MSH6

Chr 2ADSomaticAR

mutS homolog 6

Also known as: GTBP, GTMBP, HNPCC5, HSAP, LYNCH5, MMRCS3, MSH-6, p160

The MSH6 protein heterodimerizes with MSH2 to form a mismatch recognition complex that binds to DNA mismatches and initiates post-replicative DNA mismatch repair. Mutations cause Lynch syndrome 5, familial endometrial cancer, and mismatch repair cancer syndrome 3 with autosomal dominant inheritance (though some cases show autosomal recessive inheritance). This gene is highly intolerant to loss-of-function variants (pLI near 1.0, LOEUF 0.498), indicating that complete loss of function is likely incompatible with normal development.

Summary from RefSeq, OMIM, UniProt
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Primary Disease Associations & Inheritance

{Endometrial cancer, familial}MIM #608089
ADSomatic
Lynch syndrome 5MIM #614350
AD
Mismatch repair cancer syndrome 3MIM #619097
AR
UniProtColorectal cancer
12
Active trials
315
Pubs (1 yr)
0
P/LP submissions
P/LP missense
0.50
LOEUF
LOF
Mechanism· G2P
Clinical SummaryMSH6
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Gene-Disease Validity (ClinGen)
mismatch repair cancer syndrome 1 · ARDefinitive

Definitive — sufficient evidence for diagnostic panels

3 total gene-disease associations curated

Population Constraint (gnomAD)
Constrained for loss-of-function variants (OE-LoF 0.34) despite low pLI — interpret in context.
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Clinical Trials
12 active or recruiting trials — potential therapeutic options may be available
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Population Genetics & Constraint

gnomAD v4 — loss-of-function & missense intolerance

Moderate LoF intolerance
LoF Constraint
0.50LOEUF
pLI 0.000
Z-score 4.51
OE 0.34 (0.230.50)
Moderately constrained

More LoF-intolerant than ~75% of genes

Missense Constraint
-2.78Z-score
OE missense 1.29 (1.231.37)
917 obs / 708.7 exp
Tolerant

Tolerant to missense variation

Observed / Expected Ratios
LoF OE0.34 (0.230.50)
00.351.4
Missense OE1.29 (1.231.37)
00.61.4
Synonymous OE1.50
01.21.6
LoF obs/exp: 18 / 53.6Missense obs/exp: 917 / 708.7Syn Z: -6.32
Curated Mechanism (G2P)Gene2Phenotype (DDG2P) ↗
definitiveMSH6-related Lynch syndromeLOFAD
definitiveMSH6-related constitutional mismatch repair deficiency syndromeLOFAR
DN
0.6260th %ile
GOF
0.4382th %ile
LOF
0.3452th %ile

This gene has evidence for multiple mechanisms of pathogenicity (dominant-negative and loss-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
LOF1 literature citation · LOEUF 0.50

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

LOFGermline mutation of MSH6 as the cause of hereditary nonpolyposis colorectal cancerPMID:9354786

Predictions from Badonyi M, Marsh JA. PLoS ONE. 2024;19(8):e0307312. Mechanism ranking also informed by gnomAD constraint, ClinVar, and ClinGen data.

ClinVar Variant Classifications

0 submitted variants in ClinVar

Protein Context — Lollipop Plot

MSH6 · protein map & ClinVar variants

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

3D Protein StructureAlphaFold

Clinical Trials

Active and recruiting trials from ClinicalTrials.gov

Prostate Cancer

Analysing Outcomes After Prostate Cancer Diagnosis and Treatment in Carriers of Rare Germline Mutations

RECRUITING
NCT02705846Institute of Cancer Research, United KingdomStarted 2014-09
Observation of treatment outcomes via Questionnaire
Prostate CancerProstate BiopsyGenetic Counselling

The PROFILE Study: Germline Genetic Profiling: Correlation With Targeted Prostate Cancer Screening and Treatment

RECRUITING
NCT02543905Institute of Cancer Research, United KingdomStarted 2015-03-09
Prostate MRI and Biopsy
BRCA-Mutated Ovarian CarcinomaBRIP1 Gene MutationMSH2 A636P

Cascade Testing in Families With Newly Diagnosed Hereditary Breast and Ovarian Cancer Syndrome

ACTIVE NOT RECRUITING
NCT04009148NYU Langone HealthStarted 2019-03-01
CASCADE genetic screening
Lynch SyndromeEndometrial Cancer

EC_ItaLynch: Mainstreaming the Diagnosis of Lynch Syndrome

NOT YET RECRUITING
NCT06501417Fondazione Policlinico Universitario Agostino Gemelli IRCCSStarted 2024-08-01
mainstreaming
Basal Cell Carcinoma of Skin, Site UnspecifiedEpidermoid CarcinomaLynch Syndrome

Determining the Prevalence of Muir-Torre Syndrome in Patients With Lynch Syndrome

NOT YET RECRUITING
NCT07201012Phase NACentre Hospitalier Universitaire de NīmesStarted 2025-12
Sampling of suspected skin lesions (in accordance with good care practices).Constitution of a biobank
Polycythemia VeraEssential ThrombocythaemiaMyelofibrosis

Prevalence Of Germline Gene Mutations In Patients With Myeloproliferative Neoplasms With Family History

NOT YET RECRUITING
NCT06923670Phase NAFondazione Policlinico Universitario Agostino Gemelli IRCCSStarted 2025-05-21
NGS testingNGS analysis for mutations in genes involved in familial predisposition to hematological malignancies
Colorectal CancerLynch SyndromeHereditary Colorectal Cancer

Prospective Multicenter Registry Study to Assess the Frequency of Lynch Syndrome Among Patients With Colorectal Cancer

RECRUITING
NCT05495776State Scientific Centre of Coloproctology, Russian FederationStarted 2022-08-01
Urothelial CarcinomaLynch Syndrome

Urothelial Cancer Screening in Individuals With Lynch Syndrome Using a Urine Tumor DNA Panel (LS-URO Study)

RECRUITING
NCT06218433Phase NATampere University HospitalStarted 2023-04-10
Urothelial cancer screening using urine tumor DNA testUrothelial cancer screening using urine cytology (comparator)
Colorectal CancerAdenoma ColonAdenoma Colon Polyp

Liquid Biopsy and Machine Learning for Early Colorectal Cancer, Adenomas, Lynch Cancers, and Residual Disease Detection

RECRUITING
NCT07450612San Raffaele UniversityStarted 2024-01-01
BEACON
Advanced Solid Tumor

A Modular Multi-Basket Trial to Improve Personalized Medicine in Cancer Patients (Basket of Baskets)

RECRUITING
NCT03767075Phase PHASE2Vall d'Hebron Institute of OncologyStarted 2018-12-10
AtezolizumabFutibatinibAmivantamab
Pancreas CancerPancreas CystPancreatic Ductal Adenocarcinoma

Pancreatic Cancer Early Detection Consortium

RECRUITING
NCT04970056Arbor Research Collaborative for HealthStarted 2020-09-18
Pancreas CancerPeutz-Jeghers Syndrome (PJS)Gene Mutation

The Cancer of the Pancreas Screening-5 CAPS5)Study

RECRUITING
NCT02000089Phase PHASE3Johns Hopkins UniversityStarted 2014-01-06
SecretinMRITumor marker gene test with CA19-9
Clinical Literature
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Key Publications
Landmark & review papers · by relevance
PubMed
Top 5 results · since 2015Search PubMed ↗