The genetics of situs inversus totalis without primary ciliary dyskinesia

Abstract

Situs inversus totalis (SIT), a complete left-right mirror reversal of the visceral organs, is usually described as a recessive disorder. SIT can occur with Primary Ciliary Dyskinesia (PCD). However, most people with SIT do not have PCD, and the etiology of their condition remains poorly studied. Those without PCD may have an elevated rate of left-handedness, implying developmental mechanisms linking brain and body laterality. We sequenced the genomes of 15 people with SIT, of which six had PCD, and 15 controls. The SIT subjects with PCD all had likely recessive mutations in genes already known to cause PCD. Two non-PCD SIT cases also had recessive mutations in known PCD genes, suggesting reduced penetrance for PCD in some SIT cases. One non-PCD SIT case had a recessive mutation in PKD1L1, which has previously been linked to SIT without PCD. However, six of the nine non-PCD SIT cases, including most of the left-handers in this dataset, had no obvious candidate genes or significant pathways affected by the mutations that they carried. While we cannot exclude a monogenic basis, more complex genetic models must also be considered, as well as environmental influences or random effects in early development.