EFL1-related Shwachman-Diamond syndrome is the EFL1-defined molecular subtype of Shwachman-Diamond syndrome represented in MONDO as Shwachman-Diamond syndrome 2 (SDS2). Biallelic pathogenic variants in EFL1 impair the SBDS-EFL1-dependent eviction of EIF6 during late 60S ribosomal subunit maturation, leading to defective ribosome assembly and compromised protein synthesis. Reported individuals show a multisystem SDS phenotype that includes exocrine pancreatic insufficiency, cytopenias, short stature, and metaphyseal dysplasia, making this a clinically overlapping but genetically distinct entity from classic SBDS-related SDS.
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name: EFL1-related Shwachman-Diamond syndrome
creation_date: '2026-04-16T19:16:34Z'
updated_date: '2026-04-20T18:55:01Z'
category: Mendelian
description: >-
EFL1-related Shwachman-Diamond syndrome is the EFL1-defined molecular subtype
of Shwachman-Diamond syndrome represented in MONDO as Shwachman-Diamond
syndrome 2 (SDS2). Biallelic pathogenic variants in EFL1 impair the
SBDS-EFL1-dependent eviction of EIF6 during late 60S ribosomal subunit
maturation, leading to defective ribosome assembly and compromised protein
synthesis. Reported individuals show a multisystem SDS phenotype that includes
exocrine pancreatic insufficiency, cytopenias, short stature, and metaphyseal
dysplasia, making this a clinically overlapping but genetically distinct
entity from classic SBDS-related SDS.
disease_term:
preferred_term: EFL1-related Shwachman-Diamond syndrome
term:
id: MONDO:0044205
label: Shwachman-Diamond syndrome 2
parents:
- hereditary disease
synonyms:
- Shwachman-Diamond syndrome 2
- SDS2
inheritance:
- name: Autosomal recessive inheritance
inheritance_term:
preferred_term: Autosomal recessive inheritance
term:
id: HP:0000007
label: Autosomal recessive inheritance
description: >-
EFL1-related Shwachman-Diamond syndrome follows autosomal recessive
inheritance and is caused by biallelic pathogenic variants in EFL1.
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Autosomal recessive SDS: SDS caused by pathogenic variants in DNAJC21, EFL1, or SBDS is inherited in an autosomal recessive manner.
explanation: >-
GeneReviews explicitly states that the EFL1-associated SDS subtype is
inherited in an autosomal recessive manner.
pathophysiology:
- name: Defective EFL1-mediated EIF6 release during ribosomal large subunit maturation
description: >-
EFL1 encodes the elongation factor-like GTPase that cooperates with SBDS in
the final cytoplasmic maturation step of the 60S ribosomal subunit. Disease
variants impair EIF6 eviction from pre-60S particles, blocking normal late
ribosomal large-subunit maturation.
genes:
- preferred_term: EFL1
term:
id: hgnc:25789
label: EFL1
biological_processes:
- preferred_term: ribosomal large subunit assembly
modifier: ABNORMAL
term:
id: GO:0000027
label: ribosomal large subunit assembly
evidence:
- reference: PMID:28331068
reference_title: >-
Mutations in EFL1, an SBDS partner, are associated with infantile pancytopenia, exocrine pancreatic insufficiency and skeletal anomalies in aShwachman-Diamond like syndrome.
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
Similar to the molecular pathology of SDS, mutant EFL1 proteins do not promote the release of cytoplasmic Tif6 from the 60S subunit, likely preventing the formation of mature ribosomes.
explanation: >-
Functional studies in the discovery paper support impaired EIF6/Tif6
release as the proximal defect in EFL1-related SDS.
- reference: PMID:31151987
reference_title: EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Cellular defects in these individuals include impaired ribosomal subunit joining and attenuated global protein translation as a consequence of defective eIF6 eviction.
explanation: >-
Patient-derived cellular studies directly show that defective EIF6
eviction disrupts ribosomal subunit joining in EFL1-related disease.
downstream:
- target: Compromised protein synthesis
description: Impaired late 60S maturation reduces productive ribosome assembly and translation.
causal_link_type: DIRECT
evidence:
- reference: PMID:31151987
reference_title: EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Cellular defects in these individuals include impaired ribosomal subunit joining and attenuated global protein translation as a consequence of defective eIF6 eviction.
explanation: >-
Patient-derived cellular data connect defective EIF6 eviction to impaired
ribosomal subunit joining and reduced global translation.
- name: Compromised protein synthesis
description: >-
Defective EFL1 function compromises mature ribosome formation and reduces
overall protein synthesis, providing a mechanistic basis for the
tissue-specific pancreatic, hematopoietic, growth, and skeletal phenotype.
biological_processes:
- preferred_term: translation
modifier: DECREASED
term:
id: GO:0006412
label: translation
evidence:
- reference: PMID:39379149
reference_title: >-
Shwachman-Diamond syndrome due to biallelic EFL1 variants with complex and fatal clinical course in early infancy.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Functional analysis of patient-derived B-lymphoblastoid and SV40-transformed fibroblast cell lines suggests that the compound heterozygous EFL1 variants impaired mature ribosome formation leading to compromised protein synthesis, ultimately resulting in a severe form of Shwachman-Diamond syndrome.
explanation: >-
Patient-derived cell lines from a severe infantile case directly link EFL1
dysfunction to impaired mature ribosome formation and reduced protein
synthesis.
downstream:
- target: Pancytopenia
description: Hematopoietic output is vulnerable to the translation defect.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- Ribosomal stress in hematopoietic progenitors and bone marrow failure.
evidence:
- reference: PMID:31151987
reference_title: EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
In mice, Efl1 deficiency recapitulates key aspects of the SDS phenotype.
explanation: >-
EFL1 deficiency recapitulating SDS in vivo supports a causal bridge from
the ribosome defect to hematopoietic disease manifestations.
- target: Exocrine pancreatic insufficiency
description: Exocrine pancreatic function is impaired downstream of the ribosomopathy.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- Ribosomal stress in pancreatic exocrine tissue.
evidence:
- reference: PMID:31151987
reference_title: EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
In mice, Efl1 deficiency recapitulates key aspects of the SDS phenotype.
explanation: >-
The EFL1-specific model links deficient ribosome licensing to the
multisystem SDS phenotype that includes pancreatic disease.
- target: Decreased total neutrophil count
description: Myeloid output is commonly reduced within the hematopoietic phenotype.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- Bone marrow dysfunction and impaired myeloid production.
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
In almost all affected children, persistent or intermittent neutropenia is an early finding.
explanation: >-
GeneReviews supports neutropenia as an early hematologic manifestation
within the SDS spectrum that includes EFL1-related disease.
- target: Short stature
description: Reduced protein synthesis contributes to impaired somatic growth.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- Malnutrition, endocrine manifestations, and skeletal growth-plate involvement.
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: Short stature and recurrent infections are common.
explanation: >-
GeneReviews supports short stature as a common SDS-spectrum feature
requiring growth surveillance in EFL1-related disease.
- target: Metaphyseal dysplasia
description: Skeletal development is perturbed as part of the SDS2 phenotype.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- Skeletal dysplasia and abnormal growth during ribosomopathy.
evidence:
- reference: PMID:29970384
reference_title: >-
Further evidence for the involvement of EFL1 in a Shwachman-Diamond-like syndrome and expansion of the phenotypic features.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
We report a pediatric patient who presented with a metaphyseal dysplasia and was found to have biallelic variants in EFL1 on reanalysis of trio whole-exome sequencing data.
explanation: >-
An EFL1-specific case links biallelic EFL1 disease to metaphyseal
dysplasia in the SDS-like skeletal phenotype.
- target: Predisposition to hematological malignancy
description: >-
The EFL1 ribosomopathy belongs to the SDS leukemia-predisposition spectrum
with risk for MDS or AML.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- Ribosomal stress, marrow failure, and clonal hematopoietic evolution.
evidence:
- reference: PMID:31151987
reference_title: EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
By identifying biallelic EFL1 mutations in SDS, we define this leukemia predisposition disorder as a ribosomopathy that is caused by corruption of a fundamental, conserved mechanism, which licenses entry of the large ribosomal subunit into translation.
explanation: >-
The EFL1 discovery paper explicitly frames the disorder as a leukemia
predisposition ribosomopathy.
- name: Bone marrow-specific somatic UPD and partial EFL1 clonal rescue
description: >-
Bone marrow-restricted somatic uniparental disomy of chromosome 15 can skew
EFL1 allele balance toward a relatively milder pathogenic allele. This is a
somatic hematopoietic adaptation rather than a germline causal gene item, and
the rescued clone can still retain impaired 80S ribosome assembly.
genes:
- preferred_term: EFL1
term:
id: hgnc:25789
label: EFL1
evidence:
- reference: PMID:34115847
reference_title: >-
Somatic uniparental disomy mitigates the most damaging EFL1 allele combination in Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Here we present 3 unrelated Korean SDS patients who carry biallelic pathogenic variants in EFL1 with biased allele frequencies, resulting from a bone marrow-specific somatic uniparental disomy in chromosome 15.
explanation: >-
This establishes the phenomenon as bone marrow-specific somatic UPD in
patients with biallelic germline EFL1 disease.
- reference: PMID:34115847
reference_title: >-
Somatic uniparental disomy mitigates the most damaging EFL1 allele combination in Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
The loss of EFL1 resulted in a pronounced inhibition of terminal oligopyrimidine element-containing ribosomal protein transcript 80S assembly.
explanation: >-
The clonal shift is partial rescue, not correction of the underlying
ribosome-assembly defect.
downstream:
- target: Compromised protein synthesis
description: >-
The selected milder EFL1 genotype still impairs 80S ribosome assembly and
leaves residual ribosomopathy.
causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
intermediate_mechanisms:
- Partial clonal rescue with persistent abnormal 80S ribosome assembly.
evidence:
- reference: PMID:34115847
reference_title: >-
Somatic uniparental disomy mitigates the most damaging EFL1 allele combination in Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Therefore, we propose a more accurate pathogenesis mechanism of EFL1 dysfunction that eventually leads to aberrant translational control and ribosomopathy.
explanation: >-
The somatic-UPD report connects EFL1 dysfunction to persistent abnormal
translational control and ribosomopathy.
phenotypes:
- name: Pancytopenia
category: Hematologic
diagnostic: true
description: >-
Infantile pancytopenia is a recurrent hematologic presentation in the
initial EFL1-related cohort.
phenotype_term:
preferred_term: Pancytopenia
term:
id: HP:0001876
label: Pancytopenia
evidence:
- reference: PMID:28331068
reference_title: >-
Mutations in EFL1, an SBDS partner, are associated with infantile pancytopenia, exocrine pancreatic insufficiency and skeletal anomalies in aShwachman-Diamond like syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
This study aims to identify the molecular basis of an SDS-like disease, manifested by pancytopenia, exocrine pancreatic insufficiency and skeletal abnormalities in six patients from three unrelated families.
explanation: >-
The discovery cohort directly documents pancytopenia as a defining
hematologic manifestation of EFL1-related SDS.
- name: Exocrine pancreatic insufficiency
category: Gastrointestinal
diagnostic: true
description: >-
Exocrine pancreatic insufficiency is a core gastrointestinal feature of
EFL1-related Shwachman-Diamond syndrome.
phenotype_term:
preferred_term: Exocrine pancreatic insufficiency
term:
id: HP:0001738
label: Exocrine pancreatic insufficiency
evidence:
- reference: PMID:28331068
reference_title: >-
Mutations in EFL1, an SBDS partner, are associated with infantile pancytopenia, exocrine pancreatic insufficiency and skeletal anomalies in aShwachman-Diamond like syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
This study aims to identify the molecular basis of an SDS-like disease, manifested by pancytopenia, exocrine pancreatic insufficiency and skeletal abnormalities in six patients from three unrelated families.
explanation: >-
The same discovery cohort establishes exocrine pancreatic insufficiency as
part of the core clinical phenotype.
- name: Decreased total neutrophil count
category: Hematologic
description: >-
Persistent or intermittent neutropenia is a common early hematologic feature
across Shwachman-Diamond syndrome, including the EFL1-associated recessive
subtype.
phenotype_term:
preferred_term: Neutropenia
term:
id: HP:0001875
label: Decreased total neutrophil count
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
In almost all affected children, persistent or intermittent neutropenia is an early finding.
explanation: >-
GeneReviews identifies neutropenia as a common early finding in the
Shwachman-Diamond syndrome spectrum that includes EFL1-related disease.
- name: Predisposition to hematological malignancy
category: Oncologic
description: >-
EFL1-related Shwachman-Diamond syndrome carries a risk of myeloid malignant
transformation, including myelodysplastic syndrome and acute myeloid
leukemia, within the broader SDS ribosomopathy spectrum.
phenotype_term:
preferred_term: Predisposition to hematological malignancy
term:
id: HP:0004377
label: Hematological neoplasm
evidence:
- reference: PMID:31151987
reference_title: EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Shwachman-Diamond syndrome (SDS) is a recessive disorder typified by bone marrow failure and predisposition to hematological malignancies.
explanation: >-
The EFL1-specific causative series places SDS2 within the SDS spectrum of
leukemia-predisposition ribosomopathies and supports oncologic
surveillance for myeloid malignancy.
- name: Short stature
category: Growth
description: >-
Short stature is a common growth manifestation within the Shwachman-Diamond
syndrome spectrum and is included in the MONDO textual definition of SDS2.
phenotype_term:
preferred_term: Short stature
term:
id: HP:0004322
label: Short stature
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: Short stature and recurrent infections are common.
explanation: >-
GeneReviews explicitly identifies short stature as a common clinical
feature in Shwachman-Diamond syndrome caused by EFL1, DNAJC21, or SBDS.
- name: Metaphyseal dysplasia
category: Skeletal
description: >-
Metaphyseal dysplasia expands the recognized skeletal phenotype of
EFL1-related disease and supports separation from classic SBDS-related SDS
at the level of case-based phenotype curation.
phenotype_term:
preferred_term: Metaphyseal dysplasia
term:
id: HP:0100255
label: Metaphyseal dysplasia
evidence:
- reference: PMID:29970384
reference_title: >-
Further evidence for the involvement of EFL1 in a Shwachman-Diamond-like syndrome and expansion of the phenotypic features.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
We report a pediatric patient who presented with a metaphyseal dysplasia and was found to have biallelic variants in EFL1 on reanalysis of trio whole-exome sequencing data.
explanation: >-
This EFL1-specific case report directly supports metaphyseal dysplasia as
part of the clinical spectrum.
biochemical: []
genetic:
- name: EFL1
association: Causal biallelic variant
gene_term:
preferred_term: EFL1
term:
id: hgnc:25789
label: EFL1
notes: >-
Biallelic pathogenic EFL1 variants define SDS2 and impair the late
ribosome-maturation step shared with SBDS.
evidence:
- reference: PMID:31151987
reference_title: EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Here, we report biallelic mutations in EFL1 in 3 unrelated individuals with clinical features of SDS.
explanation: >-
This establishes EFL1 as the causal disease gene in molecularly confirmed
SDS2.
environmental: []
treatments:
- name: Pancreatic enzyme replacement or supplementation therapy
description: >-
Oral pancreatic enzyme replacement with fat-soluble vitamin supplementation
is used to manage exocrine pancreatic insufficiency in the SDS spectrum.
treatment_term:
preferred_term: pancreatic enzyme replacement or supplementation therapy
term:
id: MAXO:0000933
label: enzyme replacement or supplementation therapy
target_phenotypes:
- preferred_term: Exocrine pancreatic insufficiency
term:
id: HP:0001738
label: Exocrine pancreatic insufficiency
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Exocrine pancreatic insufficiency is treated with oral pancreatic enzymes and fat-soluble vitamin supplementation.
explanation: >-
GeneReviews documents pancreatic enzyme replacement as standard management
for the pancreatic component of SDS, including EFL1-related disease.
- name: Nutritional and fat-soluble vitamin surveillance
description: >-
Nutritional status and fat-soluble vitamin concentrations should be followed
longitudinally because exocrine pancreatic dysfunction can cause
malabsorption and malnutrition.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
target_phenotypes:
- preferred_term: Exocrine pancreatic insufficiency
term:
id: HP:0001738
label: Exocrine pancreatic insufficiency
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Assessment of nutritional status and measurement of serum concentration of fat-soluble vitamins every six months.
explanation: >-
GeneReviews supports scheduled nutrition and fat-soluble vitamin monitoring
for SDS management.
- name: Hematologic and marrow surveillance
description: >-
Serial complete blood counts with differential and platelet count, together
with periodic bone marrow examination, monitor cytopenias, marrow failure,
MDS, and AML risk in the SDS spectrum.
treatment_term:
preferred_term: surveillance for malignancies
term:
id: MAXO:0001492
label: surveillance for malignancies
target_phenotypes:
- preferred_term: Predisposition to hematological malignancy
term:
id: HP:0004377
label: Hematological neoplasm
- preferred_term: Pancytopenia
term:
id: HP:0001876
label: Pancytopenia
- preferred_term: Neutropenia
term:
id: HP:0001875
label: Decreased total neutrophil count
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Complete blood count with white blood cell differential and platelet count at least every three to six months; bone marrow examination every one to three years or more frequently if bone marrow changes are observed.
explanation: >-
GeneReviews gives explicit blood-count and marrow-examination surveillance
intervals for SDS.
- name: Granulocyte colony-stimulating factor therapy
description: >-
Granulocyte colony-stimulating factor pharmacotherapy can be used for
severe recurrent infection with persistent severe neutropenia in the SDS
spectrum, while prolonged cytokine or hematopoietic growth-factor exposure
should be approached cautiously.
treatment_term:
preferred_term: granulocyte colony-stimulating factor therapy
term:
id: NCIT:C15986
label: Pharmacotherapy
therapeutic_agent:
- preferred_term: recombinant granulocyte colony-stimulating factor
term:
id: NCIT:C1287
label: Recombinant Granulocyte Colony-Stimulating Factor
target_phenotypes:
- preferred_term: Neutropenia
term:
id: HP:0001875
label: Decreased total neutrophil count
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
If recurrent infections are severe and absolute neutrophil counts are persistently ≤500/mm3, treatment with granulocyte-colony stimulation factor (G-CSF) can be considered and may be especially helpful when interventions such as complex dental procedures or orthopedic surgery are being considered.
explanation: >-
GeneReviews supports G-CSF pharmacotherapy for severe persistent
neutropenia in SDS, including the EFL1-related recessive subtype.
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Prolonged use of cytokine and hematopoietic growth factors (e.g., G-CSF) should be considered with caution.
explanation: >-
GeneReviews adds a caution against prolonged growth-factor use in SDS.
- name: Hematopoietic stem cell transplantation
description: >-
Hematopoietic stem cell transplantation is considered for severe bone marrow
failure or myeloid malignant transformation in the SDS spectrum.
treatment_term:
preferred_term: hematopoietic stem cell transplantation
term:
id: MAXO:0000747
label: hematopoietic stem cell transplantation
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Hematopoietic stem cell transplantation (HSCT) should be considered for treatment of severe bone marrow failure, MDS, or AML.
explanation: >-
This review supports HSCT as the escalation therapy for severe marrow
complications in SDS.
- name: Skeletal, growth, and endocrine surveillance
description: >-
Orthopedic imaging during rapid growth stages and regular growth/endocrine
assessment are used to monitor skeletal dysplasia, asymmetric growth, and
endocrine manifestations.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
target_phenotypes:
- preferred_term: Short stature
term:
id: HP:0004322
label: Short stature
- preferred_term: Metaphyseal dysplasia
term:
id: HP:0100255
label: Metaphyseal dysplasia
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Monitor for orthopedic complications with radiographs of the hips and knees during the most rapid growth stages.
explanation: >-
GeneReviews supports radiographic orthopedic monitoring during rapid growth.
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Assess growth and for clinical signs and symptoms of additional endocrine manifestations every six months.
explanation: >-
GeneReviews supports six-monthly growth and endocrine assessment.
- name: Liver disease monitoring and multidisciplinary management
description: >-
Liver involvement should be considered in EFL1-related SDS follow-up, with
multidisciplinary management when liver disease is present.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Multidisciplinary team management of liver disease;
explanation: >-
GeneReviews includes liver disease management in SDS multidisciplinary care.
- reference: PMID:38703831
reference_title: Hepatic phenotypes of EFL1-related Shwachman-Diamond syndrome in a biopsy-validated study.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Hepatic phenotypes of EFL1-related Shwachman-Diamond syndrome in a biopsy-validated study.
explanation: >-
This EFL1-specific biopsy-validated report supports including hepatic
involvement in follow-up considerations.
- name: Genetic counseling and at-risk relative or donor evaluation
description: >-
Counsel families about autosomal recessive recurrence risk, carrier testing,
prenatal or preimplantation testing when familial variants are known, and the
need to evaluate related HSCT donor candidates for SDS.
treatment_term:
preferred_term: genetic counseling
term:
id: MAXO:0000079
label: genetic counseling
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
If both parents are known to be heterozygous for an autosomal recessive SDS-related pathogenic variant, each sib of an affected individual has at conception a 25% chance of being affected, a 50% chance of being a clinically asymptomatic carrier, and a 25% chance of being unaffected and not a carrier.
explanation: >-
GeneReviews supports autosomal recessive recurrence-risk counseling for
EFL1-related SDS.
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
It is appropriate to evaluate the older and younger sibs of a proband in order to identify those who will benefit from treatment and preventive measures as soon as possible. It is essential to evaluate any potential related donor for SDS to avoid using an asymptomatic relative with SDS as an HSCT donor.
explanation: >-
GeneReviews supports at-risk sibling evaluation and donor screening before
related-donor HSCT.
diagnosis:
- name: Clinical pancreatic and bone marrow recognition
description: >-
EFL1-related SDS should be recognized clinically in the broader SDS context
when exocrine pancreatic dysfunction and bone marrow dysfunction or cytopenias
are present.
presence: Exocrine pancreatic dysfunction with bone marrow dysfunction supports SDS-spectrum diagnosis.
diagnosis_term:
preferred_term: diagnostic procedure
term:
id: MAXO:0000003
label: diagnostic procedure
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
DIAGNOSIS/TESTING: The diagnosis of SDS is established in a proband with the classic clinical findings of exocrine pancreatic dysfunction and bone marrow dysfunction and/or biallelic pathogenic variants in DNAJC21, EFL1, or SBDS or a heterozygous pathogenic variant in SRP54 identified by molecular genetic testing.
explanation: >-
GeneReviews anchors SDS diagnosis in pancreatic and bone marrow dysfunction
and includes EFL1 among the molecular causes.
- name: Complete blood count with differential and platelet count
description: >-
CBC with differential and platelet count evaluates neutropenia, pancytopenia,
and evolving multilineage cytopenias.
results: Persistent or intermittent neutropenia and other cytopenias support SDS-spectrum marrow involvement.
diagnosis_term:
preferred_term: blood cell count
term:
id: MAXO:0001509
label: blood cell count
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Complete blood count with white blood cell differential and platelet count at least every three to six months; bone marrow examination every one to three years or more frequently if bone marrow changes are observed.
explanation: >-
GeneReviews supports serial CBC testing as part of SDS surveillance and
diagnostic monitoring.
- name: Bone marrow examination for marrow failure or malignant evolution
description: >-
Bone marrow examination evaluates marrow failure and emerging marrow changes
that may require closer monitoring or HSCT planning.
results: Bone marrow changes, MDS, or AML guide risk assessment and escalation.
diagnosis_term:
preferred_term: bone marrow examination
term:
id: MAXO:0000753
label: bone marrow examination
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Complete blood count with white blood cell differential and platelet count at least every three to six months; bone marrow examination every one to three years or more frequently if bone marrow changes are observed.
explanation: >-
GeneReviews supports scheduled marrow examination in SDS surveillance.
- name: Radiographic skeletal assessment
description: >-
Radiographs of the hips and knees during rapid growth and targeted skeletal
imaging can identify orthopedic complications and metaphyseal dysplasia.
results: Metaphyseal dysplasia or orthopedic complications support multisystem EFL1-related SDS assessment.
diagnosis_term:
preferred_term: radiograph imaging procedure
term:
id: MAXO:0000595
label: radiograph imaging procedure
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
Monitor for orthopedic complications with radiographs of the hips and knees during the most rapid growth stages.
explanation: >-
GeneReviews supports radiographic orthopedic monitoring in SDS.
- reference: PMID:29970384
reference_title: >-
Further evidence for the involvement of EFL1 in a Shwachman-Diamond-like syndrome and expansion of the phenotypic features.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
We report a pediatric patient who presented with a metaphyseal dysplasia and was found to have biallelic variants in EFL1 on reanalysis of trio whole-exome sequencing data.
explanation: >-
EFL1-specific clinical evidence supports skeletal imaging for metaphyseal
dysplasia in the diagnostic workup.
- name: Molecular genetic testing and SDS gene differential diagnosis
description: >-
Molecular testing confirms biallelic pathogenic EFL1 variants and helps
distinguish EFL1-related SDS from SBDS-, DNAJC21-, or SRP54-related SDS and
SDS-like presentations.
presence: Identification of biallelic pathogenic EFL1 variants supports SDS2 diagnosis.
diagnosis_term:
preferred_term: molecular genetic testing
term:
id: MAXO:0000533
label: molecular genetic testing
qualifiers:
- predicate:
preferred_term: has participant
term:
id: RO:0000057
label: has participant
value:
preferred_term: EFL1
term:
id: hgnc:25789
label: EFL1
evidence:
- reference: PMID:20301722
reference_title: Shwachman-Diamond Syndrome.
supports: SUPPORT
evidence_source: OTHER
snippet: >-
DIAGNOSIS/TESTING: The diagnosis of SDS is established in a proband with the classic clinical findings of exocrine pancreatic dysfunction and bone marrow dysfunction and/or biallelic pathogenic variants in DNAJC21, EFL1, or SBDS or a heterozygous pathogenic variant in SRP54 identified by molecular genetic testing.
explanation: >-
GeneReviews supports molecular genetic testing across SDS genes and
differentiates recessive EFL1 disease from SBDS, DNAJC21, and SRP54.
- reference: PMID:31151987
reference_title: EFL1 mutations impair eIF6 release to cause Shwachman-Diamond syndrome.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
Here, we report biallelic mutations in EFL1 in 3 unrelated individuals with clinical features of SDS.
explanation: >-
The EFL1 discovery paper supports EFL1-specific molecular confirmation in
SDS-like presentations.
differential_diagnoses: []
clinical_trials: []
datasets: []
notes: >-
Asta deep research was completed for this disorder. MONDO:0044205 carries the
canonical label "Shwachman-Diamond syndrome 2"; this file uses
"EFL1-related Shwachman-Diamond syndrome" as the preferred human-facing term
to distinguish the EFL1 subtype from classic SBDS-related SDS.
references:
- reference: PMID:20301722
title: "Shwachman-Diamond Syndrome."
tags:
- GeneReviews
findings: []
This report is retrieval-only and is generated directly from Asta results.
search_papers_by_relevance with snippet_search.