NKX2-5
protein-codingNK2 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]
- CSX
- NKX2E
MANE transcript
Inheritance
ClinVar variants
Top phenotype
gnomAD constraint
Max pathogenic AF
Genomic locus
External References & Databases
Transcript & Mutation Effects
hg38 • Region Span ~3.2 kbGenCC Phenotypes & Disease Associations
Curated gene-disease validity assertions and inheritance patterns
Inheritance Pattern: AD
Disease ID:MONDO:0800441
Submitter: PanelApp Australia
Inheritance Pattern: AD
Disease ID:MONDO:0007173
Submitter: Labcorp Genetics (formerly Invitae)
Inheritance Pattern: SD
Disease ID:MONDO:0016581
Submitter: Ambry Genetics
Inheritance Pattern: AD
Disease ID:MONDO:0009154
Submitter: Ambry Genetics
Inheritance Pattern: AD
Disease ID:MONDO:0016581
Submitter: Labcorp Genetics (formerly Invitae)
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.
Inheritance Pattern: AD
Disease ID:MONDO:0007173
Submitter: Ambry Genetics
Inheritance Pattern: Unknown
Disease ID:MONDO:0009154
Submitter: Labcorp Genetics (formerly Invitae)
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. .
Inheritance Pattern: AD
Disease ID:MONDO:0007173
Submitter: Genomics England PanelApp
Inheritance Pattern: AD
Disease ID:MONDO:0007194
Submitter: Orphanet
Inheritance Pattern: AD
Disease ID:MONDO:0007173
Submitter: Orphanet
Inheritance Pattern: AD
Disease ID:MONDO:0018054
Submitter: Orphanet
Inheritance Pattern: AD
Disease ID:MONDO:0010066
Submitter: Orphanet
Inheritance Pattern: AD
Disease ID:MONDO:0016333
Submitter: G2P
Inheritance Pattern: AD
Disease ID:MONDO:0008542
Submitter: G2P
Inheritance Pattern: AD
Disease ID:MONDO:0009154
Submitter: G2P
Inheritance Pattern: AD
Disease ID:MONDO:0019855
Submitter: Orphanet
Inheritance Pattern: AD
Disease ID:MONDO:0007173
Submitter: G2P
Clinical Genomic Database (CGD)
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
ClinVar Associated Diseases & Phenotypes
Reported disease conditions connected to NKX2-5 variants in ClinVar
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.
| Effect | PathogenicP | Likely pathogenicLP | VUS | Likely benignLB | BenignB | Sum |
|---|---|---|---|---|---|---|
| synonymous | 1 | 214 | 3 | 218 | ||
| missense | 15 | 16 | 357 | 42 | 2 | 432 |
| nonsense | 18 | 10 | 3 | 31 | ||
| start loss | 1 | 1 | 2 | |||
| frameshift | 51 | 22 | 5 | 78 | ||
| splice donor/acceptor (+/-2bp) | 4 | 1 | 5 | |||
| Total | 89 | 49 | 367 | 256 | 5 | 766 |
Highest pathogenic variant AF is 0.000009132336
Transcript Catalog
Annotated transcript isoforms across RefSeq and Ensembl databases
| Transcript ID | Source | Protein ID | Coding Exons | MANE Status |
|---|---|---|---|---|
| RefSeq | NP_004378.1 | 2 | MANE Select | |
| Ensembl | ENSP00000327758.4 | 2 | MANE Select | |
| RefSeq | NP_001159647.1 | 2 | Standard | |
| RefSeq | NP_001159648.1 | 2 | Standard |
Model Organisms & Knockout Phenotypes
Observed phenotypic effects in mouse and zebrafish models
| Gene / Model | Organism | Observed Phenotype |
|---|---|---|
| nkx2.5 | Danio 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:
- 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-Score | Observed | Expected | Observed/Expected | Mutation Rate | Total Possible | |
|---|---|---|---|---|---|---|
| Missense | 0.199 | 178 | 186 | 0.959 | 0.00000860 | 1991 |
| Missense (PolyPhen) | 54 | 70.872 | 0.76193 | 747 | ||
| Synonymous | -0.0159 | 90 | 89.8 | 1.00 | 0.00000438 | 728 |
| Loss of Function | 2.81 | 0 | 9.18 | 0.00 | 3.93e-7 | 108 |
Population LoF Frequency
| Population | CAF | p-value | Status |
|---|---|---|---|
| African | 0 | 0.0 | absent |
| Latino/Admixed American | 0.00035 | 0.00035 | rare |
| Ashkenazi Jewish | 0 | 0.0 | absent |
| East Asian | 0 | 0.0 | absent |
| Finnish | 0 | 0.0 | absent |
| European (Non-Finnish) | 0.000019 | 0.0000089 | rare |
| South Asian | 0 | 0.0 | absent |
| Other | 0 | 0.0 | absent |
dbNSFP Gene Annotations
Source:
- 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
| All | Recessive | Dominant | |
|---|---|---|---|
| Mendelian | Medium | Medium | Medium |
| Primary Immunodeficiency | Medium | Medium | Medium |
| Cancer | Medium | Medium | Medium |