Spectrum of pathogenic variants and multiple founder effects in amelogenesis imperfecta associated with MMP20

Amelogenesis imperfecta (AI) describes a heterogeneous group of developmental enamel defects that typically have Mendelian inheritance. Exome sequencing of ten families with recessive hypomaturation AI revealed 4 novel and 1 known variants in the matrix metallopeptidase 20 (MMP20) gene that were predicted to be pathogenic. MMP20 encodes a protease that cleaves the developing extracellular enamel matrix and is necessary for normal enamel crystal growth during amelogenesis. New homozygous missense changes were shared between four families of Pakistani heritage (c.625G>C; p.(E209Q)) and two of Omani origin (c.710C>A; p.(S237Y)). In two families of UK origin and one from Costa Rica, affected individuals were homozygous for the previously reported c.954-2A>T; p.(I319Ffs*19) variant. For each of these variants, microsatellite haplotypes appeared to exclude a recent founder effect, but elements of haplotype were conserved, suggesting more distant founding ancestors. New compound heterozygous changes were identified in one family of European heritage; c.809_811+12delACGgtaagattattainsCCAG; p.(?) and c.1122A>C; p.(Q374H). All four new variants are within the zinc dependant peptidase domain. This report further elucidates the mutation spectrum of MMP20 and the probable impact on protein function, confirms a consistent hypomaturation phenotype and shows that mutations in MMP20 are a common cause of autosomal recessive AI in some communities. Data AvailabilityThe data that support the findings of this study are openly available in ClinVar at https://www.ncbi.nlm.nih.gov/clinvar/, accession numbers: SCV001338799 - SCV001338802 and in the AI Leiden Open Variation Database (LOVD) at http://dna2.leeds.ac.uk/LOVD/ with reference numbers: 0000000313 - 0000000317.