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Features include always present findings: Agenesis of corpus callosum, Global developmental delay, and Growth delay; and very common findings: Ectrodactyly. 28 total HPO annotations.
Organ System | Phenotype Count | Example Features |
|---|---|---|
Head and neck | 5 | Median cleft upper lip, Cleft palate, Craniosynostosis |
Brain and nerves | 2 | Bilateral tonic-clonic seizure, Global developmental delay |
Hormones | 1 | Diabetes insipidus |
Bones and joints | 1 | Hypoplasia of the frontal bone |
Muscles | 1 | Neonatal hypotonia |
Pregnancy and birth | 1 | Neonatal hypotonia |
Growth and development | 1 | Growth delay |
FGFR1-related Hartsfield syndrome is characterized by findings of the holoprosencephaly (HPE) spectrum in combination with findings of the ectrodactyly spectrum. To date, 35 individuals with FGFR1-related Hartsfield syndrome have been identified [, , , , , , , , ]. The following description of the phenotypic features associated with this condition is based on these reports. HPE spectrum malformations include alobar, semilobar, or lobar holoprosencephaly. Other observed midline brain malformations include corpus callosum agenesis, absent septum pellucidum, absent olfactory bulbs and tracts, and vermian hypoplasia.
Source: GeneReviews — "FGFR1-Related Hartsfield Syndrome"
FGFR1 encodes fibroblast growth factor receptor 1 (822 aa). Tyrosine-protein kinase that acts as a cell-surface receptor for fibroblast growth factors and plays an essential role in the regulation of embryonic development, cell proliferation, differentiation and migration. Highest expression in Artery Aorta (144.8 TPM) and Ovary (142.9 TPM).
Hartsfield-Bixler-Demyer syndrome has been associated with mutations in the FGFR1 gene on chromosome 8.
The FGFR1 protein participates in p-8Y- FGFR1 R576W, p-8Y-FGFR1 N546K, and p-8Y-FGFR1 K656E pathways.
FGFR1 is classified as a druggable target (Clinically Actionable, Drug Resistance, Druggable Genome, Kinase, and Tyrosine Kinase categories) with score 1.1.
FGFR1-related Hartsfield syndrome should be suspected in individuals with the following two core features:
Source: GeneReviews — "FGFR1-Related Hartsfield Syndrome"
(HPE). See Holoprosencephaly Overview. Ectrodactyly, ectodermal dysplasia, cleft lip/palate syndrome 3 (EEC3) – an autosomal dominant disorder caused by pathogenic variants in TP63 (see TP63-Related Disorders) – is associated with:
Source: GeneReviews — "FGFR1-Related Hartsfield Syndrome"
Genetic testing for FGFR1 is available. Testing is considered supportive for diagnosis.
No approved treatments are currently available for Hartsfield-Bixler-Demyer syndrome. The disease remains an area of unmet medical need.
No clinical practice guidelines for FGFR1-related Hartsfield syndrome have been published. Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with FGFR1-related Hartsfield syndrome, the evaluations summarized (if not performed as part of the evaluation that led to the diagnosis) are recommended. Table 3. Recommended Evaluations Following Initial Diagnosis in Individuals with FGFR1-Related Hartsfield Syndrome
System/Concern | Evaluation | Comment |
|---|---|---|
Neurologic | Brain MRI | Determine type of holoprosencephaly (alobar, semilobar, or lobar). Neurologic eval |
Development | Developmental assessment incl evidence for spasticity | Incl motor, adaptive, cognitive, speech-language eval; Eval for early intervention / special education Gastrointestinal/ |
Feeding | Gastroenterology/ nutrition/ feeding team eval for evidence of problems that may result from cleft lip/palate /or oromotor dysfunction | Incl eval of aspiration risk nutritional status; Consider eval for gastrostomy tube placement in those w/dysphagia /or aspiration risk. |
Cleft lip/palate | Referral to craniofacial team | — |
Endocrine | Evaluate for evidence of endocrine deficiency (growth hormone deficiency, hypogonadotropic hypogonadism). |
Source: GeneReviews — "FGFR1-Related Hartsfield Syndrome"
Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions. Note: There may not be clinical trials for this disorder.
Source: GeneReviews — "FGFR1-Related Hartsfield Syndrome"
View trials for Hartsfield-Bixler-Demyer syndrome
Table 5.
Recommended Surveillance for Individuals with FGFR1-Related Hartsfield Syndrome
System/Concern | Evaluation | Frequency
| • Measurement of growth parameters
Eval of nutritional status safety of oral intake
| At each visit
| Monitor for evidence of aspiration, respiratory insufficiency.
| • Monitor those w/seizures as clinically indicated.
Assess for new manifestations incl seizures, changes in tone, mvmt disorders.
| Monitor developmental progress educational needs.
Psychiatric/
| Behavioral assessment for anxiety, attention, aggressive or self-injurious behavior
| Physical medicine, OT/PT assessment of mobility, self-help skills
OT = occupational therapy; PT = physical therapy
Source: GeneReviews — "FGFR1-Related Hartsfield Syndrome"
Phenotype severity distribution: 3 always present features, 1 very common feature, 5 common features.
Estimated prevalence: <1 in 1,000,000 (VERY_RARE).
No clinical trials have been registered for Hartsfield-Bixler-Demyer syndrome.
6 publications have been identified in PubMed for Hartsfield-Bixler-Demyer syndrome. Research spans Case Report / Case Series (67%) and Review / Meta-Analysis (33%).
An J (2026). [PMID: 40801429](https://pubmed.ncbi.nlm.nih.gov/40801429/). *Am J Med Genet A*. [Case Report / Case Series]
Hodges MB (2025). [PMID: 41238524](https://pubmed.ncbi.nlm.nih.gov/41238524/). *Prenat Diagn*. [Case Report / Case Series]
Illi C (2025). [PMID: 40370525](https://pubmed.ncbi.nlm.nih.gov/40370525/). *Case Rep Perinat Med*. [Case Report / Case Series]
Gaudioso F (2025). [PMID: 41562894](https://pubmed.ncbi.nlm.nih.gov/41562894/). *Med Sci (Basel)*. [Review / Meta-Analysis]
Szoszkiewicz A (2025). [PMID: 40428317](https://pubmed.ncbi.nlm.nih.gov/40428317/). *Genes (Basel)*. [Review / Meta-Analysis]
Graziani L (2024). [PMID: 38679587](https://pubmed.ncbi.nlm.nih.gov/38679587/). *J Matern Fetal Neonatal Med*. [Case Report / Case Series]
Data assembled from 8 of 12 sources · Last updated Sep 19, 2026, 8:02 PM UTC
Online Mendelian Inheritance in Man
European rare disease database
Genetic and Rare Diseases Info Center
Common questions about Hartsfield-Bixler-Demyer syndrome
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Musculoskeletal | Orthopedics/ physical medicine rehab/ PT OT eval | Incl assessment of:; Extent of ectrodactyly; Gross motor fine motor skills; Mobility, ADL, need for adaptive devices; Need for PT (to improve gross motor skills) /or OT (to improve fine motor skills) Neuroimaging for tethered spinal cord if suspicion (rare) |
Cardiac | Referral to pediatric cardiologist for eval for cardiovascular malformation | Incl echocardiogram Genetic |
counseling | By genetics professionals1 | To inform affected persons their families re nature, MOI, implications of this disorder to facilitate medical personal decision making Family support resources |
Treatment of Manifestations in Individuals with FGFR1-Related Hartsfield Syndrome Manifestation/Concern | Treatment | Considerations/Other Hypothalamic dysfunction assoc w/holoprosencephaly |
Epilepsy | Standardized treatment w/ASM by experienced neurologist | Medically refractory epilepsy typically requires multiple ASMs.; Many ASMs may be effective; none has been demonstrated effective specifically for this disorder.; Education of parents/caregivers1 Developmental delay / |
Intellectual disability | See . | Spasticity |
Tethered spinal cord (rare) | Surgery may be required. | Feeding issues |
Cleft lip/palate | Surgical repair under direction of craniofacial team | Hand foot malformations |