De novo variants were excluded from this analysis, leaving 1122 rare (ExAC allele frequency < 2 x10−5), transmitted LOF variants and 3115 transmitted damaging (LOF + D-mis) variants. All genes closely matched expectation, with the exception of SMAD6. (a) There were 6 transmitted SMAD6 LOF mutations, a 118-fold enrichment compared to the expected 0.05 (p=2.2 × 10–11). (b) Similarly, there were 10 transmitted damaging SMAD6 variants, a 71-fold enrichment compared to the expected 0.14 (p=7.0 × 10–16). The results demonstrate genome-wide significance of rare transmitted variants in SMAD6 independent of de novo mutations.