www.scielo.br/jaos http://dx.doi.org/10.1590/1679-775720130079 PAX9 polymorphism and susceptibility to sporadic non-syndromic severe anodontia: a case-control study in southwest China Jing WANG1,2, Yuanzhi XU1, Jing CHEN3, Feiyu WANG4, Renhuan HUANG4, Songtao WU4, Linjing SHU4, Jingyi QIU4, Zhi YANG5, Junjie XUE3, Raorao WANG1, Jilin ZHAO6, Wenli LAI2 1- PhD, Department of Stomatology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, P.R. China. 2- PhD, MD, State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, P.R. China. 3- MD, State Key Laboratory of Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan Province, P.R. China. 4- B.S. Med, West China School of Stomatology, Sichuan University, Chengdu, Sichuan Province, P.R. China. 5- PhD, Department of Oral & Cranio-Maxillofacial Science, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, P.R. China. 6- PhD, Department of Orthodontics, Hospital of Stomatology, Medical School, Nanjing University, Nanjing, Jiangsu Province, P.R. China. Corresponding address: Wenli Lai - State Key Laboratory of Oral Diseases, Department of Orthodontics - West China Hospital of Stomatology, Sichuan University - NO. 14 - Section 3 - Ren Min Nan Road - Chengdu - 610041 - P.R. China - Phone: 86-28-85501442 - Fax: 86-28-85582167 - e-mail: wenlilai@ hotmail.com [! ABSTRACT ur research aimed to look into the clinical traits and genetic mutations in sporadic Onon-syndromic anodontia and to gain insight into the role of mutations of PAX9, MSX1, AXIN2 and EDA in anodontia phenotypes, especially for the PAX9. Material and Methods: The female proband and her family members from the ethnic Han families underwent complete oral examinations and received a retrospective review. Venous blood samples were obtained to screen variants in the PAX9, MSX1, AXIN2, and EDA genes. A case-control study was performed on 50 subjects with sporadic tooth agenesis (cases) and 100 healthy controls, which genotyped a PAX9 gene polymorphism (rs4904210). Results: Intra-oral and panoramic radiographs revealed that the female proband had anodontia denoted by the complete absence of teeth in both the primary and secondary dentitions, while all her family members maintained normal dentitions. Detected in the female proband were variants of the PAX9 and AXIN2 including A240P (rs4904210) of the PAX9, c.148C>T (rs2240308), c.1365A>G (rs9915936) and c.1386C>T (rs1133683) of the AXIN2. The same variants were present in her unaffected younger brother. The PAX9 variations were in a different state in her parents. Mutations in the MSX1 and EDA[[ diferences were found in the allele and genotype frequencies of the PAX9 polymorphism between the controls and the subjects with sporadic tooth agenesis. Conclusions: These results suggest that the association of A240P with sporadic tooth agenesis still remains obscure, especially for different populations. The genotype/phenotype correlation in [ Key words: PAX9 transcription factor. Polymorphism. Non-syndromic Anodontia. Phenotype. Genotype. INTRODUCTION which can be inherited in an autosomal-dominant, autosomal-recessive, or X-linked mode7,32. Anodontia Tooth agenesis is a common development (OMIM 206780) is the term conventionally used in anomaly in humans, which includes two types, cases where teeth are completely absent19. Sporadic syndromic or non-syndromic. The non-syndromic non-syndromic anodontia not involving associated [ abnormalities is extremely rare. Some case reports [ have suggested that anodontia of permanent teeth J Appl Oral Sci. 256 2013;21(3):256-64 PAX9 polymorphism and susceptibility to sporadic non-syndromic severe anodontia: a case-control study in southwest China is an expression of the homozygote state of the oligodontia in the Chinese population, although gene resulting in the pegged or missing maxillary [ incisor9,31. Genetic and environmental factors may c.662C>A and c.347C>G of MSX1 for non-syndromic be of etiologic importance to this anomaly3,15. Brook1 autosomal-dominant oligodontia32, heterozygous (2009) considered that complex interactions between C139T transition in PAX934, and so on. Recently, genetic, epigenetic and environmental factors caused two polymorphisms (rs2073244, rs2073246), dental anomalies during the long process of dental which were located in the promoter region of the development, which is multi-factorial, multilevel, PAX9\! multidimensional and progressive over time. In sporadic tooth agenesis in a Caucasian population24. other words, the phenotype often reveals variations However, it was reported that p.Ala240Pro in the between affected individuals in the same family PAX9 might not be associated with tooth agenesis as a result of the multi-directional role of genetic, in a case-control study22. Therefore, whether epigenetic and environmental factors in space and the variants of PAX9 have an effect on the tooth time. A previous study30 showed that mutations agenesis in different populations is still puzzling. or polymorphisms of the PAX9 (OMIM 167416), In the current study, we investigated the MSX1 (OMIM 142983), AXIN2 (OMIM 604425), and mutations in the PAX9, MSX1, AXIN2 and EDA genes EDA (OMIM 300451)25 genes were responsible for in a Chinese family and evaluated the association isolated/non-syndromic oligodontia. The reasons of gene variation and epigenetic factors with are still unknown for the majority of the congenital sporadic non-syndromic anodontia. Additionally, sporadic forms of missing teeth in humans. we performed genotyping analyses of a SNP [ (rs4904210) of the PAX9 in subjects with sporadic number of these cases. Numbers of studies have tooth agenesis (cases) and 100 healthy controls in shown that mutations in the PAX9 or MSX1 cause a Chinese population to test the hypothesis whether non-syndromic oligodontia. Both the PAX9 and the variant A240P (rs4904210) of the PAX9 gene is MSX1 are transcription factors expressed in the associated with susceptibility to tooth agenesis in dental mesenchyme during the initiation of tooth the Chinese population. development. As a member of the paired box domain gene family, PAX9 regulates the cellular pluripotency MATERIAL AND METHODS and differentiation during embryonic patterning and organogenesis13,28. Its defects are associated with All these subjects were fully informed of the agenesis of the permanent molars, mostly including study and consent was obtained from each of them. [ The research was approved by the Ethics Committee and mandibular second molars32. MSX1 belongs of West China Hospital of Stomatology, Sichuan to the muscle segment homeobox family and is University (2009022). All participants in the study essential for the switch in odontogenic potential from were ethnic Han Chinese from Chengdu City or the the epithelium to the mesenchyme17,18. Mutations surrounding regions in southwest China. in the MSX1[ for the missing second premolars and third molars. Study individuals AXIN2 (17q23-q24), which is known as a negative The female proband from ethnic Han families was feedback regulator of the Wnt-signaling pathway, is referred to the Department of Orthodontics, West expressed by the ectomesenchyme and regulates China Hospital of Stomatology, Sichuan University early organ differentiation and development. (Chengdu, China). The pedigree of the family was Mutations in the AXIN2 lead to tooth agenesis constructed by extended interviews. Retrospective affecting mostly the permanent teeth, containing data were reviewed and panoramic radiographs the permanent molars, the lower incisors, and the [ upper lateral incisors in humans. The EDA gene (MIM agenesis for the proband. Panoramic radiographs #300451), encoding the protein ectodysplasin-A were also performed for other family members to (EDA), is a type II transmembrane protein with a assess the dental development. These 4 subjects C-terminal TNF homology domain consisting of 10 (including the proband) underwent complete oral 3! examinations with a thorough clinical investigation " [ of other ectodermal originated tissues, including tooth agenesis that underlies X-linked hypodontia the skin, hair, nails, sweat glands, ears and eyes. ectodermal dysplasia (XLHED; MIM #305100) and the mutation analysis of the EDA gene in people Case-control study with isolated oligodontia were recommended in A total of 50 subjects with sporadic tooth some studies4,8,26,33. agenesis (excluding the third molar) and 100 Until now, we do not have enough knowledge healthy controls were consecutively recruited from about the importance of genes in the etiology of the West China Hospital of Stomatology, Sichuan J Appl Oral Sci. 257 2013;21(3):256-64 WANG J, XU Y, CHEN J, WANG F, HUANG R, WU S, SHU L, QIU J, YANG Z, XUE J, WANG R, ZHAO J, LAI W University (Chengdu, China) from October 2009 to [%&'*+<=?" November 2011. Retrospective data were reviewed Maidstone, UK). The exons 1-4 of the PAX9, exons and panoramic radiographs were obtained to 1-2 of the MSX1, exons 2-11 of the AXIN2 and exons [ 1-8 of the EDA were sequenced except for the intronic patients. Every participant underwent complete oral and promoter sequences of these genes. Primers for examinations with a thorough clinical investigation the PAX9, MSX1, AXIN2 and EDA genes designed of other ectodermal originated tissues, including through the Oligo