Supporting Information_ Methods S1 Direct bidirectional sequencing of the complete coding regions and exon-intron boundaries of genes SHH (MIM 600725), SIX3 (MIM 603714), ZIC2 (MIM 603073), and TGIF (MIM 602630), were performed using the Big Dye Terminator v3.1 Cycle Sequencing Kit (Applied Biosystems, Foster City, CA), and the automated sequencer ABI Prism 3130XL (Applied Biosystems). Primers sets and PCR protocols for amplification of SHH, SIX3, and TGIF genes were used as described elsewhere (El-Jaick et al., 2007a; El-Jaick et al., 2007b). Primers sets and PCR protocols for amplification of ZIC2 gene were also described elsewhere (Costa-Lima, 2008; Savastano, 2009), however are also described here to increase availability. For amplification of ZIC2 gene, a total of four primer pairs were used: Z1 (foward) 5’ATCGGGAGCGGGAGTCGAG-3’ and Z2 (reverse) 5’AGCACATTCTGCGAGCCGTG- 3’ for amplification of the first part of exon 1; Z3.1 (forward) 5’-AACTCCACCCGGGACTTCCTGTTC-3’ and Z4.1 (reverse) 5’-CCACAGCCTGAGTCTCAG-3’ for amplification of second part of exon 1; Z5 (forward) 5’-TGCAGCCAGCGCCGATGTTTGC-3’ and Z6 (reverse) 5’TGAGGTGGTCCGGGCCAGTGC-3’ for amplification of exon 2; Z7 (forward) 5’-AGCTGCACTCACACCCAGTC-3’ and Z8 (reverse) 5’AAGGTGCCCTCGCTGCTAGCTG-3’ for amplification of coding region of exon 3. Reactions were performed in a PTC-220 thermocycler (MJ Research, Waltham, MA) in a final volume of 35 μL using 60–100 ng of genomic DNA, 200 μM dNTP, 20 pmol of each primer, 1× PCR buffer (Invitrogen, Carlsbad, CA), 0.5× enhancer (Invitrogen, Carlsbad, CA), 1.5 mM MgSO4 (Invitrogen, Carlsbad, CA), and 2.5 U of AmpliTaq Applied Biosystems). For amplification of ZIC2 exon 3, 3x enhancer (Invitrogen, Carlsbad, CA) was used. PCR cycling parameters were 95°C for 5 minutes, followed by 95°C for 45 sec, 62°C for 1 min, 72°C for 45 sec, for 35 cycles, with a final step of 72°C for 7 minutes. Annealing step for amplification of exon 3 was performed at 55˚C. Full COLD-PCR (Li et al., 2008) of ZIC2 exon 3 was performed to confirm the mutation in the father. Reagents concentration was the same as in normal PCR, and cycling conditions were 95°C for 5 minutes, 25 cycles of (95°C for 45 sec, 55°C for 1 min, 72°C for 45 sec), then 30 cycles of (95°C for 45 sec, 70°C for 8 min, 80°C for 3 sec, 55°C for 1 min, 72°C for 45 sec), and a final step of 72°C for 7 minutes. Sequences were aligned with reference coding sequences (Genbank cDNA accession numbers: SHH: NM_000193.2; SIX3: NM_005413.2; ZIC2: NM_007129.2, TGIF: NM_007129.3) using Sequencher (Gene Codes Corporation Ann Arbor), and mutation was confirmed on a new PCR and sequencing reaction. References for Supporting Information_ Methods S1 Costa-Lima MA. 2008. Estudo Molecular do Gene ZIC2 em Pacientes com Defeito de Fechamento do Tubo Neural e Holoprosencefalia. [Tese de Doutorado]. Rio de Janeiro: Universidade Federal do Rio de Janeiro. 161 p. El-Jaick KB, Fonseca RF, Moreira MA, et al. 2007a. Single median maxillary central incisor: new data and mutation review. Birth Defects Res A Clin Mol Teratol 79(8):573-580. El-Jaick KB, Powers SE, Bartholin L, et al. 2007b. Functional analysis of mutations in TGIF associated with holoprosencephaly. Mol Genet Metab 90(1):97-111. Li J, Wang L, Mamon H, Kulke MH, Berbeco R, Makrigiorgos GM. 2008. Replacing PCR with COLD-PCR enriches variant DNA sequences and redefines the sensitivity of genetic testing. Nat Med 14:579-584. Savastano CP. 2009. Estudos Moleculares em Holoprosencefalia [Dissertação de Mestrado]. Rio de Janeiro: Universidade Federal do Rio de Janeiro. 96 p.