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1
Inheritance
3
Pathophys.
27
Phenotypes
7
Pathograph
1
Genes
3
Treatments
3
Subtypes
3
References
1
Deep Research
👪

Inheritance

1
Autosomal dominant HP:0000006
SALL4-related disorders are autosomal dominant; many affected individuals have a de novo pathogenic variant, and each child of an affected individual has a 50% recurrence risk.
Autosomal dominant inheritance De novo rate: Approximately 40%-50% of cases are caused by a de novo pathogenic variant.
Show evidence (2 references)
ORPHA:93293 SUPPORT Other
"Autosomal dominant"
Orphanet lists autosomal dominant inheritance.
PMID:20301547 SUPPORT Other
"is approximately 40%-50%. Each child of an individual with a SALL4-related"
GeneReviews provides the approximate de novo rate for SALL4-related disorders.

Subtypes

3
Okihiro syndrome / Duane-radial ray syndrome
Core Duane-radial ray presentation with Duane anomaly, radial defects, renal abnormalities, hearing loss, and less frequent anorectal and spinal malformations.
Show evidence (1 reference)
ORPHA:93293 SUPPORT Other
"A rare multiple congenital anomalies syndrome characterized by the association of uni- or bilateral radial defects"
Orphanet defines Okihiro syndrome as the core Duane-radial ray syndrome entity.
Acro-renal-ocular overlap within the SALL4-related spectrum
An overlapping SALL4-related phenotype with radial ray malformations, renal abnormalities, and structural ocular anomalies including coloboma, with overlap with Okihiro syndrome.
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"The phenotype overlaps with other <i>SALL4</i>-related disorders including Okihiro syndrome and Holt-Oram syndrome."
Orphanet explicitly places acro-renal-ocular syndrome within the overlapping SALL4-related disorder spectrum.
SALL4-related Holt-Oram-like presentation
Rare SALL4-related presentation resembling Holt-Oram syndrome, with radial ray and cardiac malformations without the full Duane-radial ray spectrum.
Show evidence (1 reference)
PMID:20301547 SUPPORT Other
"HOS (i.e., radial ray malformations and cardiac malformations without additional"
GeneReviews describes a rare SALL4-related Holt-Oram-like presentation.

Pathophysiology

3
SALL4 Haploinsufficiency and DNA-Binding Defect
Heterozygous SALL4 nonsense, frameshift, deletion, or selected missense variants reduce SALL4 transcription-factor function by haploinsufficiency or impaired AT-rich DNA binding.
SALL4 link
embryo development link ⚠ ABNORMAL
DNA-binding transcription factor activity, RNA polymerase II-specific link ↓ DECREASED
Show evidence (2 references)
PMID:16086360 SUPPORT Other
"deletions. All of the mutations lead to preterminal stop codons and are thought"
This review supports SALL4 haploinsufficiency as a major mechanism for truncating variants.
PMID:36635047 SUPPORT In Vitro
"reduced overall binding to DNA but not the preference for AT-rich sequences."
Structural and DNA-binding data support impaired SALL4 DNA binding for patient-reported missense variants in the zinc-finger domain.
Embryonic Limb-Renal-Ocular Developmental Disruption
Abnormal SALL4-dependent embryonic transcriptional regulation disrupts limb morphogenesis, kidney development, eye development, and broader congenital organ patterning.
SALL4 link
embryonic limb morphogenesis link ⚠ ABNORMAL kidney development link ⚠ ABNORMAL eye development link ⚠ ABNORMAL
Show evidence (2 references)
PMID:20301547 SUPPORT Other
"be distinct entities. DRRS is characterized by uni- or bilateral Duane anomaly"
GeneReviews links the disorder to congenital ocular motility and radial ray developmental abnormalities.
ORPHA:959 SUPPORT Other
"A rare syndrome of multiple congenital anomalies characterized by radial ray malformations, renal abnormalities"
Orphanet supports the radial and renal developmental pattern in the overlapping SALL4-related spectrum.

Pathograph

Use the checkboxes to hide or show graph categories. Hover nodes for evidence and cross-linked metadata.
Pathograph: causal mechanism network for Duane-Radial Ray 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

27
Cardiovascular 1
Congenital heart defects Abnormal heart morphology (HP:0001627)
Show evidence (1 reference)
PMID:16086360 SUPPORT Other
"Other abnormalities reported in this condition are anal, renal, cardiac, ear,"
The review includes cardiac malformations among associated abnormalities.
Digestive 1
Anal atresia Anal atresia (HP:0002023)
Show evidence (2 references)
ORPHA:93293 SUPPORT Other
"imperforate anus and scoliosis"
Orphanet lists imperforate anus among less frequent features.
PMID:16086360 SUPPORT Other
"Other abnormalities reported in this condition are anal, renal, cardiac, ear,"
The review includes anal malformations among associated abnormalities.
Ear 2
Sensorineural hearing impairment FREQUENT Sensorineural hearing impairment (HP:0000407)
Show evidence (2 references)
ORPHA:93293 SUPPORT Other
"sensorineural and/or conductive hearing loss"
Orphanet lists sensorineural and/or conductive hearing loss.
ORPHA:959 SUPPORT Other
"HP:0000407 | Sensorineural hearing impairment | Frequent (79-30%)"
Orphanet records sensorineural hearing impairment as frequent.
Conductive hearing impairment FREQUENT Conductive hearing impairment (HP:0000405)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0000405 | Conductive hearing impairment | Frequent (79-30%)"
Orphanet records conductive hearing impairment as frequent.
Eye 2
Visual impairment FREQUENT Visual impairment (HP:0000505)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0000505 | Visual impairment | Frequent (79-30%)"
Orphanet records visual impairment as frequent.
Strabismus FREQUENT Strabismus (HP:0000486)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0000486 | Strabismus | Frequent (79-30%)"
Orphanet records strabismus as frequent.
Genitourinary 2
Horseshoe kidney VERY_FREQUENT Horseshoe kidney (HP:0000085)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0000085 | Horseshoe kidney | Very frequent (99-80%)"
Orphanet records horseshoe kidney as very frequent.
Bladder diverticulum FREQUENT Bladder diverticulum (HP:0000015)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0000015 | Bladder diverticulum | Frequent (79-30%)"
Orphanet records bladder diverticulum as frequent.
Limbs 7
Abnormal thumb morphology VERY_FREQUENT Abnormal thumb morphology (HP:0001172)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0001172 | Abnormal thumb morphology | Very frequent (99-80%)"
Orphanet records abnormal thumb morphology as very frequent.
Short thumb VERY_FREQUENT Short thumb (HP:0009778)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0009778 | Short thumb | Very frequent (99-80%)"
Orphanet records short thumb as very frequent.
Triphalangeal thumb FREQUENT Triphalangeal thumb (HP:0001199)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0001199 | Triphalangeal thumb | Frequent (79-30%)"
Orphanet records triphalangeal thumb as frequent.
Preaxial hand polydactyly FREQUENT Preaxial hand polydactyly (HP:0001177)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0001177 | Preaxial hand polydactyly | Frequent (79-30%)"
Orphanet records preaxial hand polydactyly as frequent.
Hypoplasia of the ulna FREQUENT Hypoplasia of the ulna (HP:0003022)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0003022 | Hypoplasia of the ulna | Frequent (79-30%)"
Orphanet records hypoplasia of the ulna as frequent.
Sandal gap FREQUENT Sandal gap (HP:0001852)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0001852 | Sandal gap | Frequent (79-30%)"
Orphanet records sandal gap as frequent.
Short hallux FREQUENT Short hallux (HP:0010109)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0010109 | Short hallux | Frequent (79-30%)"
Orphanet records short hallux as frequent.
Musculoskeletal 1
Scoliosis Scoliosis (HP:0002650)
Show evidence (1 reference)
ORPHA:93293 SUPPORT Other
"imperforate anus and scoliosis"
Orphanet lists scoliosis among less frequent features.
Other 11
Duane anomaly Duane anomaly (HP:0009921)
Show evidence (1 reference)
ORPHA:93293 SUPPORT Other
"uni- or bilateral Duane anomaly"
Orphanet lists unilateral or bilateral Duane anomaly as a defining feature.
Radial ray defects Abnormal morphology of the radius (HP:0002818)
Show evidence (2 references)
ORPHA:93293 SUPPORT Other
"uni- or bilateral radial defects"
Orphanet lists unilateral or bilateral radial defects.
PMID:20301547 SUPPORT Other
"and radial ray malformation that can include thenar hypoplasia"
GeneReviews identifies radial ray malformation as a core feature.
Aplasia/hypoplasia of the radius VERY_FREQUENT Aplasia/Hypoplasia of the radius (HP:0006501)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0006501 | Aplasia/Hypoplasia of the radius | Very frequent (99-80%)"
Orphanet records radius aplasia/hypoplasia as very frequent in the acro-renal-ocular overlap phenotype.
Short distal phalanx of the thumb VERY_FREQUENT Short distal phalanx of the thumb (HP:0009650)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0009650 | Short distal phalanx of the thumb | Very frequent (99-80%)"
Orphanet records short distal phalanx of the thumb as very frequent.
Renal malrotation VERY_FREQUENT Renal malrotation (HP:0004712)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0004712 | Renal malrotation | Very frequent (99-80%)"
Orphanet records renal malrotation as very frequent.
Crossed fused renal ectopia VERY_FREQUENT Crossed fused renal ectopia (HP:0004736)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0004736 | Crossed fused renal ectopia | Very frequent (99-80%)"
Orphanet records crossed fused renal ectopia as very frequent.
Renal hypoplasia/aplasia FREQUENT Renal hypoplasia/aplasia (HP:0008678)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0008678 | Renal hypoplasia/aplasia | Frequent (79-30%)"
Orphanet records renal hypoplasia/aplasia as frequent.
Optic disc coloboma FREQUENT Optic disc coloboma (HP:0000588)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0000588 | Optic disc coloboma | Frequent (79-30%)"
Orphanet records optic disc coloboma as frequent.
Optic disc hypoplasia FREQUENT Optic disc hypoplasia (HP:0007766)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0007766 | Optic disc hypoplasia | Frequent (79-30%)"
Orphanet records optic disc hypoplasia as frequent.
Short palpebral fissure FREQUENT Short palpebral fissure (HP:0012745)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0012745 | Short palpebral fissure | Frequent (79-30%)"
Orphanet records short palpebral fissure as frequent.
Broad hallux phalanx FREQUENT Broad hallux phalanx (HP:0010059)
Show evidence (1 reference)
ORPHA:959 SUPPORT Other
"HP:0010059 | Broad hallux phalanx | Frequent (79-30%)"
Orphanet records broad hallux phalanx as frequent.
🧬

Genetic Associations

1
SALL4 (Causal heterozygous pathogenic variant)
Show evidence (4 references)
ORPHA:959 SUPPORT Other
"SALL4 | spalt like transcription factor 4 | hgnc:15924 | Disease-causing germline mutation(s) in"
Orphanet links SALL4 disease-causing germline variants to the overlapping acro-renal-ocular phenotype.
PMID:16086360 SUPPORT Other
"mutation in the SALL4 gene, a human gene related to the developmental regulator"
The review identifies SALL4 mutations as the molecular cause.
PMID:35179219 SUPPORT Human Clinical
"pathogenic heterozygous c.3060delG variant was identified in exon 4 of"
This case report supports causal heterozygous SALL4 variants.
+ 1 more reference
💊

Treatments

3
Corrective surgery for strabismus, limb, and cardiac malformations
Action: surgical procedure MAXO:0000004
Surgery is used as needed for Duane-associated strabismus, forearm or limb malformations, and congenital heart defects; it treats manifestations rather than the SALL4 transcriptional defect.
Mechanism Target:
MODULATES SALL4-Related Congenital Anomaly Spectrum — Corrective procedures address structural manifestations produced by the congenital anomaly spectrum.
Show evidence (1 reference)
PMID:20301547 SUPPORT Other
"Duane anomaly, malformations of the forearms, and congenital heart defects;"
GeneReviews recommends surgery for these manifestations as needed.
Renal and cardiac supportive specialist management
Action: supportive care MAXO:0000950
Nephrology, urology, and cardiology management addresses renal anomalies, conduction defects, heart block, and congenital heart defects without correcting the primary SALL4 mechanism.
Mechanism Target:
MODULATES SALL4-Related Congenital Anomaly Spectrum — Specialist care monitors and treats renal and cardiovascular complications.
Show evidence (2 references)
PMID:20301547 SUPPORT Other
"management of renal anomalies per nephrologist and/or urologist"
GeneReviews recommends nephrology/urology management of renal anomalies.
PMID:20301547 SUPPORT Other
"medications or pacemaker for those with conduction defects or heart block;"
GeneReviews recommends standard cardiac management when conduction disease is present.
Hearing support
Action: supportive care MAXO:0000950
Hearing aids are used when hearing impairment is present.
Mechanism Target:
MODULATES SALL4-Related Congenital Anomaly Spectrum — Hearing support addresses auditory manifestations but not the congenital mechanism.
Show evidence (1 reference)
PMID:20301547 SUPPORT Other
"hearing aids as needed"
GeneReviews recommends hearing aids when needed.
{ }

Source YAML

click to show
name: Duane-Radial Ray Syndrome
creation_date: "2026-05-10T00:00:00Z"
updated_date: "2026-05-10T00:00:00Z"
description: >-
  Duane-radial ray syndrome, also called Okihiro syndrome, is an autosomal
  dominant SALL4-related multiple congenital anomaly syndrome. The shared
  mechanism is disruption of SALL4 zinc-finger transcription-factor function
  during embryonic development, producing Duane anomaly, radial ray
  malformations, renal and ocular abnormalities, hearing loss, and variable
  cardiac, anorectal, spinal, and foot malformations.
category: Mendelian
parents:
- autosomal dominant disease
- congenital limb malformation
- dysostosis
- syndromic disease
synonyms:
- Okihiro syndrome
- DRRS
- SALL4-related disorder
- acro-renal-ocular syndrome
disease_term:
  preferred_term: Duane-radial ray syndrome
  term:
    id: MONDO:0011812
    label: Duane-radial ray syndrome
has_subtypes:
- name: Okihiro
  display_name: Okihiro syndrome / Duane-radial ray syndrome
  description: >-
    Core Duane-radial ray presentation with Duane anomaly, radial defects,
    renal abnormalities, hearing loss, and less frequent anorectal and spinal
    malformations.
  evidence:
  - reference: ORPHA:93293
    reference_title: Okihiro syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "A rare multiple congenital anomalies syndrome characterized by the association of uni- or bilateral radial defects"
    explanation: >-
      Orphanet defines Okihiro syndrome as the core Duane-radial ray
      syndrome entity.
- name: Acro-renal-ocular overlap
  display_name: Acro-renal-ocular overlap within the SALL4-related spectrum
  description: >-
    An overlapping SALL4-related phenotype with radial ray malformations, renal
    abnormalities, and structural ocular anomalies including coloboma, with
    overlap with Okihiro syndrome.
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "The phenotype overlaps with other <i>SALL4</i>-related disorders including Okihiro syndrome and Holt-Oram syndrome."
    explanation: >-
      Orphanet explicitly places acro-renal-ocular syndrome within the
      overlapping SALL4-related disorder spectrum.
- name: Holt-Oram-like presentation
  display_name: SALL4-related Holt-Oram-like presentation
  description: >-
    Rare SALL4-related presentation resembling Holt-Oram syndrome, with radial
    ray and cardiac malformations without the full Duane-radial ray spectrum.
  evidence:
  - reference: PMID:20301547
    reference_title: SALL4-Related Disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HOS (i.e., radial ray malformations and cardiac malformations without additional"
    explanation: >-
      GeneReviews describes a rare SALL4-related Holt-Oram-like presentation.
inheritance:
- name: Autosomal dominant
  inheritance_term:
    preferred_term: Autosomal dominant inheritance
    term:
      id: HP:0000006
      label: Autosomal dominant inheritance
  de_novo_rate: Approximately 40%-50% of cases are caused by a de novo pathogenic variant.
  description: >-
    SALL4-related disorders are autosomal dominant; many affected individuals
    have a de novo pathogenic variant, and each child of an affected individual
    has a 50% recurrence risk.
  evidence:
  - reference: ORPHA:93293
    reference_title: Okihiro syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Autosomal dominant"
    explanation: Orphanet lists autosomal dominant inheritance.
  - reference: PMID:20301547
    reference_title: SALL4-Related Disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "is approximately 40%-50%. Each child of an individual with a SALL4-related"
    explanation: >-
      GeneReviews provides the approximate de novo rate for SALL4-related
      disorders.
pathophysiology:
- name: SALL4 Haploinsufficiency and DNA-Binding Defect
  description: >-
    Heterozygous SALL4 nonsense, frameshift, deletion, or selected missense
    variants reduce SALL4 transcription-factor function by haploinsufficiency
    or impaired AT-rich DNA binding.
  genes:
  - preferred_term: SALL4
    term:
      id: hgnc:15924
      label: SALL4
  molecular_functions:
  - preferred_term: DNA-binding transcription factor activity, RNA polymerase II-specific
    term:
      id: GO:0000981
      label: DNA-binding transcription factor activity, RNA polymerase II-specific
    modifier: DECREASED
  biological_processes:
  - preferred_term: embryo development
    term:
      id: GO:0009790
      label: embryo development
    modifier: ABNORMAL
  evidence:
  - reference: PMID:16086360
    reference_title: >-
      SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
      acro-renal-ocular syndrome, and related disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "deletions. All of the mutations lead to preterminal stop codons and are thought"
    explanation: >-
      This review supports SALL4 haploinsufficiency as a major mechanism for
      truncating variants.
  - reference: PMID:36635047
    reference_title: Structure of SALL4 zinc finger domain reveals link between AT-rich DNA binding and Okihiro syndrome.
    supports: SUPPORT
    evidence_source: IN_VITRO
    snippet: "reduced overall binding to DNA but not the preference for AT-rich sequences."
    explanation: >-
      Structural and DNA-binding data support impaired SALL4 DNA binding for
      patient-reported missense variants in the zinc-finger domain.
  downstream:
  - target: Embryonic Limb-Renal-Ocular Developmental Disruption
    causal_link_type: DIRECT
    description: >-
      Reduced or altered SALL4 transcription-factor function perturbs the
      developmental programs needed for limb, renal, ocular, and related
      organogenesis.
    evidence:
    - reference: PMID:36635047
      reference_title: Structure of SALL4 zinc finger domain reveals link between AT-rich DNA binding and Okihiro syndrome.
      supports: SUPPORT
      evidence_source: IN_VITRO
      snippet: "required for the development of multiple organs, including limbs. Mutations in"
      explanation: >-
        The abstract directly links SALL4 function to embryonic identity and
        multiorgan development, including limb development.
- name: Embryonic Limb-Renal-Ocular Developmental Disruption
  description: >-
    Abnormal SALL4-dependent embryonic transcriptional regulation disrupts
    limb morphogenesis, kidney development, eye development, and broader
    congenital organ patterning.
  genes:
  - preferred_term: SALL4
    term:
      id: hgnc:15924
      label: SALL4
  biological_processes:
  - preferred_term: embryonic limb morphogenesis
    term:
      id: GO:0030326
      label: embryonic limb morphogenesis
    modifier: ABNORMAL
  - preferred_term: kidney development
    term:
      id: GO:0001822
      label: kidney development
    modifier: ABNORMAL
  - preferred_term: eye development
    term:
      id: GO:0001654
      label: eye development
    modifier: ABNORMAL
  evidence:
  - reference: PMID:20301547
    reference_title: SALL4-Related Disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "be distinct entities. DRRS is characterized by uni- or bilateral Duane anomaly"
    explanation: >-
      GeneReviews links the disorder to congenital ocular motility and radial
      ray developmental abnormalities.
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "A rare syndrome of multiple congenital anomalies characterized by radial ray malformations, renal abnormalities"
    explanation: >-
      Orphanet supports the radial and renal developmental pattern in the
      overlapping SALL4-related spectrum.
  downstream:
  - target: SALL4-Related Congenital Anomaly Spectrum
    causal_link_type: DIRECT
    description: >-
      Disrupted embryonic limb, renal, ocular, and related organ development
      produces the recognizable Duane-radial ray / acro-renal-ocular clinical
      spectrum.
    evidence:
    - reference: PMID:16086360
      reference_title: >-
        SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
        acro-renal-ocular syndrome, and related disorders.
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "Other abnormalities reported in this condition are anal, renal, cardiac, ear,"
      explanation: >-
        The review summarizes the multiorgan congenital anomaly spectrum
        downstream of SALL4-related disease.
- name: SALL4-Related Congenital Anomaly Spectrum
  description: >-
    The clinical disorder combines Duane anomaly, radial ray defects, renal and
    ocular abnormalities, hearing impairment, and variable anorectal, cardiac,
    spinal, and foot malformations with marked phenotypic variability.
  evidence:
  - reference: ORPHA:93293
    reference_title: Okihiro syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "A rare multiple congenital anomalies syndrome characterized by the association of uni- or bilateral radial defects"
    explanation: >-
      The Orphanet definition supports a multiple congenital anomaly spectrum.
  - reference: PMID:26791099
    reference_title: Novel frameshift variant in gene SALL4 causing Okihiro syndrome.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "a broad spectrum of phenotypes, ranging from the severe one presented by the"
    explanation: >-
      This family report supports broad phenotypic variability among affected
      individuals with a SALL4 frameshift variant.
phenotypes:
- name: Duane anomaly
  category: Ophthalmologic
  description: >-
    Congenital limitation of horizontal eye movement with globe retraction is
    the defining ocular motility feature.
  phenotype_term:
    preferred_term: Duane anomaly
    term:
      id: HP:0009921
      label: Duane anomaly
  evidence:
  - reference: ORPHA:93293
    reference_title: Okihiro syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "uni- or bilateral Duane anomaly"
    explanation: Orphanet lists unilateral or bilateral Duane anomaly as a defining feature.
- name: Radial ray defects
  category: Musculoskeletal
  description: >-
    Radial ray malformations include radius hypoplasia or aplasia, radial
    deviation, thumb aplasia or hypoplasia, triphalangeal thumbs, and thumb
    duplication.
  phenotype_term:
    preferred_term: radial ray malformation
    term:
      id: HP:0002818
      label: Abnormal morphology of the radius
  evidence:
  - reference: ORPHA:93293
    reference_title: Okihiro syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "uni- or bilateral radial defects"
    explanation: Orphanet lists unilateral or bilateral radial defects.
  - reference: PMID:20301547
    reference_title: SALL4-Related Disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "and radial ray malformation that can include thenar hypoplasia"
    explanation: GeneReviews identifies radial ray malformation as a core feature.
- name: Aplasia/hypoplasia of the radius
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: VERY_FREQUENT
  description: >-
    Radius underdevelopment or absence is a high-frequency radial ray feature
    in the acro-renal-ocular overlap portion of the SALL4 spectrum.
  phenotype_term:
    preferred_term: Aplasia/Hypoplasia of the radius
    term:
      id: HP:0006501
      label: Aplasia/Hypoplasia of the radius
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0006501 | Aplasia/Hypoplasia of the radius | Very frequent (99-80%)"
    explanation: Orphanet records radius aplasia/hypoplasia as very frequent in the acro-renal-ocular overlap phenotype.
- name: Abnormal thumb morphology
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: VERY_FREQUENT
  description: >-
    Thumb abnormalities include hypoplastic, short, absent, triphalangeal, or
    duplicated thumbs.
  phenotype_term:
    preferred_term: Abnormal thumb morphology
    term:
      id: HP:0001172
      label: Abnormal thumb morphology
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001172 | Abnormal thumb morphology | Very frequent (99-80%)"
    explanation: Orphanet records abnormal thumb morphology as very frequent.
- name: Short thumb
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: VERY_FREQUENT
  description: Thumb hypoplasia is a frequent expression of radial ray involvement.
  phenotype_term:
    preferred_term: Short thumb
    term:
      id: HP:0009778
      label: Short thumb
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0009778 | Short thumb | Very frequent (99-80%)"
    explanation: Orphanet records short thumb as very frequent.
- name: Short distal phalanx of the thumb
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: VERY_FREQUENT
  description: Short distal phalanx of the thumb is a high-frequency thumb manifestation.
  phenotype_term:
    preferred_term: Short distal phalanx of the thumb
    term:
      id: HP:0009650
      label: Short distal phalanx of the thumb
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0009650 | Short distal phalanx of the thumb | Very frequent (99-80%)"
    explanation: Orphanet records short distal phalanx of the thumb as very frequent.
- name: Triphalangeal thumb
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Triphalangeal thumbs are part of the radial ray malformation spectrum.
  phenotype_term:
    preferred_term: Triphalangeal thumb
    term:
      id: HP:0001199
      label: Triphalangeal thumb
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001199 | Triphalangeal thumb | Frequent (79-30%)"
    explanation: Orphanet records triphalangeal thumb as frequent.
- name: Preaxial hand polydactyly
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Thumb duplication and related preaxial polydactyly occur in the SALL4 spectrum.
  phenotype_term:
    preferred_term: Preaxial hand polydactyly
    term:
      id: HP:0001177
      label: Preaxial hand polydactyly
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001177 | Preaxial hand polydactyly | Frequent (79-30%)"
    explanation: Orphanet records preaxial hand polydactyly as frequent.
- name: Hypoplasia of the ulna
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Ulnar hypoplasia can accompany the radial ray pattern.
  phenotype_term:
    preferred_term: Hypoplasia of the ulna
    term:
      id: HP:0003022
      label: Hypoplasia of the ulna
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0003022 | Hypoplasia of the ulna | Frequent (79-30%)"
    explanation: Orphanet records hypoplasia of the ulna as frequent.
- name: Renal malrotation
  category: Renal
  subtype: Acro-renal-ocular overlap
  frequency: VERY_FREQUENT
  description: Renal malrotation is one form of congenital renal abnormality in the SALL4 spectrum.
  phenotype_term:
    preferred_term: Renal malrotation
    term:
      id: HP:0004712
      label: Renal malrotation
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0004712 | Renal malrotation | Very frequent (99-80%)"
    explanation: Orphanet records renal malrotation as very frequent.
- name: Horseshoe kidney
  category: Renal
  subtype: Acro-renal-ocular overlap
  frequency: VERY_FREQUENT
  description: Horseshoe kidney is a common renal position/fusion anomaly in acro-renal-ocular syndrome.
  phenotype_term:
    preferred_term: Horseshoe kidney
    term:
      id: HP:0000085
      label: Horseshoe kidney
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000085 | Horseshoe kidney | Very frequent (99-80%)"
    explanation: Orphanet records horseshoe kidney as very frequent.
- name: Crossed fused renal ectopia
  category: Renal
  subtype: Acro-renal-ocular overlap
  frequency: VERY_FREQUENT
  description: Crossed fused renal ectopia is a frequent renal positional anomaly in the overlap phenotype.
  phenotype_term:
    preferred_term: Crossed fused renal ectopia
    term:
      id: HP:0004736
      label: Crossed fused renal ectopia
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0004736 | Crossed fused renal ectopia | Very frequent (99-80%)"
    explanation: Orphanet records crossed fused renal ectopia as very frequent.
- name: Renal hypoplasia/aplasia
  category: Renal
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Kidney underdevelopment or absence can occur as part of the renal anomaly spectrum.
  phenotype_term:
    preferred_term: Renal hypoplasia/aplasia
    term:
      id: HP:0008678
      label: Renal hypoplasia/aplasia
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0008678 | Renal hypoplasia/aplasia | Frequent (79-30%)"
    explanation: Orphanet records renal hypoplasia/aplasia as frequent.
- name: Bladder diverticulum
  category: Renal
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Bladder diverticula are included among urinary tract abnormalities in the overlap phenotype.
  phenotype_term:
    preferred_term: Bladder diverticulum
    term:
      id: HP:0000015
      label: Bladder diverticulum
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000015 | Bladder diverticulum | Frequent (79-30%)"
    explanation: Orphanet records bladder diverticulum as frequent.
- name: Sensorineural hearing impairment
  category: Auditory
  frequency: FREQUENT
  description: Sensorineural hearing loss is part of the congenital ear/hearing phenotype.
  phenotype_term:
    preferred_term: Sensorineural hearing impairment
    term:
      id: HP:0000407
      label: Sensorineural hearing impairment
  evidence:
  - reference: ORPHA:93293
    reference_title: Okihiro syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "sensorineural and/or conductive hearing loss"
    explanation: Orphanet lists sensorineural and/or conductive hearing loss.
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000407 | Sensorineural hearing impairment | Frequent (79-30%)"
    explanation: Orphanet records sensorineural hearing impairment as frequent.
- name: Conductive hearing impairment
  category: Auditory
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Conductive hearing loss may also occur in the SALL4-related spectrum.
  phenotype_term:
    preferred_term: Conductive hearing impairment
    term:
      id: HP:0000405
      label: Conductive hearing impairment
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000405 | Conductive hearing impairment | Frequent (79-30%)"
    explanation: Orphanet records conductive hearing impairment as frequent.
- name: Optic disc coloboma
  category: Ophthalmologic
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Optic disc coloboma is a common structural ocular feature in acro-renal-ocular syndrome.
  phenotype_term:
    preferred_term: Optic disc coloboma
    term:
      id: HP:0000588
      label: Optic disc coloboma
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000588 | Optic disc coloboma | Frequent (79-30%)"
    explanation: Orphanet records optic disc coloboma as frequent.
- name: Optic disc hypoplasia
  category: Ophthalmologic
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Optic disc hypoplasia can contribute to visual impairment.
  phenotype_term:
    preferred_term: Optic disc hypoplasia
    term:
      id: HP:0007766
      label: Optic disc hypoplasia
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0007766 | Optic disc hypoplasia | Frequent (79-30%)"
    explanation: Orphanet records optic disc hypoplasia as frequent.
- name: Visual impairment
  category: Ophthalmologic
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Structural ocular anomalies and optic disc abnormalities can cause impaired vision.
  phenotype_term:
    preferred_term: Visual impairment
    term:
      id: HP:0000505
      label: Visual impairment
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000505 | Visual impairment | Frequent (79-30%)"
    explanation: Orphanet records visual impairment as frequent.
- name: Strabismus
  category: Ophthalmologic
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Strabismus is part of the ocular motility phenotype and may overlap with Duane anomaly.
  phenotype_term:
    preferred_term: Strabismus
    term:
      id: HP:0000486
      label: Strabismus
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000486 | Strabismus | Frequent (79-30%)"
    explanation: Orphanet records strabismus as frequent.
- name: Short palpebral fissure
  category: Ophthalmologic
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Short palpebral fissures are a frequent periocular feature in acro-renal-ocular syndrome.
  phenotype_term:
    preferred_term: Short palpebral fissure
    term:
      id: HP:0012745
      label: Short palpebral fissure
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0012745 | Short palpebral fissure | Frequent (79-30%)"
    explanation: Orphanet records short palpebral fissure as frequent.
- name: Anal atresia
  category: Gastrointestinal
  description: Imperforate anus and related anorectal malformations are less frequent associated features.
  phenotype_term:
    preferred_term: Imperforate anus
    term:
      id: HP:0002023
      label: Anal atresia
  evidence:
  - reference: ORPHA:93293
    reference_title: Okihiro syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "imperforate anus and scoliosis"
    explanation: Orphanet lists imperforate anus among less frequent features.
  - reference: PMID:16086360
    reference_title: >-
      SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
      acro-renal-ocular syndrome, and related disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Other abnormalities reported in this condition are anal, renal, cardiac, ear,"
    explanation: The review includes anal malformations among associated abnormalities.
- name: Scoliosis
  category: Musculoskeletal
  description: Scoliosis is a less frequent spinal feature.
  phenotype_term:
    preferred_term: Scoliosis
    term:
      id: HP:0002650
      label: Scoliosis
  evidence:
  - reference: ORPHA:93293
    reference_title: Okihiro syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "imperforate anus and scoliosis"
    explanation: Orphanet lists scoliosis among less frequent features.
- name: Congenital heart defects
  category: Cardiovascular
  description: Cardiac malformations may occur, including Holt-Oram-like SALL4-related presentations.
  phenotype_term:
    preferred_term: Congenital heart defects
    term:
      id: HP:0001627
      label: Abnormal heart morphology
  evidence:
  - reference: PMID:16086360
    reference_title: >-
      SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
      acro-renal-ocular syndrome, and related disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Other abnormalities reported in this condition are anal, renal, cardiac, ear,"
    explanation: The review includes cardiac malformations among associated abnormalities.
- name: Sandal gap
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Sandal gap is a common foot feature in acro-renal-ocular syndrome.
  phenotype_term:
    preferred_term: Sandal gap
    term:
      id: HP:0001852
      label: Sandal gap
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001852 | Sandal gap | Frequent (79-30%)"
    explanation: Orphanet records sandal gap as frequent.
- name: Broad hallux phalanx
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Broad hallux phalanges are frequent foot findings in the overlap phenotype.
  phenotype_term:
    preferred_term: Broad hallux phalanx
    term:
      id: HP:0010059
      label: Broad hallux phalanx
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0010059 | Broad hallux phalanx | Frequent (79-30%)"
    explanation: Orphanet records broad hallux phalanx as frequent.
- name: Short hallux
  category: Musculoskeletal
  subtype: Acro-renal-ocular overlap
  frequency: FREQUENT
  description: Short hallux is a frequent foot finding in the overlap phenotype.
  phenotype_term:
    preferred_term: Short hallux
    term:
      id: HP:0010109
      label: Short hallux
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0010109 | Short hallux | Frequent (79-30%)"
    explanation: Orphanet records short hallux as frequent.
genetic:
- name: SALL4
  association: Causal heterozygous pathogenic variant
  relationship_type: CAUSATIVE
  variant_origin: GERMLINE
  gene_term:
    preferred_term: SALL4
    term:
      id: hgnc:15924
      label: SALL4
  notes: >-
    Reported pathogenic mechanisms include nonsense, frameshift, deletion, and
    selected missense variants that reduce SALL4 function. The phenotype is
    highly variable, even within families.
  evidence:
  - reference: ORPHA:959
    reference_title: Acro-renal-ocular syndrome
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "SALL4 | spalt like transcription factor 4 | hgnc:15924 | Disease-causing germline mutation(s) in"
    explanation: Orphanet links SALL4 disease-causing germline variants to the overlapping acro-renal-ocular phenotype.
  - reference: PMID:16086360
    reference_title: >-
      SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
      acro-renal-ocular syndrome, and related disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "mutation in the SALL4 gene, a human gene related to the developmental regulator"
    explanation: The review identifies SALL4 mutations as the molecular cause.
  - reference: PMID:35179219
    reference_title: A de novo mutation of SALL4 in a Chinese family with Okihiro syndrome.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "pathogenic heterozygous c.3060delG variant was identified in exon 4 of"
    explanation: This case report supports causal heterozygous SALL4 variants.
  - reference: PMID:36829172
    reference_title: "A novel de novo nonsense mutation in SALL4 causing duane radial ray syndrome: a case report and expanding the phenotypic spectrum."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "novel de novo heterozygous nonsense mutation in exon 2 of SALL4 gene"
    explanation: >-
      This case report provides additional human clinical support for de novo
      heterozygous SALL4 pathogenic variants causing Duane-radial ray syndrome.
diagnosis:
- name: Molecular genetic testing
  description: >-
    Diagnosis is established when suggestive clinical findings are paired with
    a heterozygous pathogenic SALL4 variant identified by molecular genetic
    testing.
  diagnosis_term:
    preferred_term: molecular genetic testing
    term:
      id: MAXO:0000533
      label: molecular genetic testing
  results: Genetic testing identifies a heterozygous pathogenic SALL4 sequence or copy-number variant.
  evidence:
  - reference: PMID:20301547
    reference_title: SALL4-Related Disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "proband with suggestive findings and a heterozygous pathogenic variant in SALL4"
    explanation: GeneReviews directly states the molecular diagnostic criterion.
- name: Multisystem clinical assessment
  description: >-
    Clinical assessment includes ophthalmologic examination, renal function and
    renal ultrasound surveillance when indicated, cardiac surveillance, hearing
    evaluation, and growth or pituitary assessment as clinically appropriate.
  diagnosis_term:
    preferred_term: clinical assessment
    term:
      id: MAXO:0000487
      label: clinical assessment
  results: Assessment defines the ocular, limb, renal, auditory, cardiac, and endocrine manifestations that require management.
  evidence:
  - reference: PMID:20301547
    reference_title: SALL4-Related Disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Ophthalmologic exam with frequency as recommended by ophthalmologist"
    explanation: GeneReviews recommends ophthalmologic surveillance.
  - reference: PMID:20301547
    reference_title: SALL4-Related Disorders.
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "renal function in those with renal anomalies, even if renal function is normal"
    explanation: GeneReviews recommends renal-function monitoring for individuals with renal anomalies.
  - reference: PMID:27941963
    reference_title: Clinical and Genetic Findings in Mexican Patients with Duane Anomaly and Radial Ray Malformations/Okihiro Syndrome.
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "ophthalmologic and general physical examination was performed in all patients."
    explanation: >-
      This clinical cohort supports combined ophthalmologic and general
      physical examination as part of evaluation.
treatments:
- name: Corrective surgery for strabismus, limb, and cardiac malformations
  description: >-
    Surgery is used as needed for Duane-associated strabismus, forearm or limb
    malformations, and congenital heart defects; it treats manifestations
    rather than the SALL4 transcriptional defect.
  treatment_term:
    preferred_term: surgical procedure
    term:
      id: MAXO:0000004
      label: surgical procedure
  target_mechanisms:
  - target: SALL4-Related Congenital Anomaly Spectrum
    treatment_effect: MODULATES
    description: >-
      Corrective procedures address structural manifestations produced by the
      congenital anomaly spectrum.
    evidence:
    - reference: PMID:20301547
      reference_title: SALL4-Related Disorders.
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "Duane anomaly, malformations of the forearms, and congenital heart defects;"
      explanation: GeneReviews recommends surgery for these manifestations as needed.
- name: Renal and cardiac supportive specialist management
  description: >-
    Nephrology, urology, and cardiology management addresses renal anomalies,
    conduction defects, heart block, and congenital heart defects without
    correcting the primary SALL4 mechanism.
  treatment_term:
    preferred_term: supportive care
    term:
      id: MAXO:0000950
      label: supportive care
  target_mechanisms:
  - target: SALL4-Related Congenital Anomaly Spectrum
    treatment_effect: MODULATES
    description: Specialist care monitors and treats renal and cardiovascular complications.
    evidence:
    - reference: PMID:20301547
      reference_title: SALL4-Related Disorders.
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "management of renal anomalies per nephrologist and/or urologist"
      explanation: GeneReviews recommends nephrology/urology management of renal anomalies.
    - reference: PMID:20301547
      reference_title: SALL4-Related Disorders.
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "medications or pacemaker for those with conduction defects or heart block;"
      explanation: GeneReviews recommends standard cardiac management when conduction disease is present.
- name: Hearing support
  description: >-
    Hearing aids are used when hearing impairment is present.
  treatment_term:
    preferred_term: supportive care
    term:
      id: MAXO:0000950
      label: supportive care
  target_mechanisms:
  - target: SALL4-Related Congenital Anomaly Spectrum
    treatment_effect: MODULATES
    description: Hearing support addresses auditory manifestations but not the congenital mechanism.
    evidence:
    - reference: PMID:20301547
      reference_title: SALL4-Related Disorders.
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "hearing aids as needed"
      explanation: GeneReviews recommends hearing aids when needed.
clinical_trials: []
datasets: []
notes: >-
  ORPHA:959 also includes HP:0004059 "Radial club hand" as frequent, but the
  local HPO cache marks HP:0004059 obsolete. This entry represents the same
  radial-ray pattern with current radius and thumb phenotype bindings instead
  of adding an obsolete term.
references:
- reference: PMID:20301547
  title: SALL4-Related Disorders.
  tags:
  - GeneReviews
  findings:
  - statement: >-
      GeneReviews summarizes the SALL4-related clinical spectrum, diagnostic
      testing, inheritance, surveillance, and management.
- reference: PMID:16086360
  title: >-
    SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome),
    acro-renal-ocular syndrome, and related disorders.
  findings:
  - statement: >-
      SALL4 truncating mutations and deletions support haploinsufficiency as a
      central disease mechanism.
- reference: PMID:36635047
  title: Structure of SALL4 zinc finger domain reveals link between AT-rich DNA binding and Okihiro syndrome.
  findings:
  - statement: >-
      Patient-associated C-terminal zinc-finger missense variants reduce SALL4
      DNA binding.
📚

References & Deep Research

References

3
SALL4-Related Disorders.
1 finding
GeneReviews summarizes the SALL4-related clinical spectrum, diagnostic testing, inheritance, surveillance, and management.
SALL4 mutations in Okihiro syndrome (Duane-radial ray syndrome), acro-renal-ocular syndrome, and related disorders.
1 finding
SALL4 truncating mutations and deletions support haploinsufficiency as a central disease mechanism.
Structure of SALL4 zinc finger domain reveals link between AT-rich DNA binding and Okihiro syndrome.
1 finding
Patient-associated C-terminal zinc-finger missense variants reduce SALL4 DNA binding.

Deep Research

1
Asta
Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Duane-Radial Ray Syndrome. Core disease mechanisms, molecular and cellular...
Asta Scientific Corpus Retrieval 19 citations 2026-05-10T17:24:29.377489

Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Duane-Radial Ray Syndrome. Core disease mechanisms, molecular and cellular...

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

  • Papers retrieved: 19
  • Snippets retrieved: 20

Relevant Papers

[1] A novel de novo nonsense mutation in SALL4 causing duane radial ray syndrome: a case report and expanding the phenotypic spectrum

  • Authors: Mobarakeh Ajam-Hosseini, Farshid Parvini, A. Angaji
  • Year: 2023
  • Venue: BMC Medical Genomics
  • URL: https://www.semanticscholar.org/paper/bfc3fc258851307680f6d2e56bbc7a78bc1d3ab2
  • DOI: 10.1186/s12920-023-01467-1
  • PMID: 36829172
  • PMCID: 9951407
  • Citations: 7
  • Summary: The findings could extend the pathogenic mutations and phenotypic spectrum of SALL4 related disorders.
  • Evidence snippets:
  • Snippet 1 (score: 0.439) > At the present study we explored the molecular mechanism of pathogenesis in a patient suspected to duane radial ray syndrome. The nonconsanguineous pedigree with an affected girl was recruited (Fig. 1a). The studied family is of Iranian origin located in Semnan province (central Iran). As shown in Fig. 1, proband was a 4-yearold girl with clinical symptoms of DRRS who results from a non-consanguineous marriage. Clinical and physical examinations of the patient showed craniofacial deformity, mild microcephaly, cleft palate, thumb aplasia of left hand, thumb hopoplasia of right hand (Fig. 1c), mild syndactyly in right hand, bilateral club foot and short leg, kyphoscoliosis, barrel chest, deep presacral sinus, anorectal abnormality, anal stenosis, constipation, and fecal incontinence. > Echocardiography diagnosed the patient with atrial septal defect. Additionally, the patient underwent audiometric and ophthalmic evaluation. This assessment showed moderate and severe hearing impairment in the right and left ear (Fig. 1b), respectively, as well as type III duan anomaly as deep-set eyes with partial strabismus of right eye. Cleft palate was surgically repaired. She did not show any impairments in the ultrasound evaluation of the kidney, liver, gallbladder and bladder. Transfontanelle ultrasound showed no evidence of hydrocephalus, as well. In addition, Fig. 1c shows the phenotypes of craniofacial deformity, mild microcephaly, mild syndactyly and thumb abnormalities in patient III-1. On the other hands, the patient underwent MRI of the brain, which showed normal structure in the supra, infratentorial, and midline areas. The cortical and white matter signals of the brain, pituitary gland, parasellar regions, base of skull, orbits and 7-8th nerve complexes were also unchanged.

[2] Duane-Radial Ray syndrome a SALL4-Related Disorder. Report of a case in Chile

  • Authors: H. Jonathan, D. Catherine
  • Year: 2020
  • Venue: Unknown venue
  • URL: https://www.semanticscholar.org/paper/13a3ea72f06d595d1ae541972bed1532cdb7daf0
  • DOI: 10.17352/2640-7876.000024
  • Citations: 1
  • Summary: The Duane-Radial Ray syndrome or Okihiro syndrome belongs to the SALL4-Related Disorders, a phenotypic spectrum, that additionally includes, acrorenoocular syndrome and Holt-Oram syndrome.
  • Evidence snippets:
  • Snippet 1 (score: 0.423) > According to the clinical characteristics of the proband, radial alterations, agenesis of the right thumb, left preaxial polydactyly, Duane anomaly, ulnar shortening, syndactyly of the fi rst, and second fi nger, bilateral deviation of the hand, right talipes equinovarus, heart disease, hearing loss, imperforate anus, and facial asymmetry, made us suspecting of a disorder related to SALL4, specifi cally a Radial Ray Duane syndrome. Therefore, it was decided for sequence the gene, which resulted in a heterozygous pathogenic variant c.516_522del (p.Gly174Trpfs* 6), evidence a 7 bp deletion, which causes a change in the reading frame, generating a premature stop codon, leading to a nonsense-mediated mRNA decay [1,6], within the embryonic cells, affecting the translation of this gene, generating a smaller amount of the SALL4 protein, that has a fundamental role in the development of the limbs and other tissues such as the heart, mesodermal tissue, eye, and brain, explaining many of the symptoms. > The molecular study has been of substantial importance, in being able to relate different phenotypes such as acrorenoocular syndrome, Duane-Radial Ray syndrome, and some cases of Holt-Oram syndrome with a pathogenic variant in the SALL4 gene, demonstrating a continuous in phenotypes [1]. To date 20 pathogenic variants have been described, 19 of them generate a change in the reading frame and one affects the splicing site [8-10]. The variant of this patient c.516_522del is located in exon 2, although it is not reported on populations databases, it is classifi ed as pathogenic, since the frameshift mechanism, described in genes with loss of heterozygosity, on the other had this variant is not found in population databases like gnomAD or DGV, and computational evidence infers a deleterious effect on this gene, according to the 2015 ACMG guidelines [9,10].

[3] Renal ciliopathies: promising drug targets and prospects for clinical trials

  • Authors: L. Devlin, Praveen Dhondurao Sudhindar, J. Sayer
  • Year: 2023
  • Venue: Expert Opinion on Therapeutic Targets
  • URL: https://www.semanticscholar.org/paper/ab2155b6e12caba53d57ac0e8ce28860d69ec9fd
  • DOI: 10.1080/14728222.2023.2218616
  • PMID: 37243567
  • Citations: 10
  • Summary: The advances in basic science and clinical research into renal ciliopathies which have yielded promising small compounds and drug targets are reviewed, within both preclinical studies and clinical trials.
  • Evidence snippets:
  • Snippet 1 (score: 0.414) > Although renal ciliopathies can be classified into distinct syndromes, causative mutations in genes encoding proteins involved in the primary cilium or centrosome mean they may share overlapping mechanisms of disease, which may be amenable for therapeutic intervention (Figure 2). Abnormal functioning of proteins involved in ciliogenesis, such as CEP164, can prevent proper cilia formation, which will effect a myriad of downstream ciliary signaling pathways. Additionally, mutations in genes encoding for proteins involved in cargo trafficking or regulation, such as CEP290, will have implications for signal pathway transduction, as well as mutations in components of signaling pathways themselves, such as PKD1. In regard to renal ciliopathies, abnormalities in signaling pathways such as cAMP, Shh, Wnt, mTOR, and AMPK, likely cause misoriented cellular divisions, increased proliferation, increased fluid secretion and subsequent cystogenesis, consequently leading to further kidney damage. Ciliary and centriolar proteins which have roles in DDR and cell cycle regulation may also be driving a renal cystogenesis phenotype alongside increased fibrosis and apoptosis. Increased inflammation and dysfunctional mitochondria are also byproducts of dysregulated signaling pathways have been shown to contribute to the progression of renal ciliopathies. Extensive reviews of mechanisms of renal ciliopathy diseases have recently been performed [23,24]. Importantly, due to the wide range of cellular processes that primary cilia regulate, it is likely that in each syndrome there are multiple pathogenic drivers of disease. In some ways, this is advantageous as it offers many points for potential therapeutic targets. However, the cross talk between pathways and feedback loops introduces complications of changing one pathway without negatively affecting another. Further challenges arise with core biological pathways, such as Shh signaling, in which modification in vitro may be beneficial, but systemic treatment is unrealistic due to the expected severe side effects [18,24,116].

[4] Drug repurposing in Rett and Rett-like syndromes: a promising yet underrated opportunity?

  • Authors: Claudia Fuchs, P. A. ‛. ’t Hoen, A. Müller, Friederike Ehrhart, C. V. van Karnebeek
  • Year: 2024
  • Venue: Frontiers in Medicine
  • URL: https://www.semanticscholar.org/paper/b00d0859458647edeebf3cf53f9b39c79311d5ed
  • DOI: 10.3389/fmed.2024.1425038
  • PMID: 39135718
  • PMCID: 11317438
  • Citations: 1
  • Summary: The potential of drug repurposing (DR) as a promising avenue for addressing the unmet medical needs of individuals with RTT and related disorders is explored and Leveraging existing drugs for new therapeutic purposes presents an attractive strategy.
  • Evidence snippets:
  • Snippet 1 (score: 0.410) > Rigorous preclinical and clinical studies are also crucial for better understanding the complex pathophysiology of these syndromes. To date, the precise molecular mechanisms underlying these complex disorders are still not fully understood; hindering the identification and validation of potential drug targets. This specifically applies to CDD and FOXG1-syndrome: both conditions were identified as distinct clinical entities only recently and it is understandable that research efforts initially focused primarily on "classical" RTT. This discrepancy is reflected also in the very different numbers of repurposing studies highlighted in Figure 1. Continued efforts in pre-clinical (identification of valuable cell and animal models etc.) and clinical research (better understanding of the natural history, clinical manifestations, disease progression, biomarkers etc.) will be essential for advancing our understanding and improving outcomes for individuals affected by these syndromes. In particular, better characterizing the shared symptoms and pathways across these entities, will provide valuable insights into the underlying biology and potentially uncover new common mechanisms and targeted therapies. If the disorders demonstrate convergence in their underlying molecular pathways, this provides an opportunity for designing joint DR 10.3389/fmed.2024.1425038 strategies across RTT and RTT-like disorders. This could reduce the time needed for the development of DR and increase the number of patients benefiting from the treatments, resulting in more attractive business models. > Despite promising DR results in preclinical or early-phase clinical trials for RTT and related disorders in our opinion DR is still underrated and underutilized in this kind of disorders. DR holds immense potential for addressing the unmet medical needs and therapeutic challenges posed by such complex NDDs, and recent advancements screening and computational techniques, offer the unique opportunity to predict drug-disease interactions and prioritize candidate compounds for further investigation. By leveraging existing drugs and repurposing them for new indications, this approach offers a pragmatic and efficient strategy to accelerate the development of treatments for individuals affected by these debilitating conditions.

[5] 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: 0.383) > 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.

[6] 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: 0.381) > 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].

[7] 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: 0.372) > 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

[8] Cohesin mediates Esco2-dependent transcriptional regulation in a zebrafish regenerating fin model of Roberts Syndrome

  • Authors: Rajeswari Banerji, R. Skibbens, M. Iovine
  • Year: 2017
  • Venue: Biology Open
  • URL: https://www.semanticscholar.org/paper/95f5ef8c420feeac5752fd70f957c8130797cc3d
  • DOI: 10.1242/bio.026013
  • PMID: 29084713
  • PMCID: 5769645
  • Citations: 21
  • Influential citations: 2
  • Summary: An underlying mechanism of RBS is revealed in which ESCO2 mutation results in cohesin-dependent dysregulation of transcriptional programs that include the clinically relevant signaling molecule CX43, which has the potential to unify RBS and CdLS as transcription-based mechanisms.
  • Evidence snippets:
  • Snippet 1 (score: 0.372) > RBS is a severe type of human developmental disorder characterized by craniofacial deformities, limb malformation and mental retardation. Currently the treatment options are very limited and not very beneficial. Thus, it is important to understand the molecular mechanisms underlying RBS if we are to identify relevant pharmacological targets for more effective treatments. In a previous study we developed a zebrafish regenerating fin vertebrate model to Zebrafish caudal fin stained with calcein examine the skeletal defects of RBS. We established a genetic link between the gene mutated in RBS -esco2and the clinically relevant gap junction gene cx43, which suggested a transcriptional role for Esco2 in Cx43 regulation. This is the first study to provide evidence that unifies RBS and similar birth defect maladies such as Cornelia de Lange syndrome (CdLS). > What, in your opinion, are some of the greatest achievements in your field and how has this influenced your research? > One of the greatest achievements in our field is the use of various model systems such as zebrafish, Drosophila and yeast to study mechanisms underlying human diseases. In particular zebrafish research plays a valuable role in developmental studies and also drug discovery. > What has surprised you the most while conducting your research? > Both RBS and CdLS are severe birth defects with overlapping phenotypes, and arise from mutation of genes that function in a common pathway, but surprisingly the etiologies of these syndromes are believed to be distinct. Though it is widely accepted that CdLS arises from transcriptional deregulation of a set of genes, the mechanism underlying RBS remains unknown. A popular model states that RBS is caused by mitotic failure and cell death that is completely distinct from CdLS. I was surprised that similar developmental diseases such as RBS and CdLS could have such distinct mechanisms and believed that this area needed further investigation.

[9] 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: 0.372) > 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).

[10] Nasopharyngeal Carcinoma Signaling Pathway: An Update on Molecular Biomarkers

  • Authors: W. Tulalamba, T. Janvilisri
  • Year: 2012
  • Venue: International Journal of Cell Biology
  • URL: https://www.semanticscholar.org/paper/307cb9186444d9dad6e2e3b53763be0de76de186
  • DOI: 10.1155/2012/594681
  • PMID: 22500174
  • PMCID: 3303613
  • Citations: 93
  • Influential citations: 5
  • Summary: The molecular signaling pathways in the NPC are discussed for the holistic view of NPC development and progression and the important insights toward NPC pathogenesis may offer strategies for identification of novel biomarkers for diagnosis and prognosis.
  • Evidence snippets:
  • Snippet 1 (score: 0.369) > In the pregenomic eras, highly integrated and complex circuitry of molecular signaling in NPC pathogenesis was only partially understood. Over the past decade, the knowledge of the molecular mechanisms in NPC carcinogenesis has been rapidly accumulated. Dysregulation and abnormal protein expression of molecules in certain signaling pathways involved in cellular functions including proliferation, adhesion, survival, and apoptosis has been demonstrated in the NPC cells. Detailed information on the complex network in signaling pathway leading to a coordinated pattern of gene expression and regulation in NPC will undoubtedly provide important clues to develop novel prognostic and therapeutic strategies for this cancer. Refining molecular markers into clinically relevant assays may assist in the detection of NPC in asymptomatic patients, as well as stage classification and monitoring disease progression and treatments. Furthermore, selective regulation of particular proteins targeting cancer cell proliferation, invasion, and apoptosis is a hopeful prospect for future anticancer therapy that slow disease progression and improve survival.

[11] Lateralized and Segmental Overgrowth in Children

  • Authors: A. Mussa, D. Carli, S. Cardaropoli, G. Ferrero, N. Resta
  • Year: 2021
  • Venue: Cancers
  • URL: https://www.semanticscholar.org/paper/1bf068188ceb52b6d570aedc7fc2b9bdfd8c7ca9
  • DOI: 10.3390/cancers13246166
  • PMID: 34944785
  • PMCID: 8699773
  • Citations: 19
  • Summary: Interestingly, some LO shares molecular mechanisms with cancer: recent advances in tumor biological pathway druggability and growth downregulation offer new avenues for the treatment of the most severe and complicated LO.
  • Evidence snippets:
  • Snippet 1 (score: 0.368) > Simple Summary Congenital lateralized or segmental overgrowth (LO) disorders are conditions characterized by excessive tissue growth of a body region often associated with a predisposition to cancer. LOs are caused by mosaic DNA anomalies, that is, they are present only in a part of the cells making up the body. LOs have an extremely heterogeneous clinical presentation: they widely overlap in presentation, are difficult to frame from a clinical point of view and have a diagnostic complexity representing a challenge for the clinician who approaches them. Here we review the key features of the various LOs, expose their molecular causes, and detail the implications for each of them, such as the need for specific cancer screening or the possibility of treatment. The latter represents a recent scientific achievement in medicine, allowed by the development of precision drugs finely tuning cellular pathways involved in growth and tumorigenesis deranged in LO. Abstract Congenital disorders of lateralized or segmental overgrowth (LO) are heterogeneous conditions with increased tissue growth in a body region. LO can affect every region, be localized or extensive, involve one or several embryonic tissues, showing variable severity, from mild forms with minor body asymmetry to severe ones with progressive tissue growth and related relevant complications. Recently, next-generation sequencing approaches have increased the knowledge on the molecular defects in LO, allowing classifying them based on the deranged cellular signaling pathway. LO is caused by either genetic or epigenetic somatic anomalies affecting cell proliferation. Most LOs are classifiable in the Beckwith–Wiedemann spectrum (BWSp), PI3KCA/AKT-related overgrowth spectrum (PROS/AROS), mosaic RASopathies, PTEN Hamartoma Tumor Syndrome, mosaic activating variants in angiogenesis pathways, and isolated LO (ILO). These disorders overlap over common phenotypes, making their appraisal and distinction challenging. The latter is crucial, as specific management strategies are key: some LO is associated with increased cancer risk making imperative tumor screening since childhood. Interestingly, some LO shares molecular mechanisms with cancer: recent advances in tumor biological pathway druggability and growth downregulation offer new avenues for the treatment of the most severe and complicated LO.

[12] The Role of Targeted Therapy in Metastatic Renal Cell Carcinoma

  • Authors: J. Unnithan, B. Rini
  • Year: 2007
  • Venue: The Scientific World Journal
  • URL: https://www.semanticscholar.org/paper/d5d6d3155431806aa44bbc5391b25cad4f4ed412
  • DOI: 10.1100/tsw.2007.149
  • PMID: 17619763
  • PMCID: 5901264
  • Citations: 6
  • Summary: The biological pathways involved in the development of RCC and the results of clinical trials using targeted therapy in metastatic RCC are described.
  • Evidence snippets:
  • Snippet 1 (score: 0.368) > Renal cell carcinoma has historically been a treatment resistant tumor. Association of renal cell carcinoma with inherited VHL syndrome and the subsequent elucidation of relevant biological pathways in clear cell RCC have changed the approach to systemic therapy. Drugs targeting the VEGF and related pathways have robust clinical activity. Ongoing clinical trials are exploring multiple options such as combining molecular targets with cytokines and combining targeting agents directed against different proteins in the same or different molecular pathways. The emergence of active agents in RCC has generated several needs within the RCC clinical research arena. One pressing need is a pre-clinical model that can replicate the phenotype of disease and treatment with these drugs to better understand mechanisms of response and resistance. Predictive clinical and molecular markers also require investigation to most appropriately target these agents. In addition, standard CT scans and RECIST criteria are often inadequate to evaluate response and progression with VEGF-targeted therapy. Investigation of newer imaging modalities and evaluation criteria is warranted. A new era of treatment in metastatic RCC has emerged, however, where rational therapeutic targeting has lead to substantial clinical advances.

[13] 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: 0.366) > 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.

[14] The Role of De Novo Variants in Formation of Human Anorectal Malformations

  • Authors: G. Dworschak, I. V. van Rooij, H. Reutter
  • Year: 2021
  • Venue: Genes
  • URL: https://www.semanticscholar.org/paper/797971808f29591fc8f276c174b34568ba9bbfa5
  • DOI: 10.3390/genes12091298
  • PMID: 34573284
  • PMCID: 8466114
  • Citations: 3
  • Summary: The implicated mortality and reduced fecundity in patients with ARM would lead to allele loss, however, mutational de novo events among the affected individuals could compensate for the evolutionary pressure.
  • Evidence snippets:
  • Snippet 1 (score: 0.365) > The Duane-radial ray syndrome (OMIM #607323) is an autosomal dominant disorder characterized by upper limb, ocular, and renal anomalies caused by variants in SALL4. Less common features comprise sensorineural hearing loss and gastrointestinal anomalies, such as ARM. Pathogenic variants in SALL4 occur in 40%-50% de novo [14].
  • Snippet 2 (score: 0.365) > The Duane-radial ray syndrome (OMIM #607323) is an autosomal dominant disorder characterized by upper limb, ocular, and renal anomalies caused by variants in SALL4. Less common features comprise sensorineural hearing loss and gastrointestinal anomalies, such as ARM. Pathogenic variants in SALL4 occur in 40%-50% de novo [14].

[15] Direct Sarcomere Modulators Are Promising New Treatments for Cardiomyopathies

  • Authors: O. Tsukamoto
  • Year: 2019
  • Venue: International Journal of Molecular Sciences
  • URL: https://www.semanticscholar.org/paper/07467943fe92ce135b52ded5e5dea2bfc2ddf179
  • DOI: 10.3390/ijms21010226
  • PMID: 31905684
  • PMCID: 6982115
  • Citations: 16
  • Summary: The direct inhibition of sarcomere contractility may be able to suppress the development and progression of HCM with hypercontractile mutations and improve clinical parameters in patients with HCM, and direct activation of sar COMs modulators that can positively influence the natural history of cardiomyopathies represent promising treatment options.
  • Evidence snippets:
  • Snippet 1 (score: 0.365) > Hereditary DCM can be caused by single point mutations in sarcomere proteins. However, the link between point mutations and clinical phenotypes in DCM is not thoroughly understood in most cases. Recent advances in biochemical, biophysical, stem cell, and gene editing technologies have provided a better understanding of the molecular mechanisms through which the initial insult in DCM (i.e., mutations in a sarcomere protein) induces alterations in cellular organization and contractility, resulting in disease phenotypes. In particular, hiPSC-CMs and genetically modified animals are excellent models because they can capture the initial molecular phenotype that occurs before major compensatory mechanisms mask it.

[16] Rare Monogenic Diseases: Molecular Pathophysiology and Novel Therapies

  • Authors: I. Condò
  • Year: 2022
  • Venue: International Journal of Molecular Sciences
  • URL: https://www.semanticscholar.org/paper/6aece75e6947f102b657851b74e8b96df5e654c1
  • DOI: 10.3390/ijms23126525
  • PMID: 35742964
  • PMCID: 9223693
  • Citations: 18
  • Influential citations: 2
  • Summary: A rare disease is defined by its low prevalence in the general population and its presence in a very small number of people.
  • Evidence snippets:
  • Snippet 1 (score: 0.365) > The selective expression or the particular role of specific genes in a single tissue explains the appearance of organ-specific inherited diseases. This is the case of genetic disorders of the kidney, which include dominant and recessive forms of cystic diseases, and renal tubulopathies. Mutations in polycystin-1 (PKD1) or -2 (PKD2) genes lead to autosomaldominant polycystic kidney disease (ADPKD), whose gender-dependent phenotype was analyzed in the study by Talbi et al. [9]. These results, obtained in mice lacking PKD1 expression, show the involvement of intracellular Ca2+ levels in the more severe phenotype affecting male ADPKD animals. Altogether, identification of the molecular mechanisms underlying enhanced Ca2+ signaling and proliferation in cells from male kidneys may contribute to develop novel therapeutics for ADPKD [9]. The autosomal-recessive form of polycystic kidney disease (ARPKD) mostly arises from defects in the gene named polycystic kidney and hepatic disease 1 (PKHD1), whereas a minority of cases is linked to a second causative gene DZIP1L. To examine the still unclear molecular pathophysiology of ARPKD, Cordido et al. recapitulate known molecular disease mechanisms and possible therapeutic approaches, from cellular and animal models to clinical trials [10]. The knowledge of ARPKD pathogenic pathways, involving the epidermal growth factor receptor (EGFR) axis, the production of adenylyl cyclase adenosine 3 ,5 -cyclic monophosphate (cAMP) and the activation of several protein kinases, begins to stimulate possible pharmacological interventions [10]. Inherited loss of function in various electrolyte transport proteins located along the nephron leads to two types of kidney tubulopathy with overlapping clinical symptoms: Gitelman and Bartter syndromes. The review by Nuñez-Gonzalez et al. aims to explain the different molecular basis of these difficult to diagnose monogenic syndromes. Moreover, the authors provide an overview of current therapeutic approaches and highlight the presence of common and specific options for Gitelman and Bartter patients [11].

[17] Investigating the role of NPR1 in dilated cardiomyopathy and its potential as a therapeutic target for glucocorticoid therapy

  • Authors: Yaomeng Huang, Tongxin Li, Shichao Gao, Shuyu Li, Xiaoran Zhu et al.
  • Year: 2023
  • Venue: Frontiers in Pharmacology
  • URL: https://www.semanticscholar.org/paper/be229f6f2059faab4c97ec0a04bd055adab9dfe1
  • DOI: 10.3389/fphar.2023.1290253
  • PMID: 38026943
  • PMCID: 10662320
  • Citations: 4
  • Summary: Natriuretic peptide receptor 1 (NPR1) was identified as a core gene associated with DCM through bioinformatics analysis and led to substantial improvements in cardiac and renal function, accompanied by an upregulation of NPR1 expression.
  • Evidence snippets:
  • Snippet 1 (score: 0.363) > Multiple pathways and molecules are involved in this process; however, the detailed underlying mechanisms remain unclear. In recent years, with the development of high-throughput sequencing and gene chip technologies, the use of bioinformatics technology to explore the occurrence, development, and prognosis of diseases has become a hot topic for scholars worldwide (Hwang et al., 2018;Nayor et al., 2019;Rinschen et al., 2019;Sturm et al., 2019;Montaner et al., 2020). > The present study aimed to use bioinformatics technology to screen for DCM-related genes and investigate their mechanisms, with the purpose of revealing the pathogenesis of DCM and seeking treatment methods. The GSE3586 dataset, containing expression profiles related to DCM, was selected from the Gene Expression Omnibus (GEO) database. This study aimed to predict the core genes that may play crucial roles in disease progression at the molecular level through the enrichment of relevant molecular pathways associated with DCM. Furthermore, the phenotype of the core genes was validated to further support the results of the bioinformatics analysis through basic and clinical experiments. Additionally, the role of glucocorticoids in DCM treatment is discussed in this article with the purpose of providing a theoretical and experimental basis for exploring the pathogenesis of DCM and elucidating therapeutic methods. This study also provides a theoretical reference for the interpretation, early diagnosis, and treatment of DCM.

[18] Targeting Hepatic Stellate Cells for the Prevention and Treatment of Liver Cirrhosis and Hepatocellular Carcinoma: Strategies and Clinical Translation

  • Authors: Hao Xiong, Jinsheng Guo
  • Year: 2025
  • Venue: Pharmaceuticals
  • URL: https://www.semanticscholar.org/paper/76e92127053136900f7e3f10e2c9278251ced5d2
  • DOI: 10.3390/ph18040507
  • PMID: 40283943
  • PMCID: 12030350
  • Citations: 10
  • Summary: HSC-targeted approaches using specific surface markers and receptors may enable the selective delivery of drugs, oligonucleotides, and therapeutic peptides that exert optimized anti-fibrotic and anti-HCC effects.
  • Evidence snippets:
  • Snippet 1 (score: 0.362) > Significant progress has been made in elucidating the cellular and molecular mechanisms of liver fibrosis; however, only a few findings have been successfully translated into clinical applications. Firstly, the high cost of drug development and target validation necessitates prolonged timelines and substantial financial investment. Secondly, as regulatory requirements become more stringent, there is an increasing demand for drugs with well-defined clinical efficacy and safety profiles. Moreover, the efficacy observed in animal models often fails to fully translate to clinical settings due to differences in pharmacokinetics, extracellular matrix (ECM) cross-linking, and disease pathophysiology. Despite advancements in anti-fibrotic drug development, accurately identifying ideal noninvasive biomarkers for fibrotic activity and establishing consensus on optimal clinical endpoints remain significant challenges [113,114]. > Currently, addressing the underlying cause remains the only proven strategy to halt or reverse liver fibrosis progression, while the development of effective anti-fibrotic therapies continues to pose a major challenge in liver disease management. Over the past few decades, substantial progress has been made in elucidating the cellular and molecular mechanisms underlying liver fibrosis. Liver fibrosis is a complex pathological change involving multiple cells, factors, and pathways, and the study of the cellular and molecular mechanisms of its occurrence and development provides an important theoretical basis and therapeutic target for clinical drug development. It is anticipated that improved animal models and well-designed clinical trials will facilitate the successful translation of anti-fibrotic research into effective clinical treatments in the near future.

[19] Non-Invasive Prenatal Screening for Down Syndrome: A Review of Mass-Spectrometry-Based Approaches

  • Authors: Răzvan Lucian Jurca, I. Pralea, M. Iacobescu, I. Rus, C. Iuga et al.
  • Year: 2025
  • Venue: Life
  • URL: https://www.semanticscholar.org/paper/77585fbeddaee796b0d9030dfccee9713f2d3e52
  • DOI: 10.3390/life15050695
  • PMID: 40430124
  • PMCID: 12112985
  • Citations: 1
  • Summary: A comprehensive examination of the differentially expressed proteins (DEPs) and metabolites (DEMs) reported in the literature in T21 prenatal screening aims to guide future research in the field and foster the development of more advanced, less invasive prenatal screening techniques for T21.
  • Evidence snippets:
  • Snippet 1 (score: 0.361) > Additionally, CS and DS are commonly associated with atherosclerosis, nerve development and repair, inflammation, tumor growth, and metastasis [80]. Modifications of the enzymes involved in the biosynthesis of glycosaminoglycans are important in Ehlers-Danlos syndrome, joint dislocations, short stature, spondyloepiphyseal dysplasia with congenital joint dislocations, spondyloepimetaphyseal dysplasia with joint laxity type 1, congenital heart defects, and Temtamy preaxial brachydactyly syndrome. While congenital heart defects and joint laxity are common in T21 patients, the co-occurrence of T21 and Ehlers-Danlos syndrome is rare, and no established correlation exists between the two conditions [104]. > Pathways associated with diseases of hemostasis were predominantly observed in maternal plasma, along with pathways related to signal transduction mediated by growth factors and second messengers-specifically, oncogenic MAPK signaling. MAPKs are protein kinases that control intracellular processes, such as gene expression, metabolism, proliferation, differentiation, and apoptosis, as part of normal physiology, being mainly studied in the context of oncogenesis, tumor progression, and drug resistance [105]. MAPK pathways in T21 patients have been primarily studied to enhance antitumor treatment efficacy in patients with B cell acute lymphoblastic leukemia [106] or to assess MAPK activity in the brains of T21 and Alzheimer's disease patients [107]. > Table 2 summarizes the key molecular pathways implicated in Down syndrome (T21), emphasizing their normal biological functions and the observed or potential alterations in T21. While direct evidence for some pathways remains limited, numerous pathways-particularly those involved in signaling, immune functions, extracellular matrix organization, and metabolic processes-show promising associations with the clinical features of T21. Regarding the metabolomic pathways of significant differentially expressed metabolites (DEMs) in T21, brief discussions on this topic are included in the description of each metabolomic study outlined in the previous section.

Notes

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