Autosomal recessive cutis laxa type 1

disease
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Also known as ARCL1autosomal recessive cutis laxa with severe systemic involvementautosomal recessive cutis laxa, pulmonary emphysema typecutis laxa, autosomal recessive type 1cutis laxa, type 1

Summary

Autosomal recessive cutis laxa type 1 (MONDO:0019572) is a disease caused by EFEMP1 (GenCC Strong), with 3 cohort genes. The dominant Reactome pathway is Molecules associated with elastic fibres (3 cohort genes).

At a glance

  • Prevalence: <1 / 1 000 000 (Worldwide) [Orphanet-validated]
  • Causal gene: EFEMP1 (GenCC Strong)
  • Cohort genes: 3
  • ClinVar variants: 1
  • Phenotypes (HPO): 37

Clinical features

Epidemiology

Prevalence records

2 prevalence record(s), Orphanet:

TypeClassValueGeographyValidation
Cases/families60WorldwideValidated
Point prevalence<1 / 1 000 000WorldwideValidated

Signs & symptoms

Clinical features (HPO)

37 HPO clinical features (Orphanet curated; top 37 by frequency):

HPO IDTermFrequency
HP:0000973Cutis laxaObligate (100%)
HP:0001582Redundant skinVery frequent (80-99%)
HP:0002097EmphysemaVery frequent (80-99%)
HP:0010750DermatochalasisVery frequent (80-99%)
HP:0025167Fragmented elastic fibers in the dermisVery frequent (80-99%)
HP:0100679Lack of skin elasticityVery frequent (80-99%)
HP:0001382Joint hypermobilityFrequent (30-79%)
HP:0000023Inguinal herniaFrequent (30-79%)
HP:0000271Abnormality of the faceFrequent (30-79%)
HP:0001270Motor delayFrequent (30-79%)
HP:0001511Intrauterine growth retardationFrequent (30-79%)
HP:0001635Congestive heart failureFrequent (30-79%)
HP:0001999Abnormal facial shapeFrequent (30-79%)
HP:0002093Respiratory insufficiencyFrequent (30-79%)
HP:0002107PneumothoraxFrequent (30-79%)
HP:0002756Pathologic fractureFrequent (30-79%)
HP:0004426Abnormality of the cheekFrequent (30-79%)
HP:0004969Peripheral pulmonary artery stenosisFrequent (30-79%)
HP:0011004Abnormal systemic arterial morphologyFrequent (30-79%)
HP:0030680Abnormal cardiovascular system morphologyFrequent (30-79%)
HP:0032153Joint subluxationFrequent (30-79%)
HP:0045027Abnormality of the thoracic cavityFrequent (30-79%)
HP:0100790HerniaFrequent (30-79%)
HP:0000010Recurrent urinary tract infectionsOccasional (5-29%)
HP:0000076Vesicoureteral refluxOccasional (5-29%)
HP:0000929Abnormal skull morphologyOccasional (5-29%)
HP:0002021Pyloric stenosisOccasional (5-29%)
HP:0002256Small bowel diverticulaOccasional (5-29%)
HP:0002617DilatationOccasional (5-29%)
HP:0002827Hip dislocationOccasional (5-29%)
HP:0004381Supravalvular aortic stenosisOccasional (5-29%)
HP:0006532Recurrent pneumoniaOccasional (5-29%)
HP:0006698Dilatation of the ventricular cavityOccasional (5-29%)
HP:0008722Urethral diverticulumOccasional (5-29%)
HP:0012330PyelonephritisOccasional (5-29%)
HP:0012619Multiple bladder diverticulaOccasional (5-29%)
HP:0030872Abnormal cardiac ventricular functionOccasional (5-29%)

Identifiers

Disease identifiers

FieldValue
Canonical nameautosomal recessive cutis laxa type 1
Mondo IDMONDO:0019572
MeSHC536225
Orphanet90349
DOIDDOID:0070144
SNOMED CT254222002
UMLSC0268351
MedGen78663
GARD0008480
Is cancer (heuristic)no

Also known as: ARCL1 · autosomal recessive cutis laxa type 1 · autosomal recessive cutis laxa with severe systemic involvement · autosomal recessive cutis laxa, pulmonary emphysema type · cutis laxa, autosomal recessive type 1 · cutis laxa, type 1

Data availability: 1 ClinVar variant · 3 GenCC gene-disease records.

Disease family

An umbrella term covering 3 Mondo subtypes.

Classification path: disease › human disease › disease by etiologic mechanism › disease of genetic or genomic mechanism › hereditary disease › autosomal genetic disease › autosomal recessive diseaseautosomal recessive cutis laxa type 1

Related subtypes (218): immunodeficiency-centromeric instability-facial anomalies syndrome, hypercalcemia, infantile, Ochoa syndrome, autosomal recessive Ehlers-Danlos syndrome, vascular type, hydrolethalus syndrome, 3-M syndrome, isolated hyperchlorhidrosis, dacryocystitis-osteopoikilosis syndrome, Hutchinson-Gilford progeria syndrome, achalasia microcephaly syndrome, acrorenal syndrome, autosomal recessive, beta-ketothiolase deficiency, autosomal recessive Alport syndrome, Alstrom syndrome, microphthalmia with limb anomalies, camptodactyly-arthropathy-coxa vara-pericarditis syndrome, Behr syndrome, bifid nose, autosomal recessive, Bloom syndrome, Bowen-Conradi syndrome, camptodactyly with fibrous tissue hyperplasia and skeletal dysplasia, heart defects-limb shortening syndrome, autosomal recessive palmoplantar keratoderma and congenital alopecia, COFS syndrome, craniometaphyseal dysplasia, autosomal recessive, Fraser syndrome, cystic fibrosis, polycystic lipomembranous osteodysplasia with sclerosing leukoencephaly, persistent hyperplastic primary vitreous, autosomal recessive, Donnai-Barrow syndrome, Schöpf-Schulz-Passarge syndrome, cleft lip/palate-ectodermal dysplasia syndrome, Ellis-van Creveld syndrome, Wolcott-Rallison syndrome, autosomal recessive faciodigitogenital syndrome, acromesomelic dysplasia 2B, brittle cornea syndrome, triple-A syndrome, autosomal recessive humeroradial synostosis, multinucleated neurons-anhydramnios-renal dysplasia-cerebellar hypoplasia-hydranencephaly syndrome, hydrocephalus, nonsyndromic, autosomal recessive 1, autosomal recessive hydrocephalus due to congenital stenosis of aqueduct of Sylvius, hypertelorism, microtia, facial clefting syndrome, hypoparathyroidism-retardation-dysmorphism syndrome, Vici syndrome, Johanson-Blizzard syndrome, autosomal recessive Kenny-Caffey syndrome, Papillon-Lefevre disease, Haim-Munk syndrome, Laurence-Moon syndrome, Donohue syndrome, lipase deficiency, combined, autosomal recessive familial Mediterranean fever, thiamine-responsive megaloblastic anemia syndrome, cartilage-hair hypoplasia, Nijmegen breakage syndrome, pseudo-TORCH syndrome, Galloway-Mowat syndrome, mulibrey nanism, myotonia congenita, autosomal recessive, Schwartz-Jampel syndrome, proteosome-associated autoinflammatory syndrome, Netherton syndrome, Niemann-Pick disease type A, oculodentodigital dysplasia, autosomal recessive, odonto-onycho-dermal dysplasia, autosomal recessive omodysplasia, osteoporosis-pseudoglioma syndrome, Shwachman-Diamond syndrome, phenylketonuria, Bjornstad syndrome, Laron syndrome, autosomal recessive polycystic kidney disease, autosomal recessive inherited pseudoxanthoma elasticum, autosomal recessive multiple pterygium syndrome, rapadilino syndrome, short-rib thoracic dysplasia 9 with or without polydactyly, autosomal recessive Robinow syndrome, Sjogren-Larsson syndrome, scapuloperoneal spinal muscular atrophy, autosomal recessive, spondyloepiphyseal dysplasia tarda, autosomal recessive, inherited threoninemia, Pendred syndrome, autosomal recessive spondylocostal dysostosis, Werner syndrome, ABCD syndrome, Naxos disease, autosomal recessive amelia, human HOXA1 syndromes, sickle cell disease, autosomal recessive proximal renal tubular acidosis, hyper-IgM syndrome type 2, temtamy preaxial brachydactyly syndrome, TH-deficient dopa-responsive dystonia, craniosynostosis syndrome, autosomal recessive, Niemann-Pick disease type B, skin fragility-woolly hair-palmoplantar keratoderma syndrome, CoQ-responsive OXPHOS deficiency, familial adenomatous polyposis 2, Pierson syndrome, palmoplantar keratoderma-XX sex reversal-predisposition to squamous cell carcinoma syndrome, cardiomyopathy-hypotonia-lactic acidosis syndrome, PHARC syndrome, Kahrizi syndrome, cutis laxa with severe pulmonary, gastrointestinal and urinary anomalies, congenital prothrombin deficiency, immunodeficiency 31B, dyskeratosis congenita, autosomal recessive 2, dyskeratosis congenita, autosomal recessive 3, Nestor-Guillermo progeria syndrome, leukoencephalopathy with calcifications and cysts, mitochondrial pyruvate carrier deficiency, branched-chain keto acid dehydrogenase kinase deficiency, dyskeratosis congenita, autosomal recessive 5, hypohidrosis-enamel hypoplasia-palmoplantar keratoderma-intellectual disability syndrome, alacrima, achalasia, and intellectual disability syndrome, hyperlipoproteinemia, type 1D, microcephaly and chorioretinopathy 2, congenital stationary night blindness 1G, combined oxidative phosphorylation deficiency 29, hypermanganesemia with dystonia 2, growth retardation, intellectual developmental disorder, hypotonia, and hepatopathy, gnb5-related intellectual disability-cardiac arrhythmia syndrome, autosomal recessive spastic paraplegia type 78, autosomal recessive limb-girdle muscular dystrophy, Bardet-Biedl syndrome, autosomal recessive cerebellar ataxia, neuronopathy, distal hereditary motor, autosomal recessive, UV-sensitive syndrome, Ehlers-Danlos syndrome, kyphoscoliotic type 1, Cockayne syndrome, hyperphenylalaninemia due to tetrahydrobiopterin deficiency, leukoencephalopathy-palmoplantar keratoderma syndrome, autosomal recessive hypohidrotic ectodermal dysplasia, Warburg micro syndrome, autosomal recessive primary microcephaly, autosomal recessive progressive external ophthalmoplegia, Meier-Gorlin syndrome, autosomal recessive sideroblastic anemia, autosomal recessive intermediate Charcot-Marie-Tooth disease, Perrault syndrome, autosomal recessive hypophosphatemic rickets, de Barsy syndrome, leukocyte adhesion deficiency, Senior-Loken syndrome, autosomal recessive spastic ataxia, childhood-onset autosomal recessive myopathy with external ophthalmoplegia, autosomal recessive cerebral atrophy, GM3 synthase deficiency, autosomal recessive distal renal tubular acidosis, pigmentation defects-palmoplantar keratoderma-skin carcinoma syndrome, autosomal recessive brachyolmia, Aicardi-Goutieres syndrome, homocystinuria without methylmalonic aciduria, Niemann-Pick disease type C, nephronophthisis, autosomal recessive osteopetrosis, peroxisome biogenesis disorder, congenital non-bullous ichthyosiform erythroderma, Seckel syndrome, Usher syndrome, autosomal recessive cutis laxa type 2, hearing loss, autosomal recessive, microcephaly, growth restriction, and increased sister chromatid exchange 2, encephalopathy, progressive, early-onset, with brain edema and/or leukoencephalopathy, 1, congenital vertebral-cardiac-renal anomalies syndrome, hair defect with photosensitivity and intellectual disability syndrome, autosomal recessive severe congenital neutropenia, severe combined immunodeficiency due to CARMIL2 deficiency, extraoral halitosis due to methanethiol oxidase deficiency, neurodevelopmental disorder with microcephaly, impaired language, epilepsy, and gait abnormalities, mitochondrial complex 2 deficiency, nuclear type 3, mitochondrial complex 2 deficiency, nuclear type 4, mismatch repair cancer syndrome, spondyloepimetaphyseal dysplasia with joint laxity, type 3, Kilquist syndrome, Duane anomaly-myopathy-scoliosis syndrome, autosomal recessive axonal charcot-marie-tooth disease due to copper metabolism defect, immune dysregulation-inflammatory bowel disease-arthritis-recurrent infections-lymphopenia syndrome, optic atrophy-ataxia-peripheral neuropathy-global developmental delay syndrome, congenital myopathy with reduced type 2 muscle fibers, NAD(P)HX dehydratase deficiency, autosomal recessive ocular albinism, ichthyosis linearis circumflexa, eosinophil peroxidase deficiency, hyperphenylalaninemia due to DNAJC12 deficiency, autosomal recessive epidermolytic ichthyosis, Ehlers-Danlos syndrome, classic-like, 2, joint laxity, short stature, and myopia, HELIX syndrome, auditory neuropathy-optic atrophy syndrome, glycosylphosphatidylinositol biosynthesis defect 15, neurodegeneration, childhood-onset, stress-induced, with variable ataxia and seizures, SCN4A-related myopathy, autosomal recessive, Uner Tan Syndrome, nephropathic cystinosis, Imerslund-Grasbeck syndrome type 1, Imerslund-Grasbeck syndrome type 2, permanent neonatal diabetes mellitus 1, growth hormone insensitivity with immune dysregulation 1, autosomal recessive, Rajab interstitial lung disease with brain calcifications 1, Roberts-SC phocomelia syndrome, neurodevelopmental disorder with microcephaly, impaired language, and gait abnormalities, RPE65-related recessive retinopathy, GUCY2D-related recessive retinopathy, autosomal recessive titinopathy, intellectual disability, autosomal recessive, ALPL-related autosomal recessive hypophosphatasia, spastic paraplegia 18b, autosomal recessive, CEP164-related ciliopathy, RP1-related recessive retinopathy, pseudohypoaldosteronism, type IB2, autosomal recessive, pseudohypoaldosteronism, type IB3, autosomal recessive, spastic paraplegia 30B, autosomal recessive, cerebral arteriopathy, autosomal recessive, with subcortical infarcts and leukoencephalopathy 1, brain small vessel disease 2B, autosomal recessive, IMPG1-related recessive retinopathy, PROM1-related recessive retinopathy

Subtypes (3): cutis laxa, autosomal recessive, type 1A, cutis laxa, autosomal recessive, type 1B, cutis laxa, autosomal recessive, type 1d

Genetics & variants

GWAS landscape

No GWAS associations recorded — common-variant (GWAS) studies don’t cover this disease (typical for Mendelian / rare diseases). See the curated gene cohort and Mendelian overlap below.

Variant details and genetic-evidence tiers

ClinVar germline variants

1 retrieved; paginated sample, class counts are floors:

1 uncertain significance

ClinVarVariant (HGVS)GeneClassificationReview
2607609NM_006329.4(FBLN5):c.910A>G (p.Thr304Ala)FBLN5Uncertain significancecriteria provided, multiple submitters, no conflicts

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 36 · Orphanet: 8 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

GenCC gene–disease validity (cohort genes)

the Disease column is the GenCC-asserted condition — a cohort gene’s strongest validity may be for a related predisposition syndrome.

GeneClassificationInheritanceDiseaseRecords
EFEMP2DefinitiveAutosomal recessivecutis laxa, autosomal recessive, type 1B9
FBLN5DefinitiveAutosomal recessivecutis laxa, autosomal recessive, type 1A14
EFEMP1StrongAutosomal recessiveautosomal recessive cutis laxa type 113

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
FBLN5Orphanet:280598Hereditary sensorimotor neuropathy with hyperelastic skin
FBLN5Orphanet:90348Autosomal dominant cutis laxa
FBLN5Orphanet:90349Autosomal recessive cutis laxa type 1
EFEMP1Orphanet:75376Familial drusen
EFEMP1Orphanet:98977Juvenile glaucoma
EFEMP2Orphanet:314718Lethal arteriopathy syndrome due to fibulin-4 deficiency
EFEMP2Orphanet:90349Autosomal recessive cutis laxa type 1
EFEMP2Orphanet:91387Familial thoracic aortic aneurysm and aortic dissection

Cohort genes → proteins

3 cohort genes, 3 distinct canonical proteins.

Evidence partition

SubsetGenes
multi_evidence3

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
FBLN5HGNC:3602ENSG00000140092Q9UBX5Fibulin-5gencc,clinvar
EFEMP1HGNC:3218ENSG00000115380Q12805EGF-containing fibulin-like extracellular matrix protein 1gencc
EFEMP2HGNC:3219ENSG00000172638O95967EGF-containing fibulin-like extracellular matrix protein 2gencc

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
FBLN5Fibulin-5Essential for elastic fiber formation, is involved in the assembly of continuous elastin (ELN) polymer and promotes the interaction of microfibrils and ELN.
EFEMP1EGF-containing fibulin-like extracellular matrix protein 1Binds EGFR, the EGF receptor, inducing EGFR autophosphorylation and the activation of downstream signaling pathways.
EFEMP2EGF-containing fibulin-like extracellular matrix protein 2Plays a crucial role in elastic fiber formation in tissue, and in the formation of ultrastructural connections between elastic laminae and smooth muscle cells in the aorta, therefore participates in terminal differentiation and maturation…

Protein-family classification

Druggable: 0 · Difficult: 0 · Unknown: 3 · Druggable fraction: 0.0

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Other/Unknown31.8×0.174

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
FBLN5Other/UnknownnoEGF-type_Asp/Asn_hydroxyl_site, EGF, EGF-like_Ca-bd_dom
EFEMP1Other/UnknownnoEGF-type_Asp/Asn_hydroxyl_site, EGF, EGF-like_Ca-bd_dom
EFEMP2Other/UnknownnoEGF-type_Asp/Asn_hydroxyl_site, EGF, EGF-like_Ca-bd_dom

Expression context

Cohort genes with no expression data: 0.

3 cohort genes are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)3
unknown0

Top tissues across cohort

TissueCohort genes
ascending aorta2
descending thoracic aorta2
thoracic aorta2
right coronary artery1
stromal cell of endometrium1
tendon of biceps brachii1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
FBLN5261ubiquitousmarkerthoracic aorta, ascending aorta, descending thoracic aorta
EFEMP1286ubiquitousmarkerright coronary artery, thoracic aorta, descending thoracic aorta
EFEMP2289ubiquitousmarkerstromal cell of endometrium, tendon of biceps brachii, ascending aorta

Protein interactions among cohort

Intra-cohort edges: 1.

Hub genes (top 10 by interactor count)

SymbolInteractor count
EFEMP12,988
FBLN52,301
EFEMP22,219

Intra-cohort edges

ABSources
EFEMP2FBLN5intact

Structural data

PDB: 1 · AlphaFold-only: 2 · No structure: 0

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
EFEMP2O959671

AlphaFold-only cohort genes (top 30 by pLDDT)

SymbolUniProtpLDDT
FBLN5Q9UBX583.69
EFEMP1Q1280577.67

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 2. Enrichment computed across 3 evidence-associated genes (3 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 3 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Molecules associated with elastic fibres3308.6×6e-08FBLN5, EFEMP1, EFEMP2
Elastic fibre formation1112.0×0.009FBLN5

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 3 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
elastic fiber assembly21021.3×3e-05FBLN5, EFEMP2
intramembranous bone growth15617.3×0.002FBLN5
positive regulation of smooth muscle cell-matrix adhesion15617.3×0.002EFEMP2
positive regulation of aortic smooth muscle cell differentiation12808.7×0.002EFEMP2
post-embryonic eye morphogenesis11872.4×0.002EFEMP1
regulation of collagen fibril organization11872.4×0.002EFEMP2
aorta smooth muscle tissue morphogenesis11404.3×0.002EFEMP2
positive regulation of collagen fibril organization11404.3×0.002EFEMP2
regulation of removal of superoxide radicals1936.2×0.003FBLN5
secretion1702.2×0.004FBLN5
vascular associated smooth muscle cell development1561.7×0.004EFEMP2
embryonic eye morphogenesis1510.7×0.004EFEMP1
positive regulation of osteoblast proliferation1401.2×0.005FBLN5
negative regulation of chondrocyte differentiation1224.7×0.008EFEMP1
negative regulation of vascular associated smooth muscle cell proliferation1224.7×0.008EFEMP2
aorta development1187.2×0.009EFEMP2
protein localization to cell surface1165.2×0.009FBLN5
peptidyl-tyrosine phosphorylation1140.4×0.010EFEMP1
camera-type eye development1119.5×0.011EFEMP1
epidermal growth factor receptor signaling pathway182.6×0.016EFEMP1
negative regulation of angiogenesis156.2×0.022FBLN5
cell-matrix adhesion154.5×0.022FBLN5
visual perception126.5×0.042EFEMP1
regulation of DNA-templated transcription110.5×0.100EFEMP1
negative regulation of transcription by RNA polymerase II15.9×0.166FBLN5
positive regulation of transcription by RNA polymerase II15.0×0.188FBLN5

Therapeutics

Drug target analysis

Approved (phase 4): 0 · Phase ≥3: 0 · Phased (≥1): 0 · Undrugged: 3

Druggability breadth: 0 of 3 evidence-associated genes (0%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Top cohort targets by molecule count

SymbolMoleculesMax phase
FBLN500
EFEMP100
EFEMP200

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 0.

Pharmacogenomics

Cohort genes with a PharmGKB record: 3; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Chemical tractability of cohort targets

0 approved/phased compounds have measured bioactivity against a cohort gene (and aren’t yet in disease-level trials). This is a research / tractability signal, NOT a therapeutic recommendation — a bioactivity row often reflects off-target or screening binding (e.g. promiscuous kinase inhibitors against a cohort kinase), implying no disease mechanism.

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)0
BPhased (≥1) drug, not yet approved0
CDruggable family + PDB, no drug0
DDruggable family + AlphaFold only, no drug0
EDifficult family or no structure, no drug3FBLN5, EFEMP1, EFEMP2

Undrugged target profiles

3 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
FBLN50
EFEMP10
EFEMP20

Clinical trials & evidence

Clinical trials

Clinical trials: 0.