Perfect and imperfect views of ultraconserved sequences.

Across the human genome, there are nearly 500 ‘ultraconserved’ elements: regions of at least 200 contiguous nucleotides that are perfectly conserved in both the mouse and rat genomes. Remarkably, the majority of these sequences are non-coding, and many can function as enhancers that activate tissue-specific gene expression during embryonic development. From their first description more than 15 years ago, their extreme conservation has both fascinated and perplexed researchers in genomics and evolutionary biology. The intrigue around ultraconserved elements only grew with the observation that they are dispensable for viability. Here, we review recent progress towards understanding the general importance and the specific functions of ultraconserved sequences in mammalian development and human disease and discuss possible explanations for their extreme conservation. In this Review, the authors discuss explanations for why ultraconserved sequences — which are presumed to be functionally crucial on the basis of strong evolutionary constraint — often result in surprisingly minor phenotypic consequences when experimentally disrupted. They also discuss the wider implications of extreme non-coding conservation for understanding the mechanisms of gene regulation and human variant interpretation.