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Human Molecular Genetics, 2001, Vol. 10, No. 15 1591-1600
© 2001 Oxford University Press

Spectrum of FOXL2 gene mutations in blepharophimosis-ptosis-epicanthus inversus (BPES) families demonstrates a genotype–phenotype correlation

Elfride De Baere1,2, Michael J. Dixon3, Kent W. Small4, Ethylin W. Jabs5, Bart P. Leroy2, Koenraad Devriendt6, Yves Gillerot7, Geert Mortier1, Françoise Meire2, Lionel Van Maldergem7, Winnie Courtens8, Helle Hjalgrim9, Shangzhi Huang10, Inge Liebaers11, Nicole Van Regemorter12, Philippe Touraine13, Verayuth Praphanphoj5, Alain Verloes14, Nitin Udar4, Vivek Yellore4, Meenal Chalukya4, Svetlana Yelchits4, Anne De Paepe1, Frédérique Kuttenn13, Marc Fellous15, Reiner Veitia15 and Ludwine Messiaen1,+

1Department of Medical Genetics and 2Department of Ophthalmology, Ghent University Hospital, B-9000 Ghent, Belgium, 3School of Biological Sciences, Stopford Building, University of Manchester, Manchester, UK, 4The Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, CA 90095, USA, 5Institute of Genetic Medicine, Department of Pediatrics, Department of Medicine and Department of Plastic Surgery, The Johns Hopkins University School of Medicine, Baltimore, USA, 6Centre for Human Genetics, B-3000 Leuven, Belgium, 7Centre de Génétique Humaine, Institut de Pathologie et de Génétique, B-6280 Gerpinnes (Loverval), Belgium, 8Universitair Verplegingscentrum Brugmann-UKZKF, Brussels, Belgium, 9The John F. Kennedy Institute, Glostrup, Denmark, 10WHO Collaborating Center for Community Control of Inherited Diseases, Department of Medical Genetics, Peking Union Medical College, Beijing 100005, China, 11Department of Medical Genetics, University Hospital, Free University of Brussels, Belgium, 12Centre de Génétique, Hôpital Erasme, ULB, Brussels, Belgium, 13Department of Endocrinology and Reproductive Medicine, Hôpital Necker, Paris, France, 14Wallonia Center for Human Genetics, Liège University, Liège, Belgium and 15Immunogénétique Humaine, Institut Pasteur, Université Denis Didérot, Paris, France

Mutations in FOXL2, a forkhead transcription factor gene, have recently been shown to cause blepharophimosis-ptosis-epicanthus inversus syndrome (BPES) types I and II, a rare genetic disorder. In BPES type I a complex eyelid malformation is associated with premature ovarian failure (POF), whereas in BPES type II the eyelid defect occurs as an isolated entity. In this study, we describe the identification of novel mutations in the FOXL2 gene in BPES types I and II families, in sporadic BPES patients, and in BPES families where the type could not be established. In 67% of the patients studied, we identified a mutation in the FOXL2 gene. In total, 21 mutations (17 of which are novel) and one microdeletion were identified. Thirteen of these FOXL2 mutations are unique. In this study, we demonstrate that there is a genotype–phenotype correlation for either types of BPES by the finding that mutations predicted to result in a truncated protein either lacking or containing the forkhead domain lead to BPES type I. In contrast, duplications within or downstream of the forkhead domain, and a frameshift downstream of them, all predicted to result in an extended protein, cause BPES type II. In addition, in 30 unrelated patients with isolated POF no causal mutations were identified in FOXL2. Our study provides further evidence that FOXL2 haploinsufficiency may cause BPES types I and II by the effect of a null allele and a hypomorphic allele, respectively. Furthermore, we propose that in a fraction of the BPES patients the genetic defect does not reside within the coding region of the FOXL2 gene and may be caused by a position effect.

+ To whom correspondence should be addressed at: Department of Medical Genetics, Ghent University Hospital-OK5, De Pintelaan 185, B- 9000 Ghent, Belgium. Tel: +32 9 240 3603; Fax: +32 9 240 4970; Email: Ludwine.Messiaen@rug.ac.be


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