INTS2

gene
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Also known as INT2

Summary

INTS2 (integrator complex subunit 2, HGNC:29241) is a protein-coding gene on chromosome 17q23.2, encoding Integrator complex subunit 2 (Q9H0H0). Component of the integrator complex, a multiprotein complex that terminates RNA polymerase II (Pol II) transcription in the promoter-proximal region of genes. It is a common-essential gene (DepMap: required in 93.9% of cancer cell lines).

INTS2 is a subunit of the Integrator complex, which associates with the C-terminal domain of RNA polymerase II large subunit (POLR2A; MIM 180660) and mediates 3-prime end processing of small nuclear RNAs U1 (RNU1; MIM 180680) and U2 (RNU2; MIM 180690) (Baillat et al., 2005 [PubMed 16239144]).

Source: NCBI Gene 57508 — RefSeq curated summary.

At a glance

  • GWAS associations: 1
  • Clinical variants (ClinVar): 159 total — 1 pathogenic
  • Cancer dependency (DepMap): dependent in 93.9% of screened cell lines (common-essential)
  • MANE Select transcript: NM_001351695

Identifiers

Gene identifiers

FieldValue
HGNC IDHGNC:29241
Approved symbolINTS2
Nameintegrator complex subunit 2
Location17q23.2
Locus typegene with protein product
StatusApproved
AliasesINT2
Ensembl geneENSG00000108506
Ensembl biotypeprotein_coding
OMIM611346
Entrez57508

Gene structure

Transcript identifiers

Ensembl transcripts: 19 — 15 protein_coding, 3 retained_intron, 1 nonsense_mediated_decay

ENST00000251334, ENST00000444766, ENST00000578805, ENST00000583076, ENST00000583822, ENST00000584967, ENST00000646745, ENST00000646954, ENST00000647009, ENST00000866719, ENST00000866720, ENST00000866721, ENST00000913652, ENST00000913653, ENST00000913654, ENST00000913655, ENST00000913656, ENST00000963385, ENST00000963386

RefSeq mRNA: 3 — MANE Select: NM_001351695 NM_001330417, NM_001351695, NM_020748

CCDS: CCDS45750, CCDS82181

Canonical transcript exons

ENST00000251334 — 25 exons

ExonStartEnd
ENSE000007409376186783361868009
ENSE000007409586188978661889894
ENSE000007409606189151361891689
ENSE000007409646189376561893899
ENSE000007409676189531561895383
ENSE000007409696189746961897583
ENSE000007409716189766861897739
ENSE000008204486192496161925099
ENSE000009252536190446061904585
ENSE000009252546190740861907634
ENSE000009252556191152061911693
ENSE000009252566191194061912070
ENSE000009252576191940061919513
ENSE000009252586192172561921827
ENSE000011130766187226561872460
ENSE000011130776186927361869380
ENSE000011130786186903461869139
ENSE000011130796186973761869988
ENSE000034988796188490161885005
ENSE000035502616187491361875038
ENSE000035663406192635261926662
ENSE000035833096187788761878088
ENSE000036519106188100761881171
ENSE000037374816186536761867726
ENSE000038194576192765461927982

Expression profiles

Bgee: expression breadth ubiquitous, 249 present calls, max score 94.39.

FANTOM5 (CAGE): breadth ubiquitous, TPM avg 11.1817 / max 143.5361, expressed in 1733 samples.

FANTOM5 promoters (3 alternative TSS)

Promoter IDTPM avgSamples expressed
1674088.89261688
1674071.6890941
1674090.6001319

Top tissues by expression

253 total, by Bgee expression score (0-100, higher = more expressed):

TissueAnatomy IDExpression scoreQuality
oviduct epitheliumUBERON:000480494.39gold quality
endothelial cellCL:000011584.23gold quality
Brodmann (1909) area 23UBERON:001355483.63gold quality
middle temporal gyrusUBERON:000277182.30gold quality
male germ line stem cell (sensu Vertebrata) in testisCL:0000089 ∩ UBERON:000047382.20gold quality
primordial germ cell in gonadCL:0000670 ∩ UBERON:000099182.17gold quality
esophagus squamous epitheliumUBERON:000692081.89gold quality
calcaneal tendonUBERON:000370181.80gold quality
germinal epithelium of ovaryUBERON:000130480.56gold quality
epithelial cell of pancreasCL:000008379.96gold quality
tibiaUBERON:000097979.96gold quality
ventricular zoneUBERON:000305379.81gold quality
islet of LangerhansUBERON:000000679.68gold quality
caput epididymisUBERON:000435879.57gold quality
adrenal tissueUBERON:001830379.37gold quality
mucosa of paranasal sinusUBERON:000503078.87gold quality
bone marrow cellCL:000209278.82gold quality
colonic epitheliumUBERON:000039778.60gold quality
cauda epididymisUBERON:000436078.59gold quality
visceral pleuraUBERON:000240178.54gold quality
epithelium of nasopharynxUBERON:000195178.53gold quality
oral cavityUBERON:000016778.33gold quality
fallopian tubeUBERON:000388978.21gold quality
gingival epitheliumUBERON:000194978.08gold quality
primary visual cortexUBERON:000243678.08gold quality
parietal pleuraUBERON:000240078.06gold quality
corpus callosumUBERON:000233677.77gold quality
cerebellar cortexUBERON:000212977.67gold quality
cerebellar hemisphereUBERON:000224577.65gold quality
gingivaUBERON:000182877.32gold quality

Single-cell (SCXA)

Detected in 3 experiment(s), a significant marker in 1.

ExperimentMarker?Max mean expression
E-ANND-3yes5.62
E-CURD-10no374.81
E-MTAB-6386no372.10

Regulation

Is transcription factor: no

miRNA regulators (miRDB)

114 targeting INTS2, top 30 by miRDB confidence (max_score; target_count = how many genes the miRNA targets in total — lower means more specific):

miRNAMax scoreAvg scoremiRNA target_count
HSA-MIR-340-5P100.0072.504437
HSA-MIR-4425100.0067.591049
HSA-MIR-30B-5P100.0076.293248
HSA-MIR-30C-5P100.0076.293248
HSA-MIR-186-5P99.9970.833707
HSA-MIR-450099.9972.722367
HSA-MIR-548C-3P99.9974.017587
HSA-MIR-371B-5P99.9975.344759
HSA-MIR-569699.9872.364487
HSA-MIR-1213699.9872.815713
HSA-LET-7A-5P99.9872.291790
HSA-LET-7B-5P99.9872.311790
HSA-LET-7C-5P99.9872.291790
HSA-LET-7E-5P99.9872.291790
HSA-LET-7F-5P99.9872.561784
HSA-LET-7G-5P99.9872.371784
HSA-LET-7I-5P99.9872.371788
HSA-MIR-98-5P99.9872.331787
HSA-MIR-433-3P99.9869.371203
HSA-MIR-520D-5P99.9873.344883
HSA-MIR-524-5P99.9873.434882
HSA-MIR-3617-3P99.9867.86918
HSA-MIR-3692-3P99.9870.272139
HSA-MIR-373-5P99.9875.364753
HSA-MIR-616-5P99.9875.584775
HSA-MIR-314899.9775.066478
HSA-MIR-3065-5P99.9771.563281
HSA-MIR-302C-5P99.9772.563642
HSA-MIR-548AT-5P99.9670.832666
HSA-MIR-146A-5P99.9668.93988

Functional genomics

DepMap (CRISPR cell-line fitness): dependent in 93.9% of screened cell lines, common-essential.

Literature-anchored findings (GeneRIF, showing 1)

  • Mutation in INTS2 gene is associated with gastric cancer peritoneal carcinomatosis. (PMID:26811494)

Cross-species orthologs

5 orthologs

OrganismSymbolGene ID
danio_rerioints2ENSDARG00000069085
mus_musculusInts2ENSMUSG00000018068
rattus_norvegicusBrip1ENSRNOG00000059997
drosophila_melanogasterIntS2FBGN0030858
caenorhabditis_elegansWBGENE00013877

Protein

Protein identifiers

Integrator complex subunit 2Q9H0H0 (reviewed: Q9H0H0)

All UniProt accessions (5): Q9H0H0, A0A2R8Y4Z6, A0A2R8Y7F8, J3KMZ7, J3KRH0

UniProt curated annotations — full annotation on UniProt →

Function. Component of the integrator complex, a multiprotein complex that terminates RNA polymerase II (Pol II) transcription in the promoter-proximal region of genes. The integrator complex provides a quality checkpoint during transcription elongation by driving premature transcription termination of transcripts that are unfavorably configured for transcriptional elongation: the complex terminates transcription by (1) catalyzing dephosphorylation of the C-terminal domain (CTD) of Pol II subunit POLR2A/RPB1 and SUPT5H/SPT5, (2) degrading the exiting nascent RNA transcript via endonuclease activity and (3) promoting the release of Pol II from bound DNA. The integrator complex is also involved in terminating the synthesis of non-coding Pol II transcripts, such as enhancer RNAs (eRNAs), small nuclear RNAs (snRNAs), telomerase RNAs and long non-coding RNAs (lncRNAs). Mediates recruitment of cytoplasmic dynein to the nuclear envelope, probably as component of the integrator complex.

Subunit / interactions. Component of the Integrator complex, composed of core subunits INTS1, INTS2, INTS3, INTS4, INTS5, INTS6, INTS7, INTS8, INTS9/RC74, INTS10, INTS11/CPSF3L, INTS12, INTS13, INTS14 and INTS15. The core complex associates with protein phosphatase 2A subunits PPP2CA and PPP2R1A, to form the Integrator-PP2A (INTAC) complex.

Subcellular location. Nucleus. Nucleus membrane. Cytoplasm.

Similarity. Belongs to the Integrator subunit 2 family.

RefSeq proteins (3): NP_001317346, NP_001338624, NP_065799 (=MANE)

Domains & families (InterPro)

IDNameType
IPR026236Int2_metazoaFamily
IPR029321INTS2Family

Pfam: PF14750

UniProt features (93 total): helix 74, strand 9, turn 7, chain 1, transmembrane region 1, sequence variant 1

Structure

Experimental structures (PDB)

8 structures.

PDBMethodResolution (Å)
8RC4ELECTRON MICROSCOPY3.1
7CUNELECTRON MICROSCOPY3.5
7PKSELECTRON MICROSCOPY3.6
8RBZELECTRON MICROSCOPY3.7
8RBXELECTRON MICROSCOPY4.1
8YJBELECTRON MICROSCOPY4.1
7YCXELECTRON MICROSCOPY4.18
9VD9ELECTRON MICROSCOPY4.6

Predicted structure (AlphaFold)

ModelpLDDTFraction very-high
AF-Q9H0H0-F178.900.27

Function

Pathways and Gene Ontology

Reactome pathways

3 pathways

IDPathway
R-HSA-6807505RNA polymerase II transcribes snRNA genes
R-HSA-73857RNA Polymerase II Transcription
R-HSA-74160Gene expression (Transcription)

MSigDB gene sets: 134 (showing top): GOBP_MACROMOLECULE_CATABOLIC_PROCESS, ATGTTAA_MIR302C, MONNIER_POSTRADIATION_TUMOR_ESCAPE_UP, GOBP_RNA_SURVEILLANCE, MODULE_285, TGCTGAY_UNKNOWN, ATTCTTT_MIR186, GOBP_DNA_TEMPLATED_TRANSCRIPTION_INITIATION, GARY_CD5_TARGETS_DN, GOBP_TRANSCRIPTION_INITIATION_AT_RNA_POLYMERASE_II_PROMOTER, ATCATGA_MIR433, ZHANG_BREAST_CANCER_PROGENITORS_UP, GOBP_SNRNA_PROCESSING, NIKOLSKY_BREAST_CANCER_17Q21_Q25_AMPLICON, GOBP_REGULATION_OF_DNA_TEMPLATED_TRANSCRIPTION_ELONGATION

GO Biological Process (4): snRNA processing (GO:0016180), regulation of transcription elongation by RNA polymerase II (GO:0034243), snRNA 3’-end processing (GO:0034472), RNA polymerase II transcription initiation surveillance (GO:0160240)

GO Molecular Function (1): protein binding (GO:0005515)

GO Cellular Component (7): nucleus (GO:0005634), nucleoplasm (GO:0005654), cytoplasm (GO:0005737), membrane (GO:0016020), nuclear membrane (GO:0031965), integrator complex (GO:0032039), INTAC complex (GO:0160232)

Reactome top-level categories

Rollup of top-2 pathways:

CategoryPathways
RNA Polymerase II Transcription1
Gene expression (Transcription)1

GO top-level categories

Rollup of top GO terms by namespace:

CategoryTerms
cellular anatomical structure3
nuclear protein-containing complex2
RNA processing1
snRNA metabolic process1
transcription elongation by RNA polymerase II1
regulation of DNA-templated transcription elongation1
snRNA processing1
RNA 3’-end processing1
transcription initiation at RNA polymerase II promoter1
nuclear RNA surveillance1
binding1
intracellular membrane-bounded organelle1
nuclear lumen1
intracellular anatomical structure1
nucleus1
nuclear envelope1
organelle membrane1
integrator complex1

Protein interactions and networks

STRING

2024 interactions, top by confidence (×1000):

Protein AProtein BPartner UniProtScore
INTS2INTS11Q5TA45913
INTS2INTS1Q8N201897
INTS2INTS5Q6P9B9874
INTS2INTS4Q96HW7831
INTS2INTS8Q75QN2799
INTS2INTS3Q68E01775
INTS2INTS6Q9UL03724
INTS2INTS9Q9NV88719
INTS2INTS7Q9NVH2713
INTS2INTS12Q96CB8665
INTS2INTS13Q9NVM9664
INTS2INTS10Q9NVR2606
INTS2MED13Q9UHV7557
INTS2POLR2AP24928548
INTS2CHCT1Q86WR6546

IntAct

120 interactions, top by confidence:

ABTypeScore
PPP2R1ASTRNpsi-mi:“MI:0914”(association)0.880
POLR2CSUPT5Hpsi-mi:“MI:0914”(association)0.640
SCN2BEXOC5psi-mi:“MI:0914”(association)0.640
VSIG1TTI1psi-mi:“MI:0914”(association)0.640
GYPATCAF2psi-mi:“MI:0914”(association)0.640
CCDC57INTS2psi-mi:“MI:0915”(physical association)0.560
INTS2DEF6psi-mi:“MI:0915”(physical association)0.560
NCK2INTS2psi-mi:“MI:0915”(physical association)0.560
FAM174ABLTP3Bpsi-mi:“MI:0914”(association)0.530
APLNRMETTL15psi-mi:“MI:0914”(association)0.530
SLC15A1METTL15psi-mi:“MI:0914”(association)0.530
CD274TTI1psi-mi:“MI:0914”(association)0.530
SUPT5HPOLR2Dpsi-mi:“MI:0914”(association)0.530
TMEM9ESYT2psi-mi:“MI:0914”(association)0.530
DPEP1ILVBLpsi-mi:“MI:0914”(association)0.530
CD70METTL15psi-mi:“MI:0914”(association)0.530
VSIG1TNPO2psi-mi:“MI:0914”(association)0.530
STK16UNC119Bpsi-mi:“MI:0914”(association)0.530
ILVBLSLC33A1psi-mi:“MI:0914”(association)0.530
APLNRSLC33A1psi-mi:“MI:0914”(association)0.530
CD40EXOC5psi-mi:“MI:0914”(association)0.530
LPAR1TMEM223psi-mi:“MI:0914”(association)0.530
P2RY10ATMpsi-mi:“MI:0914”(association)0.530
TGOLN2DENND11psi-mi:“MI:0914”(association)0.530

BioGRID (141): INTS2 (Affinity Capture-MS), INTS2 (Affinity Capture-MS), INTS2 (Affinity Capture-MS), INTS2 (Affinity Capture-MS), INTS2 (Affinity Capture-MS), ABCF3 (Co-fractionation), C7orf26 (Co-fractionation), INTS1 (Co-fractionation), INTS2 (Co-fractionation), INTS2 (Co-fractionation), INTS2 (Co-fractionation), INTS2 (Co-fractionation), RPP30 (Co-fractionation), INTS2 (Proximity Label-MS), INTS2 (Affinity Capture-MS)

ESM2 similar proteins: A1Z8X3, A1ZAK1, G5ED39, H2QII6, O01510, O08662, O94668, P42173, P42286, P49792, Q00416, Q03280, Q0IEK6, Q10573, Q10669, Q13535, Q18508, Q18892, Q196Z9, Q29L39, Q2U639, Q5EAK6, Q5EB59, Q5RIW8, Q5ZKU4, Q61CW2, Q61WP7, Q6CP76, Q6CT34, Q6V3W0, Q70PP2, Q751J3, Q756G2, Q75DV4, Q80YQ2, Q8IRS9, Q8IRT0, Q9DE14, Q9GNN7, Q9H0H0

Diamond homologs: Q5ZKU4, Q80UK8, Q9H0H0, Q9VX31

SIGNOR signaling

1 interactions.

AEffectBMechanism
INTS2“form complex”“Integrator complex”binding

Enriched among interaction partners

Reactome pathways and GO biological processes over-represented among this gene’s 142 IntAct physical interaction partners (hypergeometric vs the genome-wide background, BH-FDR, gene-set size 15–500, ranked by fold). A functional readout of the neighbourhood — distinct from this gene’s own memberships above, and biased toward well-studied / hub proteins, so read it as themes rather than proof.

Reactome pathways:

PathwayPartnersFoldFDR
FGFR2 mutant receptor activation649.1×1e-07
Signaling by FGFR2 IIIa TM638.8×3e-07
Abortive elongation of HIV-1 transcript in the absence of Tat737.4×5e-08
Pausing and recovery of Tat-mediated HIV elongation831.7×3e-08
Tat-mediated HIV elongation arrest and recovery831.7×3e-08
RNA Pol II CTD phosphorylation and interaction with CE during HIV infection730.7×1e-07
Signaling by FGFR2730.7×1e-07
RNA Pol II CTD phosphorylation and interaction with CE730.7×1e-07

GO biological processes:

GO termPartnersFoldFDR
positive regulation of cytosolic calcium ion concentration98.6×5e-04
G protein-coupled receptor signaling pathway164.7×2e-04

Disease & clinical

Clinical variants and AI predictions

ClinVar

159 variants total. Per-class counts are floors (≥ shown; pagination cap):

ClassificationCount (floor)
Pathogenic1
Likely pathogenic0
Uncertain significance126
Likely benign5
Benign2

Top pathogenic / likely-pathogenic (1)

Variant IDHGVSClassification
2685605GRCh37/hg19 17q23.2(chr17:59960921-60036130)x1Pathogenic

SpliceAI

4450 predictions. Top by Δscore:

VariantEffectΔscore
17:61867724:GACC:Gacceptor_loss1.0000
17:61867725:ACC:Aacceptor_loss1.0000
17:61867727:C:CCacceptor_gain1.0000
17:61867728:T:Aacceptor_loss1.0000
17:61867828:CTTA:Cdonor_loss1.0000
17:61867830:TACGT:Tdonor_loss1.0000
17:61867831:A:ACdonor_gain1.0000
17:61867831:A:Cdonor_loss1.0000
17:61867832:C:CCdonor_gain1.0000
17:61867832:CG:Cdonor_gain1.0000
17:61868005:TAAAA:Tacceptor_gain1.0000
17:61868006:AAAA:Aacceptor_gain1.0000
17:61868007:AAA:Aacceptor_gain1.0000
17:61868008:AA:Aacceptor_gain1.0000
17:61868009:AC:Aacceptor_loss1.0000
17:61868010:C:CCacceptor_gain1.0000
17:61868011:T:Gacceptor_loss1.0000
17:61869756:G:Cdonor_gain1.0000
17:61869813:A:Cdonor_gain1.0000
17:61869816:T:TAdonor_gain1.0000
17:61869849:T:TAdonor_gain1.0000
17:61869858:C:Adonor_gain1.0000
17:61869890:TTGA:Tdonor_gain1.0000
17:61869904:A:Cdonor_gain1.0000
17:61869984:CTATC:Cacceptor_gain1.0000
17:61869985:TATC:Tacceptor_gain1.0000
17:61869987:TC:Tacceptor_gain1.0000
17:61869987:TCC:Tacceptor_loss1.0000
17:61869988:CC:Cacceptor_gain1.0000
17:61869988:CCTA:Cacceptor_loss1.0000

AlphaMissense

7858 scored. Top likely-pathogenic:

VariantProtein changeam_pathogenicity
17:61869301:A:GL1045P1.000
17:61869740:A:CF1017L1.000
17:61869740:A:TF1017L1.000
17:61869742:A:GF1017L1.000
17:61869750:A:GL1014P1.000
17:61869774:A:TI1006N1.000
17:61869983:A:CS936R1.000
17:61869983:A:TS936R1.000
17:61869985:T:GS936R1.000
17:61877918:A:GW817R1.000
17:61877918:A:TW817R1.000
17:61891684:C:AW576C1.000
17:61891684:C:GW576C1.000
17:61891686:A:GW576R1.000
17:61891686:A:TW576R1.000
17:61893789:A:CF566L1.000
17:61893789:A:TF566L1.000
17:61893790:A:GF566S1.000
17:61893791:A:GF566L1.000
17:61893805:A:GL561P1.000
17:61893808:A:GL560P1.000
17:61893883:G:TA535E1.000
17:61893884:C:GA535P1.000
17:61893895:A:TV531D1.000
17:61895324:A:CF526L1.000
17:61895324:A:TF526L1.000
17:61895326:A:GF526L1.000
17:61897536:G:TA484D1.000
17:61897708:A:GW455R1.000
17:61897708:A:TW455R1.000

dbSNP variants (sampled 300 via entrez): RS1000107733 (17:61927177 G>A), RS1000109048 (17:61901735 C>A,T), RS1000145604 (17:61908150 C>G), RS1000198683 (17:61907907 C>T), RS1000260376 (17:61895775 C>G,T), RS1000311570 (17:61881631 A>C), RS1000343646 (17:61881363 G>A,C), RS1000526561 (17:61888577 G>A), RS1000536066 (17:61906260 C>T), RS1000599453 (17:61897332 T>A,C), RS1000644056 (17:61883225 C>T), RS1000834763 (17:61920636 G>A), RS1000846445 (17:61918250 T>C), RS1000853646 (17:61877267 G>A,T), RS1000859091 (17:61901570 A>C)

Disease associations

OMIM: gene MIM:611346 | disease phenotypes: MIM:258040

GenCC curated gene-disease

Mondo (1): exstrophy-epispadias complex (MONDO:0017919)

Orphanet (2): Exstrophy-epispadias complex (Orphanet:322), Cloacal exstrophy (Orphanet:93929)

HPO phenotypes

0 total (0 of 0 shown, HPO-id order):

GWAS associations

1 associations (top):

StudyTraitp-value
GCST90002397_582Mean spheric corpuscular volume4.000000e-12

Drugs & pharmacology

Drug and pharmacology data

Is drug target: no

PharmGKB: 1 entry (VIP=true, CPIC=false)

CTD chemical–gene interactions

30 total (human), top 30 by PubMed support.

ChemicalActions (top 5)PubMed papers
Aflatoxin B1affects expression, increases methylation3
Hydrogen Peroxideaffects expression2
Cyclosporinedecreases expression2
triphenyl phosphateaffects expression1
bisphenol Aincreases expression1
salinomycindecreases expression1
manganese chlorideincreases abundance, increases expression1
nickel sulfateincreases expression1
beta-methylcholineaffects expression1
cyanoginosin LRincreases expression1
di-n-butylphosphoric acidaffects expression1
CGP 52608affects binding, increases reaction1
jinfukangdecreases expression1
Resveratrolaffects cotreatment, increases expression1
Air Pollutantsincreases abundance, decreases expression1
Carbamazepineaffects expression1
Cisplatindecreases expression1
Doxorubicindecreases expression1
Manganeseincreases abundance, increases expression1
Ozoneincreases expression1
Plant Extractsaffects cotreatment, increases expression1
Smokedecreases expression1
Tobacco Smoke Pollutiondecreases expression1
Tretinoindecreases expression1
Valproic Aciddecreases expression1
7,8-Dihydro-7,8-dihydroxybenzo(a)pyrene 9,10-oxidedecreases expression1
Copper Sulfatedecreases expression1
Lactic Aciddecreases expression1
Acrylamideincreases expression1
Particulate Matterdecreases expression, increases abundance1

Clinical trials (associated diseases)

2 trials via MONDO — disease-level, not drug-specific.

TrialPhaseStatusTitle
NCT04760028PHASE4COMPLETEDStudy on the Influencing Factors of Electroencephalogram Parameters Under Anesthesia
NCT06106425Not specifiedUNKNOWNDiagnostic and Prognostic Criteria of EEG in Neonatal Convulsions at Assiut University Children Hospital
  • Disease cohort memberships (association, not causation — diseases whose associated-gene cohort lists this gene; a subset are also under Associated diseases): exstrophy-epispadias complex