Genetics of Complex DiseasesAbstract Introduction Next-generation sequencing is revolutionising the study of genetic variation and its role in disease. Individual DNA samples can now be sequenced cost-effectively enabling analysis of the complete spectrum of genetic variation. This technology has the potential to contribute significantly to the understanding of non-syndromic cleft lip and/or palate. This condition occurs with relatively high frequency and only a proportion of the underlying genetic causal factors have been identified. Many of the genes implicated have been found through genome-wide association studies but further progress is limited because these approaches consider only common genetic variants and neglect rarer variations. Because many of the causal genetic variants remain unknown, the role of gene-environment and genegene interaction is difficult to characterise. The identification of novel, low frequency, variants will provide new insights into the biological mechanisms and pathways involved in the condition. Sequence-based analysis will also be invaluable for fine mapping causal variants in the larger regions already identified by linkage and association studies for which positive identification of causal genetic variants has proven difficult. This review considers the available evidence for the genes involved and current understanding of how genetic variation interacts with environmental factors known to influence risk. Only by characterising the underlying genetic factors will the effort to understand gene-environment interaction and underlying functional processes be successful. Conclusion Success with next-generation sequencing will lead to improvements in prediction, prevention, and treatment for cleft lip and palate patients.
IntroductionNext-generation sequencing (NGS) is revolutionising genomics 1 and this trend of increasingly significant impact is likely to continue. Most importantly, NGS provides a route to characterising and understanding the role of genetic variation in disease. This is important because evidence from genome-wide association studies (GWAS) suggests that much of the heritability underlying complex disease phenotypes is not explained by common deleterious genetic variants with small effect sizes 2 . NGS enables new analytical strategies, which are not achievable through genome-wide association studies. These include: the identification of the complete complement of DNA variants in samples (across the allele frequency spectrum); tests on the burden of rare variation(do specific genes contain many rare variants which collectively impair gene function?); the identification of de novo mutations and the genes underlying rare Mendelian forms of disease; fine mapping of causal variants within broader regions identified by linkage and/or association and the characterisation of important structural variation, such as differences in copy number, which may contribute to disease.Orofacial cleft lip and/or palate (CLP) represents a complex phenotype for which NGS offers the po...