Purpose: To assess whether interactions of common alleles of two folate genes contribute to spina bifida risk.Methods: Case-control study, comparing 203 children with spina bifida to 583 controls. Results: Homozygosity for the 677C-T allele of 5,10-methylenetetrahydrofolate reductase (MTHFR) alone was associated with an odds ratio for spina bifida of 1.57 (95% confidence interval [CI], 1.02-2.38). For the 844ins68 allele of cystathionine--synthase alone, the odds ratio was 0.83 (95% CI, 0.39 -1.64). For the joint genotype, the odds ratio was 3.69 (95% Spina bifida is a common and severe congenital anomaly that yearly affects approximately 1 in 1,000 newborns in Italy 1 and 200,000 newborns or more worldwide. 2,3 Clinical and epidemiologic evidence, such as the variability of occurrence rates by geography, time, socioeconomic status, and ethnicity, and the relatively low recurrence risk within families, suggests that the etiology of spina bifida involves interactions between multiple genetic and environmental factors. 4,5 However, defining these factors and interactions has proven difficult. The protective effect of folic acid on the occurrence of spina bifida 6 -8 suggests that the study of folate metabolism might identify some of the genetic determinants of spina bifida. Several candidate genes have been studied, including 5,10-methylenetetrahydrofolate reductase (MTHFR), cystathionine--synthase (CBS), methionine synthase, and methionine synthase reductase. A pooled analysis suggests that homozygosity for the 677C-T allele of MTHFR in infants is associated with approximately a 70% increased risk for spina bifida. 9 Common mutations of other genes, such as the 844ins68 allele of CBS, 10 have also been described, although their association with spina bifida is still unclear. Limited data are available on potential interactions among alleles of different folate-related genes. In 1997, Ramsbottom and associates 11 from Ireland reported data on the 677C-T allele of MTHFR and the 844ins68 allele of CBS and suggested that they indicated no interaction effects for spina bifida. We suggested that these data were consistent with the presence of interaction, 12 although the original authors thought otherwise. 13 Subsequent studies yielded discordant findings, with one study from Germany reporting no interaction effects 14 and another study from the United States reporting possible evidence for interaction. 15 In this report, which expands findings reported in abstract, 16 we assess the independent and joint effects of these two common alleles (677C-T and 844ins84) on the risk for spina bifida, using data from a large case-control study from Italy.
MATERIALS AND METHODS
Study populationThe study population comprised 203 children with open spina bifida without other unrelated major malformations (case-subjects) and 583 healthy young adults and newborns (control-subjects). The subjects with spina bifida had been included in another study of MTHFR allelic variants. 17 Of the 203 children with spina bifida, 173 (85%) had my...