ALGS is an
autosomal dominant multi-system disorder affecting several body systems including the
liver,
heart,
skeleton,
eye, facial structure,
kidneys and
vascular system. The most clinically significant concerns stem from liver, heart, vascular or renal problems. Mutations in
JAG1 were first discovered to be responsible for ALGS by researchers at
The Children's Hospital of Philadelphia and the
National Institutes of Health in 1997. Over half of individuals with mutations in the gene did not inherit it from either parent, and thus have a
de novo mutation.
JAG1 mutation types include protein truncating (
splice site,
frameshift, and
nonsense),
missense, and whole gene deletions accounting for 80%, 7%, and 12% respectively. Since all mutation types lead to a patient phenotype, it is thought that
haploinsufficiency for
JAG1 is the likely disease mechanism of action. Although individuals can have a range of mutation types in
JAG1, all of the known mutations lead to loss of the function of one copy, and, there is no correlation between mutation type or location and disease severity. Though individuals with ALGS have several body systems affected, there is a subset of individuals with
JAG1 mutations who present with
tetralogy of fallot/
pulmonary stenosis that do not show the other clinical signs of the syndrome. Given the variable expressivity of the disease, there may be other genetic or environmental modifiers present beyond the original
JAG1 mutation. More recently,
JAG1 expression changes have been implicated in many types of cancer. Specifically, up regulation of JAG1 has been correlated with both poor overall breast cancer survival rates and an enhancement of tumor proliferation in adrenocortical carcinoma patients. ==See also==