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Sci."],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Premature ovarian insufficiency (POI), characterized by ovarian dysfunction before age 40, remains idiopathic in over 50% of cases, underscoring the urgent need to elucidate its genetic underpinnings. Here, we report a consanguineous Iranian family with five females diagnosed with POI, exhibiting elevated gonadotropins, undetectable anti-M\u00fcllerian hormone, and bilateral ovarian atrophy. Whole Exome Sequencing identified a novel homozygous missense variant in\u00a0\n                    <jats:italic>BIRC6<\/jats:italic>\n                    \u00a0(NM_016252.4: c.11266C\u2009&gt;\u2009T; p.Arg3756Cys), a gene encoding an apoptosis regulator. Segregation analysis confirmed an autosomal recessive inheritance pattern, with homozygosity exclusively in affected individuals. Functional studies in a CRISPR\/Cas9-generated\u00a0\n                    <jats:italic>birc6<\/jats:italic>\n                    <jats:sup>\n                      <jats:italic>del12<\/jats:italic>\n                    <\/jats:sup>\n                    \u00a0zebrafish model recapitulated POI phenotypes: homozygous females exhibited reduced fecundity, aberrant oocyte morphology, and elevated embryonic death. Transcriptional analysis revealed dysregulation of apoptotic (\n                    <jats:italic>badb<\/jats:italic>\n                    ,\u00a0\n                    <jats:italic>sortilin<\/jats:italic>\n                    ,\u00a0\n                    <jats:italic>apc<\/jats:italic>\n                    ) and fertility-related (\n                    <jats:italic>nanos1<\/jats:italic>\n                    ,\u00a0\n                    <jats:italic>vtg1<\/jats:italic>\n                    ) genes, alongside unaltered estradiol levels, implicating apoptosis-driven follicular atresia rather than endocrine dysfunction. Compensatory increase in egg production in mutants mirrored human POI progression, where initial irregular cycles culminate in follicular depletion. This study establishes\u00a0\n                    <jats:italic>BIRC6<\/jats:italic>\n                    \u00a0as a novel POI candidate, links its anti-apoptotic function to ovarian homeostasis, and highlights zebrafish as a tractable model for dissecting POI mechanisms. Our findings expand the genetic landscape of infertility and suggest therapeutic potential for apoptosis modulation in fertility preservation.\n                  <\/jats:p>","DOI":"10.1007\/s43032-026-02088-6","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T20:11:10Z","timestamp":1777925470000},"page":"1170-1188","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel BIRC6 Variant Impairs Apoptotic Regulation in Familial Premature Ovarian Insufficiency: Functional Validation in a CRISPR\/Cas9 Zebrafish Model"],"prefix":"10.1007","volume":"33","author":[{"given":"Mahsa","family":"Kazerani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umut","family":"Cagiral","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyedeh Zoha","family":"Tabatabaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remziye Nur","family":"Akalper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugur","family":"Bora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadegh","family":"Babashah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunes","family":"Ozhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7285-3155","authenticated-orcid":false,"given":"Mehdi","family":"Totonchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"2088_CR1","unstructured":"World Health Organization. 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All animal procedures complied with the European Union Directive 2010\/63\/EU on the protection of animals used for scientific purposes and were approved by the Animal Experiments Local Ethics Committee of the Institute of Biomedical Genetics (IBG-AELEC) and adhered to ARRIVE guidelines for animal research.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"All participants, including proband and other family members, voluntarily provided written informed consent after receiving detailed explanations of the study\u2019s objectives, methodologies, and potential implications. Procedures adhered to the ethical principles outlined in the Declaration of Helsinki (1975) and complied with local regulations governing human biomedical research. Confidentiality of participant data was rigorously maintained, with anonymized identifiers used throughout the investigation.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Publish"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}]}}