Mutations in the WLS are associated with dental anomalies, torus palatinus, and torus mandibularis

Eur J Orthod. 2023 May 31;45(3):317-323. doi: 10.1093/ejo/cjac068.


Background: Canonical and non-canonical WNT signaling are important for odontogenesis. WNT ligand secretion mediator (WLS; MIM611514) is required to transport lipid-modified WNT proteins from the Golgi to the cell membrane, where canonical and non-canonical WNT proteins are released into the extracellular milieu. Biallelic pathogenic variants in WLS are implicated in autosomal recessive Zaki syndrome (ZKS; MIM 619648), the only genetic condition known to be caused by pathogenic variants in WLS.

Objective: To investigate molecular etiology of dental anomalies in 250 patients with or without oral exostoses.

Patients and methods: Clinical and radiographic examination, and whole exome sequencing, were performed in the case of 250 patients with dental anomalies with or without oral exostoses.

Results: Four extremely rare heterozygous missense variants (p.Ile20Thr, p.Met46Leu, p.Ser453Ile and p.Leu516Phe) in WLS were identified in 11 patients with dental anomalies. In five of these patients, a torus palatinus or a torus mandibularis was observed.

Conclusion: We report for the first time the heterozygous WLS variants in patients with dental anomalies. Root maldevelopments in patients with WLS variants supports the role of canonical and non-canonical WNT signaling in root development. We also show that variants in WLS were implicated in torus palatinus and torus mandibularis. In addition, this is the first time that heterozygous carriers of WLS variants were found to manifest phenotypes. WLS variants were likely to have adverse effects on the concentration of WNT ligands delivered to the cell membrane, resulting in aberrant canonical and non-canonical WNT signaling, and subsequent phenotypes.

Limitations of the study: Patient's positioning during the acquisition of panoramic radiography might have affected the appearance of the tooth structures. If we had all family members of each patient to study co-segregation between genotype and phenotype, it would have strengthened the association of WLS variants and the phenotypes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Exostoses* / pathology
  • Humans
  • Mutation
  • Odontogenesis / genetics
  • Tooth*
  • Wnt Proteins / genetics
  • Wnt Proteins / metabolism


  • Wnt Proteins