title: Cleft palate, retrognathia and congenital heart disease in velo-cardio-facial syndrome: a phenotype correlation study.
abstract: OBJECTIVE
  Velo-cardio-facial syndrome (VCFS) is caused by a microdeletion of approximately 40 genes from one copy of chromosome 22. Expression of the syndrome is a variable combination of over 190 phenotypic characteristics. As of yet, little is known about how these phenotypes correlate with one another or whether there are predictable patterns of expression. Two of the most common phenotypic categories, congenital heart disease and cleft palate, have been proposed to have a common genetic relationship to the deleted T-box 1 gene (TBX1). The purpose of this study is to determine if congenital heart disease and cleft palate are correlated in a large cohort of human subjects with VCFS.
  
  
  METHODS
  This study is a retrospective chart review including 316 Caucasian non-Hispanic subjects with FISH or CGH microarray confirmed chromosome 22q11.2 deletions. All subjects were evaluated by the interdisciplinary team at the Velo-Cardio-Facial Syndrome International Center at Upstate Medical University, Syracuse, NY. Each combination of congenital heart disease, cleft palates, and retrognathia was analyzed by Chi square or Fisher exact test.
  
  
  RESULTS
  For all categories of congenital heart disease and cleft palate or retrognathia no significant associations were found, with the exception of submucous cleft palate and retrognathia (nominal p=0.0325) and occult submucous cleft palate and retrognathia (nominal p=0.000013).
  
  
  CONCLUSIONS
  Congenital heart disease and cleft palate do not appear to be correlated in human subjects with VCFS despite earlier suggestions from animal models. Possible explanations include modification of the effect of TBX1 by genes outside of the 22q11.2 region that may further influence the formation of the palate or heart, or the presence of epigenetic factors that may effect genes within the deleted region, modifying genes elsewhere, or polymorphisms on the normal copy of chromosome 22. Lastly, it is possible that TBX1 plays a role in palate formation in some species, but not in humans. In VCFS, retrognathia is caused by an obtuse angulation of the skull base. It is unknown if the correlation between retrognathia and cleft palate in VCFS indicates a developmental sequence related to skull morphology, or direct gene effects of both anomalies. Much work remains to be done to fully understand the complex relationships between phenotypic characteristics in VCFS.
authors.affiliation: Velo-Cardio-Facial Syndrome International Center, Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, 725 Irving Avenue, Suite 406, Syracuse, NY 13210, United States.
authors.forename: Marcia A
authors.initials: MA
authors.lastname: Friedman
authors.forename: Nathanial
authors.initials: N
authors.lastname: Miletta
authors.forename: Cheryl
authors.initials: C
authors.lastname: Roe
authors.forename: Dongliang
authors.initials: D
authors.lastname: Wang
authors.forename: Bernice E
authors.initials: BE
authors.lastname: Morrow
authors.forename: Wendy R
authors.initials: WR
authors.lastname: Kates
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Higgins
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Shprintzen
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology / Q000235:genetics; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002869:Chromosome Aberrations; D002891:Chromosomes, Human, Pair 21 / Q000235:genetics; D002972:Cleft Palate / Q000453:epidemiology / Q000235:genetics*; D015331:Cohort Studies; D004062:DiGeorge Syndrome / Q000453:epidemiology / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology*; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000235:genetics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D063173:Retrognathia / Q000453:epidemiology / Q000235:genetics*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D055815:Young Adult