SPAG7
geneOn this page
Also known as FSA-1ACRPMGC20134
Summary
SPAG7 (sperm associated antigen 7, HGNC:11216) is a protein-coding gene on chromosome 17p13.2, encoding Sperm-associated antigen 7 (O75391).
Predicted to enable nucleic acid binding activity. Predicted to be located in nucleus.
Source: NCBI Gene 9552 — RefSeq curated summary.
At a glance
- Gene–disease (curated): PFAPA syndrome (Limited, GenCC)
- GWAS associations: 3
- Clinical variants (ClinVar): 36 total
- MANE Select transcript:
NM_004890
Identifiers
Gene identifiers
| Field | Value |
|---|---|
| HGNC ID | HGNC:11216 |
| Approved symbol | SPAG7 |
| Name | sperm associated antigen 7 |
| Location | 17p13.2 |
| Locus type | gene with protein product |
| Status | Approved |
| Aliases | FSA-1, ACRP, MGC20134 |
| Ensembl gene | ENSG00000091640 |
| Ensembl biotype | protein_coding |
| OMIM | 610056 |
| Entrez | 9552 |
Gene structure
Transcript identifiers
Ensembl transcripts: 14 — 9 protein_coding, 2 protein_coding_CDS_not_defined, 2 retained_intron, 1 nonsense_mediated_decay
ENST00000206020, ENST00000570341, ENST00000571023, ENST00000572148, ENST00000573366, ENST00000573805, ENST00000575142, ENST00000575784, ENST00000859822, ENST00000918591, ENST00000918592, ENST00000918593, ENST00000949752, ENST00000949753
RefSeq mRNA: 1 — MANE Select: NM_004890
NM_004890
CCDS: CCDS42240
Canonical transcript exons
ENST00000206020 — 7 exons
| Exon | Start | End |
|---|---|---|
| ENSE00000676413 | 4960234 | 4960318 |
| ENSE00000676414 | 4960022 | 4960111 |
| ENSE00000676418 | 4959226 | 4959643 |
| ENSE00002633854 | 4967720 | 4967817 |
| ENSE00003548125 | 4960786 | 4960853 |
| ENSE00003586056 | 4959760 | 4959916 |
| ENSE00003757135 | 4960459 | 4960547 |
Expression profiles
Bgee: expression breadth ubiquitous, 295 present calls, max score 98.69.
FANTOM5 (CAGE): breadth ubiquitous, TPM avg 66.3429 / max 500.9994, expressed in 1825 samples.
FANTOM5 promoters (1 alternative TSS)
| Promoter ID | TPM avg | Samples expressed |
|---|---|---|
| 163989 | 66.3429 | 1825 |
Top tissues by expression
297 total, by Bgee expression score (0-100, higher = more expressed):
| Tissue | Anatomy ID | Expression score | Quality |
|---|---|---|---|
| apex of heart | UBERON:0002098 | 98.69 | gold quality |
| hindlimb stylopod muscle | UBERON:0004252 | 98.13 | gold quality |
| gastrocnemius | UBERON:0001388 | 98.11 | gold quality |
| triceps brachii | UBERON:0001509 | 98.07 | gold quality |
| muscle of leg | UBERON:0001383 | 98.03 | gold quality |
| heart left ventricle | UBERON:0002084 | 97.99 | gold quality |
| cardiac ventricle | UBERON:0002082 | 97.97 | gold quality |
| muscle organ | UBERON:0001630 | 97.95 | gold quality |
| vastus lateralis | UBERON:0001379 | 97.92 | gold quality |
| quadriceps femoris | UBERON:0001377 | 97.91 | gold quality |
| right atrium auricular region | UBERON:0006631 | 97.73 | gold quality |
| deltoid | UBERON:0001476 | 97.68 | gold quality |
| cardiac atrium | UBERON:0002081 | 97.59 | gold quality |
| skeletal muscle tissue | UBERON:0001134 | 97.57 | gold quality |
| diaphragm | UBERON:0001103 | 97.55 | gold quality |
| body of tongue | UBERON:0011876 | 97.45 | gold quality |
| left ventricle myocardium | UBERON:0006566 | 97.42 | gold quality |
| heart | UBERON:0000948 | 97.41 | gold quality |
| muscle tissue | UBERON:0002385 | 97.33 | gold quality |
| skeletal muscle tissue of rectus abdominis | UBERON:0004511 | 97.32 | gold quality |
| heart right ventricle | UBERON:0002080 | 97.21 | gold quality |
| biceps brachii | UBERON:0001507 | 97.00 | gold quality |
| metanephros cortex | UBERON:0010533 | 96.95 | gold quality |
| tibialis anterior | UBERON:0001385 | 96.93 | gold quality |
| skeletal muscle tissue of biceps brachii | UBERON:0004502 | 96.93 | gold quality |
| myocardium | UBERON:0002349 | 96.88 | gold quality |
| gluteal muscle | UBERON:0002000 | 96.75 | gold quality |
| olfactory segment of nasal mucosa | UBERON:0005386 | 96.69 | gold quality |
| right uterine tube | UBERON:0001302 | 96.64 | gold quality |
| vena cava | UBERON:0004087 | 96.64 | gold quality |
Single-cell (SCXA)
Detected in 1 experiment(s), a significant marker in 1.
| Experiment | Marker? | Max mean expression |
|---|---|---|
| E-ANND-3 | no | 0.00 |
Regulation
Is transcription factor: no
miRNA regulators (miRDB)
31 targeting SPAG7, top 30 by miRDB confidence (max_score; target_count = how many genes the miRNA targets in total — lower means more specific):
| miRNA | Max score | Avg score | miRNA target_count |
|---|---|---|---|
| HSA-MIR-4283 | 100.00 | 66.42 | 2097 |
| HSA-MIR-8485 | 100.00 | 77.57 | 4731 |
| HSA-MIR-4725-3P | 99.96 | 69.53 | 2520 |
| HSA-MIR-6780B-5P | 99.96 | 69.60 | 2562 |
| HSA-MIR-185-3P | 99.95 | 67.01 | 1743 |
| HSA-MIR-144-3P | 99.94 | 73.98 | 2698 |
| HSA-MIR-497-5P | 99.92 | 71.83 | 2674 |
| HSA-MIR-15A-5P | 99.90 | 72.80 | 2787 |
| HSA-MIR-15B-5P | 99.90 | 72.78 | 2798 |
| HSA-MIR-16-5P | 99.90 | 72.80 | 2780 |
| HSA-MIR-195-5P | 99.90 | 72.81 | 2805 |
| HSA-MIR-424-5P | 99.89 | 71.90 | 2641 |
| HSA-MIR-6838-5P | 99.89 | 71.94 | 2690 |
| HSA-MIR-4271 | 99.88 | 68.32 | 2244 |
| HSA-MIR-369-3P | 99.85 | 70.52 | 2264 |
| HSA-MIR-374C-5P | 99.80 | 72.06 | 2910 |
| HSA-MIR-655-3P | 99.80 | 72.19 | 2909 |
| HSA-MIR-6752-3P | 99.72 | 66.71 | 1587 |
| HSA-MIR-4524A-5P | 99.57 | 71.73 | 1193 |
| HSA-MIR-4524B-5P | 99.57 | 71.68 | 1195 |
| HSA-MIR-4489 | 99.50 | 65.56 | 785 |
| HSA-MIR-5683 | 99.36 | 68.59 | 2083 |
| HSA-MIR-361-3P | 99.19 | 66.45 | 1381 |
| HSA-MIR-503-5P | 97.87 | 66.83 | 575 |
| HSA-MIR-3173-5P | 97.35 | 65.82 | 1282 |
| HSA-MIR-6799-3P | 97.35 | 65.60 | 1302 |
| HSA-MIR-1913 | 97.07 | 66.20 | 1417 |
| HSA-MIR-3126-5P | 96.87 | 65.83 | 912 |
| HSA-MIR-6875-5P | 96.87 | 65.49 | 958 |
| HSA-MIR-342-3P | 96.44 | 67.48 | 1344 |
Literature-anchored findings (GeneRIF, showing 1)
- SPAG7 is a candidate gene for the periodic fever, aphthous stomatitis, pharyngitis and adenopathy (PFAPA) syndrome. (PMID:24452265)
Cross-species orthologs
4 orthologs
| Organism | Symbol | Gene ID |
|---|---|---|
| danio_rerio | spag7 | ENSDARG00000011555 |
| mus_musculus | Spag7 | ENSMUSG00000018287 |
| rattus_norvegicus | Spag7 | ENSRNOG00000004246 |
| drosophila_melanogaster | CG2608 | FBGN0032870 |
Protein
Protein identifiers
Sperm-associated antigen 7 — O75391 (reviewed: O75391)
All UniProt accessions (4): O75391, I3L0Q5, I3L0X5, I3L4C3
UniProt curated annotations — full annotation on UniProt →
Subcellular location. Nucleus.
Tissue specificity. Detected in fetal brain.
RefSeq proteins (1): NP_004881* (*=MANE)
Domains & families (InterPro)
| ID | Name | Type |
|---|---|---|
| IPR001374 | R3H_dom | Domain |
| IPR017330 | SPAG7 | Family |
| IPR034068 | R3H_sperm-antigen | Domain |
| IPR036867 | R3H_dom_sf | Homologous_superfamily |
Pfam: PF01424
UniProt features (20 total): modified residue 4, strand 4, helix 3, region of interest 2, short sequence motif 2, compositionally biased region 2, initiator methionine 1, chain 1, domain 1
Structure
Experimental structures (PDB)
1 structures.
| PDB | Method | Resolution (Å) |
|---|---|---|
| 2CPM | SOLUTION NMR |
Predicted structure (AlphaFold)
| Model | pLDDT | Fraction very-high |
|---|---|---|
| AF-O75391-F1 | 86.21 | 0.49 |
Functional residue map
Curated UniProt residues grouped by drug-discovery relevance — catalytic, ligand-binding, modification, and mutation-validated positions. Source: UniProtKB sequence features.
Post-translational modifications (4): 114, 158, 202, 2
Function
Pathways and Gene Ontology
Reactome pathways
0 pathways
MSigDB gene sets: 142 (showing top):
WWTAAGGC_UNKNOWN, SP3_Q3, GRAESSMANN_APOPTOSIS_BY_DOXORUBICIN_DN, GRAESSMANN_RESPONSE_TO_MC_AND_DOXORUBICIN_DN, SRF_C, GATA1_03, GFI1_01, NOUZOVA_TRETINOIN_AND_H4_ACETYLATION, YAGI_AML_WITH_11Q23_REARRANGED, GTATTAT_MIR3693P, DODD_NASOPHARYNGEAL_CARCINOMA_DN, MORF_NME2, KIM_ALL_DISORDERS_OLIGODENDROCYTE_NUMBER_CORR_UP, KIM_BIPOLAR_DISORDER_OLIGODENDROCYTE_DENSITY_CORR_UP, KIM_ALL_DISORDERS_CALB1_CORR_UP
GO Biological Process (0):
GO Molecular Function (2): nucleic acid binding (GO:0003676), protein binding (GO:0005515)
GO Cellular Component (1): nucleus (GO:0005634)
GO top-level categories
Rollup of top GO terms by namespace:
| Category | Terms |
|---|---|
| binding | 2 |
| intracellular membrane-bounded organelle | 1 |
Protein interactions and networks
STRING
206 interactions, top by confidence (×1000):
| Protein A | Protein B | Partner UniProt | Score |
|---|---|---|---|
| SPAG7 | FAM220A | Q7Z4H9 | 952 |
| SPAG7 | CD34 | P28906 | 495 |
| SPAG7 | M0QYU9 | M0QYU9 | 447 |
| SPAG7 | RPAP3 | Q9H6T3 | 446 |
| SPAG7 | SMIM7 | Q9BQ49 | 444 |
| SPAG7 | TEX261 | Q6UWH6 | 439 |
| SPAG7 | SPAG5 | Q96R06 | 394 |
| SPAG7 | AQP12B | A6NM10 | 392 |
| SPAG7 | SNU13 | P55769 | 391 |
| SPAG7 | TMEM141 | Q96I45 | 378 |
| SPAG7 | SPATA24 | Q86W54 | 370 |
| SPAG7 | SPAG8 | Q99932 | 370 |
| SPAG7 | ZNF232 | Q9UNY5 | 368 |
| SPAG7 | UAP1 | Q16222 | 360 |
| SPAG7 | ITPRID2 | P28290 | 357 |
IntAct
21 interactions, top by confidence:
| A | B | Type | Score |
|---|---|---|---|
| SPAG7 | LXN | psi-mi:“MI:0915”(physical association) | 0.560 |
| H3C1 | SMCHD1 | psi-mi:“MI:2364”(proximity) | 0.410 |
| SPAG7 | RAN | psi-mi:“MI:0915”(physical association) | 0.400 |
| KLHL20 | KRBA1 | psi-mi:“MI:0914”(association) | 0.350 |
| SLC25A32 | NEDD8-MDP1 | psi-mi:“MI:0914”(association) | 0.350 |
| KRT27 | CCDC88B | psi-mi:“MI:0914”(association) | 0.350 |
| LMNA | SMCHD1 | psi-mi:“MI:2364”(proximity) | 0.270 |
| H2BC10 | SMCHD1 | psi-mi:“MI:2364”(proximity) | 0.270 |
| HNRNPC | SBNO1 | psi-mi:“MI:2364”(proximity) | 0.270 |
| PPIL4 | ESYT2 | psi-mi:“MI:2364”(proximity) | 0.270 |
| SMNDC1 | SMCHD1 | psi-mi:“MI:2364”(proximity) | 0.270 |
| SRSF7 | ESYT2 | psi-mi:“MI:2364”(proximity) | 0.270 |
| U2AF1 | MED19 | psi-mi:“MI:2364”(proximity) | 0.270 |
| ZRANB2 | SBNO1 | psi-mi:“MI:2364”(proximity) | 0.270 |
| TAF15 | SBNO1 | psi-mi:“MI:2364”(proximity) | 0.270 |
| NPM1 | SBNO1 | psi-mi:“MI:2364”(proximity) | 0.270 |
| LXN | SPAG7 | psi-mi:“MI:0915”(physical association) | 0.000 |
| ABHD16A | SPAG7 | psi-mi:“MI:0915”(physical association) | 0.000 |
BioGRID (38): SPAG7 (Affinity Capture-MS), SPAG7 (Two-hybrid), SPAG7 (Co-fractionation), SPAG7 (Proximity Label-MS), SPAG7 (Proximity Label-MS), SPAG7 (Affinity Capture-MS), SPAG7 (Affinity Capture-MS), SPAG7 (Affinity Capture-MS), SPAG7 (Negative Genetic), SPAG7 (Negative Genetic), UBA2 (Positive Genetic), SPAG7 (Proximity Label-MS), SPAG7 (Proximity Label-MS), SPAG7 (Affinity Capture-MS), SPAG7 (Two-hybrid)
ESM2 similar proteins: A0JPM9, A2AQ19, O43395, O75391, O75822, P04973, P09496, P29084, P29540, Q02614, Q0VCU8, Q13123, Q15650, Q2HJ41, Q2KIA6, Q2KJF9, Q3MHJ0, Q3UGC7, Q5BK07, Q5I0B5, Q5NVI3, Q5R5F1, Q5R8D1, Q5RAD5, Q5RE03, Q5ZJ85, Q5ZJ97, Q5ZK25, Q5ZKA4, Q66HG8, Q66JS6, Q6GMH0, Q6INR1, Q6P320, Q7SXU0, Q7SYJ9, Q7TNE3, Q8BM39, Q91WE2, Q922U1
Diamond homologs: O75391, Q7SYJ9, Q7TNE3
SIGNOR signaling
0 interactions.
Enriched among interaction partners
Reactome pathways and GO biological processes over-represented among this gene’s 24 IntAct physical interaction partners (hypergeometric vs the genome-wide background, BH-FDR, gene-set size 15–500, ranked by fold). A functional readout of the neighbourhood — distinct from this gene’s own memberships above, and biased toward well-studied / hub proteins, so read it as themes rather than proof.
Reactome pathways:
| Pathway | Partners | Fold | FDR |
|---|---|---|---|
| Dengue Virus-Host Interactions | 7 | 20.0× | 3e-06 |
| mRNA Splicing - Major Pathway | 5 | 17.1× | 5e-04 |
GO biological processes:
| GO term | Partners | Fold | FDR |
|---|---|---|---|
| RNA splicing | 5 | 21.0× | 4e-04 |
Disease & clinical
Clinical variants and AI predictions
ClinVar
36 variants total. Per-class counts are floors (≥ shown; pagination cap):
| Classification | Count (floor) |
|---|---|
| Pathogenic | 0 |
| Likely pathogenic | 0 |
| Uncertain significance | 24 |
| Likely benign | 1 |
| Benign | 3 |
Top pathogenic / likely-pathogenic (0)
SpliceAI
962 predictions. Top by Δscore:
| Variant | Effect | Δscore |
|---|---|---|
| 17:4959753:GCCT:G | donor_loss | 1.0000 |
| 17:4959754:CCTCA:C | donor_loss | 1.0000 |
| 17:4959755:CTC:C | donor_loss | 1.0000 |
| 17:4959756:TCACC:T | donor_loss | 1.0000 |
| 17:4959757:CA:C | donor_loss | 1.0000 |
| 17:4959759:C:A | donor_loss | 1.0000 |
| 17:4959759:CCA:C | donor_gain | 1.0000 |
| 17:4959776:A:AC | donor_gain | 1.0000 |
| 17:4959776:ATTGG:A | donor_gain | 1.0000 |
| 17:4959813:C:CA | donor_gain | 1.0000 |
| 17:4959912:AGCTC:A | acceptor_gain | 1.0000 |
| 17:4959914:CTC:C | acceptor_gain | 1.0000 |
| 17:4959915:TC:T | acceptor_gain | 1.0000 |
| 17:4959916:CC:C | acceptor_gain | 1.0000 |
| 17:4959917:C:CC | acceptor_gain | 1.0000 |
| 17:4959923:G:C | acceptor_gain | 1.0000 |
| 17:4959923:G:GC | acceptor_gain | 1.0000 |
| 17:4960015:AGCT:A | donor_gain | 1.0000 |
| 17:4960018:TCAC:T | donor_loss | 1.0000 |
| 17:4960019:CA:C | donor_loss | 1.0000 |
| 17:4960020:A:AC | donor_gain | 1.0000 |
| 17:4960020:AC:A | donor_gain | 1.0000 |
| 17:4960020:ACCTT:A | donor_gain | 1.0000 |
| 17:4960021:C:CC | donor_gain | 1.0000 |
| 17:4960021:C:G | donor_loss | 1.0000 |
| 17:4960021:CC:C | donor_gain | 1.0000 |
| 17:4960021:CCT:C | donor_gain | 1.0000 |
| 17:4960021:CCTT:C | donor_gain | 1.0000 |
| 17:4960021:CCTTC:C | donor_gain | 1.0000 |
| 17:4960107:AACTC:A | acceptor_gain | 1.0000 |
AlphaMissense
1510 scored. Top likely-pathogenic:
| Variant | Protein change | am_pathogenicity |
|---|---|---|
| 17:4959602:C:G | A206P | 1.000 |
| 17:4959610:A:T | I203N | 1.000 |
| 17:4959627:C:A | K197N | 1.000 |
| 17:4959627:C:G | K197N | 1.000 |
| 17:4959589:A:G | I210T | 0.999 |
| 17:4959606:T:A | E204D | 0.999 |
| 17:4959606:T:G | E204D | 0.999 |
| 17:4959610:A:C | I203S | 0.999 |
| 17:4959613:G:A | S202F | 0.999 |
| 17:4959617:G:T | R201S | 0.999 |
| 17:4959621:G:C | D199E | 0.999 |
| 17:4959621:G:T | D199E | 0.999 |
| 17:4959622:T:A | D199V | 0.999 |
| 17:4959622:T:G | D199A | 0.999 |
| 17:4959623:C:G | D199H | 0.999 |
| 17:4959629:T:C | K197E | 0.999 |
| 17:4959765:C:T | G190D | 0.999 |
| 17:4959825:A:G | L170P | 0.999 |
| 17:4959835:A:G | Y167H | 0.999 |
| 17:4960237:T:A | K108N | 0.999 |
| 17:4960237:T:G | K108N | 0.999 |
| 17:4960292:A:G | L90P | 0.999 |
| 17:4960298:G:T | A88D | 0.999 |
| 17:4960317:G:C | H82D | 0.999 |
| 17:4960462:A:T | I80K | 0.999 |
| 17:4960467:C:A | R78S | 0.999 |
| 17:4960467:C:G | R78S | 0.999 |
| 17:4960468:C:A | R78M | 0.999 |
| 17:4960468:C:G | R78T | 0.999 |
| 17:4967782:A:G | I8T | 0.999 |
dbSNP variants (sampled 300 via entrez): RS1000105806 (17:4967406 G>A,C), RS1000414575 (17:4964668 T>C), RS1000456742 (17:4967579 G>A,C), RS1000749234 (17:4966304 C>T), RS1000999789 (17:4963119 G>A), RS1001058184 (17:4968892 A>G,T), RS1001161052 (17:4968314 C>G), RS1001201473 (17:4968774 C>G,T), RS1001273520 (17:4969089 G>A), RS1001506477 (17:4958774 C>A), RS1001602539 (17:4964607 C>A,T), RS1001864761 (17:4958813 A>G), RS1002003345 (17:4964328 T>C), RS1002660958 (17:4965476 A>T), RS1002784460 (17:4960199 G>A,C,T)
Disease associations
OMIM: gene MIM:610056 | disease phenotypes:
GenCC curated gene-disease
| Disease | Classification | Inheritance |
|---|---|---|
| PFAPA syndrome | Limited | Autosomal dominant |
Mondo (1): PFAPA syndrome (MONDO:0018540)
Orphanet (0):
HPO phenotypes
0 total (0 of 0 shown, HPO-id order):
GWAS associations
3 associations (top):
| Study | Trait | p-value |
|---|---|---|
| GCST004599_114 | Mean platelet volume | 4.000000e-09 |
| GCST012020_148 | Serum metabolite levels | 3.000000e-11 |
| GCST90013442_27 | Keratoconus | 2.000000e-14 |
Drugs & pharmacology
Drug and pharmacology data
Is drug target: no
PharmGKB: 1 entry (VIP=true, CPIC=false)
CTD chemical–gene interactions
28 total (human), top 28 by PubMed support.
| Chemical | Actions (top 5) | PubMed papers |
|---|---|---|
| Valproic Acid | affects expression, decreases expression | 3 |
| bisphenol A | decreases expression, increases expression | 2 |
| FR900359 | decreases phosphorylation | 1 |
| beta-lapachone | increases expression | 1 |
| manganese chloride | decreases expression, increases abundance | 1 |
| CGP 52608 | affects binding, increases reaction | 1 |
| K 7174 | increases expression | 1 |
| abrine | increases expression | 1 |
| jinfukang | increases expression | 1 |
| Caffeine | decreases phosphorylation | 1 |
| Cannabidiol | affects cotreatment, decreases expression | 1 |
| Cuprizone | affects cotreatment, decreases expression | 1 |
| Dexamethasone | decreases expression | 1 |
| Diazinon | increases methylation | 1 |
| Dimethyl Sulfoxide | increases expression | 1 |
| Doxorubicin | increases expression | 1 |
| Enzyme Inhibitors | decreases activity, increases O-linked glycosylation | 1 |
| Ivermectin | increases expression | 1 |
| Lead | decreases expression | 1 |
| Manganese | decreases expression, increases abundance | 1 |
| Paraquat | increases expression | 1 |
| Rotenone | increases expression | 1 |
| Smoke | decreases expression | 1 |
| Urethane | decreases expression | 1 |
| Vitamin E | increases expression | 1 |
| Palmitic Acid | increases phosphorylation | 1 |
| Copper Sulfate | decreases expression | 1 |
| Lactic Acid | decreases expression | 1 |
Cellosaurus cell lines
1 cell lines: 1 transformed cell line
First 10 cell lines (id-ordered, not curated):
| Cellosaurus | Name | Category | Sex |
|---|---|---|---|
| CVCL_B3HZ | Abcam HEK293T SPAG7 KO | Transformed cell line | Female |
Clinical trials (associated diseases)
3 trials via MONDO — disease-level, not drug-specific.
| Trial | Phase | Status | Title |
|---|---|---|---|
| NCT02811705 | Not specified | COMPLETED | Life Quality Study for PFAPA Patient |
| NCT03331497 | Not specified | COMPLETED | Tonsillotomy or Follow-up in PFAPA Syndrome |
| NCT05200715 | Not specified | RECRUITING | AutoInflammatory Disease Alliance Registry (AIDA) |
Related Atlas pages
- Associated diseases: PFAPA syndrome
- Disease cohort memberships (association, not causation — diseases whose associated-gene cohort lists this gene; a subset are also under Associated diseases): keratoconus, PFAPA syndrome