Copy number variation analysis of twin pairs discordant for cleft lip with or without cleft palate.

Non-syndromic cleft lip with or without cleft palate (nsCL/P) is a frequent orofacial malformation. The comparison of concordance rate observed in monozygotic and dizygotic twins supports high level of heritability and a strong genetic component. However, phenotype concordance for orofacial cleft in monozygotic twins is about 50%. The aim of the present investigation was to detect postzygotic events that may account for discordance in monozygotic twins. High-density SNP microarrays hybridization was used to genotype two pairs of monozygotic twins discordant for nsCL/P. Discordant SNP genotypes and copy number variants were analyzed to identify genetic differences responsible of phenotype discrepancy. A number of differences were observed, none involving known nsCL/P candidate genes or genomic regions. Considering the limitation of the study, related to the small sample size and to the large-scale investigation method, the results suggest that the detection of discordant events in other monozygotic twin pairs would be remarkable and warrant further investigations.

Introduction

Cleft of the lip with or without cleft palate (CL/P) is the most common orofacial malformation, with a prevalence close to 1/1000 at birth.[1] However, the prevalence varies depending on ethnic origin.[2,3] The non-syndromic cleft lip with or without cleft palate (nsCL/P) is a heterogeneous disorder with multiple phenotypic presentations and is considered a typical example of trait with complex inheritance, where a combination of multiple genetic and environmental factors contributes to phenotype expression. Twin studies are commonly used to investigate etiology of common diseases with complex inheritance. Monozygotic (MZ) or identical twins result from a single ovum, fertilized by one sperm, while dizygotic (DZ) twins result from two different ova, fertilized by two different sperm. Otherwise from DZ twins, which originate from two zygotes and share on average half of the genome, MZ twins are long thought to share 100% of their genomic information, because they originate from the same zygote. However, additional genetic components, such as epigenetic factors and postzygotic somatic mutation events, may explain different traits of expression in MZ twins.[4,5] Increasing evidences of genetic differences have been reported both in typically developing and in clinically discordant MZ pairs.[6]

Twin studies demonstrated a consistent genetic component in nsCL/P etiology, indeed a higher concordance rate in MZ (25%–50%) was often observed compared to DZ (3%–6%) twins.[7] Molecular analysis of discordant MZ twins has been attempted to identify nsCL/P genetic factors. A de novo nonsense mutation in IRF6 was detected in the affected twin of a twin pair discordant for the presentation of Van der Woude clefting syndrome.[8] However, other investigations, using different technical approaches, were unsuccessful to identify genetic differences in discordant nsCL/P twin pairs.[9-12]

Discordant MZ twin pairs, that are informative in respect to variability of phenotypic expression, epigenetics, and postzygotic mutagenesis, may represent an alternative approach to identify genes in inherited disorders. We hypothesized that postzygotic de novo mutations could cause discordant MZ twin pairs for nsCL/P, that are otherwise genetically identical. To test this hypothesis we have investigated two MZ twin pairs by means of high-density SNP genotyping arrays that consent the analysis of postzygotic de novo copy number variation (CNV) events.

Materials and methods

Discordant twin pair collection was part of a broader investigation aimed to identify inherited susceptibility factors of nsCL/P.[13] A team of clinicians performed the diagnosis and excluded additional birth malformations or metabolic diseases. A detailed interview excluded families that may be subjected to known or suspected clefting agents, such as phenytoin, warfarin, ethanol, and smoking. The study was approved by the local ethics committees and it complied with the Helsinki Declaration’s Ethical Principles for Medical Research Involving Human Subjects. Written informed consent was obtained from all patients and parents.

Five twin pairs discordant for nsCL/P were identified. Genomic DNA was extracted and purified from whole blood using standard techniques. Twin pairs were analyzed for zigosity by direct genotype comparison of a panel of highly polymorphic microsatellite DNA loci. Three twin pairs were excluded from the investigation because the originated by different zygotes. Two molecularly ascertained MZ twin pairs that were discordant for nsCL/P were analyzed by high-density SNP microarray. Genotyping was performed using the Illumina HumanOmni1-Quad array, which contains nearly 1.14 million markers including SNP and CNV probes.

BeadChip data were processed using GenomeStudioV2011.1 (Illumina Inc.) and PennCNV.[14] Primary data analyses, including raw data normalization, clustering, and genotype calling were performed using algorithms in the genotyping module. The software derives, for each sample, log R ratios (LRRs) and B allele frequencies for each probe on the Quad array; the LRR reflects relative probe fluorescence intensity, which varies with the discrete number of copies of probe-specific DNA present within an individual’s genome. A copy number state of 2 per individual is considered normal (one copy per chromosome); lower value reflects copy number loss and higher values, a copy number gain. Each sample CNV pool was subjected to filtering steps in order to remove alteration smaller than 10 kb in size and containing lower than 5 probes. CNV that passed these filtering steps were retained for downstream analysis. Chromosome regions annotations were obtained from UCSC Refseq track Human genome build 19. All analyses were conducted with R version 3.4.3, Platform: x86 64-pc-linux-gnu (64-bit) running under Ubuntu 16.04.3 LTS.

Results

Genotyping of SNPs of the four DNA samples by microarray hybridization produced high quality results; indeed, for each sample, the genotype call rate was >99.7%. As expected, the comparison of genotypes between the affected and the unaffected twin revealed a high level of concordance in each twin pair (Table 1). Indeed, only 25 (0.002% of total genotypes) discordant calls were observed in each pair. The high level of concordance confirmed that twin pairs were actually MZ, while discordant SNP genotypes could be explained as either genotyping errors or de novo mutations. Discordant polymorphisms did not alter gene coding sequences, and they were not classified as pathogenic in the ClinVar database.

Table 1.

Comparison of SNP genotypes between the discordant twins.

Twin pair	Sample ID	# concordant SNPs	# discordant SNPs
1	NBF3-NBF4	1,011,267	25
2	100101-100104	1,011,764	25

The intensities of allele probe hybridization in the SNP array platforms were analyzed to evaluate the ploidy of each tested locus. Indeed, CNVs such as duplication and deletion increase or decrease the total measured intensities; moreover, for large CNVs that span multiple SNPs, intensity ratios have patterns distinct from normal disomic genomic regions. In this investigation, we considered CNV regions spanning more than 10 kbp. In the four samples, the number of detected CNVs varied between 51 and 70 with a median length of 23 kbp. In order to identify inherited CNVs that could act as nsCL/P susceptibility loci, we first looked for CNVs detected in all the investigated samples (Table 2). Two CNVs of the list consisted of deletions that did not include any transcripted sequence. The remaining CNVs spanned 12 genes, including JAG2 a possible genetic factor of nsCL/P.

Table 2.

List of CNVs detected in all analyzed samples.

Chr.	Start	End	Width	# of SNPs	CNV_TYPE	Genes
2	41,092,961	41,103,770	10,810	13	Loss	−
2	88,932,848	89,090,893	15,8046	59	Gain	RPIA, ANKRD36BP2
6	103,850,891	103,868,723	17,833	9	Deletion	−
8	32,799,628	32,810,651	11,024	14	Deletion	−
11	55,122,337	55,175,539	53,203	35	Loss	OR4A15
14	105,275,606	105,697,201	421,596	244	Gain	JAG2, CEP170B, PLD4, AHNAK2, CDCA4, GPR132, NUDT14, BRF1, BTBD6

CNV: copy number variation.

Then we focused on genetic differences in each twin pair, particularly to CNVs that may account for phenotype discordance. The CNVs detected exclusively in the affected individual of each pair are shown in Table 3. Such CNVs include 34 out of 66 variations detected in patient ID = 100101, and 13 out of 50 variations detected in patient ID = NBF3.

Table 3.

List of CNVs that were detected only in the CL/P affected twin.

Patient ID	Chr.	Start	End	Width	# of SNPs	CNV type	Genes involved
100101	2	14,109,052	14,119,079	10,028	10	Loss	−
100101	2	52,607,219	52,621,681	14,463	5	Loss	−
100101	2	89,904,056	89,920,851	16,796	10	Gain
100101	2	97,150,351	97,165,854	15,504	6	Loss	NEURL3
100101	2	153,489,894	153,508,850	18,957	22	Loss	FMNL2, PRPF40A
100101	2	238,262,529	238,275,105	12,577	15	Gain	COL6A3
100101	3	149,649,355	149,660,146	10,792	5	Loss	RNF13
100101	4	14,529,946	14,543,205	13,260	12	Loss	−
100101	4	100,728,344	100,744,538	16,195	11	Loss	DAPP1
100101	4	144,879,245	144,889,446	10,202	9	Loss	−
100101	5	18,365,795	18,382,021	16,227	14	Loss	−
100101	5	84,822,505	84,868,110	45,606	8	Loss	−
100101	6	29,962,774	29,981,888	19,115	78	Gain	HLAH, HLAG, HLAJ
100101	6	67,893,398	67,923,322	29,925	13	Loss	−
100101	6	67,954,304	68,004,709	50,406	19	Loss	−
100101	6	77,496,688	77,509,808	13,121	22	Loss	−
100101	6	141,015,260	141,045,617	30,358	8	Loss	−
100101	7	142,157,556	142,172,768	15,213	13	Loss	TCRBV22S1A2N1T, TCRBV5S1A1T
100101	8	130,571,112	130,581,329	10,218	10	Loss	–
100101	9	10,384,286	10,395,076	10,791	11	Deletion	PTPRD
100101	11	48,284,271	48,304,374	20,104	36	Loss	OR4X1
100101	11	51,052,130	51,152,453	100,324	8	Gain	–
100101	11	114,007,895	114,017,913	10,019	10	Loss	ZBTB16
100101	12	74,069,809	74,089,055	19,247	10	Loss	−
100101	13	17,982,800	18,006,081	23,282	7	Gain	−
100101	13	71,012,389	71,028,770	16,382	8	Loss	−
100101	14	79,168,636	79,184,616	15,981	17	Loss	NRXN3
100101	15	19,129,051	19,158,166	29,116	14	Loss	−
100101	17	31,478,254	31,501,499	23,246	22	Gain	ASIC2
100101	17	41,004,182	41,016,180	11,999	16	Gain	AOC3
100101	18	62,342,876	62,353,618	10,743	5	Loss	−
100101	18	64,098,920	64,110,327	11,408	16	Loss	−
100101	20	1,524,714	1,537,988	13,275	8	Gain	SIRPD
100101	22	22,697,511	22,725,367	27,857	13	Gain	abParts
NBF3	2	34,809,903	34,820,073	10,171	15	Loss	−
NBF3	2	91,293,640	91,322,549	28,910	12	Loss	−
NBF3	3	198,837,449	198,871,090	33,642	13	Loss	−
NBF3	6	26,849,823	26,860,992	11,170	15	Loss	−
NBF3	6	32,617,395	32,633,666	16,272	24	Gain	HLA-DQB1
NBF3	7	57,728,536	57,767,235	38,700	13	Gain	GUSBP2
NBF3	7	64,895,813	64,925,393	29,581	15	Gain	−
NBF3	10	46,781,951	46,805,985	24,035	7	Gain	PTPN20, GLUD1P7
NBF3	14	105,648,434	105,725,651	77,218	9	Gain	BRF1, BTBD6
NBF3	16	34,343,935	34,601,761	257,827	27	Gain	LINC01566, UBE2MP1
NBF3	16	68,615,369	68,650,243	34,875	6	Gain	−
NBF3	18	14,211,931	14,239,072	27,142	6	Gain	ANKRD20A5P
NBF3	20	1,526,976	1,541,888	14,913	9	Gain	SIRPD

CNV: copy number variation.

No overlap between the two CNV lists, specific for each twin pair, was found.

Discussion

Several factors could contribute to discordance of diseases between MZ twins, including postzygotic somatic mutations, X chromosome inactivation, differential methylation, stochastic factors, and non-genetic intrauterine environmental factors such as unequal cell allocation at twinning and disproportionate placental blood supply.[5,15] Discordant MZ twins can be a valuable resource for complex diseases, indeed genetic comparison of discordant twins could potentially help to increase reliability of candidate genes in complex diseases or to find novel disease susceptibility genes that could partly explain missing heritability.

The current study reports genome-wide SNP and CNV results on two MZ twin pairs discordant for nsCL/P. A small number of in-pair discordant SNP genotypes were found; none of them appeared as a probable causative mutation. The genotype discrepancy may be related to genotyping inaccuracy of large-scale microarray typing, although at a level similar to those previously reported.[11] We searched for postzygotic CNVs that may account for the discordant phenotype. In addition, we analyzed the shared CNVs among twin pairs looking for variants of face development genes. Lists of selected CNVs were reported along with annotations including involved genes and previous contribution to clinical relevant data. The reported genetic regions and genes did not overlap with any of the candidate regions by previous genome wide allelic association analyses. These data partially agree with a previous report by Shi et al. who investigated 333 nsCL/P candidate genes for CNVs; they found that CNVs could have a role in nsCL/P etiology but with relatively rare occurrence. Indeed, analyzing 725 nsCL/P Scandinavian families, they identified only seven deletions.[16]

Previous investigations attempted the identification of nsCL/P genetic factors by comparison of discordant MZ twins. Mansilla et al.,[9] by comparing sequences of 18 candidate genes, did not find etiologic somatic mutations in 13 MZ pairs. Similarly, Kimani et al.[10] investigated 25 discordant MZ twin pairs with different genome scale genetic methods; they not only concluded that postzygotic genomic alterations are not a common cause of MZ twin discordance for isolated nsCL/P but also suggested that detection of discordant events in other MZ twin pairs would be remarkable and of potential disease significance.

A possible limitation of our study was related with the CNV calling method from microarray data. Indeed, discrimination of biologically relevant data from noise CNV is still a bioinformatics challenge and different algorithms produce different results.[17] We tried to increase accuracy for CNV calling by setting stringent threshold of CNV size and spanning SNP number. However, this could reduce sensitivity increasing missing calls, while the false positive call remains a concrete possibility, as observed in other investigations.[18] There is no clear estimate of the rate of somatic CNVs, and our sample that is limited to discordant twins, in theory should have a higher rate of such events. Considering all these limitations, together with the small size of our sample study, the results of this investigation should be considered with caution and more data obtained with different technical approaches are needed to evaluate the real impact of CNVs in nsCL/P. Further investigations of specifically involved tissue, aimed to screen for epigenetic factors or postzygotic somatic mutation events, could possibly help to explain different trait expression in MZ twins.