Skip navigation

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock ( ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

URL of this page:

MSX2 gene

msh homeobox 2

Normal Function

The MSX2 gene provides instructions for producing a protein that is necessary for proper development of cells and tissues throughout the body. The MSX2 protein is a transcription factor, which means it attaches (binds) to specific regions of DNA and helps control the activity of certain genes. Specifically, the protein controls the activity of genes that regulate cell growth and division (proliferation), cell maturation and specialization (differentiation), and cell survival. The regulation of these functions ensures that cells start and stop growing at specific times and that they are positioned correctly during development.

The MSX2 protein is part of a chemical signaling pathway known as the bone morphogenic protein (BMP) pathway. This signaling pathway regulates various cellular processes and is involved in the growth of cells, including new bone cells. The MSX2 protein seems to be particularly critical for the development of the skull.

Health Conditions Related to Genetic Changes

Enlarged parietal foramina

At least 10 mutations in the MSX2 gene have been identified in people with enlarged parietal foramina type 1. This condition is characterized by enlarged openings (foramina) in the parietal bones, which are the two bones that form the top and sides of the skull. Openings in the parietal bones are normal during fetal development, but they usually close before birth. In people with this condition, the parietal foramina remain open throughout life.

The mutations that cause enlarged parietal foramina result in the production of an MSX2 protein that cannot bind to DNA, which alters the regulation of multiple genes. As a result, several cell processes are disrupted, including proliferation, differentiation, and survival. In early development, the skull seems to be particularly sensitive to changes in MSX2 protein activity and changes in cell function. Specifically, cells in the skull that are involved in bone formation (ossification) cannot function normally, leading to a lack of bone in areas of the skull and enlarged parietal foramina.

More About This Health Condition

Other disorders

At least two mutations in the MSX2 gene cause a condition called craniosynostosis type 2 (also known as Boston type craniosynostosis). Craniosynostosis involves premature closure of the bones of the skull, leading to a misshapen head. People with craniosynostosis type 2 can have skull malformations including a protruding forehead (frontal bossing), a short wide head that is pointed at the top (turribrachycephaly), or a cloverleaf-shaped skull (Kleeblattschaedel deformity). Most affected people have vision problems, and a few have experienced seizures. Intelligence is typically normal.

It is unclear how changes in the MSX2 gene can cause premature closure of the skull bones in craniosynostosis type 2 and impaired bone formation in enlarged parietal foramina (described above).

Other Names for This Gene

  • CRS2
  • FPP
  • HOX8
  • MSH
  • msh homeobox homolog 2
  • PFM
  • PFM1

Additional Information & Resources

Tests Listed in the Genetic Testing Registry

Scientific Articles on PubMed

Catalog of Genes and Diseases from OMIM

Gene and Variant Databases


  • Florisson JM, Verkerk AJ, Huigh D, Hoogeboom AJ, Swagemakers S, Kremer A, Heijsman D, Lequin MH, Mathijssen IM, van der Spek PJ. Boston type craniosynostosis: report of a second mutation in MSX2. Am J Med Genet A. 2013 Oct;161A(10):2626-33. doi: 10.1002/ajmg.a.36126. Epub 2013 Aug 15. Citation on PubMed
  • Griessenauer CJ, Veith P, Mortazavi MM, Stewart C, Grochowsky A, Loukas M, Tubbs RS. Enlarged parietal foramina: a review of genetics, prognosis, radiology, and treatment. Childs Nerv Syst. 2013 Apr;29(4):543-7. doi: 10.1007/s00381-012-1982-7. Epub 2012 Dec 4. Citation on PubMed
  • Wilkie AO, Tang Z, Elanko N, Walsh S, Twigg SR, Hurst JA, Wall SA, Chrzanowska KH, Maxson RE Jr. Functional haploinsufficiency of the human homeobox gene MSX2 causes defects in skull ossification. Nat Genet. 2000 Apr;24(4):387-90. doi: 10.1038/74224. Citation on PubMed
  • Wu Q, Zhang L, Su P, Lei X, Liu X, Wang H, Lu L, Bai Y, Xiong T, Li D, Zhu Z, Duan E, Jiang E, Feng S, Han M, Xu Y, Wang F, Zhou J. MSX2 mediates entry of human pluripotent stem cells into mesendoderm by simultaneously suppressing SOX2 and activating NODAL signaling. Cell Res. 2015 Dec;25(12):1314-32. doi: 10.1038/cr.2015.118. Epub 2015 Oct 2. Citation on PubMed or Free article on PubMed Central
  • Wuyts W, Reardon W, Preis S, Homfray T, Rasore-Quartino A, Christians H, Willems PJ, Van Hul W. Identification of mutations in the MSX2 homeobox gene in families affected with foramina parietalia permagna. Hum Mol Genet. 2000 May 1;9(8):1251-5. doi: 10.1093/hmg/9.8.1251. Citation on PubMed

The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.