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Background Premature ovarian insufficiency (POI) plagues 1% of women under 40, while quite a few remain an unknown cause. The development of sequencing has helped find pathogenic genes and reveal the relationship between DNA repair and ovarian reserve. Through the exome sequencing, our study targets screening out the possible POI pathogenic gene and variants in a Chinese family and 20 sporadic POI patients, preliminarily exploring the functional impact and finding out potential linkages between the gene and POI. Results The whole exome sequencing suggested a novel  FMN2  heterozygous variant c.1949C &gt; T (p.Ser650Leu) carried by all three patients in a Chinese family and another c.1967G &gt; A(p.Arg656His) variant in a sporadic case. Since no  FMN2  missense mutation is reported for causing human POI, we preliminarily assessed p.Ser650Leu variant via cross-species alignment and 3D modeling and found it possibly deleterious. A series of functional evidence was consistent with our hypothesis. We proved the expression of FMN2 in different stages of oocytes and observed a statistical difference of chromosomal breakages between the POI patient carrying p.Arg656His variant and the health control ( p  = 0.0013). Western Blot also suggested a decrease in FMN2 and P21 in the mutant type and an associated increase in H2AX. The p.Arg656His variant with an extremely low frequency also indicated that the gene  FMN2  might play an essential role in the genetic etiology of POI. To the best of our knowledge, this is the first POI report on missense variants of  FMN2 . Conclusion This finding indicates a novel gene possibly related to POI and sheds lights on the study of  FMN2 .

Heterozygous FMN2 missense variant found in a family case of premature ovarian insufficiency