Mutations in the human UBR1 gene and the associated phenotypic spectrum

Hum Mutat. 2014 May;35(5):521-31. doi: 10.1002/humu.22538. Epub 2014 Apr 9.


Johanson-Blizzard syndrome (JBS) is a rare, autosomal recessive disorder characterized by exocrine pancreatic insufficiency, typical facial features, dental anomalies, hypothyroidism, sensorineural hearing loss, scalp defects, urogenital and anorectal anomalies, short stature, and cognitive impairment of variable degree. This syndrome is caused by a defect of the E3 ubiquitin ligase UBR1, which is part of the proteolytic N-end rule pathway. Herein, we review previously reported (n = 29) and a total of 31 novel UBR1 mutations in relation to the associated phenotype in patients from 50 unrelated families. Mutation types include nonsense, frameshift, splice site, missense, and small in-frame deletions consistent with the hypothesis that loss of UBR1 protein function is the molecular basis of JBS. There is an association of missense mutations and small in-frame deletions with milder physical abnormalities and a normal intellectual capacity, thus suggesting that at least some of these may represent hypomorphic UBR1 alleles. The review of clinical data of a large number of molecularly confirmed JBS cases allows us to define minimal clinical criteria for the diagnosis of JBS. For all previously reported and novel UBR1 mutations together with their clinical data, a mutation database has been established at LOVD.

Keywords: Johanson-Blizzard syndrome; UBR1; aplasia of alae nasi; cognitive impairment; exocrine pancreatic insufficiency.

Publication types

  • Review

MeSH terms

  • Abnormalities, Multiple / genetics
  • Abnormalities, Multiple / pathology
  • Anus, Imperforate / genetics*
  • Anus, Imperforate / pathology
  • Databases, Genetic
  • Dwarfism / genetics
  • Dwarfism / pathology
  • Ectodermal Dysplasia / genetics*
  • Ectodermal Dysplasia / pathology
  • Growth Disorders / genetics*
  • Growth Disorders / pathology
  • Hearing Loss, Sensorineural / genetics*
  • Hearing Loss, Sensorineural / pathology
  • Humans
  • Hypothyroidism / genetics*
  • Hypothyroidism / pathology
  • Intellectual Disability / genetics*
  • Intellectual Disability / pathology
  • Mutation / genetics*
  • Nose / abnormalities*
  • Nose / pathology
  • Pancreatic Diseases / genetics*
  • Pancreatic Diseases / pathology
  • Phenotype
  • Ubiquitin-Protein Ligases / genetics*


  • UBR1 protein, human
  • Ubiquitin-Protein Ligases

Supplementary concepts

  • Johanson Blizzard syndrome