Alagille Syndrome

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Alagille syndrome (AGS) is a genetic disorder affecting the gastrointestinal (liver cholestasis), cardiac (heart), renal (kidney), skeletal, ocular, and facial. Alagille syndrome is transmitted in an autosomal dominant pattern of inheritance (1 in every 100,000 live births) with incomplete penetrance. Caused by mutations in the human homolog of Jagged-1 (JAG1) on chromosome 20p12. Jagged-1 is a ligand in the Notch receptor signalling pathway.

Named after Daniel Alagille (1925 - 2005) a French physician who specialized in pediatric hepatology, the study of childhood liver diseases.

Genetic Links: genetic abnormalities | maternal age | Trisomy 21 | Trisomy 18 | Trisomy 13 | Trisomy X | trisomy mosaicism | Monosomy | Fragile X | Williams | Alagille | Philadelphia chromosome | mitochondria | VACTERL | hydatidiform mole | epigenetics | Prenatal Diagnosis | Neonatal Diagnosis | meiosis | mitosis | International Classification of Diseases | genetics

Some Recent Findings

Chromosome 20
  • Clinical features, Outcomes, and Genetic analysis in Korean Children with Alagille Syndrome[1] "Alagille syndrome (AGS) is a multisystem autosomal dominant disorder that affects the liver, heart, eyes, face, bone, and other organs. AGS is caused by mutations in one of two genes, JAG1 or NOTCH2. We evaluated clinical features, outcomes, and the presence of JAG1 and NOTCH2 mutations in Korean children with AGS. PATIENTS AND METHODS: Between January 1997 and December 2013, 19 children were diagnosed with AGS at Asan Medical Center, Seoul, Korea. Their clinical features, outcomes, and JAG1 and NOTCH2 mutation status were retrospectively analyzed. RESULTS: The prevalence of clinical features in the 19 patients is as follows: Dysmorphic facial features, 100% (n=19); liver symptoms, 89% (n=17); cardiac symptoms, 95% (n=18); ophthalmologic symptoms, 67% (n=10); skeletal deformities, 47% (n=9); and renal symptoms, 21% (n=4). JAG1 mutations were identified in 14 patients. The thirteen different JAG1 mutations, seven of which were novel, included four deletions, three insertions, two missense mutations, three nonsense mutations, and one indel mutation. No NOTCH2 mutations were found. Two patients who received liver transplantation due to liver failure are still alive. Two patients died of comorbidities related to AGS, one of cardiac failure and one of hepatic failure."
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<pubmed limit=5>Alagille Syndrome</pubmed>


<pubmed limit=5>Jagged-1</pubmed>

Daniel Alagille

This genetic syndrome is named for Daniel Alagille (1925 - 2005)[2] a paediatric hepatologist, originally trained at Hôpital St-Vincent-de-Paul and was then appointed Professeur agrégé (1963). He was director of the Paediatric Hepatology Unit at Bicêtre Hospital (Paris, France).

International Classification of Diseases

ICD10 Other congenital malformations of the digestive system (Q38-Q45)  
XVII Congenital Malformations - Other congenital malformations of the digestive system (Q38-Q45)
Q38 Other congenital malformations of tongue, mouth and pharynx

Excl.: macrostomia (Q18.4) microstomia (Q18.5)

  • Q38.0 Congenital malformations of lips, not elsewhere classified Congenital: fistula of lip malformation of lip NOS Van der Woude's syndrome Excl.: cleft lip (Q36.-) cleft lip with cleft palate (Q37.-) macrocheilia (Q18.6) microcheilia (Q18.7)
  • Q38.1 Ankyloglossia Tongue tie
  • Q38.2 Macroglossia
  • Q38.3 Other congenital malformations of tongue Aglossia Bifid tongue Congenital: adhesion fissure malformation NOS of tongue Hypoglossia Hypoplasia of tongue Microglossia
  • Q38.4 Congenital malformations of salivary glands and ducts Absence Accessory Atresia (of) salivary gland or duct Congenital fistula of salivary gland
  • Q38.5 Congenital malformations of palate, not elsewhere classified Absence of uvula Congenital malformation of palate NOS High arched palate Excl.: cleft palate (Q35.-) cleft palate with cleft lip (Q37.-)
  • Q38.6 Other congenital malformations of mouth Congenital malformation of mouth NOS
  • Q38.7 Pharyngeal pouch Diverticulum of pharynx Excl.: pharyngeal pouch syndrome (D82.1)
  • Q38.8 Other congenital malformations of pharynx Congenital malformation of pharynx NOS
Q39 Congenital malformations of oesophagus
  • Q39.0 Atresia of oesophagus without fistula Atresia of oesophagus NOS
  • Q39.1 Atresia of oesophagus with tracheo-oesophageal fistula Atresia of oesophagus with broncho-oesophageal fistula
  • Q39.2 Congenital tracheo-oesophageal fistula without atresia Congenital tracheo-oesophageal fistula NOS
  • Q39.3 Congenital stenosis and stricture of oesophagus
  • Q39.4 Oesophageal web
  • Q39.5 Congenital dilatation of oesophagus
  • Q39.6 Diverticulum of oesophagus Oesophageal pouch
  • Q39.8 Other congenital malformations of oesophagus Absent Congenital displacement Duplication (of) oesophagus
  • Q39.9 Congenital malformation of oesophagus, unspecified
Q40 Other congenital malformations of upper alimentary tract
  • Q40.0 Congenital hypertrophic pyloric stenosis Congenital or infantile: constriction hypertrophy spasm stenosis stricture of pylorus
  • Q40.1 Congenital hiatus hernia Displacement of cardia through oesophageal hiatus Excl.: congenital diaphragmatic hernia (Q79.0)
  • Q40.2 Other specified congenital malformations of stomach Congenital: displacement of stomach diverticulum of stomach hourglass stomach Duplication of stomach Megalogastria Microgastria
  • Q40.3 Congenital malformation of stomach, unspecified
  • Q40.8 Other specified congenital malformations of upper alimentary tract
  • Q40.9 Congenital malformation of upper alimentary tract, unspecified Congenital: anomaly deformity NOS of upper alimentary tract
Q41 Congenital absence, atresia and stenosis of small intestine

Incl.: congenital obstruction, occlusion and stricture of small intestine or intestine NOS Excl.: meconium ileus (E84.1)

  • Q41.0 Congenital absence, atresia and stenosis of duodenum
  • Q41.1 Congenital absence, atresia and stenosis of jejunum Apple peel syndrome Imperforate jejunum
  • Q41.2 Congenital absence, atresia and stenosis of ileum
  • Q41.8 Congenital absence, atresia and stenosis of other specified parts of small intestine
  • Q41.9 Congenital absence, atresia and stenosis of small intestine, part unspecified Congenital absence, atresia and stenosis of intestine NOS
Q42 Congenital absence, atresia and stenosis of large intestine

Incl.: congenital obstruction, occlusion and stricture of large intestine

  • Q42.0 Congenital absence, atresia and stenosis of rectum with fistula
  • Q42.1 Congenital absence, atresia and stenosis of rectum without fistula Imperforate rectum
  • Q42.2 Congenital absence, atresia and stenosis of anus with fistula
  • Q42.3 Congenital absence, atresia and stenosis of anus without fistula Imperforate anus
  • Q42.8 Congenital absence, atresia and stenosis of other parts of large intestine
  • Q42.9 Congenital absence, atresia and stenosis of large intestine, part unspecified
Q43 Other congenital malformations of intestine
  • Q43.0 Meckel's diverticulum Persistent: omphalomesenteric duct vitelline duct
  • Q43.1 Hirschsprung's disease Aganglionosis Congenital (aganglionic) megacolon
  • Q43.2 Other congenital functional disorders of colon Congenital dilatation of colon
  • Q43.3 Congenital malformations of intestinal fixation Congenital adhesions [bands]: omental, anomalous peritoneal Jackson's membrane Malrotation of colon Rotation: failure of incomplete insufficient of caecum and colon Universal mesentery
  • Q43.4 Duplication of intestine
  • Q43.5 Ectopic anus
  • Q43.6 Congenital fistula of rectum and anus Excl.: congenital fistula: rectovaginal (Q52.2) urethrorectal (Q64.7) pilonidal fistula or sinus (L05.-) with absence, atresia and stenosis (Q42.0,Q42.2)
  • Q43.7 Persistent cloaca Cloaca NOS
  • Q43.8 Other specified congenital malformations of intestine Congenital: blind loop syndrome diverticulitis, colon diverticulum, intestine Dolichocolon Megaloappendix Megaloduodenum Microcolon Transposition of: appendix colon intestine
  • Q43.9 Congenital malformation of intestine, unspecified
Q44 Congenital malformations of gallbladder, bile ducts and liver
  • Q44.0 Agenesis, aplasia and hypoplasia of gallbladder Congenital absence of gallbladder
  • Q44.1 Other congenital malformations of gallbladder Congenital malformation of gallbladder NOS Intrahepatic gallbladder
  • Q44.2 Atresia of bile ducts
  • Q44.3 Congenital stenosis and stricture of bile ducts
  • Q44.4 Choledochal cyst
  • Q44.5 Other congenital malformations of bile ducts Accessory hepatic duct Congenital malformation of bile duct NOS Duplication: biliary duct cystic duct
  • Q44.6 Cystic disease of liver Fibrocystic disease of liver
  • Q44.7 Other congenital malformations of liver Accessory liver Alagille's syndrome Congenital: absence of liver hepatomegaly malformation of liver NOS
Q45 Other congenital malformations of digestive system

Excl.: congenital: diaphragmatic hernia (Q79.0) hiatus hernia (Q40.1)

  • Q45.0 Agenesis, aplasia and hypoplasia of pancreas Congenital absence of pancreas
  • Q45.1 Annular pancreas
  • Q45.2 Congenital pancreatic cyst
  • Q45.3 Other congenital malformations of pancreas and pancreatic duct Accessory pancreas Congenital malformation of pancreas or pancreatic duct NOS Excl.: diabetes mellitus: congenital (E10.-) neonatal (P70.2) fibrocystic disease of pancreas (E84.-)
  • Q45.8 Other specified congenital malformations of digestive system Absence (complete)(partial) of alimentary tract NOS Duplication Malposition, congenital of digestive organs NOS
  • Q45.9 Congenital malformation of digestive system, unspecified Congenital: anomaly deformity NOS of digestive system

World Health Organisation. International Statistical Classification of Diseases and Related Health Problems. (1992) 10th Revision (ICD-10). Geneva: WHO ICD-10 - 2016 Online (English)

Links: Gastrointestinal Abnormalities
GIT Links: Introduction | Medicine Lecture | Science Lecture | endoderm | mouth | oesophagus | stomach | liver | gallbladder | Pancreas | intestine | mesentery | tongue | taste | enteric nervous system | Stage 13 | Stage 22 | gastrointestinal abnormalities | Movies | Postnatal | milk | tooth | salivary gland | BGD Lecture | BGD Practical | GIT Terms | Category:Gastrointestinal Tract
GIT Histology Links: Upper GIT | Salivary Gland | Smooth Muscle Histology | Liver | Gallbladder | Pancreas | Colon | Histology Stains | Histology | GIT Development
Historic Embryology - Gastrointestinal Tract  
1878 Alimentary Canal | 1882 The Organs of the Inner Germ-Layer The Alimentary Tube with its Appended Organs | 1884 Great omentum and transverse mesocolon | 1902 Meckel's diverticulum | 1902 The Organs of Digestion | 1903 Submaxillary Gland | 1906 Liver | 1907 Development of the Digestive System | 1907 Atlas | 1907 23 Somite Embryo | 1908 Liver | 1908 Liver and Vascular | 1910 Mucous membrane Oesophagus to Small Intestine | 1910 Large intestine and Vermiform process | 1911-13 Intestine and Peritoneum - Part 1 | Part 2 | Part 3 | Part 5 | Part 6 | 1912 Digestive Tract | 1912 Stomach | 1914 Digestive Tract | 1914 Intestines | 1914 Rectum | 1915 Pharynx | 1915 Intestinal Rotation | 1917 Entodermal Canal | 1918 Anatomy | 1921 Alimentary Tube | 1932 Gall Bladder | 1939 Alimentary Canal Looping | 1940 Duodenum anomalies | 2008 Liver | 2016 GIT Notes | Historic Disclaimer
Human Embryo: 1908 13-14 Somite Embryo | 1921 Liver Suspensory Ligament | 1926 22 Somite Embryo | 1907 23 Somite Embryo | 1937 25 Somite Embryo | 1914 27 Somite Embryo | 1914 Week 7 Embryo
Animal Development: 1913 Chicken | 1951 Frog
ICD10 - Gastrointestinal | Genital | Renal | Integumentary



Jagged-mediated signaling through the notch pathway drives a cell (receiver) to maintain a similar fate to that of its signaling neighbour (sender).

Notch Jagged signaling[3]

  • sender cell (high ligand, low receptor) and receiver cell (low ligand, high receptor).
  • Notch Intracellular Domain (NICD) - activates many downstream target genes.


  1. <pubmed>25676721</pubmed>
  2. Claude, R. Obituary for Daniel Alagille. Journal of Pediatric Gastroenterology & Nutrition: February 2006 - Volume 42 - Issue 2 - pp 127-128 doi: 10.1097/01.mpg.0000189357.93784.48 J Pediatr Gastroenterol Nutr.
  3. <pubmed>25605936</pubmed>




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Cite this page: Hill, M.A. (2024, June 22) Embryology Alagille Syndrome. Retrieved from

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