Orofacial clefts (OFC) are the most common congenital defects of the head and neck. They are divided into syndromic OFCs, with a monogenic cause, and non-syndromic OFCs, which can have a multifactorial etiology. Clinically, they are classified as cleft lip, cleft alveolus, cleft palate, and the most severe form, which combines all of the above, cleft lip, alveolus, and palate. A previous study Genetic Variants Associated with Orofacial Clefts in the Slovenian Population, was unable to identify the genetic cause of OFC in 25 families. The purpose of this master's thesis is to analyze next-generation sequencing data from 28 index patients from 25 families with a family history of OFC of unknown origin. We tried to identify the genetic cause by examining 43 candidate genes: ABCA3, ABCC6, COG1, COL11A1, COL1A2, COL6A2, CTNND1, ECEL1, ERCC2, FBN1, GDF11, GJB6, GRIN2A, IDUA, IFT122, IFT140, IFT172, IKBKG, LRP6, KMT2A, KMT2D, MCPH1, NKX3-2, NOTCH2, PALB2, PCGF2, PGM1, PKLR, PROKR2, RPGRIP1L, SEC23A, SF3B4, SH3PXD2B, SOX9, SRCAP, SZT2, TBX1, TFR2, TNNT3, TP63, TRPS1, TUBB2B, and UBE3B. Candidate genes associated with non-syndromic OFCs were selected based on a review of two scientific articles. The functional consequences of the discovered changes in candidate genes were examined using the platform Franklin (Genoox). Each genetic variant was evaluated using ACMG criteria, and family trees of the investigated families were drawn using the Progeny program. We considered variants that met the criteria for genotype quality, were rarer than 1% in the general population, and were identified by most predictive models as a variant of uncertain significance, likely pathogenic, or pathogenic. After analyzing the results of the next-generation sequencing of index patients, we discovered 34 rare genetic variants in 22 genes. Among the 34 discovered variants, three were classified as likely pathogenic according to ACMG guidelines, while the rest were classified as variants of uncertain significance. Three of the investigated families had two index patients but only in one such family (OFC_182) a candidate variant was present in both index patients, meaning it segregates with OFC within the family. This was an intronic mutation in the IDUA gene. Two families (OFC_185 and OFC_186) were closely related, and we discovered a missense mutation in the ERCC2 gene that segregated with the disease phenotype in both families.
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