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Charcot-Marie-Tooth disease type 4D (CMT4D) is a subtype of Charcot-Marie-Tooth disease type 4 characterized by a childhood-onset of severe, progressive, demyelinating sensorimotor neuropathy manifesting with distal muscle weakness and atrophy, sensorineural hearing impairment leading to deafness (usually in third decade), severely reduced nerve conduction velocities, and skeletal, especially foot, deformities. Tongue atrophy has also been reported.
Features include always present findings: Impaired distal proprioception, Impaired distal tactile sensation, Areflexia, and Decreased nerve conduction velocity and others; and very common findings: Decreased motor nerve conduction velocity, Decreased amplitude of sensory action potentials, Demyelinating peripheral neuropathy, and Distal lower limb muscle weakness. 42 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Arms and legs | 7 | Claw hand deformity, Distal lower limb muscle weakness, Abnormal foot morphology |
Brain and nerves | 6 | Unsteady gait, Hyporeflexia, Difficulty walking (gait disturbance) |
Muscles | 5 | Distal muscle weakness, Frequent falls, Proximal muscle weakness |
Ears | 2 | Hearing loss (hearing impairment), Inner ear hearing loss (sensorineural hearing impairment) |
Bones and joints | 2 | Kyphoscoliosis, Postural tremor |
Eyes | 1 | Glaucoma |
NDRG1 encodes N-myc downstream regulated 1 (394 aa). Stress-responsive protein involved in hormone responses, cell growth, and differentiation. Acts as a tumor suppressor in many cell types. Highest expression in Nerve Tibial (816.8 TPM) and Brain Spinal cord cervical c-1 (440.5 TPM).
Charcot-Marie-Tooth disease type 4D is associated with mutations in the NDRG1 gene on chromosome 8.
The NDRG1 protein participates in TP53 stimulates NDRG1 gene expression, BRD7 promotes EP300-mediated acetylation of TP53, and p-S15,S20-TP53 Tetramer:NDRG1 Gene pathways.
NDRG1 is classified as a druggable target (Clinically Actionable category) with score 0.0.
Genetic testing for NDRG1 is available. Testing is considered confirmatory for diagnosis.
Phenotype severity distribution: 5 always present features, 4 very common features, 11 common features.
Estimated prevalence: Unknown (Unknown prevalence).
2 clinical trials registered, 2 recruiting. Interventions under study include other interventions. Research is primarily sponsored by academic and government institutions.
4 publications have been identified in PubMed for Charcot-Marie-Tooth disease type 4D. Research spans Basic Science / Preclinical (50%), Review / Meta-Analysis (25%), and Case Report / Case Series (25%).
Abati E (2026). [PMID: 42089726](https://pubmed.ncbi.nlm.nih.gov/42089726/). *J Neuromuscul Dis*. [Review / Meta-Analysis]
Chowdhary PK (2025). [PMID: 40462946](https://pubmed.ncbi.nlm.nih.gov/40462946/). *bioRxiv*. [Basic Science / Preclinical]
Atkinson D (2024). [PMID: 39201732](https://pubmed.ncbi.nlm.nih.gov/39201732/). *Int J Mol Sci*. [Basic Science / Preclinical]
Wilhelm SDP (2024). [PMID: 39352000](https://pubmed.ncbi.nlm.nih.gov/39352000/). *IUBMB Life*. [Case Report / Case Series]
Data assembled from 7 of 12 sources · Last updated Sep 19, 2026, 9:40 PM UTC
Online Mendelian Inheritance in Man
European rare disease database
Genetic and Rare Diseases Info Center
Common questions about Charcot-Marie-Tooth disease type 4D
AI-curated news mentioning Charcot-Marie-Tooth disease type 4D
Updated May 6, 2026
A study details clinical and pathological findings in two Italian siblings of Romani ancestry diagnosed with Charcot-Marie-Tooth type 4D. This research contributes to the understanding of the disease's genetic and phenotypic variability.