NKX2-5

protein-coding

NK2 homeobox 5, the group of NKL subclass homeoboxes and pseudogenes

Gene summary

This gene encodes a homeobox-containing transcription factor. This transcription factor functions in heart formation and development. Mutations in this gene cause atrial septal defect with atrioventricular conduction defect, and also tetralogy of Fallot, which are both heart malformation diseases. Mutations in this gene can also cause congenital hypothyroidism non-goitrous type 5, a non-autoimmune condition. Alternative splicing results in multiple transcript variants. [provided by RefSeq, Oct 2009]

Previous symbols:
  • CSX
  • NKX2E

MANE transcript

NM_004387.4

Inheritance

AD, SD

ClinVar variants

P:138U:367B:261

Top phenotype

Atrial septal defect 7, with or without AV conduction defects; Conotruncal heart malformations; Hypothyroidism, congenital nongoitrous, 5; Hypoplastic left heart syndrome 2; Ventricular septal defect 3; Conotruncal heart malformations, variable; Tetralogy of Fallot

gnomAD constraint

pLI —, LoF o/e 0

Max pathogenic AF

—

Genomic locus

chr5:173,232,109-173,235,311

External References & Databases

Transcript & Mutation Effects

hg38 • Region Span ~3.2 kb
Loading mutation effect viewer...

GenCC Phenotypes & Disease Associations

Curated gene-disease validity assertions and inheritance patterns

NKX2.5-related congenital, conduction and myopathic heart diseaseSTRONG

Inheritance Pattern: AD

Disease ID:MONDO:0800441

Submitter: PanelApp Australia

atrial septal defect 7STRONG

Inheritance Pattern: AD

Disease ID:MONDO:0007173

Submitter: Labcorp Genetics (formerly Invitae)

conotruncal heart malformationsDEFINITIVE

Inheritance Pattern: SD

Disease ID:MONDO:0016581

Submitter: Ambry Genetics

hypothyroidism, congenital, nongoitrous, 5MODERATE

Inheritance Pattern: AD

Disease ID:MONDO:0009154

Submitter: Ambry Genetics

conotruncal heart malformationsSTRONG

Inheritance Pattern: AD

Disease ID:MONDO:0016581

Submitter: Labcorp Genetics (formerly Invitae)

atrial septal defect 7STRONG

Inheritance Pattern: AD

Disease ID:MONDO:0007173

Submitter: Laboratory for Molecular Medicine

This gene-disease relationship has undergone rapid assessment. Classifications are based on preliminary review of gene-disease validity during analysis of genomic sequencing results.

atrial septal defect 7STRONG

Inheritance Pattern: AD

Disease ID:MONDO:0007173

Submitter: Ambry Genetics

hypothyroidism, congenital, nongoitrous, 5LIMITED

Inheritance Pattern: Unknown

Disease ID:MONDO:0009154

Submitter: Labcorp Genetics (formerly Invitae)

NKX2.5-related congenital, conduction and myopathic heart diseaseDEFINITIVE

Inheritance Pattern: AD

Disease ID:MONDO:0800441

Submitter: ClinGen

*NKX2.5* was first reported in relation to autosomal dominant NKX2.5-related congenital, conduction and myopathic heart disease in 1998 (Schott et al., PMID:9651244) including congenital heart disease entities: Atrial septal defect 7, with or without AV conduction defects (OMIM:108900), Conotruncal heart malformations, variable (OMIM:217095), Hypoplastic left heart syndrome 2 (OMIM:614435), Tetralogy of Fallot (OMIM:187500), Ventricular septal defect 3 (OMIM:614432). Since then, more than 26 unique variants (missense, nonsense, frameshift, deletions) across 18 papers have reported cases of a similar phenotype including congenital heart disease (predominantly ASD), AV block and later onset dilated cardiomyopathy and/or hypertrabeculation with predisposition to atrial and ventricular arrhythmias (PMIDs 38670870, 36609421, 34277740, 33082984, 31654754, 30471092, 30479953, 30354339, 28690296, 26679770, 27855642, 25503402, 24880466, 23661673, 20456451, 15810002, 14607454, 10587520 ). Per criteria outlined by the ClinGen Lumping and Splitting Working Group, we found no difference in molecular mechanisms or inheritance pattern and these phenotypes have been lumped. Phenotype is variable within families and individuals may have only some of these features. Variants causing this phenotype appear to be either truncating or missense within the homeodomain. The relevance of non-truncating variants outside of the homeodomain is unclear. This gene-disease relationship is supported by three mouse models, functional alteration data, and protein interaction data (PMIDs: 28352650, 18689573, 7628699, 26146939, 27154817). In summary, *NKX2.5* is definitively associated with autosomal dominant NKX2.5-related congenital, conduction and myopathic heart disease. This has been repeatedly demonstrated in both the research and clinical diagnostic settings and has been upheld over time. This classification was approved by the ClinGen Congenital Heart Disease GCEP on the meeting date 3/7/2023 (SOP Version 9), and the summary was updated by the ClinGen Hereditary Cardiovascular Disease GCEP after meeting on 11/7/2024 to expand detail on the cardiomyopathy and arrhythmia aspects of the phenotype. .

atrial septal defect 7STRONG

Inheritance Pattern: AD

Disease ID:MONDO:0007173

Submitter: Genomics England PanelApp

familial bicuspid aortic valveSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0007194

Submitter: Orphanet

atrial septal defect 7SUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0007173

Submitter: Orphanet

familial atrial fibrillationSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0018054

Submitter: Orphanet

familial isolated congenital aspleniaSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0010066

Submitter: Orphanet

familial dilated cardiomyopathyLIMITED

Inheritance Pattern: AD

Disease ID:MONDO:0016333

Submitter: G2P

tetralogy of fallotDEFINITIVE

Inheritance Pattern: AD

Disease ID:MONDO:0008542

Submitter: G2P

hypothyroidism, congenital, nongoitrous, 5DEFINITIVE

Inheritance Pattern: AD

Disease ID:MONDO:0009154

Submitter: G2P

athyreosisSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0019855

Submitter: Orphanet

atrial septal defect 7DEFINITIVE

Inheritance Pattern: AD

Disease ID:MONDO:0007173

Submitter: G2P

Clinical Genomic Database (CGD)

Atrial septal defect 7, with or without AV conduction defects; Conotruncal heart malformations; Hypothyroidism, congenital nongoitrous, 5; Hypoplastic left heart syndrome 2; Ventricular septal defect 3; Conotruncal heart malformations, variable; Tetralogy of FallotAD

Manifestation: Cardiovascular; Endocrine

Intervention: Cardiovascular; Endocrine

Rationale: Individuals may have arrhythmias as well as congenital cardiac malformations (and can have arrhthymias without obvious structural cardiac malformations), and surveillance and treatment may be beneficial; In Hypothyroidism, congenital nongoitrous, medical treatment for thyroid insufficiency may be effective, and individuals may also be at risk for cardiac anomalies

Refs: 1260978; 9651244; 10587520; 11714651; 12414819; 14607454; 15810002; 16418214; 16896344; 20659440; 21110066; 19948535; 20456451; 21637914Source: CGD (NHGRI)

ClinVar Associated Diseases & Phenotypes

Reported disease conditions connected to NKX2-5 variants in ClinVar

33 Conditions Cataloged
Atrial septal defect 7Total: 550
Cardiovascular phenotypeTotal: 360
not providedTotal: 185
not specifiedTotal: 81
NKX2-5-related disorderTotal: 76
Tetralogy of FallotTotal: 51
Ventricular septal defect 3Total: 48
Hypoplastic left heart syndrome 2Total: 45

ClinVar Variants & Pathogenicity by Type

Statistics based on transcript NM_004387.4. Only rare variants are included.

We include only reliable ClinVar variants with their consequences to MANE Select, MANE Plus Clinical transcripts, or transcripts with TSL equal to 1. Click a count to filter the variants table below.

Slight differences between displayed counts and ClinVar may occur due to a different transcript/consequence chosen by our variant effect predictor, or because we classify Benign/Likely benign as Likely benign and Pathogenic/Likely pathogenic as Likely pathogenic.

EffectPLPVUSLBBSum
synonymous
1
clinvar
214
clinvar
3
clinvar
218
missense
15
clinvar
16
clinvar
357
clinvar
42
clinvar
2
clinvar
432
nonsense
18
clinvar
10
clinvar
3
clinvar
31
start loss
1
clinvar
1
clinvar
2
frameshift
51
clinvar
22
clinvar
5
clinvar
78
splice donor/acceptor (+/-2bp)
4
clinvar
1
clinvar
5
Total89493672565766

Highest pathogenic variant AF is 0.000009132336

Loading ClinVar variants...

Transcript Catalog

Annotated transcript isoforms across RefSeq and Ensembl databases

Showing 4 of 16 transcripts
Transcript IDSourceProtein IDCoding ExonsMANE Status
NM_004387.4RefSeqNP_004378.12MANE Select
ENST00000329198.5EnsemblENSP00000327758.42MANE Select
NM_001166175.2RefSeqNP_001159647.12Standard
NM_001166176.2RefSeqNP_001159648.12Standard

Model Organisms & Knockout Phenotypes

Observed phenotypic effects in mouse and zebrafish models

Gene / ModelOrganismObserved Phenotype
nkx2.5Danio rerio

Structure: cardiac muscle myoblast

Quality: disrupted

abnormal

Gene Ontology (GO) Annotations & Pathways

Biological processes, molecular functions, cellular components and pathways

Pathways ConsensusPathDB

  • Heart Development
  • SRF and miRs in Smooth Muscle Differentiation and Proliferation
  • Cardiac Progenitor Differentiation
  • hop pathway in cardiac development
  • alk in cardiac myocytes

Biological Process

  • negative regulation of transcription by RNA polymerase II
  • vasculogenesis
  • heart looping
  • heart morphogenesis
  • outflow tract septum morphogenesis

Molecular Function

  • RNA polymerase II proximal promoter sequence-specific DNA binding
  • DNA-binding transcription factor activity, RNA polymerase II-specific
  • DNA-binding transcription activator activity, RNA polymerase II-specific
  • DNA binding
  • chromatin binding

Cellular Component

  • nucleus
  • transcription factor complex
  • cytoplasm
  • protein-containing complex
  • protein-DNA complex

gnomAD Constraint

Source: gnomAD

Gene type
protein_coding
Transcript type
protein_coding
Transcript
ENST00000329198
Coding exons
2
Length
3249
Individuals with no LoFs
125234
Homozygous LoFs
0
Heterozygous LoFs
13
Defined
125247
p
0.0000519
Z-ScoreObservedExpectedObserved/ExpectedMutation RateTotal Possible
Missense0.1991781860.9590.000008601991
Missense (PolyPhen)5470.8720.76193747
Synonymous-0.01599089.81.000.00000438728
Loss of Function2.8109.180.003.93e-7108

Population LoF Frequency

PopulationCAFp-valueStatus
African00.0absent
Latino/Admixed American0.000350.00035rare
Ashkenazi Jewish00.0absent
East Asian00.0absent
Finnish00.0absent
European (Non-Finnish)0.0000190.0000089rare
South Asian00.0absent
Other00.0absent

dbNSFP Gene Annotations

Source: dbNSFP

Function
FUNCTION: Implicated in commitment to and/or differentiation of the myocardial lineage. Acts as a transcriptional activator of ANF in cooperation with GATA4 (By similarity). Binds to the core DNA motif of NPPA promoter (PubMed:22849347, PubMed:26926761). It is transcriptionally controlled by PBX1 and acts as a transcriptional repressor of CDKN2B (By similarity). It is required for spleen development. {ECO:0000250|UniProtKB:P42582, ECO:0000269|PubMed:22560297, ECO:0000269|PubMed:22849347, ECO:0000269|PubMed:26926761}.;
Disease
DISEASE: Atrial septal defect 7, with or without atrioventricular conduction defects (ASD7) [MIM:108900]: A congenital heart malformation characterized by incomplete closure of the wall between the atria resulting in blood flow from the left to the right atria, and atrioventricular conduction defects in some cases. {ECO:0000269|PubMed:10587520, ECO:0000269|PubMed:14607454, ECO:0000269|PubMed:15342699, ECO:0000269|PubMed:15810002, ECO:0000269|PubMed:9651244}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Tetralogy of Fallot (TOF) [MIM:187500]: A congenital heart anomaly which consists of pulmonary stenosis, ventricular septal defect, dextroposition of the aorta (aorta is on the right side instead of the left) and hypertrophy of the right ventricle. In this condition, blood from both ventricles (oxygen-rich and oxygen-poor) is pumped into the body often causing cyanosis. {ECO:0000269|PubMed:10587520, ECO:0000269|PubMed:11714651, ECO:0000269|PubMed:14607454}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Conotruncal heart malformations (CTHM) [MIM:217095]: A group of congenital heart defects involving the outflow tracts. Examples include truncus arteriosus communis, double-outlet right ventricle and transposition of great arteries. Truncus arteriosus communis is characterized by a single outflow tract instead of a separate aorta and pulmonary artery. In transposition of the great arteries, the aorta arises from the right ventricle and the pulmonary artery from the left ventricle. In double outlet of the right ventricle, both the pulmonary artery and aorta arise from the right ventricle. {ECO:0000269|PubMed:14607454, ECO:0000269|PubMed:17891434}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Hypothyroidism, congenital, non-goitrous, 5 (CHNG5) [MIM:225250]: A non-autoimmune condition characterized by resistance to thyroid-stimulating hormone (TSH) leading to increased levels of plasma TSH and low levels of thyroid hormone. CHNG5 presents variable severity depending on the completeness of the defect. Most patients are euthyroid and asymptomatic, with a normal sized thyroid gland. Only a subset of patients develop hypothyroidism and present a hypoplastic thyroid gland. {ECO:0000269|PubMed:16418214}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Ventricular septal defect 3 (VSD3) [MIM:614432]: A common form of congenital cardiovascular anomaly that may occur alone or in combination with other cardiac malformations. It can affect any portion of the ventricular septum, resulting in abnormal communications between the two lower chambers of the heart. Classification is based on location of the communication, such as perimembranous, inlet, outlet (infundibular), central muscular, marginal muscular, or apical muscular defect. Large defects that go unrepaired may give rise to cardiac enlargement, congestive heart failure, pulmonary hypertension, Eisenmenger's syndrome, delayed fetal brain development, arrhythmias, and even sudden cardiac death. {ECO:0000269|PubMed:21110066, ECO:0000269|PubMed:21165553}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Hypoplastic left heart syndrome 2 (HLHS2) [MIM:614435]: A syndrome due to defective development of the aorta proximal to the entrance of the ductus arteriosus, and hypoplasia of the left ventricle and mitral valve. As a result of the abnormal circulation, the ductus arteriosus and foramen ovale are patent and the right atrium, right ventricle, and pulmonary artery are enlarged. {ECO:0000269|PubMed:14607454, ECO:0000269|PubMed:15810002}. Note=The disease is caused by mutations affecting the gene represented in this entry.;

Recessive Scores

pRec
0.479

Intolerance Scores

LoFtool
0.0374
RVIS EVS
-0.1
RVIS percentile EVS
46.49

Essentials

Essential (CRISPR)
N
Essential (CRISPR2)
N
Essential (gene trap)
N
Indispensability pred.
E
Indispensability score
0.940

Gene Damage Prediction

AllRecessiveDominant
MendelianMediumMediumMedium
Primary ImmunodeficiencyMediumMediumMedium
CancerMediumMediumMedium
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