Birt-Hogg-Dube syndrome

disease
On this page

Also known as BHD

Summary

Birt-Hogg-Dube syndrome (MONDO:0800444) is a disease caused by FLCN (GenCC Strong), with 3 cohort genes and 6 clinical trials. Top therapeutic interventions include everolimus.

At a glance

  • Causal gene: FLCN (GenCC Strong)
  • Cohort genes: 3
  • ClinVar variants: 2,172
  • Clinical trials: 6

Clinical features

No curated clinical features (Orphanet) for this disease.

Identifiers

Disease identifiers

FieldValue
Canonical nameBirt-Hogg-Dube syndrome
Mondo IDMONDO:0800444
OMIM135150
UMLSC0346010
MedGen91070
GARD0028061
Is cancer (heuristic)no

Also known as: BHD

Data availability: 2,172 ClinVar variants · 1 GenCC gene-disease record · 6 cell lines.

Disease family

An umbrella term covering 2 Mondo subtypes.

Classification path: disease › human disease › disease by etiologic mechanism › disease of genetic or genomic mechanism › hereditary disease › autosomal genetic disease › autosomal dominant disease › Birt-Hogg-Dube syndrome

Related subtypes (191): autosomal dominant polycystic liver disease, cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy, type 1, tuberous sclerosis, Treacher-Collins syndrome, hereditary breast ovarian cancer syndrome, autosomal dominant polycystic kidney disease, Lynch syndrome, branchio-oto-renal syndrome, autosomal dominant Aarskog syndrome, acroosteolysis dominant type, ADULT syndrome, autosomal dominant Alport syndrome, amelogenesis imperfecta type 1B, Townes-Brocks syndrome, nevoid basal cell carcinoma syndrome, blepharophimosis, ptosis, and epicanthus inversus syndrome, autosomal dominant brachyolmia, branchiooculofacial syndrome, pheochromocytoma/paraganglioma syndrome 4, cataract-aberrant oral frenula-growth delay syndrome, cherubism, autosomal dominant chondrodysplasia punctata, autosomal dominant popliteal pterygium syndrome, blepharocheilodontic syndrome, cochleosaccular degeneration-cataract syndrome, renal coloboma syndrome, Beare-Stevenson cutis gyrata syndrome, autosomal dominant vibratory urticaria, neurohypophyseal diabetes insipidus, autosomal dominant Kenny-Caffey syndrome, Rapp-Hodgkin syndrome, Ehlers-Danlos syndrome, classic type, autosomal dominant Ehlers-Danlos syndrome, vascular type, multiple endocrine neoplasia type 1, Coffin-Siris syndrome 1, isolated congenital adermatoglyphia, Flynn-Aird syndrome, Frasier syndrome, hand-foot-genital syndrome, Holt-Oram syndrome, hyperkeratosis-hyperpigmentation syndrome, autosomal dominant ichthyosis vulgaris, hyper-IgE recurrent infection syndrome 1, autosomal dominant, autosomal dominant keratitis, autosomal dominant keratitis-ichthyosis-hearing loss syndrome, LADD syndrome, trichorhinophalangeal syndrome type II, Noonan syndrome with multiple lentigines, microcephaly with or without chorioretinopathy, lymphedema, or intellectual disability, Marfan syndrome, melanoma, cutaneous malignant, susceptibility to, 2, autosomal dominant primary microcephaly, autosomal dominant progressive external ophthalmoplegia, monilethrix, Muir-Torre syndrome, autosomal dominant myoglobinuria, autosomal dominant centronuclear myopathy, nail-patella syndrome, multiple endocrine neoplasia type 2B, autosomal dominant omodysplasia, pheochromocytoma/paraganglioma syndrome 1, Pelger-Huet anomaly, multiple endocrine neoplasia type 2A, piebaldism, autosomal dominant medullary cystic kidney disease with or without hyperuricemia, generalized juvenile polyposis/juvenile polyposis coli, juvenile polyposis/hereditary hemorrhagic telangiectasia syndrome, Peutz-Jeghers syndrome, contractures, pterygia, and spondylocarpotarsal fusion syndrome 1A, autosomal dominant distal renal tubular acidosis, retinoschisis, autosomal dominant, autosomal dominant Robinow syndrome, scapuloperoneal spinal muscular atrophy, autosomal dominant, autosomal dominant sideroblastic anemia, spondyloepiphyseal dysplasia tarda, autosomal dominant, proximal symphalangism, calcaneonavicular coalition, thanatophoric dysplasia type 1, trichorhinophalangeal syndrome type I, Muckle-Wells syndrome, autosomal dominant hypophosphatemic rickets, von Hippel-Lindau disease, Denys-Drash syndrome, autosomal dominant severe congenital neutropenia, Costello syndrome, EEC syndrome, multiple cutaneous and mucosal venous malformations, diffuse nonepidermolytic palmoplantar keratoderma, Timothy syndrome, pheochromocytoma/paraganglioma syndrome 2, spondyloepimetaphyseal dysplasia with multiple dislocations, Brooke-Spiegler syndrome, macrocephaly-autism syndrome, pheochromocytoma/paraganglioma syndrome 3, Duane-radial ray syndrome, PCWH syndrome, heart-hand syndrome, Slovenian type, congenital stationary night blindness autosomal dominant 3, mandibulofacial dysostosis-microcephaly syndrome, multiple endocrine neoplasia type 4, juvenile cataract-microcornea-renal glucosuria syndrome, Crouzon syndrome-acanthosis nigricans syndrome, Birk-Barel syndrome, thrombophilia due to protein S deficiency, autosomal dominant, dyskeratosis congenita, autosomal dominant 2, dyskeratosis congenita, autosomal dominant 3, colorectal cancer, hereditary nonpolyposis, type 6, colorectal cancer, hereditary nonpolyposis, type 7, brain small vessel disease 2A, autosomal dominant, intellectual disability, autosomal dominant 14, intellectual disability, autosomal dominant 15, intellectual disability, autosomal dominant 16, hypopigmentation-punctate palmoplantar keratoderma syndrome, intellectual disability-facial dysmorphism syndrome due to SETD5 haploinsufficiency, postaxial polydactyly-anterior pituitary anomalies-facial dysmorphism syndrome, intellectual developmental disorder with microcephaly and with or without ocular malformations or hypogonadotropic hypogonadism, intellectual disability, autosomal dominant 29, intellectual disability, autosomal dominant 30, Houge-Janssens syndrome 2, severe achondroplasia-developmental delay-acanthosis nigricans syndrome, dyskeratosis congenita, autosomal dominant 6, epidermolysis bullosa simplex 6, generalized, with scarring and hair loss, autosomal dominant complex spastic paraplegia, early-onset autosomal dominant Alzheimer disease, muscular dystrophy, limb-girdle, autosomal dominant, Feingold syndrome, Carney complex, neuronopathy, distal hereditary motor, autosomal dominant, autosomal dominant coarctation of aorta, autosomal dominant spondylocostal dysostosis, autosomal dominant hypohidrotic ectodermal dysplasia, Cowden disease, autosomal dominant distal myopathy, autosomal dominant rhegmatogenous retinal detachment, palmoplantar keratoderma-spastic paralysis syndrome, Alagille syndrome due to a JAG1 point mutation, PTEN hamartoma tumor syndrome, gastric adenocarcinoma and proximal polyposis of the stomach, autosomal dominant proximal renal tubular acidosis, autosomal dominant spastic ataxia, Waardenburg syndrome, hereditary retinoblastoma, autosomal dominant hypocalcemia, Li-Fraumeni syndrome, Loeys-Dietz syndrome, hereditary hemorrhagic telangiectasia, hereditary inclusion body myopathy-joint contractures-ophthalmoplegia syndrome, microcephalic osteodysplastic dysplasia, Saul-Wilson type, autosomal dominant intermediate Charcot-Marie-Tooth disease, autosomal dominant cutis laxa, autosomal dominant nonsyndromic hearing loss, autosomal dominant optic atrophy, autosomal dominant Emery-Dreifuss muscular dystrophy, autosomal dominant cerebellar ataxia, autosomal dominant osteopetrosis, autosomal dominant epidermolytic ichthyosis, ventricular arrhythmias due to cardiac ryanodine receptor calcium release deficiency syndrome, distal arthrogryposis type 2B1, neurofibromatosis, autosomal dominant cataract, arthrogryposis, distal, type 2B2, arthrogryposis, distal, type 2B3, Charcot-Marie-Tooth disease, demyelinating, type 1G, Delpire-McNeill syndrome, LAMA5-related multisystemic syndrome, autosomal dominant oculocutaneous albinism, Charcot-Marie-tooth disease, axonal, type 2DD, Pilarowski-Bjornsson syndrome, intellectual disability, autosomal dominant, fatty acyl-CoA reductase 1 upregulation, GUCY2D-related dominant retinopathy, RPE65-related dominant retinopathy, autosomal dominant titinopathy, NOG-related symphalangism spectrum disorder, ALPL-related autosomal dominant hypophosphatasia, MYH10-related neurodevelopmental disorder with congenital anomalies, spastic paraplegia 30A, autosomal dominant, TMEM127-related tumor predisposition, MAX-related tumor predisposition, BMPR1A-related juvenile polyposis syndrome, RP1-related dominant retinopathy, inclusion body myopathy and brain white matter abnormalities, KINSSHIP syndrome, autosomal dominant nebulin-related myopathy, IMPG1-related dominant retinopathy, PROM1-related dominant retinopathy, PURA-related severe neonatal hypotonia-seizures-encephalopathy syndrome, ALG8-related autosomal dominant polycystic kidney and/or liver disease, NOTCH1-related AOS spectrum disorder, FLNB-associated autosomal dominant filamin related bone disorder, familial antiphospholipid syndrome

Subtypes (2): Birt-Hogg-Dube syndrome 1, Birt-Hogg-Dube syndrome 2

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

600 retrieved; paginated sample, class counts are floors:

234 uncertain significance, 174 likely benign, 76 benign/likely benign, 49 conflicting classifications of pathogenicity, 45 pathogenic, 11 likely pathogenic, 10 pathogenic/likely pathogenic, 1 benign

ClinVarVariant (HGVS)GeneClassificationReview
1068460NM_144997.7(FLCN):c.319_320del (p.Val107fs)FLCNPathogeniccriteria provided, single submitter
1068469NM_144997.7(FLCN):c.57_58del (p.Phe20fs)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
1068651NM_144997.7(FLCN):c.367C>T (p.Gln123Ter)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
1069125NM_144997.7(FLCN):c.826_842del (p.Gly276fs)FLCNPathogeniccriteria provided, single submitter
1069356NC_000017.10:g.(?17131193)(17140502_?)delFLCNPathogeniccriteria provided, single submitter
1069357NC_000017.10:g.(?17127226)(17140502_?)delFLCNPathogeniccriteria provided, single submitter
1071535NM_144997.7(FLCN):c.827_828insAG (p.Ala277fs)FLCNPathogeniccriteria provided, single submitter
1071737NM_144997.7(FLCN):c.995dup (p.Ser333fs)FLCNPathogeniccriteria provided, single submitter
1071832NM_144997.7(FLCN):c.1477C>T (p.Gln493Ter)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
1071978NM_144997.7(FLCN):c.321dup (p.Ser108fs)FLCNPathogeniccriteria provided, single submitter
1072205NM_144997.7(FLCN):c.397-1G>TFLCNPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1072796NM_144997.7(FLCN):c.1333_1352del (p.Ala445fs)FLCNPathogeniccriteria provided, single submitter
1073198NM_144997.7(FLCN):c.1347_1353dup (p.Val452fs)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
1074043NM_144997.7(FLCN):c.558G>A (p.Trp186Ter)FLCNPathogeniccriteria provided, single submitter
1075238NC_000017.10:g.(?17116969)(17140502_?)delFLCNPathogeniccriteria provided, single submitter
1075239NC_000017.10:g.(?17116969)(17117180_?)delFLCNPathogeniccriteria provided, single submitter
1075380NC_000017.10:g.(?17124841)(17125985_?)delFLCNPathogeniccriteria provided, single submitter
1076330NM_144997.7(FLCN):c.1616dup (p.Ala541fs)FLCNPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1076910NM_144997.7(FLCN):c.1153C>T (p.Gln385Ter)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
1349973NM_144997.7(FLCN):c.1300+1G>CFLCNPathogeniccriteria provided, single submitter
1361458NM_144997.7(FLCN):c.810del (p.Glu271fs)FLCNPathogeniccriteria provided, single submitter
1361582NM_144997.7(FLCN):c.476_479dup (p.Asp160fs)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
1381774NM_144997.7(FLCN):c.970C>T (p.Gln324Ter)FLCNPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1382685NM_144997.7(FLCN):c.919del (p.Glu307fs)FLCNPathogeniccriteria provided, single submitter
1404404NM_144997.7(FLCN):c.30del (p.Cys11fs)FLCNPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
1408666NM_144997.7(FLCN):c.1063-2A>GFLCNPathogenic/Likely pathogeniccriteria provided, multiple submitters, no conflicts
141706NM_144997.7(FLCN):c.943G>T (p.Glu315Ter)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
141865NM_144997.7(FLCN):c.499C>T (p.Gln167Ter)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
1451720NM_144997.7(FLCN):c.1127G>A (p.Trp376Ter)FLCNPathogeniccriteria provided, multiple submitters, no conflicts
1451945NC_000017.10:g.(?17131193)(17131475_?)delFLCNPathogeniccriteria provided, single submitter

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 12 · Orphanet: 4 · 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
FLCNDefinitiveAutosomal dominantBirt-Hogg-Dube syndrome 112

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
FLCNOrphanet:122Birt-Hogg-Dubé syndrome
FLCNOrphanet:2903Familial spontaneous pneumothorax
FLCNOrphanet:422526Hereditary clear cell renal cell carcinoma
PKD2Orphanet:730Autosomal dominant polycystic kidney disease

Cohort genes → proteins

3 cohort genes, 3 distinct canonical proteins.

Evidence partition

SubsetGenes
multi_evidence3

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
FLCNHGNC:27310ENSG00000154803Q8NFG4Folliculingencc,clinvar
FLIIHGNC:3750ENSG00000177731Q13045Protein flightless-1 homologclinvar
PKD2HGNC:9009ENSG00000118762Q13563Polycystin-2clinvar

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
FLCNFolliculinMulti-functional protein, involved in both the cellular response to amino acid availability and in the regulation of glycolysis.
FLIIProtein flightless-1 homologIs a regulator of actin polymerization, required for proper myofibril organization and regulation of the length of sarcomeric thin filaments.
PKD2Polycystin-2Forms a nonselective cation channel.

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)
FLCNOther/UnknownnoFolliculin, Folliculin_DENN, Folliculin/SMCR8_longin
FLIIOther/UnknownnoLeu-rich_rpt, Leu-rich_rpt_typical-subtyp, Villin/Gelsolin
PKD2Other/UnknownnoEF_hand_dom, PKD_2, EF-hand-dom_pair

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
buccal mucosa cell1
cerebellar hemisphere1
right hemisphere of cerebellum1
apex of heart1
hindlimb stylopod muscle1
lower esophagus mucosa1
blood vessel layer1
calcaneal tendon1
saphenous vein1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
FLCN261ubiquitousmarkerbuccal mucosa cell, right hemisphere of cerebellum, cerebellar hemisphere
FLII134ubiquitousmarkerlower esophagus mucosa, apex of heart, hindlimb stylopod muscle
PKD2288ubiquitousmarkerblood vessel layer, calcaneal tendon, saphenous vein

Protein interactions among cohort

Intra-cohort edges: 0.

Hub genes (top 10 by interactor count)

SymbolInteractor count
FLII2,364
PKD21,644
FLCN1,317

Structural data

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

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
PKD2Q1356331
FLCNQ8NFG44

AlphaFold-only cohort genes (top 30 by pLDDT)

SymbolUniProtpLDDT
FLIIQ1304581.20

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 2. Enrichment computed across 3 evidence-associated genes (2 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 2 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
VxPx cargo-targeting to cilium1259.6×0.008PKD2
Amino acids regulate mTORC11100.2×0.010FLCN

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
metanephric cortex development15617.3×0.004PKD2
metanephric cortical collecting duct development15617.3×0.004PKD2
metanephric distal tubule development15617.3×0.004PKD2
negative regulation of cell proliferation involved in kidney development15617.3×0.004FLCN
renal artery morphogenesis12808.7×0.004PKD2
mesonephric tubule development12808.7×0.004PKD2
metanephric smooth muscle tissue development12808.7×0.004PKD2
detection of nodal flow11872.4×0.004PKD2
cellular response to hydrostatic pressure11872.4×0.004PKD2
cell proliferation involved in kidney development11872.4×0.004FLCN
metanephric part of ureteric bud development11404.3×0.004PKD2
renal tubule morphogenesis11404.3×0.004PKD2
metanephric ascending thin limb development11404.3×0.004PKD2
metanephric S-shaped body morphogenesis11404.3×0.004PKD2
negative regulation of post-translational protein modification11404.3×0.004FLCN
negative regulation of lysosome organization11404.3×0.004FLCN
mesonephric duct development11123.5×0.005PKD2
regulation of pro-B cell differentiation11123.5×0.005FLCN
determination of liver left/right asymmetry1936.2×0.005PKD2
negative regulation of brown fat cell differentiation1936.2×0.005FLCN
metanephric mesenchyme development1802.5×0.005PKD2
positive regulation of phospholipase C-activating G protein-coupled receptor signaling pathway1802.5×0.005PKD2
regulation of calcium ion import1702.2×0.006PKD2
regulation of Ras protein signal transduction1624.1×0.006FLCN
placenta blood vessel development1468.1×0.008PKD2
cellular response to fluid shear stress1432.1×0.008PKD2
detection of mechanical stimulus1401.2×0.008PKD2
actin filament severing1401.2×0.008FLII
cellular response to osmotic stress1401.2×0.008PKD2
myofibril assembly1374.5×0.009FLII

Therapeutics

Drug target analysis

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

Druggability breadth: 1 of 3 evidence-associated genes (33%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Top cohort targets by molecule count

SymbolMoleculesMax phase
FLCN00
FLII00
PKD200

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 0.

Cohort genes with ChEMBL bioactivity (full, sorted by assay count)

SymbolAssaysType breakdown
PKD212Binding:12

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 drug3FLCN, FLII, PKD2

Undrugged target profiles

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

SymbolChEMBL assaysDrugged partners (top 3)
FLCN0
FLII0
PKD212

Clinical trials & evidence

Clinical trials

Clinical trials: 6.

Phase distribution (across all retrieved trials)

PhaseTrials
Not specified5
PHASE21

Top trials by phase / activity

NCTPhaseStatusTitle
NCT02504892PHASE2TERMINATEDEverolimus Therapy in People With Birt-Hogg-Dube Syndrome (BHD)-Associated Kidney Cancer or Sporadic Chromophobe Renal Cancer
NCT03749980Not specifiedRECRUITINGMyVHL: Patient Natural History Study
NCT06330324Not specifiedENROLLING_BY_INVITATIONReproductive Options in Inherited Skin Diseases
NCT06330350Not specifiedRECRUITINGQualitative Study in Patients With Genodermatoses and Healthcare Professionals on Reproductive Counselling
NCT03040115Not specifiedCOMPLETEDAssessment of Safety of Air Travel in Patients With Birt-Hogg-Dube Syndrome
NCT05534854Not specifiedUNKNOWNFrequency, Clinical Phenotype and Genetic Analysis of Heritable Kidney Cancer Syndromes

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
EVEROLIMUS41