An autosomal dominant limb malformation associated with deletions spanning EPHA4 and the boundary between the EPHA4 and PAX3 regulatory domains. The PAX3 coding sequence remains intact. Affected families have predominantly preaxial brachydactyly, short thumbs and index fingers, and cutaneous webbing between the first two fingers. Patient fibroblasts demonstrate abnormal PAX3 contacts with the EPHA4 regulatory domain; engineered mouse deletions cause ectopic distal limb Pax3 expression and recapitulate the digit malformation. The intervening cellular mechanism linking ectopic PAX3 to skeletal morphology remains unresolved.
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name: Preaxial Digit Brachydactyly-Webbed Fingers
creation_date: "2026-09-21T17:00:00Z"
category: Mendelian
synonyms:
- Preaxial brachydactyly PAX3 type
disease_term:
preferred_term: Preaxial digit brachydactyly-webbed fingers
term:
id: MONDO:0859005
label: preaxial digit brachydactyly-webbed fingers
parents:
- Congenital Limb Malformation
description: >-
An autosomal dominant limb malformation associated with deletions spanning
EPHA4 and the boundary between the EPHA4 and PAX3 regulatory domains.
The PAX3 coding sequence remains intact. Affected families have predominantly
preaxial brachydactyly, short thumbs and index fingers, and cutaneous webbing
between the first two fingers. Patient fibroblasts demonstrate abnormal
PAX3 contacts with the EPHA4 regulatory domain; engineered mouse deletions
cause ectopic distal limb Pax3 expression and recapitulate the digit
malformation. The intervening cellular mechanism linking ectopic PAX3 to
skeletal morphology remains unresolved.
inheritance:
- name: Autosomal dominant
inheritance_term:
preferred_term: Autosomal dominant inheritance
term:
id: HP:0000006
label: Autosomal dominant inheritance
description: >-
Heterozygous deletions segregate with the limb phenotype in three unrelated
families described by Lupiáñez et al.; this is distinct from coding PAX3
disorders and IHH-related brachydactyly type A1.
evidence:
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
First, we investigated a dominantly inherited novel type of brachydactyly
in three unrelated families
explanation: The original family series establishes dominant inheritance.
pathophysiology:
- name: Deletion of the EPHA4-PAX3 Regulatory Boundary
biological_scale: MOLECULAR
role: trigger
genetic_context:
variant_type: deletion
genomic_contexts:
- coding sequence
- intergenic region
affected_regions:
- name: EPHA4-PAX3 regulatory boundary
regulatory_element_type: TAD_BOUNDARY
between_genes:
- preferred_term: EPHA4
term:
id: hgnc:3388
label: EPHA4
- preferred_term: PAX3
term:
id: hgnc:8617
label: PAX3
description: >-
Boundary between the EPHA4 and PAX3 regulatory domains. The
represented deletions remove this boundary and extend through EPHA4,
while retaining PAX3 coding sequence. The gene landmarks locate the
boundary, not the full deletion interval.
zygosity: HETEROZYGOUS
variant_origin: GERMLINE
allele_type: deletions spanning EPHA4 and the adjacent boundary with the PAX3 domain
description: >-
Heterozygous deletions remove EPHA4 coding sequence and part of its
surrounding topologically associating domain, extending into noncoding
sequence of the neighboring PAX3 domain. The PAX3 coding sequence is
retained. The loss of intervening boundary sequence is a physical event
distinct from altered enhancer contacts and ectopic target-gene expression.
genes:
- preferred_term: EPHA4
term:
id: hgnc:3388
label: EPHA4
evidence:
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
All three deletions include the EPHA4 gene along with a large portion of
its surrounding TAD and extend into the non-coding part of the adjacent
PAX3 TAD, thereby removing the predicted boundary between the EPHA4 and PAX3 TADs.
explanation: Defines the removed sequence and distinguishes the intact regulatory target.
downstream:
- target: Ectopic PAX3 Contacts with EPHA4 Limb Enhancers
causal_link_type: DIRECT
description: Removing the intervening boundary permits contacts across the former domain boundary.
- name: Ectopic PAX3 Contacts with EPHA4 Limb Enhancers
biological_scale: MOLECULAR
description: >-
Circular chromosome-conformation capture (4C-seq) in adult
fibroblasts from a family B1 patient detects abnormal contact between the
PAX3 promoter and the centromeric EPHA4 domain. Mouse limb 4C and enhancer
reporter assays identify limb-active elements in the ectopic interaction
region. Patient fibroblast contact data establish altered architecture;
they do not measure embryonic limb expression.
genes:
- preferred_term: PAX3
term:
id: hgnc:8617
label: PAX3
biological_processes:
- preferred_term: PAX3 enhancer-promoter contacts
term:
id: GO:0140588
label: chromatin looping
modifier: ABNORMAL
evidence:
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
evidence_source: IN_VITRO
snippet: >-
Similar to DelB mice, the human brachydactyly-associated deletion resulted
in aberrant contact of the PAX3 promoter region with the centromeric part
of the EPHA4 TAD
explanation: Human adult fibroblast 4C supports abnormal contacts in the patient allele.
downstream:
- target: Ectopic PAX3 Expression in the Distal Anterior Limb
causal_link_type: DIRECT
description: >-
In the corresponding DelB mouse model, contacts with the Epha4 limb
enhancer region accompany adoption of an Epha4-like Pax3 expression domain.
- name: Ectopic PAX3 Expression in the Distal Anterior Limb
biological_scale: MOLECULAR
regulatory_category: GOE
description: >-
At mouse embryonic day E11.5, Pax3 is normally restricted to migrating
muscle cells in the proximal limb and absent from the hand plate. DelB
heterozygotes instead express Pax3 in distal anterior autopod tissue,
resembling the Epha4 expression domain. This spatial change supports GOE,
independently of the accompanying increase in RNA abundance. The evidence
comes from an engineered mouse deletion; ectopic PAX3 expression was not
directly measured in the patients' embryonic limbs.
genes:
- preferred_term: PAX3
term:
id: hgnc:8617
label: PAX3
biological_processes:
- preferred_term: PAX3 gene expression
term:
id: GO:0010467
label: gene expression
modifier: INCREASED
evidence:
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
DelB/+ (brachydactyly-like deletion) mice showed strong misexpression of
Pax3 in the distal anterior part of the autopod, in a pattern resembling
endogenous Epha4 expression
explanation: In situ hybridization establishes ectopic expression in the model limb.
downstream:
- target: Abnormal Preaxial Digit Morphogenesis
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: >-
The DelB mouse recapitulates the human digit malformation, while
boundary-preserving controls lack ectopic expression and digit defects.
How ectopic PAX3 changes skeletal differentiation remains unresolved.
- name: Abnormal Preaxial Digit Morphogenesis
biological_scale: TISSUE
role: consequence
description: >-
Distal digit development is altered, producing shortened predominantly
radial digits and first-to-second finger skin webbing in the human
families. The mouse model has corresponding phalangeal hypoplasia; this
supports developmental convergence without establishing the precise
PAX3-dependent cellular pathway or excluding every effect of the multigene
deletion.
biological_processes:
- preferred_term: digit morphogenesis within the developing limb
term:
id: GO:0035108
label: limb morphogenesis
modifier: ABNORMAL
evidence:
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: >-
Thus, mutant mice with a deletion corresponding to the human disease
alleles recapitulated the phenotype observed in patients.
explanation: Supports model-to-human phenotypic correspondence, not a resolved cellular intermediate.
downstream:
- target: Brachydactyly
causal_link_type: DIRECT
- target: Short Thumb
causal_link_type: DIRECT
- target: First-Second Finger Cutaneous Syndactyly
causal_link_type: DIRECT
phenotypes:
- name: Brachydactyly
category: Skeletal
phenotype_term:
preferred_term: Brachydactyly
term:
id: HP:0001156
label: Brachydactyly
description: Short digits predominate on the radial side, especially the thumb and index finger.
evidence:
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
characterized by short digits predominantly on the preaxial (radial)
side resulting in stub thumbs, short index fingers and a cutaneous web
between the first and second fingers
explanation: Describes the human families' clinical phenotype.
- name: Short Thumb
category: Skeletal
phenotype_term:
preferred_term: Short thumb
term:
id: HP:0009778
label: Short thumb
evidence:
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: >-
resulting in stub thumbs, short index fingers and a cutaneous web between
the first and second fingers
explanation: The clinically described stub thumbs support shortened thumbs.
- name: First-Second Finger Cutaneous Syndactyly
category: Skeletal
phenotype_term:
preferred_term: First-second finger cutaneous syndactyly
term:
id: HP:0010704
label: 1-2 finger cutaneous syndactyly
evidence:
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: a cutaneous web between the first and second fingers
explanation: Defines the location and cutaneous character of the webbing.
genetic:
- name: PAX3 regulatory dysregulation
gene_term:
preferred_term: PAX3
term:
id: hgnc:8617
label: PAX3
relationship_type: CAUSATIVE
variant_origin: GERMLINE
features: >-
PAX3 is the intact regulatory target. The causal deletions physically
remove EPHA4 and domain-boundary sequence rather than disrupting PAX3
protein coding sequence. The functional experiments support enhancer
adoption and ectopic expression in the corresponding mouse limb model.
variants:
- name: POSTRE Table 1 Nr4 EPHA4-PAX3 boundary deletion
variant_type: deletion
genomic_contexts:
- coding sequence
- intergenic region
affected_regions:
- name: EPHA4-PAX3 regulatory boundary
regulatory_element_type: TAD_BOUNDARY
between_genes:
- preferred_term: EPHA4
term:
id: hgnc:3388
label: EPHA4
- preferred_term: PAX3
term:
id: hgnc:8617
label: PAX3
description: >-
The deleted regulatory boundary lies between the EPHA4 and PAX3
domains. The entire deletion extends through EPHA4 and is not
confined to the sequence between these genes.
gene:
preferred_term: EPHA4
term:
id: hgnc:3388
label: EPHA4
regulatory_target_gene:
preferred_term: PAX3
term:
id: hgnc:8617
label: PAX3
regulatory_category: GOE
description: >-
POSTRE represents the brachydactyly deletion from Lupiáñez et al. as
hg19/GRCh37 chr2:221278232-223014332, approximately 1.74 Mb. This is a
secondary benchmark interval; its precise correspondence to one of
families B1-B3 has not been independently resolved here. It is not a new
patient or a second allele in addition to the source family. EPHA4 coding
sequence and intergenic regulatory-boundary sequence are deleted;
PAX3 coding sequence is intact. The GOE assignment is supported by the
corresponding engineered mouse deletion, not a patient limb-expression
measurement.
functional_effects:
- function: PAX3 enhancer adoption
regulatory_element_type: TAD_BOUNDARY
regulatory_mechanism: Loss of boundary insulation permits contacts with EPHA4 limb enhancers
description: >-
Human fibroblast 4C and mouse limb assays support altered contacts
across the former domain boundary.
- function: Ectopic PAX3 expression in the distal limb
regulatory_element_type: ENHANCER
regulatory_category: GOE
affected_developmental_stage: Embryonic limb development; mouse E11.5
description: >-
Mouse DelB heterozygotes gain an Epha4-like distal anterior Pax3
expression domain. The downstream cellular mechanism remains unresolved.
evidence:
- reference: PMID:36999617
reference_title: 'POSTRE: a tool to predict the pathological effects of human structural variants.'
supports: SUPPORT
evidence_source: OTHER
snippet: The coordinates of the SVs in positive control patients (Table 1 and Table 2)
explanation: >-
Table 1 Nr4, Supplementary Data 3 Table1_SVs and the author input TSV
provide the hg19 interval. This is coordinate provenance, not
experimental proof of the expression mechanism.
- reference: PMID:25959774
reference_title: Disruptions of topological chromatin domains cause pathogenic rewiring of gene-enhancer interactions.
supports: SUPPORT
directness: INDIRECT
evidence_source: MODEL_ORGANISM
snippet: >-
DelB/+ (brachydactyly-like deletion) mice showed strong misexpression
of Pax3 in the distal anterior part of the autopod, in a pattern
resembling endogenous Epha4 expression
explanation: The corresponding mouse allele supports regulatory GOE for this deletion class.
Deep research results are used as seeds for research; they do not undergo the same validation as the main records and may contain errors. How we use deep research.
Curate PAX3 regulatory brachydactyly from the POSTRE reference set · 2026-09-21T17:12:17Z · View source
Created MONDO:0859005 entry after upstream KB and all-state PR/issue preflight found no duplicate. GeneReviews online baseline: NO_CHAPTER. Separate EPHA4-containing deletion, altered enhancer contacts, model ectopic PAX3 expression (GOE), and digit morphogenesis; retain intact PAX3 and unresolved cellular intermediates. POSTRE hg19 input interval retained with unresolved B1-B3 exact family attribution. Human clinical phenotype, patient fibroblast contacts, and DelB mouse expression are independently anchored to PMID:25959774 full text; PMID:36999617 supplies only benchmark provenance. Required just research-disorder workflow initially failed with Claude exit1 and Perplexity quota failure; generated a recorded Asta fallback after disabling failing Claude for the retry. Initial broad Asta retrieval confused brachydactyly and polydactyly and was discarded; focused gene/locus query generated the retained Preaxial_Digit_Brachydactyly-Webbed_Fingers-deep-research-asta.md and citations. Its 28 references resolve; relevance flags for PMID:26340639 and DOI:10.3390/genes6030790 concern one generic chromatin review, read and not used as patient evidence. Report has no proposed CURIEs. NEC preflight SKIP because MONDO lacks a causal-gene annotation; manual MONDO synonym and primary PAX3/EPHA4 identity checks passed. Independent primary-source review found no material issue. Ten cached evidence snippets verified; final batch checks recorded in PR.
This report is retrieval-only and is generated directly from Asta results.
search_papers_by_relevance with snippet_search.Checked with linkml-reference-validator 0.2.1.
| Outcome | Count |
|---|---|
| References checked | 28 |
| Resolved | 28 |
| Unresolved (possible confabulation) | 0 |
| Unverifiable | 0 |
| References weighed for topical relevance | 28 |
| On topic | 2 |
| Off topic | 2 |
These identifiers resolve, so they are not fabrications, but the records they resolve to share almost none of this report's vocabulary. That is a clue and not a verdict - a paper can be relevant in ways its title and abstract do not spell out - so read them before deciding:
PMID:26340639 (1 mention) - Chromatin Insulators and Topological Domains: Adding New Dimensions to 3D Genome Architecture.DOI:10.3390/genes6030790 (1 mention) - Chromatin Insulators and Topological Domains: Adding New Dimensions to 3D Genome ArchitectureWeighed against this report's own most characteristic terms: pax3, epha4, gene, deletion, snippet, score, year, expression, url, venue, enhancer, tad, limb, genetic, brachydactyly, human, mice, tads, regulatory, region.
All extracted references resolved successfully. Resolving is not the same as being relevant, though - see the references listed above as possibly off topic.
No ontology term identifiers were found in this report.