De novo mutations in inhibitors of Wnt, BMP, and Ras/ERK signaling pathways in non-syndromic midline craniosynostosis

Yale Center for Genome Analysis

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76 Citations (Scopus)


Non-syndromic craniosynostosis (NSC) is a frequent congenital malformation in which one or more cranial sutures fuse prematurely. Mutations causing rare syndromic craniosynostoses in humans and engineered mouse models commonly increase signaling of the Wnt, bone morphogenetic protein (BMP), or Ras/ERK pathways, converging on shared nuclear targets that promote bone formation. In contrast, the genetics of NSC is largely unexplored. More than 95% of NSC is sporadic, suggesting a role for de novo mutations. Exome sequencing of 291 parent–offspring trios with midline NSC revealed 15 probands with heterozygous damaging de novo mutations in 12 negative regulators of Wnt, BMP, and Ras/ERK signaling (10.9-fold enrichment, P = 2.4 × 10−11). SMAD6 had 4 de novo and 14 transmitted mutations; no other gene had more than 1. Four familial NSC kindreds had mutations in genes previously implicated in syndromic disease. Collectively, these mutations contribute to 10% of probands. Mutations are predominantly loss-of-function, implicating haploinsufficiency as a frequent mechanism. A common risk variant near BMP2 increased the penetrance of SMAD6 mutations and was overtransmitted to patients with de novo mutations in other genes in these pathways, supporting a frequent two-locus pathogenesis. These findings implicate new genes in NSC and demonstrate related pathophysiology of common non-syndromic and rare syndromic craniosynostoses. These findings have implications for diagnosis, risk of recurrence, and risk of adverse neurodevelopmental outcomes. Finally, the use of pathways identified in rare syndromic disease to find genes accounting for non-syndromic cases may prove broadly relevant to understanding other congenital disorders featuring high locus heterogeneity.

Original languageEnglish
Pages (from-to)E7341-E7347
JournalProceedings of the National Academy of Sciences of the United States of America
Issue number35
Publication statusPublished - 2017 Aug 29
Externally publishedYes

Bibliographical note

Funding Information:
ACKNOWLEDGMENTS. This project was supported by the Yale Center for Mendelian Genomics (NIH Grant M#UM1HG006504-05), the NIH Medical Scientist Training Program (NIH/National Institute of General Medical Sciences Grant T32GM007205), and the Howard Hughes Medical Institute.

Publisher Copyright:
© 2017, National Academy of Sciences. All rights reserved.


  • BMP signaling
  • Craniosynostosis
  • De novo mutation
  • Ras/ERK signaling
  • Wnt signaling

ASJC Scopus subject areas

  • General


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