Oligodontia-Colorectal Cancer via the AXIN2 Gene

  • Summary and Pricing
  • Clinical Features and Genetics
  • Citations
  • Methods
  • Ordering/Specimens
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Test Code Test Copy GenesIndividual Gene PriceCPT Code Copy CPT Codes
719 AXIN2$840.00 81479 Add to Order
Targeted Testing

For ordering targeted known variants, please proceed to our Targeted Variants landing page.

Turnaround Time

The great majority of tests are completed within 18 days.

Clinical Sensitivity
The clinical sensitivity of this test is currently unknown.

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Deletion/Duplication Testing via aCGH

Test Code Test Copy GenesIndividual Gene PriceCPT Code Copy CPT Codes
600 AXIN2$690.00 81479 Add to Order
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Turnaround Time

The great majority of tests are completed within 28 days.

Clinical Sensitivity
The clinical sensitivity of this test is currently unknown.

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Clinical Features
Oligodontia is a congenital condition where six or more permanent teeth fail to develop (Matalova et al. J Dent Res 87:617-623, 2008; Coster et al. J Oral Pathol Med 38:1-17, 2009). Often, oligodontia is included as a symptom of a syndromic genetic disorder, as in the case of Charcot-Marie-Tooth or Cleft lip/palate syndromes. However, oligodontia can also occur as an isolated condition (i.e. non-syndromic), without any other readily apparent symptoms. Several genes are known to be involved in oligodontia and tooth agenesis, including MSX1, PAX9 and AXIN2 (Nieminen et al. Eur J Hum Genet 9:743-746, 2001; Nieminen et al. J Dent Res 82:1013-1017, 2003; Mostowska et al. J Hum Genet 51:262-266, 2006). Importantly, mutations in AXIN2 were also found to segregate with colorectal neoplasia (Lammi et al. Am J Hum Genet 74:1043-1050, 2004). In patients with AXIN2 mutations, oligodontia presented at an early age when their permanent teeth failed to develop, whereas colorectal neoplasia developed much later, usually between the ages of 30 and 60. Accordingly, screening patients with non-syndromic oligodontia for mutations in the AXIN2 gene can be an effective way to identify individuals with a risk of developing colorectal cancer later in life.
Oligodontia-Colorectal Cancer (OMIM 608615) syndrome is inherited in an autosomal dominant fashion. Lammi et al. (2004) described a large, four-generation Finnish family in which nine family members presented with oligodontia. All nine were found to have a heterozygous nonsense mutation (p.Arg656Stop) in the AXIN2 gene, while none of the family members with normal dentation had the mutation. Importantly, six (67%) of the individuals with oligodontia also developed colorectal neoplasia by the age of 62. In addition to this family, the authors also screened AXIN2 in other patients with oligodontia and identified a heterozygous frameshift mutation (p.Asn666GlnfsX40) in a 13 year old boy. Interestingly, the healthy parents of this boy were not found to have the mutation, indicating it was de novo. In addition to these germline mutations, several somatic frameshift mutations in AXIN2 have been identified in colorectal tumors, further providing support for the role of AXIN2 in the development of cancer (Liu et al. Nat Genet 26:146-147, 2000).
Testing Strategy
This test involves bidirectional DNA sequencing of all 10 exons (2-11) of the AXIN2 gene, plus ~10 bp of flanking non-coding DNA on either side of each exon. We will also sequence any single exon (Test #100) in family members of patients with a known mutation or to confirm research results.
Indications for Test
Candidates for this test are patients with oligodontia. This test is specifically designed for heritable germline mutations and is not appropriate for the detection of somatic mutations in tumor tissue.


Official Gene Symbol OMIM ID
AXIN2 604025
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT


Name Inheritance OMIM ID
Oligodontia-Colorectal Cancer Syndrome 608615


Genetic Counselors
  • De Coster, P. J., (2009). "Dental agenesis: genetic and clinical perspectives." J Oral Pathol Med 38(1): 1-17. PubMed ID: 18771513
  • Lammi, L., (2004). "Mutations in AXIN2 cause familial tooth agenesis and predispose to colorectal cancer." Am J Hum Genet 74(5): 1043-50. PubMed ID: 15042511
  • Liu, W., (2000). "Mutations in AXIN2 cause colorectal cancer with defective mismatch repair by activating beta-catenin/TCF signalling." Nat Genet 26(2): 146-7. PubMed ID: 11017067
  • Matalova, E., (2008). "Tooth agenesis: from molecular genetics to molecular dentistry." J Dent Res 87(7): 617-23. PubMed ID: 18573979
  • Mostowska, A., (2006). "Axis inhibition protein 2 (AXIN2) polymorphisms may be a risk factor for selective tooth agenesis." J Hum Genet 51(3): 262-6. PubMed ID: 16432638
  • Nieminen, P., (2001). "Identification of a nonsense mutation in the PAX9 gene in molar oligodontia." Eur J Hum Genet 9(10): 743-6. PubMed ID: 11781684
  • Nieminen, P., (2003). "MSX1 gene is deleted in Wolf-Hirschhorn syndrome patients with oligodontia." J Dent Res 82(12): 1013-7. PubMed ID: 14630905
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Bi-Directional Sanger Sequencing

Test Procedure

Nomenclature for sequence variants was from the Human Genome Variation Society (  As required, DNA is extracted from the patient specimen.  PCR is used to amplify the indicated exons plus additional flanking non-coding sequence.  After cleaning of the PCR products, cycle sequencing is carried out using the ABI Big Dye Terminator v.3.0 kit.  Products are resolved by electrophoresis on an ABI 3730xl capillary sequencer.  In most cases, sequencing is performed in both forward and reverse directions; in some cases, sequencing is performed twice in either the forward or reverse directions.  In nearly all cases, the full coding region of each exon as well as 10 bases of non-coding DNA flanking the exon are sequenced.

Analytical Validity

As of February 2018, we compared 26.8 Mb of Sanger DNA sequence generated at PreventionGenetics to NextGen sequence generated in other labs. We detected only 4 errors in our Sanger sequences, and these were all due to allele dropout during PCR. For Proficiency Testing, both external and internal, in the 14 years of our lab operation we have Sanger sequenced roughly 14,300 PCR amplicons. Only one error has been identified, and this was an error in analysis of sequence data.

Our Sanger sequencing is capable of detecting virtually all nucleotide substitutions within the PCR amplicons. Similarly, we detect essentially all heterozygous or homozygous deletions within the amplicons. Homozygous deletions which overlap one or more PCR primer annealing sites are detectable as PCR failure. Heterozygous deletions which overlap one or more PCR primer annealing sites are usually not detected (see Analytical Limitations). All heterozygous insertions within the amplicons up to about 100 nucleotides in length appear to be detectable. Larger heterozygous insertions may not be detected. All homozygous insertions within the amplicons up to about 300 nucleotides in length appear to be detectable. Larger homozygous insertions may masquerade as homozygous deletions (PCR failure).

Analytical Limitations

In exons where our sequencing did not reveal any variation between the two alleles, we cannot be certain that we were able to PCR amplify both of the patient’s alleles. Occasionally, a patient may carry an allele which does not amplify, due for example to a deletion or a large insertion. In these cases, the report contains no information about the second allele.

Similarly, our sequencing tests have almost no power to detect duplications, triplications, etc. of the gene sequences.

In most cases, only the indicated exons and roughly 10 bp of flanking non-coding sequence on each side are analyzed. Test reports contain little or no information about other portions of the gene, including many regulatory regions.

In nearly all cases, we are unable to determine the phase of sequence variants. In particular, when we find two likely causative mutations for recessive disorders, we cannot be certain that the mutations are on different alleles.

Our ability to detect minor sequence variants, due for example to somatic mosaicism is limited. Sequence variants that are present in less than 50% of the patient’s nucleated cells may not be detected.

Runs of mononucleotide repeats (eg (A)n or (T)n) with n >8 in the reference sequence are generally not analyzed because of strand slippage during PCR and cycle sequencing.

Unless otherwise indicated, the sequence data that we report are based on DNA isolated from a specific tissue (usually leukocytes). Test reports contain no information about gene sequences in other tissues.

Deletion/Duplication Testing via Array Comparative Genomic Hybridization

Test Procedure

Equal amounts of genomic DNA from the patient and a gender matched reference sample are amplified and labeled with Cy3 and Cy5 dyes, respectively. To prevent any sample cross contamination, a unique sample tracking control is added into each patient sample. Each labeled patient product is then purified, quantified, and combined with the same amount of reference product. The combined sample is loaded onto the designed array and hybridized for at least 22-42 hours at 65°C. Arrays are then washed and scanned immediately with 2.5 µM resolution. Only data for the gene(s) of interest for each patient are extracted and analyzed.

Analytical Validity

PreventionGenetics' high density gene-centric custom designed aCGH enables the detection of relatively small deletions and duplications within a single exon of a given gene or deletions and duplications encompassing the entire gene. PreventionGenetics has established and verified this test's accuracy and precision.

Analytical Limitations

Our dense probe coverage may allow detection of deletions/duplications down to 100 bp; however due to limitations and probe spacing this cannot be guaranteed across all exons of all genes. Therefore, some copy number changes smaller than 100-300 bp within a targeted large exon may not be detected by our array.

This array may not detect deletions and duplications present at low levels of mosaicism or those present in genes that have pseudogene copies or repeats elsewhere in the genome.

aCGH will not detect balanced translocations, inversions, or point mutations that may be responsible for the clinical phenotype.

Breakpoints, if occurring outside the targeted gene, may be hard to define.

The sensitivity of this assay may be reduced when DNA is extracted by an outside laboratory.

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Ordering Options

myPrevent - Online Ordering
  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.
  • A completed requisition form must accompany all specimens.
  • Billing information along with specimen and shipping instructions are within the requisition form.
  • All testing must be ordered by a qualified healthcare provider.


(Delivery accepted Monday - Saturday)

  • Collect 3 ml -5 ml (5 ml preferred) of whole blood in EDTA (purple top tube) or ACD (yellow top tube). For Test #500-DNA Banking only, collect 10 ml -20 ml of whole blood.
  • For small babies, we require a minimum of 1 ml of blood.
  • Only one blood tube is required for multiple tests.
  • Ship blood tubes at room temperature in an insulated container. Do not freeze blood.
  • During hot weather, include a frozen ice pack in the shipping container. Place a paper towel or other thin material between the ice pack and the blood tube.
  • In cold weather, include an unfrozen ice pack in the shipping container as insulation.
  • At room temperature, blood specimen is stable for up to 48 hours.
  • If refrigerated, blood specimen is stable for up to one week.
  • Label the tube with the patient name, date of birth and/or ID number.


(Delivery accepted Monday - Saturday)

  • Send in screw cap tube at least 5 µg -10 µg of purified DNA at a concentration of at least 20 µg/ml for NGS and Sanger tests and at least 5 µg of purified DNA at a concentration of at least 100 µg/ml for gene-centric aCGH, MLPA, and CMA tests, minimum 2 µg for limited specimens.
  • For requests requiring more than one test, send an additional 5 µg DNA per test ordered when possible.
  • DNA may be shipped at room temperature.
  • Label the tube with the composition of the solute, DNA concentration as well as the patient’s name, date of birth, and/or ID number.
  • We only accept genomic DNA for testing. We do NOT accept products of whole genome amplification reactions or other amplification reactions.


(Delivery preferred Monday - Thursday)

  • PreventionGenetics should be notified in advance of arrival of a cell culture.
  • Culture and send at least two T25 flasks of confluent cells.
  • Some panels may require additional flasks (dependent on size of genes, amount of Sanger sequencing required, etc.). Multiple test requests may also require additional flasks. Please contact us for details.
  • Send specimens in insulated, shatterproof container overnight.
  • Cell cultures may be shipped at room temperature or refrigerated.
  • Label the flasks with the patient name, date of birth, and/or ID number.
  • We strongly recommend maintaining a local back-up culture. We do not culture cells.
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