PEX6 and peroxisome biogenesis disorder: For example, Zellweger spectrum disorder (ZSD) is an autosomal recessive disorder caused by deleterious variants in any of 13 PEX genes, with the most common cause being variants in PEX1 or PEX6. Affected heterozygous carriers have been identified with ZSD despite lacking a second pathogenic allele, with all affected heterozygotes presenting with the allelic overexpression of the variant allele compared to WT, and a common polymorphism has been linked to this allelic overexpression (Falkenberg et al., 2017).