Stromme syndrome is an ultra-rare autosomal recessive congenital malformation syndrome caused by biallelic pathogenic variants in CENPF. The classic phenotype combines microcephaly, ocular anomalies such as microphthalmia or anterior chamber abnormalities, and apple-peel intestinal or jejunal atresia. CENPF encodes a centromere and centriolar protein with roles in cilium assembly, intraflagellar transport protein targeting, mitotic spindle organization, and cortical neurogenesis; severe loss-of-function alleles can cause a lethal fetal ciliopathy spectrum with brain, craniofacial, gastrointestinal, renal, and cardiac malformations.
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name: Stromme Syndrome
creation_date: "2026-05-08T05:44:00Z"
updated_date: "2026-05-08T05:44:00Z"
category: Mendelian
synonyms:
- Apple-peel intestinal atresia-ocular anomalies-microcephaly syndrome
- Jejunal atresia-microcephaly-ocular anomalies syndrome
- Apple peel syndrome with microcephaly and ocular anomalies
- Jejunal atresia with microcephaly and ocular anomalies
- Ciliary dyskinesia, primary, type 31
- Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome
description: >-
Stromme syndrome is an ultra-rare autosomal recessive congenital malformation
syndrome caused by biallelic pathogenic variants in CENPF. The classic
phenotype combines microcephaly, ocular anomalies such as microphthalmia or
anterior chamber abnormalities, and apple-peel intestinal or jejunal atresia.
CENPF encodes a centromere and centriolar protein with roles in cilium
assembly, intraflagellar transport protein targeting, mitotic spindle
organization, and cortical neurogenesis; severe loss-of-function alleles can
cause a lethal fetal ciliopathy spectrum with brain, craniofacial,
gastrointestinal, renal, and cardiac malformations.
disease_term:
preferred_term: Stromme syndrome
term:
id: MONDO:0009477
label: Stromme syndrome
parents:
- multiple congenital anomalies/dysmorphic syndrome-intellectual disability
- primary ciliary dyskinesia
- hereditary lethal multiple congenital anomalies/dysmorphic syndrome
external_assertions:
- name: Orphanet Stromme syndrome structured disease record
source: Orphanet
assertion_type: structured_disease_record
external_id: ORPHA:506307
url: http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=506307
description: >-
ORPHA:506307 supplies the Stromme syndrome definition, synonyms,
inheritance, antenatal onset, prevalence, CENPF gene association, and
MONDO/OMIM cross-references used in this entry.
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "CENPF | centromere protein F | hgnc:1857 | Disease-causing germline mutation(s) in"
explanation: Orphanet identifies CENPF as the disease-causing germline gene for Stromme syndrome.
- name: Orphanet lethal fetal CENPF ciliopathy record
source: Orphanet
assertion_type: structured_disease_record
external_id: ORPHA:444069
url: http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=444069
description: >-
ORPHA:444069 records the severe lethal fetal CENPF-associated ciliopathy
spectrum with duodenal atresia, renal hypoplasia, brain malformations, and
dysmorphic craniofacial findings.
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "CENPF | centromere protein F | hgnc:1857 | Disease-causing germline mutation(s) (loss of function) in"
explanation: Orphanet records CENPF loss-of-function germline mutations for the lethal fetal phenotype.
definitions:
- name: Orphanet Stromme syndrome definition
definition_type: OTHER
description: >-
Orphanet defines Stromme syndrome as a rare multiple congenital anomalies
syndrome centered on microcephaly, ocular anomalies, and apple-peel
intestinal atresia, with variable craniofacial, renal, cardiac,
neurologic, and hematologic findings.
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "A rare multiple congenital anomalies syndrome usually characterized by microcephaly, ocular anomalies such as microphthalmia, and apple-peel intestinal atresia."
explanation: Orphanet provides the structured clinical definition for Stromme syndrome.
- reference: PMID:26820108
reference_title: "Strømme Syndrome Is a Ciliary Disorder Caused by Mutations in CENPF."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Strømme syndrome was first described by Strømme et al. (1993) in siblings presenting with \"apple peel\" type intestinal atresia, ocular anomalies and microcephaly."
explanation: The CENPF discovery paper anchors the classic triad in affected siblings.
- name: CENPF ciliopathy definition
definition_type: OTHER
description: >-
CENPF-related Stromme syndrome is modeled as a ciliopathy because patient,
fetal tissue, cell, and zebrafish data link CENPF dysfunction to basal-body
localization, IFT88 ciliary targeting, short or abnormal cilia, and
ciliopathy phenotypes.
evidence:
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "CONCLUSIONS: Our data identify CENPF as a new centriolar disease gene implicated in severe human ciliopathy and microcephaly related phenotypes."
explanation: This directly supports defining CENPF disease as a centriolar/ciliopathy disorder.
inheritance:
- name: Autosomal recessive inheritance
inheritance_term:
preferred_term: Autosomal recessive inheritance
term:
id: HP:0000007
label: Autosomal recessive inheritance
description: >-
Stromme syndrome is caused by biallelic CENPF variants, including compound
heterozygous and homozygous truncating alleles reported in affected sibling
pairs and families.
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Autosomal recessive"
explanation: Orphanet records autosomal recessive inheritance.
- reference: PMID:26820108
reference_title: "Strømme Syndrome Is a Ciliary Disorder Caused by Mutations in CENPF."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "We show for the first time that Strømme syndrome is an autosomal-recessive disease caused by mutations in CENPF that can result in a wide phenotypic spectrum."
explanation: The discovery report directly states autosomal recessive CENPF disease.
prevalence:
- population: Worldwide
percentage: <1 per 1,000,000
notes: Orphanet classifies Stromme syndrome as ultra-rare worldwide.
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "<1 / 1 000 000 | Worldwide | Point prevalence | PMID:28407396"
explanation: Orphanet records worldwide point prevalence below one per million.
progression:
- phase: Onset
age_range: Antenatal
notes: >-
Core structural malformations are congenital and Orphanet records
antenatal onset.
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Age of onset: Antenatal"
explanation: Orphanet records antenatal onset for Stromme syndrome.
- phase: Severe fetal spectrum
age_range: Mid-gestation
notes: >-
Severe CENPF loss-of-function presentations can be lethal in utero, with
brain, renal, gastrointestinal, and craniofacial malformations recognized
at fetal autopsy.
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "A rare genetic lethal multiple congenital anomalies/dysmorphic syndrome characterized by mid-gestation lethality and features of a ciliopathy."
explanation: Orphanet records the lethal fetal CENPF-associated ciliopathy phenotype.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Whole exome sequencing data from a non-consanguineous Caucasian kindred exhibiting mid-gestation lethality and ciliopathic malformations revealed two novel non-synonymous variants in CENPF, a microtubule-regulating gene."
explanation: Human fetal data support the severe antenatal/lethal end of the CENPF spectrum.
has_subtypes:
- name: Classic
display_name: Classic Stromme syndrome
description: >-
The classic presentation combines microcephaly, ocular anomalies, and
apple-peel intestinal or jejunal atresia, with variable developmental,
craniofacial, renal, cardiac, and hematologic involvement.
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "A rare multiple congenital anomalies syndrome usually characterized by microcephaly, ocular anomalies such as microphthalmia, and apple-peel intestinal atresia."
explanation: Orphanet supports the classic phenotype definition.
- name: Lethal fetal
display_name: Lethal fetal CENPF ciliopathy spectrum
description: >-
The severe fetal phenotype includes mid-gestation lethality with
hydrocephalus, cerebellar vermis hypoplasia, corpus callosum agenesis,
duodenal atresia, gastrointestinal malrotation, bilateral renal hypoplasia,
and dysmorphic craniofacial features.
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Clinical manifestations include hydrocephalus, cerebellar vermis hypoplasia, corpus callosum agenesis, duodenal atresia, gastrointestinal malrotation, bilateral renal hypoplasia, and dysmorphic craniofacial features"
explanation: Orphanet supports the severe fetal CENPF-associated subtype description.
genetic:
- name: Biallelic CENPF pathogenic variants
gene_term:
preferred_term: CENPF
term:
id: hgnc:1857
label: CENPF
association: Biallelic pathogenic variants causing autosomal recessive Stromme syndrome
relationship_type: CAUSATIVE
variant_origin: GERMLINE
features: >-
Reported alleles include compound heterozygous truncating or splice-site
variants and homozygous frameshift variants. More severe fetal cases have
loss-of-function alleles with absent or severely reduced CENP-F activity,
while residual CENP-F activity may contribute to milder microcephaly-dominant
phenotypes.
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "CENPF | centromere protein F | hgnc:1857 | Disease-causing germline mutation(s) in"
explanation: Orphanet identifies CENPF as the disease-causing germline gene.
- reference: PMID:26820108
reference_title: "Strømme Syndrome Is a Ciliary Disorder Caused by Mutations in CENPF."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Using family-based whole-exome sequencing, we identified truncating mutations in the centrosome gene CENPF in the two nonconsanguineous Caucasian sibling pairs."
explanation: This directly supports truncating CENPF variants in affected sibling pairs.
- reference: PMID:28407396
reference_title: "A further family of Stromme syndrome carrying CENPF mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "we report a Stromme syndrome family with two affected siblings with a homozygous truncating frameshift mutation in CENPF."
explanation: This independently supports homozygous truncating CENPF variation in Stromme syndrome.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "All four affected fetuses showed segregation for two mutated alleles [IVS5-2A>C, predicted to abolish the consensus splice-acceptor site from exon 6; c.1744G>T, p.E582X]."
explanation: The fetal ciliopathy study supports biallelic CENPF variants segregating with disease.
pathophysiology:
- name: Biallelic CENPF dysfunction
description: >-
Biallelic truncating, splice-site, or frameshift CENPF variants reduce
CENP-F function at the kinetochore, centrosome, and ciliary basal body,
initiating Stromme syndrome and the severe fetal CENPF ciliopathy spectrum.
genes:
- preferred_term: CENPF
term:
id: hgnc:1857
label: CENPF
biological_processes:
- preferred_term: cilium assembly
modifier: ABNORMAL
term:
id: GO:0060271
label: cilium assembly
- preferred_term: mitotic spindle organization
modifier: ABNORMAL
term:
id: GO:0007052
label: mitotic spindle organization
cellular_components:
- preferred_term: ciliary basal body
term:
id: GO:0036064
label: ciliary basal body
evidence:
- reference: PMID:26820108
reference_title: "Strømme Syndrome Is a Ciliary Disorder Caused by Mutations in CENPF."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Using family-based whole-exome sequencing, we identified truncating mutations in the centrosome gene CENPF in the two nonconsanguineous Caucasian sibling pairs."
explanation: Human sequencing evidence places biallelic truncating CENPF variants at the start of the disease mechanism.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "CENP-F has a novel putative function in ciliogenesis and cortical neurogenesis."
explanation: The mechanistic study links CENPF function to the key cellular processes modeled downstream.
downstream:
- target: Defective CENPF-dependent IFT88 ciliary targeting
causal_link_type: DIRECT
description: >-
Loss of CENP-F function impairs localization of IFT88 and related ciliary
transport components to ciliary axonemes.
evidence:
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Intraflagellar transport protein-88 (IFT-88) colocalised with CENP-F along the ciliary axonemes of renal epithelial cells in age-matched control human fetuses but did not in truncated cilia of mutant CENPF kidneys."
explanation: Human fetal kidney evidence supports CENP-F-dependent IFT88 ciliary targeting.
- target: Cortical neurogenesis impairment
causal_link_type: DIRECT
description: >-
CENP-F interacts with spindle-orientation and cortical polarity machinery,
providing a mechanism for microcephaly.
evidence:
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: IN_VITRO
snippet: "Our data supports a role for CENP-F in asymmetric cell divisions through its putative interactions with p150-dynactin, NuMA and Par3, proteins which have been implicated in this pathway."
explanation: Cell-based interaction data support a CENPF role in asymmetric division relevant to cortical neurogenesis.
- name: Defective CENPF-dependent IFT88 ciliary targeting
description: >-
CENP-F localizes to the ciliary basal body and interacts with IFT88/KIF3B;
mutant CENPF kidneys show short abnormal renal epithelial cilia and loss of
IFT88 localization to ciliary axonemes and centrioles. Zebrafish cenpf
knockdown produces ciliary-function phenotypes including abnormal heart
looping, hydrocephalus, and pronephric cysts.
genes:
- preferred_term: CENPF
term:
id: hgnc:1857
label: CENPF
cell_types:
- preferred_term: kidney epithelial cell
term:
id: CL:0002518
label: kidney epithelial cell
biological_processes:
- preferred_term: intraciliary transport
modifier: ABNORMAL
term:
id: GO:0042073
label: intraciliary transport
- preferred_term: protein localization to cilium
modifier: DECREASED
term:
id: GO:0061512
label: protein localization to cilium
cellular_components:
- preferred_term: cilium
term:
id: GO:0005929
label: cilium
- preferred_term: ciliary basal body
term:
id: GO:0036064
label: ciliary basal body
evidence:
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "IFT88 did not localise to ciliary axonemes and centrioles in mutant CENPF kidneys"
explanation: Mutant human fetal kidney tissue directly supports defective IFT88 ciliary localization.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: "The occurrence of these morphological findings support a role for CENP-F in zebrafish ciliary function."
explanation: Zebrafish knockdown phenotypes support CENP-F function in ciliary biology.
downstream:
- target: Jejunal atresia
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: >-
The ciliary developmental defect is consistent with the core congenital
apple-peel jejunal atresia phenotype.
- target: Microphthalmia
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: Ciliary developmental disruption contributes to ocular malformation.
- target: Abnormal anterior chamber morphology
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: Ciliary developmental disruption contributes to anterior segment anomalies.
- target: Renal hypoplasia
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: Fetal CENPF ciliopathy includes renal developmental hypoplasia.
- target: Hydrocephalus
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: CENPF ciliary dysfunction causes hydrocephalus in the severe developmental spectrum.
- target: Abnormal heart morphology
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: Zebrafish cenpf knockdown supports heart-looping and laterality effects relevant to variable cardiac anomalies.
- name: Cortical neurogenesis impairment
description: >-
CENP-F has a putative role in cortical neurogenesis and asymmetric
division through interactions with spindle-orientation and cortical
polarity proteins; impaired function provides a mechanistic basis for
microcephaly and neurodevelopmental findings.
genes:
- preferred_term: CENPF
term:
id: hgnc:1857
label: CENPF
cell_types:
- preferred_term: neural progenitor cell
term:
id: CL:0011020
label: neural progenitor cell
biological_processes:
- preferred_term: asymmetric cell division
modifier: ABNORMAL
term:
id: GO:0008356
label: asymmetric cell division
- preferred_term: cell division
modifier: ABNORMAL
term:
id: GO:0051301
label: cell division
evidence:
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Our data identify CENPF as a new centriolar disease gene implicated in severe human ciliopathy and microcephaly related phenotypes."
explanation: Human genetic and fetal data support CENPF as a microcephaly-related disease gene.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "MCPH phenotypes have been ascribed to defective asymmetric divisions of neuronal progenitors and failure of correct neural cell fate specification."
explanation: The mechanistic discussion links microcephaly to neuronal progenitor asymmetric division and cell fate specification.
downstream:
- target: Microcephaly
causal_link_type: DIRECT
description: Impaired cortical neurogenesis manifests as congenital microcephaly.
- target: Motor delay
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: Neurodevelopmental disruption contributes to delayed motor milestones.
- target: Intellectual disability
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: Neurodevelopmental disruption contributes to cognitive impairment.
- target: Agenesis of corpus callosum
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: Severe fetal CENPF ciliopathy can include major brain malformations.
- target: Cerebellar vermis hypoplasia
causal_link_type: INDIRECT_UNKNOWN_INTERMEDIATES
description: Severe fetal CENPF ciliopathy can include posterior fossa malformations.
phenotypes:
- name: Microcephaly
description: >-
Microcephaly is a core congenital feature in classic Stromme syndrome and
also appears in the severe fetal CENPF spectrum.
phenotype_term:
preferred_term: Microcephaly
term:
id: HP:0000252
label: Microcephaly
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "A rare multiple congenital anomalies syndrome usually characterized by microcephaly, ocular anomalies such as microphthalmia, and apple-peel intestinal atresia."
explanation: Orphanet identifies microcephaly as part of the usual syndrome characterization.
- reference: PMID:28407396
reference_title: "A further family of Stromme syndrome carrying CENPF mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "A 3-month-old girl was hospitalized due to prenatally diagnosed microcephaly, microphthalmia, and dysmorphological features."
explanation: A CENPF-confirmed family report supports prenatal microcephaly.
- name: Jejunal atresia
description: >-
The classic intestinal manifestation is apple-peel type jejunal or
intestinal atresia.
phenotype_term:
preferred_term: Jejunal atresia
term:
id: HP:0005235
label: Jejunal atresia
evidence:
- reference: PMID:28407396
reference_title: "A further family of Stromme syndrome carrying CENPF mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Stromme syndrome is a rare genetic disorder characterized by microcephaly, anterior ocular chamber anomalies, and \"apple peel\" type jejunal atresia."
explanation: A CENPF family report directly supports apple-peel type jejunal atresia.
- reference: PMID:26820108
reference_title: "Strømme Syndrome Is a Ciliary Disorder Caused by Mutations in CENPF."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "presenting with \"apple peel\" type intestinal atresia, ocular anomalies and microcephaly."
explanation: The discovery cohort supports apple-peel intestinal atresia as part of the core triad.
- name: Microphthalmia
description: Microphthalmia is a recurrent ocular malformation in Stromme syndrome.
phenotype_term:
preferred_term: Microphthalmia
term:
id: HP:0000568
label: Microphthalmia
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "ocular anomalies such as microphthalmia"
explanation: Orphanet identifies microphthalmia among ocular anomalies.
- reference: PMID:18203155
reference_title: "Exclusion of a PAX6, FOXC1, PITX2, and MYCN mutation in another patient with apple peel intestinal atresia, ocular anomalies and microcephaly and review of the literature."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "We describe another patient with the combination of apple peel intestinal atresia, microcephaly, microphthalmia, and anterior eye chamber anomalies."
explanation: This case report directly supports microphthalmia in the clinical syndrome.
- name: Abnormal anterior chamber morphology
description: Anterior chamber anomalies are part of the ocular phenotype.
phenotype_term:
preferred_term: Anterior chamber anomalies
term:
id: HP:0000593
label: Abnormal anterior chamber morphology
evidence:
- reference: PMID:28407396
reference_title: "A further family of Stromme syndrome carrying CENPF mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Stromme syndrome is a rare genetic disorder characterized by microcephaly, anterior ocular chamber anomalies, and \"apple peel\" type jejunal atresia."
explanation: The case report directly identifies anterior ocular chamber anomalies.
- reference: PMID:18203155
reference_title: "Exclusion of a PAX6, FOXC1, PITX2, and MYCN mutation in another patient with apple peel intestinal atresia, ocular anomalies and microcephaly and review of the literature."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "microcephaly, microphthalmia, and anterior eye chamber anomalies."
explanation: The case report supports anterior chamber anomalies in the classic syndrome.
- name: Corneal opacity
description: Corneal clouding can cause major visual impairment.
phenotype_term:
preferred_term: Corneal opacity
term:
id: HP:0007957
label: Corneal opacity
evidence:
- reference: PMID:18203155
reference_title: "Exclusion of a PAX6, FOXC1, PITX2, and MYCN mutation in another patient with apple peel intestinal atresia, ocular anomalies and microcephaly and review of the literature."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "there is major visual impairment due to the corneal clouding."
explanation: This directly supports corneal clouding as the cause of visual impairment.
- name: Visual impairment
description: Visual impairment may be severe when ocular anomalies include corneal clouding.
phenotype_term:
preferred_term: Visual impairment
term:
id: HP:0000505
label: Visual impairment
evidence:
- reference: PMID:18203155
reference_title: "Exclusion of a PAX6, FOXC1, PITX2, and MYCN mutation in another patient with apple peel intestinal atresia, ocular anomalies and microcephaly and review of the literature."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Development so far seems to be normal, although there is major visual impairment due to the corneal clouding."
explanation: This case report directly supports major visual impairment.
- name: Motor delay
description: Motor delay has been reported in affected individuals.
phenotype_term:
preferred_term: Motor delay
term:
id: HP:0001270
label: Motor delay
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Motor delay and intellectual disability have been reported."
explanation: Orphanet reports motor delay in Stromme syndrome.
- name: Intellectual disability
description: Intellectual disability is variably reported in survivors.
phenotype_term:
preferred_term: Intellectual disability
term:
id: HP:0001249
label: Intellectual disability
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Motor delay and intellectual disability have been reported."
explanation: Orphanet reports intellectual disability in Stromme syndrome.
- name: Abnormal heart morphology
description: Cardiac malformations are variably present.
phenotype_term:
preferred_term: Cardiac abnormality
term:
id: HP:0001627
label: Abnormal heart morphology
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Heart, brain, craniofacial abnormalities, renal hypoplasia and other anomalies (e.g. lower limb edema, thrombocytopenia) are variably present."
explanation: Orphanet records variable heart abnormalities.
- name: Renal hypoplasia
subtype: Lethal fetal
description: Bilateral renal hypoplasia is part of the severe fetal CENPF ciliopathy spectrum.
phenotype_term:
preferred_term: Renal hypoplasia
term:
id: HP:0000089
label: Renal hypoplasia
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "bilateral renal hypoplasia"
explanation: Orphanet records bilateral renal hypoplasia in the lethal fetal phenotype.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Autopsy findings revealed ciliopathy features, such as cerebellar vermis hypoplasia, corpus callosum agenesis, cleft palate, duodenal atresia and bilateral renal hypoplasia."
explanation: Human fetal autopsy findings directly support bilateral renal hypoplasia.
- name: Hydrocephalus
subtype: Lethal fetal
description: Hydrocephalus occurs in the severe fetal phenotype.
phenotype_term:
preferred_term: Hydrocephalus
term:
id: HP:0000238
label: Hydrocephalus
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Clinical manifestations include hydrocephalus"
explanation: Orphanet records hydrocephalus in the lethal fetal phenotype.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: MODEL_ORGANISM
snippet: "At 72 hpf, hydrocephalus was observed in cenpf morphants"
explanation: Zebrafish cenpf knockdown supports hydrocephalus as a ciliary-function phenotype.
- name: Cerebellar vermis hypoplasia
subtype: Lethal fetal
description: Cerebellar vermis hypoplasia is reported in the severe fetal phenotype.
phenotype_term:
preferred_term: Cerebellar vermis hypoplasia
term:
id: HP:0001320
label: Cerebellar vermis hypoplasia
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "cerebellar vermis hypoplasia"
explanation: Orphanet records cerebellar vermis hypoplasia in the lethal fetal phenotype.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Autopsy findings revealed ciliopathy features, such as cerebellar vermis hypoplasia, corpus callosum agenesis, cleft palate, duodenal atresia and bilateral renal hypoplasia."
explanation: Human fetal autopsy directly supports cerebellar vermis hypoplasia.
- name: Agenesis of corpus callosum
subtype: Lethal fetal
description: Corpus callosum agenesis is part of the severe fetal brain malformation spectrum.
phenotype_term:
preferred_term: Agenesis of corpus callosum
term:
id: HP:0001274
label: Agenesis of corpus callosum
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "corpus callosum agenesis"
explanation: Orphanet records corpus callosum agenesis in the lethal fetal phenotype.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Autopsy findings revealed ciliopathy features, such as cerebellar vermis hypoplasia, corpus callosum agenesis, cleft palate, duodenal atresia and bilateral renal hypoplasia."
explanation: Human fetal autopsy directly supports corpus callosum agenesis.
- name: Duodenal atresia
subtype: Lethal fetal
description: Complete duodenal atresia is reported in the severe fetal phenotype.
phenotype_term:
preferred_term: Duodenal atresia
term:
id: HP:0002247
label: Duodenal atresia
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "duodenal atresia"
explanation: Orphanet records duodenal atresia in the lethal fetal phenotype.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Examination of a dissected gastrointestinal tract from the same affected fetus revealed complete duodenal atresia."
explanation: Human fetal autopsy directly supports complete duodenal atresia.
- name: Intestinal malrotation
subtype: Lethal fetal
description: Gastrointestinal malrotation is reported in the severe fetal phenotype.
phenotype_term:
preferred_term: Intestinal malrotation
term:
id: HP:0002566
label: Intestinal malrotation
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "gastrointestinal malrotation"
explanation: Orphanet records gastrointestinal malrotation in the lethal fetal phenotype.
- name: Hypertelorism
description: Hypertelorism is among reported dysmorphic craniofacial features.
phenotype_term:
preferred_term: Hypertelorism
term:
id: HP:0000316
label: Hypertelorism
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Facial dysmorphism is reported in some cases and may include narrow or sloped forehead, hypertelorism, microphthalmia"
explanation: Orphanet records hypertelorism among reported facial features.
- name: Low-set ears
description: Low-set ears are reported in the severe fetal and classic dysmorphic spectra.
phenotype_term:
preferred_term: Low-set ears
term:
id: HP:0000369
label: Low-set ears
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "low-set ears"
explanation: Orphanet records low-set ears in the severe fetal phenotype.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "dysmorphic craniofacial features such as a high nasal bridge, short columella, micrognathia, wide mouth and low-set ears."
explanation: Human fetal morphology directly supports low-set ears.
- name: Wide nasal bridge
description: A broad nasal root or high/wide nasal bridge is part of the craniofacial phenotype.
phenotype_term:
preferred_term: Broad nasal root
term:
id: HP:0000431
label: Wide nasal bridge
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "broad nasal root"
explanation: Orphanet records broad nasal root among reported facial features.
- name: Anteverted nares
description: Anteverted or broad nasal tip is reported in the craniofacial spectrum.
phenotype_term:
preferred_term: Anteverted nares
term:
id: HP:0000463
label: Anteverted nares
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "anteverted or broad nasal tip"
explanation: Orphanet records anteverted or broad nasal tip.
- name: Long philtrum
description: Long philtrum is among reported facial dysmorphic features.
phenotype_term:
preferred_term: Long philtrum
term:
id: HP:0000343
label: Long philtrum
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "long philtrum"
explanation: Orphanet records long philtrum among reported facial features.
- name: Micrognathia
description: Micrognathia is reported in both classic and severe fetal records.
phenotype_term:
preferred_term: Micrognathia
term:
id: HP:0000347
label: Micrognathia
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "micrognathia"
explanation: Orphanet records micrognathia among reported facial features.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "dysmorphic craniofacial features such as a high nasal bridge, short columella, micrognathia, wide mouth and low-set ears."
explanation: Human fetal morphology directly supports micrognathia.
- name: Wide mouth
description: Large or wide mouth is reported in the craniofacial phenotype.
phenotype_term:
preferred_term: Wide mouth
term:
id: HP:0000154
label: Wide mouth
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "large mouth"
explanation: Orphanet records large mouth among reported facial features.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "dysmorphic craniofacial features such as a high nasal bridge, short columella, micrognathia, wide mouth and low-set ears."
explanation: Human fetal morphology directly supports wide mouth.
- name: Cleft palate
subtype: Lethal fetal
description: Cleft palate is part of the severe fetal craniofacial phenotype.
phenotype_term:
preferred_term: Cleft palate
term:
id: HP:0000175
label: Cleft palate
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "cleft palate"
explanation: Orphanet records cleft palate in the severe fetal phenotype.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Autopsy findings revealed ciliopathy features, such as cerebellar vermis hypoplasia, corpus callosum agenesis, cleft palate, duodenal atresia and bilateral renal hypoplasia."
explanation: Human fetal autopsy directly supports cleft palate.
- name: Prominent nose
subtype: Lethal fetal
description: Prominent nose is reported in the severe fetal craniofacial phenotype.
phenotype_term:
preferred_term: Prominent nose
term:
id: HP:0000448
label: Prominent nose
evidence:
- reference: ORPHA:444069
reference_title: "Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "prominent nose"
explanation: Orphanet records prominent nose in the severe fetal phenotype.
- name: Macrotia
description: Large ears are among reported facial features.
phenotype_term:
preferred_term: Large ears
term:
id: HP:0000400
label: Macrotia
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "large or low set ears"
explanation: Orphanet records large or low-set ears among reported facial features.
- name: Lower limb edema
description: Lower limb edema is variably reported.
phenotype_term:
preferred_term: Lower limb edema
term:
id: HP:0000969
label: Edema
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "lower limb edema"
explanation: Orphanet records lower limb edema among variable anomalies.
- name: Thrombocytopenia
description: Thrombocytopenia is among variable reported anomalies.
phenotype_term:
preferred_term: Thrombocytopenia
term:
id: HP:0001873
label: Thrombocytopenia
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "thrombocytopenia"
explanation: Orphanet records thrombocytopenia among variable anomalies.
histopathology:
- name: Short renal epithelial cilia with IFT88 mislocalization
description: >-
Mutant CENPF fetal kidneys show short abnormal cilia on renal epithelial
cells and loss of IFT88 localization to ciliary axonemes and centrioles,
supporting a tissue-level ciliopathy mechanism.
evidence:
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "GT335-positive cilia are shorter than cilia in control kidneys."
explanation: Human fetal kidney immunofluorescence supports short renal epithelial cilia.
- reference: PMID:25564561
reference_title: "The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "IFT88 did not localise to ciliary axonemes and centrioles in mutant CENPF kidneys"
explanation: Human fetal kidney immunofluorescence supports IFT88 mislocalization.
biochemical: []
environmental: []
treatments:
- name: Symptom-directed supportive care
description: >-
Management is supportive and multidisciplinary, directed at the congenital
gastrointestinal, ocular, neurologic, renal, cardiac, and craniofacial
manifestations present in an individual child.
treatment_term:
preferred_term: supportive care
term:
id: MAXO:0000950
label: supportive care
target_phenotypes:
- preferred_term: Jejunal atresia
term:
id: HP:0005235
label: Jejunal atresia
- preferred_term: Microphthalmia
term:
id: HP:0000568
label: Microphthalmia
- preferred_term: Microcephaly
term:
id: HP:0000252
label: Microcephaly
evidence:
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Heart, brain, craniofacial abnormalities, renal hypoplasia and other anomalies (e.g. lower limb edema, thrombocytopenia) are variably present."
explanation: The multisystem variable phenotype supports symptom-directed multidisciplinary care.
- name: Genetic counseling
description: >-
Genetic counseling addresses autosomal recessive inheritance, carrier
testing for parents and relatives, recurrence risk, prenatal diagnostic
options, and genotype-informed counseling for the severe fetal spectrum.
treatment_term:
preferred_term: genetic counseling
term:
id: MAXO:0000079
label: genetic counseling
evidence:
- reference: PMID:26820108
reference_title: "Strømme Syndrome Is a Ciliary Disorder Caused by Mutations in CENPF."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Compound heterozygous inheritance was confirmed in both families."
explanation: Confirmed familial biallelic inheritance supports recurrence-risk counseling.
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "Autosomal recessive"
explanation: Orphanet inheritance supports genetic counseling for affected families.
diagnosis:
- name: Clinical whole-exome sequencing
description: >-
Exome sequencing or equivalent molecular genetic testing can identify
biallelic pathogenic CENPF variants in patients or fetuses with the
Stromme syndrome phenotype.
diagnosis_term:
preferred_term: clinical whole-exome sequencing
term:
id: MAXO:0009004
label: clinical whole-exome sequencing
evidence:
- reference: PMID:26820108
reference_title: "Strømme Syndrome Is a Ciliary Disorder Caused by Mutations in CENPF."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Using family-based whole-exome sequencing, we identified truncating mutations in the centrosome gene CENPF in the two nonconsanguineous Caucasian sibling pairs."
explanation: This directly supports exome sequencing as a molecular diagnostic approach.
- reference: PMID:28407396
reference_title: "A further family of Stromme syndrome carrying CENPF mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Exome-sequencing of these two cases showed the homozygous mutation (c.5912_5913insA)/(p.T1974Nfs*9) in CENPF."
explanation: Independent cases support exome sequencing for CENPF variant detection.
- name: Clinical assessment of the congenital triad
description: >-
Clinical and prenatal assessment should consider the combination of
microcephaly, ocular anomalies, and apple-peel intestinal or jejunal
atresia, with evaluation for renal, cardiac, neurologic, and craniofacial
involvement.
diagnosis_term:
preferred_term: clinical assessment
term:
id: MAXO:0000487
label: clinical assessment
evidence:
- reference: PMID:28407396
reference_title: "A further family of Stromme syndrome carrying CENPF mutation."
supports: SUPPORT
evidence_source: HUMAN_CLINICAL
snippet: "Regarding the clinical features of both affected siblings, a diagnosis of Stromme syndrome was established."
explanation: The report supports clinical diagnosis based on the recurrent feature pattern.
- reference: ORPHA:506307
reference_title: "Stromme syndrome (Orphanet structured-database record)"
supports: SUPPORT
evidence_source: OTHER
snippet: "A rare multiple congenital anomalies syndrome usually characterized by microcephaly, ocular anomalies such as microphthalmia, and apple-peel intestinal atresia."
explanation: Orphanet provides the key clinical pattern for assessment.
clinical_trials: []
references:
- reference: ORPHA:506307
title: Stromme syndrome
findings:
- statement: >-
Orphanet provides the structured Stromme syndrome definition,
inheritance, antenatal onset, prevalence, CENPF gene association, and
cross-references.
supporting_text: "CENPF | centromere protein F | hgnc:1857 | Disease-causing germline mutation(s) in"
- reference: ORPHA:444069
title: Lethal fetal brain malformation-duodenal atresia-bilateral renal hypoplasia syndrome
findings:
- statement: >-
Orphanet provides the severe fetal CENPF-associated ciliopathy spectrum.
supporting_text: "A rare genetic lethal multiple congenital anomalies/dysmorphic syndrome characterized by mid-gestation lethality and features of a ciliopathy."
- reference: PMID:26820108
title: Strømme Syndrome Is a Ciliary Disorder Caused by Mutations in CENPF.
findings:
- statement: >-
Family-based exome sequencing identified truncating CENPF variants in
Stromme syndrome sibling pairs and established autosomal recessive CENPF
disease.
supporting_text: "Using family-based whole-exome sequencing, we identified truncating mutations in the centrosome gene CENPF in the two nonconsanguineous Caucasian sibling pairs."
- reference: PMID:28407396
title: A further family of Stromme syndrome carrying CENPF mutation.
findings:
- statement: >-
An independent affected sibling family carried a homozygous truncating
frameshift CENPF mutation and showed the classic Stromme syndrome triad.
supporting_text: "we report a Stromme syndrome family with two affected siblings with a homozygous truncating frameshift mutation in CENPF."
- reference: PMID:18203155
title: Exclusion of a PAX6, FOXC1, PITX2, and MYCN mutation in another patient with apple peel intestinal atresia, ocular anomalies and microcephaly and review of the literature.
findings:
- statement: >-
A pre-CENPF case report supports the classic apple-peel intestinal
atresia, microcephaly, microphthalmia, anterior chamber anomaly, and
corneal clouding phenotype.
supporting_text: "We describe another patient with the combination of apple peel intestinal atresia, microcephaly, microphthalmia, and anterior eye chamber anomalies."
- reference: PMID:25564561
title: The kinetochore protein, CENPF, is mutated in human ciliopathy and microcephaly phenotypes.
findings:
- statement: >-
CENPF variants segregated with severe fetal ciliopathy and microcephaly,
and mechanistic data support CENP-F roles in IFT88 ciliary targeting,
ciliary function, and cortical neurogenesis.
supporting_text: "CONCLUSIONS: Our data identify CENPF as a new centriolar disease gene implicated in severe human ciliopathy and microcephaly related phenotypes."
notes: >-
ORPHA:506307 is the primary structured Stromme syndrome record. ORPHA:444069
is modeled here as a severe fetal CENPF ciliopathy spectrum rather than as a
separate disorder entry because MONDO:0009477 aggregates both Orphanet
cross-references under Stromme syndrome.
This fallback artifact supports curation of Stromme syndrome, represented by MONDO:0009477 and structured Orphanet records ORPHA:506307 and ORPHA:444069.
just research-disorder openai Stromme_Syndrome was started and remained
silent after the startup line for about 60 seconds. The process was
terminated with signal 15 before producing an OpenAI provider artifact.timeout 60s just research-disorder falcon Stromme_Syndrome was terminated
by the timeout (signal 15 / exit 124) before producing a Falcon provider
artifact.The curation was completed from structured Orphanet rows and cached PubMed evidence to avoid blocking on provider availability.