{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:12:51Z","timestamp":1793157171857,"version":"4.5.0"},"reference-count":98,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:p>\n                    <jats:list list-type=\"plain\">\n                      <jats:list-item>\n                        <jats:p>\u00bb Multifactorial Pathogenesis: Legg-Calv\u00e9-Perthes disease (LCPD) may result from a complex interplay of genetic, epigenetic, and environmental factors, culminating in avascular necrosis of the femoral head in children aged 4 to 10 years.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\n                          \u00bb Genetic Contributions: Mutations in\n                          <jats:italic toggle=\"yes\">COL2A1<\/jats:italic>\n                          weaken cartilage integrity, and polymorphisms in\n                          <jats:italic toggle=\"yes\">IL6<\/jats:italic>\n                          drive inflammatory responses, exacerbating bone resorption and necrosis.\n                        <\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb Role of Epigenetics: Epigenetic mechanisms, such as altered DNA methylation and miRNA dysregulation, may modulate disease progression by linking genetic susceptibility to environmental influences.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb Environmental Amplifiers: Key environmental risk factors, including maternal smoking, low birth weight, and socioeconomic deprivation, may exacerbate the genetic and epigenetic predisposition to LCPD.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>\u00bb Future Directions: Advancements in genetic screening and epigenetic therapies, such as miRNA modulators and DNA methylation inhibitors, combined with preventive measures like improved prenatal care and reduced smoke exposure, may offer promising avenues for optimizing outcomes in LCPD.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:p>","DOI":"10.2106\/jbjs.rvw.24.00209","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T09:02:44Z","timestamp":1743152564000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Genetics and Epigenetics of Legg-Calv\u00e9-Perthes 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Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0027-8446","authenticated-orcid":false,"given":"Elio","family":"Bitar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4076-6188","authenticated-orcid":false,"given":"Pablo","family":"Castaneda","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Texas Children's Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3602-2215","authenticated-orcid":false,"given":"Karim","family":"Masrouha","sequence":"additional","affiliation":[{"name":"NYU Langone Orthopedics, NYU Langone Health, New York, New 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