Nail-patella syndrome (NPS) is an autosomal dominant disease characterized by dysplastic nails, absent or hypoplastic patellae, elbow dysplasia, and nephropathy. Recently, it was shown that NPS is the result of heterozygous mutations in the LIM-homeodomain gene, LMX1B. Subsequently, many mutations of the LMX1B gene have been reported in NPS patients. However, functional analyses of the mutant proteins have been performed in only a few mutations. Furthermore, the mechanisms of dominant inheritance in humans have not been established. In the present study, we analyzed the LMX1B gene in three Japanese patients with NPS and identified two novel mutations, 6 nucleotide deletion (⌬246⌵ 247Q) and V242L. These two mutations are located in the homeodomain of LMX1B.Functional analyses of the LMX1B mutants revealed that these mutants had diminished transcriptional activity and had lost DNA binding ability. Furthermore, we demonstrated that each mutant did not manifest a dominant-negative effect on the transcriptional activity of wild-type LMX1B. These results suggested that NPS is caused by loss-of-function mutations of LMX1B, and haploinsufficiency of LMX1B should be the predominant pathogenesis of NPS in humans. Nail-patella syndrome (NPS; MIM#161200) is an autosomal dominant disease characterized by dysplastic nails, absent or hypoplastic patellae, elbow dysplasia, iliac horns, and, in some cases, open-angle glaucoma and nephropathy (1-3). Nail dysplasia is the most constant feature of NPS observed at birth. The most serious aspect of NPS is nephropathy, which might develop end-stage renal failure. Although development to endstage renal failure is usually slow, a minority of cases have been reported to show rapid progression during early childhood (3,4).It has been demonstrated that mutations of the LMX1B gene, which is located on chromosome 9q34, result in NPS (5-8). LMX1B is a member of the LIM-homeodomain family of transcription factors that are involved in body-pattern formation during development (9,10). These proteins contain two cysteine-rich zinc-binding motifs (LIM-A and LIM-B domain) at their amino termini that are important in mediating proteinprotein interactions and a homeodomain involved in DNA binding (9,10). The LMX1B-mediated transactivation presumably requires interaction with a transcriptional complex including a helix-loop-helix protein, E47/shPan1 (11,12). During embryogenesis, Lmx1b is strongly expressed in dorsal mesenchymal tissues in mice (12). Lmx1bϪ/Ϫ mice showed the absence of dorsal limb structures and duplication of ventral structures (7). These findings suggest that Lmx1b is essential for dorsoventral patterning during development and that the skeletal phenotype of NPS is the result of a deficiency in dorsoventral patterning. LMX1B is also expressed in human fetal and adult kidneys (5).From the analysis of Lmx1bϪ/Ϫ mice, it was suggested that LMX1B regulates the expression of type IV collagen ␣3 and ␣4 and podocin and that Lmx1b mutations cause disruption of these proteins, resulting in...