Variants inCALD1,ESRP1, andRBFOX1are associated with orofacial cleft risk
Authors: Carlson Jenna C. , Zhang Xinyi , Erdogan-Yildirim Zeynep , Beaty Terri H. , Butali Azeez , Buxó Carmen J. , Gowans Lord J.J. , Hecht Jacqueline T. , Long Ross E. , Moreno Lina , Murray Jeffrey C. , Orioli Ieda M. , Padilla Carmencita , Wehby George L. , Feingold Eleanor , Leslie-Clarkson Elizabeth J. , Weinberg Seth M. , Marazita Mary L. , Shaffer John R. 
Published: January 2025

Nonsyndromic orofacial clefts (OFCs) are common, heritable birth defects caused by both genetic and environmental risk factors. Despite the identification of many genetic loci harboring OFC-risk variants, there are many unknown genetic determinants of OFC. Furthermore, while the process of embryonic facial development is well characterized, the molecular mechanisms that underly it are not. This represents a major hurdle in understanding how disruptions in these biological processes result in OFC. Thus, we sought to identify novel OFC-risk loci through a genome-wide multi-ancestry study of five nested OFC phenotypes (isolated cleft lip [CLO], isolated cleft palate [CPO], cleft lip and palate [CLP], cleft lip with/without cleft palate [CL/P], and any cleft [ANY]) representing distinct cleft subtypes to identify subtype-specific signals and grouped types to maximize power to detect shared genetic effects. We performed genome-wide meta-analyses of these five OFC phenotypes from three cohorts totaling >14,000 individuals using METAL. In addition to replicating 13 known OFC-risk loci, we observed novel association in three regions: the 1p36.32 locus (lead variant rs584402, an intergenic variant, pCLO= 3.14e-8), the 7q33 locus (lead variant rs17168118, an intronic variant inCALD1, pCLP= 9.17e-9), and the 16p13.3 locus (lead variant rs77075754, an intronic variant inRBFOX1, pCL/P= 1.53e-9, pANY= 1.93e-9). We also observed a novel association within the known risk locus 8q22.1 that was independent of the previously reported signal (lead variant rs4735314, an intronic variant inESRP1, pCLP= 1.07e-9, pCL/P= 3.88e-8). Next, we performed multi-tissue TWAS with s-MulTiXcan and identified four overlapping genes with significant genetically predicted transcription associated with OFC risk. These genes also overlapped the genome-wide significant association signals from the meta-analysis, includingCALD1andESRP1and known OFC-risk genesTANC2andNTN1. Each of the newly reported loci has potential regulatory effects, including evidence of craniofacial enhancer activity, that offer new clues as to the molecule mechanisms underlying embryonic facial development.

Author Summary

Orofacial clefts, including cleft lip and cleft palate, are common birth defects that can be caused by both genetic and environmental factors. While many of these factors are known, there are still significant gaps in our understanding of how and why clefts arise. To help address this deficiency, we measured association between variants across the genome and clefting in cases and controls from diverse genetic ancestries. We identified three new candidate genes (CALD1,ESRP1, andRBFOX1) that may be involved in cleft risk and reaffirmed the role of 12 previously reported risk genes. We also found evidence that clefting was associated with predicted gene expression atCALD1andESRP1and that the associated variants in these genes were located near regions known to be involved in the regulation of gene expression in craniofacial tissues during development.