Cumulative ligand activity of NODAL mutations and modifiers are linked to human heart defects and holoprosencephaly

Mol Genet Metab. 2009 Sep-Oct;98(1-2):225-34. doi: 10.1016/j.ymgme.2009.05.005. Epub 2009 May 27.


The cyclopic and laterality phenotypes in model organisms linked to disturbances in the generation or propagation of Nodal-like signals are potential examples of similar impairments resulting in birth defects in humans. However, the types of gene mutation(s) and their pathogenetic combinations in humans are poorly understood. Here we describe a mutational analysis of the human NODAL gene in a large panel of patients with phenotypes compatible with diminished NODAL ligand function. Significant reductions in the biological activity of NODAL alleles are detected among patients with congenital heart defects (CHD), laterality anomalies (e.g. left-right mis-specification phenotypes), and only rarely holoprosencephaly (HPE). While many of these NODAL variants are typical for family-specific mutations, we also report the presence of alleles with significantly reduced activity among common population variants. We propose that some of these common variants act as modifiers and contribute to the ultimate phenotypic outcome in these patients; furthermore, we draw parallels with strain-specific modifiers in model organisms to bolster this interpretation.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Alleles
  • Amino Acid Sequence
  • Family
  • Growth Differentiation Factor 1 / chemistry
  • Heart Defects, Congenital / complications*
  • Heart Defects, Congenital / genetics*
  • Holoprosencephaly / complications*
  • Holoprosencephaly / genetics*
  • Humans
  • Ligands
  • Molecular Sequence Data
  • Mutation / genetics*
  • Nodal Protein / chemistry
  • Nodal Protein / genetics*
  • Polymorphism, Genetic
  • Protein Structure, Tertiary
  • Sequence Homology, Amino Acid
  • Signal Transduction
  • Transforming Growth Factor beta / chemistry


  • GDF1 protein, human
  • Growth Differentiation Factor 1
  • Ligands
  • NODAL protein, human
  • Nodal Protein
  • Transforming Growth Factor beta

Associated data

  • RefSeq/NM_001492
  • RefSeq/NM_018055