VAX1

gene
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Summary

VAX1 (ventral anterior homeobox 1, HGNC:12660) is a protein-coding gene on chromosome 10q25.3, encoding Ventral anterior homeobox 1 (Q5SQQ9). Transcription factor that may function in dorsoventral specification of the forebrain.

This gene encodes a homeo-domain containing protein from a class of homeobox transcription factors which are conserved in vertebrates. Genes of this family are involved in the regulation of body development and morphogenesis. The most conserved genes, called HOX genes are found in special gene clusters. This gene belongs to the VAX subfamily and lies in the vicinity of the EMX homeobox gene family. Another member of VAX family is located on chromosome 2. The encoded protein may play an important role in the development of anterior ventral forebrain and visual system. Multiple transcript variants encoding different isoforms have been found for this gene.

Source: NCBI Gene 11023 — RefSeq curated summary.

At a glance

  • Gene–disease (curated): microphthalmia, syndromic 11 (Limited, GenCC)
  • GWAS associations: 7
  • Clinical variants (ClinVar): 83 total — 1 pathogenic, 1 likely-pathogenic
  • Phenotypes (HPO): 9
  • MANE Select transcript: NM_001112704

Identifiers

Gene identifiers

FieldValue
HGNC IDHGNC:12660
Approved symbolVAX1
Nameventral anterior homeobox 1
Location10q25.3
Locus typegene with protein product
StatusApproved
Ensembl geneENSG00000148704
Ensembl biotypeprotein_coding
OMIM604294
Entrez11023

Gene structure

Transcript identifiers

Ensembl transcripts: 2 — 2 protein_coding

ENST00000277905, ENST00000369206

RefSeq mRNA: 2 — MANE Select: NM_001112704 NM_001112704, NM_199131

CCDS: CCDS44483, CCDS7597

Canonical transcript exons

ENST00000369206 — 3 exons

ExonStartEnd
ENSE00001449099117133290117134583
ENSE00002523041117136472117136659
ENSE00003623939117137816117138270

Expression profiles

Bgee: expression breadth broad, 38 present calls, max score 92.82.

FANTOM5 (CAGE): breadth tissue_specific, TPM avg 0.7918 / max 102.7187, expressed in 174 samples.

FANTOM5 promoters (8 alternative TSS)

Promoter IDTPM avgSamples expressed
1115930.333886
1115900.129870
1115890.072635
1115910.071142
1115920.069531
1115940.054212
1115880.051025
1115950.00983

Top tissues by expression

130 total, by Bgee expression score (0-100, higher = more expressed):

TissueAnatomy IDExpression scoreQuality
male germ line stem cell (sensu Vertebrata) in testisCL:0000089 ∩ UBERON:000047392.82gold quality
caudate nucleusUBERON:000187370.70gold quality
nucleus accumbensUBERON:000188269.15gold quality
putamenUBERON:000187468.08gold quality
prefrontal cortexUBERON:000045163.52gold quality
primordial germ cell in gonadCL:0000670 ∩ UBERON:000099161.86gold quality
hypothalamusUBERON:000189861.47gold quality
frontal cortexUBERON:000187060.29gold quality
Brodmann (1909) area 9UBERON:001354059.31gold quality
anterior cingulate cortexUBERON:000983557.77gold quality
cerebral cortexUBERON:000095657.69gold quality
dorsolateral prefrontal cortexUBERON:000983457.19gold quality
superior frontal gyrusUBERON:000266157.14gold quality
primary visual cortexUBERON:000243656.23gold quality
right frontal lobeUBERON:000281055.67gold quality
brainUBERON:000095553.26gold quality
temporal lobeUBERON:000187153.20gold quality
amygdalaUBERON:000187653.07gold quality
Ammon’s hornUBERON:000195452.96gold quality
C1 segment of cervical spinal cordUBERON:000646951.88gold quality
ventricular zoneUBERON:000305349.77gold quality
ganglionic eminenceUBERON:000402347.28gold quality
substantia nigraUBERON:000203846.62gold quality
cortical plateUBERON:000534343.79silver quality
adenohypophysisUBERON:000219643.45gold quality
sural nerveUBERON:001548842.24gold quality
colonic epitheliumUBERON:000039741.33gold quality
skeletal muscle tissueUBERON:000113440.67gold quality
bone marrow cellCL:000209240.03gold quality
muscle tissueUBERON:000238537.69gold quality

Single-cell (SCXA)

Detected in 1 experiment(s), a significant marker in 0.

ExperimentMarker?Max mean expression
E-ANND-3no2.46

Regulation

Is transcription factor: yes

Downstream targets (CollecTRI)

1 targets.

TargetRegulation
PAX6Repression

JASPAR motifs

MotifNameFamily
MA0722.1VAX1NK
MA0722.2VAX1NK

JASPAR matrix evidence (PMIDs): PMID:18585360

miRNA regulators (miRDB)

29 targeting VAX1, top 30 by miRDB confidence (max_score; target_count = how many genes the miRNA targets in total — lower means more specific):

miRNAMax scoreAvg scoremiRNA target_count
HSA-MIR-196A-5P100.0068.16684
HSA-MIR-196B-5P100.0068.16681
HSA-MIR-6783-3P99.8967.922059
HSA-MIR-1343-3P99.8966.781815
HSA-MIR-137-3P99.8774.742401
HSA-MIR-6739-5P99.8067.872806
HSA-MIR-6733-5P99.7467.942759
HSA-MIR-3059-5P99.7069.932491
HSA-MIR-317599.6566.302031
HSA-MIR-6751-5P99.5664.991145
HSA-MIR-315399.5567.592337
HSA-MIR-6733-3P99.5467.801281
HSA-MIR-477099.4969.091451
HSA-MIR-143-3P99.4969.051457
HSA-MIR-608899.2968.451284
HSA-MIR-6803-5P99.1963.901026
HSA-MIR-6852-5P99.1766.692073
HSA-MIR-807099.0769.301303
HSA-MIR-374A-3P98.8767.821531
HSA-MIR-197-3P98.0969.231004
HSA-MIR-18B-3P98.0565.55595
HSA-MIR-6847-5P97.9366.741808
HSA-MIR-10526-3P97.8664.971342
HSA-MIR-1914-5P97.8366.21807
HSA-MIR-5571-3P97.8066.07640
HSA-MIR-625-3P97.3266.55554
HSA-MIR-4653-3P96.2667.03725
HSA-MIR-3157-3P95.8667.08454
HSA-MIR-4787-5P89.0866.1888

Literature-anchored findings (GeneRIF, showing 11)

  • This is the first description of a patient with a VAX1 mutation and establishes VAX1 as a new causative gene for anophthalmia/microphthalmia (A/M) in humans. (PMID:22095910)
  • The data do not support the hypothesis that highly penetrant rare variants in VAX1 are a cause of nonsyndromic cleft lip with or without cleft palate. (PMID:23081944)
  • Our study replicated previous GWAS findings for markers in VAX1 in the Asian population, and identified rare variants in PAX7 and VAX1 that may contribute to the etiology of CL(P). (PMID:23463464)
  • VAX1 rs10787760, rs6585429 and rs1871345 polymorphisms may be involved in nonsyndromic cleft lip with or without cleft palate in Brazilian patients, but there is no association with polymorphisms in FGF12, VCL, or CX43 (PMID:23679094)
  • rs4752028 weakly associated with nonsyndromic cleft lip with or without cleft palate in northern Chinese Han population (PMID:28383424)
  • Our study first revealed VAX1 gene could contribute to the etiology of NSCL/P and have a paternal-special transmission in Western Han Chinese. Additionally, the study also implied that rs7078160 might be associated with NSCLP. (PMID:30048854)
  • This is the first study to find a relationship between these two loci on 10q25 (rs4752028 and rs7078160) and Nonsyndromic Orofacial Cleft in a population with high levels of consanguinity. (PMID:30633559)
  • The risk of nonsyndromic cleft lip with or without cleft palate and Vax1 rs7078160 polymorphisms in southern Han Chinese. (PMID:33132092)
  • Genetic markers for non-syndromic orofacial clefts in populations of European ancestry: a meta-analysis. (PMID:35075162)
  • Target sequencing reveals the association between variants in VAX1 and NSCL/P in Chinese population. (PMID:35419918)
  • The potential up-regulation risk of 3’ UTR SNP (rs10787760 G > A) for the VAX1 gene is associated with NSCLP in the northwest Chinese population. (PMID:38608796)

Cross-species orthologs

4 orthologs

OrganismSymbolGene ID
danio_reriovax1ENSDARG00000021916
mus_musculusVax1ENSMUSG00000006270
rattus_norvegicusVax1ENSRNOG00000008824
drosophila_melanogasterlmsFBGN0034520

Paralogs (3): VAX2 (ENSG00000116035), EMX1 (ENSG00000135638), EMX2 (ENSG00000170370)

Protein

Protein identifiers

Ventral anterior homeobox 1Q5SQQ9 (reviewed: Q5SQQ9)

All UniProt accessions (1): Q5SQQ9

UniProt curated annotations — full annotation on UniProt →

Function. Transcription factor that may function in dorsoventral specification of the forebrain. Required for axon guidance and major tract formation in the developing forebrain. May contribute to the differentiation of the neuroretina, pigmented epithelium and optic stalk.

Subcellular location. Nucleus.

Disease relevance. Microphthalmia, syndromic, 11 (MCOPS11) [MIM:614402] A rare clinical entity including as main characteristics microphthalmia and small optic nerves, cleft lip and palate, absence of corpus callosum, hippocampal malformations, and absence of the pineal gland. Microphthalmia is a disorder of eye formation, ranging from small size of a single eye to complete bilateral absence of ocular tissues (anophthalmia). In many cases, microphthalmia/anophthalmia occurs in association with syndromes that include non-ocular abnormalities. The disease is caused by variants affecting the gene represented in this entry.

Similarity. Belongs to the EMX homeobox family.

Isoforms (2)

UniProt IDNamesCanonical?
Q5SQQ9-11yes
Q5SQQ9-22

RefSeq proteins (2): NP_001106175, NP_954582 (=MANE)

Domains & families (InterPro)

IDNameType
IPR000047HTH_motifConserved_site
IPR001356HDDomain
IPR009057Homeodomain-like_sfHomologous_superfamily
IPR017970Homeobox_CSConserved_site
IPR050877EMX-VAX-Noto_Homeobox_TFsFamily

Pfam: PF00046

UniProt features (9 total): region of interest 3, compositionally biased region 2, chain 1, DNA-binding region 1, splice variant 1, sequence variant 1

Structure

Experimental structures (PDB)

0 structures.

Predicted structure (AlphaFold)

ModelpLDDTFraction very-high
AF-Q5SQQ9-F165.770.23

Function

Pathways and Gene Ontology

Reactome pathways

0 pathways

MSigDB gene sets: 183 (showing top): GOBP_NEGATIVE_REGULATION_OF_CELL_DEVELOPMENT, GOBP_MUSCLE_TISSUE_DEVELOPMENT, BENPORATH_ES_WITH_H3K27ME3, GGGNRMNNYCAT_UNKNOWN, GOBP_NEUROGENESIS, GOBP_REGULATION_OF_NERVOUS_SYSTEM_DEVELOPMENT, YY1_Q6, GOBP_NEGATIVE_REGULATION_OF_NERVOUS_SYSTEM_DEVELOPMENT, GOBP_NEURAL_PRECURSOR_CELL_PROLIFERATION, TCF4_Q5, GOBP_NEGATIVE_REGULATION_OF_MULTICELLULAR_ORGANISMAL_PROCESS, GOBP_MUSCLE_STRUCTURE_DEVELOPMENT, FREAC3_01, BRN2_01, GATA6_01

GO Biological Process (17): neuron migration (GO:0001764), regulation of transcription by RNA polymerase II (GO:0006357), neuroblast proliferation (GO:0007405), negative regulation of neuroblast proliferation (GO:0007406), axon guidance (GO:0007411), central nervous system development (GO:0007417), brain development (GO:0007420), neuron differentiation (GO:0030182), skeletal muscle cell differentiation (GO:0035914), camera-type eye development (GO:0043010), astrocyte differentiation (GO:0048708), roof of mouth development (GO:0060021), neuroepithelial cell differentiation (GO:0060563), negative regulation of transcription by RNA polymerase II (GO:0000122), regulation of DNA-templated transcription (GO:0006355), nervous system development (GO:0007399), glial cell differentiation (GO:0010001)

GO Molecular Function (9): RNA polymerase II cis-regulatory region sequence-specific DNA binding (GO:0000978), DNA-binding transcription factor activity, RNA polymerase II-specific (GO:0000981), RNA polymerase II intronic transcription regulatory region sequence-specific DNA binding (GO:0001162), DNA-binding transcription repressor activity, RNA polymerase II-specific (GO:0001227), chromatin DNA binding (GO:0031490), sequence-specific double-stranded DNA binding (GO:1990837), DNA binding (GO:0003677), DNA-binding transcription factor activity (GO:0003700), protein binding (GO:0005515)

GO Cellular Component (2): chromatin (GO:0000785), nucleus (GO:0005634)

GO top-level categories

Rollup of top GO terms by namespace:

CategoryTerms
RNA polymerase II transcription regulatory region sequence-specific DNA binding4
generation of neurons3
cell differentiation3
regulation of DNA-templated transcription2
transcription by RNA polymerase II2
system development2
central nervous system development2
regulation of transcription by RNA polymerase II2
cell migration1
neural precursor cell proliferation1
neuroblast proliferation1
negative regulation of neurogenesis1
regulation of neuroblast proliferation1
negative regulation of neural precursor cell proliferation1
axonogenesis1
neuron projection guidance1
nervous system development1
animal organ development1
head development1
skeletal muscle tissue development1
eye development1
glial cell differentiation1
anatomical structure development1
columnar/cuboidal epithelial cell differentiation1
negative regulation of DNA-templated transcription1
DNA-templated transcription1
regulation of gene expression1
regulation of RNA biosynthetic process1
gliogenesis1
cis-regulatory region sequence-specific DNA binding1
chromatin1
DNA-binding transcription factor activity1
intronic transcription regulatory region sequence-specific DNA binding1
negative regulation of transcription by RNA polymerase II1
DNA-binding transcription factor activity, RNA polymerase II-specific1
DNA-binding transcription repressor activity1
DNA binding1
chromatin binding1
double-stranded DNA binding1
sequence-specific DNA binding1

Protein interactions and networks

STRING

818 interactions, top by confidence (×1000):

Protein AProtein BPartner UniProtScore
VAX1ZNF462Q96JM2898
VAX1ASXL2Q76L83825
VAX1IRF6O14896781
VAX1SIX3O95343588
VAX1FOXE1O00358549
VAX1PAX2Q02962545
VAX1ABCA4P78363541
VAX1SIX6O95475540
VAX1MAFBQ9Y5Q3513
VAX1ARHGAP29Q52LW3505
VAX1NTN1O95631480
VAX1SHHQ15465464
VAX1ATOH7Q8N100453
VAX1SHTN1A0MZ66435
VAX1LHX2P50458421

IntAct

3 interactions, top by confidence:

ABTypeScore
VAX1H1-5psi-mi:“MI:0915”(physical association)0.400
KLHL22TRAV18psi-mi:“MI:0914”(association)0.350

BioGRID (16): VAX1 (Two-hybrid), VAX1 (Two-hybrid), VAX1 (Two-hybrid), VAX1 (Two-hybrid), VAX1 (Two-hybrid), VAX1 (Two-hybrid), VAX1 (Two-hybrid), VAX1 (Two-hybrid), VAX1 (Two-hybrid), DVL3 (Two-hybrid), MLLT3 (Two-hybrid), POLR3C (Two-hybrid), ESRRG (Two-hybrid), SPANXN2 (Two-hybrid), VAX1 (Proximity Label-MS)

ESM2 similar proteins: A0A8V0YY16, A0JPN1, A7MB54, A8MTJ6, O35762, O42115, O57601, O88181, O95096, P09065, P23683, P28356, P31311, P31315, P32443, P39020, P42581, P42586, P43697, P48031, P49640, P50222, P50476, P52951, P52954, P52955, P78426, P81067, P81068, P97334, Q14549, Q14774, Q1KKY1, Q1XID0, Q2NKI2, Q2VL76, Q2VL80, Q4V5A3, Q5SQQ9, Q60554

Diamond homologs: A2X7U1, A2X980, A2YR02, A2ZAI7, A3BPF2, A9ZPC9, G5EE18, O93528, P09075, P09076, P14150, P34326, P46607, P46897, Q00400, Q01IK0, Q04896, Q0J9X2, Q0WV12, Q2NKI2, Q336P2, Q5JMF3, Q5SQQ9, Q5ZAY0, Q651Z5, Q69T58, Q6EPF0, Q6H6S3, Q6YWR4, Q6ZAR0, Q707Y6, Q7XUJ5, Q7Y0V7, Q7Y0V9, Q801E0, Q801E1, Q8L7H4, Q8RWU4, Q93V99, Q94C37

SIGNOR signaling

0 interactions.

Disease & clinical

Clinical variants and AI predictions

ClinVar

83 variants total. Per-class counts are floors (≥ shown; pagination cap):

ClassificationCount (floor)
Pathogenic1
Likely pathogenic1
Uncertain significance56
Likely benign17
Benign6

Top pathogenic / likely-pathogenic (2)

Variant IDHGVSClassification
36954NM_001112704.2(VAX1):c.454C>A (p.Arg152Ser)Pathogenic
1710333NM_001112704.2(VAX1):c.212del (p.Pro71fs)Likely pathogenic

SpliceAI

615 predictions. Top by Δscore:

VariantEffectΔscore
10:117136467:GGTAC:Gdonor_loss1.0000
10:117136468:GTAC:Gdonor_loss1.0000
10:117136469:TA:Tdonor_loss1.0000
10:117136470:AC:Adonor_loss1.0000
10:117136471:C:CAdonor_loss1.0000
10:117136531:A:ACdonor_gain1.0000
10:117136532:C:CCdonor_gain1.0000
10:117136657:CAT:Cacceptor_gain1.0000
10:117136660:C:CCacceptor_gain1.0000
10:117137868:A:ACdonor_gain1.0000
10:117137869:C:CCdonor_gain1.0000
10:117134584:CTGCG:Cacceptor_loss0.9900
10:117134585:T:Gacceptor_loss0.9900
10:117134592:CGGGG:Cacceptor_gain0.9900
10:117134596:G:Cacceptor_gain0.9900
10:117134596:G:GCacceptor_gain0.9900
10:117134599:C:CTacceptor_gain0.9900
10:117134600:G:Tacceptor_gain0.9900
10:117134608:T:Cacceptor_gain0.9900
10:117134608:T:TCacceptor_gain0.9900
10:117136466:GGGTA:Gdonor_loss0.9900
10:117136655:GGCAT:Gacceptor_gain0.9900
10:117136656:GCAT:Gacceptor_gain0.9900
10:117136656:GCATC:Gacceptor_gain0.9900
10:117136657:CATC:Cacceptor_gain0.9900
10:117136657:CATCT:Cacceptor_gain0.9900
10:117136658:AT:Aacceptor_gain0.9900
10:117136658:ATC:Aacceptor_gain0.9900
10:117136659:TC:Tacceptor_gain0.9900
10:117136660:CTG:Cacceptor_gain0.9900

AlphaMissense

2102 scored. Top likely-pathogenic:

VariantProtein changeam_pathogenicity
10:117134065:G:CF316L1.000
10:117134065:G:TF316L1.000
10:117134067:A:GF316L1.000
10:117134542:C:AK157N1.000
10:117134542:C:GK157N1.000
10:117134544:T:CK157E1.000
10:117134545:C:AK156N1.000
10:117134545:C:GK156N1.000
10:117134547:T:CK156E1.000
10:117134549:T:GQ155P1.000
10:117134551:C:AK154N1.000
10:117134551:C:GK154N1.000
10:117134552:T:AK154M1.000
10:117134552:T:GK154T1.000
10:117134553:T:CK154E1.000
10:117134553:T:GK154Q1.000
10:117134558:C:AR152L1.000
10:117134558:C:GR152P1.000
10:117134558:C:TR152H1.000
10:117134559:G:AR152C1.000
10:117134559:G:CR152G1.000
10:117134559:G:TR152S1.000
10:117134561:C:AR151L1.000
10:117134561:C:GR151P1.000
10:117134562:G:AR151W1.000
10:117134562:G:CR151G1.000
10:117134563:G:CN150K1.000
10:117134563:G:TN150K1.000
10:117134564:T:AN150I1.000
10:117134564:T:CN150S1.000

dbSNP variants (sampled 300 via entrez): RS1000339393 (10:117139911 C>A), RS1000372082 (10:117139550 G>A,C), RS1000384346 (10:117135313 C>T), RS1000879724 (10:117135070 C>A,T), RS1001353615 (10:117134799 C>T), RS1001388995 (10:117133237 A>G), RS1001445477 (10:117136056 A>T), RS1001617003 (10:117139015 C>T), RS1002807729 (10:117129717 C>A,G), RS1002886027 (10:117137670 GC>G), RS1002919253 (10:117130130 A>G), RS1002960246 (10:117137140 C>G,T), RS1003163539 (10:117137468 C>T), RS1003186312 (10:117131654 G>A), RS1003368735 (10:117137409 G>C,T)

Disease associations

OMIM: gene MIM:604294 | disease phenotypes: MIM:614402

GenCC curated gene-disease

DiseaseClassificationInheritance
microphthalmia, syndromic 11LimitedAutosomal recessive

Mondo (2): microphthalmia, syndromic 11 (MONDO:0013734), microphthalmia (MONDO:0021129)

Orphanet (0):

HPO phenotypes

9 total (9 of 9 shown, HPO-id order):

HPOTerm
HP:0000007Autosomal recessive inheritance
HP:0000175Cleft palate
HP:0000204Cleft upper lip
HP:0000568Microphthalmia
HP:0001263Global developmental delay
HP:0001274Agenesis of corpus callosum
HP:0003577Congenital onset
HP:0012687Agenesis of pineal gland
HP:0034396Hippocampal malrotation

GWAS associations

7 associations (top):

StudyTraitp-value
GCST000547_5Orofacial clefts2.000000e-08
GCST002811_2Nonsyndromic cleft lip with or without cleft palate3.000000e-10
GCST004166_16Nonsyndromic cleft lip with cleft palate7.000000e-13
GCST005951_66Body mass index4.000000e-08
GCST009357_6Nonsyndromic cleft lip3.000000e-10
GCST010703_309Brain morphology (MOSTest)2.000000e-25
GCST90000050_49Age at first birth1.000000e-11

EFO canonical traits (4, from GWAS)

EFO IDTrait name
EFO:0003959cleft lip
EFO:0004340body mass index
EFO:0004346neuroimaging measurement
EFO:0009101age at first birth measurement

MeSH disease descriptors (1)

DescriptorNameTree numbers
D008850MicrophthalmosC11.250.566; C16.131.384.666

Drugs & pharmacology

Drug and pharmacology data

Is drug target: no

PharmGKB: 1 entry (VIP=true, CPIC=false)

CTD chemical–gene interactions

11 total (human), top 11 by PubMed support.

ChemicalActions (top 5)PubMed papers
bisphenol Aaffects cotreatment, affects methylation1
butyraldehydeincreases expression1
tetrabromobisphenol Aincreases expression1
(+)-JQ1 compounddecreases expression1
Resveratroldecreases expression, affects cotreatment1
Fulvestrantaffects cotreatment, affects methylation1
Benzo(a)pyreneaffects methylation, increases methylation1
Plant Extractsaffects cotreatment, decreases expression1
Asbestos, Serpentinedecreases methylation1
Asbestos, Crocidolitedecreases methylation1
Asbestos, Amositedecreases methylation1

Cellosaurus cell lines

3 cell lines: 3 embryonic stem cell

First 10 cell lines (id-ordered, not curated):

CellosaurusNameCategorySex
CVCL_A7T0SEES3-1V human VAX1, clone1Embryonic stem cellMale
CVCL_A7T1SEES3-1V human VAX1, clone2Embryonic stem cellMale
CVCL_A7T2SEES3-1V human VAX1, clone3Embryonic stem cellMale

Clinical trials (associated diseases)

5 trials via MONDO — disease-level, not drug-specific.

TrialPhaseStatusTitle
NCT01778543Not specifiedRECRUITINGPathogenesis and Genetics of Microphthalmia, Anophthalmia and Uveal Coloboma (MAC)
NCT03748732Not specifiedUNKNOWNExtensive Circumferential Partial Thickness Sclerectomy in Nanophthalmic Eyes
NCT04759560Not specifiedUNKNOWNBiometric Characteristics of the Eye With Microcornea/Microphthalmia and Congenital Cataract Before And After Cataract Extraction
NCT05954403Not specifiedRECRUITINGNational Cohort on Congenital Defects of the Eye
NCT06293560Not specifiedRECRUITINGMicrophthalmia, Anophthalmia, and Coloboma Genetic Epidemiology in Children