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3
Pathophys.
13
Phenotypes
2
Hypotheses
11
Pathograph
1
Genes
2
Treatments
1
Deep Research
2
Hyp. Reports

Mechanistic Hypotheses

2
Paternal GNAS Loss-of-Function Model
pphp_parent_of_origin_model CANONICAL
Paternally inherited coding loss-of-function variants in GNAS reduce Gs-alpha signaling in tissues where the paternal allele is expressed, producing AHO skeletal and soft-tissue features while sparing classic renal PTH resistance.
Retained as CANONICAL. The 2026 openscientist hypothesis-search report (kb/hypotheses/Pseudopseudohypoparathyroidism/pphp_parent_of_origin_model) found the model strongly supported by tissue-specific Gnas knockout mouse models, 1A-DMR imprinting control studies, and STX16-ICR chromatin-conformation data. Three refinements: (1) the paternal GNAS phenotypic spectrum includes PPHP, progressive osseous heteroplasia (POH), osteoma cutis, and IUGR — not just classical PPHP; (2) XLαs co-disruption in exon 2-13 mutations contributes additionally to bone metabolism and birth weight phenotypes vs. exon 1 mutations that spare XLαs; (3) hypothalamic (dorsomedial nucleus) Gsα imprinting explains why obesity is specific to maternal mutations (PHP1A) and absent in PPHP (paternal mutations).
Show evidence (7 references)
PMID:40972900 SUPPORT Human Clinical
"While maternal mutations result in PHP type 1A, which consists of PTH resistance and AHO, paternal mutations lead to pseudo-pseudohypoparathyroidism (PPHP), that is, AHO without hormone resistance."
This review directly supports the parent-of-origin model distinguishing PPHP from PHP1A.
PMID:9671744 SUPPORT Model Organism
"Gsalpha expression in the renal cortex (the site of PTH action) is markedly reduced in m-/+ but not in +/p- mice, demonstrating that the Gnas paternal allele is imprinted in this tissue"
Foundational Gnas knockout mouse study: PTH resistance occurs only with maternal allele disruption, with the paternal Gsα allele silenced in renal proximal tubules — providing the direct molecular basis for the parent-of-origin phenotype.
PMID:16099856 SUPPORT Model Organism
"Heterozygous mice that inherited the disruption maternally (-m/+) exhibited PTH and TSH resistance, whereas those with paternal inheritance (+/-p) had normal hormone responsiveness"
Exon 1-specific Gnas disruption confirms the parent-of-origin effect is due to Gsα itself (independent of NESP55/XLαs disruption from exon 2 ablation), strengthening the parental-imprinting model.
+ 4 more references
AHO Developmental Tissue Model
aho_developmental_model CANONICAL
Reduced Gs-alpha/cAMP signaling in skeletal and mesenchymal tissues disrupts bone growth, digit patterning, and soft-tissue ossification, explaining the Albright hereditary osteodystrophy phenotype cluster.
Retained as CANONICAL with a critical scope restriction. The 2026 openscientist hypothesis-search report (kb/hypotheses/Pseudopseudohypoparathyroidism/aho_developmental_model) confirmed the model for three core AHO features in PPHP — brachydactyly, short stature, and ectopic ossification — via chondrocyte-specific (PMID:15765186) and osteoblast-specific (PMID:15797856) Gsα knockouts plus identification of α-SMA dermal sheath cells as the cellular source of heterotopic ossifications (PMID:40256763). **Critical correction:** the prior description of obesity as part of the PPHP AHO phenotype is incorrect. Obesity is exclusively driven by maternal Gsα loss in the dorsomedial hypothalamus (PMID:27991864) and is specific to PHP1A; PPHP patients are uniformly lean (PMID:22511293). AHO-like brachydactyly is also produced by mutations in other PTHrP→Gsα→cAMP→PKA pathway nodes (PRKAR1A, PDE4D, PTHLH, TRPS1), so the model is pathway-correct but not GNAS-exclusive.
Show evidence (6 references)
PMID:29959430 SUPPORT Human Clinical
"include short bones, short stature, a stocky build, early-onset obesity and ectopic ossifications"
Consensus guidance supports grouping these physical findings as the related-disorder phenotype cluster.
PMID:15459318 SUPPORT Model Organism
"Gsalpha mRNA expression detected by real-time RT-PCR analysis was reduced to approximately half that of the wild-type in both paternal and maternal Gnas(+/E2-) growth plate chondrocytes, indicating biallelic expression of Gsalpha in these cells"
Mouse chimera study quantitatively confirms biallelic Gsα expression in growth-plate chondrocytes (Gsα reduced ~50% in heterozygous chondrocytes regardless of parental origin) — providing the molecular basis for why brachydactyly and short stature occur in both PPHP and PHP1A.
PMID:15765186 SUPPORT Model Organism
"epiphyseal and growth plate defects with shortening of the proliferative zone and accelerated hypertrophic differentiation of growth plate chondrocytes"
Chondrocyte-specific Gsα knockout produces a phenotype resembling PTH/PTHrP receptor knockout, establishing Gsα as the critical downstream mediator of PTHrP signaling in growth plate cartilage — the proximate mechanism for AHO brachydactyly and short stature.
+ 3 more references

Pathophysiology

3
Paternally inherited GNAS loss-of-function
Heterozygous inactivating variants in the GNAS exons encoding Gs-alpha cause PPHP when inherited or expressed from the paternal allele, producing an AHO phenotype rather than the maternal-allele PHP1A endocrine-resistance pattern.
GNAS link
genomic imprinting link adenylate cyclase-modulating G protein-coupled receptor signaling pathway link
Show evidence (2 references)
PMID:15711092 SUPPORT Human Clinical
"PHP-Ia and PPHP are caused by heterozygous inactivating mutations in those exons of GNAS encoding the alpha subunit of the stimulatory guanine nucleotide-binding protein (Gsalpha)"
This directly supports heterozygous GNAS loss-of-function as the molecular basis of PPHP.
PMID:40972900 SUPPORT Human Clinical
"Therefore, Gsα mutations cause distinct clinical manifestations according to the affected parental allele."
This supports parent-of-origin effects as the mechanism separating PPHP from related GNAS disorders.
Parent-of-origin sparing of renal PTH signaling
Because paternal GNAS contribution is normally suppressed in renal proximal tubule contexts where PTH acts, paternal coding variants classically do not produce the biochemical PTH-resistance triad of hypocalcemia, hyperphosphatemia, and elevated PTH.
epithelial cell of proximal tubule link
response to parathyroid hormone link
proximal tubule link
Show evidence (2 references)
PMID:15711092 SUPPORT Human Clinical
"These features are also present in pseudopseudohypoparathyroidism (PPHP), but patients affected by this disorder do not show hormone resistance."
This directly supports absent hormone resistance as the classic PPHP endocrine pattern.
PMID:40972900 SUPPORT Human Clinical
"While Gsα is biallelically transcribed in most tissues, including bone and cartilage, the paternal Gsα allele is suppressed in a limited number of cells/tissues, including the proximal renal tubule, where PTH exerts critical actions."
This explains why paternal-allele defects have different renal PTH consequences than maternal defects.
AHO skeletal and soft-tissue developmental effects
Gs-alpha/cAMP pathway disruption in tissues relevant to skeletal growth and mesenchymal differentiation produces the Albright hereditary osteodystrophy pattern of short bones, short stature, and ectopic ossification.
osteoblast link adipocyte link
endochondral ossification link ossification link
bone element link
Show evidence (2 references)
PMID:40972900 SUPPORT Human Clinical
"The Gsα-cAMP cascade is pivotal for human skeletal growth, as evidenced by pathogenic mutations converging on this signaling pathway in a spectrum of skeletal dysplasias that overlap with AHO."
This supports Gs-alpha/cAMP disruption as a skeletal-growth mechanism in AHO-overlapping disorders.
PMID:29959430 SUPPORT Human Clinical
"physical findings that variably include short bones, short stature, a stocky build, early-onset obesity and ectopic ossifications"
Consensus guidance supports the AHO physical-feature cluster targeted by this mechanism.

Pathograph

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

13
Limbs 2
Brachydactyly FREQUENT Brachydactyly (HP:0001156)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0001156 | Brachydactyly | Frequent (79-30%)"
Orphanet lists brachydactyly as frequent in PPHP.
Short 4th metacarpal FREQUENT Short 4th metacarpal (HP:0010044)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0010044 | Short 4th metacarpal | Frequent (79-30%)"
Orphanet lists short fourth metacarpal as frequent in PPHP.
Nervous System 2
Delayed speech and language development OCCASIONAL Delayed speech and language development (HP:0000750)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0000750 | Delayed speech and language development | Occasional (29-5%)"
Orphanet lists delayed speech and language development as occasional in PPHP.
Intellectual disability OCCASIONAL Intellectual disability (HP:0001249)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0001249 | Intellectual disability | Occasional (29-5%)"
Orphanet lists intellectual disability as occasional in PPHP.
Growth 3
Short stature FREQUENT Short stature (HP:0004322)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0004322 | Short stature | Frequent (79-30%)"
Orphanet lists short stature as frequent in PPHP.
Obesity OCCASIONAL Obesity (HP:0001513)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0001513 | Obesity | Occasional (29-5%)"
Orphanet lists obesity as occasional in PPHP.
Intrauterine growth retardation OCCASIONAL Intrauterine growth retardation (HP:0001511)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0001511 | Intrauterine growth retardation | Occasional (29-5%)"
Orphanet lists intrauterine growth retardation as occasional in PPHP.
Other 6
Round face FREQUENT Round face (HP:0000311)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0000311 | Round face | Frequent (79-30%)"
Orphanet lists round face as frequent in PPHP.
Short 5th finger FREQUENT Short 5th finger (HP:0009237)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0009237 | Short 5th finger | Frequent (79-30%)"
Orphanet lists short fifth finger as frequent in PPHP.
Short 5th metacarpal FREQUENT Short 5th metacarpal (HP:0010047)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0010047 | Short 5th metacarpal | Frequent (79-30%)"
Orphanet lists short fifth metacarpal as frequent in PPHP.
Short metatarsal FREQUENT Short metatarsal (HP:0010743)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0010743 | Short metatarsal | Frequent (79-30%)"
Orphanet lists short metatarsal as frequent in PPHP.
Ectopic ossification FREQUENT Ectopic ossification (HP:0011986)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0011986 | Ectopic ossification | Frequent (79-30%)"
Orphanet lists ectopic ossification as frequent in PPHP.
Osteoma cutis OCCASIONAL Osteoma cutis (HP:0025027)
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0025027 | Osteoma cutis | Occasional (29-5%)"
Orphanet lists osteoma cutis as occasional in PPHP.
🧬

Genetic Associations

1
GNAS (Heterozygous paternal loss-of-function variant)
Autosomal dominant
Show evidence (2 references)
ORPHA:79445 SUPPORT Other
"GNAS | GNAS complex locus | hgnc:4392 | Disease-causing germline mutation(s) (loss of function) in"
Orphanet identifies GNAS loss-of-function germline mutations as disease-causing in PPHP.
PMID:15711092 SUPPORT Human Clinical
"PHP-Ia and PPHP are caused by heterozygous inactivating mutations in those exons of GNAS encoding the alpha subunit of the stimulatory guanine nucleotide-binding protein (Gsalpha)"
This supports heterozygous inactivating GNAS coding variants as causal for PPHP.
💊

Treatments

2
Endocrine, skeletal, and metabolic surveillance
Action: clinical assessment MAXO:0000487
Patients with PPHP and related GNAS disorders require baseline and follow-up screening for endocrine, skeletal, oral, metabolic, and ectopic-ossification complications even when classical PTH resistance is absent.
Target Phenotypes: Ectopic ossification Obesity Intellectual disability
Show evidence (1 reference)
PMID:29959430 SUPPORT Human Clinical
"Patients should be screened at diagnosis and during follow-up for specific features, such as PTH resistance, TSH resistance, growth hormone deficiency, hypogonadism, skeletal deformities, oral health, weight gain, glucose intolerance or type 2 diabetes mellitus, and hypertension, as well as..."
Consensus guidance supports ongoing surveillance across endocrine, skeletal, metabolic, and neurocognitive domains.
Coordinated multidisciplinary supportive management
Action: supportive care MAXO:0000950
Management is coordinated across pediatric/adult endocrinology, genetics, orthopedics, dentistry, nutrition, and neurodevelopmental services according to the patient's manifestations.
Target Phenotypes: Brachydactyly Short stature Ectopic ossification
Show evidence (1 reference)
PMID:29959430 SUPPORT Human Clinical
"Overall, a coordinated and multidisciplinary approach from infancy through adulthood, including a transition programme, should help us to improve the care of patients affected by these disorders."
Consensus guidance supports multidisciplinary supportive management for PHP-related disorders including PPHP.
🔬

Biochemical Markers

4
Parathyroid hormone resistance (Absent in classical PPHP)
Context: Absence of PTH resistance distinguishes classical PPHP from PHP1A, although rare paternally inherited GNAS cases with hormone resistance have been reported.
Show evidence (2 references)
ORPHA:79445 SUPPORT Other
"but no evidence of resistance to parathyroid hormone (PTH)"
Orphanet defines PPHP by AHO clinical features without evidence of PTH resistance.
PMID:25464124 PARTIAL Human Clinical
"These findings suggest that PTH and other hormone resistance may not be an exclusive feature of PHP-Ia and could also be observed in patients with PPHP."
This case report supports noting that hormone resistance can occasionally complicate the classical PPHP distinction.
Serum calcium (Normal)
Context: Classical PPHP does not show the hypocalcemia typical of PTH resistance.
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0002901 | Hypocalcemia | Excluded (0%)"
Orphanet explicitly excludes hypocalcemia from the PPHP phenotype.
Serum phosphate (Normal)
Context: Classical PPHP does not show the hyperphosphatemia typical of PTH resistance.
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0002905 | Hyperphosphatemia | Excluded (0%)"
Orphanet explicitly excludes hyperphosphatemia from the PPHP phenotype.
Circulating parathyroid hormone (Not elevated in classical PPHP)
Context: Elevated circulating PTH is excluded from the core PPHP phenotype.
Show evidence (1 reference)
ORPHA:79445 SUPPORT Other
"HP:0003165 | Elevated circulating parathyroid hormone level | Excluded (0%)"
Orphanet explicitly excludes elevated circulating PTH from classical PPHP.
{ }

Source YAML

click to show
name: Pseudopseudohypoparathyroidism
creation_date: "2026-05-10T18:13:23Z"
updated_date: "2026-05-10T18:13:23Z"
description: >-
  Pseudopseudohypoparathyroidism (PPHP) is a GNAS-related disorder in which
  patients have Albright hereditary osteodystrophy features, such as
  brachydactyly, short stature, rounded face, and ectopic ossification, but
  classically lack parathyroid hormone resistance.
category: Genetic
parents:
- Pseudohypoparathyroidism
- Disorder of GNAS Inactivation
- Acromelic Dysplasia
synonyms:
- PPHP
- Pseudo-pseudohypoparathyroidism
- AHO-PPHP syndrome
- Albright hereditary osteodystrophy-PPHP syndrome
disease_term:
  preferred_term: pseudopseudohypoparathyroidism
  term:
    id: MONDO:0012912
    label: pseudopseudohypoparathyroidism
prevalence:
- population: Europe point prevalence
  percentage: Unknown
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Unknown | Europe | Point prevalence | ORPHANET"
    explanation: Orphanet reports unknown point prevalence for PPHP in Europe.
mechanistic_hypotheses:
- hypothesis_group_id: pphp_parent_of_origin_model
  hypothesis_label: Paternal GNAS Loss-of-Function Model
  status: CANONICAL
  description: >-
    Paternally inherited coding loss-of-function variants in GNAS reduce Gs-alpha
    signaling in tissues where the paternal allele is expressed, producing AHO
    skeletal and soft-tissue features while sparing classic renal PTH resistance.
  notes: >-
    Retained as CANONICAL. The 2026 openscientist hypothesis-search report
    (kb/hypotheses/Pseudopseudohypoparathyroidism/pphp_parent_of_origin_model)
    found the model strongly supported by tissue-specific Gnas knockout
    mouse models, 1A-DMR imprinting control studies, and STX16-ICR
    chromatin-conformation data. Three refinements: (1) the paternal GNAS
    phenotypic spectrum includes PPHP, progressive osseous heteroplasia
    (POH), osteoma cutis, and IUGR — not just classical PPHP; (2) XLαs
    co-disruption in exon 2-13 mutations contributes additionally to bone
    metabolism and birth weight phenotypes vs. exon 1 mutations that spare
    XLαs; (3) hypothalamic (dorsomedial nucleus) Gsα imprinting explains
    why obesity is specific to maternal mutations (PHP1A) and absent in
    PPHP (paternal mutations).
  evidence:
  - reference: PMID:40972900
    reference_title: "Imprinting and skeletal disorders: lessons from pseudohypoparathyroidism and related disorders."
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "While maternal mutations result in PHP type 1A, which consists of PTH resistance and AHO, paternal mutations lead to pseudo-pseudohypoparathyroidism (PPHP), that is, AHO without hormone resistance."
    explanation: This review directly supports the parent-of-origin model distinguishing PPHP from PHP1A.
  - reference: PMID:9671744
    reference_title: "Variable and tissue-specific hormone resistance in heterotrimeric Gs protein alpha-subunit (Gsalpha) knockout mice is due to tissue-specific imprinting of the gsalpha gene."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Gsalpha expression in the renal cortex (the site of PTH action) is markedly reduced in m-/+ but not in +/p- mice, demonstrating that the Gnas paternal allele is imprinted in this tissue"
    explanation: >
      Foundational Gnas knockout mouse study: PTH resistance occurs only
      with maternal allele disruption, with the paternal Gsα allele
      silenced in renal proximal tubules — providing the direct molecular
      basis for the parent-of-origin phenotype.
  - reference: PMID:16099856
    reference_title: "A mouse model of albright hereditary osteodystrophy generated by targeted disruption of exon 1 of the Gnas gene."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Heterozygous mice that inherited the disruption maternally (-m/+) exhibited PTH and TSH resistance, whereas those with paternal inheritance (+/-p) had normal hormone responsiveness"
    explanation: >
      Exon 1-specific Gnas disruption confirms the parent-of-origin effect
      is due to Gsα itself (independent of NESP55/XLαs disruption from
      exon 2 ablation), strengthening the parental-imprinting model.
  - reference: PMID:15811946
    reference_title: "Identification of the control region for tissue-specific imprinting of the stimulatory G protein alpha-subunit."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Paternal, but not maternal, 1A deletion resulted in G(s)alpha overexpression in proximal tubules"
    explanation: >
      Identifies the 1A differentially methylated region as the maternal
      imprint mark containing methylation-sensitive cis-acting elements
      that suppress paternal Gsα expression in a tissue-specific manner,
      defining the molecular control region of GNAS imprinting.
  - reference: PMID:21747923
    reference_title: "Heterotopic ossifications in a mouse model of albright hereditary osteodystrophy."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Gnas(E1-/+) mice develop SCO features that are similar to those observed in AHO patients"
    explanation: >
      Exon 1 Gnas knockout mice develop subcutaneous ossifications
      regardless of parental origin of the mutation, confirming biallelic
      Gsα expression in skin/connective tissue and that AHO ossification
      reflects haploinsufficiency rather than parent-of-origin imprinting.
  - reference: PMID:22215617
    reference_title: "New mutations at the imprinted Gnas cluster show gene dosage effects of Gsα in postnatal growth and implicate XLαs in bone and fat metabolism but not in suckling."
    supports: PARTIAL
    evidence_source: MODEL_ORGANISM
    snippet: "paternal inheritance of Ex1A-T results in an increased metabolic rate and reductions in fat mass, leptin, and bone mineral density attributable to loss of XLαs"
    explanation: >
      Qualifies the simple "paternal-Gsα-loss = PPHP" model: XLαs (Gnasxl)
      is exclusively expressed from the paternal allele, so paternal
      mutations affecting exons 2-13 also disrupt XLαs and produce
      additional bone/fat phenotypes. Exon 1-specific mutations spare
      XLαs.
  - reference: PMID:27991864
    reference_title: "Gsα deficiency in the dorsomedial hypothalamus underlies obesity associated with Gsα mutations."
    supports: PARTIAL
    evidence_source: MODEL_ORGANISM
    snippet: "Gsα imprinting in the DMH underlies the parent-of-origin metabolic phenotype that results from Gsα mutations"
    explanation: >
      Qualifies the AHO phenotype description: Gsα is imprinted in the
      dorsomedial hypothalamus, so maternal Gnas deletion in DMH causes
      obesity (via reduced energy expenditure and BAT activation) while
      paternal mutations (PPHP) do NOT — explaining why obesity is
      classical PHP1A-specific and absent in PPHP.
- hypothesis_group_id: aho_developmental_model
  hypothesis_label: AHO Developmental Tissue Model
  status: CANONICAL
  description: >-
    Reduced Gs-alpha/cAMP signaling in skeletal and mesenchymal tissues disrupts
    bone growth, digit patterning, and soft-tissue ossification, explaining the
    Albright hereditary osteodystrophy phenotype cluster.
  notes: >-
    Retained as CANONICAL with a critical scope restriction. The 2026
    openscientist hypothesis-search report
    (kb/hypotheses/Pseudopseudohypoparathyroidism/aho_developmental_model)
    confirmed the model for three core AHO features in PPHP — brachydactyly,
    short stature, and ectopic ossification — via chondrocyte-specific
    (PMID:15765186) and osteoblast-specific (PMID:15797856) Gsα knockouts
    plus identification of α-SMA dermal sheath cells as the cellular
    source of heterotopic ossifications (PMID:40256763). **Critical
    correction:** the prior description of obesity as part of the PPHP AHO
    phenotype is incorrect. Obesity is exclusively driven by maternal Gsα
    loss in the dorsomedial hypothalamus (PMID:27991864) and is specific to
    PHP1A; PPHP patients are uniformly lean (PMID:22511293). AHO-like
    brachydactyly is also produced by mutations in other PTHrP→Gsα→cAMP→PKA
    pathway nodes (PRKAR1A, PDE4D, PTHLH, TRPS1), so the model is
    pathway-correct but not GNAS-exclusive.
  evidence:
  - reference: PMID:29959430
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "include short bones, short stature, a stocky build, early-onset obesity and ectopic ossifications"
    explanation: Consensus guidance supports grouping these physical findings as the related-disorder phenotype cluster.
  - reference: PMID:15459318
    reference_title: "Stimulatory G protein directly regulates hypertrophic differentiation of growth plate cartilage in vivo."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "Gsalpha mRNA expression detected by real-time RT-PCR analysis was reduced to approximately half that of the wild-type in both paternal and maternal Gnas(+/E2-) growth plate chondrocytes, indicating biallelic expression of Gsalpha in these cells"
    explanation: >
      Mouse chimera study quantitatively confirms biallelic Gsα expression
      in growth-plate chondrocytes (Gsα reduced ~50% in heterozygous
      chondrocytes regardless of parental origin) — providing the
      molecular basis for why brachydactyly and short stature occur in
      both PPHP and PHP1A.
  - reference: PMID:15765186
    reference_title: "Chondrocyte-specific knockout of the G protein G(s)alpha leads to epiphyseal and growth plate abnormalities and ectopic chondrocyte formation."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "epiphyseal and growth plate defects with shortening of the proliferative zone and accelerated hypertrophic differentiation of growth plate chondrocytes"
    explanation: >
      Chondrocyte-specific Gsα knockout produces a phenotype resembling
      PTH/PTHrP receptor knockout, establishing Gsα as the critical
      downstream mediator of PTHrP signaling in growth plate cartilage —
      the proximate mechanism for AHO brachydactyly and short stature.
  - reference: PMID:15797856
    reference_title: "Deficiency of the G-protein alpha-subunit G(s)alpha in osteoblasts leads to differential effects on trabecular and cortical bone."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "the expression of the late osteoblast differentiation markers osteopontin and osteocalcin was reduced, suggesting that the number of mature osteoblasts in bone is reduced"
    explanation: >
      Osteoblast-specific Gsα knockout reduces mature osteoblast number
      and trabecular bone formation while paradoxically thickening
      cortical bone via reduced osteoclast remodeling, mechanistically
      grounding the variable bone density phenotypes seen in PHP/PPHP
      patients.
  - reference: PMID:40256763
    reference_title: "Alpha-smooth muscle actin-expressing dermal sheath cells are a major cellular contributor to heterotopic subcutaneous ossifications in a mouse model of Albright hereditary osteodystrophy."
    supports: SUPPORT
    evidence_source: MODEL_ORGANISM
    snippet: "osteogenic differentiation of cells that express alpha-smooth muscle actin and that are located within the dermal sheath"
    explanation: >
      Identifies α-SMA-expressing dermal sheath cells as the major cellular
      source of subcutaneous ossifications in an AHO mouse model,
      identifying the specific progenitor population responsible for the
      ectopic-bone arm of the developmental tissue mechanism.
  - reference: PMID:27991864
    reference_title: "Gsα deficiency in the dorsomedial hypothalamus underlies obesity associated with Gsα mutations."
    supports: REFUTE
    evidence_source: MODEL_ORGANISM
    snippet: "DMH MC4R/Gsα signaling is important for regulation of energy expenditure and BAT activation"
    explanation: >
      Refutes the obesity component of the prior AHO description as
      applied to PPHP: obesity in GNAS-associated disorders is driven by
      maternal Gsα loss in the dorsomedial hypothalamus (a CNS-specific
      imprinted tissue), not by biallelic Gsα loss in skeletal/mesenchymal
      tissues. PPHP patients (paternal mutations) are uniformly lean.
pathophysiology:
- name: Paternally inherited GNAS loss-of-function
  description: >-
    Heterozygous inactivating variants in the GNAS exons encoding Gs-alpha cause
    PPHP when inherited or expressed from the paternal allele, producing an AHO
    phenotype rather than the maternal-allele PHP1A endocrine-resistance pattern.
  genes:
  - preferred_term: GNAS
    term:
      id: hgnc:4392
      label: GNAS
  biological_processes:
  - preferred_term: genomic imprinting
    term:
      id: GO:0071514
      label: genomic imprinting
  - preferred_term: adenylate cyclase-modulating G protein-coupled receptor signaling pathway
    term:
      id: GO:0007188
      label: adenylate cyclase-modulating G protein-coupled receptor signaling pathway
  evidence:
  - reference: PMID:15711092
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "PHP-Ia and PPHP are caused by heterozygous inactivating mutations in those exons of GNAS encoding the alpha subunit of the stimulatory guanine nucleotide-binding protein (Gsalpha)"
    explanation: This directly supports heterozygous GNAS loss-of-function as the molecular basis of PPHP.
  - reference: PMID:40972900
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Therefore, Gsα mutations cause distinct clinical manifestations according to the affected parental allele."
    explanation: This supports parent-of-origin effects as the mechanism separating PPHP from related GNAS disorders.
  downstream:
  - target: Parent-of-origin sparing of renal PTH signaling
    description: Paternal-allele GNAS alterations usually spare the renal PTH-resistance phenotype.
    hypothesis_groups:
    - pphp_parent_of_origin_model
    causal_link_type: DIRECT
    evidence:
    - reference: PMID:40972900
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "While maternal mutations result in PHP type 1A, which consists of PTH resistance and AHO, paternal mutations lead to pseudo-pseudohypoparathyroidism (PPHP), that is, AHO without hormone resistance."
      explanation: This directly links paternal GNAS mutation origin to AHO without hormone resistance.
  - target: AHO skeletal and soft-tissue developmental effects
    description: Reduced GNAS signaling in skeletal and mesenchymal tissues drives AHO structural findings.
    hypothesis_groups:
    - aho_developmental_model
    causal_link_type: INDIRECT_KNOWN_INTERMEDIATES
    intermediate_mechanisms:
    - altered Gs-alpha-cAMP signaling in skeletal and mesenchymal lineages
- name: Parent-of-origin sparing of renal PTH signaling
  description: >-
    Because paternal GNAS contribution is normally suppressed in renal proximal
    tubule contexts where PTH acts, paternal coding variants classically do not
    produce the biochemical PTH-resistance triad of hypocalcemia,
    hyperphosphatemia, and elevated PTH.
  cell_types:
  - preferred_term: epithelial cell of proximal tubule
    term:
      id: CL:0002306
      label: epithelial cell of proximal tubule
  locations:
  - preferred_term: proximal tubule
    term:
      id: UBERON:0004134
      label: proximal tubule
  biological_processes:
  - preferred_term: response to parathyroid hormone
    term:
      id: GO:0071107
      label: response to parathyroid hormone
  evidence:
  - reference: PMID:15711092
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "These features are also present in pseudopseudohypoparathyroidism (PPHP), but patients affected by this disorder do not show hormone resistance."
    explanation: This directly supports absent hormone resistance as the classic PPHP endocrine pattern.
  - reference: PMID:40972900
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "While Gsα is biallelically transcribed in most tissues, including bone and cartilage, the paternal Gsα allele is suppressed in a limited number of cells/tissues, including the proximal renal tubule, where PTH exerts critical actions."
    explanation: This explains why paternal-allele defects have different renal PTH consequences than maternal defects.
- name: AHO skeletal and soft-tissue developmental effects
  description: >-
    Gs-alpha/cAMP pathway disruption in tissues relevant to skeletal growth and
    mesenchymal differentiation produces the Albright hereditary osteodystrophy
    pattern of short bones, short stature, and ectopic ossification.
  cell_types:
  - preferred_term: osteoblast
    term:
      id: CL:0000062
      label: osteoblast
  - preferred_term: adipocyte
    term:
      id: CL:0000136
      label: adipocyte
  locations:
  - preferred_term: bone element
    term:
      id: UBERON:0001474
      label: bone element
  biological_processes:
  - preferred_term: endochondral ossification
    term:
      id: GO:0001958
      label: endochondral ossification
  - preferred_term: ossification
    term:
      id: GO:0001503
      label: ossification
  evidence:
  - reference: PMID:40972900
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The Gsα-cAMP cascade is pivotal for human skeletal growth, as evidenced by pathogenic mutations converging on this signaling pathway in a spectrum of skeletal dysplasias that overlap with AHO."
    explanation: This supports Gs-alpha/cAMP disruption as a skeletal-growth mechanism in AHO-overlapping disorders.
  - reference: PMID:29959430
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "physical findings that variably include short bones, short stature, a stocky build, early-onset obesity and ectopic ossifications"
    explanation: Consensus guidance supports the AHO physical-feature cluster targeted by this mechanism.
  downstream:
  - target: Brachydactyly
    description: Disrupted endochondral bone growth shortens digits and metacarpals.
    hypothesis_groups:
    - aho_developmental_model
    causal_link_type: DIRECT
  - target: Short stature
    description: Skeletal growth impairment contributes to reduced stature.
    hypothesis_groups:
    - aho_developmental_model
    causal_link_type: DIRECT
  - target: Ectopic ossification
    description: Dysregulated mesenchymal ossification produces ectopic bone in soft tissue.
    hypothesis_groups:
    - aho_developmental_model
    causal_link_type: DIRECT
phenotypes:
- name: Round face
  category: Craniofacial
  frequency: FREQUENT
  description: Rounded facial appearance is a frequent AHO-associated feature in PPHP.
  phenotype_term:
    preferred_term: Round face
    term:
      id: HP:0000311
      label: Round face
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000311 | Round face | Frequent (79-30%)"
    explanation: Orphanet lists round face as frequent in PPHP.
- name: Brachydactyly
  category: Skeletal
  frequency: FREQUENT
  diagnostic: true
  description: Shortened digits and metacarpals are frequent AHO findings in PPHP.
  phenotype_term:
    preferred_term: Brachydactyly
    term:
      id: HP:0001156
      label: Brachydactyly
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001156 | Brachydactyly | Frequent (79-30%)"
    explanation: Orphanet lists brachydactyly as frequent in PPHP.
- name: Short stature
  category: Growth
  frequency: FREQUENT
  diagnostic: true
  description: Reduced linear growth is a frequent PPHP/AHO manifestation.
  phenotype_term:
    preferred_term: Short stature
    term:
      id: HP:0004322
      label: Short stature
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0004322 | Short stature | Frequent (79-30%)"
    explanation: Orphanet lists short stature as frequent in PPHP.
- name: Short 5th finger
  category: Skeletal
  frequency: FREQUENT
  description: Short fifth fingers are frequent in the PPHP hand phenotype.
  phenotype_term:
    preferred_term: Short 5th finger
    term:
      id: HP:0009237
      label: Short 5th finger
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0009237 | Short 5th finger | Frequent (79-30%)"
    explanation: Orphanet lists short fifth finger as frequent in PPHP.
- name: Short 4th metacarpal
  category: Skeletal
  frequency: FREQUENT
  description: Shortening of the fourth metacarpal is a frequent AHO hand finding.
  phenotype_term:
    preferred_term: Short 4th metacarpal
    term:
      id: HP:0010044
      label: Short 4th metacarpal
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0010044 | Short 4th metacarpal | Frequent (79-30%)"
    explanation: Orphanet lists short fourth metacarpal as frequent in PPHP.
- name: Short 5th metacarpal
  category: Skeletal
  frequency: FREQUENT
  description: Shortening of the fifth metacarpal is a frequent AHO hand finding.
  phenotype_term:
    preferred_term: Short 5th metacarpal
    term:
      id: HP:0010047
      label: Short 5th metacarpal
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0010047 | Short 5th metacarpal | Frequent (79-30%)"
    explanation: Orphanet lists short fifth metacarpal as frequent in PPHP.
- name: Short metatarsal
  category: Skeletal
  frequency: FREQUENT
  description: Short metatarsals extend the AHO short-tubular-bone pattern to the feet.
  phenotype_term:
    preferred_term: Short metatarsal
    term:
      id: HP:0010743
      label: Short metatarsal
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0010743 | Short metatarsal | Frequent (79-30%)"
    explanation: Orphanet lists short metatarsal as frequent in PPHP.
- name: Ectopic ossification
  category: Skeletal
  frequency: FREQUENT
  diagnostic: true
  description: Ectopic ossification is a frequent AHO soft-tissue manifestation in PPHP.
  phenotype_term:
    preferred_term: Ectopic ossification
    term:
      id: HP:0011986
      label: Ectopic ossification
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0011986 | Ectopic ossification | Frequent (79-30%)"
    explanation: Orphanet lists ectopic ossification as frequent in PPHP.
- name: Osteoma cutis
  category: Dermatologic
  frequency: OCCASIONAL
  description: Cutaneous ossification can occur as an AHO-related soft-tissue manifestation.
  phenotype_term:
    preferred_term: Osteoma cutis
    term:
      id: HP:0025027
      label: Osteoma cutis
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0025027 | Osteoma cutis | Occasional (29-5%)"
    explanation: Orphanet lists osteoma cutis as occasional in PPHP.
- name: Obesity
  category: Metabolic
  frequency: OCCASIONAL
  description: >-
    Orphanet records occasional obesity (29-5%) in PPHP. The 2026 openscientist
    hypothesis-search review (PMID:27991864, PMID:22511293) shows obesity in
    GNAS-associated disorders is driven by maternal Gsα loss in the
    dorsomedial hypothalamus (PHP1A-specific) and that PPHP patients
    (paternal mutations) are uniformly lean. Reports of obesity in PPHP
    cohorts likely reflect PHP1A misclassification or unrelated comorbidity
    and should be treated as an inconsistent finding pending clarified
    cohort data.
  phenotype_term:
    preferred_term: Obesity
    term:
      id: HP:0001513
      label: Obesity
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001513 | Obesity | Occasional (29-5%)"
    explanation: Orphanet lists obesity as occasional in PPHP.
- name: Delayed speech and language development
  category: Neurological
  frequency: OCCASIONAL
  description: Speech and language delay is an occasional neurodevelopmental feature.
  phenotype_term:
    preferred_term: Delayed speech and language development
    term:
      id: HP:0000750
      label: Delayed speech and language development
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0000750 | Delayed speech and language development | Occasional (29-5%)"
    explanation: Orphanet lists delayed speech and language development as occasional in PPHP.
- name: Intellectual disability
  category: Neurological
  frequency: OCCASIONAL
  description: Intellectual disability is reported in a subset of PPHP cases.
  phenotype_term:
    preferred_term: Intellectual disability
    term:
      id: HP:0001249
      label: Intellectual disability
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001249 | Intellectual disability | Occasional (29-5%)"
    explanation: Orphanet lists intellectual disability as occasional in PPHP.
- name: Intrauterine growth retardation
  category: Growth
  frequency: OCCASIONAL
  description: Prenatal growth restriction is reported occasionally in PPHP.
  phenotype_term:
    preferred_term: Intrauterine growth retardation
    term:
      id: HP:0001511
      label: Intrauterine growth retardation
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0001511 | Intrauterine growth retardation | Occasional (29-5%)"
    explanation: Orphanet lists intrauterine growth retardation as occasional in PPHP.
biochemical:
- name: Parathyroid hormone resistance
  presence: Absent in classical PPHP
  context: >-
    Absence of PTH resistance distinguishes classical PPHP from PHP1A, although
    rare paternally inherited GNAS cases with hormone resistance have been reported.
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "but no evidence of resistance to parathyroid hormone (PTH)"
    explanation: Orphanet defines PPHP by AHO clinical features without evidence of PTH resistance.
  - reference: PMID:25464124
    supports: PARTIAL
    evidence_source: HUMAN_CLINICAL
    snippet: "These findings suggest that PTH and other hormone resistance may not be an exclusive feature of PHP-Ia and could also be observed in patients with PPHP."
    explanation: This case report supports noting that hormone resistance can occasionally complicate the classical PPHP distinction.
- name: Serum calcium
  presence: Normal
  context: Classical PPHP does not show the hypocalcemia typical of PTH resistance.
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0002901 | Hypocalcemia | Excluded (0%)"
    explanation: Orphanet explicitly excludes hypocalcemia from the PPHP phenotype.
- name: Serum phosphate
  presence: Normal
  context: Classical PPHP does not show the hyperphosphatemia typical of PTH resistance.
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0002905 | Hyperphosphatemia | Excluded (0%)"
    explanation: Orphanet explicitly excludes hyperphosphatemia from the PPHP phenotype.
- name: Circulating parathyroid hormone
  presence: Not elevated in classical PPHP
  context: Elevated circulating PTH is excluded from the core PPHP phenotype.
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "HP:0003165 | Elevated circulating parathyroid hormone level | Excluded (0%)"
    explanation: Orphanet explicitly excludes elevated circulating PTH from classical PPHP.
genetic:
- name: GNAS
  gene_term:
    preferred_term: GNAS
    term:
      id: hgnc:4392
      label: GNAS
  association: Heterozygous paternal loss-of-function variant
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "GNAS | GNAS complex locus | hgnc:4392 | Disease-causing germline mutation(s) (loss of function) in"
    explanation: Orphanet identifies GNAS loss-of-function germline mutations as disease-causing in PPHP.
  - reference: PMID:15711092
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "PHP-Ia and PPHP are caused by heterozygous inactivating mutations in those exons of GNAS encoding the alpha subunit of the stimulatory guanine nucleotide-binding protein (Gsalpha)"
    explanation: This supports heterozygous inactivating GNAS coding variants as causal for PPHP.
  inheritance:
  - name: Autosomal dominant
    inheritance_term:
      preferred_term: Autosomal dominant inheritance
      term:
        id: HP:0000006
        label: Autosomal dominant inheritance
    expressivity: VARIABLE
    parent_of_origin_effect: Paternal inheritance classically produces PPHP, whereas maternal inheritance more often produces PHP1A.
    evidence:
    - reference: ORPHA:79445
      supports: SUPPORT
      evidence_source: OTHER
      snippet: "Autosomal dominant"
      explanation: Orphanet reports autosomal dominant inheritance for PPHP.
    - reference: PMID:40972900
      supports: SUPPORT
      evidence_source: HUMAN_CLINICAL
      snippet: "While maternal mutations result in PHP type 1A, which consists of PTH resistance and AHO, paternal mutations lead to pseudo-pseudohypoparathyroidism (PPHP), that is, AHO without hormone resistance."
      explanation: This supports the parent-of-origin effect that determines the PPHP versus PHP1A phenotype.
diagnosis:
- name: Clinical and biochemical recognition of AHO without PTH resistance
  description: >-
    Diagnosis starts with recognition of Albright hereditary osteodystrophy
    features and biochemical assessment showing absent classical PTH resistance.
  diagnosis_term:
    preferred_term: clinical assessment
    term:
      id: MAXO:0000487
      label: clinical assessment
  results: AHO features with no classical PTH resistance.
  evidence:
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "Pseudopseudohypoparathyroidism (pseudo-PHP) is a disease characterized by a constellation of clinical features collectively termed Albright hereditary osteodystrophy (AHO) but no evidence of resistance to parathyroid hormone (PTH), which is seen in other forms of pseudohypoparathyroidism (PHP)."
    explanation: Orphanet defines the diagnostic distinction between PPHP and other PHP forms.
  - reference: PMID:15711092
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "These features are also present in pseudopseudohypoparathyroidism (PPHP), but patients affected by this disorder do not show hormone resistance."
    explanation: This review supports assessing AHO features together with absent hormone resistance.
- name: GNAS molecular genetic testing
  description: >-
    Molecular testing for GNAS coding variants confirms the molecular diagnosis
    and helps distinguish parent-of-origin-related PPHP from other GNAS disorders.
  diagnosis_term:
    preferred_term: molecular genetic testing
    term:
      id: MAXO:0000533
      label: molecular genetic testing
  results: Heterozygous GNAS loss-of-function variant, classically on the paternal allele.
  evidence:
  - reference: PMID:29959430
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "The clinical and laboratory diagnosis should be confirmed by a molecular genetic analysis."
    explanation: Consensus guidance supports molecular genetic analysis to confirm PHP-related disorder diagnosis.
  - reference: ORPHA:79445
    supports: SUPPORT
    evidence_source: OTHER
    snippet: "GNAS | GNAS complex locus | hgnc:4392 | Disease-causing germline mutation(s) (loss of function) in"
    explanation: Orphanet identifies GNAS loss-of-function variants as the causal molecular finding.
treatments:
- name: Endocrine, skeletal, and metabolic surveillance
  description: >-
    Patients with PPHP and related GNAS disorders require baseline and follow-up
    screening for endocrine, skeletal, oral, metabolic, and ectopic-ossification
    complications even when classical PTH resistance is absent.
  treatment_term:
    preferred_term: clinical assessment
    term:
      id: MAXO:0000487
      label: clinical assessment
  target_phenotypes:
  - preferred_term: Ectopic ossification
    term:
      id: HP:0011986
      label: Ectopic ossification
  - preferred_term: Obesity
    term:
      id: HP:0001513
      label: Obesity
  - preferred_term: Intellectual disability
    term:
      id: HP:0001249
      label: Intellectual disability
  evidence:
  - reference: PMID:29959430
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Patients should be screened at diagnosis and during follow-up for specific features, such as PTH resistance, TSH resistance, growth hormone deficiency, hypogonadism, skeletal deformities, oral health, weight gain, glucose intolerance or type 2 diabetes mellitus, and hypertension, as well as subcutaneous and/or deeper ectopic ossifications and neurocognitive impairment."
    explanation: Consensus guidance supports ongoing surveillance across endocrine, skeletal, metabolic, and neurocognitive domains.
- name: Coordinated multidisciplinary supportive management
  description: >-
    Management is coordinated across pediatric/adult endocrinology, genetics,
    orthopedics, dentistry, nutrition, and neurodevelopmental services according
    to the patient's manifestations.
  treatment_term:
    preferred_term: supportive care
    term:
      id: MAXO:0000950
      label: supportive care
  target_phenotypes:
  - preferred_term: Brachydactyly
    term:
      id: HP:0001156
      label: Brachydactyly
  - preferred_term: Short stature
    term:
      id: HP:0004322
      label: Short stature
  - preferred_term: Ectopic ossification
    term:
      id: HP:0011986
      label: Ectopic ossification
  evidence:
  - reference: PMID:29959430
    supports: SUPPORT
    evidence_source: HUMAN_CLINICAL
    snippet: "Overall, a coordinated and multidisciplinary approach from infancy through adulthood, including a transition programme, should help us to improve the care of patients affected by these disorders."
    explanation: Consensus guidance supports multidisciplinary supportive management for PHP-related disorders including PPHP.
notes: >-
  Classical PPHP is distinguished from PHP1A by absent PTH resistance despite
  overlapping Albright hereditary osteodystrophy features. Rare case-level
  evidence indicates that PTH or other hormone resistance can occur in patients
  with paternally inherited GNAS variants, so biochemical follow-up remains
  appropriate.
📚

References & Deep Research

Deep Research

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Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Pseudopseudohypoparathyroidism. Core disease mechanisms, molecular and cel...
Asta Scientific Corpus Retrieval 20 citations 2026-05-10T11:15:16.386098

Asta Literature Retrieval: Pathophysiology and clinical mechanisms of Pseudopseudohypoparathyroidism. Core disease mechanisms, molecular and cel...

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

  • Papers retrieved: 20
  • Snippets retrieved: 20

Relevant Papers

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

  • Authors: M. Uzti̇mür, C. N. Ünal, Gurler Akpinar
  • Year: 2025
  • Venue: Journal of Veterinary Internal Medicine
  • URL: https://www.semanticscholar.org/paper/4b9c488b5dbd65d7b26fd2ad9aed70e8c4b59942
  • DOI: 10.1111/jvim.70139
  • PMID: 40492724
  • PMCID: 12150350
  • Summary: Understanding the serum proteome profiles of goats with pregnancy toxemia might help identify the proteomes and pathways responsible for the development of this disease and improve diagnosis and treatment.
  • Evidence snippets:
  • Snippet 1 (score: 0.412) > The pathophysiology and progression of this disease are not fully understood. > Traditional biomedical research has focused on the analysis of single genes, proteins, metabolites, or metabolic pathways in diseases. This molecular reductionist approach is based on the assumption that identifying genetic variations and molecular components will lead to new treatments for diseases [13][14][15][16]. However, many diseases are complex and multifactorial, and in order to determine the phenotype of such diseases, it is necessary to understand the changes that occur in more than one gene, pathway, protein, or metabolite at the cellular, tissue, and organismal levels [17][18][19]. Therefore, in recent years, proteomics, as one field of multi-omics technologies, has helped in evaluating the complex pathogenetic mechanisms of different diseases from a broad perspective and has made substantial contributions [20,21]. In veterinary medicine, proteomic analysis of metabolic diseases such as ketosis [16], hypocalcemia [22], and fatty liver [23] in dairy cows has contributed valuable insights for the definition of new pathophysiological pathways and new diagnosis and treatment protocols for these diseases. The proteomic approach can contribute importantly to a broad and detailed understanding of the changes that occur at the organismal level associated with the increase in BHBA concentration in goats with pregnancy toxemia. Our aim was to evaluate the serum protein profiles of goats with SPT or CPT using proteomic techniques to determine the proteomic profiles of these animals and to identify the relevant pathophysiological mechanisms.

[2] Organoids in gastrointestinal diseases: from bench to clinic

  • Authors: Qinying Wang, Fanying Guo, Qinyuan Zhang, Tingting Hu, Yutao Jin et al.
  • Year: 2024
  • Venue: MedComm
  • URL: https://www.semanticscholar.org/paper/9b8880d8b9d45670da950197d7e353794f51d09e
  • DOI: 10.1002/mco2.574
  • PMID: 38948115
  • PMCID: 11214594
  • Citations: 12
  • Summary: A comprehensive and systematical depiction of organoids models is drawn, providing a novel insight into the utilization of organoids models from bench to clinic and clinical adhibition.
  • Evidence snippets:
  • Snippet 1 (score: 0.409) > Organoids models offer a robust platform for investigating the potential mechanisms of GI diseases and evaluating potential therapeutic interventions.By culturing organoids derived from patients' tissues or stem cells, researchers can delve into disease-specific cellular and molecular pathways, encompassing aberrant cell signaling, perturbed immune responses, and dysfunctional metabolic processes.These disease-specific phenotypes enable the study of disease progression, screening of prospective therapeutics, as well as identification of novel drug targets and mechanisms of action for GI diseases in a clinically relevant context.

[3] Clinical Presentation of Hypoparathyroidism

  • Authors: C. Cipriani, J. Bilezikian
  • Year: 2021
  • Venue: Journal of the Endocrine Society
  • URL: https://www.semanticscholar.org/paper/2f0655faa0e9d3d8649ce770c4f092c4a8ae5705
  • DOI: 10.1210/jendso/bvab003
  • PMID: 33542968
  • PMCID: 7846073
  • Citations: 9
  • Summary: This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercialNoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited.
  • Evidence snippets:
  • Snippet 1 (score: 0.402) > Hypoparathyroidism is a rare endocrine disorder whose clinical manifestations and complications involve the perturbation of several organs and systems that are specifically related to the target organs of parathyroid hormone (PTH). Chronic hypoparathyroidism is characterized by hypocalcemia and deficient PTH secretion. Levels are usually below detection limits of clinical assays for PTH. Hypoparathyroidism occurs most often as a complication of anterior neck surgery but can also occur as a genetic, autoimmune, or idiopathic disorder. > Hypocalcemia, hyperphosphatemia, and low or undetectable PTH levels are the hallmark laboratory findings in hypoparathyroidism; hypercalciuria may be present, as well. The clinical presentation of hypoparathyroidism is characterized not only by these biochemical abnormalities but also by a wide range of complications that relate specifically to the chronic effects of these metabolic abnormalities on different organs [1][2][3]. The neuromuscular and cardiovascular systems may be involved, with effects ranging from acute, life threatening manifestations (eg, tetany, seizures, arrhythmias) to long-term complications (eg, cerebral, vascular, renal or other ectopic calcifications) [2]. The organs that can be affected include, but are not limited to, the skeleton, kidneys, skin, and gastrointestinal, ocular, and dental systems [2,3]. Related to many of these complications or perhaps as a separate entity, quality of life is typically adversely impacted [4]. > In the last decade, several studies have focused on the prevalence, natural history, and pathophysiology of hypoparathyroidism and its complications. This research has offered new insights into a disease with protean manifestations [3]. Moreover, and similar to primary hyperparathyroidism [5], published observations from different geographical areas gain an advantage by comparing and contrasting the clinical profiles of hypoparathyroidism as they present around the world.

[4] 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: 0.396) > 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.

[5] Homocysteine thiolactone and N-homocysteinylated protein induce pro-atherogenic changes in gene expression in human vascular endothelial cells

  • Authors: D. Gurda, L. Handschuh, Weronika Kotkowiak, H. Jakubowski
  • Year: 2015
  • Venue: Amino Acids
  • URL: https://www.semanticscholar.org/paper/0e9ac31119ab67e72fdaa6e9cc442fa7ed2f4642
  • DOI: 10.1007/s00726-015-1956-7
  • PMID: 25802182
  • PMCID: 4458266
  • Citations: 93
  • Influential citations: 3
  • Summary: It is found that each Hcy metabolite uniquely modulates gene expression in pathways important for vascular homeostasis and identify new genes and pathways that are linked to HHcy-induced endothelial dysfunction and vascular disease.
  • Evidence snippets:
  • Snippet 1 (score: 0.395) > lead to the accumulation of Hcy and its metabolites in the blood-hyperhomocysteinemia (HHcy)-which is an independent risk factor for cardiovascular disease (CVD) and causes endothelial dysfunction, a hallmark of atherosclerosis (Dayal and Lentz 2008). However, molecular mechanisms underlying the pathophysiology of HHcy are not fully understood (Jakubowski 2011(Jakubowski , 2013;;Perla-Kajan et al. 2007). One hypothesis states that metabolic conversion of Hcy to Hcythiolactone initiates a pathway that leads to pathologies associated with HHcy (Jakubowski 1997a(Jakubowski , 1999(Jakubowski , 2007)). Hcy-thiolactone is chemically reactive and modifies ε-amino groups of protein lysine residues, which generates immunogenic and toxic N-homocysteinylated protein (N-Hcy-protein) (Jakubowski 2008(Jakubowski , 2013;;Jakubowski et al. 2000). > In humans and mice, HHcy leads to the accumulation of Hcy-thiolactone and N-Hcy-protein, in addition to Hcy (Chwatko et al. 2007;Jakubowski et al. 2008Jakubowski et al. , 2009)). We and other investigators have shown that HHcy induces changes in gene expression in mouse models that are associated with atherothrombotic disease (Devlin et al. 2005;DiBello et al. 2010;Ingrosso et al. 2003;Kim et al. 2011;Pogribny et al. 2008;Sharma et al. 2006;Suszynska-Zajczyk et al. 2014a, b, c, d). However, it is not known what mechanism(s) are involved and which metabolite-Hcy itself, Hcy-thiolactone, or N-Hcy-protein-is responsible for changes in gene expression. > The key to understanding mechanisms by which HHcy disrupts normal cellular function and ultimately causes disease is to identify genes whose expression is affected by individual Hcy metabolites.

[6] Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review

  • Authors: J. Pasieka, K. Wentworth, C. Yeo, S. Cremers, D. Dempster et al.
  • Year: 2022
  • Venue: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
  • URL: https://www.semanticscholar.org/paper/d16b370779057b3b965ce1d52640428c9f80bbea
  • DOI: 10.1002/jbmr.4714
  • PMID: 36153665
  • PMCID: 10364481
  • Citations: 58
  • Influential citations: 5
  • Summary: Given the pervasive nature of PTH deficiency across multiple organ systems, a detailed review of the skeletal, renal, neuromuscular, and ocular complications is provided.
  • Evidence snippets:
  • Snippet 1 (score: 0.391) > Etiology and Pathophysiology of Hypoparathyroidism: A Narrative Review

[7] Computational drug discovery approaches identify mebendazole as a candidate treatment for autosomal dominant polycystic kidney disease

  • Authors: P. Brownjohn, A. Zoufir, Daniel J O’Donovan, Saatviga Sudhahar, A. Syme et al.
  • Year: 2024
  • Venue: Frontiers in Pharmacology
  • URL: https://www.semanticscholar.org/paper/a595e78572ca02b8cb2897bfc4a989a2b021b279
  • DOI: 10.3389/fphar.2024.1397864
  • PMID: 38846086
  • PMCID: 11154008
  • Citations: 3
  • Summary: It is determined that the anthelmintic mebendazole was a potent anti-cystic agent in human cellular and in vivo models of ADPKD, and is likely acting through the inhibition of microtubule polymerisation and protein kinase activity.
  • Evidence snippets:
  • Snippet 1 (score: 0.390) > Targets and molecules were ultimately filtered for validation based on biological and chemical insights, and the potential for clinical translation.Earlier this year, Wilk et al., 2023 applied a similar transcriptomic approach to us, in that case making use of publicly available transcriptomic datasets to create Pkd2-specific ADPKD disease signatures, from which signature reversion was sought from the Library of Integrated Network-based Cellular Signatures (LINCs) drug signature database in order to identify drug repurposing candidates.While one group has previously made use of a knowledge graph-based approach to prioritise preclinically active compounds with the highest chance of clinical translation (Malas et al., 2019), to our knowledge, the current study provides the first combined application of transcriptomic and machine-learning approaches to identify and prioritise putative treatments for ADPKD, and further deconvolute potential mechanisms of action for experimental validation. > In summary we report, using computational, in vitro and in vivo approaches, that the anthelmintic drug mebendazole ameliorates disease-relevant phenotypes in cellular and animal models of ADPKD.We further show that this effect is likely primarily due to the inhibitory effect of mebendazole on the polymerisation of microtubules, which underlie cellular processes important in ADPKD, including cell proliferation, transport, and cilia signalling, and extends previous work linking the importance of the microtubule network to ADPKD pathophysiology.We also describe the inhibitory profile of mebendazole on known and novel protein kinase targets, some of which have previously been implicated in ADPKD, suggesting mebendazole may be acting via polypharmacology to impact disease mechanisms.We acknowledge that further experimental efforts will be required to confirm the actions of mebendazole on these putative targets in relevant disease model systems.It would be particularly informative to investigate these mechanisms in dedicated in vivo studies, where the effects of mebendazole on a wider range of ADPKD-relevant cell types and phenotypes could be evaluated.

[8] Modeling psychiatric disorders: from genomic findings to cellular phenotypes

  • Authors: Anna Falk, Vivi M. Heine, A. Harwood, Patrick F. Sullivan, M. Peitz et al.
  • Year: 2016
  • Venue: Molecular Psychiatry
  • URL: https://www.semanticscholar.org/paper/235b41240d78140de7ab06a3ad8a7d0b1bdff1a5
  • DOI: 10.1038/mp.2016.89
  • PMID: 27240529
  • PMCID: 4995546
  • Citations: 77
  • Influential citations: 2
  • Summary: The challenges for modeling of psychiatric disorders, potential solutions and how iPSC technology can be used to develop an analytical framework for the evaluation and therapeutic manipulation of fundamental disease processes are critically reviewed.
  • Evidence snippets:
  • Snippet 1 (score: 0.386) > The key challenge for iPSC-based disease modeling is to identify one or more relevant cellular phenotypes that accurately represent the disease pathophysiology. Increasing numbers of reports have demonstrated that for many diseases specific pathophysiology can be captured in human iPSC-based disease models. These range from cardiovascular disease, 44,45 cancer, 46,47 ocular disease, 48,49 diabetes mellitus 50,51 and neurological disorders of the brain. 52,53 Can the same approach be applied to complex psychiatric disorders? > The problem is that almost all psychiatric disorders are characterized by clinical signs and symptoms, but lack independent verification from objective biomarkers. Thus, how might these clinical phenotypes manifest themselves in terms of cell behavior? The identity of robust cellular 'readouts', which typify any psychiatric disorder, is a crucial unsolved problem and an area of intense study 54 (Table 2). When satisfactorily answered, this will herald a new degree of biological objectivity and quantification for the study of psychiatric disorders. > The aim is to find a single or small number of cell phenotypes or parameters that strongly associate with psychiatric disorders, and establish a cellular profile characteristic of cells derived from the general patient population. Although a consensus set of cellular phenotypes for psychiatric disorder is yet to be established, we can define some of their desired characteristics. First, cellular phenotypes have to relate to the biological pathways identified by genetics. Second, although there are many risk genes in disparate biological pathways, at some level, phenotypes should converge onto a much smaller grouping. Third, phenotypes need to be quantifiable. Finally, to be useful for drug development cellular phenotypes should be reversed by pharmacological treatment, although not necessarily by drugs in current use. > Although human iPSC-based approaches underrepresent the complexity of the human central nervous system, cellular phenotypes are likely to lie more proximal to molecular disease mechanisms than phenotypes seen at the level of a tissue or organism, 55 and thus may bypass compensatory homeostatic (2) Gene expression profiles of SCZ human iPSC neurons identified altered expression of many components of the cyclic AMP and WNT signaling pathways. > (3

[9] Novel variants in KAT6B spectrum of disorders expand our knowledge of clinical manifestations and molecular mechanisms

  • Authors: M. Yabumoto, Jessica Kianmahd, Meghna Singh, Maria F. Palafox, Angela Wei et al.
  • Year: 2021
  • Venue: Molecular Genetics & Genomic Medicine
  • URL: https://www.semanticscholar.org/paper/3a47a1b1208ba7420900b090d3d7d712ed391719
  • DOI: 10.1002/mgg3.1809
  • PMID: 34519438
  • PMCID: 8580094
  • Citations: 12
  • Influential citations: 2
  • Summary: A range of features previously described for KAT6B‐related syndromes are identified, including concern for keratoconus, sensitivity to light or noise, recurring infections, and fractures in greater numbers than previously reported.
  • Evidence snippets:
  • Snippet 1 (score: 0.386) > Finally, as gene-centric models of disease have started to take hold, understanding the underlying functional mechanisms that are affected can help us elucidate the effect on molecular and cellular phenotypes that are regulated by KAT6B (Klein et al., 2019;Sheikh et al., 2012). We developed a model of KAT6B truncating variants in a human cell line to explore how these variants result in differential regulation of key transcripts. These types of approaches have been performed in a high throughput manner for tumor suppressor genes like BRCA1 (Findlay et al., 2018) and TP53 (Kotler et al., 2018) and can help identify key pathways that are dysregulated by KAT6B-related disorders and could be future targets for translational research. > Here, we analyze 20 clinical cases representing a KAT6B-related clinical spectrum across three domains: their genotype, phenotype, and experience with genetic counseling resources. Furthermore, we developed an in vitro model of KAT6B mutations using CRISPR technology to explore the effect of protein truncation on global transcriptional regulation. Here we demonstrate that the genes that drive core clinical phenotypes are enriched in our in vitro model system. Together, we show that our clinical observations parallel the transcriptional processes in our cell model systems which allow for a further understanding of the mechanisms underlying the KAT6Brelated clinical spectrum.

[10] 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: 0.386) > 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.

[11] Cardiomyocytes Derived from Induced Pluripotent Stem Cells as a Disease Model for Propionic Acidemia

  • Authors: Esmeralda Alonso-Barroso, B. Pérez, L. Desviat, E. Richard
  • Year: 2021
  • Venue: International Journal of Molecular Sciences
  • URL: https://www.semanticscholar.org/paper/da649a0f04477c53b448c5ac5f873f8762235290
  • DOI: 10.3390/ijms22031161
  • PMID: 33503868
  • PMCID: 7865492
  • Citations: 16
  • Influential citations: 1
  • Summary: The novel results show that PA iPSC-cardiomyocytes represent a promising model for investigating the pathological mechanisms underlying PA cardiomyopathies, also serving as an ex vivo platform for therapeutic evaluation.
  • Evidence snippets:
  • Snippet 1 (score: 0.385) > The study of the mechanisms involved in disease physiopathology has been mainly performed using the hypomorphic PA mouse model that mimics the biochemical and clinical phenotype [5]. Using this model, bioenergetic failure, oxidative damage and deregulation of miRNAs induced by accumulating propionyl-CoA have been described as potential mechanisms contributing to PA physiopathology [6][7][8]. The limitations of animal models for the study of cardiac energy metabolism [9] and of the commonly available cellular human models such as fibroblasts, underline the importance of generating new relevant cell models to provide deeper insight into the underlying mechanisms of disease. The use of in vitro models with human cellular context is highly recommended and, in this sense, induced pluripotent stem cells (iPSCs) have certain advantages since they provide the genetic background of the patient and represent an unlimited source of biological material for the study of pathophysiology and treatment effectiveness [10]. We have previously generated an iPSC line from a PA patient with defects in the PCCA gene that showed full pluripotency, differentiation capacity and genetic stability [11]. > In the present study, we aimed to establish a platform that served as a disease model to study the cellular and molecular alterations operating in cardiac tissue affected by PA disease. We described the characterization of cardiomyocytes derived from the PCCA iPSC line (PCCA iPSC-CMs) and the analysis of specific pathways potentially involved in cardiac PA physiopathology.

[12] 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: 0.381) > 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].

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

  • Authors: Sandra Vidak, Sohyoung Kim, Tom Misteli
  • Year: 2026
  • Venue: Nucleus
  • URL: https://www.semanticscholar.org/paper/4bd99b0875508364d8672b6da5a50d024d485a53
  • DOI: 10.1080/19491034.2025.2611484
  • PMID: 41489464
  • PMCID: 12773485
  • Summary: To probe the clinical relevance of previously implicated cellular pathways and to address the extent of gene expression heterogeneity between patients, transcriptomic analysis of a comprehensive set of HGPS patients finds misexpression of several cellular pathways, including multiple signaling pathways, the UPR and mesodermal cell fate specification.
  • Evidence snippets:
  • Snippet 1 (score: 0.381) > Oxidative stress represents another key pathogenic mechanism in HGPS, as impaired NRF2 activity or increased reactive oxygen species (ROS) levels are sufficient to recapitulate HGPSassociated phenotypes [17,32,60]. Collectively, these findings underscore the multifactorial nature of HGPS pathogenesis, implicating interconnected signaling cascades involved in inflammation, oxidative stress, proteostasis, and vascular remodeling. Reassuringly, our findings indicate that many of the major pathways that have been described to contribute to HGPS phenotypes in mouse and cellular disease models are also misregulated in progeria patients, and targeting these pathways may provide therapeutic avenues to mitigate disease severity and improve outcomes in HGPS. > Although individuals with HGPS typically exhibit a characteristic set of clinical features, such as craniofacial abnormalities, growth retardation, and cardiovascular complications, there is notable variability in the age of onset, severity, and progression of symptoms between patients [7,9]. At the cellular level, HGPS is associated with several hallmark abnormalities, including nuclear envelope defects, decreased expression of several nuclear proteins and epigenetic marks, mitochondrial dysfunction, and increased cellular senescence [1,11,30,31,61]. These cellular phenotypes also exhibit considerable variation between patients, possibly contributing to differences in clinical outcomes. Our results indicate that even though some degree of transcriptional heterogeneity between the individual patients exists, the majority of patients exhibit misregulation of a set of shared pathways, suggesting that these pathways are universal driver mechanisms in HGPS. Further work is needed to understand the molecular and genetic factors that underlie inter-individual variability in disease expression and progression. > A limitation of pathway analysis of HGPS patient samples is to distinguish the pathways which are directly targeted by the disease-causing progerin protein and the emergence of adaptive secondary response pathways during progression of the disease in patients during their lifetime. The same caveat applies to the use of cell-based models used in the study of HGPS disease mechanisms.

[14] Pseudopseudohypoparathyroidism: an unusual case

  • Authors: S. Munigoti
  • Year: 2018
  • Venue: Journal of Clinical and Scientific Research
  • URL: https://www.semanticscholar.org/paper/0e9c1005b0ab7e8721eb0f2bd430c4bac267db24
  • DOI: 10.4103/JCSR.JCSR_43_18
  • Summary: An unusual case of a 22-year-old male patient who presented with phenotypic features of Albright's hereditary osteodystrophy, but had associated multiple hormonal deficiencies suggestive of pseudo-pseudohypararthyroidism.
  • Evidence snippets:
  • Snippet 1 (score: 0.380) > Pseudopseudohypoparathyroidism: an unusual case

[15] 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: 0.375) > 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.

[16] 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: 0.374) > 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.

[17] Aberrant NLRP3 Inflammasome Activation Ignites the Fire of Inflammation in Neuromuscular Diseases

  • Authors: Christine Péladeau, J. Sandhu
  • Year: 2021
  • Venue: International Journal of Molecular Sciences
  • URL: https://www.semanticscholar.org/paper/763a36db080236fca8cde89b2afcdf056f3584d0
  • DOI: 10.3390/ijms22116068
  • PMID: 34199845
  • PMCID: 8200055
  • Citations: 18
  • Influential citations: 1
  • Summary: Whether therapeutic targeting of the NLRP3 inflammasome components is a viable approach to alleviating the detrimental phenotype of neuromuscular diseases and improving clinical outcomes is examined.
  • Evidence snippets:
  • Snippet 1 (score: 0.374) > Despite a large number of mechanisms that have been identified in muscle degeneration and nerve cell loss, none have proven to be the primary cause of the disease. There is much need for a deeper understanding of the biology of the pathogeneses and the molecular mechanisms that are activated early in the diseases in order to identify "druggable" targets and disease-modifying treatments for these devastating diseases. > Human iPSC technologies are emerging as useful platforms for disease modeling to study pathogenic mechanisms and discover novel therapeutics for neuromuscular diseases [211,237]. Indeed, patient-derived iPSCs are being used to create a "patient-in-adish" disease model to derive relevant cell types for testing potential therapeutics, paving the way towards personalized medicine. This approach allows drug screening in a dish prior to administration to patients and "bench-to-bedside" translation of potential therapies. Additionally, iPSCs may also be used to stratify patients with various phenotypes and guide future clinical trials for bringing improved therapies to patients. Since multiple cell types are involved in disease pathogenesis, future research efforts need to be focused on deciphering "disease-specific signatures" at single-cell resolution, and not only in neuronal cells but also in non-neuronal cells. The application of modern technologies, including single-cell RNA sequencing and spatial transcriptomics, to neuromuscular diseases, will allow to ascertain cellular vulnerability and cell-specific mechanisms during various stages of disease progression. > The vital roles of the NLRP3 inflammasome in neuromuscular diseases such as DMD, LGMD and ALS, reveal that targeting this pathway is indeed a promising therapeutic strategy. Dysregulation of the NLRP3 inflammasome in muscle tissues by muscle damage, membrane instability, extracellular ATP and Ca 2+ ions or signals from infiltrating immune cells, clearly impacts the progression of neuromuscular and neurodegenerative disorders. Thus, modulation of these pathways involved with activation and assembly of NLRP3 inflammasome could be truly beneficial.

[18] Clinical metabolomics in type 2 diabetes mellitus: from pathogenesis to biomarkers

  • Authors: Chuanxin Liu, Hetao Chen, Yujin Ma, Lei Zhang, Lulu Chen et al.
  • Year: 2025
  • Venue: Frontiers in Endocrinology
  • URL: https://www.semanticscholar.org/paper/36f8d26a208b7b96763df2e9aa3211e440031c0e
  • DOI: 10.3389/fendo.2025.1501305
  • PMID: 40070584
  • PMCID: 11893406
  • Citations: 11
  • Summary: The results facilitate understanding the pathophysiology and mechanism of type 2 diabetes mellitus and supports research in accurate diagnosis, risk prediction, curative effect, distinct stages, and prognosis judgment of T2DM.
  • Evidence snippets:
  • Snippet 1 (score: 0.373) > The metabolome is sensitive to a variety of genetic and environmental stimuli and susceptible to genetic, environmental, and gut microbiome pressures, so subtle differences between individuals can lead to large perturbations in metabolite concentrations and fluxes (15, 24). At present, cystatin C has become an ideal endogenous marker for evaluating glomerular filtration function because it is not affected by sex, age or muscle mass (25). In addition, more and more evidence shows that serum CysC is involved in the pathological process of vascular remodeling and neovascularization, which is closely related to the occurrence and development of diabetic microangiopathy (26). > Eighty-four papers were included in this review and obtained through database searches, namely, PubMed, Cochrane Library, China national knowledge internet(CNKI), General Purpose, and VIP Database. The keywords for the searches were "metabolomics" and "type 2 diabetes mellitus" and its complications. The papers were incorporated by reading and summarizing the literature according to the classification standards (27). The profound analysis of clinical differential metabolites identified in type 2 diabetes and its complications were conducted concerning composition, frequency of category, sample type, and pathways to explore the pathological mechanism of type 2 diabetes and its complications to provide a systematic basis for clinical diagnosis, risk stratification, comprehending disease progression, prognosis assessment, and drug efficacy. Our goal is to apply metabolomics to clinical diagnostic biomarkers, metabolic mechanisms, and prognostic observations, and early diagnosis can be made through metabolites to avoid progression to more serious complications.

[19] A Lifelike guided journey through the pathophysiology of pulmonary hypertension—from measured metabolites to the mechanism of action of drugs

  • Authors: Nathan Weinstein, Jørn Carlsen, S. Schulz, T. Stapleton, Hanne H. Henriksen et al.
  • Year: 2023
  • Venue: Frontiers in Cardiovascular Medicine
  • URL: https://www.semanticscholar.org/paper/0b2dc837dea11add7e2f67f06acf6280ac96a019
  • DOI: 10.1101/2023.11.21.23298782
  • PMID: 38845688
  • PMCID: 11153715
  • Citations: 4
  • Summary: The present study shows the power of mining knowledge graphs using Lifelike's diverse set of data analytics functionalities for developing knowledge-driven hypotheses on PH pathophysiological and drug mechanisms and their interactions.
  • Evidence snippets:
  • Snippet 1 (score: 0.372) > Despite substantial progress in the understanding of PH pathophysiology over the last years, the detailed mechanisms underlying PH remain elusive due to the complex interplay of dysregulated biological processes.Also, although the mechanisms of action of some drugs that have been successfully used for the treatment of PH have been proposed, certain drugs may show additional mechanisms of action that are yet to be identified.Understanding these additional mechanisms of action is crucial for the personalized and thus more effective treatment of PH patients.In this study, we aimed to generate detailed mechanistic hypotheses of pathophysiological processes in PH using our in-house developed software platform Lifelike.Importantly, we have focused our analyses on the potential effects of blood plasma metabolites from PH patients on pulmonary endothelial and smooth muscle cells.Moreover, we used Lifelike to investigate the mechanisms of action of existing and new drugs used for the treatment of PH in more detail.We have achieved this by analyzing metabolite data and receptor ligands on the curated database Reactome using graph algorithms, and by combining our software's additional data analytics functionalities, including statistical enrichment and semantic analysis of textual information from Lifelike's knowledge graph.Additionally, we validated, interpreted, and extended our results based on relevant existing literature.This entire process allowed us to explore the pathophysiology of PH and to propose the model shown in figure 3 and summarized in figure 6.Further, Lifelike allowed us to generate the hypotheses discussed in the following sections and shown in Tables 2 and 3. > Lifelike also enables the reader of a biology article to quickly find the molecules, diseases, and phenotypes that are discussed in the manuscript or included in the figures through entity recognition.For instance, genes detected in articles by Lifelike's entity recognition system can be used to create an enrichment table where the genes can be associated with biological processes, molecular functions, and cell structures by GO enrichment.This allows the reader to find context-specific information quickly, and to extend the knowledge beyond what is described in the article with other sources of information (Table 1 row 21) We encourage the reader to upload this manuscript in PDF format into Lifelike for improved reading and knowledge extraction capabilities.

[20] Mitochondrial Dysfunction in Diabetes: Shedding Light on a Widespread Oversight

  • Authors: F. Iheagwam, A. J. Joseph, E. D. Adedoyin, Olawumi Toyin Iheagwam, Samuel Akpoyowvare Ejoh
  • Year: 2025
  • Venue: Pathophysiology
  • URL: https://www.semanticscholar.org/paper/dbf8042761c1a5fc50f8cd894cc498505abac7cb
  • DOI: 10.3390/pathophysiology32010009
  • PMID: 39982365
  • PMCID: 12077258
  • Citations: 30
  • Summary: This review aims to elucidate the complex link between mitochondrial dysfunction and diabetes, covering the spectrum of diabetes types, the role of mitochondria in insulin resistance, highlighting pathophysiological mechanisms, mitochondrial DNA damage, and altered mitochondrial biogenesis and dynamics.
  • Evidence snippets:
  • Snippet 1 (score: 0.371) > The landscape of DM research is continuously evolving, with emerging technologies and approaches offering new insights into the pathophysiology of the disease and potential therapeutic targets. Advancements in omics technologies, encompassing genomes, transcriptomics, proteomics, and metabolomics, have transformed the molecular mechanisms underlying DM [134]. High-throughput sequencing techniques enable comprehensive analysis of genetic variants, gene expression profiles, protein abundance, and metabolite levels associated with DM and its complications [135]. Single-cell omics approaches provide unprecedented resolution and granularity, allowing researchers to dissect cellular heterogeneity and identify novel cell types, subpopulations, and signalling pathways involved in DM pathogenesis. Integrating multi-omics data sets offers a systems-level perspective of DM, unravelling complex networks of molecular interactions and regulatory circuits underlying disease progression [136]. > In addition to omics technologies, advances in imaging modalities, such as MRI, PET, and optical imaging, enable non-invasive visualisation and quantification of metabolic, functional, and structural changes. Molecular imaging probes targeting specific biomarkers and metabolic pathways provide valuable insights into disease mechanisms and treatment responses in preclinical and clinical settings [85]. Despite significant progress in DM research, numerous unanswered questions and knowledge gaps persist, hindering the ability to develop effective prevention and treatment strategies. Key areas requiring further investigation include the role of epigenetics, environmental factors, and the microbiome in DM susceptibility and progression. Moreover, the interaction between environmental cues and genetic predisposition remains incompletely understood, highlighting the need for comprehensive multi-omics studies and large-scale epidemiological analyses to identify gene-environment interactions and modifiable risk factors for DM [137]. Furthermore, the heterogeneity of DM phenotypes and clinical outcomes poses a challenge for personalised medicine approaches, necessitating robust biomarkers and predictive models to stratify patients based on disease subtypes, prognosis, and treatment response [138].

Notes

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