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Human Molecular Genetics Advance Access originally published online on March 16, 2006
Human Molecular Genetics 2006 15(9):1413-1422; doi:10.1093/hmg/ddl064
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© The Author 2006. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Mutations in SOX2 cause anophthalmia-esophageal-genital (AEG) syndrome

Kathleen A. Williamson1, Ann M. Hever1, Joe Rainger1, R. Curtis Rogers4, Alex Magee2, Zdenek Fiedler3, Wee Teik Keng1, Freddie H. Sharkey1, Niolette McGill1, Clare J. Hill5, Adele Schneider6, Mario Messina7, Peter D. Turnpenny8, Judy A. Fantes1, Veronica van Heyningen1 and David R. FitzPatrick1,*

1Medical Genetics Section, MRC Human Genetics Unit, Western General Hospital, Edinburgh EH4 2XU, UK, 2Regional Genetics Service A Floor, Belfast City Hospital, Lisburn Road, Belfast BT9 7AB, UK, 3Department of Biological and Biochemical Sciences, University Pardubice, Czech Republic, 4Greenwood Genetic Center, 1 Gregor Mendel Circle, Greenwood, South Carolina 29646, USA, 5Institute of Medical Genetics, University Hospital of Wales, Cardiff CF14 4XW, UK, 6Department of Clinical Genetics, Albert Einstein Medical Center, Philadelphia, PA, USA, 7Section of Pediatric Surgery, Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Italy and 8Institute of Biomedical and Clinical Science, Peninsula Medical School, Exeter, UK

* To whom correspondence should be addressed. Tel: +44 1313322471; Fax: +44 1314678456; Email: david.fitzpatrick{at}hgu.mrc.ac.uk

Received December 23, 2005; Accepted March 10, 2006

We report heterozygous, loss-of-function SOX2 mutations in three unrelated individuals with Anophthalmia-Esophageal-Genital (AEG) syndrome. One previously reported case [Rogers, R.C. (1988) Unknown cases. Proceedings of the Greenwood Genetic Center. 7, 57.] has a 2.7 Mb deletion encompassing SOX2 and associated with a cryptic translocation t(3;7)(q28;p21.3). The deletion and translocation breakpoints on chromosome 3q are >8.6 Mb apart and both chromosome rearrangements have occurred de novo. Another published case [Petrackova et al. (2004) Association of oesophageal atresia, anophthalmia and renal duplex. Eur. J. Pediatr., 163, 333–334.] has a de novo nonsense mutation, Q55X. A previously unreported case with severe bilateral microphthalmia and oesophageal atresia has a de novo missense mutation, R74P, that alters a highly evolutionarily conserved residue within the high mobility group domain, which is critical for DNA-binding of SOX2. In a yeast one-hybrid assay, this mutation abolishes Sox2-induced activation of the chick delta-crystallin DC5 enhancer. Four other reported AEG syndrome cases were extensively screened and do not have detectable SOX2 mutations. Two of these cases have unilateral eye malformations. SOX2 mutations are known to cause severe bilateral eye malformations but this is the first report implicating loss of function mutations in this transcription factor in oesophageal malformations. SOX2 is expressed in the developing foregut in mouse and zebrafish embryos and an apparently normal pattern of expression is maintained in Shh–/– mouse embryos, suggesting either that Sox2 acts upstream of Shh or functions in a different pathway. Three-dimensional reconstructions of the major morphological events in the developing foregut and eye from Carnegie Stages 12 and 13 human embryos are presented and compared with the data from model organisms. SOX2, with NMYC and CHD7, is now the third transcriptional regulator known to be critical for normal oesophageal development in humans.


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