title: TBX6, LHX1 and copy number variations in the complex genetics of Müllerian aplasia.
abstract: BACKGROUND
  Müllerian aplasia (MA) is a congenital disorder of the female reproductive tract with absence of uterus and vagina with paramount impact on a woman's life. Despite intense research, no major genes have been found to explain the complex genetic etiology.
  
  
  RESULTS
  We have used several genetic methods to study 112 patients with MA. aCGH identified CNVs in 8/50 patients (16%), including 16p11.2 and 17q12 deletions previously associated with MA. Subsequently, another four patients were shown to carry the ~0.53 Mb deletion in 16p11.2. More importantly, sequencing of TBX6, residing within 16p11.2, revealed two patients carrying a splice site mutation. Two previously reported TBX6 variants in exon 4 and 6 were shown to have a significantly higher frequency in patients (8% and 5%, respectively) than in controls (2% each). We also sequenced LHX1 and found three apparently pathogenic missense variants in 5/112 patients. Altogether, we identified either CNVs or variations in TBX6 or LHX1 in 30/112 (26.8%) MA patients. CNVs were found in 12/112 (10.7%), patients, novel variants in TBX6 or LHX1 in 7/112 (6.3%), and rare variants in TBX6 in 15/112 (13.4%) patients. Furthermore, four of our patients (4/112, 3.6%) were shown to carry variants in both TBX6 and LHX1 or a CNV in combination with TBX6 variants lending support to the complex genetic etiology of MA.
  
  
  CONCLUSIONS
  We have identified TBX6 as a new gene associated with MA. Our results also support the relevance of LHX1 and CNVs in the development of this congenital malformation.
authors: Folkhälsan Institute of Genetics, Helsinki, Finland. kristiina.aittomaki@hus.fi.
authors: Maria
authors: M
authors: Sandbacka
authors: Hannele
authors: H
authors: Laivuori
authors: Érika
authors: É
authors: Freitas
authors: Mervi
authors: M
authors: Halttunen
authors: Varpu
authors: V
authors: Jokimaa
authors: Laure
authors: L
authors: Morin-Papunen
authors: Carla
authors: C
authors: Rosenberg
authors: Kristiina
authors: K
authors: Aittomäki
mesh_terms: D058489:46, XX Disorders of Sex Development / Q000235:genetics*; D000013:Congenital Abnormalities / Q000235:genetics*; D056915:DNA Copy Number Variations / Q000235:genetics*; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D060850:LIM-Homeodomain Proteins / Q000235:genetics*; D009095:Mullerian Ducts / Q000002:abnormalities*; D009154:Mutation / Q000235:genetics; D020825:T-Box Domain Proteins / Q000235:genetics*; D014157:Transcription Factors / Q000235:genetics*
chemical_list: C085473:LHX1 protein, human; D060850:LIM-Homeodomain Proteins; D020825:T-Box Domain Proteins; C491182:TBX6 protein, human; D014157:Transcription Factors
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