{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T18:58:21Z","timestamp":1781895501096,"version":"3.54.5"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2010,3,23]]},"abstract":"<jats:p>\n                    <jats:bold>\n                      <jats:italic>Background\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Mutations of the transcription factor\n                    <jats:italic>Nkx2-5<\/jats:italic>\n                    cause pleiotropic heart defects with incomplete penetrance. This variability suggests that additional factors can affect or prevent the mutant phenotype. We assess here the role of genetic modifiers and their interactions.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Methods and Results\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Heterozygous\n                    <jats:italic>Nkx2-5<\/jats:italic>\n                    knockout mice in the inbred strain background C57Bl\/6 frequently have atrial and ventricular septal defects. The incidences are substantially reduced in the\n                    <jats:italic>Nkx2-5<\/jats:italic>\n                    <jats:sup>+\/\u2212<\/jats:sup>\n                    progeny of first-generation (F1) outcrosses to the strains FVB\/N or A\/J. Defects recur in the second generation (F2) of the F1\u00d7F1 intercross or backcrosses to the parental strains. Analysis of &gt;3000\n                    <jats:italic>Nkx2-5<\/jats:italic>\n                    <jats:sup>+\/\u2212<\/jats:sup>\n                    hearts from 5 F2 crosses demonstrates the profound influence of genetic modifiers on disease presentation. On the basis of their incidences and coincidences, anatomically distinct malformations have shared and unique modifiers. All 3 strains carry susceptibility alleles at different loci for atrial and ventricular septal defects. Relative to the other 2 strains, A\/J carries polymorphisms that confer greater susceptibility to atrial septal defect and atrioventricular septal defects and C57Bl\/6 to muscular ventricular septal defects. Segregation analyses reveal that \u22652 loci influence membranous ventricular septal defect susceptibility, whereas \u22652 loci and at least 1 epistatic interaction affect muscular ventricular and atrial septal defects.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Conclusions\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Alleles of modifier genes can either buffer perturbations on cardiac development or direct the manifestation of a defect. In a genetically heterogeneous population, the predominant effect of modifier genes is health.\n                  <\/jats:p>","DOI":"10.1161\/circulationaha.109.887687","type":"journal-article","created":{"date-parts":[[2010,3,9]],"date-time":"2010-03-09T00:29:37Z","timestamp":1268094577000},"page":"1313-1321","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":80,"title":["Heterogeneity of Genetic Modifiers Ensures Normal Cardiac Development"],"prefix":"10.1161","volume":"121","author":[{"given":"Julia B.","family":"Winston","sequence":"first","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan M.","family":"Erlich","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney A.","family":"Green","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Aluko","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine A.","family":"Kaiser","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai","family":"Takematsu","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert S.","family":"Barlow","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish O.","family":"Sureka","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin J.","family":"LaPage","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luc L.","family":"Janss","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; and Radboud University Nijmegen Medical Centre, Donders Centre for Neuroscience, Nijmegen, the Netherlands (L.L.J.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Y.","family":"Jay","sequence":"additional","affiliation":[{"name":"From the Departments of Pediatrics (J.B.W., J.M.E., C.A.G., A.A., K.A.K., M.T., R.S.B., A.O.S., M.J.L., P.Y.J.) and Genetics (P.Y.J.), Washington University School of Medicine, St. Louis, Mo; 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