Hand, foot and mouth disease

disease
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Also known as hand foot and mouth diseasehand, foot, and mouth diseaseHFMD

Summary

Hand, foot and mouth disease (MONDO:0005779) is a disease with 5 cohort genes (6 GWAS associations across 1 studies) and 51 clinical trials. Top therapeutic interventions include sucralfate and suramin hexasodium.

At a glance

  • Cohort genes: 5
  • GWAS associations: 6
  • Clinical trials: 51

Clinical features

No curated clinical features (Orphanet) for this disease.

Identifiers

Disease identifiers

FieldValue
Canonical namehand, foot and mouth disease
Mondo IDMONDO:0005779
EFOEFO:0007294
MeSHD006232
DOIDDOID:10881
ICD-10-CMB08.4
NCITC128439
SNOMED CT266108008
UMLSC0018572
MedGen42330
Is cancer (heuristic)no

Also known as: hand foot and mouth disease · hand, foot, and mouth disease · HFMD

Data availability: 6 GWAS associations (1 study).

Disease family

Classification path: disease › human disease › disease by etiologic mechanism › disease of primarily extrinsic mechanism › infectious diseaseviral infectious disease › primary viral infectious disease › Picornaviridae infectious diseaseenterovirus infectious disease › coxsackievirus infectious disease › hand, foot and mouth disease

Related subtypes (1): Keshan disease

Genetics & variants

GWAS landscape

6 GWAS associations across 1 studies. Top hits map to 4 distinct genes (as reported by GWAS).

Top associations by p-value

rsIDp-valueGeneRisk alleleOdds ratio
rs76132134e-06EPHB1?
rs40737515e-06LINC01940 - HDAC4?
rs98778985e-06LPP?
rs119905506e-06XKR6?
rs99381958e-06LINC01082?
rs96800209e-06NKILA - LINC01742?

Top studies (by case count)

StudyLead authorYearCasesControlsTitle
GCST010578Meng Y20201150Genome-wide association study identifies TPH2 variant as a novel locus for severe CV-A6-associated hand, foot, and mouth disease in Han Chinese.

Variant details and genetic-evidence tiers

Tier distribution (top 50 variants)

TierVariants
Tier 1: coding0
Tier 2: splice/UTR0
Tier 3: regulatory0
Tier 4: intronic/intergenic6

MAF distribution

BucketVariants
common (>=0.05)6
low_freq (0.01-0.05)0
rare (<0.01)0
unknown0

Functional consequences

ConsequenceCount
intron_variant4
intergenic_variant2

Top variants

rsIDChrPosAllelesMAFConsequenceGenep-valueTier
rs76132133134991109C>T0.05intron_variantEPHB14e-06Tier 4: intronic/intergenic
rs40737512238956383A>C,G,T0.05intergenic_variantLINC01940 - HDAC45e-06Tier 4: intronic/intergenic
rs98778983188620975C>G,T0.05intron_variantLPP5e-06Tier 4: intronic/intergenic
rs11990550810940321G>A,C0.05intron_variantXKR66e-06Tier 4: intronic/intergenic
rs99381951686215879A>C0.05intron_variantLINC010828e-06Tier 4: intronic/intergenic
rs96800202057943637G>A,T0.05intergenic_variantNKILA - LINC017429e-06Tier 4: intronic/intergenic

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 0 · Orphanet: 1 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
HDAC4Orphanet:10012q37 microdeletion syndrome

Cohort genes → proteins

5 cohort genes, 5 distinct canonical proteins.

Evidence partition

SubsetGenes
gwas_only5

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
HDAC4HGNC:14063ENSG00000068024P56524Histone deacetylase 4gwas
PMEPA1HGNC:14107ENSG00000124225Q969W9Protein TMEPAIgwas
XKR6HGNC:27806ENSG00000171044Q5GH73XK-related protein 6gwas
EPHB1HGNC:3392ENSG00000154928P54762Ephrin type-B receptor 1gwas
LPPHGNC:6679ENSG00000145012Q93052Lipoma-preferred partnergwas

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
HDAC4Histone deacetylase 4Responsible for the deacetylation of lysine residues on the N-terminal part of the core histones (H2A, H2B, H3 and H4).
PMEPA1Protein TMEPAIFunctions as a negative regulator of TGF-beta signaling and thereby probably plays a role in cell proliferation, differentiation, apoptosis, motility, extracellular matrix production and immunosuppression.
EPHB1Ephrin type-B receptor 1Receptor tyrosine kinase which binds promiscuously transmembrane ephrin-B family ligands residing on adjacent cells, leading to contact-dependent bidirectional signaling into neighboring cells.
LPPLipoma-preferred partnerMay play a structural role at sites of cell adhesion in maintaining cell shape and motility.

Protein-family classification

Druggable: 2 · Difficult: 1 · Unknown: 2 · Druggable fraction: 0.4

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
Kinase15.5×0.634
Enzyme (other)12.4×0.634
Transcription factor11.6×0.634
Other/Unknown20.7×0.877

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
HDAC4Enzyme (other)yes3.5.1.98HDACs, Ureohydrolase_dom_sf, His_deacetylse_dom
PMEPA1Other/UnknownnoTMEPAI/LRAD4
XKR6Other/UnknownnoXK-rel, XK-related_scramblase
EPHB1Kinaseyes2.7.10.1Prot_kinase_dom, EPH_LBD, Ser-Thr/Tyr_kinase_cat_dom
LPPTranscription factornoZnf_LIM

Expression context

Cohort genes with no expression data: 0.

4 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)5
unknown0

Top tissues across cohort

TissueCohort genes
gastrocnemius1
gluteal muscle1
sural nerve1
ascending aorta1
thoracic aorta1
visceral pleura1
buccal mucosa cell1
middle temporal gyrus1
primordial germ cell in gonad1
cortical plate1
endothelial cell1
ganglionic eminence1
saphenous vein1
urethra1
vena cava1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
HDAC4277ubiquitousmarkersural nerve, gluteal muscle, gastrocnemius
PMEPA1277ubiquitousmarkervisceral pleura, ascending aorta, thoracic aorta
XKR6167ubiquitousyesbuccal mucosa cell, primordial germ cell in gonad, middle temporal gyrus
EPHB1208ubiquitousmarkercortical plate, endothelial cell, ganglionic eminence
LPP292ubiquitousmarkersaphenous vein, urethra, vena cava

Protein interactions among cohort

Intra-cohort edges: 0.

Hub genes (top 10 by interactor count)

SymbolInteractor count
HDAC44,771
PMEPA12,193
EPHB12,144
LPP1,113
XKR6631

Structural data

PDB: 2 · AlphaFold-only: 3 · No structure: 0

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
HDAC4P5652419
EPHB1P547628

AlphaFold-only cohort genes (top 30 by pLDDT)

SymbolUniProtpLDDT
XKR6Q5GH7364.85
LPPQ9305260.99
PMEPA1Q969W957.03

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 14. Enrichment computed across 5 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
RUNX2 regulates chondrocyte maturation1761.3×0.018HDAC4
RUNX3 regulates p14-ARF1380.7×0.018HDAC4
Ephrin signaling1190.3×0.019EPHB1
Downregulation of TGF-beta receptor signaling1135.9×0.019PMEPA1
Notch-HLH transcription pathway1135.9×0.019HDAC4
SUMOylation of intracellular receptors1112.0×0.019HDAC4
EPHB-mediated forward signaling188.5×0.019EPHB1
NOTCH1 Intracellular Domain Regulates Transcription179.3×0.019HDAC4
EPH-ephrin mediated repulsion of cells173.2×0.019EPHB1
Constitutive Signaling by NOTCH1 PEST Domain Mutants165.6×0.019HDAC4
Constitutive Signaling by NOTCH1 HD+PEST Domain Mutants165.6×0.019HDAC4
EPH-Ephrin signaling155.2×0.020EPHB1
SUMOylation of chromatin organization proteins152.9×0.020HDAC4
Differentiation of naive CD4+ T cells to T helper 2 cells (Th2 cells)148.8×0.020HDAC4

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 5 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
skeletal muscle satellite cell activation11123.5×0.013EPHB1
hindbrain tangential cell migration11123.5×0.013EPHB1
negative regulation of protein refolding11123.5×0.013HDAC4
negative regulation of skeletal muscle satellite cell proliferation1842.6×0.013EPHB1
optic nerve morphogenesis1674.1×0.013EPHB1
negative regulation of satellite cell differentiation1674.1×0.013EPHB1
phosphatidylserine exposure on apoptotic cell surface1561.7×0.013XKR6
response to denervation involved in regulation of muscle adaptation1481.5×0.014HDAC4
central nervous system projection neuron axonogenesis1374.5×0.014EPHB1
engulfment of apoptotic cell1374.5×0.014XKR6
apoptotic process involved in development1337.0×0.014XKR6
immunological synapse formation1259.3×0.014EPHB1
obsolete negative regulation of transcription by competitive promoter binding1259.3×0.014HDAC4
positive regulation of protein sumoylation1259.3×0.014HDAC4
dendritic spine development1240.7×0.014EPHB1
negative regulation of myotube differentiation1224.7×0.014HDAC4
cardiac muscle hypertrophy in response to stress1210.7×0.014HDAC4
negative regulation of glycolytic process1210.7×0.014HDAC4
regulation of JNK cascade1177.4×0.014EPHB1
dendritic spine morphogenesis1177.4×0.014EPHB1
detection of temperature stimulus involved in sensory perception of pain1168.5×0.014EPHB1
retinal ganglion cell axon guidance1153.2×0.014EPHB1
cell-substrate adhesion1153.2×0.014EPHB1
camera-type eye morphogenesis1153.2×0.014EPHB1
androgen receptor signaling pathway1140.4×0.015PMEPA1
neural precursor cell proliferation1134.8×0.015EPHB1
negative regulation of SMAD protein signal transduction1120.4×0.016PMEPA1
regulation of ERK1 and ERK2 cascade1116.2×0.016EPHB1
response to interleukin-11102.1×0.018HDAC4
B cell activation191.1×0.019HDAC4

Therapeutics

Drug target analysis

Approved (phase 4): 2 · Phase ≥3: 2 · Phased (≥1): 2 · Undrugged: 3

Druggability breadth: 2 of 5 evidence-associated genes (40%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Genes with an approved drug

The molecule shown is one approved compound that hits the gene — not necessarily a drug of choice or one indicated for this disease.

SymbolExample approved molecule
HDAC4CELECOXIB
EPHB1FEDRATINIB

Top cohort targets by molecule count

SymbolMoleculesMax phase
HDAC4314
EPHB1284
PMEPA100
XKR600
LPP00

Drugs targeting cohort genes (top 30)

MoleculeMax phaseTargets in cohort
CELECOXIB4HDAC4
PHENYLBUTANOIC ACID4HDAC4
SODIUM PHENYLBUTYRATE4HDAC4
ROMIDEPSIN4HDAC4
BELINOSTAT4HDAC4
PANOBINOSTAT4HDAC4
VORINOSTAT4HDAC4
GIVINOSTAT4HDAC4
BENDAMUSTINE4HDAC4
FEDRATINIB4EPHB1
SORAFENIB4EPHB1
INFIGRATINIB PHOSPHATE4EPHB1
INFIGRATINIB4EPHB1
VANDETANIB4EPHB1
NILOTINIB4EPHB1
BOSUTINIB4EPHB1
NINTEDANIB4EPHB1
SUNITINIB4EPHB1
DASATINIB4EPHB1
ERLOTINIB4EPHB1
CRIZOTINIB4EPHB1
GEFITINIB4EPHB1
CURCUMIN3HDAC4
CAFFEIC ACID3HDAC4
PRACINOSTAT3HDAC4
TACEDINALINE3HDAC4
ENTINOSTAT3HDAC4
TUCIDINOSTAT3HDAC4
ABEXINOSTAT3HDAC4
TASQUINIMOD3HDAC4

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 2.

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

SymbolAssaysType breakdown
HDAC41,941Binding:1919, ADMET:13, Functional:6, Toxicity:3
EPHB1273Binding:273

Cohort enzymes (BRENDA EC)

SymbolEC numbersNames
HDAC43.5.1.98histone deacetylase
EPHB12.7.10.1receptor protein-tyrosine kinase

Cohort genes with high screening signal

≥100 ChEMBL assays — a studied-ness signal; see Therapeutics for approved-drug status.

SymbolChEMBL assays
HDAC41,941
EPHB1273

Pharmacogenomics

Cohort genes with a PharmGKB record: 5; with CPIC/DPWG dosing guidelines: 0.

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

Chemical tractability of cohort targets

30 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.

CompoundMax phaseCohort target (bioactivity)
CELECOXIB4HDAC4
PHENYLBUTANOIC ACID4HDAC4
SODIUM PHENYLBUTYRATE4HDAC4
ROMIDEPSIN4HDAC4
BELINOSTAT4HDAC4
PANOBINOSTAT4HDAC4
VORINOSTAT4HDAC4
GIVINOSTAT4HDAC4
BENDAMUSTINE4HDAC4
FEDRATINIB4EPHB1
SORAFENIB4EPHB1
INFIGRATINIB PHOSPHATE4EPHB1
INFIGRATINIB4EPHB1
VANDETANIB4EPHB1
NILOTINIB4EPHB1
BOSUTINIB4EPHB1
NINTEDANIB4EPHB1
SUNITINIB4EPHB1
DASATINIB4EPHB1
ERLOTINIB4EPHB1
CRIZOTINIB4EPHB1
GEFITINIB4EPHB1
CURCUMIN3HDAC4
CAFFEIC ACID3HDAC4
PRACINOSTAT3HDAC4
TACEDINALINE3HDAC4
ENTINOSTAT3HDAC4
TUCIDINOSTAT3HDAC4
ABEXINOSTAT3HDAC4
TASQUINIMOD3HDAC4

Druggability pyramid

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

TierDefinitionGenesSymbols
AApproved (phase 4 drug)2HDAC4, EPHB1
BPhased (≥1) drug, not yet approved0
CDruggable family + PDB, no drug0
DDruggable family + AlphaFold only, no drug0
EDifficult family or no structure, no drug3PMEPA1, XKR6, LPP

Undrugged target profiles

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

SymbolChEMBL assaysDrugged partners (top 3)
PMEPA10
XKR60
LPP0

Clinical trials & evidence

Clinical trials

Clinical trials: 51.

Phase distribution (across all retrieved trials)

PhaseTrials
Not specified17
PHASE416
PHASE18
PHASE35
PHASE22
PHASE1/PHASE22
PHASE2/PHASE31

Top trials by phase / activity

NCTPhaseStatusTitle
NCT06146088PHASE4RECRUITINGLot-to-lot Consistency Study of Three Commercial Batches of Enterovirus 71 Vaccine
NCT02889497PHASE4UNKNOWNSafety, Three Batches Consistency and Immunity Duration of the Post-marketing Inactivated Enterovirus Type 71 (EV71) Vaccine in Children Aged 6-71 Months
NCT03001986PHASE4COMPLETEDThe Phase IVb of Inactivated Enterovirus 71 Vaccine (Human Diploid Cell, KMB-17) in Chinese Children
NCT03240744PHASE4UNKNOWNThe Phase IVc of Inactivated Enterovirus 71 Vaccine (Human Diploid Cell)
NCT03274102PHASE4COMPLETEDSafety and Immunogenicity of Concomitant Administration of EV71 Vaccine With EPI Vaccines
NCT03278132PHASE4COMPLETEDPhase IV Clinical Trial, Immunogenicity and Safety of EV71 Vaccine
NCT03296410PHASE4UNKNOWNThe Phase IVd of Inactivated Enterovirus 71 Vaccine
NCT03519568PHASE4UNKNOWNClinical Study on Combined Immune Effect of EV71 Inactivated Vaccine
NCT03582761PHASE4COMPLETEDEfficacy Evaluation for Inactivated Vaccine (Vero Cell) Against EV71
NCT03873740PHASE4COMPLETEDImmunogenicity and Safety of Two Different Commercial EV71 Vaccines
NCT03893747PHASE4COMPLETEDImmunity and Safety of Inactivated Enterovirus 71 Vaccine Post-marketing Among Children Aged 6-35 Months in China
NCT03903926PHASE4COMPLETEDEfficacy Trial of a Commercial EV71 Vaccine
NCT04111432PHASE4COMPLETEDSafety and Immunogenicity of Concomitant Administration of EV71 Vaccine With Expanded Programme on Immunization Vaccines
NCT04133584PHASE4COMPLETEDThe Immunogenicity and Safety of the Vaccination of Inactivated Enterovirus 71 Vaccine and Seasonal Influenza Vaccine
NCT05397587PHASE4UNKNOWNAn Immunity Persistence Study of Enterovirus 71 Inactivated Vaccine (Vero Cell)
NCT06209398PHASE4UNKNOWNImmunogenicity of the Inactivated EV71 Vaccine Combined With Hepatitis B and Group A Meningococcal Vaccine
NCT07611513PHASE3NOT_YET_RECRUITINGProtective Efficacy , Immunogenicity and Safety of the Tetravalent Inactivated Enterovirus Vaccine (Vero Cell).
NCT01507857PHASE3COMPLETEDAn Efficacy Trial in Inactivated Enterovirus Type 71 (EV71) Vaccine
NCT01508247PHASE3COMPLETEDA Clinical Trial to Assess the Efficacy and Safety of an Inactivated Vaccine (Vero Cell) Against EV71 in Chinese Children Aged 6-35 Months
NCT01636245PHASE3COMPLETEDImmunogenicity and Safety of Three Consecutive Lots of a New Inactivated Enterovirus Type 71 (EV71) Vaccine
NCT03909074PHASE3COMPLETEDClinical Trial of Enterovirus 71(EV71) Inactivated Vaccine in Children Aged 36-71 Months
NCT06353477PHASE2/PHASE3COMPLETEDHand, Foot, and Mouth Disease: Could EPs®7630 be a Treatment Option
NCT06063057PHASE1/PHASE2ACTIVE_NOT_RECRUITINGInactivated Bivalent Enterovirus Vaccine (Vero Cell) Phase I/II Clinical Trial
NCT01940250PHASE2COMPLETEDMagnesium Sulphate for Severe Hand, Foot and Mouth Disease in Vietnam
NCT03241030PHASE2COMPLETEDSucralfate to Improve Oral Intake in Children With Infectious Oral Ulcers: a Randomized, Double-blind, Placebo-Controlled Trial
NCT06754384PHASE1/PHASE2COMPLETEDTolerability, Safety, and Immunogenicity of Tetravalent Inactivated Enterovirus Vaccine (Vero Cell).
NCT07326878PHASE1NOT_YET_RECRUITINGPhase I Clinical Trial of Enterovirus Type71 - Coxsackievirus Type A16 Bivalent Vaccine
NCT01267903PHASE1COMPLETEDA Clinical Trial for Inactivated Vaccine(Vero Cell) Against EV71 in Chinese Healthy Young Adults and Children
NCT01313715PHASE1COMPLETEDA Clinical Trial for Inactivated Vaccine (Vero Cell) Against EV71 in Chinese Children and Infants
NCT01376479PHASE1COMPLETEDSafety and Immunogenicity Study of an Inactivated Vaccine Against Hand, Foot and Mouth Disease Caused by Enterovirus 71
NCT01391494PHASE1COMPLETEDA Safety Study of Inactivated EV71 Vaccine (Human Diploid Cell, KMB-17) in Chinese Adults, Children and Infants
NCT03804749PHASE1UNKNOWNStudy to Evaluate the Tolerance and Pharmacokinetics of Suramin Sodium
NCT04182932PHASE1UNKNOWNSafety and Immunogenicity of CJ-40010 in Healthy Subjects
NCT04637919PHASE1UNKNOWNSafety and Immunogenicity of High-dose IN-B001 in Healthy Subjects
NCT06263439Not specifiedRECRUITINGSurveillance of HFMD in Pediatric Outpatients
NCT06699433Not specifiedRECRUITINGArtificial Intelligence-driven Virtual Standardized Pediatric Patients Trial
NCT07008755Not specifiedRECRUITINGClinical Trial of Pegylated Interferon α-2b Via Nebulization for Treatment of Hand, Foot, and Mouth Disease .
NCT07144202Not specifiedENROLLING_BY_INVITATIONStudy on the Persistence of Immunity Following EV71 Vaccination
NCT01145664Not specifiedUNKNOWNA Multi-Center Clinical Trial To Evaluate Chinese Herbal Medicines in the Treatment of Severe Hand-foot-mouth Disease
NCT01175915Not specifiedUNKNOWNA Clinical Trial To Evaluate Reduning Injection in the Treatment of Mild Type of Hand, Foot, and Mouth Disease

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
SUCRALFATE41
SURAMIN HEXASODIUM31
CHEMBL44323201
CHEMBL236770601
CHEMBL239773701
CHEMBL445362101