Uniparental Disomy Reveals Hidden Genetic Causes of Congenital Heart Disease.

Congenital heart disease (CHD) affects ~1% of live births, yet the genetic basis of many cases remains unresolved. Uniparental disomy (UPD), the inheritance of both homologous chromosomes from one parent, is often overlooked. We developed TrioMix-UPD, an integrated short- and long-read sequencing framework for UPD detection and classification. Applying it to 3,740 CHD trios, we identified 12 UPD events, representing a 6.57-fold enrichment relative to the general population. Both advanced maternal age and enrichment of rare inherited variants in synaptonemal complex genes implicated meiotic chromosome segregation defects in UPD risk. Within UPD regions, we identified pathogenic homozygous variants in PIEZO1 and GLYR1 and nominate MESD as a novel CHD candidate gene. Functional studies in zebrafish and human cells recapitulated patient-specific cardiac phenotypes. Differential methylation analyses implicated imprinting dysregulation, including at the Prader-Willi critical region. Collectively, these findings establish UPD as an underrecognized contributor to CHD.