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LIG4 syndrome is a hereditary disorder associated with impaired DNA double-strand break repair mechanisms and characterized by microcephaly, unusual facial features, growth and developmental delay, skin anomalies, and pancytopenia, which is associated with combined immunodeficiency (CID).
Features include always present findings: Narrow forehead, Astigmatism, Micropenis, and Asthma and others; and very common findings: Microcephaly, Global developmental delay, Bird-like facies, and Growth delay and others. 53 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Blood and immune system | 7 | Recurrent respiratory infections, Low platelet count (thrombocytopenia), Low blood cell counts (all types) (pancytopenia) |
LIG4 encodes DNA ligase 4 (911 aa). DNA ligase involved in DNA non-homologous end joining (NHEJ); required for double-strand break (DSB) repair and V(D)J recombination. Highest expression in Pituitary (17.9 TPM) and Brain Cerebellar Hemisphere (17.6 TPM).
DNA ligase IV deficiency is caused by mutations in the LIG4 gene on chromosome 13.
The LIG4 protein participates in p-T2609,S2612,T2638,T2647-PRKDC:XRCC5:XRCC6:p-S516,S645-DCLRE1C:XRCC4:LIG4:NHEJ1:POLL,POLM:Ligatable DNA DSB ends, p-T2609,S2612,T2638,T2647-PRKDC:XRCC5:XRCC6:p-S516,S645-DCLRE1C:XRCC4:LIG4:NHEJ1:POLL,POLM:Extended ligatable DNA DSB ends, and XRCC4:LIG4 ligates DNA DSB ends during NHEJ pathways.
LIG4 is classified as a druggable target (Enzyme and Kinase categories) with score 0.0.
Genetic testing for LIG4 is available. Testing is considered confirmatory for diagnosis.
Phenotype severity distribution: 7 always present features, 6 very common features, 18 common features.
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).
1 clinical trial registered. Interventions under study include other interventions. Research is primarily sponsored by academic and government institutions.
7 publications have been identified in PubMed for DNA ligase IV deficiency. Research spans Case Report / Case Series (43%), Basic Science / Preclinical (29%), and Review / Meta-Analysis (14%).
Kose H (2026). [PMID: 41705238](https://pubmed.ncbi.nlm.nih.gov/41705238/). *Front Immunol*. [Epidemiology / Natural History]
Kawata M (2026). [PMID: 41242337](https://pubmed.ncbi.nlm.nih.gov/41242337/). *Radiat Res*. [Basic Science / Preclinical]
Yasar D (2025). [PMID: 39953892](https://pubmed.ncbi.nlm.nih.gov/39953892/). *J Pediatr Endocrinol Metab*. [Case Report / Case Series]
Singh A (2025). [PMID: 38591195](https://pubmed.ncbi.nlm.nih.gov/38591195/). *Curr Pediatr Rev*. [Review / Meta-Analysis]
Nicolle R (2024). [PMID: 38351293](https://pubmed.ncbi.nlm.nih.gov/38351293/). *Eur J Hum Genet*. [Case Report / Case Series]
Data assembled from 8 of 12 sources · Last updated Sep 19, 2026, 5:47 AM UTC
Online Mendelian Inheritance in Man
European rare disease database
Genetic and Rare Diseases Info Center
Common questions about DNA ligase IV deficiency
Skin | 5 | Telangiectasia, Psoriasiform dermatitis, Cutaneous photosensitivity |
Hormones | 3 | Amenorrhea, Hypothyroidism, Type II diabetes mellitus |
Brain and nerves | 3 | Delayed speech and language development, Global developmental delay, Intellectual disability |
Growth and development | 2 | Failure to thrive, Growth delay |
Lungs and breathing | 2 | Asthma, Recurrent respiratory infections |
Bones and joints | 2 | Bone and joint problems (abnormality of the skeletal system), Abnormal bone marrow cell morphology |
Digestive system | 2 | Malabsorption, Enlarged liver (hepatomegaly) |
Head and neck | 1 | Microcephaly |
Arms and legs | 1 | Clinodactyly of the 5th finger |
Jiang C (2024). [PMID: 39698004](https://pubmed.ncbi.nlm.nih.gov/39698004/). *Clin Case Rep*. [Case Report / Case Series]
Bedir M (2024). [PMID: 38943005](https://pubmed.ncbi.nlm.nih.gov/38943005/). *EMBO Rep*. [Basic Science / Preclinical]