DeSanto-Shinawi syndrome is an autosomal dominant neurodevelopmental disorder caused by heterozygous loss-of-function variants in WAC. WAC participates in transcription-coupled chromatin regulation and in starvation-induced autophagy, where it regulates centrosomal GABARAP trafficking and ULK kinase activation. Loss of WAC function disrupts these cellular processes and is associated with developmental delay or intellectual disability, autism and behavioral symptoms, seizures in a subset of individuals, and characteristic craniofacial findings.
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Conditions with similar clinical presentations that must be differentiated from DeSanto-Shinawi syndrome:
name: DeSanto-Shinawi syndrome
creation_date: '2026-04-11T19:38:25Z'
updated_date: '2026-04-12T00:05:00Z'
category: Mendelian
description: >-
DeSanto-Shinawi syndrome is an autosomal dominant neurodevelopmental disorder
caused by heterozygous loss-of-function variants in WAC. WAC participates in
transcription-coupled chromatin regulation and in starvation-induced
autophagy, where it regulates centrosomal GABARAP trafficking and ULK kinase
activation. Loss of WAC function disrupts these cellular processes and is
associated with developmental delay or intellectual disability, autism and
behavioral symptoms, seizures in a subset of individuals, and characteristic
craniofacial findings.
disease_term:
preferred_term: DeSanto-Shinawi syndrome
term:
id: MONDO:0018760
label: DeSanto-Shinawi syndrome
mappings:
mondo_mappings:
- term:
id: MONDO:0018760
label: DeSanto-Shinawi syndrome
mapping_predicate: skos:exactMatch
mapping_source: MONDO
parents:
- syndromic intellectual disability
- hereditary disease
inheritance:
- name: Autosomal dominant inheritance
inheritance_term:
preferred_term: Autosomal dominant inheritance
term:
id: HP:0000006
label: Autosomal dominant inheritance
description: >-
DeSanto-Shinawi syndrome is typically caused by heterozygous de novo loss of
function variants in WAC.
evidence:
- reference: PMID:35018708
reference_title: "Clinical and molecular characterization of five new individuals with WAC-related intellectual disability: Evidence of pathogenicity for a novel splicing variant."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
All individuals were heterozygous for de novo, previously unreported, loss of function variants in WAC.
explanation: >-
This directly supports the typical dominant de novo inheritance mechanism.
pathophysiology:
- name: WAC haploinsufficiency
description: >-
DeSanto-Shinawi syndrome results from heterozygous loss-of-function variants
in WAC.
genes:
- preferred_term: WAC
term:
id: hgnc:17327
label: WAC
evidence:
- reference: PMID:35018708
reference_title: "Clinical and molecular characterization of five new individuals with WAC-related intellectual disability: Evidence of pathogenicity for a novel splicing variant."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
WAC-related intellectual disability (ID) is a rare genetic condition characterized by a spectrum of neurodevelopmental disorders of varying severity, including global developmental delay (GDD), ID, and autism spectrum disorder.
explanation: >-
This supports WAC-related haploinsufficiency as the basis of the
neurodevelopmental syndrome.
downstream:
- target: Impaired ULK activation and autophagy
description: Loss of WAC disrupts one of its established cellular functions in autophagy regulation
- name: Impaired ULK activation and autophagy
description: >-
WAC regulates starvation-induced autophagy by controlling centrosomal
GABARAP trafficking and ULK kinase activation.
biological_processes:
- preferred_term: autophagy
modifier: DECREASED
term:
id: GO:0006914
label: autophagy
evidence:
- reference: PMID:26687599
reference_title: "Activation of ULK Kinase and Autophagy by GABARAP Trafficking from the Centrosome Is Regulated by WAC and GM130."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
WAC suppresses GM130 binding to GABARAP, regulating starvation-induced centrosomal GABARAP delivery to the phagophore.
explanation: >-
This directly supports a mechanistic role for WAC in autophagosome
initiation.
- reference: PMID:26687599
reference_title: "Activation of ULK Kinase and Autophagy by GABARAP Trafficking from the Centrosome Is Regulated by WAC and GM130."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
In short, during amino acid starvation WAC promotes ULK1 activation and the initiation of autophagosome formation.
explanation: >-
This directly links WAC to ULK1 activation and autophagy initiation.
downstream:
- target: GABAergic-neuron perturbation
description: WAC loss perturbs inhibitory neuronal development and brain circuitry
- name: GABAergic-neuron perturbation
description: >-
Vertebrate models of Wac loss show direct impacts on GABAergic neurons and
altered brain-development programs.
evidence:
- reference: PMID:38826421
reference_title: "Complimentary vertebrate Wac models exhibit phenotypes relevant to DeSanto-Shinawi Syndrome."
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
In addition, each model revealed impacts to GABAergic neurons
explanation: >-
This directly supports a discrete downstream neuronal-cell-type abnormality
in vertebrate Wac models.
downstream:
- target: Seizure susceptibility and neurobehavioral abnormalities
description: Perturbed inhibitory circuitry contributes to seizure and behavioral phenotypes
- name: Seizure susceptibility and neurobehavioral abnormalities
description: >-
Wac-deficient vertebrate models show seizure susceptibility, brain-volume
changes, and relevant behavioral abnormalities aligned with the human
syndrome.
evidence:
- reference: PMID:38826421
reference_title: "Complimentary vertebrate Wac models exhibit phenotypes relevant to DeSanto-Shinawi Syndrome."
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
further studies showed that the mouse mutants are susceptible to seizures, changes in brain volumes that are different between sexes and relevant behaviors.
explanation: >-
This supports a downstream phenotype-oriented branch linking Wac loss to
seizure susceptibility and neurobehavioral abnormalities.
phenotypes:
- name: Global developmental delay
category: Neurologic
description: >-
Developmental delay is a central and recurring feature of DeSanto-Shinawi
syndrome.
phenotype_term:
preferred_term: Global developmental delay
term:
id: HP:0001263
label: Global developmental delay
evidence:
- reference: PMID:35018708
reference_title: "Clinical and molecular characterization of five new individuals with WAC-related intellectual disability: Evidence of pathogenicity for a novel splicing variant."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
All individuals presented with GDD, some degree of ID, and variable dysmorphism.
explanation: >-
This directly supports global developmental delay as a core phenotype.
- name: Intellectual disability
category: Neurologic
description: >-
Intellectual disability is common, although severity varies across the
syndrome spectrum.
phenotype_term:
preferred_term: Intellectual disability
term:
id: HP:0001249
label: Intellectual disability
evidence:
- reference: PMID:35018708
reference_title: "Clinical and molecular characterization of five new individuals with WAC-related intellectual disability: Evidence of pathogenicity for a novel splicing variant."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
All individuals presented with GDD, some degree of ID, and variable dysmorphism.
explanation: >-
The clinical series explicitly reports intellectual disability in the
affected individuals.
- name: Autistic behavior
category: Behavioral
description: >-
Autism spectrum symptoms are part of the recurrent neurobehavioral profile
of DeSanto-Shinawi syndrome.
phenotype_term:
preferred_term: Autistic behavior
term:
id: HP:0000729
label: Autistic behavior
evidence:
- reference: PMID:38826421
reference_title: "Complimentary vertebrate Wac models exhibit phenotypes relevant to DeSanto-Shinawi Syndrome."
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
Individuals with DESSH syndrome exhibit a recognizable craniofacial gestalt, developmental delay/intellectual disability, neurobehavioral symptoms that include autism, ADHD, behavioral difficulties and seizures.
explanation: >-
This disease-focused abstract explicitly lists autism among the recurrent
neurobehavioral symptoms.
- name: Seizure
category: Neurologic
description: >-
Seizures affect a subset of individuals with DeSanto-Shinawi syndrome.
phenotype_term:
preferred_term: Seizure
term:
id: HP:0001250
label: Seizure
evidence:
- reference: PMID:38826421
reference_title: "Complimentary vertebrate Wac models exhibit phenotypes relevant to DeSanto-Shinawi Syndrome."
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
Individuals with DESSH syndrome exhibit a recognizable craniofacial gestalt, developmental delay/intellectual disability, neurobehavioral symptoms that include autism, ADHD, behavioral difficulties and seizures.
explanation: >-
The syndrome summary directly includes seizures among the recognized
features.
- name: Abnormal facial shape
category: Craniofacial
description: >-
A recognizable craniofacial gestalt is a recurrent component of
DeSanto-Shinawi syndrome.
phenotype_term:
preferred_term: Abnormal facial shape
term:
id: HP:0001999
label: Abnormal facial shape
evidence:
- reference: PMID:35018708
reference_title: "Clinical and molecular characterization of five new individuals with WAC-related intellectual disability: Evidence of pathogenicity for a novel splicing variant."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
All individuals presented with GDD, some degree of ID, and variable dysmorphism.
explanation: >-
This directly supports recurring craniofacial dysmorphism in the human
clinical series.
genetic:
- name: WAC
association: Loss-of-function
gene_term:
preferred_term: WAC
term:
id: hgnc:17327
label: WAC
notes: >-
Most reported individuals carry heterozygous de novo truncating, splice, or
other loss-of-function variants in WAC.
evidence:
- reference: PMID:35018708
reference_title: "Clinical and molecular characterization of five new individuals with WAC-related intellectual disability: Evidence of pathogenicity for a novel splicing variant."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
All individuals were heterozygous for de novo, previously unreported, loss of function variants in WAC.
explanation: >-
This directly supports the causal gene and variant class.
- reference: CGGV:assertion_6a1f3c78-d7d2-4a8c-8dbf-ddda78769bd7-2022-11-10T170000.000Z
reference_title: "WAC / DeSanto-Shinawi syndrome (Definitive)"
supports: SUPPORT
evidence_source: OTHER
snippet: "WAC | HGNC:17327 | DeSanto-Shinawi syndrome | MONDO:0018760 | AD | Definitive"
explanation: ClinGen classifies the WAC-DeSanto-Shinawi syndrome gene-disease relationship as definitive with autosomal dominant inheritance.
treatments:
- name: Supportive neurodevelopmental and behavioral care
description: >-
Management is supportive and typically includes developmental therapies,
educational support, and symptom-guided neurologic or behavioral treatment.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
differential_diagnoses:
- name: Kabuki syndrome
disease_term:
preferred_term: Kabuki syndrome
term:
id: MONDO:0016512
label: Kabuki syndrome
description: >-
Kabuki syndrome overlaps with DeSanto-Shinawi syndrome through developmental
delay, hypotonia, and distinctive facial features, but differs in its
characteristic epigenetic gene causes and broader multisystem pattern.
distinguishing_features:
- WAC loss-of-function with autism-predominant neurobehavioral features favors DeSanto-Shinawi syndrome.
- Persistent fingertip pads and the classic Kabuki craniofacial gestalt favor Kabuki syndrome.
- name: Noonan syndrome
disease_term:
preferred_term: Noonan syndrome
term:
id: MONDO:0018997
label: Noonan syndrome
description: >-
Noonan syndrome may enter the differential because of developmental delay
and craniofacial overlap, but it is usually distinguished by congenital
heart disease, short stature, and a RASopathy mechanism.
distinguishing_features:
- Autism and seizure-associated WAC-related neurodevelopmental findings favor DeSanto-Shinawi syndrome.
- Pulmonary valve stenosis, lymphatic findings, and RASopathy facies favor Noonan syndrome.
clinical_trials: []
datasets:
- accession: PMID:35018708
title: "Clinical and molecular characterization of five new individuals with WAC-related intellectual disability: Evidence of pathogenicity for a novel splicing variant."
description: >-
Human clinical-genetic case series of five individuals with WAC-related
neurodevelopmental disorder, including phenotype expansion and splicing
validation for a recurrent pathogenic variant.
organism:
preferred_term: human
term:
id: NCBITaxon:9606
label: Homo sapiens
sample_count: 5
conditions:
- DeSanto-Shinawi syndrome
- WAC loss-of-function variants
publication: PMID:35018708
evidence:
- reference: PMID:35018708
reference_title: "Clinical and molecular characterization of five new individuals with WAC-related intellectual disability: Evidence of pathogenicity for a novel splicing variant."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Here, we describe five affected individuals, age range 9-20 years, and provide proof of pathogenicity of a novel splicing variant.
explanation: >-
This defines a disease-specific human case-series dataset for WAC-related
disorder phenotyping and variant interpretation.
notes: >-
Asta deep research was run as requested, but final curation relied on direct
PubMed review because the retrieval output was noisy and only partially
disease-specific.
This report is retrieval-only and is generated directly from Asta results.
search_papers_by_relevance with snippet_search.