Preview

Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)

Advanced search
Open Access Open Access  Restricted Access Subscription or Fee Access

Modern approaches to the management of children with Alagille syndrome

https://doi.org/10.21508/1027-4065-2025-70-4-29-38

Abstract

Alagille syndrome is a disease with a predominantly autosomal dominant type of inheritance, characterized by multisystem damage caused by mutations in the JAG1 and NOTCH2 genes. The most common manifestations of this syndrome are intrahepatic cholestasis due to underdevelopment of the bile ducts, heart defects, maxillofacial dysmorphism, vertebral pathology — radiographically manifested as “butterfly vertebrae”, ophthalmological disorders, vascular anomalies and kidney pathology. In addition to the above, a violation of neuropsychic and physical development is significant. The use of high-tech diagnostic methods in the observation of such children allows us to identify rare disorders that require equally close monitoring by doctors of a multidisciplinary team. The presented article is devoted to modern approaches to the management of children with Alagille syndrome, emphasizing variability of clinical manifestations, diagnostic features and new targeted drugs for the treatment of patients with this disease.

About the Authors

L. A. Levchenko
Pirogov Russian National Research Medical University
Russian Federation

117513, Moscow



K. S. Zizyukina
Pirogov Russian National Research Medical University
Russian Federation

117513, Moscow



T. Yu. Kravchenko
Pirogov Russian National Research Medical University
Russian Federation

117513, Moscow



T. Lungu
Pirogov Russian National Research Medical University
Russian Federation

117513, Moscow



A. A. Petrichenko
Pirogov Russian National Research Medical University
Russian Federation

117513, Moscow



А. A. Gryaznova
Pirogov Russian National Research Medical University
Russian Federation

117513, Moscow



A. Ya. Ilyina
Pirogov Russian National Research Medical University
Russian Federation

117513, Moscow



H. A. Sarkisyan
Pirogov Russian National Research Medical University
Russian Federation

117513, Moscow



References

1. Ayoub M.D., Kamath B.M. Alagille Syndrome: Current Understanding of Pathogenesis, and Challenges in Diagnosis and Management. Clin Liver Dis. 2022; 26(3): 355–370. DOI: 10.1016/j.cld.2022.03.002

2. Diaz-Frias J., Kondamudi N.P. Alagille Syndrome. 2023 Aug 12. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. PMID: 29939604

3. Semenova N., Kamenets E., Annenkova E., Marakhonov A., Gusarova E., Demina N., et al. Clinical Characterization of Alagille Syndrome in Patients with Cholestatic Liver Disease. Int J Mol Sci. 2023; 24(14): 11758. DOI: 10.3390/ijms241411758

4. Rizvanullah, Saad M., Ahmad KT., Gul A., Ali K. Alajille syndrome in infants: a rare case. J.D.D. Hepatol, 2022; 6: 176. DOI: 10.29011/2574–3511.100076

5. Eiamkulbutr S., Tubjareon C., Sanpavat A., Phewplung T., Srisan N., Sintusek P. Diseases of bile duct in children. World J Gastroenterol. 2024; 30(9): 1043–1072. DOI: 10.3748/wjg.v30.i9.1043

6. Alagille D., Odièvre M., Gautier M., Dommergues J.P. Hepatic ductular hypoplasia associated with characteristic facies, vertebral malformations, retarded physical, mental, and sexual development, and cardiac murmur. J Pediatr. 1975; 86(1): 63–71. DOI: 10.1016/s0022–3476(75)80706–2

7. Halma J., Lin H.C. Alagille syndrome: understanding the genotype-phenotype relationship and its potential therapeutic impact. Expert Rev Gastroenterol Hepatol. 2023; 17(9): 883–892. DOI: 10.1080/17474124.2023.2255518

8. NazarenkoL.P. Federal clinical guidelines for the diagnosis and treatment of Alagille syndrome. M., 2015; 25 (in Russ.)]

9. Degtyareva A.V., Dokshukina A.A., Got’e M.S., Filippova E.A., Tumanova E.L., Zaharova E. YU. Early clinical, laboratory and instrumental characteristics of Alagille syndrome. Neonatologiya: novosti, mneniya, obuchenie. 2024; 12(1): 27–36.(in Russ.)]. DOI: 10.33029/2308–2402–2024–12–1–27–36

10. Volynec G.V., Nikitin A.V., Skvorcova T.A. Alagille syndrome in children. Rossijskij vestnik perinatologii i pediatr 2020; 65:(2): 108–116.(in Russ.)] DOI: 10.21508/1027–4065–2020–65–2–108–116

11. Karim F., Hiremath G., Samayoa J.C., Said S.M. Complex Pulmonary Artery Rehabilitation in Children with Alagille Syndrome: An Early Single-Center Experience of a Successful Collaborative Work. J Cardiovasc Dev Dis. 2024; 11(8): 232. DOI: 10.3390/jcdd11080232

12. Kohut T.J., Gilbert M.A., Loomes K.M. Alagille Syndrome: A Focused Review on Clinical Features, Genetics, and Treatment. Semin Liver Dis. 2021; 41(4): 525–537. DOI: 10.1055/s-0041–1730951

13. Şafak A., Karakaya E., Varan B., Özçay F., Çekmen N., Yıldırım S., et al. Experience and Results of Liver Transplantation in Patients With Alagille Syndrome at Our Center. Exp Clin Transplant. 2024; 22(Suppl 5): 94–99. DOI: 10.6002/ect.вpedsymp2024.O27

14. Gilbert M.A., Loomes K.M. Alagille syndrome and non-syndromic paucity of the intrahepatic bile ducts. TranslGastroenterol Hepatol. 2021; 6: 22. DOI: 10.21037/tgh-2020–03

15. Chen L., Chen J., Lou J., Yu J. Clinical and genetic characteristics of patients with Alagille syndrome in China: identification of six novel JAG1 and NOTCH2 mutations. Transl Pediatr. 2024; 13(12): 2144–2154. DOI: 10.21037/tp-24–301

16. Morton A., Kumar S. Alagille syndrome and pregnancy. Obstet Med. 2021; 14(1): 39–41. DOI: 10.1177/1753495X19849738

17. Zhou B., Lin W., Long Y., Yang Y., Zhang H., Wu K., et al. Notch signaling pathway: architecture, disease, and therapeutics. Signal Transduct Target Ther. 2022; 7(1): 95. DOI: 10.1038/s41392–022–00934–y

18. Spinner N.B., Loomes K.M., Krantz I.D., Gilbert M.A. Alagille Syndrome. 2000 May 19 [updated 2024 Jan 4]. In: GeneReviews®[Internet]. Editros: Adam M.P., Feldman J., Mirzaa G.M., Pagon R.A., Wallace S.E., Amemiya A. Seattle (WA): University of Washington, Seattle; 1993–2025

19. Bufler P., Howard R., Quadrado L., Lacey G., TernerRosenthal J., Goldstein A., et al. The burden of Alagille syndrome: uncovering the potential of emerging therapeutics — a comprehensive systematic literature review. J Comp Eff Res. 2025; 14(2):e240188. DOI: 10.57264/cer-2024–0188

20. Lee P.S., Silva Sepulveda J.A., Del Campo M., Leibel S.L., Hildreth A., Marc-Aurele K.L. A neonatal case of vascular ring with Alagille syndrome. SAGE Open Med Case Rep. 2023; 11: 2050313X231197321. DOI: 10.1177/2050313X231197321

21. D’Amico A., Perillo T., Cuocolo R., Ugga L., Di Dato F., Caranci F., et al. Neuroradiological findings in Alagille syndrome. Br J Radiol. 2022; 95(1129): 20201241. DOI: 10.1259/bjr.20201241

22. Gadzhimuradov M.N., Alieva M.G., Mamasheva G.D. Alagille syndrome. Vrach. 2020; 31 (8): 64–69.(in Russ.)] DOI: 10.29296/25877305–2020–08–10

23. Isa H.M., Alahmed F.A. Clinical, Laboratory, Radiological, and Genetic Characteristics of Pediatric Patients with Alagille Syndrome. Adv Biomed Res. 2023; 12: 155. DOI: 10.4103/abr.abr_201_22

24. Xu F., Peng Q., He X., Chen X., Jiang S., Lu X., et al. Alagille syndrome due to a de novo NOTCH2 mutation presenting as prenatal oligohydramnios and congenital bilateral renal hypodysplasia: A case report. Front Pediatr. 2022; 10: 1020536. DOI: 10.3389/fped.2022.1020536

25. Bonnet A.L., Greset V., Davit-Beal T. Oral manifestations of Alagille syndrome. BMJ Case Rep. 2020; 13(5):e234689. DOI: 10.1136/bcr-2020–234689

26. Andersson E.R., Chivukula I.V., Hankeova S., Sjöqvist M., Tsoi Y.L., Ramsköld D., et al. Mouse Model of Alagille Syndrome and Mechanisms of Jagged1 Missense Mutations. Gastroenterology. 2018; 154(4): 1080–1095. DOI: 10.1053/j.gastro.2017.11.002

27. Sharma A.D., Parihar A., Reddy P., Mandlik R. Oral manifestations of Alagille-2 syndrome: a rare case report. International Journal of Research in Medical Sciences, 2023; 11(9): 3471–3474. DOI: 10.18203/2320–6012.ijrms20232813

28. Zeng H.S., Zhang Z.H., Hu Y., Zheng G.L., Wang J., Zhang J.W., et al. Alagille syndrome associated with total anomalous pulmonary venous connection and severe xanthomas: A case report. World J Clin Cases. 2022; 10(25): 8932–8938. DOI: 10.12998/wjcc.v10.i25.8932

29. Yuan S.M. Pulmonary artery pathologies in Alagille syndrome: a meta-analysis. Postepy Kardiol Interwencyjnej. 2022; 18(2): 111–117. DOI: 10.5114/aic.2022.118526. Epub 2022 Aug 19

30. Wu K.Y., Treece A.L., Russo P.A., Wen J.W. An Atypical Presentation of Alagille Syndrome. Pediatr Dev Pathol. 2018; 21(1): 79–83. DOI: 10.1177/1093526616686902

31. Katsoulos K.F., Kapsala Z., Livir-Rallatos G. Case Report: Alagille Syndrome Presenting with Angioid Streaks. Optom Vis Sci. 2021; 98(2): 109–112. DOI: 10.1097/OPX.0000000000001641

32. Ranchin B., Meaux M.N., Freppel M., Ruiz M., De Mul A. Kidney and vascular involvement in Alagille syndrome. Pediatr Nephrol. 2025; 40(4): 891–899. DOI: 10.1007/s00467–024–06562–8. Epub 2024 Oct 24

33. Cerron-Vela C.R., Tierradentro-García L.O., Rimba Z.L., Andronikou S. Evolution of cerebrovascular imaging and associated clinical findings in children with Alagille syndrome. Neuroradiology. 2024; 66(8): 1325–1334. DOI: 10.1007/s00234–024–03316–z. Epub 2024 Feb 24

34. Guida L., Gardin A., James S., Arnaud E., Toujouse C., Roux J., et al. Craniosynostosis as a cause of intracranial hypertension in Alagille syndrome: a case series of 6 consecutive pediatric patients. Neurosurg Focus. 2025; 58(1):E6. DOI: 10.3171/2024.10.FOCUS24588

35. Gilbert M.A., Keefer-Jacques E., Jadhav T., Antfolk D., Ming Q., Valente N., Shaw G.T., et al. Functional characterization of 2,832 JAG1 variants supports reclassification for Alagille syndrome and improves guidance for clinical variant interpretation. Am J Hum Genet. 2024; 111(8): 1656–1672. DOI: 10.1016/j.ajhg.2024.06.011

36. Andrews A.R., Putra J. Central Hepatic Regenerative Nodules in Alagille Syndrome: A Clinicopathological Review. Fetal Pediatr Pathol. 2021; 40(1): 69–79. DOI: 10.1080/15513815.2019.1675834. Epub 2019 Oct 14

37. Surapaneni A., Kuo J., Wang M., Ashour R. Epidermoid cyst in a patient with Alagille syndrome: Coincidence or connection? Surg Neurol Int. 2020; 11: 432 DOI: 10.25259/SNI_611_2020

38. Leung D.H., Sorensen L.G., Ye W., Hawthorne K., Ng V.L., Loomes K.M., et al. Childhood Liver Disease Research Network (ChiLDReN). Neurodevelopmental Outcomes in Children With Inherited Liver Disease and Native Liver. J Pediatr Gastroenterol Nutr. 2022; 74(1): 96–103. DOI: 10.1097/MPG.0000000000003337

39. Yan J., Huang Y., Cao L., Dong Y., Xu Z., Wang F., et al. Clinical, pathological and genetic characteristics of 17 unrelated children with Alagille Syndrome. BMC Pediatr. 2024; 24(1): 532. DOI: 10.1186/s12887–024–04973–y

40. Neonatology: National guidelines: in 2 volumes. Volume 1. Editors Volodin N.N., Degtyarev D.N. 2nd ed., revised and add. Moscow: GEOTAR-Media, 2023; 752 (in Russ)] DOI: 10.33029/9704–7828–8–NNG-2023–1–752

41. Kamath B.M., Stein P., Houwen R.H.J., Verkade H.J. Potential of ileal bile acid transporter inhibition as a therapeutic target in Alagille syndrome and progressive familial intrahepatic cholestasis. Liver Int. 2020; 40(8): 1812–1822. DOI: 10.1111/liv.14553

42. Heinz N., Vittorio J. Treatment of Cholestasis in Infants and Young Children. Curr Gastroenterol Rep. 2023; 25(11): 344–354. DOI: 10.1007/s11894–023–00891–8

43. Gonzales E., Hardikar W., Stormon M., Baker A., Hierro L., Gliwicz D., et al. Efficacy and safety of maralixibat treatment in patients with Alagille syndrome and cholestatic pruritus (ICONIC): a randomised phase 2 study. Lancet. 2021; 398(10311): 1581–1592. DOI: 10.1016/S0140–6736(21)01256–3

44. Jarasvaraparn C., Rodrigo M., Hartley C., Karnsakul W. Exploring odevixibat’s efficacy in alagille syndrome: insights from recent clinical trials and IBAT inhibitor experiences. Expert Opin Pharmacother. 2024; 25(12): 1647–1655. DOI: 10.1080/14656566.2024.2392873

45. Shirley M. Maralixibat: First Approval. Drugs. 2022; 82(1): 71–76. DOI: 10.1007/s40265–021–01649–0

46. Hansen B.E., Vandriel S.M., Vig P., Garner W., Mogul D.B., Loomes K.M., et al. Global Alliance (GALA) Study Group ALagille. Event-free survival of maralixibat-treated patients with Alagille syndrome compared to a real-world cohort from GALA. Hepatology. 2024; 79(6): 1279–1292. DOI: 10.1097/HEP.0000000000000727

47. Vandriel S.M., Li L.T., She H., Wang J.S., Gilbert M.A., Jankowska I., et al. Global ALagille Alliance (GALA) Study Group. Natural history of liver disease in a large international cohort of children with Alagille syndrome: Results from the GALA study. Hepatology. 2023; 77(2): 512–529. DOI: 10.1002/hep.32761


Review

For citations:


Levchenko L.A., Zizyukina K.S., Kravchenko T.Yu., Lungu T., Petrichenko A.A., Gryaznova А.A., Ilyina A.Ya., Sarkisyan H.A. Modern approaches to the management of children with Alagille syndrome. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2025;70(4):29–38. (In Russ.) https://doi.org/10.21508/1027-4065-2025-70-4-29-38

Views: 104


ISSN 1027-4065 (Print)
ISSN 2500-2228 (Online)