A short history of a young gene

From fruit flies to family registries.

1910s+

Delta is discovered in fruit flies

The Delta gene is identified in Drosophila as a controller of which embryonic cells become neurons. The Notch pathway as we know it begins to take shape.

1990s

Human DLL1 is cloned and characterised

The mammalian Delta-like ligands — DLL1, DLL3, DLL4 — are identified and mapped. DLL1 is localised to 6q27.

1990s–2000s

Mouse models prove the role in somitogenesis & neurogenesis

Targeted disruption of Dll1 in mice produces vertebral patterning defects and disrupted neurogenesis — foreshadowing the human disorder.

2019

Fischer-Zirnsak et al. — DLL1 as a human disease gene

An international collaboration identifies heterozygous DLL1 variants in patients with neurodevelopmental disorder, brain abnormalities, and vertebral malformations. OMIM #618709 is established.

2020–2024

The phenotype expands

Additional families and case reports broaden the picture: more vertebral involvement in some, more autism features in others, less severe presentations alongside the originally described ones.

now

Natural history, registries, and family-led science

A community is taking shape around the gene. Patient registries, natural-history studies, and functional work on specific variants are now possible — and largely propelled by families.

Foundational

Original disease description and authoritative gene-level resources.

American Journal of Human Genetics · 2019

Haploinsufficiency of the Notch Ligand DLL1 Causes Variable Neurodevelopmental Disorders

Fischer-Zirnsak B, Segebrecht L, Schubach M, et al.

First description of NEDBAS: 15 individuals from 12 families with heterozygous DLL1 variants — established the dominant haploinsufficiency mechanism and the OMIM #618709 phenotype entry.

GenCC / ClinGen · 2023

ClinGen Gene-Disease Validity: DLL1 — NEDBAS, Definitive (Autosomal Dominant)

ClinGen Brain Malformation GCEP

Independent expert review classified the DLL1–NEDBAS association as Definitive — the highest evidence tier for a gene-disease relationship.

OMIM · 2024

DLL1 — Delta-Like Canonical Notch Ligand 1 (gene entry)

OMIM curators

Canonical gene entry: 6q27, 11 exons, encodes a 723-aa type-I transmembrane DSL-family ligand for NOTCH receptors.

Mechanism & functional studies

Animal models and molecular work supporting Notch-pathway disruption.

Frontiers in Neuroscience · 2022

Dll1 haploinsufficiency causes brain abnormalities with functional relevance

Aguilar-Hernández L, et al.

Mouse model showing Dll1+/- animals develop the brain abnormalities and behavioural phenotypes seen in patients — provides the first functional evidence supporting haploinsufficiency.

SCDO7 (recessive form)

Vertebral segmentation literature relevant to the rare recessive form.

OMIM · 2024

Spondylocostal Dysostosis 7 (SCDO7), Autosomal Recessive — OMIM entry

OMIM curators

Catalog entry establishing SCDO7 as a distinct autosomal recessive condition caused by biallelic DLL1 missense variants — to date documented in a single consanguineous family.

GeneReviews® (NCBI Bookshelf) · 2023

Spondylocostal Dysostosis, Autosomal Recessive — GeneReviews

Turnpenny PD, Sloman M, Dunwoodie S

Authoritative clinical synopsis of recessive SCDO including DLL3, MESP2, LFNG, HES7, TBX6, RIPPLY2, and DLL1 (SCDO7) — diagnostic criteria, surveillance, and management.

Frontiers in Genetics · 2022

Clinical genetics of spondylocostal dysostosis: A mini review

Umair M, Younus M, Shafiq S, Nayab A, Alfadhel M

Concise review covering all known SCDO subtypes including the DLL1-associated SCDO7 — useful primer for clinicians evaluating vertebral segmentation defects.

6q27 terminal deletions

Cytogenetic and prenatal series where DLL1 is part of a larger deletion.

medRxiv (preprint, later peer-reviewed) · 2022

The phenotypic spectrum of terminal 6q deletions based on a large cohort derived from social media and literature: a prominent role for DLL1

Engwerda A, et al.

Largest cohort to date of terminal 6q deletions — demonstrates that DLL1 loss is a major driver of neurodevelopmental features regardless of additional co-deleted genes.

Frontiers in Genetics · 2025

DLL1 haploinsufficiency in prenatal brain anomalies: a retrospective analysis of 6q terminal deletions

Multiple authors

Retrospective analysis linking DLL1 haploinsufficiency to specific prenatal brain findings (cerebellar hypoplasia, ventriculomegaly) detectable on fetal imaging.

Know a paper we missed?

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The work ahead

Six questions worth funding next.

The open scientific questions whose answers would most change life for families with a DLL1 result in hand.

01

A real natural history

How features evolve across infancy, childhood, adolescence, adulthood. With cases identified only since 2019, the longest follow-ups are still short.

02

Variant-to-phenotype mapping

Do specific variants — DSL-domain missense versus whole-gene deletion — produce different phenotypic profiles? With more cases collected, this becomes answerable.

03

Why such variable expression?

Two individuals with the same DLL1 variant can present very differently. Identifying genetic modifiers — variants elsewhere in the genome that turn the volume up or down — is open and important.

04

Functional studies of specific variants

Cell-based and model-organism studies that test whether a patient's variant actually impairs Notch signalling, and how much. This is how VUS variants get reclassified.

05

A patient-driven registry

A consented, longitudinal registry that pools clinical and genetic information across families gives every single case more scientific value.

06

Therapeutic possibilities

Notch signalling is one of the most therapeutically targeted pathways in biology — though largely in cancer. Whether any of that pharmacology eventually informs treatment of haploinsufficiency disorders is a long-horizon but real question.

How families help research happen

Your data, with your consent, is the most valuable resource in rare disease.

Submit your variant to ClinVar via your testing lab.

This makes the variant visible to every clinician and researcher who looks up the gene in the future. Many labs do this automatically; it doesn't hurt to ask.

Enrol in a research registry or natural-history study.

These studies turn a scattered group of case reports into something a clinical guideline can be written from. Voluntary, confidential, takes 10–15 minutes.

Re-contact your testing lab for periodic reanalysis.

This not only helps your family — it helps the laboratory's interpretation database stay current for everyone else.

Connect with the foundation.

One of the things this site exists for is to help families find researchers, and researchers find families. The connection is often the bottleneck.

Useful resources

Where families and researchers find each other.

A short list of trusted, generally-free resources for rare neurodevelopmental disorders. None is DLL1-specific yet — but the foundation is working on changing that.