Saunders, Carol; Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO, United States, 64108 and University of Missouri Kansas City, School of Medicine, Kansas City, MO, United States, 64108
Lehman, Anna; Department of Medical Genetics, University of British Columbia, BC Children's Hospital and BC Women's Hospital, Vancouver, British Columbia, Canada
Pienkowski, Catherine; Centre Reference Pathologies Gynecologiques Rares, CHU Toulouse, 31059 Toulouse Cedex9, France
Morcel, Karine; Univ. Brest, Inserm, UMR1304, GETBO, F-29200 Brest, France and Department of Obstetrics and Gynecology, CHU Brest, F-29200 Brest, France
Guerrier, Daniel; Univ. Rennes, CNRS, IGDR (Institut de Génétique et Développement de Rennes) - UMR 6290, Rennes, France
Bours, Vincent ✱; Université de Liège - ULiège > Département des sciences biomédicales et précliniques ; Université de Liège - ULiège > GIGA > GIGA Cancer - Human Genetics ; Centre Hospitalier Universitaire de Liège - CHU > > Service de génétique
Peers, Bernard ✱; Université de Liège - ULiège > Département des sciences de la vie ; Université de Liège - ULiège > GIGA > GIGA Cancer - Zebrafish Development and Disease Model
✱ These authors have contributed equally to this work.
Language :
English
Title :
Variants in NR6A1 as a cause for congenital renal, vertebral and uterine anomalies
Publication date :
24 February 2026
Journal title :
Human Genetics
ISSN :
0340-6717
eISSN :
1432-1203
Publisher :
Springer, Germany
Peer reviewed :
Peer Reviewed verified by ORBi
Funders :
CHU Liège - Central University Hospital of Liege F.R.S.-FNRS - Fonds de la Recherche Scientifique Walloon region ULiège - University of Liège Leon Fredericq Foundation
Adam AP Curry CJ Hall JG et al. Recurrent constellations of embryonic malformations re-conceptualized as an overlapping group of disorders with shared pathogenesis Am J Med Genet A 2020 182 2646 2661 10.1002/ajmg.a.61847 32924308
Bertrand S Thisse B Tavares R et al. Unexpected novel relational links uncovered by extensive developmental profiling of nuclear receptor expression PLoS Genet 2007 3 e188 10.1371/journal.pgen.0030188 17997606 2065881
Bird NC Mabee PM Developmental morphology of the axial skeleton of the zebrafish, Danio rerio (Ostariophysi: Cyprinidae) Dev Dyn Off Publ Am Assoc Anat 2003 228 337 357 10.1002/dvdy.10387
Bjørsum-Meyer T Herlin M Qvist N Petersen MB Vertebral defect, anal atresia, cardiac defect, tracheoesophageal fistula/esophageal atresia, renal defect, and limb defect association with Mayer-Rokitansky-Küster-Hauser syndrome in co-occurrence: two case reports and a review of the literature J Med Case Rep 2016 10 374 10.1186/s13256-016-1127-9 28003020 5178070
Boissel S Fallet-Bianco C Chitayat D et al. Genomic study of severe fetal anomalies and discovery of GREB1L mutations in renal agenesis Genet Med Off J Am Coll Med Genet 2017 10.1038/gim.2017.173
Carapuco M Nóvoa A Bobola N Mallo M Hox genes specify vertebral types in the presomitic mesoderm Genes Dev 2005 19 2116 2121 10.1101/gad.338705 16166377 1221883
Chang Y-C Manent J Schroeder J et al. Nr6a1 controls hox expression dynamics and is a master regulator of vertebrate trunk development Nat Commun 2022 13 7766 10.1038/s41467-022-35303-4 36522318 9755267
Cheng J Novati G Pan J et al. Accurate proteome-wide missense variant effect prediction with alphamissense Science 2023 381 eadg7492 10.1126/science.adg7492 37733863
Chen JW Galloway JL The development of zebrafish tendon and ligament progenitors Dev Camb Engl 2014 141 2035 2045 10.1242/dev.104067
Chen S Francioli LC Goodrich JK et al. A genomic mutational constraint map using variation in 76,156 human genomes Nature 2024 625 92 100 10.1038/s41586-023-06045-0 38057664
Christians A Kesdiren E Hennies I et al. Heterozygous variants in the DVL2 interaction region of DACT1 cause CAKUT and features of Townes-Brocks syndrome 2 Hum Genet 2023 142 73 88 10.1007/s00439-022-02481-6 36066768
Chung AC Katz D Pereira FA et al. Loss of orphan receptor germ cell nuclear factor function results in ectopic development of the tail bud and a novel posterior truncation Mol Cell Biol 2001 21 663 677 10.1128/MCB.21.2.663-677.2001 11134352 86646
Collins RL Glessner JT Porcu E et al. A cross-disorder dosage sensitivity map of the human genome Cell 2022 185 3041 3055e25 10.1016/j.cell.2022.06.036 35917817 9742861
David R Joos TO Dreyer C Anteroposterior patterning and organogenesis of xenopus laevis require a correct dose of germ cell nuclear factor (xGCNF) Mech Dev 1998 79 137 152 10.1016/S0925-4773(98)00181-6 10349627
Drake KA Adam M Mahoney R Potter SS Disruption of Hox9,10,11 function results in cellular level lineage infidelity in the kidney Sci Rep 2018 8 6306 10.1038/s41598-018-24782-5 29679048 5910417
Ferreri F Nicolais C Boglione C Bmertoline B Skeletal characterization of wild and reared zebrafish: anomalies and meristic characters J Fish Biol 2000 56 1115 1128 10.1111/j.1095-8649.2000.tb02127.x
Fuhrmann G Chung AC Jackson KJ et al. Mouse germline restriction of Oct4 expression by germ cell nuclear factor Dev Cell 2001 1 377 387 10.1016/s1534-5807(01)00038-7 11702949
Gonzales-Portillo GS Rizvi O Avila MJ Dumont TM The prevalence of 11 ribs and its potential implications in spine surgery Clin Neurol Neurosurg 2021 203 10.1016/j.clineuro.2021.106544 33711639 106544
Greschik H Wurtz JM Hublitz P et al. Characterization of the DNA-binding and dimerization properties of the nuclear orphan receptor germ cell nuclear factor Mol Cell Biol 1999 19 690 703 10.1128/MCB.19.1.690 9858592 83926
Gu P LeMenuet D Chung AC-K et al. Orphan nuclear receptor GCNF is required for the repression of pluripotency genes during retinoic acid-induced embryonic stem cell differentiation Mol Cell Biol 2005 25 8507 8519 10.1128/MCB.25.19.8507-8519.2005 16166633 1265758
Gurtan AM Ravi A Rahl PB et al. Let-7 represses Nr6a1 and a mid-gestation developmental program in adult fibroblasts Genes Dev 2013 27 941 954 10.1101/gad.215376.113 23630078 3650230
Hall-Craggs MA Williams CE Pattison SH et al. Mayer-rokitansky-kuster-hauser syndrome: diagnosis with MR imaging Radiology 2013 269 787 792 10.1148/radiol.13130211 23942608
Hambraeus M Börjesson A Ekmark AN et al. Genital malformations in children with VACTERL - has time come to include “G” in the acronym? J Pediatr Surg 2024 10.1016/j.jpedsurg.2024.05.005 38849227
Hauptmann G Gerster T Two-color whole-mount in situ hybridization to vertebrate and Drosophila embryos Trends Genet TIG 1994 10 266 10.1016/0168-9525(90)90008-t 7940754
Hauswirth GM Garside VC Wong LSF et al. Breaking constraint of mammalian axial formulae Nat Commun 2022 13 243 10.1038/s41467-021-27335-z 35017475 8752674
Hentschke M Kurth I Borgmeyer U Hübner CA Germ cell nuclear factor is a repressor of CRIPTO-1 and CRIPTO-3 J Biol Chem 2006 281 33497 33504 10.1074/jbc.M606975200 16954206
Herlin M Højland AT Petersen MB Familial occurrence of Mayer-Rokitansky-Küster-Hauser syndrome: a case report and review of the literature Am J Med Genet A 2014 164A 2276 2286 10.1002/ajmg.a.36652 24975471
Hershkovitz R Prenatal diagnosis of isolated abnormal number of ribs Ultrasound Obstet Gynecol 2008 32 506 509 10.1002/uog.5296 18537105
Hilger A Schramm C Draaken M et al. Familial occurrence of the VATER/VACTERL association Pediatr Surg Int 2012 28 725 729 10.1007/s00383-012-3073-y 22422375
Hubert KA Wellik DM Hox genes in development and beyond Development 2023 150 10.1242/dev.192476 36645372 10216783 dev192476
Ibarra-Soria X, Thierion E, Mok GF et al (2023) A transcriptional and regulatory map of mouse somitogenesis. 2023.01.24.525253
Ioannidis NM Rothstein JH Pejaver V et al. REVEL: an ensemble method for predicting the pathogenicity of rare missense variants Am J Hum Genet 2016 99 877 885 10.1016/j.ajhg.2016.08.016 27666373 5065685
Jacquinet A Boujemla B Fasquelle C et al. GREB1L variants in familial and sporadic hereditary urogenital adysplasia and Mayer-Rokitansky-Kuster-Hauser syndrome Clin Genet 2020 98 126 137 10.1111/cge.13769 32378186
Jacquinet A Millar D Lehman A Etiologies of uterine malformations Am J Med Genet A 2016 170 2141 2172 10.1002/ajmg.a.37775 27273803
Joos TO David R Dreyer C xGCNF, a nuclear orphan receptor is expressed during neurulation in xenopus laevis Mech Dev 1996 60 45 57 10.1016/s0925-4773(96)00599-0 9025060
Kanamori A Kitani R Oota A et al. Wnt4a is indispensable for genital duct elongation but not for gonadal sex differentiation in the medaka, Oryzias latipes Zoolog Sci 2023 40 348 359 10.2108/zs230050 37818883
Kapczuk K Iwaniec K Friebe Z Kędzia W Congenital malformations and other comorbidities in 125 women with Mayer-Rokitansky-Küster-Hauser syndrome Eur J Obstet Gynecol Reprod Biol 2016 207 45 49 10.1016/j.ejogrb.2016.10.014 27825026
Köhler S Doelken SC Mungall CJ et al. The human phenotype ontology project: linking molecular biology and disease through phenotype data Nucleic Acids Res 2014 42 D966 974 10.1093/nar/gkt1026 24217912
Kircher M Witten DM Jain P et al. A general framework for estimating the relative pathogenicity of human genetic variants Nat Genet 2014 46 310 315 10.1038/ng.2892 24487276 3992975
Kmita M van Der Hoeven F Zákány J et al. Mechanisms of Hox gene colinearity: transposition of the anterior Hoxb1 gene into the posterior HoxD complex Genes Dev 2000 14 198 211 10.1101/gad.14.2.198 10652274 316340
Kossack ME High SK Hopton RE et al. Female sex development and reproductive duct formation depend on Wnt4a in zebrafish Genetics 2019 211 219 233 10.1534/genetics.118.301620 30446521
Laurichesse Delmas H Kohler M Doray B et al. Congenital unilateral renal agenesis: prevalence, prenatal diagnosis, associated anomalies. Data from two birth-defect registries Birth Defects Res 2017 109 1204 1211 10.1002/bdr2.1065 28722320
Li G Strong A Wang H et al. TBX6 as a cause of a combined skeletal-kidney dysplasia syndrome Am J Med Genet A 2022 188 3469 3481 10.1002/ajmg.a.62972 36161696 10473889
Ma C Chen N Jolly A et al. Functional characteristics of a broad spectrum of TBX6 variants in Mayer-Rokitansky-Küster-Hauser syndrome Genet Med 2022 24 2262 2273 10.1016/j.gim.2022.08.012 36112137
McCampbell KK, Springer KN, Wingert RA (2014) Analysis of nephron composition and function in the adult zebrafish kidney. J Vis Exp JoVE E 51644. https://doi.org/10.3791/51644
Mercader N Fischer S Neumann CJ Prdm1 acts downstream of a sequential RA, Wnt and Fgf signaling cascade during zebrafish forelimb induction Dev Camb Engl 2006 133 2805 2815 10.1242/dev.02455
Milo Rasouly H, Krishna Murthy SB, Vena N, et al (2025) Exome analysis links kidney malformations to developmental disorders and reveals causal genes. Nat Commun 16:7290. https://doi.org/10.1038/s41467-025-62319-3
Neelathi UM, Ullah E, George A et al (2025) Variants in NR6A1 cause a novel oculovertebralrenal syndrome. Nat Commun 16:6111. https://doi.org/10.1038/s41467-025-60574-y
Okumura LM Lesch BJ Page DC The ligand binding domain of GCNF is not required for repression of pluripotency genes in mouse fetal ovarian germ cells PLoS One 2013 8 e66062 10.1371/journal.pone.0066062 23762465 3676325
Pijuan-Sala B Griffiths JA Guibentif C et al. A single-cell molecular map of mouse gastrulation and early organogenesis Nature 2019 566 490 495 10.1038/s41586-019-0933-9 30787436 6522369
Purkiss SB, Driscoll B, Cole WG, Alman B (2002) Idiopathic scoliosis in families of children with congenital scoliosis. Clin Orthop 27–31. https://doi.org/10.1097/00003086-200208000-00005
Rai AS Taylor TKF Smith GHH et al. Congenital abnormalities of the urogenital tract in association with congenital vertebral malformations J Bone Joint Surg Br 2002 84 891 895 10.1302/0301-620x.84b6.11814 12211685
Raines AM Adam M Magella B et al. Recombineering-based dissection of flanking and paralogous Hox gene functions in mouse reproductive tracts Development 2013 140 2942 2952 10.1242/dev.092569 23760953 3699281
Rall K Eisenbeis S Henninger V et al. Typical and atypical associated findings in a group of 346 patients with Mayer-Rokitansky-Kuester-Hauser syndrome J Pediatr Adolesc Gynecol 2015 28 362 368 10.1016/j.jpag.2014.07.019 26148785
Saunders CJ Miller NA Soden SE et al. Rapid whole-genome sequencing for genetic disease diagnosis in neonatal intensive care units Sci Transl Med 2012 4 10.1126/scitranslmed.3004041 23035047 154ra135
Sobreira N Schiettecatte F Valle D Hamosh A GeneMatcher: a matching tool for connecting investigators with an interest in the same gene Hum Mutat 2015 36 928 930 10.1002/humu.22844 26220891 4833888
Soden SE Saunders CJ Willig LK et al. Effectiveness of exome and genome sequencing guided by acuity of illness for diagnosis of neurodevelopmental disorders Sci Transl Med 2014 6 10.1126/scitranslmed.3010076 25473036 265ra168
Solomon BD Pineda-Alvarez DE Raam MS Cummings DAT Evidence for inheritance in patients with VACTERL association Hum Genet 2010 127 731 733 10.1007/s00439-010-0814-7 20369369 2871973
Sordino P Duboule D Kondo T Zebrafish hoxa and Evx-2 genes: cloning, developmental expression and implications for the functional evolution of posterior hox genes Mech Dev 1996 59 165 175 10.1016/0925-4773(96)00587-4 8951794
Stevens SJC Stumpel CTRM Diderich KEM et al. The broader phenotypic spectrum of congenital caudal abnormalities associated with mutations in the caudal type homeobox 2 gene Clin Genet 2022 101 183 189 10.1111/cge.14076 34671974
Suman Gök E Ayvacı A Ağbaş A et al. The frequency of familial congenital anomalies of the kidney and urinary tract: should we screen asymptomatic first-degree relatives using urinary tract ultrasonography? Nephron 2020 144 170 175 10.1159/000505402 31910412
Suzuki A Shibata N Developmental process of genital ducts in the medaka, Oryzias latipes Zoolog Sci 2004 21 397 406 10.2108/zsj.21.397 15118227
Taylor HS Vanden Heuvel GB Igarashi P A conserved hox axis in the mouse and human female reproductive system: late establishment and persistent adult expression of the hoxa cluster genes Biol Reprod 1997 57 1338 1345 10.1095/biolreprod57.6.1338 9408238
Thaëron C Avaron F Casane D et al. Zebrafish evx1 is dynamically expressed during embryogenesis in subsets of interneurones, posterior gut and urogenital system Mech Dev 2000 99 167 172 10.1016/s0925-4773(00)00473-1 11091087
Thiem CE Stegmann JD Hilger AC et al. Re-sequencing of candidate genes FOXF1, HSPA6, HAAO, and KYNU in 522 individuals with VATER/VACTERL, VACTER/VACTERL-like association, and isolated anorectal malformation Birth Defects Res 2022 114 478 486 10.1002/bdr2.2008 35362267
Thisse C Thisse B High-resolution in situ hybridization to whole-mount zebrafish embryos Nat Protoc 2008 3 59 69 10.1038/nprot.2007.514 18193022
van der Hoeven F Sordino P Fraudeau N et al. Teleost HoxD and HoxA genes: comparison with tetrapods and functional evolution of the HOXD complex Mech Dev 1996 54 9 21 10.1016/0925-4773(95)00455-6 8808402
van der Ven AT Vivante A Hildebrandt F Novel insights into the pathogenesis of monogenic congenital anomalies of the kidney and urinary tract J Am Soc Nephrol 2018 29 36 50 10.1681/ASN.2017050561 29079659
van de Ven C Bialecka M Neijts R et al. Concerted involvement of Cdx/Hox genes and Wnt signaling in morphogenesis of the caudal neural tube and cloacal derivatives from the posterior growth zone Development 2011 138 3451 3462 10.1242/dev.066118 21752936
Warot X Fromental-Ramain C Fraulob V et al. Gene dosage-dependent effects of the Hoxa-13 and Hoxd-13 mutations on morphogenesis of the terminal parts of the digestive and urogenital tracts Development 1997 124 4781 4791 10.1242/dev.124.23.4781 9428414
Wellik DM Hawkes PJ Capecchi MR Hox11 paralogous genes are essential for metanephric kidney induction Genes Dev 2002 16 1423 1432 10.1101/gad.993302 12050119 186320
Wingert RA Selleck R Yu J et al. The Cdx genes and retinoic acid control the positioning and segmentation of the zebrafish pronephros PLoS Genet 2007 3 1922 1938 10.1371/journal.pgen.0030189 17953490 2042002
Wurtz JM Bourguet W Renaud JP et al. A canonical structure for the ligand-binding domain of nuclear receptors Nat Struct Biol 1996 3 206 10.1038/nsb0296-206 8564548
Yan Y-Z Li Q-P Wu C-C et al. Rate of presence of 11 thoracic vertebrae and 6 lumbar vertebrae in asymptomatic Chinese adult volunteers J Orthop Surg Res 2018 13 10.1186/s13018-018-0835-9 29792213 5966918 124
Yan ZH Medvedev A Hirose T et al. Characterization of the response element and DNA binding properties of the nuclear orphan receptor germ cell nuclear factor/retinoid receptor-related testis-associated receptor J Biol Chem 1997 272 10565 10572 10.1074/jbc.272.16.10565 9099702
Yan Z Jetten AM Characterization of the repressor function of the nuclear orphan receptor retinoid receptor-related testis-associated receptor/germ cell nuclear factor J Biol Chem 2000 275 35077 35085 10.1074/jbc.M005566200 10940306
Young T Rowland JE van de Ven C et al. Cdx and Hox genes differentially regulate posterior axial growth in mammalian embryos Dev Cell 2009 17 516 526 10.1016/j.devcel.2009.08.010 19853565
Zhao Y Potter SS Functional specificity of the Hoxa13 homeobox Dev Camb Engl 2001 128 3197 3207 10.1242/dev.128.16.3197