A systematic review and critical analysis of the evidence for transmission ratio distortion in humans

Mendel's law of equal segregation states that during gamete formation, the 2 alleles at a gene locus segregate such that each gamete has an equal probability of containing either allele. Transmission ratio distortion (TRD) occurs when 1 of the 2 alleles from either parent is preferentially transmitted to the offspring, resulting in a deviation from the expected 1:1 ratio. Although TRD has been observed and studied in nonhuman species, the full extent and underlying biology of TRD in humans remains poorly summarized. Here we present a systematic review to assess evidence of TRD in the human genome, tracing reports from the 1970s through 2025. Overall, 96 studies including 42 different human variants/genes/loci met inclusion criteria. These studies provided only preliminary and/or conflicting evidence of TRD. Study methods were limited by multiple recurrent biases. Experimental validation of the biological mechanism(s) underlying the putative distortion was rarely performed or possible. TRD warrants renewed attention in the field of human genetics, especially with the growing availability of very large, family-based genome-wide sequencing datasets.