GREM2

Chr 1AD

gremlin 2, DAN family BMP antagonist

Also known as: CKTSF1B2, DAND3, PRDC, STHAG9

The protein is a secreted cytokine that inhibits BMP2 and BMP4 signaling, thereby regulating embryonic morphogenesis and tissue differentiation. Mutations cause selective tooth agenesis, which follows an autosomal dominant inheritance pattern. The gene shows low constraint to loss-of-function variation, consistent with its role in developmental patterning rather than essential cellular functions.

OMIMResearchSummary from RefSeq, OMIM, UniProt
MultiplemechanismADLOEUF 1.271 OMIM phenotype
Clinical SummaryGREM2
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Gene-Disease Validity (ClinGen)
tooth agenesis, selective, 9 · ADLimited

Limited evidence — not for standalone diagnostic reporting

Population Constraint (gnomAD)
Low constraint (pLI 0.03) — loss-of-function variants are relatively tolerated in the population.
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Clinical Trials
1 active or recruiting trial — potential therapeutic options may be available

Population Genetics & Constraint

gnomAD v4 — loss-of-function & missense intolerance

Tolerant — LoF & missense variants common in population
LoF Constraint
1.27LOEUF
pLI 0.032
Z-score 1.15
OE 0.49 (0.221.27)
Tolerant

Highly tolerant — LoF variants common in population

Missense Constraint
1.23Z-score
OE missense 0.68 (0.560.82)
78 obs / 115.2 exp
Tolerant

Mild missense constraint

Observed / Expected Ratios
LoF OE0.49 (0.221.27)
00.351.4
Missense OE0.68 (0.560.82)
00.61.4
Synonymous OE0.76
01.21.6
LoF obs/exp: 3 / 6.1Missense obs/exp: 78 / 115.2Syn Z: 1.38
DN
0.6259th %ile
GOF
0.3094th %ile
LOF
0.3843th %ile

This gene has evidence for multiple mechanisms of pathogenicity (dominant-negative and gain-of-function). Both the Badonyi & Marsh prediction and the broader genomic evidence point to dominant-negative as the predominant mechanism. Different variants in this gene may act through different mechanisms — interpret in context of the specific variant.

DNprediction above median
GOF1 literature citation

Note: In-silico variant effect predictors (SIFT, PolyPhen, REVEL, CADD) may underestimate pathogenicity of missense variants in genes with GOF or DN mechanisms. Consider functional evidence and clinical context.

Literature Evidence

GOFOverall, these data support the hypothesis that GREM2 regulates cardiac rhythm in the atrium, and establish that higher than normal GREM2 activity, either by overexpression or gain-of-function mutations such as the Q76E variant, have arrhythmogenic potential.PMID:23223679

Predictions from Badonyi M, Marsh JA. PLoS ONE. 2024;19(8):e0307312.

ClinVar Variant Classifications

0 submitted variants in ClinVar

Protein Context — Lollipop Plot

GREM2 · protein map & ClinVar variants

Showing all ClinVar variants across the protein. Search a specific variant to highlight its position.

3D Protein StructureAlphaFold
Clinical Literature
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