PAX6

protein-coding

paired box 6, the group of PRD class homeoboxes and pseudogenes|Paired boxes

Gene summary

This gene encodes paired box protein Pax-6, one of many human homologs of the Drosophila melanogaster gene prd. In addition to a conserved paired box domain, a hallmark feature of this gene family, the encoded protein also contains a homeobox domain. Both domains are known to bind DNA and function as regulators of gene transcription. Activity of this protein is key in the development of neural tissues, particularly the eye. This gene is regulated by multiple enhancers located up to hundreds of kilobases distant from this locus. Mutations in this gene or in the enhancer regions can cause ocular disorders such as aniridia and Peter's anomaly. Use of alternate promoters and alternative splicing results in multiple transcript variants encoding different isoforms. Interestingly, inclusion of a particular alternate coding exon has been shown to increase the length of the paired box domain and alter its DNA binding specificity. Consequently, isoforms that carry the shorter paired box domain regulate a different set of genes compared to the isoforms carrying the longer paired box domain. [provided by RefSeq, Mar 2019]

Previous symbols:
  • AN1
  • AN2

MANE transcript

NM_001368894.2

Inheritance

AD

ClinVar variants

P:449U:178B:108

Top phenotype

Anterior segment dysgenesis 5; Aniridia 1; Aniridia, cerebellar ataxia, and mental retardation (Gillespie syndrome); Optic nerve hypoplasia; Keratitis; Foveal hypoplasia 1; Microphthalmia/coloboma 12; Morning glory disc anomaly

gnomAD constraint

pLI —, LoF o/e 0.04

Max pathogenic AF

—

Genomic locus

chr11:31,784,779-31,817,961

External References & Databases

Transcript & Mutation Effects

hg38 • Region Span ~33.2 kb
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GenCC Phenotypes & Disease Associations

Curated gene-disease validity assertions and inheritance patterns

autosomal dominant keratitisLIMITED

Inheritance Pattern: Unknown

Disease ID:MONDO:0007848

Submitter: Labcorp Genetics (formerly Invitae)

aniridia 1STRONG

Inheritance Pattern: AD

Disease ID:MONDO:0024507

Submitter: Genomics England PanelApp

Peters anomalyDEFINITIVE

Inheritance Pattern: AD

Disease ID:MONDO:0011414

Submitter: G2P

aniridia 1STRONG

Inheritance Pattern: AD

Disease ID:MONDO:0024507

Submitter: Labcorp Genetics (formerly Invitae)

PAX6-related ocular dysgenesisDEFINITIVE

Inheritance Pattern: AD

Disease ID:MONDO:0800183

Submitter: ClinGen

PAX6 was first reported in 1990s in relation to autosomal dominant aniridia (OMIM:10620, PMID: 1684738; 1302030), anterior segment malformations including Peters' anomaly (OMIM:604229, PMID: 8162071), and autosomal dominant keratitis (OMIM: 148190, PMID: 7668281). Per criteria outlined by the ClinGen Lumping and Splitting Working Group, we found no difference in molecular mechanism(s) AND inheritance pattern of these disorders and therefore they have been lumped into one disease entities as autosomal dominant anterior segment dysgenesis. Over 200 unique variants, including frameshift, nonsense, splice site, C-terminal extension (run-on), in-frame deletion, missense variants, that have been reported in over 300 probands in numerous publications (PMID: PMID: 1302030 (2), 8111379 (6), 7909985 (5), 17595013 (1), 28321846 (91), 10477494 (1), 12552561 (7), 12721955 ((8), 33514497 (254), are included in this curation. The mechanism of pathogenicity is known to be loss-of-function as predicted by haploinsufficiency. This gene-disease association is also supported by experimental evidence including biochemical function studies (PMID: 12183364), protein interaction (PMID: 14744876, 15020705), animal model/rescue (PMID: 1684639, 7914031, 8689689). More evidence is available in the literature, but the maximum score for genetic (12 points) and experimental (6 points) evidence have been reached. In summary, PAX6 is definitively associated with autosomal dominant anterior segment dysgenesis. This has been repeatedly demonstrated in both the research and clinical diagnostic settings and has been upheld over time.

PAX6-related ocular dysgenesisSTRONG

Inheritance Pattern: AD

Disease ID:MONDO:0800183

Submitter: PanelApp Australia

Peters anomalySUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0011414

Submitter: Orphanet

isolated aniridiaSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0007119

Submitter: Orphanet

aniridia-cerebellar ataxia-intellectual disability syndromeSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0008795

Submitter: Orphanet

aniridia 1DEFINITIVE

Inheritance Pattern: AD

Disease ID:MONDO:0024507

Submitter: G2P

autosomal dominant keratitisSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0007848

Submitter: Orphanet

Peters anomalySTRONG

Inheritance Pattern: AD

Disease ID:MONDO:0011414

Submitter: Labcorp Genetics (formerly Invitae)

diabetes mellitusSTRONG

Inheritance Pattern: AD

Disease ID:MONDO:0005015

Submitter: Genomics England PanelApp

foveal hypoplasia-presenile cataract syndromeSUPPORTIVE

Inheritance Pattern: AD

Disease ID:MONDO:0016395

Submitter: Orphanet

Clinical Genomic Database (CGD)

Anterior segment dysgenesis 5; Aniridia 1; Aniridia, cerebellar ataxia, and mental retardation (Gillespie syndrome); Optic nerve hypoplasia; Keratitis; Foveal hypoplasia 1; Microphthalmia/coloboma 12; Morning glory disc anomalyAD

Manifestation: Neurologic; Ophthalmologic

Intervention: Ophthalmologic; Pharmacogenomic

Rationale: Individuals with PAX6 related eye anomalies may be recognizable, but some may also be at high risk of developing glaucoma; Agents that may contribute to glaucoma should be avoided

Comments: Severe and difficult to treat glaucoma has been reported in many individuals with Anterior segment dysgenesis; Homozygous/compound heterozygous variants may cause severe disease, including neuroanatomic anomalies

Refs: 17948455; 14246186; 868970; 1302030; 8364574; 7951315; 8162071; 7550230; 7668281; 8640214; 9138149; 9482572; 9705283; 9931324; 11553050; 11826019; 12325030; 12721955; 15629294; 16543198; 17148041; 17417613; 17595013; 19876904; 22171686; 24290376Source: CGD (NHGRI)

ClinVar Associated Diseases & Phenotypes

Reported disease conditions connected to PAX6 variants in ClinVar

43 Conditions Cataloged
Aniridia 1Total: 638
Irido-corneo-trabecular dysgenesisTotal: 459
not providedTotal: 217
PAX6-related disorderTotal: 111
not specifiedTotal: 40
Foveal hypoplasia 1Total: 31
Inborn genetic diseasesTotal: 30
Autosomal dominant keratitisTotal: 28

ClinVar Variants & Pathogenicity by Type

Statistics based on transcript NM_001368894.2. 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
5
clinvar
8
clinvar
94
clinvar
6
clinvar
114
missense
35
clinvar
73
clinvar
163
clinvar
6
clinvar
2
clinvar
279
nonsense
60
clinvar
10
clinvar
2
clinvar
72
start loss
5
clinvar
5
frameshift
165
clinvar
26
clinvar
2
clinvar
193
splice donor/acceptor (+/-2bp)
58
clinvar
11
clinvar
3
clinvar
72
Total3241251781008735

Highest pathogenic variant AF is 0.0002485622

Loading ClinVar variants...

Transcript Catalog

Annotated transcript isoforms across RefSeq and Ensembl databases

Showing 4 of 126 transcripts
Transcript IDSourceProtein IDCoding ExonsMANE Status
NM_001368894.2RefSeqNP_001355823.111MANE Select
ENST00000640368.2EnsemblENSP00000492024.111MANE Select
NM_000280.6RefSeqNP_000271.110Standard
NM_001127612.3RefSeqNP_001121084.110Standard

Model Organisms & Knockout Phenotypes

Observed phenotypic effects in mouse and zebrafish models

Gene / ModelOrganismObserved Phenotype
pax6aDanio rerio

Structure: rhombomere

Quality: condensed

abnormal

Gene Ontology (GO) Annotations & Pathways

Biological processes, molecular functions, cellular components and pathways

Pathways ConsensusPathDB

  • Maturity onset diabetes of the young - Homo sapiens (human)
  • Signaling pathways regulating pluripotency of stem cells - Homo sapiens (human)
  • Cardiac Progenitor Differentiation
  • Mesodermal Commitment Pathway
  • Ectoderm Differentiation

Biological Process

  • negative regulation of transcription by RNA polymerase II
  • establishment of mitotic spindle orientation
  • blood vessel development
  • eye development
  • cell fate determination

Molecular Function

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

Cellular Component

  • nuclear chromatin
  • nucleus
  • nucleoplasm
  • cytoplasm
  • cytosol

gnomAD Constraint

Source: gnomAD

Gene type
protein_coding
Transcript type
protein_coding
Transcript
ENST00000419022
Coding exons
11
Length
33170
Individuals with no LoFs
125741
Homozygous LoFs
0
Heterozygous LoFs
2
Defined
125743
p
0.00000795
Z-ScoreObservedExpectedObserved/ExpectedMutation RateTotal Possible
Missense2.821202440.4920.00001272843
Missense (PolyPhen)1988.3180.215131035
Synonymous-0.85010089.81.110.00000513855
Loss of Function4.74128.10.03560.00000171269

Population LoF Frequency

PopulationCAFp-valueStatus
African00.0absent
Latino/Admixed American00.0absent
Ashkenazi Jewish00.0absent
East Asian00.0absent
Finnish00.0absent
European (Non-Finnish)0.00000880.0000088rare
South Asian0.0000330.000033rare
Other00.0absent

dbNSFP Gene Annotations

Source: dbNSFP

Function
FUNCTION: Transcription factor with important functions in the development of the eye, nose, central nervous system and pancreas. Required for the differentiation of pancreatic islet alpha cells (By similarity). Competes with PAX4 in binding to a common element in the glucagon, insulin and somatostatin promoters. Regulates specification of the ventral neuron subtypes by establishing the correct progenitor domains (By similarity). Isoform 5a appears to function as a molecular switch that specifies target genes. {ECO:0000250}.;
Disease
DISEASE: Aniridia 1 (AN1) [MIM:106210]: A congenital, bilateral, panocular disorder characterized by complete absence of the iris or extreme iris hypoplasia. Aniridia is not just an isolated defect in iris development but it is associated with macular and optic nerve hypoplasia, cataract, corneal changes, nystagmus. Visual acuity is generally low but is unrelated to the degree of iris hypoplasia. Glaucoma is a secondary problem causing additional visual loss over time. {ECO:0000269|PubMed:10234503, ECO:0000269|PubMed:10737978, ECO:0000269|PubMed:11309364, ECO:0000269|PubMed:11553050, ECO:0000269|PubMed:11826019, ECO:0000269|PubMed:12552561, ECO:0000269|PubMed:12634864, ECO:0000269|PubMed:16493447, ECO:0000269|PubMed:17595013, ECO:0000269|PubMed:21850189, ECO:0000269|PubMed:24033328, ECO:0000269|PubMed:8364574, ECO:0000269|PubMed:9147640, ECO:0000269|PubMed:9281415, ECO:0000269|PubMed:9792406, ECO:0000269|PubMed:9856761, ECO:0000269|PubMed:9931324, ECO:0000269|Ref.27, ECO:0000269|Ref.28}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Anterior segment dysgenesis 5 (ASGD5) [MIM:604229]: A form of anterior segment dysgenesis, a group of defects affecting anterior structures of the eye including cornea, iris, lens, trabecular meshwork, and Schlemm canal. Anterior segment dysgeneses result from abnormal migration or differentiation of the neural crest derived mesenchymal cells that give rise to components of the anterior chamber during eye development. Different anterior segment anomalies may exist alone or in combination, including iris hypoplasia, enlarged or reduced corneal diameter, corneal vascularization and opacity, posterior embryotoxon, corectopia, polycoria, abnormal iridocorneal angle, ectopia lentis, and anterior synechiae between the iris and posterior corneal surface. Clinical conditions falling within the phenotypic spectrum of anterior segment dysgeneses include aniridia, Axenfeld anomaly, Reiger anomaly/syndrome, Peters anomaly, and iridogoniodysgenesis. {ECO:0000269|PubMed:10441571, ECO:0000269|PubMed:12721955, ECO:0000269|PubMed:8162071}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Foveal hypoplasia 1 (FVH1) [MIM:136520]: An isolated form of foveal hypoplasia, a developmental defect of the eye defined as the lack of foveal depression with continuity of all neurosensory retinal layers in the presumed foveal area. Clinical features include absence of foveal pit on optical coherence tomography, absence of foveal hyperpigmentation, absence of foveal avascularity, absence of foveal and macular reflexes, decreased visual acuity, and nystagmus. Anterior segment anomalies and cataract are observed in some FVH1 patients. {ECO:0000269|PubMed:8640214, ECO:0000269|PubMed:9931324}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Keratitis hereditary (KERH) [MIM:148190]: An ocular disorder characterized by corneal opacification, recurrent stromal keratitis and vascularization. {ECO:0000269|PubMed:7668281}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Coloboma, ocular, autosomal dominant (COAD) [MIM:120200]: A set of malformations resulting from abnormal morphogenesis of the optic cup and stalk, and the fusion of the fetal fissure (optic fissure). The clinical presentation is variable. Some individuals may present with minimal defects in the anterior iris leaf without other ocular defects. More complex malformations create a combination of iris, uveoretinal and/or optic nerve defects without or with microphthalmia or even anophthalmia. {ECO:0000269|PubMed:12721955}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Coloboma of optic nerve (COLON) [MIM:120430]: An ocular defect that is due to malclosure of the fetal intraocular fissure affecting the optic nerve head. In some affected individuals, it appears as enlargement of the physiologic cup with severely affected eyes showing huge cavities at the site of the disk. {ECO:0000269|PubMed:12721955}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Bilateral optic nerve hypoplasia (BONH) [MIM:165550]: A congenital anomaly in which the optic disk appears abnormally small. It may be an isolated finding or part of a spectrum of anatomic and functional abnormalities that includes partial or complete agenesis of the septum pellucidum, other midline brain defects, cerebral anomalies, pituitary dysfunction, and structural abnormalities of the pituitary. {ECO:0000269|PubMed:12721955}. Note=The disease is caused by mutations affecting the gene represented in this entry.; DISEASE: Aniridia 2 (AN2) [MIM:617141]: A form of aniridia, a congenital, bilateral, panocular disorder characterized by complete absence of the iris or extreme iris hypoplasia. Aniridia is not just an isolated defect in iris development but it is associated with macular and optic nerve hypoplasia, cataract, corneal changes, nystagmus. Visual acuity is generally low but is unrelated to the degree of iris hypoplasia. Glaucoma is a secondary problem causing additional visual loss over time. {ECO:0000269|PubMed:24290376}. Note=The gene represented in this entry is involved in disease pathogenesis. A mutation in a PAX6 long-range cis-regulatory element, known as SIMO, affects PAX6 expression in the developing eye and has pathological consequences. The mutation is located in ELP4 intron 9, 150 kb downstream of PAX6. {ECO:0000269|PubMed:24290376}.;

Recessive Scores

pRec
0.829

Intolerance Scores

LoFtool
0.0409
RVIS EVS
-0.36
RVIS percentile EVS
28.63

Essentials

Essential (CRISPR)
N
Essential (CRISPR2)
N
Essential (gene trap)
N
Indispensability pred.
E
Indispensability score
0.654

Gene Damage Prediction

AllRecessiveDominant
MendelianMediumLowMedium
Primary ImmunodeficiencyMediumLowMedium
CancerMediumMediumMedium
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