A Genetic-Pathophysiological Framework for Craniosynostosis
Open accessAbstract
Craniosynostosis, the premature fusion of one or more cranial sutures of the skull, provides a paradigm for investigating the interplay of genetic and environmental factors leading to malformation. Over the past 20 years molecular genetic techniques have provided a new approach to dissect the underlying causes; success has mostly come from investigation of clinical samples, and recent advances in high-throughput DNA sequencing have dramatically enhanced the study of the human as the preferred "model organism." In parallel, however, we need a pathogenetic classification to describe the pathways and processes that lead to cranial suture fusion. Given the prenatal onset of most craniosynostosis, investigation of mechanisms requires more conventional model organisms; principally the mouse, because of similarities in cranial suture development. We present a framework for classifying genetic causes of craniosynostosis based on current understanding of cranial suture biology and molecular and developmental pathogenesis. Of note, few pathologies result from complete loss of gene function. Instead, biochemical mechanisms involving haploinsufficiency, dominant gain-of-function and recessive hypomorphic mutations, and an unusual X-linked cellular interference process have all been implicated. Although few of the genes involved could have been predicted based on expression patterns alone (because the genes play much wider roles in embryonic development or cellular homeostasis), we argue that they fit into a limited number of functional modules active at different stages of cranial suture development. This provides a useful approach both when defining the potential role of new candidate genes in craniosynostosis and, potentially, for devising pharmacological approaches to therapy.
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Environmental influences, including in utero mechanical constraints, maternal health conditions, medication exposure, and other prenatal risk factors, have been proposed as contributing factors particularly in non-syndromic cases.
“Environmental influences have also been proposed as contributing factors, particularly in non-syndromic cases. These include in utero mechanical constraints, maternal health conditions, medication exposure, and other prenatal risk factors [1, 2, 11, 22–25].”
From Genetics versus environment in the pathophysiology of sagittal synostosis (2026) · cites this paper as [22]
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- Authors
- Twigg, S. R. F., & Wilkie, A. O. M.
- Affiliations
- John Radcliffe Hospital (GB)
- Corresponding author
- Wilkie, Andrew O.M.
- Venue
- The American Journal of Human Genetics
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 97
- Issue
- 3
- Pages
- 359-377
- ISSN
- 0002-9297 (ISSN-L)
- PMC
- PMC4564941
- OpenAlex
- W1929611763
- Cited by
- 276
- References
- 156
- Citations by year
- 2026: 24 · 2025: 21 · 2024: 26 · 2023: 29 · 2022: 25 · 2021: 25 · 2020: 24 · 2019: 26 · 2018: 25 · 2017: 26 · 2016: 23 · 2015: 2
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- The American Journal of Human Genetics (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust (102731/Z/13/Z, 102731)
- National Institute for Health and Care Research
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Craniofacial Disorders and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › dental development and anomalies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Keywords
- craniosynostosis, cranial sutures, premature suture fusion, genetic pathogenesis, haploinsufficiency, gain-of-function mutations, hypomorphic mutation, mouse model
- MeSH terms
- Animals, Brain, Cranial Sutures, Craniosynostoses, Humans, Models, Biological, Osteogenesis, Phenotype, Risk Factors, Cell Lineage, Mice
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