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5
Pathophys.
8
Phenotypes
5
Pathograph
6
Genes
3
Treatments
6
Subtypes
1
Deep Research

Subtypes

6
AOS1 (ARHGAP31, autosomal dominant)
Autosomal dominant form caused by gain-of-function mutations in ARHGAP31, encoding a Rho GTPase-activating protein. The mutant protein shows constitutive Cdc42/Rac1 GAP activity, disrupting cytoskeletal dynamics and cell migration.
Show evidence (1 reference)
PMID:21565291 SUPPORT Human Clinical
"Candidate-gene- and exome-based sequencing led to the identification of independent premature truncating mutations in the terminal exon of the Rho GTPase-activating protein 31 gene, ARHGAP31, which encodes a Cdc42/Rac1 regulatory protein."
Original identification of ARHGAP31 as causative for autosomal dominant AOS.
AOS2 (DOCK6, autosomal recessive)
Autosomal recessive form caused by loss-of-function mutations in DOCK6, a guanine nucleotide exchange factor for Cdc42 and Rac1. Loss of DOCK6 function impairs cytoskeletal regulation and cell migration.
Show evidence (1 reference)
PMID:21820096 SUPPORT Human Clinical
"we combined autozygome analysis with exome sequencing to identify a homozygous truncating mutation in dedicator of cytokinesis 6 gene (DOCK6) which encodes an atypical guanidine exchange factor (GEF) known to activate two members of the Rho GTPase family: Cdc42 and Rac1."
Original identification of DOCK6 as causative for autosomal recessive AOS.
AOS3 (RBPJ, autosomal dominant)
Autosomal dominant form caused by dominant-negative mutations in RBPJ, the central transcriptional mediator of canonical Notch signaling. Mutant RBPJ retains cofactor binding but has impaired DNA binding, sequestering Notch pathway cofactors from target gene promoters.
Show evidence (1 reference)
PMID:22883147 SUPPORT Human Clinical
"we identified two unique mutations in recombination signal binding protein for immunoglobulin kappa J (RBPJ) in two independent families affected by Adams-Oliver syndrome (AOS)"
Original identification of RBPJ mutations in AOS families.
AOS4 (EOGT, autosomal recessive)
Autosomal recessive form caused by loss-of-function mutations in EOGT, which encodes an EGF-domain-specific O-linked N-acetylglucosamine transferase that modifies Notch receptors.
Show evidence (1 reference)
PMID:23522784 SUPPORT Human Clinical
"exome sequencing in one family revealed one missense mutation in EOGT (C3orf64), and subsequent targeted sequencing of this gene revealed a homozygous missense mutation and a homozygous frameshift deletion mutation in the other two families."
Original identification of EOGT mutations in autosomal recessive AOS.
AOS5 (NOTCH1, autosomal dominant)
Autosomal dominant form caused by loss-of-function mutations in NOTCH1. This is the most common genetic subtype. NOTCH1 haploinsufficiency directly impairs Notch signaling in vascular and skeletal development.
Show evidence (1 reference)
PMID:25963545 SUPPORT Human Clinical
"This report establishes NOTCH1 mutation as the primary cause of AOS, accounting for 17% of cases in our cohort, and an important genetic factor in AOS with associated cardiovascular complications."
Demonstrates NOTCH1 as the most common cause of AOS with cardiac associations.
AOS6 (DLL4, autosomal dominant)
Autosomal dominant form caused by loss-of-function mutations in DLL4, a Notch ligand critical for angiogenesis and vascular patterning.
Show evidence (1 reference)
PMID:26299364 SUPPORT Human Clinical
"nine heterozygous mutations in DLL4 were identified, including two nonsense and seven missense variants"
Original identification of DLL4 mutations as a cause of autosomal dominant AOS.

Pathophysiology

5
Disrupted Notch Signaling
The core pathogenic mechanism in AOS involves disruption of the Notch signaling pathway. NOTCH1 (AOS5), DLL4 (AOS6), RBPJ (AOS3), and EOGT (AOS4) are direct components or modifiers of Notch signaling. NOTCH1 haploinsufficiency reduces Notch pathway activation in endothelial cells, impairing angiogenesis and vascular development. DLL4 is a key Notch ligand in tip cell selection during sprouting angiogenesis. RBPJ is the obligate transcriptional effector of canonical Notch signaling. EOGT O-GlcNAcylates Notch EGF repeats, modulating receptor-ligand interactions.
endothelial cell link
Notch signaling pathway link angiogenesis link sprouting angiogenesis link
Show evidence (3 references)
PMID:25963545 SUPPORT Human Clinical
"NOTCH1 expression is down-regulated in AOS subjects harboring NOTCH1 mutation in vivo"
Demonstrates that NOTCH1 mutations lead to haploinsufficiency and reduced Notch signaling.
PMID:41055965 SUPPORT Model Organism
"expression of the Rbpj AOS allele in endothelial cells is both necessary and sufficient to cause lethality and cardiovascular defects"
Mouse model demonstrates that defective Notch signaling specifically in endothelial cells drives AOS pathogenesis.
PMID:22883147 SUPPORT Human Clinical
"These identified mutations link RBPJ, the primary transcriptional regulator for the Notch pathway, with AOS, a human genetic disorder."
RBPJ mutations confirm the central role of Notch signaling in AOS.
Rho GTPase Signaling Dysregulation
ARHGAP31 (AOS1) and DOCK6 (AOS2) act through the Rho GTPase pathway. ARHGAP31 gain-of-function mutations produce a constitutively active C-terminal truncation that hyperactivates GAP activity toward Cdc42 and Rac1, reducing their active GTP-bound forms. Conversely, DOCK6 loss-of-function reduces GEF activity toward Cdc42 and Rac1. Both mechanisms converge on reduced Cdc42/Rac1 activity, impairing cytoskeletal dynamics, cell migration, and cell survival during limb and skin development.
mesenchymal stem cell link
Rho protein signal transduction link cell migration link
Show evidence (2 references)
PMID:21565291 SUPPORT Human Clinical
"Constitutively active ARHGAP31 mutations result in a loss of available active Cdc42 and consequently disrupt actin cytoskeletal structures."
Demonstrates the gain-of-function mechanism of ARHGAP31 mutations disrupting Rho GTPase signaling.
PMID:21820096 SUPPORT Human Clinical
"Consistent with the established role of Cdc42 and Rac1 in the organization of the actin cytoskeleton, we demonstrate a cellular phenotype typical of a defective actin cytoskeleton in patient cells."
Confirms DOCK6 loss-of-function disrupts actin cytoskeleton via reduced Cdc42/Rac1 activity.
Impaired Vascular Development
Disrupted Notch and Rho GTPase signaling converge on impaired vascular morphogenesis. Defective angiogenesis leads to vascular insufficiency in the developing scalp, limbs, and potentially other organs. This vascular disruption hypothesis explains the pattern of terminal defects (scalp vertex, distal limbs) as watershed areas vulnerable to ischemic injury during development. Cutis marmorata telangiectatica congenita and pulmonary arterial hypertension reflect ongoing vascular dysfunction.
blood vessel endothelial cell link
vasculogenesis link angiogenesis link
Show evidence (2 references)
PMID:25132448 SUPPORT Human Clinical
"We propose that the limb and scalp defects might also be due to a vasculopathy in NOTCH1-related AOS."
Proposes the vascular disruption hypothesis for limb and scalp defects in AOS.
PMID:41055965 SUPPORT Model Organism
"reduced Notch1 signaling in the vasculature is a key driver of pathogenesis in this AOS mouse model"
Direct evidence from conditional mouse genetics that vascular-specific Notch signaling defects drive AOS.
Defective Skeletal Morphogenesis
Impaired osteoblast differentiation and skeletal patterning lead to skull ossification defects and terminal limb deficiencies. The calvarial defects reflect disrupted intramembranous ossification of the skull vault, while limb defects represent failure of distal limb patterning and growth.
osteoblast link
osteoblast differentiation link
Show evidence (1 reference)
PMID:21565291 SUPPORT Human Clinical
"Arhgap31 expression in the mouse is substantially restricted to the terminal limb buds and craniofacial processes during early development; these locations closely mirror the sites of impaired organogenesis that characterize this syndrome."
Expression pattern of ARHGAP31 mirrors the anatomical sites of skeletal defects in AOS.
Cardiac Outflow Tract Maldevelopment
DLL4-mediated Notch signaling is required for second heart field (SHF) progenitor cell proliferation. Loss of DLL4 depletes the SHF progenitor pool, leading to underdevelopment of the right ventricle and outflow tract malalignment. This mechanism explains the congenital heart defects observed in approximately 23% of AOS patients.
second heart field progenitor cell link
Notch signaling pathway link
Show evidence (1 reference)
PMID:33899511 SUPPORT Model Organism
"Dll4-mediated Notch signaling is critically required for SHF proliferation such that Dll4 knockout results in a 33% reduction in proliferation and a fourfold increase in apoptosis in SHF cells, leading to a 56% decline in the size of the SHF progenitor pool."
Mouse model demonstrates the mechanism by which DLL4 haploinsufficiency causes cardiac defects in AOS.

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Adams-Oliver Syndrome Interactive directed graph showing how pathophysiology mechanisms, phenotypes, genetic factors and variants, experimental models, environmental triggers, and treatments relate through causal and linked edges.

Phenotypes

8
Cardiovascular 3
Congenital Heart Defects OCCASIONAL Abnormal heart morphology (HP:0001627)
Show evidence (2 references)
PMID:28160419 SUPPORT Human Clinical
"the most commonly associated anomalies included a wide variety of central nervous system (CNS) anomalies and congenital heart defects each seen in 23%."
Large literature review establishing 23% frequency of congenital heart defects in AOS.
PMID:25963545 SUPPORT Human Clinical
"cardiovascular anomalies were identified in 47% (8/17) of all affected variant carriers, thereby indicating that NOTCH1 variants may represent a distinct subtype of AOS associated with cardiac malformations."
NOTCH1-related AOS shows particularly high frequency of cardiac defects.
Pulmonary Arterial Hypertension OCCASIONAL Pulmonary arterial hypertension (HP:0002092)
Show evidence (1 reference)
PMID:38778082 SUPPORT Human Clinical
"pulmonary hypertension (2/33)"
NOTCH1 variant carrier cohort documenting pulmonary hypertension in 2 of 33 individuals.
Hepatoportal Sclerosis with Portal Hypertension OCCASIONAL Portal hypertension (HP:0001409)
Show evidence (1 reference)
PMID:28160419 SUPPORT Human Clinical
"A relatively large number of non-familial probands were reported to have hepatoportal sclerosis with portal hypertension and esophageal varices."
Literature review documenting hepatoportal sclerosis as a notable feature particularly in non-familial AOS cases.
Other 5
Aplasia Cutis Congenita of the Scalp VERY_FREQUENT Aplasia cutis congenita of scalp (HP:0007385)
Show evidence (1 reference)
PMID:28160419 SUPPORT Human Clinical
"The Adams-Oliver syndrome (AOS) is defined as aplasia cutis congenita (ACC) with transverse terminal limb defects (TTLD)."
ACC is a defining feature of AOS.
Terminal Transverse Limb Defects VERY_FREQUENT Transverse terminal limb defect (HP:6000818)
Show evidence (1 reference)
PMID:28160419 SUPPORT Human Clinical
"The Adams-Oliver syndrome (AOS) is defined as aplasia cutis congenita (ACC) with transverse terminal limb defects (TTLD)."
TTLD is a defining feature of AOS.
Calvarial Skull Defect FREQUENT Calvarial skull defect (HP:0001362)
Show evidence (1 reference)
PMID:25963545 SUPPORT Human Clinical
"Patient 3-III:1 was born with a large area of scalp ACC with an underlying calvarial defect and shortened distal phalanges of the toes"
Clinical documentation of calvarial skull defects accompanying aplasia cutis in AOS patients.
Cutis Marmorata Telangiectatica Congenita OCCASIONAL Cutis marmorata telangiectatica congenita (HP:0025107)
Show evidence (1 reference)
PMID:28160419 SUPPORT Human Clinical
"Cutis marmorata telangiectasia congenita (CMTC) was found in 19% of the study population and other vascular anomalies were seen in 14%."
Literature review establishing 19% frequency of CMTC in AOS.
Central Nervous System Anomalies OCCASIONAL Morphological central nervous system abnormality (HP:0002011)
Show evidence (1 reference)
PMID:28160419 SUPPORT Human Clinical
"the most commonly associated anomalies included a wide variety of central nervous system (CNS) anomalies and congenital heart defects each seen in 23%. CNS anomalies included structural anomalies, microcephaly, vascular defects, and vascular sequelae. CNS migration defects were common."
Literature review establishing 23% frequency of CNS anomalies in AOS.
🧬

Genetic Associations

6
ARHGAP31 (AOS1) (CAUSAL)
Autosomal dominant
Show evidence (2 references)
PMID:21565291 SUPPORT Human Clinical
"Mutant transcripts are stable and increase ARHGAP31 activity in vitro through a gain-of-function mechanism."
Demonstrates gain-of-function mechanism of ARHGAP31 mutations.
PMID:29924900 SUPPORT Human Clinical
"ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort."
Large cohort establishing 3% frequency of ARHGAP31 mutations in AOS.
DOCK6 (AOS2) (CAUSAL)
Autosomal recessive
Show evidence (3 references)
PMID:21820096 SUPPORT Human Clinical
"we combined autozygome analysis with exome sequencing to identify a homozygous truncating mutation in dedicator of cytokinesis 6 gene (DOCK6)"
Original identification of DOCK6 mutations in AOS.
PMID:29924900 SUPPORT Human Clinical
"DOCK6 (6%), ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort."
Large cohort establishing 6% frequency of DOCK6 mutations in AOS.
"DOCK6 | HGNC:19189 | Adams-Oliver syndrome | MONDO:0007034 | AR | Definitive"
ClinGen classifies the DOCK6-Adams-Oliver syndrome gene-disease relationship as definitive with autosomal recessive inheritance.
RBPJ (AOS3) (CAUSAL)
Autosomal dominant
Show evidence (2 references)
PMID:22883147 SUPPORT Human Clinical
"Functional assays confirmed impaired DNA binding of mutated RBPJ, placing it among other notch-pathway proteins altered in human genetic syndromes."
Demonstrates functional impact of RBPJ mutations on DNA binding.
PMID:41055965 SUPPORT Model Organism
"AOS-associated RBPJ missense variants compromise DNA binding but not cofactor binding. These findings suggest that AOS-associated RBPJ variants do not function as loss-of-function alleles but instead act as dominant-negative proteins that sequester cofactors from DNA."
Demonstrates dominant-negative mechanism of RBPJ mutations - they retain cofactor binding while losing DNA binding, titrating cofactors away from DNA.
EOGT (AOS4) (CAUSAL)
Autosomal recessive
Show evidence (2 references)
PMID:23522784 SUPPORT Human Clinical
"EOGT encodes EGF-domain-specific O-linked N-acetylglucosamine (O-GlcNAc) transferase, which is involved in the O-GlcNAcylation (attachment of O-GlcNAc to serine and threonine residues) of a subset of extracellular EGF-domain-containing proteins."
Identifies EOGT function and its connection to Notch signaling.
PMID:29924900 SUPPORT Human Clinical
"ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort."
Large cohort establishing 3% frequency of EOGT mutations in AOS.
NOTCH1 (AOS5) (CAUSAL)
Autosomal dominant
Show evidence (3 references)
PMID:25132448 SUPPORT Human Clinical
"we report five heterozygous NOTCH1 variants in unrelated individuals with Adams-Oliver syndrome (AOS), a rare disease with major features of aplasia cutis of the scalp and terminal transverse limb defects."
Original identification of NOTCH1 mutations in AOS.
PMID:25963545 SUPPORT Human Clinical
"NOTCH1 transcript levels were significantly reduced by comparison to an unaffected control individual, demonstrating approximately 50% expression in all samples tested"
Demonstrates NOTCH1 haploinsufficiency as the molecular mechanism.
PMID:29924900 SUPPORT Human Clinical
"NOTCH1 is the major contributor, underlying 10% of AOS/ACC/TTLD cases"
Large cohort confirming NOTCH1 as the most common genetic cause of AOS.
DLL4 (AOS6) (CAUSAL)
Autosomal dominant
Show evidence (3 references)
PMID:26299364 SUPPORT Human Clinical
"Our findings demonstrate that DLL4 mutations are an additional cause of autosomal-dominant AOS or isolated ACC and provide further evidence for a key role of NOTCH signaling in the etiology of this disorder."
Establishes DLL4 as a cause of autosomal dominant AOS.
PMID:29924900 SUPPORT Human Clinical
"DLL4 (6%), DOCK6 (6%), ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort."
Large cohort establishing 6% frequency of DLL4 mutations in AOS.
PMID:33899511 SUPPORT Model Organism
"Similar to the clinical syndrome, 32% of SHF-specific Dll4 heterozygotes demonstrate foreshortened and misaligned OFT, resulting in a double outlet right ventricle."
Mouse model providing molecular mechanism for cardiac defects in DLL4-related AOS.
💊

Treatments

3
Wound Care for Aplasia Cutis
Action: wound care management Ontology label: supportive care MAXO:0000950
Conservative wound management of scalp defects with moist wound dressings and infection prevention. Most small to moderate aplasia cutis lesions heal spontaneously with conservative care.
Surgical Reconstruction
Action: surgical procedure MAXO:0000004
Surgical intervention for large scalp defects, exposed dura, or significant limb deficiencies. May include skin grafting, tissue expansion, or prosthetic fitting for limb defects.
Genetic Counseling
Action: genetic counseling MAXO:0000079
Genetic counseling for families with AOS to discuss inheritance patterns, recurrence risks, and available genetic testing options. Important given the genetic heterogeneity (6 known genes) and variable inheritance patterns (autosomal dominant and recessive forms).
{ }

Source YAML

click to show
name: Adams-Oliver Syndrome
creation_date: '2026-04-22T00:00:00Z'
updated_date: '2026-04-26T22:34:05Z'
category: Genetic
synonyms:
- AOS
- Aplasia cutis congenita with terminal transverse limb defects
description: >
  Adams-Oliver syndrome (AOS) is a rare congenital disorder characterized by
  the combination of aplasia cutis congenita (ACC) of the scalp vertex and
  terminal transverse limb defects (TTLD) ranging from nail dystrophy to
  complete digit or limb absence. Additional features include congenital heart
  defects, cutis marmorata telangiectatica congenita, and pulmonary arterial
  hypertension. AOS is genetically heterogeneous with both autosomal dominant
  (NOTCH1, DLL4, RBPJ, ARHGAP31) and autosomal recessive (DOCK6, EOGT) forms.
  RBPJ mutations act through a dominant-negative mechanism.
  The pathophysiology converges on disrupted Notch signaling and vascular
  development, affecting skin, limb, and cardiovascular morphogenesis.
disease_term:
  preferred_term: Adams-Oliver syndrome
  term:
    id: MONDO:0007034
    label: Adams-Oliver syndrome
parents:
- Ectodermal dysplasia
- Congenital limb malformation
- Congenital heart disease
has_subtypes:
- name: AOS1
  display_name: AOS1 (ARHGAP31, autosomal dominant)
  description: >
    Autosomal dominant form caused by gain-of-function mutations in ARHGAP31,
    encoding a Rho GTPase-activating protein. The mutant protein shows
    constitutive Cdc42/Rac1 GAP activity, disrupting cytoskeletal dynamics
    and cell migration.
  evidence:
  - reference: PMID:21565291
    reference_title: "Gain-of-function mutations of ARHGAP31, a Cdc42/Rac1 GTPase regulator, cause syndromic cutis aplasia and limb anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Candidate-gene- and exome-based sequencing led to the identification of independent premature truncating mutations in the terminal exon of the Rho GTPase-activating protein 31 gene, ARHGAP31, which encodes a Cdc42/Rac1 regulatory protein."
    explanation: Original identification of ARHGAP31 as causative for autosomal dominant AOS.
- name: AOS2
  display_name: AOS2 (DOCK6, autosomal recessive)
  description: >
    Autosomal recessive form caused by loss-of-function mutations in DOCK6,
    a guanine nucleotide exchange factor for Cdc42 and Rac1. Loss of DOCK6
    function impairs cytoskeletal regulation and cell migration.
  evidence:
  - reference: PMID:21820096
    reference_title: "Recessive mutations in DOCK6, encoding the guanidine nucleotide exchange factor DOCK6, lead to abnormal actin cytoskeleton organization and Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "we combined autozygome analysis with exome sequencing to identify a homozygous truncating mutation in dedicator of cytokinesis 6 gene (DOCK6) which encodes an atypical guanidine exchange factor (GEF) known to activate two members of the Rho GTPase family: Cdc42 and Rac1."
    explanation: Original identification of DOCK6 as causative for autosomal recessive AOS.
- name: AOS3
  display_name: AOS3 (RBPJ, autosomal dominant)
  description: >
    Autosomal dominant form caused by dominant-negative mutations in RBPJ,
    the central transcriptional mediator of canonical Notch signaling.
    Mutant RBPJ retains cofactor binding but has impaired DNA binding,
    sequestering Notch pathway cofactors from target gene promoters.
  evidence:
  - reference: PMID:22883147
    reference_title: "RBPJ mutations identified in two families affected by Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "we identified two unique mutations in recombination signal binding protein for immunoglobulin kappa J (RBPJ) in two independent families affected by Adams-Oliver syndrome (AOS)"
    explanation: Original identification of RBPJ mutations in AOS families.
- name: AOS4
  display_name: AOS4 (EOGT, autosomal recessive)
  description: >
    Autosomal recessive form caused by loss-of-function mutations in EOGT,
    which encodes an EGF-domain-specific O-linked N-acetylglucosamine
    transferase that modifies Notch receptors.
  evidence:
  - reference: PMID:23522784
    reference_title: "Mutations in EOGT confirm the genetic heterogeneity of autosomal-recessive Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "exome sequencing in one family revealed one missense mutation in EOGT (C3orf64), and subsequent targeted sequencing of this gene revealed a homozygous missense mutation and a homozygous frameshift deletion mutation in the other two families."
    explanation: Original identification of EOGT mutations in autosomal recessive AOS.
- name: AOS5
  display_name: AOS5 (NOTCH1, autosomal dominant)
  description: >
    Autosomal dominant form caused by loss-of-function mutations in NOTCH1.
    This is the most common genetic subtype. NOTCH1 haploinsufficiency
    directly impairs Notch signaling in vascular and skeletal development.
  evidence:
  - reference: PMID:25963545
    reference_title: "Haploinsufficiency of the NOTCH1 Receptor as a Cause of Adams-Oliver Syndrome With Variable Cardiac Anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "This report establishes NOTCH1 mutation as the primary cause of AOS, accounting for 17% of cases in our cohort, and an important genetic factor in AOS with associated cardiovascular complications."
    explanation: Demonstrates NOTCH1 as the most common cause of AOS with cardiac associations.
- name: AOS6
  display_name: AOS6 (DLL4, autosomal dominant)
  description: >
    Autosomal dominant form caused by loss-of-function mutations in DLL4,
    a Notch ligand critical for angiogenesis and vascular patterning.
  evidence:
  - reference: PMID:26299364
    reference_title: "Heterozygous Loss-of-Function Mutations in DLL4 Cause Adams-Oliver Syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "nine heterozygous mutations in DLL4 were identified, including two nonsense and seven missense variants"
    explanation: Original identification of DLL4 mutations as a cause of autosomal dominant AOS.
pathophysiology:
- name: Disrupted Notch Signaling
  description: >
    The core pathogenic mechanism in AOS involves disruption of the Notch
    signaling pathway. NOTCH1 (AOS5), DLL4 (AOS6), RBPJ (AOS3), and EOGT
    (AOS4) are direct components or modifiers of Notch signaling. NOTCH1
    haploinsufficiency reduces Notch pathway activation in endothelial cells,
    impairing angiogenesis and vascular development. DLL4 is a key Notch
    ligand in tip cell selection during sprouting angiogenesis. RBPJ is
    the obligate transcriptional effector of canonical Notch signaling.
    EOGT O-GlcNAcylates Notch EGF repeats, modulating receptor-ligand
    interactions.
  cell_types:
  - preferred_term: endothelial cell
    term:
      id: CL:0000115
      label: endothelial cell
  biological_processes:
  - preferred_term: Notch signaling pathway
    term:
      id: GO:0007219
      label: Notch signaling pathway
  - preferred_term: angiogenesis
    term:
      id: GO:0001525
      label: angiogenesis
  - preferred_term: sprouting angiogenesis
    term:
      id: GO:0002040
      label: sprouting angiogenesis
  downstream:
  - target: Impaired Vascular Development
  - target: Defective Skeletal Morphogenesis
  - target: Cardiac Outflow Tract Maldevelopment
  evidence:
  - reference: PMID:25963545
    reference_title: "Haploinsufficiency of the NOTCH1 Receptor as a Cause of Adams-Oliver Syndrome With Variable Cardiac Anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "NOTCH1 expression is down-regulated in AOS subjects harboring NOTCH1 mutation in vivo"
    explanation: Demonstrates that NOTCH1 mutations lead to haploinsufficiency and reduced Notch signaling.
  - reference: PMID:41055965
    reference_title: "Defective Notch1 signaling in endothelial cells drives pathogenesis in a mouse model of Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "expression of the Rbpj AOS allele in endothelial cells is both necessary and sufficient to cause lethality and cardiovascular defects"
    explanation: Mouse model demonstrates that defective Notch signaling specifically in endothelial cells drives AOS pathogenesis.
  - reference: PMID:22883147
    reference_title: "RBPJ mutations identified in two families affected by Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "These identified mutations link RBPJ, the primary transcriptional regulator for the Notch pathway, with AOS, a human genetic disorder."
    explanation: RBPJ mutations confirm the central role of Notch signaling in AOS.
- name: Rho GTPase Signaling Dysregulation
  description: >
    ARHGAP31 (AOS1) and DOCK6 (AOS2) act through the Rho GTPase pathway.
    ARHGAP31 gain-of-function mutations produce a constitutively active
    C-terminal truncation that hyperactivates GAP activity toward Cdc42
    and Rac1, reducing their active GTP-bound forms. Conversely, DOCK6
    loss-of-function reduces GEF activity toward Cdc42 and Rac1. Both
    mechanisms converge on reduced Cdc42/Rac1 activity, impairing
    cytoskeletal dynamics, cell migration, and cell survival during
    limb and skin development.
  cell_types:
  - preferred_term: mesenchymal stem cell
    term:
      id: CL:0000134
      label: mesenchymal stem cell
  biological_processes:
  - preferred_term: Rho protein signal transduction
    term:
      id: GO:0007266
      label: Rho protein signal transduction
  - preferred_term: cell migration
    term:
      id: GO:0016477
      label: cell migration
  downstream:
  - target: Impaired Vascular Development
  - target: Defective Skeletal Morphogenesis
  evidence:
  - reference: PMID:21565291
    reference_title: "Gain-of-function mutations of ARHGAP31, a Cdc42/Rac1 GTPase regulator, cause syndromic cutis aplasia and limb anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Constitutively active ARHGAP31 mutations result in a loss of available active Cdc42 and consequently disrupt actin cytoskeletal structures."
    explanation: Demonstrates the gain-of-function mechanism of ARHGAP31 mutations disrupting Rho GTPase signaling.
  - reference: PMID:21820096
    reference_title: "Recessive mutations in DOCK6, encoding the guanidine nucleotide exchange factor DOCK6, lead to abnormal actin cytoskeleton organization and Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Consistent with the established role of Cdc42 and Rac1 in the organization of the actin cytoskeleton, we demonstrate a cellular phenotype typical of a defective actin cytoskeleton in patient cells."
    explanation: Confirms DOCK6 loss-of-function disrupts actin cytoskeleton via reduced Cdc42/Rac1 activity.
- name: Impaired Vascular Development
  description: >
    Disrupted Notch and Rho GTPase signaling converge on impaired vascular
    morphogenesis. Defective angiogenesis leads to vascular insufficiency
    in the developing scalp, limbs, and potentially other organs. This
    vascular disruption hypothesis explains the pattern of terminal defects
    (scalp vertex, distal limbs) as watershed areas vulnerable to ischemic
    injury during development. Cutis marmorata telangiectatica congenita
    and pulmonary arterial hypertension reflect ongoing vascular dysfunction.
  cell_types:
  - preferred_term: blood vessel endothelial cell
    term:
      id: CL:0000071
      label: blood vessel endothelial cell
  biological_processes:
  - preferred_term: vasculogenesis
    term:
      id: GO:0001570
      label: vasculogenesis
  - preferred_term: angiogenesis
    term:
      id: GO:0001525
      label: angiogenesis
  evidence:
  - reference: PMID:25132448
    reference_title: "Mutations in NOTCH1 cause Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "We propose that the limb and scalp defects might also be due to a vasculopathy in NOTCH1-related AOS."
    explanation: Proposes the vascular disruption hypothesis for limb and scalp defects in AOS.
  - reference: PMID:41055965
    reference_title: "Defective Notch1 signaling in endothelial cells drives pathogenesis in a mouse model of Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "reduced Notch1 signaling in the vasculature is a key driver of pathogenesis in this AOS mouse model"
    explanation: Direct evidence from conditional mouse genetics that vascular-specific Notch signaling defects drive AOS.
- name: Defective Skeletal Morphogenesis
  description: >
    Impaired osteoblast differentiation and skeletal patterning lead to
    skull ossification defects and terminal limb deficiencies. The calvarial
    defects reflect disrupted intramembranous ossification of the skull vault,
    while limb defects represent failure of distal limb patterning and growth.
  cell_types:
  - preferred_term: osteoblast
    term:
      id: CL:0000062
      label: osteoblast
  biological_processes:
  - preferred_term: osteoblast differentiation
    term:
      id: GO:0001649
      label: osteoblast differentiation
  evidence:
  - reference: PMID:21565291
    reference_title: "Gain-of-function mutations of ARHGAP31, a Cdc42/Rac1 GTPase regulator, cause syndromic cutis aplasia and limb anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Arhgap31 expression in the mouse is substantially restricted to the terminal limb buds and craniofacial processes during early development; these locations closely mirror the sites of impaired organogenesis that characterize this syndrome."
    explanation: Expression pattern of ARHGAP31 mirrors the anatomical sites of skeletal defects in AOS.
- name: Cardiac Outflow Tract Maldevelopment
  description: >
    DLL4-mediated Notch signaling is required for second heart field (SHF)
    progenitor cell proliferation. Loss of DLL4 depletes the SHF progenitor
    pool, leading to underdevelopment of the right ventricle and outflow
    tract malalignment. This mechanism explains the congenital heart defects
    observed in approximately 23% of AOS patients.
  cell_types:
  - preferred_term: second heart field progenitor cell
    term:
      id: CL:0000513
      label: cardiac muscle myoblast
  biological_processes:
  - preferred_term: Notch signaling pathway
    term:
      id: GO:0007219
      label: Notch signaling pathway
  evidence:
  - reference: PMID:33899511
    reference_title: "Murine Model of Cardiac Defects Observed in Adams-Oliver Syndrome Driven by Delta-Like Ligand-4 Haploinsufficiency."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Dll4-mediated Notch signaling is critically required for SHF proliferation such that Dll4 knockout results in a 33% reduction in proliferation and a fourfold increase in apoptosis in SHF cells, leading to a 56% decline in the size of the SHF progenitor pool."
    explanation: Mouse model demonstrates the mechanism by which DLL4 haploinsufficiency causes cardiac defects in AOS.
phenotypes:
- category: Dermatological
  name: Aplasia Cutis Congenita of the Scalp
  frequency: VERY_FREQUENT
  description: >
    Congenital absence of skin, typically at the vertex of the scalp.
    Ranges from small, well-circumscribed defects to large areas of absent
    skin with exposed skull or dura. This is a hallmark feature of AOS.
  phenotype_term:
    preferred_term: Aplasia cutis congenita of scalp
    term:
      id: HP:0007385
      label: Aplasia cutis congenita of scalp
  evidence:
  - reference: PMID:28160419
    reference_title: "Adams-Oliver syndrome review of the literature: Refining the diagnostic phenotype."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The Adams-Oliver syndrome (AOS) is defined as aplasia cutis congenita (ACC) with transverse terminal limb defects (TTLD)."
    explanation: ACC is a defining feature of AOS.
- category: Musculoskeletal
  name: Terminal Transverse Limb Defects
  frequency: VERY_FREQUENT
  description: >
    Congenital terminal transverse limb defects ranging from nail
    dystrophy and short distal phalanges to oligodactyly or complete
    absence of digits, hands, or feet. Lower limbs are more frequently
    affected than upper limbs.
  phenotype_term:
    preferred_term: Terminal transverse limb defect
    term:
      id: HP:6000818
      label: Transverse terminal limb defect
  evidence:
  - reference: PMID:28160419
    reference_title: "Adams-Oliver syndrome review of the literature: Refining the diagnostic phenotype."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The Adams-Oliver syndrome (AOS) is defined as aplasia cutis congenita (ACC) with transverse terminal limb defects (TTLD)."
    explanation: TTLD is a defining feature of AOS.
- category: Musculoskeletal
  name: Calvarial Skull Defect
  frequency: FREQUENT
  description: >
    Defects in skull ossification overlying the aplasia cutis, reflecting
    impaired intramembranous ossification. May range from thinning to
    complete absence of calvarium.
  phenotype_term:
    preferred_term: Calvarial skull defect
    term:
      id: HP:0001362
      label: Calvarial skull defect
  evidence:
  - reference: PMID:25963545
    reference_title: "Haploinsufficiency of the NOTCH1 Receptor as a Cause of Adams-Oliver Syndrome With Variable Cardiac Anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Patient 3-III:1 was born with a large area of scalp ACC with an underlying calvarial defect and shortened distal phalanges of the toes"
    explanation: Clinical documentation of calvarial skull defects accompanying aplasia cutis in AOS patients.
- category: Cardiovascular
  name: Congenital Heart Defects
  frequency: OCCASIONAL
  description: >
    Various structural heart defects reported in AOS, most commonly
    ventricular septal defects, tetralogy of Fallot, and coarctation
    of the aorta. Observed in approximately 23% of AOS cases overall,
    but up to 47% in NOTCH1-positive cases.
  phenotype_term:
    preferred_term: Congenital heart defect
    term:
      id: HP:0001627
      label: Abnormal heart morphology
  evidence:
  - reference: PMID:28160419
    reference_title: "Adams-Oliver syndrome review of the literature: Refining the diagnostic phenotype."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "the most commonly associated anomalies included a wide variety of central nervous system (CNS) anomalies and congenital heart defects each seen in 23%."
    explanation: Large literature review establishing 23% frequency of congenital heart defects in AOS.
  - reference: PMID:25963545
    reference_title: "Haploinsufficiency of the NOTCH1 Receptor as a Cause of Adams-Oliver Syndrome With Variable Cardiac Anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "cardiovascular anomalies were identified in 47% (8/17) of all affected variant carriers, thereby indicating that NOTCH1 variants may represent a distinct subtype of AOS associated with cardiac malformations."
    explanation: NOTCH1-related AOS shows particularly high frequency of cardiac defects.
- category: Cardiovascular
  name: Cutis Marmorata Telangiectatica Congenita
  frequency: OCCASIONAL
  description: >
    A vascular skin anomaly characterized by a persistent reticular
    mottling pattern with telangiectasias. Reflects underlying vascular
    dysregulation and is more common in Notch pathway-associated subtypes.
  phenotype_term:
    preferred_term: Cutis marmorata telangiectatica congenita
    term:
      id: HP:0025107
      label: Cutis marmorata telangiectatica congenita
  evidence:
  - reference: PMID:28160419
    reference_title: "Adams-Oliver syndrome review of the literature: Refining the diagnostic phenotype."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Cutis marmorata telangiectasia congenita (CMTC) was found in 19% of the study population and other vascular anomalies were seen in 14%."
    explanation: Literature review establishing 19% frequency of CMTC in AOS.
- category: Cardiovascular
  name: Pulmonary Arterial Hypertension
  frequency: OCCASIONAL
  description: >
    Pulmonary arterial hypertension can occur in AOS, particularly in
    NOTCH1-related cases, and carries significant morbidity and mortality.
  phenotype_term:
    preferred_term: Pulmonary arterial hypertension
    term:
      id: HP:0002092
      label: Pulmonary arterial hypertension
  evidence:
  - reference: PMID:38778082
    reference_title: "Expanding the phenotypic spectrum of NOTCH1 variants: clinical manifestations in families with congenital heart disease."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "pulmonary hypertension (2/33)"
    explanation: NOTCH1 variant carrier cohort documenting pulmonary hypertension in 2 of 33 individuals.
- category: Hepatic
  name: Hepatoportal Sclerosis with Portal Hypertension
  frequency: OCCASIONAL
  description: >
    Non-cirrhotic portal hypertension due to hepatoportal sclerosis,
    with potential for esophageal varices. Observed particularly in
    non-familial AOS cases.
  phenotype_term:
    preferred_term: Portal hypertension
    term:
      id: HP:0001409
      label: Portal hypertension
  evidence:
  - reference: PMID:28160419
    reference_title: "Adams-Oliver syndrome review of the literature: Refining the diagnostic phenotype."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "A relatively large number of non-familial probands were reported to have hepatoportal sclerosis with portal hypertension and esophageal varices."
    explanation: Literature review documenting hepatoportal sclerosis as a notable feature particularly in non-familial AOS cases.
- category: Neurological
  name: Central Nervous System Anomalies
  frequency: OCCASIONAL
  description: >
    A wide variety of CNS anomalies including structural defects,
    microcephaly, vascular malformations, and migration defects.
    Reported in approximately 23% of AOS cases.
  phenotype_term:
    preferred_term: CNS structural anomaly
    term:
      id: HP:0002011
      label: Morphological central nervous system abnormality
  evidence:
  - reference: PMID:28160419
    reference_title: "Adams-Oliver syndrome review of the literature: Refining the diagnostic phenotype."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "the most commonly associated anomalies included a wide variety of central nervous system (CNS) anomalies and congenital heart defects each seen in 23%. CNS anomalies included structural anomalies, microcephaly, vascular defects, and vascular sequelae. CNS migration defects were common."
    explanation: Literature review establishing 23% frequency of CNS anomalies in AOS.
genetic:
- name: ARHGAP31 (AOS1)
  gene_term:
    preferred_term: ARHGAP31
    term:
      id: hgnc:29216
      label: ARHGAP31
  association: CAUSAL
  subtype: AOS1
  inheritance:
  - name: Autosomal dominant
    evidence:
    - reference: PMID:21565291
      reference_title: "Gain-of-function mutations of ARHGAP31, a Cdc42/Rac1 GTPase regulator, cause syndromic cutis aplasia and limb anomalies."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Mutant transcripts are stable and increase ARHGAP31 activity in vitro through a gain-of-function mechanism."
      explanation: Heterozygous gain-of-function ARHGAP31 mutations are inherited in an autosomal dominant pattern.
  features: >
    Gain-of-function mutations produce C-terminally truncated proteins with
    constitutive GAP activity toward Cdc42 and Rac1, disrupting cytoskeletal
    dynamics and cell migration. Accounts for approximately 3% of AOS cases.
  evidence:
  - reference: PMID:21565291
    reference_title: "Gain-of-function mutations of ARHGAP31, a Cdc42/Rac1 GTPase regulator, cause syndromic cutis aplasia and limb anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Mutant transcripts are stable and increase ARHGAP31 activity in vitro through a gain-of-function mechanism."
    explanation: Demonstrates gain-of-function mechanism of ARHGAP31 mutations.
  - reference: PMID:29924900
    reference_title: "Elucidating the genetic architecture of Adams-Oliver syndrome in a large European cohort."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort."
    explanation: Large cohort establishing 3% frequency of ARHGAP31 mutations in AOS.
- name: DOCK6 (AOS2)
  gene_term:
    preferred_term: DOCK6
    term:
      id: hgnc:19189
      label: DOCK6
  association: CAUSAL
  subtype: AOS2
  inheritance:
  - name: Autosomal recessive
    evidence:
    - reference: PMID:21820096
      reference_title: "Recessive mutations in DOCK6, encoding the guanidine nucleotide exchange factor DOCK6, lead to abnormal actin cytoskeleton organization and Adams-Oliver syndrome."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "we combined autozygome analysis with exome sequencing to identify a homozygous truncating mutation in dedicator of cytokinesis 6 gene (DOCK6)"
      explanation: Homozygous loss-of-function DOCK6 mutations identify autosomal recessive inheritance for AOS2.
  features: >
    Loss-of-function mutations in DOCK6 reduce GEF activity toward
    Cdc42 and Rac1, impairing cytoskeletal regulation and cell migration.
    Associated with more severe phenotypes. Accounts for approximately 6% of AOS cases.
  evidence:
  - reference: PMID:21820096
    reference_title: "Recessive mutations in DOCK6, encoding the guanidine nucleotide exchange factor DOCK6, lead to abnormal actin cytoskeleton organization and Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "we combined autozygome analysis with exome sequencing to identify a homozygous truncating mutation in dedicator of cytokinesis 6 gene (DOCK6)"
    explanation: Original identification of DOCK6 mutations in AOS.
  - reference: PMID:29924900
    reference_title: "Elucidating the genetic architecture of Adams-Oliver syndrome in a large European cohort."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "DOCK6 (6%), ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort."
    explanation: Large cohort establishing 6% frequency of DOCK6 mutations in AOS.
  - reference: CGGV:assertion_ea64d74c-583d-4ed1-af91-6a7c6f80a1d3-2022-06-28T160000.000Z
    reference_title: "DOCK6 / Adams-Oliver syndrome (Definitive)"
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "DOCK6 | HGNC:19189 | Adams-Oliver syndrome | MONDO:0007034 | AR | Definitive"
    explanation: ClinGen classifies the DOCK6-Adams-Oliver syndrome gene-disease relationship as definitive with autosomal recessive inheritance.
- name: RBPJ (AOS3)
  gene_term:
    preferred_term: RBPJ
    term:
      id: hgnc:5724
      label: RBPJ
  association: CAUSAL
  subtype: AOS3
  inheritance:
  - name: Autosomal dominant
    evidence:
    - reference: PMID:22883147
      reference_title: "RBPJ mutations identified in two families affected by Adams-Oliver syndrome."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Functional assays confirmed impaired DNA binding of mutated RBPJ, placing it among other notch-pathway proteins altered in human genetic syndromes."
      explanation: Heterozygous dominant-negative RBPJ mutations are transmitted in autosomal dominant fashion in AOS3 families.
  features: >
    Dominant-negative mutations in RBPJ compromise DNA binding but retain
    cofactor binding, sequestering Notch pathway cofactors from target
    gene promoters. Accounts for approximately 2% of AOS cases.
  evidence:
  - reference: PMID:22883147
    reference_title: "RBPJ mutations identified in two families affected by Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Functional assays confirmed impaired DNA binding of mutated RBPJ, placing it among other notch-pathway proteins altered in human genetic syndromes."
    explanation: Demonstrates functional impact of RBPJ mutations on DNA binding.
  - reference: PMID:41055965
    reference_title: "Defective Notch1 signaling in endothelial cells drives pathogenesis in a mouse model of Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "AOS-associated RBPJ missense variants compromise DNA binding but not cofactor binding. These findings suggest that AOS-associated RBPJ variants do not function as loss-of-function alleles but instead act as dominant-negative proteins that sequester cofactors from DNA."
    explanation: Demonstrates dominant-negative mechanism of RBPJ mutations - they retain cofactor binding while losing DNA binding, titrating cofactors away from DNA.
- name: EOGT (AOS4)
  gene_term:
    preferred_term: EOGT
    term:
      id: hgnc:28526
      label: EOGT
  association: CAUSAL
  subtype: AOS4
  inheritance:
  - name: Autosomal recessive
    evidence:
    - reference: PMID:23522784
      reference_title: "Mutations in EOGT confirm the genetic heterogeneity of autosomal-recessive Adams-Oliver syndrome."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "EOGT encodes EGF-domain-specific O-linked N-acetylglucosamine (O-GlcNAc) transferase, which is involved in the O-GlcNAcylation (attachment of O-GlcNAc to serine and threonine residues) of a subset of extracellular EGF-domain-containing proteins."
      explanation: Biallelic EOGT mutations confer autosomal recessive AOS4, as established in the title and original report.
  features: >
    Loss-of-function mutations in EOGT impair O-GlcNAcylation of Notch
    receptor EGF repeats, disrupting Notch signaling modulation.
    Accounts for approximately 3% of AOS cases.
  evidence:
  - reference: PMID:23522784
    reference_title: "Mutations in EOGT confirm the genetic heterogeneity of autosomal-recessive Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "EOGT encodes EGF-domain-specific O-linked N-acetylglucosamine (O-GlcNAc) transferase, which is involved in the O-GlcNAcylation (attachment of O-GlcNAc to serine and threonine residues) of a subset of extracellular EGF-domain-containing proteins."
    explanation: Identifies EOGT function and its connection to Notch signaling.
  - reference: PMID:29924900
    reference_title: "Elucidating the genetic architecture of Adams-Oliver syndrome in a large European cohort."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort."
    explanation: Large cohort establishing 3% frequency of EOGT mutations in AOS.
- name: NOTCH1 (AOS5)
  gene_term:
    preferred_term: NOTCH1
    term:
      id: hgnc:7881
      label: NOTCH1
  association: CAUSAL
  subtype: AOS5
  inheritance:
  - name: Autosomal dominant
    evidence:
    - reference: PMID:25132448
      reference_title: "Mutations in NOTCH1 cause Adams-Oliver syndrome."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "we report five heterozygous NOTCH1 variants in unrelated individuals with Adams-Oliver syndrome (AOS), a rare disease with major features of aplasia cutis of the scalp and terminal transverse limb defects."
      explanation: Heterozygous NOTCH1 variants establish autosomal dominant inheritance for AOS5.
  features: >
    Loss-of-function mutations causing NOTCH1 haploinsufficiency.
    This is the most common genetic subtype, underlying 10% of AOS cases.
    Strong genotype-phenotype correlation with cardiac anomalies (47%
    of NOTCH1-positive cases). Impairs Notch signaling in endothelial
    cells, cardiac development, and skeletal morphogenesis.
  evidence:
  - reference: PMID:25132448
    reference_title: "Mutations in NOTCH1 cause Adams-Oliver syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "we report five heterozygous NOTCH1 variants in unrelated individuals with Adams-Oliver syndrome (AOS), a rare disease with major features of aplasia cutis of the scalp and terminal transverse limb defects."
    explanation: Original identification of NOTCH1 mutations in AOS.
  - reference: PMID:25963545
    reference_title: "Haploinsufficiency of the NOTCH1 Receptor as a Cause of Adams-Oliver Syndrome With Variable Cardiac Anomalies."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "NOTCH1 transcript levels were significantly reduced by comparison to an unaffected control individual, demonstrating approximately 50% expression in all samples tested"
    explanation: Demonstrates NOTCH1 haploinsufficiency as the molecular mechanism.
  - reference: PMID:29924900
    reference_title: "Elucidating the genetic architecture of Adams-Oliver syndrome in a large European cohort."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "NOTCH1 is the major contributor, underlying 10% of AOS/ACC/TTLD cases"
    explanation: Large cohort confirming NOTCH1 as the most common genetic cause of AOS.
- name: DLL4 (AOS6)
  gene_term:
    preferred_term: DLL4
    term:
      id: hgnc:2910
      label: DLL4
  association: CAUSAL
  subtype: AOS6
  inheritance:
  - name: Autosomal dominant
    evidence:
    - reference: PMID:26299364
      reference_title: "Heterozygous Loss-of-Function Mutations in DLL4 Cause Adams-Oliver Syndrome."
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "Our findings demonstrate that DLL4 mutations are an additional cause of autosomal-dominant AOS or isolated ACC and provide further evidence for a key role of NOTCH signaling in the etiology of this disorder."
      explanation: Heterozygous DLL4 loss-of-function variants establish autosomal dominant inheritance for AOS6.
  features: >
    Loss-of-function mutations in DLL4, a key Notch ligand for
    angiogenesis and vascular patterning. Accounts for approximately 6%
    of AOS cases. Associated with cardiac outflow tract defects through
    disruption of second heart field progenitor biology.
  evidence:
  - reference: PMID:26299364
    reference_title: "Heterozygous Loss-of-Function Mutations in DLL4 Cause Adams-Oliver Syndrome."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Our findings demonstrate that DLL4 mutations are an additional cause of autosomal-dominant AOS or isolated ACC and provide further evidence for a key role of NOTCH signaling in the etiology of this disorder."
    explanation: Establishes DLL4 as a cause of autosomal dominant AOS.
  - reference: PMID:29924900
    reference_title: "Elucidating the genetic architecture of Adams-Oliver syndrome in a large European cohort."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "DLL4 (6%), DOCK6 (6%), ARHGAP31 (3%), EOGT (3%), and RBPJ (2%) representing additional causality in this cohort."
    explanation: Large cohort establishing 6% frequency of DLL4 mutations in AOS.
  - reference: PMID:33899511
    reference_title: "Murine Model of Cardiac Defects Observed in Adams-Oliver Syndrome Driven by Delta-Like Ligand-4 Haploinsufficiency."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Similar to the clinical syndrome, 32% of SHF-specific Dll4 heterozygotes demonstrate foreshortened and misaligned OFT, resulting in a double outlet right ventricle."
    explanation: Mouse model providing molecular mechanism for cardiac defects in DLL4-related AOS.
treatments:
- name: Wound Care for Aplasia Cutis
  description: >
    Conservative wound management of scalp defects with moist wound dressings
    and infection prevention. Most small to moderate aplasia cutis lesions
    heal spontaneously with conservative care.
  treatment_term:
    preferred_term: wound care management
    term:
      id: MAXO:0000950
      label: supportive care
- name: Surgical Reconstruction
  description: >
    Surgical intervention for large scalp defects, exposed dura, or significant
    limb deficiencies. May include skin grafting, tissue expansion, or
    prosthetic fitting for limb defects.
  treatment_term:
    preferred_term: surgical procedure
    term:
      id: MAXO:0000004
      label: surgical procedure
- name: Genetic Counseling
  description: >
    Genetic counseling for families with AOS to discuss inheritance patterns,
    recurrence risks, and available genetic testing options. Important given
    the genetic heterogeneity (6 known genes) and variable inheritance patterns
    (autosomal dominant and recessive forms).
  treatment_term:
    preferred_term: genetic counseling
    term:
      id: MAXO:0000079
      label: genetic counseling
prevalence:
- population: General population
  percentage: Unknown (very rare)
  notes: >
    AOS is a very rare disorder with unknown precise prevalence.
    Molecular diagnostic screening achieves a diagnostic yield of
    approximately 36% in familial cases and 30% overall, suggesting
    additional undiscovered genetic causes.
  evidence:
  - reference: PMID:29924900
    reference_title: "Elucidating the genetic architecture of Adams-Oliver syndrome in a large European cohort."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Molecular diagnostic screening of 194 AOS/ACC/TTLD probands/families was conducted using next-generation and/or capillary sequencing analyses. In total, we identified 63 (likely) pathogenic mutations, comprising 56 distinct and 22 novel mutations, providing a molecular diagnosis in 30% of patients."
    explanation: Large cohort study providing molecular diagnostic yield data for AOS.
datasets:
📚

References & Deep Research

Deep Research

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Asta
Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Adams-Oliver Syndrome. Core disease mechanisms, molecular and cellular pat...
Asta Scientific Corpus Retrieval 20 citations 2026-04-22T22:29:15.733952

Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Adams-Oliver Syndrome. Core disease mechanisms, molecular and cellular pat...

This report is retrieval-only and is generated directly from Asta results.

  • Papers retrieved: 20
  • Snippets retrieved: 20

Relevant Papers

[1] 18O-assisted dynamic metabolomics for individualized diagnostics and treatment of human diseases

  • Authors: E. Nemutlu, Song Zhang, N. Juranic, A. Terzic, S. Macura et al.
  • Year: 2012
  • Venue: Croatian Medical Journal
  • URL: https://www.semanticscholar.org/paper/880f053c7f060db4b990e447d0a22c4b69372ddb
  • DOI: 10.3325/cmj.2012.53.529
  • PMID: 23275318
  • PMCID: 3541579
  • Citations: 28
  • Summary: The potential use of dynamic phosphometabolomic platform for disease diagnostics currently under development at Mayo Clinic is described and discussed briefly.
  • Evidence snippets:
  • Snippet 1 (score: 0.375) > Living cells represent an integrated and interacting network of genes, transcripts, proteins, small signaling molecules, and metabolites that define cellular phenotype and function. Traditionally the focus of biomedical research was on individual genes, single protein targets, single metabolites, and metabolic or signaling pathways. This "molecular reductionist" paradigm was based on the assumption that identifying genetic variations and molecular components would lead to discovery of cures for human diseases. However, most of diseases are complex and multi-factorial and the disease phenotype is determined by the alterations of multiple genes, pathways, proteins and metabolites (at cellular, tissue, and organismal levels). Therefore, an integrated "omics" approach is more viable direction for uncovering alterations in metabolic networks, disease mechanisms, and mechanisms of drug effects. > Recent advent of large-scale metabolomics and fluxomic (metabolite dynamics and metabolic flux analysis) completed the "omics revolution" (Figure 1), where genomics, transcriptomics, proteomics, metabolomics, and fluxomics all together complement phenotype determination of living organism. Such integrated "omics" cascades provide a framework for advances in system and network biology, integrative physiology, and system medicine as well as system pharmacology and regenerative medicine. Noteworthy is the "reverse omic" approach or "metabolomicsinformed pharmacogenomics, " where discovery of specific metabolite changes have led to discovery of genetic alterations (2). Therefore, bringing new "omics" technologies to clinical practice will improve disease diagnostics and treatment by targeting drugs and procedures for each unique transcriptomic and metabolomic profiles.

[2] The evolving burden of asthma and contemporary advances in management: Implications for clinical practice in Southern Africa

  • Authors: A. Kiboneka
  • Year: 2020
  • Venue: Unknown venue
  • URL: https://www.semanticscholar.org/paper/0ba536bc7dbea898dcaabe247c92c7897c7e059c
  • DOI: 10.30574/wjarr.2020.8.3.0315
  • Citations: 1
  • Summary: The development of novel asthma phenotyping & endo typing plus better classification of patients using machine learning and big data have markedly improved asthma treatment outcomes in both children and Adults, and several research groups have developed cluster analyses of phenotypes in severe asthma.
  • Evidence snippets:
  • Snippet 1 (score: 0.365) > Research Program (SARP) I and II cohorts to study mechanisms differentiating severe from non-severe asthma. SARP investigators characterized severe asthma as a heterogeneous syndrome with diverse molecular, biochemical, and cellular inflammatory features and structure-function abnormalities. > Adults and children with severe asthma were further categorized by unbiased statistical methods into clusters based on distinguishing clinical features. These studies have not been done in Sub-Sahara Africa. Research performed over the past one to two decades has sought to better understand the heterogeneous clinical nature of asthma. Whereas older attempts at phenotyping asthma emphasized the duality of allergic vs. non-allergic asthma, more recent non-biased analyses have attempted to cluster patients by a multitude of possible features, including age of onset, atopy, severity of airways obstruction, and requirement for medication. Examples of these phenotypes include early-onset mild allergic asthma, later-onset asthma associated with obesity, and severe non-atopic asthma with frequent exacerbations. The elucidation of asthma phenotypes has been further refined by including information regarding pathophysiologic mechanisms present in different groups. These groups, called endo-types, include examples such as aspirin-exacerbated respiratory disease and allergic bronchopulmonary mycosis. > A phenotype covers the clinically relevant properties of the disease, but does not show the direct relationship to disease etiology and pathophysiology. Different patho-genetic mechanisms might cause similar asthma symptoms and might be operant in a certain phenotype. These putative mechanisms are addressed by the term 'endotype'. > Classification of asthma based on endo-types provides advantages for epidemiological, genetic, and drug-related studies. A successful definition of endo-types should link key pathogenic mechanisms with the asthma phenotype. Thus, the identification of corresponding molecular biomarkers for individual pathogenic-mechanism underlying phenotypes or subgroups within a phenotype is important. > The term asthma encompasses a disease spectrum with mild to very severe disease phenotypes whose traditional common characteristic is reversible airflow limitation. Unlike milder disease, severe asthma is poorly controlled by the current standard of care.

[3] Towards Mutation-Specific Precision Medicine in Atypical Clinical Phenotypes of Inherited Arrhythmia Syndromes

  • Authors: T. Nakajima, S. Tamura, M. Kurabayashi, Y. Kaneko
  • Year: 2021
  • Venue: International Journal of Molecular Sciences
  • URL: https://www.semanticscholar.org/paper/3d299f57f344d42eff9d3565d1581dae7fb87a54
  • DOI: 10.3390/ijms22083930
  • PMID: 33920294
  • PMCID: 8069124
  • Citations: 6
  • Influential citations: 1
  • Summary: Since the epileptic phenotype appears to manifest prior to cardiac events in this mutation carrier, identifying KCND3 mutations in patients with epilepsy and providing optimal therapy will help prevent sudden unexpected death in epilepsy.
  • Evidence snippets:
  • Snippet 1 (score: 0.363) > Recent advances in molecular genetics have identified many causal genes for inherited arrhythmia syndromes (IASs) such as long QT syndrome (LQTS) [1], short QT syndrome (SQTS) [2], Brugada syndrome (BrS) [3,4] and early repolarization (ER) syndrome (ERS) [3,5]. Most causal genes for IASs encode cardiac ion channels or their related proteins. Genotype-phenotype studies and functional analyses of mutant genes, using heterologous expression systems and experimental animal models, have revealed the pathophysiology of IASs and enabled the establishment of causal gene-specific precision medicine [6][7][8]. Furthermore, analyses of patient-specific and/or genome-edited induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) have provided further insights into the pathophysiology of IASs and novel promising therapeutic strategies for IASs, although there are still some limitations of using iPSC-CMs, such as immature structure and function and mixed population of atrial, ventricular, and nodal cells, as a standard technology [9]. > The altered function of causal genes that encode cardiac ion channels is caused by multiple mechanisms, including trafficking defects, producing non-functional channels, altered channel gating properties, and a combination thereof. These altered functions of mutant channels underly the clinical phenotypes of IASs [10][11][12]. Particularly, unique electrophysiological properties of mutant channels have been shown to be associated with the atypical clinical phenotypes of IASs [10,13]. Furthermore, the elucidation of the mechanisms underlying the atypical clinical phenotypes of IASs has raised the possibility of mutation-specific precision medicine. > We herein review the current knowledge of genotype-phenotype relationships, underlying molecular and cellular mechanisms, and established pharmacological therapies of IASs, including LQTS, SQTS, and J wave syndrome (BrS and ERS).

[4] Changes in Serum Proteomic Profiles at Different Stages of Pregnancy Toxemia in Goats

  • Authors: M. Uzti̇mür, C. N. Ünal, Gurler Akpinar
  • Year: 2025
  • Venue: Journal of Veterinary Internal Medicine
  • URL: https://www.semanticscholar.org/paper/4b9c488b5dbd65d7b26fd2ad9aed70e8c4b59942
  • DOI: 10.1111/jvim.70139
  • PMID: 40492724
  • PMCID: 12150350
  • Summary: Understanding the serum proteome profiles of goats with pregnancy toxemia might help identify the proteomes and pathways responsible for the development of this disease and improve diagnosis and treatment.
  • Evidence snippets:
  • Snippet 1 (score: 0.352) > The pathophysiology and progression of this disease are not fully understood. > Traditional biomedical research has focused on the analysis of single genes, proteins, metabolites, or metabolic pathways in diseases. This molecular reductionist approach is based on the assumption that identifying genetic variations and molecular components will lead to new treatments for diseases [13][14][15][16]. However, many diseases are complex and multifactorial, and in order to determine the phenotype of such diseases, it is necessary to understand the changes that occur in more than one gene, pathway, protein, or metabolite at the cellular, tissue, and organismal levels [17][18][19]. Therefore, in recent years, proteomics, as one field of multi-omics technologies, has helped in evaluating the complex pathogenetic mechanisms of different diseases from a broad perspective and has made substantial contributions [20,21]. In veterinary medicine, proteomic analysis of metabolic diseases such as ketosis [16], hypocalcemia [22], and fatty liver [23] in dairy cows has contributed valuable insights for the definition of new pathophysiological pathways and new diagnosis and treatment protocols for these diseases. The proteomic approach can contribute importantly to a broad and detailed understanding of the changes that occur at the organismal level associated with the increase in BHBA concentration in goats with pregnancy toxemia. Our aim was to evaluate the serum protein profiles of goats with SPT or CPT using proteomic techniques to determine the proteomic profiles of these animals and to identify the relevant pathophysiological mechanisms.

[5] Therapies for Mitochondrial Disease: Past, Present, and Future

  • Authors: Megan Ball, Nicole J. Van Bergen, A. Compton, David R Thorburn, S. Rahman et al.
  • Year: 2025
  • Venue: Journal of Inherited Metabolic Disease
  • URL: https://www.semanticscholar.org/paper/196ee50a950f29bc4134cfb8fe6bdfa9a3a1468b
  • DOI: 10.1002/jimd.70065
  • PMID: 40714961
  • PMCID: 12301291
  • Citations: 3
  • Summary: The latest developments in the pursuit to identify effective treatments for mitochondrial disease are examined and the barriers impeding their success in translation to clinical practice are discussed.
  • Evidence snippets:
  • Snippet 1 (score: 0.352) > Mitochondrial disease is a diverse group of clinically and genetically complex disorders caused by pathogenic variants in nuclear or mitochondrial DNA‐encoded genes that disrupt mitochondrial energy production or other important mitochondrial pathways. Mitochondrial disease can present with a wide spectrum of clinical features and can often be difficult to recognize. These conditions can be devastating; however, for the majority, there is no targeted treatment. In the last 60 years, mitochondrial medicine has experienced significant evolution, moving from the pre‐molecular era to the Age of Genomics in which considerable gene discovery and advancement in our understanding of the pathophysiology of mitochondrial disease have been made. In the last decade, in response to the urgent need for effective treatments, a wide range of emerging therapies have been developed, driven by innovative approaches addressing both the genetic and cellular mechanisms underpinning the diseases. Emerging therapies include dietary intervention, small molecule therapies aimed to restore mitochondrial function, stem cell or liver transplantation, and gene or RNA‐based therapies. However, despite these advances, translation to clinical practice is complicated by the sheer genetic and clinical complexity of mitochondrial disease, difficulty in efficient and precise delivery of therapies to affected tissues, rarity of individual genetic conditions, lack of reliable biomarkers and clinically relevant outcome measures, and the dearth of natural history data. This review examines the latest developments in the pursuit to identify effective treatments for mitochondrial disease and discusses the barriers impeding their success in translation to clinical practice. While treatment for mitochondrial disease may be on the horizon, many challenges must be addressed before it can become a reality.

[6] Future research trends in understanding the mechanisms underlying allergic diseases for improved patient care

  • Authors: H. Breiteneder, Z. Diamant, T. Eiwegger, W. Fokkens, C. Traidl‐Hoffmann et al.
  • Year: 2019
  • Venue: Allergy
  • URL: https://www.semanticscholar.org/paper/e19b0755c4f4903f68377333676edebf9bd73c89
  • DOI: 10.1111/all.13851
  • PMID: 31056763
  • PMCID: 6973012
  • Citations: 90
  • Influential citations: 3
  • Summary: Recent developments in research and patient care and future trends in the discipline are reviewed and topics on food allergy, biologics, small molecules, and novel therapeutic concepts in allergen‐specific immunotherapy for airway disease are highlighted.
  • Evidence snippets:
  • Snippet 1 (score: 0.350) > The past decades have witnessed extensive progress in unraveling cellular and molecular mechanisms of immune regulation in asthma, allergic diseases, organ transplantation, autoimmune diseases, tumor biology, and chronic infections. 1,2 Consequently, a better understanding of the functions, the reciprocal regulation, and the counterbalance of subsets of immune and inflammatory cells but also structural cells-for example, epithelial and vascular cells, airway smooth muscle cells, neuroendocrine system-that interact via various intercellular messengers will indicate avenues for immune interventions and novel treatment modalities of allergic diseases and immunological disorders. It is generally expected that drug development in the next decades will show a significant shift from chemicals to biologicals. > After more than 20 years without any breakthrough drug becoming available for patients, several disciplines including allergology are now experiencing extraordinary times with the recent licensing of several major biological drugs and novel allergen-specific immunotherapy (AIT) vaccines. Several biological modifiers of the immune response targeting intracellular messengers or their receptors have been developed to date. [3][4][5][6][7][8] In addition, a number of promising small molecule drugs and vaccines are in the development pipeline. [9][10][11] This new era is now calling for the development of biomarkers and phenoand endotyping of diseases for customized patient care, which is termed stratified medicine, precision medicine, or personalized medicine. 4 Distinguishing phenotypes of a complex disease covers the observable clinically relevant properties of the disease but does not show a direct relationship to disease etiology and pathophysiology. In a complex condition, such as asthma, different pathogenetic mechanisms can induce similar clinical manifestations; however, they may require different treatment approaches. 12,13 These pathophysiological mechanisms underlying disease subgroups are addressed by the term "endotype." [12][13][14] Classification of complex diseases based on the concept of endotypes provides advantages for epidemiological, genetic, and drug-related studies. Accurate endotyping by using reliable biomarkers reflects the natural history of the disease and aims to predict the response to (targeted) treatments. 15 Recent studies have focused on better understanding

[7] New therapeutic targets in rare genetic skeletal diseases

  • Authors: M. Briggs, Peter A. Bell, M. Wright, K. A. Pirog
  • Year: 2015
  • Venue: Expert Opinion on Orphan Drugs
  • URL: https://www.semanticscholar.org/paper/1363107f71ae6d2d60abca471cddf3da5d13644b
  • DOI: 10.1517/21678707.2015.1083853
  • PMID: 26635999
  • PMCID: 4643203
  • Citations: 38
  • Influential citations: 1
  • Summary: An overview of disease mechanisms that are shared amongst groups of different GSDs and potential therapeutic approaches that are under investigation are described to generate critical mass for the identification and validation of novel therapeutic targets and biomarkers.
  • Evidence snippets:
  • Snippet 1 (score: 0.350) > proteins of the cartilage ECM such as type II collagen [50]. However, emerging knowledge suggests that the primary genetic defect may be less important than the cells' response to the expression of the mutant gene product [107]. Moreover, the largely overlooked response of a cell (i.e. chondrocyte) to the abnormal extracellular environment is also important for disease progression as illustrated by several GSDs discussed in this review. > It is important that 'omics'-based approaches and technologies are systematically applied to the study of rare GSDs so that definitive reference profiles and disease signatures are generated for each phenotype. These can then be used in a Systems Biology approach to identify both common and dissimilar pathological signatures and disease mechanisms. This approach is entirely dependent upon relevant in vitro and in vivo models (and also novel 'disease-mechanism phenocopies' [107]) for testing new diagnostic and prognostic tools and for determining the molecular mechanisms that underpin the pathophysiology so that effective therapeutic treatments can be developed and validated. This approach will eventually lead to personalized treatments and care strategies centred on shared disease mechanisms with the use of relevant biomarkers to monitor the efficacy of treatment and disease progression. > It is vital that all relevant stakeholders are involved from the outset in defining the appropriate outcomes of any potential therapeutic regime. The perceptions of a successful therapy can differ widely between the clinical academic community and the relevant patient-support groups and it is vital that there is engagement on all these issues. > In summary, the identification of causative genes and mutations for GSDs over the last 20 years, coupled with the generation and in-depth analysis of a plethora of relevant cell and mouse models, has derived new knowledge on disease mechanisms and suggested potential therapeutic targets. The fast-evolving hypothesis that clinically disparate diseases can share common disease mechanisms is a powerful concept that will generate critical mass for the identification and validation of novel therapeutic targets and biomarkers.

[8] Can network biology unravel the aetiology of congenital hyperinsulinism?

  • Authors: A. Stevens, K. Cosgrove, R. Padidela, M. Skae, P. Clayton et al.
  • Year: 2013
  • Venue: Orphanet Journal of Rare Diseases
  • URL: https://www.semanticscholar.org/paper/474ed97fdbb2a604459faa0b626a8b7d20ed6bf4
  • DOI: 10.1186/1750-1172-8-21
  • PMID: 23394473
  • PMCID: 3599136
  • Citations: 9
  • Influential citations: 1
  • Summary: A rational argument for the use of computational biology as a valuable resource for identifying new candidate genes which may cause disease and for understanding the complex mechanisms which define the pathophysiology of this rare disease is presented.
  • Evidence snippets:
  • Snippet 1 (score: 0.348) > Congenital Hyperinsulinism (CHI) is a rare disease, but is the most common cause of recurrent hypoglycaemia in infancy [1]. The treatment of CHI can be difficult and involves drugs which may not be successful and often are poorly tolerated. As a potentially life-threatening condition, CHI is associated with lifelong sequelae -including critical brain damage (epilepsy, cerebral palsy and neurological impairment) in up to 40% of cases. To date, nine candidate genes associate with CHI, but for the majority of patientsestimated to be approximately 65%, both the aetiology of the CHI and the mechanisms of disease are unknown. > Our current approach to the classification and treatment of CHI is based largely upon observational correlations between the pathological analysis of candidate gene defects and clinical symptoms of hypoglycaemia [1][2][3]. In this respect, there are similarities between CHI and many other diseases in which numerous mutations in different genes give rise to clinical phenotypes that are essentially indistinguishable from one another. However, under normal physiological conditions, cells function correctly because there is a high degree of interdependency between individual biochemical components (DNA, RNA, proteins and metabolites) and their complex interactions (DNA-protein interactions, protein-protein interactions, metabolic and biochemical pathways, etc.), and tissues function in a co-ordinated manner because there is interplay between different cell types. Diseases rarely result from an abnormality in a single gene, but are in fact the manifestation of disturbances in the multiple networks that integrate cellular processes, and those that link cells with tissues, and tissues with organ systems. As a result, current approaches to molecular diagnosis, however valuable, have shortcomings. These include a lack of sensitivity in identifying preclinical disease, a poor ability to predict prognosis, and ambiguity in defining and resolving a condition where several clinical phenotypes can be observed. All of these inadequacies are evident in CHI, with our current understanding of the causes of disease failing to distinguish transient from persistent disease at the point of presentation and to determine accurately the severity of disease.

[9] Precision Therapeutics in Lennox–Gastaut Syndrome: Targeting Molecular Pathophysiology in a Developmental and Epileptic Encephalopathy

  • Authors: Debopam Samanta
  • Year: 2025
  • Venue: Children
  • URL: https://www.semanticscholar.org/paper/455479c1bfbea7b90b73c109228f67c813d13888
  • DOI: 10.3390/children12040481
  • PMID: 40310132
  • PMCID: 12025602
  • Citations: 19
  • Influential citations: 1
  • Summary: A narrative review explores precision therapeutic strategies for LGS based on molecular pathophysiology, including channelopathies, receptor and ligand dysfunction, receptor and ligand dysfunction, cell signaling abnormalities, cell signaling abnormalities, synaptopathies, and the repurposing of existing medications with mechanism-specific effects.
  • Evidence snippets:
  • Snippet 1 (score: 0.347) > A key advantage of disease-modifying therapies is their potential to target pathogenic mechanisms early in the disease course, potentially preventing the progression of some infantile epileptic encephalopathies to LGS. > This narrative review explores precision therapeutic strategies based on specific monogenic causes and disease mechanisms relevant to LGS. A comprehensive literature search (PubMed, MEDLINE, ClinicalTrials.gov, conference abstracts from the American Academy of Neurology and American Epilepsy Society, and gray literature) was conducted through 19 February 2025 to identify established ASMs, repurposed and novel drugs, as well as various gene therapy approaches with potential relevance to LGS. Given that over 900 monogenic causes of DEEs have been identified-implicating diverse cellular components such as ion channels, receptors, synaptic proteins, signaling pathways, metabolic processes, and epigenetic regulators-this review discusses current and emerging precision therapeutics based on shared molecular mechanisms and the pathophysiology of select genes associated with LGS [17] (Table 1).

[10] Conceptualizing Epigenetics and the Environmental Landscape of Autism Spectrum Disorders

  • Authors: G. Torres, Mervat Mourad, Saba Iqbal, Emmanuel Moses-Fynn, Ashani Pandita et al.
  • Year: 2023
  • Venue: Genes
  • URL: https://www.semanticscholar.org/paper/bf76f0682a8a1986ce889cee1fef818480abc83b
  • DOI: 10.3390/genes14091734
  • PMID: 37761876
  • PMCID: 10531442
  • Citations: 11
  • Summary: The present work reviews recent evolutionary, molecular, and epigenetic mechanisms potentially linked to the etiology of autism, and presents a clinical vignette to describe clusters of maladaptive behaviors frequently diagnosed in autistic patients.
  • Evidence snippets:
  • Snippet 1 (score: 0.346) > Currently, there are hundreds of gene variants associated with the onset of ASD. Thus, the clinical presentation of the disease is highly variable, as one or more behavioral symptoms may be related to other comorbid conditions (e.g., anxiety disorder, seizure disorder) besides autism. In addition, antagonistic pleiotropy and dosage-sensitive genes further fragment the phenotypic characteristics of ASD. Regardless, here, we present a prototypical autism clinical vignette with five behavioral specifiers: cognitive disability; deficits in social-emotional reciprocity; repetitive or stereotyped motor behavior; improper coordinated language communication; and gastrointestinal distress. Underneath this clinical vignette, we microdissected and correlated a particular phenotype of the disease to functionally and anatomically related regions of the brain and bilateral body plan. The structural organization imposed here will not only identify a wide network of cells, but also specific clusters of genes targeting a particular symptom within behaviorally relevant regions. It is expected that such structural organization will help lay a solid foundation in psychiatry and point to more focused approaches to a deeper understanding of ASD and its individualized treatment (Table 2). Autism Spectrum Disorders can be managed with appropriate pharmacotherapy. Selective dopamine (DA) and serotonin (5HT) based drugs are the mainstay of pharmacological treatment [43,44]. Additional neurotransmitter systems (e.g., norepinephrine (NE) and histamine) are also drug targets. It is not known whether the listed drugs regulate epigenetic mechanisms to counteract autistic symptoms. What is broadly known is that atypical, typical and psychoactive drugs act on DA and 5HT signaling pathways within regions of the human brain (e.g., cortex and basal ganglia) that are behaviorally relevant to the pathophysiology of ASD. Attention Deficit Hyperactivity Disorder (ADHD) and Fragile X Syndrome are debilitating neuropsychiatric conditions commonly diagnosed in pediatric populations. Fragile X Syndrome is a monogenic inherited disease leading to cognitive disability and ASD.

[11] An overview on cardiac involvement in Inborn Errors of Metabolism: from clinical clues to nutritional management strategies

  • Authors: C. Montanari, V. Tagi, Martina Tosi, Eliana Stucchi, Eleonora Pisano et al.
  • Year: 2025
  • Venue: Frontiers in Cardiovascular Medicine
  • URL: https://www.semanticscholar.org/paper/53edcd65284033a78e81633fbeb8012f21599561
  • DOI: 10.3389/fcvm.2025.1648010
  • PMID: 41425985
  • PMCID: 12711851
  • Summary: This review examines nutritional strategies for managing patients affected by IEMs with cardiac involvement, providing clinicians with research-backed guidance to support cardiological care, since specific nutritional strategies have shown promise in reversing or improving cardiac function in specific IEMs.
  • Evidence snippets:
  • Snippet 1 (score: 0.345) > Approximately 10% to 30% of the known causes of cardiomyopathy in childhood are attributable to IEMs (10, 130,131). In IEMs, cardiac manifestations can be indicative symptoms discovered during regular multisystem screening. While in disorders like MPS, heart manifestations may dominate the clinical presentation, in others, such as PD, they represent the sole clinical manifestation. Four fundamental mechanisms underlie the pathophysiology of cardiac involvement. First, cardiac symptoms can be linked to a reduction in energy production resulting from genetic mutations in proteins involved in energy homeostasis, molecular transport, or cellular organelles. Second, the intracellular accumulation of intermediates or storage substrates within cardiac myocytes can lead to structural and functional damage of the cardiac tissue. Third, the accumulation of intermediate metabolites may exert toxic effects on cardiac and surrounding tissues, for example, by triggering apoptosis in cardiac myocytes. Fourth, altered cellular functions such as signal transduction, depolarization, and cell adhesion, caused by the absence or alteration of glyconjugates, can compromise tissue integrity and cardiac function. It is important to note that pathogenetic mechanisms, summarized in Figure 3, may often overlap, particularly in later stages of the illness progression (33). In this review, we offered a comprehensive description of the cardiovascular diseases primarily associated with various types of IEMs, to guide cardiologists in the differential diagnosis (Figure 4). Moreover, the diagnosis of an underlying metabolic disorder should rely on the recognition of associated signs and symptoms characteristic of each specific disease. > IEMs have a wide phenotypic spectrum and may be characterized by a late onset or mild organ involvement, remaining misdiagnosed. Following the diagnosis of heart complications, the cardiologist should first conduct a detailed investigation of the patient's and family's medical history, including an assessment of consanguinity and/or the presence of rare inherited disorders. The patient's history should include age of onset of each clinically relevant symptom, the presence of associated pathological conditions and/or symptoms (hypoglycemia, myalgia, neurological issues or liver problems) and the result of neonatal screening.

[12] Transcriptional profiling of Hutchinson-Gilford progeria patients identifies primary target pathways of progerin

  • Authors: Sandra Vidak, Sohyoung Kim, Tom Misteli
  • Year: 2026
  • Venue: Nucleus
  • URL: https://www.semanticscholar.org/paper/4bd99b0875508364d8672b6da5a50d024d485a53
  • DOI: 10.1080/19491034.2025.2611484
  • PMID: 41489464
  • PMCID: 12773485
  • Summary: To probe the clinical relevance of previously implicated cellular pathways and to address the extent of gene expression heterogeneity between patients, transcriptomic analysis of a comprehensive set of HGPS patients finds misexpression of several cellular pathways, including multiple signaling pathways, the UPR and mesodermal cell fate specification.
  • Evidence snippets:
  • Snippet 1 (score: 0.345) > Oxidative stress represents another key pathogenic mechanism in HGPS, as impaired NRF2 activity or increased reactive oxygen species (ROS) levels are sufficient to recapitulate HGPSassociated phenotypes [17,32,60]. Collectively, these findings underscore the multifactorial nature of HGPS pathogenesis, implicating interconnected signaling cascades involved in inflammation, oxidative stress, proteostasis, and vascular remodeling. Reassuringly, our findings indicate that many of the major pathways that have been described to contribute to HGPS phenotypes in mouse and cellular disease models are also misregulated in progeria patients, and targeting these pathways may provide therapeutic avenues to mitigate disease severity and improve outcomes in HGPS. > Although individuals with HGPS typically exhibit a characteristic set of clinical features, such as craniofacial abnormalities, growth retardation, and cardiovascular complications, there is notable variability in the age of onset, severity, and progression of symptoms between patients [7,9]. At the cellular level, HGPS is associated with several hallmark abnormalities, including nuclear envelope defects, decreased expression of several nuclear proteins and epigenetic marks, mitochondrial dysfunction, and increased cellular senescence [1,11,30,31,61]. These cellular phenotypes also exhibit considerable variation between patients, possibly contributing to differences in clinical outcomes. Our results indicate that even though some degree of transcriptional heterogeneity between the individual patients exists, the majority of patients exhibit misregulation of a set of shared pathways, suggesting that these pathways are universal driver mechanisms in HGPS. Further work is needed to understand the molecular and genetic factors that underlie inter-individual variability in disease expression and progression. > A limitation of pathway analysis of HGPS patient samples is to distinguish the pathways which are directly targeted by the disease-causing progerin protein and the emergence of adaptive secondary response pathways during progression of the disease in patients during their lifetime. The same caveat applies to the use of cell-based models used in the study of HGPS disease mechanisms.

[13] Role of Transcriptomics in Precision Oncology

  • Authors: Ruby Srivastava
  • Year: 2024
  • Venue: Reports of Radiotherapy and Oncology
  • URL: https://www.semanticscholar.org/paper/0bd862558bbb7286336111d9dfd232b5f905d3d9
  • DOI: 10.5812/rro-142195
  • Citations: 4
  • Summary: : Transcriptome profiling is one of the most widely used approaches in the field of multiomics research. It plays a crucial role in the prognostic, diagnostic, and predictive treatment of cancer patients. Novel next-generation sequencing (NGS) technologies permit the identification of cancer biomarkers, gene signatures, and their abnormal expression, affecting oncogenic and molecular targets and novel biomarkers for cancer therapies. Multiomics studies have changed the overall understanding o...
  • Evidence snippets:
  • Snippet 1 (score: 0.343) > : Transcriptome profiling is one of the most widely used approaches in the field of multiomics research. It plays a crucial role in the prognostic, diagnostic, and predictive treatment of cancer patients. Novel next-generation sequencing (NGS) technologies permit the identification of cancer biomarkers, gene signatures, and their abnormal expression, affecting oncogenic and molecular targets and novel biomarkers for cancer therapies. Multiomics studies have changed the overall understanding of cancer and opened a precise perspective for tumor diagnostics and therapy. The use of these approaches has strengthened our understanding of disease pathophysiology and classifications at the molecular level, including specific interference with drug mechanisms of action. Still, it has limited added value in the clinical setting. The omics data on precision medicine include the application of data from genes, transcripts, and proteins for diagnosis, monitoring of diseases, risk factor determination, counseling, and development of novel therapeutics. Bioinformatics applications have expanded statistics-based analysis toward deriving molecular pathways and process models for characterizing phenotypes and drug action mechanisms. In this review, we will discuss transcriptomics and interference analysis that allows the identification of predictive biomarkers at the molecular level to test drug response and analyze the molecular process interface of disease progression-relevant pathophysiology and mechanism of action to propose predictive biomarkers.

[14] Novel Approaches to Studying SLC13A5 Disease

  • Authors: Adriana S. Beltran
  • Year: 2024
  • Venue: Metabolites
  • URL: https://www.semanticscholar.org/paper/8469c534cd81d96f84b61e2d963dead12088feb7
  • DOI: 10.3390/metabo14020084
  • PMID: 38392976
  • PMCID: 10890222
  • Citations: 2
  • Summary: Current technologies for generating patient-specific induced pluripotent stem cells (iPSCs) and their inherent advantages and limitations are discussed, followed by a summary of the methods for differentiating iPSCs into neurons, hepatocytes, and organoids.
  • Evidence snippets:
  • Snippet 1 (score: 0.343) > The precise pathophysiology underlying how SLC13A5 loss-of-function results in epilepsy refractory to treatment is a subject of open and ongoing research. Several hypotheses suggest SLC13A5 alters metabolic pathways, leading to neuronal dysfunction. Conversely, therapeutic inhibition of NaCT in the liver is a target to improve metabolic diseases, including non-alcoholic fatty liver disease, obesity, and insulin resistance. Thus, functionally accurate modeling and characterization of the mechanisms involved in citrate transport disruption are critical for understanding its role in human disease. > IPSC-derived cellular systems are a powerful tool for modeling rare human genetic diseases, such as SLC13A5 (Figure 5). IPSCs derived from patients containing the genetic information of the disease can overcome the limitations of animal models, providing access to relevant human cell types that recapitulate the disease phenotype. For instance, patient-derived iPSCs differentiated into neurons or hepatocytes can be used to investigate molecular and cellular mechanisms, including citrate transport and accumulation, energy metabolism, oxidative stress, and other cellular processes. They can also be used to define the spectrum of the disease and how different mutations might lead to various disease severities, screen for potential therapeutic compounds that can restore the transporter function or ameliorate the symptoms, and enable personalized medicine approaches that can tailor treatments to individual patients based on their genetic background and disease severity. > transport disruption are critical for understanding its role in human disease. > IPSC-derived cellular systems are a powerful tool for modeling rare human genetic diseases, such as SLC13A5 (Figure 5). IPSCs derived from patients containing the genetic information of the disease can overcome the limitations of animal models, providing access to relevant human cell types that recapitulate the disease phenotype. For instance, patient-derived iPSCs differentiated into neurons or hepatocytes can be used to investigate molecular and cellular mechanisms, including citrate transport and accumulation, energy metabolism, oxidative stress, and other cellular processes.

[15] Common immunopathogenesis of central nervous system diseases: the protein-homeostasis-system hypothesis

  • Authors: Kyung-Yil Lee
  • Year: 2022
  • Venue: Cell & Bioscience
  • URL: https://www.semanticscholar.org/paper/2984270ae67451b93007040848d9694d19714c9f
  • DOI: 10.1186/s13578-022-00920-5
  • PMID: 36384812
  • PMCID: 9668226
  • Citations: 9
  • Influential citations: 1
  • Summary: This article proposes a common immunopathogenesis of CNS diseases, including prion diseases, Alzheimer’s disease, and genetic diseases, through the PHS hypothesis, which proposes that the immune systems in the host control those substances according to the size and biochemical properties of the substances.
  • Evidence snippets:
  • Snippet 1 (score: 0.342) > There are hundreds of genetic diseases of the CNS. The defective proteins in genetic disorders include structural proteins for neurotransmitter receptors and other receptors or ion channels on CNS cells, and proteins involved in enzymatic process, metabolism (transport), or signal transduction pathways in various communication systems [98]. Because a discussion of each genetic disease is beyond the scope of this review, only crucial points about the pathogenesis of genetic diseases are discussed. Singlegene defect diseases of the CNS can be caused by a defective product from a gene, i.e., a protein deficiency or a malfunctioning protein. In general, autosomal dominant genetic diseases are caused by structural protein defects, and autosomal recessive diseases are caused by defects in enzymatic proteins. However, certain genetic diseases that involve an enzymatic or multifunctional protein defect can induce structural cell injury during the natural course of the illness. > Patients with genetic diseases, including HD, familial JCD, GSS, and the genetic forms of AD and PD, show different clinical manifestations from other affected people in their family, including the time of onset of neurological symptoms, speed of progression of the disease, and prognosis, suggesting that phenotypes can vary even when the genotypes are identical. Likewise, similar phenotypes of CNS symptoms can be found in different genetic diseases. In genetic animal models, the phenotypes of single gene knockout can vary by strain in mice, and the clinical manifestations of a gene defect can differ between mice and humans, and mice null for some genes have also no observable phenotypic abnormalities compared with controls [99]. These findings suggest that default of a protein might be at least partly controlled by individual's control systems and that there might exist a similar immune/repair system against cell injury in genetic diseases. > The pathophysiology of most genetic diseases in the CNS is complex because any affected gene is associated with numerous proteins and their corresponding activations of genes and epigenetic changes that occur during disease processes. Thus, the use of a genetic marker for diagnosing or predicting a prognosis remains impractical in clinical settings [100].

[16] Systems pharmacology-based integration of human and mouse data for drug repurposing to treat thoracic aneurysms.

  • Authors: J. Hansen, J. Galatioto, Cristina I. Caescu, P. Arnaud, R. C. Calizo et al.
  • Year: 2019
  • Venue: JCI insight
  • URL: https://www.semanticscholar.org/paper/261628418de4c8b21daeb694301dc1b8759b622d
  • DOI: 10.1172/jci.insight.127652
  • PMID: 31167969
  • Citations: 20
  • Summary: System pharmacology approaches that compare patient- and mouse-derived transcriptomic data for subcellular pathway-based drug repurposing represent an effective strategy to identify potential new treatments of human diseases.
  • Evidence snippets:
  • Snippet 1 (score: 0.342) > TAA with ensuing dissection and rupture of the vessel wall is the clinical hallmark of Marfan syndrome (MFS), a relatively common connective tissue disease associated with mutations in the gene that codes for the multifunctional ECM glycoprotein fibrillin-1 (4,5). Fibrillin-1 assemblies (microfibrils and elastic fibers) impart specific physical properties to tissues, distribute mechanical forces within and across them, communicate to multiple types of vessel wall cells through integrin receptors, and modulate local bioavailability of ECM-bound latent TGF-β complexes (5). In spite of significant research effort, the molecular pathogenesis of arterial disease in MFS remains unresolved, therefore hindering advances in drug therapy. Earlier studies of MFS mice with nondissecting TAA (Fbn1 C1039G/+ mice) have correlated aneurysm onset and progression with increased TGF-β signaling in the media stimulated by improper angiotensin II (AngII) type I receptor (AT1r) activity (6,7). More recent findings indicate a more complex disease mechanism involving the gradual stratification of stress-stimulated interactions among different cell types and multiple regulatory pathways, of which the AT1r and TGF-β signaling pathways are a critical subset (8)(9)(10)(11)(12)(13)(14). > An overview of regulatory pathways and networks associated with a given pathology can often be obtained by examining changes in gene expression during disease progression. Systems pharmacology approaches that consider drug targets as nodes within cellular regulatory networks can use differentially expressed genes (DEGs) to predict dysregulated SCPs that underlie cell-level mechanisms (1,3). Further, computational analyses of the pharmacologically induced perturbations of gene expression listed in the Connectivity Map (CMap) database can predict drugs to be repurposed to normalize dysregulated SCPs (15).

[17] Recent advances in modelling of cerebellar ataxia using induced pluripotent stem cells

  • Authors: M. M. Wong, L. Watson, Esther B. E. Becker
  • Year: 2017
  • Venue: Journal of neurology & neuromedicine
  • URL: https://www.semanticscholar.org/paper/0d962652305116e383ab260b9e82d3a5ffe1722f
  • DOI: 10.29245/2572.942X/2017/7.1134
  • PMID: 28825058
  • PMCID: 5558869
  • Citations: 9
  • Summary: This review focuses on recent breakthroughs in generating human iPSC-derived Purkinje cells and highlights the future challenges that will need to be addressed in order to fully exploit these models for the modelling of the molecular mechanisms underlying cerebellar ataxias and the development of effective therapeutics.
  • Evidence snippets:
  • Snippet 1 (score: 0.341) > dominant polyglutamine spinocerebellar ataxias (SCAs) are the most studied forms of ataxias. Despite significant clinical and genetic heterogeneity, emerging evidence points to the existence of common pathogenic mechanisms that may be shared by several genetically distinct forms of cerebellar ataxias (reviewed in5-8). However, it is still unclear how the proposed pathological pathways ultimately result in cerebellar dysfunction and degeneration, predominantly affecting Purkinje cells. > Understanding disease mechanisms is key to treating neurodegenerative disorders. The heterogeneous nature of the cerebellar ataxias combined with the unavailability of human brain tissue and the lack of reliable disease models have, however, hampered our understanding of the molecular disease mechanisms underlying cerebellar ataxias and thus, the development of effective therapies. Although mouse models of several cerebellar ataxias, including FRDA and SCAs, have provided valuable insights into the pathophysiology of these disorders (reviewed in9), many questions remain about the observed species differences in disease phenotypes and the effectiveness of potential drugs in clinical trials. > To help translate research from animal models into novel treatments for ataxia patients, it is essential to validate findings in the relevant affected human cell types, particularly in cerebellar Purkinje cells. The current obstacles might be overcome by exploiting recently developed human induced pluripotent stem cell (iPSC) technology and neuronal differentiation protocols.

[18] Copy number variants (CNVs): a powerful tool for iPSC-based modelling of ASD

  • Authors: D. Drakulić, S. Djurovic, Y. A. Syed, Sebastiano Trattaro, N. Caporale et al.
  • Year: 2020
  • Venue: Molecular Autism
  • URL: https://www.semanticscholar.org/paper/c6cac51304043d34c93254007adca11883e387cd
  • DOI: 10.1186/s13229-020-00343-4
  • PMID: 32487215
  • PMCID: 7268297
  • Citations: 23
  • Influential citations: 1
  • Summary: Here, it is examined how iPSCs derived from ASD patients with an associated CNV inform the understanding of the genetic and biological mechanisms underlying the aetiology of ASD.
  • Evidence snippets:
  • Snippet 1 (score: 0.341) > external factors. These complications hinder identification of the basic pathophysiological mechanisms that lead to ASD and hence hamper development of effective therapies. > Molecular and cellular analysis of human patients is generally prospective with data mostly derived from post-mortem tissue. As mentioned above, such studies are subject to the confounds of secondary effects and record the outcomes of underlying disease mechanism rather than directly probe the causative mechanisms. Animal models can be highly informative for the study of a basic mechanism; however, it is difficult to directly translate between observed patient phenotype and animal models. A particular weakness is the ability to capture the phenotypic variation across the patient population. > Human stem cell models offer an opportunity to directly study the molecular and cellular mechanisms of diseases. Key to this approach is the generation of human-induced pluripotent stem cells (iPSCs) derived from patient cells. These are generated by reprogramming of somatic cells into pluripotent stem cells from which many cell types can be differentiated, including neurons and glial cells. Importantly, they can be easily obtained in the clinic from fibroblasts (skin biopsies), keratinocytes (hair roots) [3], T lymphocytes (peripheral blood) [4,5] and exfoliated renal epithelial cells from urine samples [6,7]. Importantly, patient iPSCs enable the in vitro study of different cells types in isolation or co-culture in order to investigate cell function. Uniquely they can track the development profile of patient cell differentiation. More recently the capacity of iPSCs to form 3D organoids has opened up the possibility to investigate the interaction of multiple cell types in a more brain-like microenvironment. Methods for increasing reproducibility of brain organoid differentiation are improving substantially [8,9] and being exploited to mechanistically dissect the effect of genetic lesions causing ASD and ID [10][11][12], as well as the role of specific genes and molecular modules key to human-specific neuronal differentiation trajectories and pathophysiology [13]. > The major question is how to identify the relevant cellular phenotypes that converge on the common pathophysiological mechanisms underlying patient aeti

[19] Exploring the molecular mechanisms of subarachnoid hemorrhage and potential therapeutic targets: insights from bioinformatics and drug prediction

  • Authors: Yi Liu, Yang Zhang, Huan Wei, Li Wang, Lishang Liao
  • Year: 2025
  • Venue: Scientific Reports
  • URL: https://www.semanticscholar.org/paper/19a91d9c8cabec6a5a186729d545077e252ecb67
  • DOI: 10.1038/s41598-025-97642-8
  • PMID: 40229542
  • PMCID: 11997208
  • Summary: The findings not only elucidate the molecular mechanisms underlying SAH but also provide robust bioinformatics and experimental evidence supporting IRN as a promising therapeutic candidate, offering novel insights for future intervention strategies in SAH.
  • Evidence snippets:
  • Snippet 1 (score: 0.341) > involved in SAH pathology. As a result, our understanding of the cellular composition and microenvironment in SAH remains incomplete 8 . > Advances in bioinformatics provide powerful tools to analyze large-scale gene expression data and understand complex biological processes. By integrating transcriptomic data with immune cell infiltration analysis, we can gain a deeper understanding of the molecular mechanisms underlying SAH and identify potential key genes as therapeutic targets 9,10 . Previous studies have indicated that inflammation, oxidative stress, and cell death play crucial roles in the development of SAH, processes that are often closely associated with changes in specific cell types and immune responses 11 . > The goal of this study is to explore the molecular mechanisms of SAH, with a focus on immune cell infiltration and its role in disease progression. We aim to identify key genes and signaling pathways associated with SAH and investigate potential therapeutic strategies. Specifically, we will examine Isorhynchophylline (IRN) as a potential treatment for SAH and analyze its effects on relevant targets and signaling pathways. Through a comprehensive understanding of the pathological features of SAH, this study aims to provide valuable insights into future clinical interventions and treatment strategies.

[20] Heat Shock Proteins in Oxidative Stress and Ischemia/Reperfusion Injury and Benefits from Physical Exercises: A Review to the Current Knowledge

  • Authors: Jakub Szyller, I. Bil-Lula
  • Year: 2021
  • Venue: Oxidative Medicine and Cellular Longevity
  • URL: https://www.semanticscholar.org/paper/4ec4bee9f1b89cdf5a3c513d847990f3cfc18bb8
  • DOI: 10.1155/2021/6678457
  • PMID: 33603951
  • PMCID: 7868165
  • Citations: 113
  • Influential citations: 2
  • Summary: The latest research focuses on determining the role of H SPs in OS, their antioxidant activity, and the possibility of using HSPs in the treatment of I/R consequences, where reactive oxygen species play a major role.
  • Evidence snippets:
  • Snippet 1 (score: 0.340) > Heat shock proteins play a cytoprotective role under pathological conditions such as cardiovascular diseases. The knowledge about cellular and molecular mechanisms underlying ROS-mediated modulation of HSP expression can help to better understand the pathophysiology of OS, which is associated with the development of many diseases (cardiovascular, neurodegenerative, etc.). I/R injury is considered a major contributor to tissue damage in multiple clinical situations such as myocardial infarction, stroke, and organ transplantation. Oxidative damage is a key factor in the initiation of I/R. HSP expression is highly sensitive to I/R injury. > Understanding the exact mechanisms of HSP and the structure of the protein interaction network can help to better understand the pathophysiology and treatment of many diseases, as well as to develop new drugs. There is a need to understand the relationship between cell pathways-signaling, metabolism, etc. The relationships between HSP and OS discussed in this work seem to be very complicated and not yet fully understood. Data showed that modulation of HSP expression in reperfusion injuries may result in better treatment of myocardial infarction. This can also help to prepare organs for the transplantation.

Notes

  • This provider combines search_papers_by_relevance with snippet_search.
  • No synthesis or second-stage model call is performed.