Craniofacial variation and growth in the Prader-Labhart-Willi syndrome

A study of anthropometric variation and craniofacial growth in individuals with the Prader-Labhart-Willi syndrome (PLWS) illustrates the utility of anthropometry in clinical evaluation and research. Anthropometric measurements, including head length and breadth, minimum frontal diameter, and head circumference, were obtained on 38 PLWS individuals (21 with chromosome 15 deletions) with an age range from 2 weeks to 39 years. No anthropometric differences were found between the two chromosome subgroups. A relative deceleration in the growth of certain craniofacial dimensions (head circumference and length) is suggested by the negative correlations between age and Z-scores for the measurements. Raw values for minimum frontal diameter and head breadth were near or below the 5th percentile curve, while almost all values for head length and circumference fell within normal limits. The data support suggestions that dolichocephaly be considered an early diagnostic feature of PLWS. Furthermore, the status of narrow bifrontal diameter as a major feature of PLWS is confirmed.     

Distribution of craniofacial variables in south Dalmatian and middle Croatian populations

The objective of the present work was to determine some relevant craniofacial parameters, particularly in relation to sex, for the study of the distribution of basic head and face types, and to investigate craniofacial and morphological differences between two population samples. The study sample comprised 100 subjects of both sex aged 18 to 30 from South Dalmatia and 200 subjects from Middle Croatia. Eight basic craniofacial variables were measured to obtain head, forehead and face indexes. The data indicate that average values of all variables can be used as standard craniofacial parameters for the examined population groups. All the craniofacial variables are considerably higher in men than in women (p < 0.05). In the South Dalmatian population mesocephalia (48.0%) and leptoprosopia (82.0%) prevail, while in the Middle Croatian population the brachycephalia (62.0%), and euriprosopia (73.5%) are present to a greater degree. The most significant craniofacial and morphological differences between the examined study samples are head width (Eu-Eu), face width (Zy-Zy), and forehead height (Tr-N). They were found to be statistically significant in the examined Middle Croatian population (p < 0.05). The presented measurements are highly relevant to orthodontic diagnostics and therapy.     

Morphological integration of soft-tissue facial morphology in Down Syndrome and siblings

Down syndrome (DS), resulting from trisomy of chromosome 21, is the most common live-born human aneuploidy. The phenotypic expression of trisomy 21 produces variable, though characteristic, facial morphology. Although certain facial features have been documented quantitatively and qualitatively as characteristic of DS (e.g., epicanthic folds, macroglossia, and hypertelorism), all of these traits occur in other craniofacial conditions with an underlying genetic cause. We hypothesize that the typical DS face is integrated differently than the face of non-DS siblings, and that the pattern of morphological integration unique to individuals with DS will yield information about underlying developmental associations between facial regions. We statistically compared morphological integration patterns of immature DS faces (N = 53) with those of non-DS siblings (N = 54), aged 6-12 years using 31 distances estimated from 3D coordinate data representing 17 anthropometric landmarks recorded on 3D digital photographic images. Facial features are affected differentially in DS, as evidenced by statistically significant differences in integration both within and between facial regions. Our results suggest a differential affect of trisomy on facial prominences during craniofacial development.     

Craniofacial characteristics of Croatian and Syrian populations

Craniofacial area is apart of the human body which undergoes the greatest changes during development and is characterized by uneven growth. External and internal factors affect the growth and development of craniofacial structures. They are responsible for the occurrence of specific craniofacial characteristics in different races or populations within the same race. The present study investigates the possible differences of the basic head and face shapes between the Croatian and Syrian populations. The sample included 400 subjects of both sexes aged 18-24 years and was divided into a Croatian and a Syrian group with 200 subjects each. Six variables defined according to Martin and Saller were measured by standard anthropometric instruments. The results of the study demonstrated statistically significant differences between our subjects in all variables except face width. The dolichocephalic head type and the mesoprosopic face type were predominant in the Croatian population, while the brachycephalic head type and the euryprosopic face type dominated in the Syrian population.     

Some variables of the craniofacial complex in a Venezuelan population of negroid ancestry

A total of 226 individuals (101 males and 125 females), from La Sabana, a Venezuelan Negroid isolate, with ages between 8 and 60 years, were studied in order to characterize the population for its craniofacial variables and to study the behavior of these variables in relation to age and sex. The variables studied were grouped in three categories: direct cephalometric variables, which included 6 measurements taken directly on the individuals; indirect cephalometric variables, which included 18 measurements (9 angular and 9 linear), taken on lateral head films; and dental variables, which included 9 measurements taken from dental models. In general the direct variables showed the lowest coefficients of variation (CV), suggesting homogeneity within this sample. They were followed by the dental and the indirect variables, which had the highest CV values. In order to detect age and sex effects on the variables, sex and age group comparisons were performed with Student t tests. A greater proportion of significant differences were found among the direct variables, indicating that age and sex have more influence on this group of variables than upon the other two. Comparisons of our sample from La Sabana, with samples from African Negroid, Caucasoid, and Amerindian population show that La Sabana individuals have a craniofacial pattern basically Negroid, as we expected, although some contribution from Caucasoides and especially Amerindians is also suggested in our data.     

Trisomy 21 and facial developmental instability

The most common live‐born human aneuploidy is trisomy 21, which causes Down syndrome (DS). Dosage imbalance of genes on chromosome 21 (Hsa21) affects complex gene‐regulatory interactions and alters development to produce a wide range of phenotypes, including characteristic facial dysmorphology. Little is known about how trisomy 21 alters craniofacial morphogenesis to create this characteristic appearance. Proponents of the "amplified developmental instability" hypothesis argue that trisomy 21 causes a generalized genetic imbalance that disrupts evolutionarily conserved developmental pathways by decreasing developmental homeostasis and precision throughout development. Based on this model, we test the hypothesis that DS faces exhibit increased developmental instability relative to euploid individuals. Developmental instability was assessed by a statistical analysis of fluctuating asymmetry. We compared the magnitude and patterns of fluctuating asymmetry among siblings using three‐dimensional coordinate locations of 20 anatomic landmarks collected from facial surface reconstructions in four age‐matched samples ranging from 4 to 12 years: 1) DS individuals (n = 55); 2) biological siblings of DS individuals (n = 55); 3) and 4) two samples of typically developing individuals (n = 55 for each sample), who are euploid siblings and age‐matched to the DS individuals and their euploid siblings (samples 1 and 2). Identification in the DS sample of facial prominences exhibiting increased fluctuating asymmetry during facial morphogenesis provides evidence for increased developmental instability in DS faces. We found the highest developmental instability in facial structures derived from the mandibular prominence and lowest in facial regions derived from the frontal prominence. Am J Phys Anthropol 151:49–57, 2013. © 2013 Wiley Periodicals, Inc.     

Trisomic and allelic differences influence phenotypic variability during development of Down syndrome mice

Individuals with full or partial Trisomy 21 (Ts21) present with clinical features collectively referred to as Down syndrome (DS), although DS phenotypes vary in incidence and severity between individuals. Differing genetic and phenotypic content in individuals with DS as well as mouse models of DS facilitate the understanding of the correlation between specific genes and phenotypes associated with Ts21. The Ts1Rhr mouse model is trisomic for 33 genes (the "Down syndrome critical region" or DSCR) hypothesized to be responsible for many clinical DS features, including craniofacial dysmorphology with a small mandible. Experiments with Ts1Rhr mice showed that the DSCR was not sufficient to cause all DS phenotypes by identifying uncharacteristic craniofacial abnormalities not found in individuals with DS or other DS mouse models. We hypothesized that the origins of the larger, dysmorphic mandible observed in adult Ts1Rhr mice develop from larger embryonic craniofacial precursors. Because of phenotypic variability seen in subsequent studies with Ts1Rhr mice, we also hypothesized that genetic background differences would alter Ts1Rhr developmental phenotypes. Using Ts1Rhr offspring from two genetic backgrounds, we found differences in mandibular precursor volume as well as total embryonic volume and postnatal body size of Ts1Rhr and nontrisomic littermates. Additionally, we observed increased relative expression of Dyrk1a and differential expression of Ets2 on the basis of the genetic background in the Ts1Rhr mandibular precursor. Our results suggest that trisomic gene content and allelic differences in trisomic or nontrisomic genes influence variability in gene expression and developmental phenotypes associated with DS.     

Genetic polymorphism analysis of killer cell immunoglobulin-like receptor genes in the Chinese Uygur population

Human killer cell immunoglobulin-like receptors are expressed in natural killer cells and subsets of T lymphocytes. They regulate these cells upon interaction with human leukocyte antigen class I molecules and other ligands presented by target cells. KIR gene frequencies and haplotype distributions have been shown to differ significantly between populations from different geographical regions and ethnic origins, which relates to functional variations in the immune response. We have investigated KIR gene frequencies and genotype diversities of 15 KIR genes (KIR2DL1, 2DL2, 2DL3, 2DL4, 2DL5, 2DS1, 2DS2, 2DS3, 2DS4, ID, 2DS5, 3DL1, 3DL2, 3DL3, 3DS1) and two pseudogenes (KIR3DP1 and 2DP1) in 120 unrelated healthy individuals of the Uygur population living in the Xinjiang autonomous region of China. All individuals were typed positive for the four framework loci KIR3DL3, 2DL4, 3DL2 and KIR3DP1, while activating genes (KIR2DS1, 2DS2, 2DS3, 2DS5 and KIR3DS1) indicated some variation in this population. KIR3DS1 was found in a higher frequency in the studied population than in other groups from China. Linkage disequilibrium among KIR genes displayed a wide range. ??² analysis, conducted among non-ubiquitous genes, based on the KIR gene frequency data from our study population and previously published population data, revealed significant differences in the KIR2DL1, 2DL2, 2DL3, 2DL5, 3DL1, 2DS1, 2DS2, 2DS3, 2DS5, and 3DS1 genes. A neighbor-joining phylogenic tree, built using the observed carrier frequencies data of 13 KIR loci (KIR2DL1, 2DL2, 2DL3, 2DL4, 2DL5, 3DL1, 3DL2, 3DL3, 2DS1, 2DS2, 2DS3, 2DS5, and 3DS1), showed relationships between the population studied and other previously reported populations. The present study can therefore be valuable for enriching the ethnical gene information resources of the KIR gene pool, for population origin studies and for KIR-related clinical practice.     

Healthy growth in children with Down syndrome

Objective

To provide cross-sectional height and head circumference (HC) references for healthy Dutch children with Down syndrome (DS), while considering the influence of concomitant disorders on their growth, and to compare growth between children with DS and children from the general population.

Study design

Longitudinal growth and medical data were retrospectively collected from medical records in 25 of the 30 regional hospital-based outpatient clinics for children with DS in the Netherlands. Children with Trisomy 21 karyotype of Dutch descent born after 1982 were included. The LMS method was applied to fit growth references.

Results

We enrolled 1,596 children, and collected 10,558 measurements for height and 1,778 for HC. Children with DS without concomitant disorders (otherwise healthy children) and those suffering only from mild congenital heart defects showed similar growth patterns. The established growth charts, based on all measurements of these two groups, demonstrate the three age periods when height differences between children with and without DS increase: during pregnancy, during the first three years of life, and during puberty. This growth pattern results in a mean final height of 163.4 cm in boys and 151.8 cm in girls (−2.9 standard deviation (SD) and −3.0 SD on general Dutch charts, respectively). Mean HC (0 to 15 months) was 2 SD less than in the general Dutch population. The charts are available at www.tno.nl/growth.

Conclusions

Height and HC references showed that growth retardation in otherwise healthy children with DS meanly occurs in three critical periods of growth, resulting in shorter final stature and smaller HC than the general Dutch population shows. With these references, health care professionals can optimize their preventive care: monitoring growth of individual children with DS optimal, so that growth retarding comorbidities can be identified early, and focusing on the critical age periods to establish ways to optimize growth.     

Craniofacial pattern profile (CFPP) evaluation of facial dysmorphology in a familial syndrome with corneal anesthesia and multiple congenital anomalies

Roentgencephalometric findings are presented for a family with an unusual facial morphology. Twenty measurements defining the size and shape of major anatomic areas of the head and face were taken. The measurements were transformed into Z-scores. Using the sigma z (i.e., standard deviation of the Z-scores) value, an estimate of craniofacial pattern deviation from the norms was made for each family member. All members of this family have highly aberrant, i.e., dysmorphic, craniofacial pattern profiles. Familial as well as syndromic craniofacial similarities vs. dissimilarities between Z-score values of pairs of family members were assessed by the Pearson's correlation coefficient rz. Results of correlation coefficients demonstrate a high level (far in excess of the expected value of rz 0.50) of craniofacial pattern profile (CFPP) similarity between sibs and between sibs and their mother. This strongly suggests that the two sibs and their mothers are the carrier of the same genetic syndrome.     

Craniofacial anthropometric pattern profile in hypohidrotic ectodermal dysplasia--application in detection of gene carriers

Hypohidrotic ectodermal dysplasia (HED) is characterized by clinical manifestations of severe hypodontia or anodontia, hypotrichosis, hypohidrosis, and specific facial appearance. Affected males show complete expression of clinical features of this condition. Their mothers, who are gene carriers, express only some signs, which are usually very mild. Currently available clinical methods are not sufficient for routine identification of the HED heterozygous gene carriers. The purpose of this study was to identify and describe the facial characteristics of HED patients and their mothers and to evaluate the usefulness of craniofacial pattern profile analysis (CFPP) in the diagnosis of this syndrome and the detection of gene carriers. In this study six affected males and their mothers were evaluated. Z-scores for each variable were calculated and compared with age- and sex-matched controls. Anthropometric analysis showed a specific dysmorphic pattern in CST patients that includes decreased skull base width (t-t: -1.67 Z); decreased forehead width (ft-ft: -1.8 Z), decreased midface depth (sn-t: -2.02 Z), markedly decreased total facial height (n-gn: -3.4 Z), and markedly decreased maxillary arc (t-sn-t: -2.5 Z). Gene carriers showed a similar tendency in their pattern profiles. They showed the same tendency towards lower Z-values for forehead width, facial height, and mouth width. The values for these measurements were between those of the affected and healthy controls. The most pronounced findings were increased head width (eu-eu: +2.83 Z), increased lower face width (go-go: +2.06 Z), and reduction of total facial height (n-gn: -0.95 Z). They also displayed increased nose width (al-al: +2.41 Z) and increased biocular distance (ex-ex: +2.01 Z). When used in conjunction with other methods the anthropometrics pattern profile analysis can considerably enhance detection of gene carriers for HED and increase objective assessment of the craniofacial region in HED patients.     

Heritability of anthropometric phenotypes in caste populations of Visakhapatnam,India

In this study, we used anthropometric data from six Andhra caste populations to examine heritability patterns of 23 anthropometric phenotypes (linear, craniofacial, and soft tissue measures) with special reference to caste differences. We obtained anthropometric data from 342 nuclear families from Brahmin, Reddy, Telaga, Nagara, Ag. Kshatriya, and Mala castes of Visakhapatnam, India. These caste groups represent the existing hierarchical stratification of Indian populations. We used a variance components approach to determine the heritability (h2) of these 23 anthropometric phenotypes (height, weight, BMI, etc.). The sample consisted of 1918 individuals ranging in age from 6 to 72 years (mean = 21.5, S.D. = 13.8). The heritabilities (h2 +/- S.E.) for all anthropometric traits for the entire sample were significant (p < 0.0001) and varied from 0.25 +/- 0.05 (BMI) to 0.61 +/- 0.05 (bizygomatic breadth) after accounting for sex, age, and caste effects. Since data on socioeconomic and nutritional covariates were available for a subset of families, we repeated the genetic analyses using this subset, which has yielded higher heritabilities ranging from 0.21 +/- 0.16 (head breadth) to 0.72 +/- 0.18 (nasal breadth). In general, craniofacial measurements exhibited higher h2 compared to linear measures. Breadth measurements and circumferences yielded more or less similar heritabilities. Age and sex effects were significant (p < 0.0001 ) for most of the traits, while the effects of caste, socioeconomic status, and nutritional status were inconsistent across the traits. In conclusion, anthropometric phenotypes examined in this study are under appreciable additive genetic influences.     

Anthropometric evaluation of dysmorphology in craniofacial anomalies: Treacher Collins syndrome

Advances in surgical techniques for correction of craniofacial anomalies have necessitated the development of objective pre- and postoperative quantitative assessments. Standard anthropometric techniques, supplemented by additional methods oriented to specific clinical problems, have proved useful in defining surface dysmorphology in craniofacial patients. A series of 77 surface measurements of the head and face and 41 proportions were determined in 20 preoperative patients with Treacher Collins syndrome, a rare congenital defect of the first and second branchial arches. To permit comparison with age- and sex-specific data for healthy North American children, the patient data were converted to standard (Z) scores. To test the hypothesis Z = 0, Student's t-test was performed on all variables. The anthropometric findings verified many of the clinical findings in this syndrome. In addition, a number of previously unreported defects were found. The cranium was low and short with a low, narrow forehead and a narrow cranial base. The face was narrow and shallow, the mandible long and narrow, and the lower face receding. The eye fissures were short with an antimongoloid inclination, but the orbits were hyperteloric. The nasal root was high and wide, the nasofrontal angle open, and the bridge inclination low. The labial fissure was narrow, and the ears were microtic. Except in the nasal root the defects were hypoplastic. Most of these defects were either horizontal or anteroposterior. Recognition of the defective areas and their contribution to disproportions of the head and face is important in the development of surgical strategies.     

Genetic drift and anthropometric variation in Ireland

The effect of genetic drift on the genetic structure of seven Irish populations was investigated using anthropometric data collected during the 1890s on 259 adult males. These populations ranged in size from 769 to 3757, were relatively stable over time, and were located within 119 km of one another. Two populations are known to have experienced considerable English admixture. Data on ten anthropometric variables (three body measures and seven craniofacial measures) were adjusted for age and used to compute a relationship (R) matrix. The R matrix was converted into a distance measure and compared with a potential genetic drift distance measure, defined as (1/Ni + 1/Nj), where Ni and Nj are the effective population sizes of groups i and j (derivation of this formula is presented). Distances were rank-transformed, and the correlation between their pairwise elements was computed using matrix permutation methods to assess significance. Under the hypothesis that drift affects anthropometric variation, these correlations are expected to be positive. The correlation between anthropometric distance and potential genetic drift distance is 0.123, which is not significantly different from 0 (P = 0.368). When a multiple regression model is used to adjust for geographic distance and English admixture, the partial correlation (0.369) is significant (p = 0.021). As part of further analysis of the genetic structure of these populations, the same analyses were repeated using a distance matrix derived from surname frequencies. The correlation of surname distance and potential genetic drift distance is 0.164, which is not significant (p = 0.264). When the multiple regression model is applied, the correlation is 0.401, which is borderline significant (p = 0.055). These results show the influence of genetic drift, local migration, and admixture on Irish population structure.     

Genetic analysis of craniofacial traits in the medaka

Family and twin studies suggest that a substantial genetic component underlies individual differences in craniofacial morphology. In the current study, we quantified 444 craniofacial traits in 100 individuals from two inbred medaka (Oryzias latipes) strains, HNI and Hd-rR. Relative distances between defined landmarks were measured in digital images of the medaka head region. A total of 379 traits differed significantly between the two strains, indicating that many craniofacial traits are controlled by genetic factors. Of these, 89 traits were analyzed via interval mapping of 184 F(2) progeny from an intercross between HNI and Hd-rR. We identified quantitative trait loci for 66 craniofacial traits. The highest logarithm of the odds score was 6.2 for linkage group (LG) 9 and 11. Trait L33, which corresponds to the ratio of head length to head height at eye level, mapped to LG9; trait V15, which corresponds to the ratio of snout length to head width measured behind the eyes, mapped to LG11. Our initial results confirm the potential of the medaka as a model system for the genetic analysis of complex traits such as craniofacial morphology.     

Measurement precision and reliability in craniofacial anthropometry: implications and suggestions for clinical applications.

Craniofacial anthropometry has become an important tool used by both clinical geneticists and reconstructive surgeons. Yet little attention has been paid to the potentially serious problem of measurement error. This paper examines intra-observer measurement error and precision (also called repeatability or reliability) for 52 commonly used anthropometric variables of the head and face. Two factors proved critical to reliability: magnitude of the measurement in question and the degree to which its constituant landmarks could be readily identified. Thus, all of the measurement variables with means above 10 cm proved to have good or excellent reliability. In contrast measurement variables with means below 10 cm were more likely to have poor reliability. This trend was especially evident in variables with means of 6 cm or less where 18 of the 20 variables in this range had poor reliability. The least reliable variables were those like philtrum breadth, columella breadth, and nasal root breadth that combine small magnitude with difficult to define landmarks. While these results suggest that it may be prudent to avoid using craniofacial variables with small dimensions this may be neither practical nor desirable. In such cases repeat measurements may be the best means for optimizing reliability.     

Natural Killer Cell Immunoglobulin-like Receptors (KIR) Genotypes in two Arab Populations: Will KIR become a genetic landmark between nations?

Genotypic profiles of the Natural killer cell Immunoglobulin-like Receptors (KIR) have been reported to vary among different ethnic groups and this study represents a comparative report on its distribution between two Arabic populations in the Middle East: Lebanese and Palestinians. Our compared population samples included 120 unrelated healthy Lebanese (as per Mahfouz et al.) and a Palestinian population of 105 individuals (as per Norman et al.). All had their DNA typed using Sequence Specific Primer (SSP) technique for the presence of the different KIR loci. Similar to most published data, we observed that the two framework genes 2DL4 and 3DL2 are present in 100% of individuals from both communities, while 2DL2, 2DL3, 2DS1, 2DS2, 2DS3, 2DS5, 3DL1, and 3DS1 were very similar in frequency. However, significant differences were noted in the frequencies of 2DL1 and 2DS4. This report is comparing KIR genotyping distribution in two Arab populations that sheds additional light on the importance of this gene in delineating a possible geographic genetic demarcation among different ethnicities or even different communities among the same or close ethnic groups.     

Age variations in anthropometric and body composition characteristics and underweight among male Bathudis--a tribal population of Keonjhar District, Orissa, India

A cross-sectional study of 226 male Bathudis, a tribal population of Keonjhar District, Orissa, India, was undertaken to investigate age variations in anthropometric and body composition characteristics and the frequency of underweight. The subjects were categorized into three age groups: Group I: < 30 years, Group 11: 30-49 years, Group III: 2 50 years. Height, weight, circumferences and skinfolds data were collected. Body mass index (BMI) and several body composition variables and indices were derived using standard equations. Results revealed that there existed significant negative age variations for most of the anthropometric and body composition variables and indices. Correlation studies of age with these variables and indices revealed significant negative correlations. Linear regression analyses revealed that for all these variables, age had a significant negative impact. It was also observed that with increasing age, there was an increase in the frequency of underweight individuals. In conclusion, this study showed that among Bathudi men, age was significantly negatively related with anthropometric and body composition variables and indices. Furthermore, with increasing age, the frequency of underweight individuals increased.