familial occurrences, reccurence risks, known to cause cleft lip and/or palate, including
and elevated concordance rates in monozygotic steroids, anticonvulsants, retinoids, and rubella
twins provide evidence for a strong genetic virus. Although many teratogenic substances
component in NSCL/P. The disorder has a have been discovered, the incidence of cleft lip/or
complex inheritance pattern with no clear mode palate has not decreased significantly.8Maternal
of inheritance, with a positive family historty for cigarette smoking leading to embryonic hypoxia,
clefting in approximately one third of patients.1 has been associated with an increased incidence
Defects of growth factors of their of non-syndromic cleft lip and palate, and also
receptors have been shown to cause isolated nutritional status of pregnant mothers.3
(non-syndromic) or syndromic oral clefts in
humans.For the development of the head a Prevalence of Cleft
group of cells with stem cell properties, called Occurance estimates range between
cranial neural crest (CNC) cells, are of particular 1/300 and 1/2500 births for cleft lip and palate
importance. These cells delaminate from the and approximatelty 1/500 births for cleft palate
lateral ridges of the neural plate (which will form only.Ethnic and sex differences in the prevalence
the neural tube) and then emigrate towards the of orofacial clefting provide further support of a
developing branchial arches. The proliferation of genetic component to these disorders. It is well
the CNC cells is responsible for the budding of established that there is substansial population to
tissues around the future oral cavity. Continuous population variation in the rates of orofacial
neural crest stem cell proliferation leads to the clefting at birth on the basis of geographic origin,
formation of a single frontonasal process and of with Asian populations having the highest
pairs of maxillary and mandibular processes. As prevalence of clefting at birth (1/500 births) and
development advances, all these processes join African populations having the lowest (1/2500
and fuse giving rise to the completed face. births), with Caucasians being intermediate
Thereafter, in both the maxillary and mandibular (1/1000 births).1The cleft lip with or without cleft
processes teeth will form.4 palate is more common, affecting 1-2 in 1000
Orofacial and dental disorders result births and presenting considerable differences in
when mutations in the sequence of either a gene prevalence, with Native Americans and Asians
or a group of genes cause alterations to the showing the highest rate and Africans the lowest.
expression or function of the encoded protein(s). The cleft palate onlyphenotype is less common,
Gene mutations, but also environmental factors, with a prevalence of approximately one in 1500-
can affect the expression of genes or interfere 2000 births in most ethnic backgrounds.2
with the normal function of their protein
products.4 Cleft Classification
Mutations in single genes and Oral-facial clefts can be further classified
chromosomal abnormalities are the most as non-syndromic (isolated) or syndromic,based
common mechanisms underlying syndromic cleft on the presence of other structural anomalies. It
lip with or without palate. The Online Mendelian is generally accepted that cleft lip with or without
Inheritance in Man database (OMIM) describes cleft palate and cleft palate only are genetically
more than 500 syndromes with cleft lip with or distinct phenotypes.2Broadly speaking,
without palate as part of the phenotype. approximately 70% of cleft lip with or without cleft
Furthermore, several cases of trisomy of palate cases are non-syndromic, occuring as an
Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 442
Journal of International Dental and Medical Research ISSN 1309-100X Genes Contributing in Cleft Lip and Cleft Palate Stella Lesmana, and Elza Ibrahim Auerkari

isolated condition unassociated with any other target genes for this transcription factor have
recognizable anomalies, while the remaining been shown to include members of the fibroblast
30% of syndromic cases are present in growth factor and TGFβ families, which are
association with deficits or stuctural abnormalities known to encode signalling molecules heavily
occuring outside the region of the cleft.3 implicated in early craniofacial development.
With all clinically recognizable syndromes, TBX22 is the first gene to be identified for a
cases of syndromic cleft lip and palate or cleft major CP syndrome and is particularly significant
palate can be broadly subdivided into3: in view of the fact that targeted disruption of Tbx1
1. Those that occur as part of a characterized in the mouse results in a wide range of
Mendelian disorder (resulting from a single developmental anomalies which encompass
gene defect) almost all of the common features of the
2. Those arising from structural abnormalities DiGeorge/ velocardiofacial syndromes. These
of the chromosomes, syndromes associated syndromes, which arise as manifestations of
with known teratogens deletions in chromosome 22q11, are tought to be
3. Those whose causation remains obscure caused by a failure in function or migration of
and are therefore currently uncharacterized. neural crest cells and predominantly affect
derivatives of the third and fourth branchial
Syndromic CLP arches and their associated pharyngeal pouches,
Single gene disorder are the result of but affected individuals can also have CP.
specific gene mutations on the autosomes or sex Non-syndromic clefting3
chromosomes and are inherited following The first report of such analysis
Mendelian rules (autosomal dominant or suggested possible linkage between cleft lip and
recessive and X-linked dominant or rescessive, palate (CLP) and the blood clotting factor XIII
respectively) with varying levels of penetrance gene (F13A) on chromosome 6p. Linkage has
and expressivity. Cytogenesis, or the study of been reported for CLP to endothelin-1 (ET1),
chromosomal abnormalities, has revealed a wide which encodes a vasactive peptide expressed in
range of physical chromosomal alterations, vascular endothelial cells. ET1 is involved in the
including variaions in both number and structur, regulation of blood pressure. They exhibit
which can cause perturbarions of gene function craniofacial defects including a marked reduction
and congenital malformations.3 One of the most in tounge size, microagnathia and cleft palate
common human autosomal dominant disorders (CP) in mice. A more recent GWAS in families
associated with cleft lip and palate is van der with multiple cases of non-syndromic CLP
Woude syndrome (VWS), which contributes to concluded that no single major CLP locus exists
around 1-2 % of syndromic cleft lip and palate and a multifactorial model was the most likely
cases. VWS is a single gene disorder with an explanation of the genetic component of this
autosomal dominant pattern of inheritance. This disorder.
condition is associated with highly characteristic
pitting of the lower lip mucosa and cleft lip and Genes Contributing in Cleft
palate, fistulae on the lower lip, and hypodontia. 1. Transforming Growth Factor (TGF)
Kondo et al. showed that missense and a. Transforming Growth Factor Beta 2
nonsense mutations in interferon regulatory (TGFβ2)
factor 6 (IRF6) were responsible for the majority The Transforming Growth Factor Beta (TGFβ)
of VWS cases.3, 7 family of growth factors plays multiple and
Syndromic Cleft Palate (CP)3 critical roles during all stages of tooth
X-linked CP (CPX) is a rare semi- development.4 TGFβ2 is a member of the
dominant X-linked disorder characterized by CP highly conserved TGFβ super-gene family
and ankyloglossia. The causative gene was and located at chromosome 1q41. TGFβ2 is
originally localized to chromosome Xq21, but involved in palatogenesis along with other
recently Braybrook et al succeeded in pinpointing TGFβ family isoforms. Inactivation of a TGFβ
a variety of mutations in the TBX22 gene in receptor gene (TGFβ2) in mouse neural
individuals from a number of separate families, crest cells resulted in cleft palate and
as being responsible for CPX. TBX22 is also abnormalities in the formation of the
expressed in the developing palate and potential cranium.9
Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 443
Journal of International Dental and Medical Research ISSN 1309-100X Genes Contributing in Cleft Lip and Cleft Palate Stella Lesmana, and Elza Ibrahim Auerkari

b. TGFβ3 associations between IRGF6 and NSCL/P have

TGFβ3 is one of the strongest candidate gene been reported in multiple populations. In a follow-
for cleft lip and palate in humans. TGFβ3 up study, a common etiologic variant (rs642961)
has a broad spectrum of biological activities in a highly conserved IRF6 enhance element was
and is known to induce palatal fusion responsible for 18% of cleft lip occurrence in
especially secondary palatal development. Northern European populations (Rahimov et al.,
Inactivaiton of the TGFβ3 gene in mice 2008).14
results in bilateral cleft of the secondary IRF6 and TGFA gene belong to transcription
palate due to the non-fusion of the palatal factors and growth factors respectively. IRF6
shelf processes. TGFβ3 is located at contains a helix-turn-helix DNA-binding motif and
chromosome14q24. The role of TGFβ3 in is thought to play an important role in NSCL/P as
clefts has emerged from animal studies mutations have been identified in this gene in
which indicate that TGFβ3 play a crucial role Van der Woude syndrome, which is a dominant
in secondary palate development. In humans, disorder sharing some symptoms with NSCL/P.12
TGFβ3 is associated with non-syndromic There were a SNPs loci found being
CL/P in different populations. 9 overtransmitted in the study of Zucchero and
c. Transforming growth factor-alpha (TGFα) colleagues, rs2235375. Scapoli et al obtained
The gene is located at chromosome 2p13. strong evidence that linkage disequilibrium
TGFα have been shown to be present in the existed between rs2235375 and NSCL/P in an
regulation of palate development and are Italian population. However the same evidence
present at high levels in the MEE of palatal was not found between rs2235375 and NScl/P in
shelves. Previous genetic studies have the current research. Since the etiology of
demonstrated a significant association NSCL/P is complex, the different results might be
between transforming growth factor-alpha due to ethnic and/or environment variances
(TGFα) and CL/P. In contrast, Lidral et between the Chinese population and Italian
al. and Passos-Bueno et al. showed no population, or the small sample size. 12 In a
association between TGFA with CL/P in non- larger context this study provides evidence of the
Caucasian population.9 IRF6 gene contributing to the formation of
NSCL/P in southeast China. This study attempts
2. Interferon Regulatory Factor 6 (IRF6) to screen IRG6 among cleft families with at least
Gene two affected members and also single cases with
Disease-causing mutations in the IRF 6 CLO that have been classified as non-
gene have been identified in Van der Woude syndromic.12
syndrome, a single-gene Mendelian disorder that
includes presentation of a cleft lip or cleft palate 3. Axis Inhibition Protein 2 (AXIN2) Gene5
phenotype, this gene maps to 1q32.1Van der WNT signaling has been im- plicated in
Woude syndrome is the most common syndromic regulation of diverse developmental events, as
form of oral clefts and has an autosomal well as in aberrations of cell homeostasis that
dominant inheritance pattern. Mutations in the may lead to cancer. Experiments in mice have
interferon regulatory factor 6 (IRF6) gene are also shown that SHH and WNT signals are
responsible for approximately 70% of VWS case, necessary for nor- mal tooth development. It is
while the other 30% of cases have unknown thought that integrated networks of signaling
cases.13 pathways are the key regulators of tooth
IRF6 is strongly expressed in the morphogenesis.15
ectoderm covering the developing facial Members of the WNT gene family have
primordia. Mice deficient for both Irf6 alleles been associated with clefts in humans and mice.
develop abnormally thick skin with severe limb The AXIN2 (axis inhibition protein 2) gene is a
and craniofacial abnormalities, including cleft of negative regulator of the WNT pathway due to its
the secondary palate. The lack of a normally role in the degradation of β-catenin. Mutations in
stratified epidermis in Irf6-null mice, due to a AXIN2 have been associated with increased
defect in keratinocyte proliferation and susceptibility to cancer and in some cases have
differentiation, confirms an important role for Irf6 been detected segregating together with familial
in epidermal development. Significant tooth agenesis. The mutations of AXIN2 are
Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 444
Journal of International Dental and Medical Research ISSN 1309-100X Genes Contributing in Cleft Lip and Cleft Palate Stella Lesmana, and Elza Ibrahim Auerkari

responsible for the severe oligodontia of the craniofacial complex, including the palate. Mice
patients, showing that AXIN2 function is essential lacking Msx1 function exhibit a variety of
for the development of dentition in humans. Letra, craniofacial defects including clefting of the
et al. found Axin2 and Irf6 proteins co-localizing secondary palate, complete arrest of tooth
particularly in the developing secondary palate, development at the bud stage and anomalies of
nasal, oral, and eye epithelial. several facial bones. A heterozygous MSX1
4. Poliovirus Receptor-Related 1(PVRL1) nonsense mutation has recently been identified
Gene in a three-generation Dutch family exhibiting
Poliovirus receptor related 1 gene various combinations of CLP, CP, and selective
(PVRL1) which is located on chromosome 11 tooth agenesis. Significant linkage disequilibrium
was shown to have a significant association with has also been found between CLP and neutral
non-syndromic CL/P in northern polymorphisms within MSX1 and TGFβ.7
Venezuela.16Rare mutations in sporadic cases
and a statistically significant association between 8. Sonic Hedgehog (SHH) Gene4
a common coding variant (G361V) in PVRL1 and Sonic hedgehog (SHH) is the main
NS CL/P were found in multiple population.14 member of the Hedgehog family which is
associated with abnormal orofacial and tooth
5. Cysteine-rich secretory protein development. SHH is expressed in the ectoderm
containing LCCL domain 2 (CRISPLD2)Gene17 of the frontonasal and maxillary processes during
CRISPLD 2 (cysteine-rich secretory development. In humans, muattions of SHH
protein containing LCCL domain 2) gene is result in holoprosencephaly, demonstrating the
located on chromosome 16q24.1 and has been crucial role of this growth factor in the
recently associated with nonsyndromic CL(P) in development of the face. In the chick model, the
US Caucasian and Hispanic populations. transient loss of SHH signalling results in
Moreover, the authors detected CRISPLD2 midfacial clefts analogous to the human cleft
expression in the mandible, palate, and lip/palate.
nasopharynx regions during craniofacial
development at E13.5-E17.5 and have 9. Methylenetetrahydrofolate Reductase
suggested CRISPLD2 as a novel candidate gene (MTHFR) Gene9
for the etiology of NSCL(P). Methylenetetrahydrofolate reductase
(MTHFR) maps on chromosome 1q36 is a key
6. Forkhead Box E1 (FOXE1) Gene14 enzyme in folic acid metabolism. Previous
FOXE1 is a member of the forkhead/ studies in non-syndromic CL/P, the MTHFR
winged helix domain transcription factor family C77T genotype in the mother conferred an
whose members are primarily involved in increased risk of C/LP in their offspring. Similarly
embryonic development. Targeted disruption of Carinci et al. demonstrated a significantly higher
mouse Foxe1 results in cleft palate and thyroid mutation frequency of MTHFR in mothers of
malformation. Loss-of-function mutations within children with CL/P. Thus, the important of peri-
its forkhead DNA-binding domain cause conceptional folate intake were emphasized in
Bamforth-Lazarus syndrome, which is these studies and its deficiencies could lead to
characterized by thyroid agenesis, choanal CL/P.
atresia, bifid epiglottis, spiky hair, and cleft palate
(Clifton-Blight et al., 1998; Castanet et al., 2002). 10. MMPs18
Subsequently, significant associations were During embryonic development, the
reported between FOXE1 and NS CL/P in process of morphogenesis is accompanied by
multiple populations, although no common changes in the composition of the extracellular
coding variants were identified. matrix that further allow for cell migration and
differentiation, cell-cell interactions, and tissue
7. Murine Muscle-segment Homeobox resorption. Matrix metalloproteinases (MMPs) are
1/Msh Homeobox 1 (MSX1) Gene a family of proteolytic anzymes that are known to
MSX1 encodes a transcription factor and play an important role in these processes
also demonstrates a regionally restricted because of their ability to collectively degrade all
expression pattern in the developing murine components of the ECM. Previous studies have
Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 445
Journal of International Dental and Medical Research ISSN 1309-100X Genes Contributing in Cleft Lip and Cleft Palate Stella Lesmana, and Elza Ibrahim Auerkari

suggested MMPS as potential candidate genes 10 FGF and FGF receptor (FGFR) genes for their
for CL/P based on expression patterns and the potential role in controlling risk to NSCL/P using
roles they play in modelling craniofacial tissues 297 case-parent trios from the populations. Wang
during early embryogenesis. Furthermore, they H, et al. collected peripheral blood and all
may be implicated in cleft lip/ palate. The MMP subjects were classified as having an isolated,
family is composed of 23 enzymes that share nonsyndromic iCL(P). Single nucleotide
significant sequence homologies. It is divided into polymorphisms (SNPs) were selected in 10
fiva classes: collagenases, gelatinases, FGF/FGFR genes (including FGFBP1, FGF2,
stromelysins, membrane-type MMPs, and others, FGF10, FGF18, FGFR1, FGFR2, FGF19, FGF4,
including a few of the most recently identifed FGF3, and FGF9).20
MMPs. 111 markers in 10FGF/FGFR genes using
MMP-3 shows the most extensive 297 case-parent trios collected from an
distribution of all MMPs during palatal shelf international study, SNPs in seven of these
morphogenesis. MMP-3 has been detected in genes gave some evidence of linkage and
vivo subjacent to the MEE following contasct of association with unobserved casual variants for
the palatal shelves and has been demonstrated iCL(P). Genes in the FGF/FGFR pathway are
to play a role in epithelial-mesenchymal considered good candidates for iCL(P) because
transformation (EMT). Induction of its exoression they play important roles in craniofacial
results in cleavage of cadherin, loss of the development and several of them (FGFR1,
epithelial phenotype and subsequent stable FGFR2, and FGF10) control Mendelian
conversion of epithelial into mesenchyme. malformation syndromes that can include oral
Constantly high levels of active MMP-3 were clefts as a hallmark feature.20 Mammalian
observed during the latter stages of fibroblast growth factors (FGFs) (FGF1-FGF10
palatogenesis and may represent an important and FGF16-FGF23) control multiple
stimulus for EMT. developmental processes including craniofacial
and palatal development. The biological activities
11. Dihydrofolate reductase (DHFR) Gene19 of FGFs are conveted by seven principal FGF
The role of folate in risk reduction of receptor tyrosine kinases encoded by four
orofacial clefts has been supported by several distinct genes (FGFR1-FGFR4).
studies. Foloc acid is a water soluble B-vitamin It has been revealed that coordinated
that plays a crucial role in embryonic epithelial-mesenchymal interactions are essential
development. In fact, it is essential for DNA during the initial stages of palate development
stability maintainance, being involved in DNA and require an FGF signaling network, which
synthesis, repair, and methylation. Alterations mediates the epithelial-mesenchymal interactyion
involving genes responsible for each step of the involved in the development of palate and upper
folate pathway can lead to aberrations in lip. In addition, several lines of studies on animal
organogenesis that result in congenital models point to the involvement of FGF-FGFR
malformations such as neural tube defects or oral signaling in the pathogenesis of oral clefting.21
Alteration of folate metabolism appears to 13. Gremlin-1 (GREM1)
modify the risk of at least two congenital GREM1 plays a specific role not only in
malformations: neural tube defects (NTDs) and the development of the lip, but also during
orofacial clefts (OFC). These embryogenesis formation of the soft palate. Analyses of Grem1-
anomalies occur almost at the same time of deficient mouse models have shown that during
development and both involve the embryo embryogenesis Grem1 function is crucial for limb
midline structures. This study is a family-based- development and kidney formation. However,
association study to test if DHFR polymorphisms complete loss of Grem1 function causes no
could influence the risk of NS-CL/P. obvious craniofacial defects. GREM1 acts as a
secreted antagonist of various members of the
12. Fibroblast Growth Factor (FGF) Gene bone morphogenetic protein (BMP) family, which
Genes in the fibroblast growth factor has been shown to play a critical role in both lip
(FGF) signaling pathway are excellent candidate and palate development.22
genes for NSCL/P . This study tested markers in
Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 446
Journal of International Dental and Medical Research ISSN 1309-100X Genes Contributing in Cleft Lip and Cleft Palate Stella Lesmana, and Elza Ibrahim Auerkari

14. Special AT-rich sequence-binding Loss of function of WNT genes is associated with
protein 2 (SATB2) defects in the facial region, incomplete
The role of SATB2 in craniofacial penetrance of cleft lip, and defects in kidney
development has been discussed widely. Strong morphogenesis in homozygous mice mutants.
expression of SATB2 was de- tected during
palatal shelves development with maximum 17. Paired Box 9 Gene (PAX9)27
expression in the mesenchyme underlying the Animal models demosntrated that FGFs
medial edge epithelia [27]. Strong evidence interact with Pax9 during craniofacial
emerged from multiple un- related reports development. Fgf3 expression is strongly
including several patients who had deletion at affected by combined reduction of Pax9 and
2q32-33 [28–31], a patient who had a Msx1 gene dosages and interestingly our study
translocation with a breakpoint site in the SATB2 provides statistical evidence that oral clefts can
gene and another who had SATB2 mutation.23 be the result of FG3 and PAX9 interaction.
The Satb2 is the first cell-type-specific
Treatment of Cleft
transcription factor that specifically binds nuclear
Patients with orofacial clefts require
matrix attachment regions (MARs) and is
surgical, nutritional, dental, speech, medical and
involved in transcriptional regulation and
behavioral interventions and impose a substantial
chromatin remodelling. It plays an important role
emotional and economic burden on the
in tooth and craniofacial development.24
society.11Identification of the molecular players
and unravelling of the genetic pathways that
15. Midline-1 Gene (MID1)25
dictate palatogenesis and lip formation could
MID1 is a gene that responsible for Opitz
offer new and exciting possibilities for the
Syndrome (OS), a congenital disorder affecting
prevention and therapy of cleft lip and palate.
primarily midline structures. In fact, OS patients
Stem cell therapy is another future possibility of
exhibit facial anomalies, such as cleft lip and
correcting cleft lip and palate. before birth. During
palate, hypertelorism, and also laryngo–tracheo–
the formation of orocafacial structures (5 to 12
esophageal, cardiac, and genitourinary defects.
weeks of pregnancy) the immature immune
MID1 encodes a protein belonging to the
system of the fouetus allows the introduction of
TRIM/RBCC family (TRIM/ RBCC: proteins
stm cells free of the genetic abnormality. The
having a tripartite motif composed of a RING
transplantation and enfragment of suitable stem
domain, one or two B-box motifs and a coiled-coil
cells could in principle result in the correction of
the malformation. Stem cell technology combined
Mutations in the MID1 gene have been
with tissue engineering culd also provide
found in OS-affected individuals and suggest that
solutions for improvements in the treatment of
a loss-of-function mechanism is the basis of OS
oral clefts in children.4
pathogenesis25. The specific cellular function of
When surgically correcting oral clefts, the
the MID1 protein product, and its role in the
surgeon frequently faces the problem of tissue
pathogenesis of the disease and its possible
shortage. Currently, intense research is under
involvement in causing NSCLP, are still to be
way for the isolation of suitable stem cells from
amniotic fluit and adult tissues, including the
dental pulp, which could be potentially used to
16. WNT9B26
treat orofacial abnormalities. Such programmed
The wingless-type MMTV integration site
cells can be seeded on suitably engineered
family (Wnt) signaling pathway plays an
scaffolds to regenerate an appropriate
important role in craniofacial development. Wnt
craniofacial tissue of the desired shape and
signaling genes are conserved among species
and are essential to the development of several
processes, including face morphogenesis. Conclusions
Studies using animal models have revealed that
these genes are expressed in the midface of 1. Oral-facial clefts are common birth
mice and chickens and that Wnt signaling plays defects and the etiology is complex,
an important role in various aspects of involving the genetic factor and
craniofacial development in many species. enviromental exposures.

Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 447
Journal of International Dental and Medical Research ISSN 1309-100X Genes Contributing in Cleft Lip and Cleft Palate Stella Lesmana, and Elza Ibrahim Auerkari

2. There are many genes that had 13. Salahshourifar I, Sulaiman WAW, Halim AS, Zilfalil BA.
Mutation Screening of IRF 6 Among Families with Non-
considered to be the etiology of orofacial syndromic Oral Clefts and Identification of Two Novel Variants:
clefts. Review of the Literature. Eur J of Med Gen. 2012;55:389-93.
14. Mostowska A, Hozyasz KK, Biedziak B, et al. Genotype and
3. Orofacial cleft case still needs more Haplotype Analysis of WNT Genes in Non-syndromic Cleft Lip
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Volume ∙ 9 ∙ Special Issue (U.I. 1st International Workshop on Dental Research) ∙ 2016 Page 448

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