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two faced babyEarlier this week, it was reported that a baby with two faces was born to a young couple in rural northern India. Lali, born last month in a normal delivery, has a condition known as craniofacial duplication. Diprosopus is well-documented in the literature, but the number of cases in which the diprosopic infant is complication-free is very low. Complications of this condition include anencephaly (the absence of a brain/skull cap), upper gastrointestinal organ malformations as well as cardiac abnormalities.


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wieschausnussleinvolhardHow does something like this happen?, you might wonder. Recall that there is a series of genes in our genome known as homeobox (Hox) genes, responsible for the basic body plan. These genes are present in animals, fungi as well as plants and have been highly conserved in each of these kingdoms over time, with only slight modifications. The set of Hox genes (located on chromosome 7) in humans responsible for determining placement and size of facial features is known as the Sonic Hedgehog homolog (SHH).


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The SHH genes were first discovered by Christiane Nusslein-Volhard and Eric Wieschaus, two researchers who studied embryonic development in Drosophila and whose work was rewarded in 1995 with a Nobel Prize. Along with Edward Lewis, a developmental geneticist, Nusslein-Volhard and Wieschaus discovered the set of genes responsible for segmentation of fruit fly bodies. These same genes are the ones responsible for proper placement and development of digits on human limbs, facial features, patterning of blood vessels, lung development and even brain development. How SHH regulates organogenesis is through production of a protein known as a ligand which binds to a certain protein on the cell's extracellular matrix. The concentration of the SHH protein that is produced determines the effects the protein has on the cells it affects. This is known as the French Flag model.


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SHH genesIn Drosophila, if mutated, the SHH genes cause small spikes to form all over the body of the fly, hence the "hedgehog"-like appearance. The mutation of the SHH genes causes a loss of function so that the protein does not function as it should if it were normal, as many gene mutations do. In humans, if mutated, SHH genes cause multiple malformations of the head, brain and other organs whose organogenesis is controlled by the production of the SHH protein.


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lali familyIt is unknown whether or not Lali, the original subject of this post, has any other developmental abnormalities. Her parents have been quoted in the press as saying that she is behaving normally and that she does not need medical attention. However, doctors are concerned that Lali may have other developmental abnormalities that cannot be seen with the naked eye that require imaging technology to view, such as potential duplication of internal organs. Currently, Lali is able to see with all 4 of her eyes, hear with both of her ears and eat with both of her mouths. It is unknown (and may remain so) if she has two esophagi and two tracheas, as her parents refuse to allow Lali to be examined by doctors for other abnormalities.


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Currently, Lali is visited by hundreds of people from her village as well as surrounding villages, as she is thought to be an incarnation of a Hindu goddess who also possesses two faces.


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Isn't it interesting that something so small as the interaction of proteins on the cell's membrane can have such drastic consequences? How does Lali's condition illustrate to you the importance and relationship of genes to protein production and their role in development? What do you think about her parents' decision to disallow Lali to be further examined by medical professionals?

Posted by scienceguru on April 9, 2008
Tags discuss, genetics, proteins can be uncool too

Total comments on this page: 56

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Kamene Dornubari-Ogidi on paragraph 6:

I know that I digress from a “scientific” analysis…

…but she may just be a reincarnation. heck, I’ll have to catch a plane and pay my dues,too!

April 10, 2008 6:47 pm
Kamene Dornubari-Ogidi on paragraph 7:

I’m not sure exactly WHY they won’t allow medical professionals to examine their child. I’m sure they don’t want their child to be turned into a case study (of course), but they may be inadvertently dooming her if their are other abberations present in her body.

Because of their rural lack of education, I’m sure that they have reservations about the invasive nature of medical doctors, but I think more people should be trying to convince them to allow medical examination.

If the baby does have one brain, that’ll be something.

April 10, 2008 7:12 pm
Brandi Manthei :

I can see why they wouldn’t want their child to be examined any more because it is not a part of their culture. Of course in America we are so fearful of any deformity that we will put our children through anything to fix it so they can fit into society. Since in their society she is viewed as a goddess they see this more as a blessing than a hinderance. They probably aren’t willing to change her unless they know that her survival rate is very low.

April 16, 2008 7:06 pm
Kaston Murrell :

It also depends largely on the people. I don’t know how much they did but the doctors of another child in India examined a child born with extra arms and legs. I believe they also removed them.

April 17, 2008 4:08 pm
Karen MacPherson on paragraph 7:

It’s amazing how the mutation of one gene can cause such a chain of reactions in the development of an organism. However, the thing that impresses me the most is actually the flexibility of the human body that allows Lali to fuction normally in such abnormal conditions. Because of her parents decision, we don’t know how her brain(s) is structured, but whether she has one connected to two faces or two smaller brains, her body has adapted to its condition to survive miraculously. I think her parents should let the doctors examine her for her own sake, to make sure she really is healthy, but I understand cultural influence in a person’s life often dictates these decisions.

April 10, 2008 8:34 pm
Andrea Deschenes on paragraph 7:

I completly understand WHY the parents won’t allow their child to be made into a medical exhibit but for the safety of the child i see that its best fit that the child recieves some sort of medical examination to see weather or not the health of the child has been affected by set gene. There may be more underlying effects that are not visible much like the face. Such a small gene can have such a major effect so what if there is another gene that has been altered that has not as an apparent effect? The child NEEDS to be examined.

April 11, 2008 3:03 pm
Angie on paragraph 7:

It’s definitely scary how one small variation can have such extreme affects. It would be very interesting to see how this child grows and develops. We can’t be too judgmental on Lali’s parent not wanting her to be examined by doctors though. As Kamene said, it’s a lack of education, and it isn’t necessarily the parent’s fault. It might be a fatal decision but it’s up to the parents nonetheless. Maybe it’s because she resembles a Hindu goddess that they want to respect her.

April 11, 2008 5:09 pm
Kaston Murrell :

While it is the parent’s decision whether or not to allow for Lali to get medical examination, and very much isn’t necessary, some still is a necessity. To know which side effects to look out for they need to do a few tests, such as internal scans to see how much of her anatomy has been duplicated.

April 17, 2008 3:53 pm
joce g on whole page :

the relationship of genes and proteins for the developmental process is very important. this child will most likely have short life because of the complications of the mutation. i think it is great Lali’s parents are not allowing scientists to examine her. They would never get to see their daughter. if Lali begins to have health issues then i think it would be appropriate.

April 12, 2008 1:46 pm
Ty Vessels on paragraph 7:

It is truly humbling to think how such small things as proteins have such an extreme impact on our lives. I understand the parents decision to refuse medical examination of their child/children. However it would be more beneficial for the child/children and perhaps all of mankind if they were allowed to be examined thoroughly by professionals.

April 13, 2008 7:19 pm
Hannah on paragraph 7:

Lali parents decision to disallow her to be examinend by medical professionals may be a fatal one. A physician needs to be able to make sure all of Lali’s organs are fully functioning and developed especially her heart. An examination would also conclude how many of each organ she has and if she is one or two people conjoined. I can understand the first time parents are scared or trying to protect their child by acting as though she is no different than any other child but the fact remains she is different from normal babies. It is critical for her to have an examination to depict how different she is from the normal to secure her body functions as it should.

April 14, 2008 10:31 am
Kristal Jackson on paragraph 1:

What I’d like to know is if the baby is healthy or not. Just because she can see/breathe/eat with all of her extra organs, it doesn’t mean that she’s healthy. Who knows if she’ll be alright? Personally, I don’t think she’s going to live much longer. Conditions like these usually end up being lethal.

April 14, 2008 1:06 pm
Kristal Jackson on paragraph 7:

I think it would be utterly stupid for the parents not to allow a doctor to see their child, but that’s me. I’m also aware of the fact that they may not know about the medical advances. If they want to allow their daughter to grow up without seeing a medical profession, that’s their choice. They should also be informed that this condition could quite possibly kill her.

Anyway.

Isn’t cystic fibrosis caused by a faulty sodium/chloride pump? I’m not sure if that has much relevance to the topic at hand. It’s pretty crazy though that just a few messed up codes and there’s no telling what it will do to a baby or person.

April 14, 2008 1:10 pm
Destiny on whole page :

I think it is a good decision on the parents part to have medical proffesionals leave the baby alone. If the child begins to have problems, of course a doctor is appropriate. However, the baby seems happy for the time being and is going through a crucial bonding time with her parents. They would hardly be able to see their daughter and enjoy their time with her if the medical proffesionals got their hands on her.

April 14, 2008 9:30 pm
Aadil Sarfani :

But don’t you think that a little research (not researching on her all day, but to a limited extent) would actually help her because the doctors could possibly find out something about her which would allow them to save her life? Also, it could possibly help the world a lot if they could learn things about the human body from her.

April 20, 2008 3:29 pm
Isha Banerjea on whole page :

Although, it may seem completely irrational to us that parents would deprive their child, which a severely abnormal defect, from medical attention. However, we need to look at the lack of information these parents are being given and the overwhelming feelings they must feel at this point. Living in such a secluded part of India, they probably have not been to a hospital before or have even seen a camera before (judging by the bewildered expression on their face). I hope that the right people help these parents out in figuring out the best options for their little girl.

April 15, 2008 1:23 pm
Kaston Murrell on whole page :

Little changes can certainly have drastic consequences. I don’t think the original article I saw this in said that all four eyes are functional. That’s interesting. She can probably see in about 270 degrees. How her brain processes this and what that looks like, I have no clue. I don’t know that her parent’s decision to disallow Lali to be further examined is a good one, however. Those who have had her condition do not typically live without complication. I would imagine that Lali could easily have two esophagi that lead to either the same stomach or even two stomachs because she can eat from both mouths.

April 15, 2008 3:22 pm
K. Wise on paragraph 7:

I think that this is super neat. Obviously things like this don’t happen everyday, and it’s cool how we’re constantly being amazed by human genetics. Of course, it’s entirely the parents’ call whether they allow their child to see medical professionals, and though they are reluctant now, I think that when, on down the road she gets sick with something, they’ll give in. My prediction is that there are two brains because of the two pairs of eyes (they connect directly with the brain). Hundreds of other questions are inevitably going to come up later-such as how the nervous system is divided if, in fact, there are two separate minds or *souls* within the body.

April 15, 2008 3:49 pm
K. Wise on whole page :

After looking at this article a second time, I wonder now how, if it infact possesses two different brains, how the two individuals can work together to turn their shared head or how movement is coordinated. At the beginning of the year, I remember reading articles and watching on the internet about the Hensel twins-the conjoined girls. Because they had two separate heads, they were able to coordinate movement pretty easily. In the case of one head, it befuddles me what they’ll do.

April 16, 2008 2:40 pm
Sara Lacock :

If she had one brain would she be able to tell which face to act with? It doesn’t seem as if our brains would be able to cope with something this different. I know mine only has to deal with one face. It seems more likely that she would have two brains, unless the one brain somehow has a way of controlling two faces at once.

April 17, 2008 8:51 pm
Andrea Deschenes on whole page :

I cannot imagine what living life with four eyes would be like. I think I would feel very dizzy? Its amazing for one child to live and eat with two mouths but does that mean that the organs have to do double work to keep up with the digestion of both mouths? Is one mouth more dominant to eat out of?

April 16, 2008 7:39 pm
David Golynskiy :

About bieng dizzy….. it depends. I am wondering if Lali can move each pair of facial muscles seperately. Or are all her movements unified. For example, when she looking at some thing, does she focus all 4 eyes towards the target or can she control which pair of eyes (or independent eyes) look at what. Same goes with the mouth, when she eats do both mouths move? This can determine how she develops.

April 18, 2008 6:25 pm
Stephen Geest on whole page :

Wow! These parents being deprvied of information is somewhat disconcerning. that there are people out there in this world that have no sense of education like that of the people in africa. But its pretty cool that there is a gene in us that configures our facial make up. and ishas got a point they look like they have never seen a camera before they are probably thoroughly confused about this whole situation. i wonder how we could keep this from happening? Stephen out

April 17, 2008 11:29 am
Sussana Elkassih on paragraph 5:

Wow, that certainly amazing she can “see with all 4 of her eyes, hear with both her ears, and eat with both her mouths…” I wish the article was more specific, for example, the article states that the child can see through all four eyes, but do all eyes move in the same direction, or are both sets of eyes independent of one another? Same with her ears and her mouths? If that is the case then is “Lali” one child, or is she considered two children that happen to share a body but not a face? It’s too bad that the couple won’t take their child in for medical treatment/examination, but you have to consider that this couple comes from rural India and so they may not be sure what to expect.

April 17, 2008 5:11 pm
Sussana Elkassih on paragraph 7:

I truly wish that the parents did allow Lali to be further examined by medical professionals, but I understand that the parents are from Rural India, so they may not be familiar with hospitals, or doctors. I want to know so much more about this child, if she has two smaller sets of each organ, or if she only has one of each organ. If that’s the case then would her organs need to work twice as hard to cope with the two faces? Of if you touch one face will the other face feel that touch? Plus, I’m pretty sure that there is some complication that this child has that needs medical assistance on a daily bases.

April 17, 2008 5:20 pm
Joshua Geevarghese on paragraph 1:

This is my personal and kind of a racial comment. but I think i Could say this. Why is that things like this happen in India or South Asia. Baby with two heads, Baby with a tail. I just dont get this

April 17, 2008 7:30 pm
Joshua Geevarghese on paragraph 6:

i will explain the reason why people think the baby is a reincarnation. I am not a Hindu but i think i am right in this one. Hindus believe in polytheism. they have numerous gods. one of the god is four headed. thats why people think this could be reincarnation. also hindus believe in reincarnation of god to save people( just like our Christian belief that the Jesus is the human form of God). Even though I am not a Hindu, I am tired of people making fun of these type of religious pratices. so go easy one them and i hope explained it right.

April 17, 2008 7:38 pm
Joshua Geevarghese on paragraph 7:

I can see why the parents dont want their baby to be tested, because they think that this baby is also reincarnated. Also as part of Indian life you dont see anything wrong with the baby they are not going take the baby to a hospital. That is western style that going to hospital for a monthly check up. so Ican perfectly understand the parents position. but i cant believe that such a small interaction on the protein will have this kind of drastic consequences. that is unbelievable.

April 17, 2008 7:44 pm
Brigham on whole page :

I wonder if the recent publicity has something to do with the parents decision not to allow the doctors near their child. I mean, if what people are viewing as a goddess could be disproved by science, the parents will not have those people coming to see them and they will no longer be the center of attention. I think it would be good for them to have their child checked out however, to be sure that it has no severe problems especially with its internal organs.

April 17, 2008 8:33 pm
Sara Lacock on paragraph 7:

I wonder if this Hindu goddess is based off someone from long ago that was born with two faces like Lali…

How long is she expected to live? Or maybe they can’t find out because the doctors can’t look at her. If she lives to be older, having two faces will probably be an issue for her. She might be alright now, but why can’t her parents see that their daughter’s condition isn’t normal, which means that something is going on inside of her that isn’t normal?

April 17, 2008 8:45 pm
Marcos on whole page :

The question begging me to ask it is how many cases like this go undocumented in all the rural parts of the world? Also, if it could ever be studied, I would be interested to know if there was a correlation between SHH gene mutation and ethnicity and/or geographic area. There could be an environmental factor that wreaks havoc in certain parts of the world when the stars, or the chromosomes, align just so.

April 17, 2008 10:48 pm
Destiny on paragraph 7:

Now that I think about it…it would definately be benificial to the child gets screened. I mean, if there is abnormalities that are not yet noticable that go untreated…the baby could die. All due to the parents need for privacy. Yes, privacy is imoportant…but not more important than human lives.

April 18, 2008 7:29 pm
Kishan Patel on paragraph 7:

If I was in the parent’s spot I would allow researchers to examine my two faced child to see what is wrong with her. But I also can see where the child’s parents are coming from, they live in a mostly non educated area of India and well if they lack that knowledge on genetics or any kind of basic science then obviously there child is considered holy and any kind of research would probably be considered a sin.

April 19, 2008 3:53 pm
Kishan Patel on whole page :

Well I’m kind of split on the parent’s decision on whether to let medical researchers examine my child, from a medical researcher’s point of view the parents are being stubborn in not letting any kind of tests being done on Lali. But from the parent’s point of view which is the side that I would agree with more, is that they don’t know anything about genetics, so to them their child having two faces is a mircle, and if researchers do tests on their child well that could scar the miricle that their child incorporates.

April 19, 2008 3:59 pm
Kishan Patel on paragraph 5:

WHAT!? When I first heard about this in class i didn’t know that she could see out of all four eyes and eat with both mouths. I for one am surprised. Could this mean that she has two sets of vocal chords and every time she would say something there would just be an echo, and that brings up the question, what else is duplicated in this child, chances are here facial features arent the only thing that are duplicated. If only the parents would allow doctors to atleast get an xray of her. Well I knowing whether her internal organs are also duplicated will never be known for sure.

April 19, 2008 4:38 pm
Karen MacPherson on paragraph 6:

Do you know which goddess it is that they beleive was reincarnated? Just out of curiosity. I looked up some and found a hindu goddess wih six heads… might or not be the one they think she is, I don’t know much about hinduism. But if it is this goddess, Kartikay that they are going to see, I think it’s amazingly ironic, because the source says that she is the goddess of science.

April 20, 2008 7:47 am
J-nuggetsenior08 on paragraph 6:

I agree with Josh V. it is true that hindus believe in many gods of all origins however it is common in india for children to be born with malformations and numerous physical defects. I doubt that this baby is a reincarnation of a god but I am speaking mainly, as a christian, from a biased perspective.

April 20, 2008 7:58 am
J-nuggetsenior08 on paragraph 1:

She is lucky to have been born without any complications but overall she will have many complications later on in life. It is good that she is healthy but have two faces will not make life easy for her. I know that being healthy is more important than being “sexy” but I believe that if there were more and more people showing up in this day and age that were deformed yet healthy the human population would decline dramatically. People would fear the prospect of having children if there was a high probability of children being born with intense physical defects such as lali’s.

April 20, 2008 8:03 am
J-nuggetsenior08 on paragraph 7:

Most people tend to want things like this publicized however it would be a good thing for scientists to observe and document in regards to lalis birth without complications.

April 20, 2008 8:07 am
kaitlin willems on paragraph 7:

I believe culture plays a large role in why they wont let a doctor examine them, as others have said. This case obviously shows a tremendous relationship between the relationship amongst genes and protein production. With the offspring being born in such a condition, it is also amazing that is was born without complications. It will be interesting to see if the child is able to further develop normally.

April 20, 2008 9:16 am
kaitlin willems on paragraph 2:

Do they know if it was a defect in the homeobox genes or if it was the SHH that caused this specific birth problem? Is this kind of defect heritable or does it happen by chance through something like a mutation? If there was a problem with the placement and development of the child’s facial features, does that mean that there is a greater chance that there might also be more wrong with its digits, blood vessels, lung and brain development?

April 20, 2008 9:51 am
Prashi on paragraph 2:

This is quite interestiong becuase maybe only one of the faces is alive and the other one is not actually functional. I mean that only one can control herself. That would be wierd if she can be controlled by both faces. She does have a larger head so maybe it might work.

April 20, 2008 9:51 am
kaitlin willems on paragraph 4:

When conducting their experimentation of the fly, were flies able to live with the mutated SHH genes and the spikes all over their body? If the flies could live, does that have any indication if whether humans could live with this mutation?

April 20, 2008 9:54 am
bonnie kellum on paragraph 7:

It is unfortunate that they wont let any doctors examine the baby, although I understand the cultural aspect of the situation.

April 20, 2008 9:55 am
bonnie kellum on paragraph 7:

It it possible that this child will live a perfectly functional life?

April 20, 2008 9:56 am
bonnie kellum on paragraph 3:

It will be interesting to find out if the mutation caused any other defects in organogenisis in the childs body.

April 20, 2008 9:57 am
ethan nelson on paragraph 5:

well i have to point out the obvious if this child continues to grow and mature and she doesn’t have any major problems she will be most likely be the weirdest kid in the entire world. it is hard to imagine seeing and eating with both sides of the head. it is hard to imagine doing it.

April 20, 2008 10:15 am
Prashi on paragraph 6:

If she survives atleast she won’t be an outcast like certain people with disorders in undecated parts of the world become. Since every one considers her a godess, then she will not be able to live a normal life, but then agian 2 faces is not normal anyways. But atleast no one will make fun of her.

April 20, 2008 10:16 am
ethan nelson on paragraph 7:

this is an interesting story. i think that because of the culture that the parents live in is the reason they don’t want their child to be examined the culture their is different than ours. i think just to be safe they should allow an examnation. but i guess i wouldn’t know their culture and their ideals.

April 20, 2008 10:19 am
Bonnie Kellum on paragraph 7:

I know if my child had potential deformities that could possibly be fixed with corrective surgery, then I would certainly want to know. However, that is my point of view as an American. It is probably much different for someone living in rural India. Plus, these parents and many of those surrounding them believe that the child is a form of a goddess. Perhaps performing any sort of testing would be viewed as doubting the goddess’ power or strength and would be disrespectful to their religion. However, when is

April 20, 2008 12:39 pm
Aadil Sarfani on whole page :

If her parents allowed research to be done on her (without harming her), a lot can be learned. If she can see normally despite of having a weird arrangement of eyes, it would show a lot about what the brain is and isn’t capable of. This is a rare case which can be used to study many things, not just genes.

April 20, 2008 3:22 pm
Aadil Sarfani on whole page :

I think the fact that such a small genetic change can have such a drastic impact on the phenotype, shows that the genome of multicellular organisms (especially humans), is much simpler than you might think. It provides evidence for microevolution.

April 20, 2008 3:26 pm
Stephen Geest on whole page :

This is a crazy event one in a million and the fact that the parents wont let anyone get near their newborn is kidda frustating but i completly understand, thats there baby, there child and they are just protecting it. but just imagine what could be learned from this situation………to much. This event brings up endless questions on how the brain functions is the child working with two brains or one how are they connected and what is the inside of this infant look like?? stephen out

April 20, 2008 8:02 pm
Stephen Geest on paragraph 1:

I agree it is amazing that this child came out without any complications. people say that there are no miracles today and what do we have hear. this is so cool in the ways of science. there is much to be learned from this child but i am curious to know what the cardia abnormalities are and how the circulatory system functions. stephen out

April 20, 2008 8:19 pm
Stephen Geest on paragraph 4:

Good question KW i wonder. i dont know. but i would think yes and i say that because yes we are very much diffrent from flies but we are also much alike.

April 20, 2008 8:21 pm
Stephen Geest on paragraph 2:

i think it said in the article that both faces of the child are fully functional but either way how do they move and what brain activity is going on up there?

April 20, 2008 8:22 pm
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