DLL1

Chr 6AD

delta like canonical Notch ligand 1

Transmembrane ligand protein of NOTCH1, NOTCH2 and NOTCH3 receptors that binds the extracellular domain (ECD) of Notch receptor in a cis and trans fashion manner (PubMed:11006133). Following transinteraction, ligand cells produce mechanical force that depends of a clathrin-mediated endocytosis, requiring ligand ubiquitination, EPN1 interaction, and actin polymerisation; these events promote Notch receptor extracellular domain (NECD) transendocytosis and triggers Notch signaling through induction of cleavage, hyperphosphorylation, and nuclear accumulation of the intracellular domain of Notch receptors (NICD) (By similarity). Is required for embryonic development and maintenance of adult stem cells in many different tissues and immune systeme; the DLL1-induced Notch signaling is mediated through an intercellular communication that regulates cell lineage, cell specification, cell patterning and morphogenesis through effects on differentiation and proliferation (PubMed:11581320). Plays a role in brain development at different level, namely by regulating neuronal differentiation of neural precursor cells via cell-cell interaction, most likely through the lateral inhibitory system in an endogenous level dependent-manner. During neocortex development, Dll1-Notch signaling transmission is mediated by dynamic interactions between intermediate neurogenic progenitors and radial glia; the cell-cell interactions are mediated via dynamic and transient elongation processes, likely to reactivate/maintain Notch activity in neighboring progenitors, and coordinate progenitor cell division and differentiation across radial and zonal boundaries. During cerebellar development, regulates Bergmann glial monolayer formation and its morphological maturation through a Notch signaling pathway. At the retina and spinal cord level, regulates neurogenesis by preventing the premature differentiation of neural progenitors and also by maintaining progenitors in spinal cord through Notch signaling pathway. Also controls neurogenesis of the neural tube in a progenitor domain-specific fashion along the dorsoventral axis. Maintains quiescence of neural stem cells and plays a role as a fate determinant that segregates asymmetrically to one daughter cell during neural stem cells mitosis, resulting in neuronal differentiation in Dll1-inheriting cell. Plays a role in immune systeme development, namely the development of all T-cells and marginal zone (MZ) B-cells (By similarity). Blocks the differentiation of progenitor cells into the B-cell lineage while promoting the emergence of a population of cells with the characteristics of a T-cell/NK-cell precursor (PubMed:11581320). Also plays a role during muscle development. During early development, inhibits myoblasts differentiation from the medial dermomyotomal lip and later regulates progenitor cell differentiation. Directly modulates cell adhesion and basal lamina formation in satellite cells through Notch signaling. Maintains myogenic progenitors pool by suppressing differentiation through down-regulation of MYOD1 and is required for satellite cell homing and PAX7 expression. During craniofacial and trunk myogenesis suppresses differentiation of cranial mesoderm-derived and somite-derived muscle via MYOD1 regulation but in cranial mesoderm-derived progenitors, is neither required for satellite cell homing nor for PAX7 expression. Also plays a role during pancreatic cell development. During type B pancreatic cell development, may be involved in the initiation of proximodistal patterning in the early pancreatic epithelium. Stimulates multipotent pancreatic progenitor cells proliferation and pancreatic growth by maintaining HES1 expression and PTF1A protein levels. During fetal stages of development, is required to maintain arterial identity and the responsiveness of arterial endothelial cells for VEGFA through regulation of KDR activation and NRP1 expression. Controls sprouting angiogenesis and subsequent vertical branch formation through regulation on tip cell differentiation. Negatively regulates goblet cell differentiation in intestine and controls secretory fat commitment through lateral inhibition in small intestine. Plays a role during inner ear development; negatively regulates auditory hair cell differentiation. Plays a role during nephron development through Notch signaling pathway. Regulates growth, blood pressure and energy homeostasis (By similarity)

Primary Disease Associations & Inheritance

Neurodevelopmental disorder with nonspecific brain abnormalities and with or without seizuresMIM #618709
AD
587
ClinVar variants
84
Pathogenic / LP
1.00
pLI score· haploinsufficient
12
Active trials
Clinical SummaryDLL1
🧬
Gene-Disease Validity (ClinGen)
neurodevelopmental disorder with nonspecific brain abnormalities and with or without seizures · ADDefinitive

Definitive — sufficient evidence for diagnostic panels

Population Constraint (gnomAD)
Highly constrained gene — heterozygous loss-of-function variants are very rare in the population (pLI 1.00). One damaged copy is likely sufficient to cause disease.
📋
ClinVar Variants
84 Pathogenic / Likely Pathogenic· 281 VUS of 587 total submissions
💊
Clinical Trials
12 active or recruiting trials — potential therapeutic options may be available

Population Genetics & Constraint

gnomAD v4 — loss-of-function & missense intolerance

LoF intolerant — likely haploinsufficient
LoF Constraint?LOEUF (Loss-of-function Observed/Expected Upper bound Fraction) is the upper bound of the 90% CI for LoF OE — the preferred gnomAD v4 metric. Lower = more intolerant to LoF. LOEUF < 0.35 = highly constrained.
0.10LOEUF
pLI 1.000
Z-score 5.20
OE 0.00 (0.000.10)
Highly constrained

Among the most LoF-intolerant genes (~top 3%)

Missense Constraint?Missense Z-score: standard deviations fewer missense variants observed vs. expected. Z > 3.09 (p < 0.001) = gene does not tolerate missense variation. OE missense < 0.6 is also considered constrained.
1.82Z-score
OE missense 0.76 (0.690.83)
335 obs / 442.5 exp
Tolerant

Mild missense constraint

Observed / Expected Ratios?Shaded band = 90% confidence interval. Vertical tick = point estimate. Grey threshold line = gnomAD constraint cutoff for that variant class.
LoF OE?Ratio of observed to expected LoF variants. Upper CI bound (LOEUF) ≤ 0.35 = strong LoF constraint signal.0.00 (0.000.10)
00.351.4
Missense OE?Ratio of observed to expected missense variants. OE ≤ 0.6 = fewer missense variants than expected by chance.0.76 (0.690.83)
00.61.4
Synonymous OE?Control metric — synonymous variants are largely neutral and expected near OE = 1.0. Significant deviation may indicate annotation issues.1.23
01.21.6
LoF obs/exp: 0 / 31.5Missense obs/exp: 335 / 442.5Syn Z: -2.49

ClinVar Variant Classifications

587 submitted variants in ClinVar

Classification Summary

Pathogenic60
Likely Pathogenic24
VUS281
Likely Benign171
Benign24
Conflicting27
60
Pathogenic
24
Likely Pathogenic
281
VUS
171
Likely Benign
24
Benign
27
Conflicting

Curated Variants Distribution

Classified variants from ClinVar · 5 ACMG categories

ClassificationLoFMissense + InframeNon-codingSynonymousTotal
Pathogenic
19
0
41
0
60
Likely Pathogenic
14
4
6
0
24
VUS
3
255
20
3
281
Likely Benign
0
14
54
103
171
Benign
0
2
18
4
24
Conflicting
27
Total36275139110587

LoF = frameshift, stop gained/lost, canonical splice · Counts from ClinVar esearch · Updated hourly

View in ClinVar →

Protein Context — Lollipop Plot

DLL1 · protein map & ClinVar variants

Showing all ClinVar variants across the protein. Search a specific variant to highlight its position.

Gene2Phenotype Curations

DLL1-related neurodevelopmental disorder with nonspecific brain abnormalities, with or without seizures

moderate
ADLoss Of FunctionAbsent Gene Product, Altered Gene Product Structure, Decreased Gene Product Level
Dev. Disorders
G2P ↗
splice region variantstop gainedcopy number variation

Gene2Phenotype curations · DECIPHER consortium patient cohort (public variants) · deciphergenomics.org

OMIM — Genotype-Phenotype Relationships

1 OMIM entry

Neurodevelopmental disorder with nonspecific brain abnormalities and with or without seizures

MIM #618709

Molecular basis of disorder known

Autosomal dominant
📖
GeneReview available — DLL1
Authoritative clinical overview · NCBI Bookshelf · Recommended first read
Open GeneReview ↗
Clinical Literature
Landmark / reviewRecent case evidence
Key Publications
Landmark & review papers · by relevance
PubMed
Notch in skeletal physiology and disease.
Canalis E·Osteoporos Int
2018Review
Top 10 resultsSearch PubMed ↗

Clinical Trials

Active and recruiting trials from ClinicalTrials.gov

B-cell Acute Lymphoblastic Leukemia

Allogeneic Second-generation CD19-CAR T Cells for Pediatric Relapsed/Refractory B-ALL

RECRUITING
NCT06080191Phase PHASE1Bambino Gesù Hospital and Research InstituteStarted 2024-04-28
CD19-CAR_Lenti_ALLO
Hodgkin LymphomaNon-Hodgkin LymphomaHodgkin Disease

Administration of TAA-Specific CTLs; Hodgkin or Non-Hodgkin Lymphoma; TACTAL

ACTIVE NOT RECRUITING
NCT01333046Phase PHASE1Baylor College of MedicineStarted 2012-01
Antigen-Escalation StageDose-Escalation Stageazacytidine and multiTAA T cells Stage
Acute Myeloid Leukemia

Chimeric Antigen Receptor T-cells for The Treatment of AML Expressing CLL-1 Antigen

ACTIVE NOT RECRUITING
NCT04219163Phase PHASE1Baylor College of MedicineStarted 2020-07-09
CLL-1.CAR T cells
Relapsed/Refractory Small Cell Lung Cancer

This Study is an Open-lable, Phase I Study to Evaluate the Safety, Feasibility, Cytokinetics, and Preliminary Efficacy of GC511B in DLL3+ Relapsed/Refractory Small Cell Lung Cancer.

NOT YET RECRUITING
NCT07249879Phase PHASE1Cancer Institute and Hospital, Chinese Academy of Medical SciencesStarted 2025-11-21
GC511B CAR-T Cell Injection
Hodgkin DiseaseNon-Hodgkin LymphomaSevere Chronic Active Epstein Barr Virus

Most Closely Matched 3rd Party Rapidly Generated LMP, BARF1 And EBNA1 Specific CTL, EBV-Positive Lymphoma (MABEL)

ACTIVE NOT RECRUITING
NCT02287311Phase PHASE1Baylor College of MedicineStarted 2015-02
MABEL CTLsCyclophosphamideFludarabine
Head and Neck CancerHead and Neck NeoplasmsHead and Neck Squamous Cell Carcinoma

Decitabine and Nivolumab in Participants With Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck

NOT YET RECRUITING
NCT07216833Phase PHASE1Kyunghee Burkitt, DO, PhDStarted 2026-01
DecitabineNivolumab
LeukemiaMyelodysplastic SyndromesLymphoma

Study of Gene Modified Donor T Cell Infusion in Patients With Recurrent Disease After Allogeneic Transplant

ACTIVE NOT RECRUITING
NCT02477878Phase PHASE1Bellicum PharmaceuticalsStarted 2016-07
BPX-501Rimiducid
Liver Cell CarcinomaSolid TumorWilms Tumor

Interleukin-15 Armored Glypican 3-specific Chimeric Antigen Receptor Expressed in Autologous T Cells for Solid Tumors

ACTIVE NOT RECRUITING
NCT05103631Phase PHASE1Baylor College of MedicineStarted 2021-06-17
CATCH T cells
Brain TumorCancer

A Phase I/II Study of Zotiraciclib for Recurrent Malignant Gliomas With Isocitrate Dehydrogenase 1 or 2 (IDH1 or IDH2) Mutations

RECRUITING
NCT05588141Phase PHASE1, PHASE2National Cancer Institute (NCI)Started 2023-05-16
Zotiraciclib
T-Cell Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma

CD7-CAR-T Cells in Pediatric Relapsed/Refractory CD7+ T-ALL/LL

RECRUITING
NCT06064903Phase PHASE1, PHASE2Bambino Gesù Hospital and Research InstituteStarted 2024-04-21
CD7-CART01
Human Papillomavirus-Related CarcinomaHuman Papillomavirus Positive Oropharyngeal CarcinomaHuman Papillomavirus Positive Cervical Carcinoma

HPV-16/18 E6/E7-Specific T Lymphocytes, Relapsed HPV-Associated Cancers, HESTIA

ACTIVE NOT RECRUITING
NCT02379520Phase PHASE1Baylor College of MedicineStarted 2015-09
HPV Specific T CellsCytoxanFludarabine
EGFR Gene MutationGlioblastomaMGMT-Unmethylated Glioblastoma

Anti-EGFRvIII synNotch Receptor Induced Anti-EphA2/IL-13Ralpha2 CAR (E-SYNC) T Cells

RECRUITING
NCT06186401Phase PHASE1Hideho Okada, MD, PhDStarted 2024-04-30
E-SYNC T CellsCyclophosphamide (non-investigational)Fludarabine (non-investigational)