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Craniofacial and dental development in cardio-facio-cutaneous syndrome: the importance of Ras signaling homeostasis

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  • The authors declare no conflict of interest.

Corresponding author: Katherine Rauen, MD, PhD Associate Professor, UCSF Helen Diller Family

Comprehensive Cancer Center, 2340 Sutter Street, Room S429, 94115 San Francisco, CA, USA.

Tel.: +1 415 514 3513

fax: +1 415 476 9305

e-mail: rauenk@peds.ucsf.edu [PO BOX 0808]

Abstract

Cardio-facio-cutaneous syndrome (CFC) is a RASopathy that is characterized by craniofacial, dermatologic, gastrointestinal, ocular, cardiac, and neurologic anomalies. CFC is caused by activating mutations in the Ras/mitogen-activated protein kinase (MAPK) signaling pathway that is downstream of receptor tyrosine kinase (RTK) signaling. RTK signaling is known to play a central role in craniofacial and dental development, but to date, no studies have systematically examined individuals with CFC to define key craniofacial and dental features. To fill this critical gap in our knowledge, we evaluated the craniofacial and dental phenotype of a large cohort (n = 32) of CFC individuals who attended the 2009 and 2011 CFC International Family Conferences. We quantified common craniofacial features in CFC which include macrocephaly, bitemporal narrowing, convex facial profile, and hypoplastic supraorbital ridges. In addition, there is a characteristic dental phenotype in CFC syndrome that includes malocclusion with open bite, posterior crossbite, and a high-arched palate. This thorough evaluation of the craniofacial and dental phenotype in CFC individuals provides a step forward in our understanding of the role of RTK/MAPK signaling in human craniofacial development and will aid clinicians who treat patients with CFC.

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