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Two common subtypes\u2014cleft lip alone (CL) and CL plus cleft palate (CLP)\u2014are typically grouped into a single phenotype for genetic analysis (i.e., CL with or without cleft palate, CL\/P). However, mounting evidence suggests there may be unique underlying pathophysiology and\/or genetic modifiers influencing expression of these two phenotypes. To this end, we performed a genome\u2010wide scan for genetic modifiers by directly comparing 450 CL cases with 1,692 CLP cases from 18 recruitment sites across 13 countries from North America, Central or South America, Asia, Europe, and Africa. We identified a region on 16q21 that is strongly associated with different cleft type (<jats:italic>P<\/jats:italic>\u00a0=\u00a05.611\u00a0\u00d7\u00a010<jats:sup>\u22128<\/jats:sup>). We also identified significant evidence of gene\u2013gene interactions between this modifier locus and two recognized CL\/P risk loci: 8q21 and 9q22 (<jats:italic>FOXE1<\/jats:italic>) (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.012 and 0.023, respectively). Single nucleotide polymorphism (SNPs) in the 16q21 modifier locus demonstrated significant association with CL over CLP. The marker alleles on 16q21 that increased risk for CL were found at highest frequencies among individuals with a family history of CL (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.003). Our results demonstrate the existence of modifiers for which type of OFC develops and suggest plausible elements responsible for phenotypic heterogeneity, further elucidating the complex genetic architecture of OFCs.<\/jats:p>","DOI":"10.1002\/gepi.22090","type":"journal-article","created":{"date-parts":[[2017,11,10]],"date-time":"2017-11-10T08:06:39Z","timestamp":1510301199000},"page":"887-897","source":"Crossref","is-referenced-by-count":27,"title":["Identification of 16q21 as a modifier of nonsyndromic orofacial cleft phenotypes"],"prefix":"10.1002","volume":"41","author":[{"given":"Jenna C.","family":"Carlson","sequence":"first","affiliation":[{"name":"Department of Biostatistics Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Standley","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Carver College of Medicine University of Iowa  Iowa City Iowa United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline","family":"Petrin","sequence":"additional","affiliation":[{"name":"Department of Orthodontics College of Dentistry University of Iowa  Iowa City Iowa United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Shaffer","sequence":"additional","affiliation":[{"name":"Department of Human Genetics Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Azeez","family":"Butali","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology Radiology and Medicine Dows Institute for Dental Research College of Dentistry University of Iowa  Iowa City Iowa United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen J.","family":"Bux\u00f3","sequence":"additional","affiliation":[{"name":"Dental and Craniofacial Genomics Center School of Dental Medicine University of Puerto Rico  San Juan Puerto Rico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Castilla","sequence":"additional","affiliation":[{"name":"CEMIC: Center for Medical Education and Clinical Research  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaare","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Institute of Public Health University of Southern Denmark  Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederic W.\u2010D.","family":"Deleyiannis","sequence":"additional","affiliation":[{"name":"Department of Surgery Plastic and Reconstructive Surgery University of Colorado School of Medicine  Denver Colorado United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline T.","family":"Hecht","sequence":"additional","affiliation":[{"name":"Department of Pediatrics McGovern Medical School and School of Dentistry UT Health at Houston  Houston Texas United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. 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Aichi\u2010Gakuin University  Nisshin Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ieda M.","family":"Orioli","sequence":"additional","affiliation":[{"name":"ECLAMC (Latin American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics)  Rio de Janeiro Brazil"},{"name":"Department of Genetics Institute of Biology Federal University of Rio de Janeiro  Rio de Janeiro Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmencita","family":"Padilla","sequence":"additional","affiliation":[{"name":"Department of Pediatrics College of Medicine University of the Philippines Manila  Manila Philippines"},{"name":"Institute of Human Genetics, National Institutes of Health University of the Philippines Manila  Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Poletta","sequence":"additional","affiliation":[{"name":"CEMIC: Center for Medical Education and Clinical Research  Buenos Aires Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Division of Research and Treatment for Oral and Maxillofacial Congenital Anomalies School of Dentistry Aichi\u2010Gakuin University  Nisshin Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre R.","family":"Vieira","sequence":"additional","affiliation":[{"name":"Department of Oral Biology Center for Craniofacial and Dental Genetics School of Dental Medicine University of Pittsburgh  Pittsburgh Pennsylvania United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George L.","family":"Wehby","sequence":"additional","affiliation":[{"name":"Department of Health Management and Policy College of Public Health University of Iowa  Iowa City Iowa United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth M.","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Oral Biology Center for Craniofacial and Dental Genetics School of Dental Medicine University of Pittsburgh  Pittsburgh Pennsylvania United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terri H.","family":"Beaty","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore Maryland United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Feingold","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania United States of America"},{"name":"Department of Human Genetics Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey C.","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Carver College of Medicine University of Iowa  Iowa City Iowa United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary L.","family":"Marazita","sequence":"additional","affiliation":[{"name":"Department of Human Genetics Graduate School of Public Health University of Pittsburgh  Pittsburgh Pennsylvania United States of America"},{"name":"Department of Oral Biology Center for Craniofacial and Dental Genetics School of Dental Medicine University of Pittsburgh  Pittsburgh Pennsylvania United States of America"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5735-1712","authenticated-orcid":false,"given":"Elizabeth J.","family":"Leslie","sequence":"additional","affiliation":[{"name":"Department of Human Genetics Emory University 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