Identification of a HOXD13 mutation in a VACTERL patient

Am J Med Genet A. 2008 Dec 15;146A(24):3181-5. doi: 10.1002/ajmg.a.32426.


VACTERL acronym is assigned to a non-random association of malformations in humans with poorly known etiology. It is comprised of vertebral defects (V), anal atresia (A), cardiac anomaly (C), tracheoesophageal fistula with esophageal atresia (TE), renal dysplasia (R) and limb lesions (L). Here, we report on, for the first time, a female patient with VACTERL association with a 21 base-pair deletion in the exon 1 triplet repeats of HOXD13, a sonic hedgehog (SHH) downstream target. Our data provide the first piece of clinical evidence of the implication of the SHH pathway in VACTERL. Moreover, HOXD13 may not only be implicated in limb malformations but also in the development of gut and genitourinary structures, as predicted from the mouse models.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abnormalities, Multiple / diagnostic imaging
  • Abnormalities, Multiple / genetics*
  • Adolescent
  • Amino Acid Sequence
  • Anus, Imperforate / complications
  • Anus, Imperforate / genetics
  • Base Sequence
  • DNA Mutational Analysis
  • Esophageal Atresia / complications
  • Esophageal Atresia / genetics
  • Female
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / genetics
  • Homeodomain Proteins / genetics*
  • Humans
  • Limb Deformities, Congenital / complications
  • Limb Deformities, Congenital / diagnostic imaging
  • Limb Deformities, Congenital / genetics
  • Molecular Sequence Data
  • Mutation / genetics*
  • Radiography
  • Syndrome
  • Tracheoesophageal Fistula / complications
  • Tracheoesophageal Fistula / genetics
  • Transcription Factors / genetics*


  • HOXD13 protein, human
  • Homeodomain Proteins
  • Transcription Factors