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Original article
Manitoba-oculo-tricho-anal (MOTA) syndrome is caused by mutations in FREM1
  1. Anne M Slavotinek1,
  2. Sergio E Baranzini2,
  3. Denny Schanze3,
  4. Cassandre Labelle-Dumais4,5,
  5. Kieran M Short6,7,
  6. Ryan Chao1,
  7. Mani Yahyavi1,
  8. Emilia K Bijlsma8,
  9. Catherine Chu9,
  10. Stacey Musone9,
  11. Ashleigh Wheatley10,
  12. Pui-Yan Kwok9,
  13. Sandra Marles10,
  14. Jean-Pierre Fryns11,
  15. A Murat Maga12,
  16. Mohamed G Hassan12,
  17. Douglas B Gould4,5,
  18. Lohith Madireddy2,
  19. Chumei Li12,
  20. Timothy C Cox13,14,
  21. Ian Smyth6,7,
  22. Albert E Chudley10,
  23. Martin Zenker3
  1. 1Department of Pediatrics, Division of Genetics, UCSF, San Francisco, California, USA
  2. 2Department of Neurology, UCSF, San Francisco, California, USA
  3. 3Institute of Human Genetics, University Hospital of Magdeburg, Magdeburg, Germany
  4. 4Department of Ophthalmology, Institute for Human Genetics, UCSF School of Medicine, San Francisco, California, USA
  5. 5Department of Anatomy, Institute for Human Genetics, UCSF School of Medicine, San Francisco, California, USA
  6. 6Department of Biochemistry, Monash University, Clayton, Melbourne, Victoria, Australia
  7. 7Department of Molecular Biology, Monash University, Clayton, Melbourne, Victoria, Australia
  8. 8Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
  9. 9Department of Dermatology, Cardiovascular Research Institute and Institute for Human Genetics, UCSF, San Francisco, California, USA
  10. 10Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
  11. 11Center for Human Genetics, Catholic University of Leuven, Leuven, Belgium
  12. 12Department of Paediatrics, McMaster University, Hamilton, Canada
  13. 13Department of Pediatrics (Craniofacial Medicine), University of Washington, and Center for Tissue & Cell Sciences, Seattle Children's Research Institute, Seattle, Washington, USA
  14. 14Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Dr Anne M Slavotinek, Department of Pediatrics, Division of Genetics, University of California, 533 Parnassus Street, Room U585P, San Francisco, CA 94143-0748, USA; slavotia{at}


Background Manitoba-oculo-tricho-anal (MOTA) syndrome is a rare condition defined by eyelid colobomas, cryptophthalmos and anophthalmia/microphthalmia, an aberrant hairline, a bifid or broad nasal tip, and gastrointestinal anomalies such as omphalocele and anal stenosis. Autosomal recessive inheritance had been assumed because of consanguinity in the Oji-Cre population of Manitoba and reports of affected siblings, but no locus or cytogenetic aberration had previously been described.

Methods and results This study shows that MOTA syndrome is caused by mutations in FREM1, a gene previously mutated in bifid nose, renal agenesis, and anorectal malformations (BNAR) syndrome. MOTA syndrome and BNAR syndrome can therefore be considered as part of a phenotypic spectrum that is similar to, but distinct from and less severe than, Fraser syndrome. Re-examination of Frem1bat/bat mutant mice found new evidence that Frem1 is involved in anal and craniofacial development, with anal prolapse, eyelid colobomas, telecanthus, a shortened snout and reduced philtral height present in the mutant mice, similar to the human phenotype in MOTA syndrome.

Conclusions The milder phenotypes associated with FREM1 deficiency in humans (MOTA syndrome and BNAR syndrome) compared to that resulting from FRAS1 and FREM2 loss of function (Fraser syndrome) are also consistent with the less severe phenotypes resulting from Frem1 loss of function in mice. Together, Fraser, BNAR and MOTA syndromes constitute a clinically overlapping group of FRAS–FREM complex diseases.

  • MOTA syndrome
  • BNAR syndrome
  • Fraser syndrome
  • FREM1
  • FRAS1
  • clinical genetics
  • molecular genetics
  • ophthalmology

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  • Funding This work was supported by The Eunice Kennedy Shriver National Institute of Child Health, National Institutes of Health (grant K08HD053476-01A1 to AS), the National Eye Institute, National Institutes of Health (grant R21EY019999-01 to AS), and the National Health and Medical Research Council and Monash University (Project Grant and Fellowship funding to IS). SEB is a Harry Weaver Neuroscience Scholar from the National Multiple Sclerosis Society.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Committee for Human Research, UCSF.

  • Provenance and peer review Not commissioned; externally peer reviewed.