VHL

Chr 3ARAD

von Hippel-Lindau tumor suppressor

Also known as: HRCA1, RCA1, VHL1, pVHL

The VHL protein functions as a component of an E3 ubiquitin ligase complex that targets hypoxia-inducible factor (HIF) for degradation, regulating oxygen-dependent gene expression and other cellular processes including cilia formation and extracellular matrix formation. Mutations cause von Hippel-Lindau syndrome with cerebellar hemangioblastomas, pheochromocytomas, and renal cell carcinomas, as well as isolated familial erythrocytosis, with both autosomal dominant and recessive inheritance patterns reported. The pathogenic mechanism involves gain-of-function effects leading to dysregulated HIF signaling and abnormal cellular responses to oxygen levels.

GeneReviewsOMIMResearchSummary from RefSeq, OMIM, UniProt, Mechanism
MultiplemechanismAR/ADLOEUF 0.935 OMIM phenotypes
Clinical SummaryVHL
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Gene-Disease Validity (ClinGen)
von Hippel-Lindau disease · ADDefinitive

Definitive — sufficient evidence for diagnostic panels

Population Constraint (gnomAD)
Low constraint (pLI 0.08) — loss-of-function variants are relatively tolerated in the population.
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ClinVar Variants
50 unique Pathogenic / Likely Pathogenic· 132 VUS of 300 total submissions
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Clinical Trials
12 active or recruiting trials — potential therapeutic options may be available
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GeneReview available — VHL
Authoritative clinical overview · Recommended first read
Open GeneReview ↗

Population Genetics & Constraint

gnomAD v4 — loss-of-function & missense intolerance

Tolerant — LoF & missense variants common in population
LoF Constraint
0.93LOEUF
pLI 0.080
Z-score 1.72
OE 0.36 (0.160.93)
Tolerant

Typical tolerance to LoF variation

Missense Constraint
-0.39Z-score
OE missense 1.10 (0.961.27)
136 obs / 123.6 exp
Tolerant

Tolerant to missense variation

Observed / Expected Ratios
LoF OE0.36 (0.160.93)
00.351.4
Missense OE1.10 (0.961.27)
00.61.4
Synonymous OE1.11
01.21.6
LoF obs/exp: 3 / 8.4Missense obs/exp: 136 / 123.6Syn Z: -0.63
Curated Mechanism (G2P)Gene2Phenotype (DDG2P) ↗
definitiveVHL-related pheochromocytomaGOFAD
definitiveVHL-related von Hippel-Lindau syndromeLOFAD
DN
0.5967th %ile
GOF
0.6443th %ile
LOF
0.2970th %ile

This gene has evidence for multiple mechanisms of pathogenicity (loss-of-function and gain-of-function). The Badonyi & Marsh model scores gain-of-function highest among its predictions, but genomic evidence (constraint, ClinVar variant spectrum, and literature) most strongly supports loss-of-function (haploinsufficiency). Different variants in this gene may act through different mechanisms — interpret in context of the specific variant.

LOF1 literature citation · 44% of P/LP variants are LoF
GOFprediction above median

Note: In-silico variant effect predictors (SIFT, PolyPhen, REVEL, CADD) may underestimate pathogenicity of missense variants in genes with GOF or DN mechanisms. Consider functional evidence and clinical context.

Literature Evidence

LOFGenetic analysis of von Hippel-Lindau diseasePMID:20151405

Predictions from Badonyi M, Marsh JA. PLoS ONE. 2024;19(8):e0307312. Mechanism ranking also informed by gnomAD constraint, ClinVar, and ClinGen data.

ClinVar Variant Classifications

300 submitted variants in ClinVar

Classification Summary

Pathogenic36
Likely Pathogenic14
VUS132
Likely Benign67
Benign23
Conflicting9
36
Pathogenic
14
Likely Pathogenic
132
VUS
67
Likely Benign
23
Benign
9
Conflicting

Curated Variants Distribution

Classified variants from ClinVar · 5 ACMG categories

ClassificationLoFMissense + InframeNon-codingSynonymousTotal
Pathogenic
18
4
14
0
36
Likely Pathogenic
4
6
3
1
14
VUS
14
82
35
1
132
Likely Benign
2
13
23
29
67
Benign
0
4
7
12
23
Conflicting
9
Total381098243281

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

View in ClinVar →

Protein Context — Lollipop Plot

VHL · protein map & ClinVar variants

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

3D Protein StructureAlphaFold

Clinical Trials

Active and recruiting trials from ClinicalTrials.gov

Lymphoma, Non-HodgkinMultiple MyelomaAdvanced Solid Tumors

Canadian Profiling and Targeted Agent Utilization Trial (CAPTUR)

RECRUITING
NCT03297606Phase PHASE2Canadian Cancer Trials GroupStarted 2018-03-23
OlaparibDasatinibNivolumab plus Ipilimumab
Polycythemia VeraEssential ThrombocythaemiaMyelofibrosis

Prevalence Of Germline Gene Mutations In Patients With Myeloproliferative Neoplasms With Family History

NOT YET RECRUITING
NCT06923670Phase NAFondazione Policlinico Universitario Agostino Gemelli IRCCSStarted 2025-05-21
NGS testingNGS analysis for mutations in genes involved in familial predisposition to hematological malignancies
Age-Related Macular DegenerationDiabetic RetinopathyVon Hippel-Lindau Syndrome

National Eye Institute Biorepository for Retinal Diseases

RECRUITING
NCT01496625National Eye Institute (NEI)Started 2012-06-18
Acute LeukemiaAdenomatous PolyposisAdrenocortical Carcinoma

Familial Investigations of Childhood Cancer Predisposition

RECRUITING
NCT03050268St. Jude Children's Research HospitalStarted 2017-04-06
Von Hippel-Lindau DiseaseHereditary Leiomyomatosis and Renal Cell CancerBirt-Hogg-Dube Syndrome

MyVHL: Patient Natural History Study

RECRUITING
NCT03749980Joshua Mann, MPHStarted 2012-01
Renal Cell Carcinoma

A Study of HC-7366 in Combination With Belzutifan (WELIREG™) in Patients With Renal Cell Carcinoma

RECRUITING
NCT06234605Phase PHASE1HiberCell, Inc.Started 2024-04-29
HC-7366Belzutifan
VHL - Von Hippel-Lindau SyndromeVHL Gene MutationVHL Syndrome

A Phase 2 Study of Belzutifan (PT2977, MK-6482) for the Treatment of Von Hippel Lindau (VHL) Disease-Associated Renal Cell Carcinoma (RCC) (MK-6482-004)

ACTIVE NOT RECRUITING
NCT03401788Phase PHASE2Peloton Therapeutics, Inc., a subsidiary of Merck & Co., Inc. (Rahway, New Jersey USA)Started 2018-05-02
Belzutifan
Neuroendocrine NeoplasmNeuroendocrine Neoplasm of Gastrointestinal TractNeuroendocrine Neoplasm of Lung

Genetic Bases of Neuroendocrine Neoplasms in Mexican Patients

RECRUITING
NCT06523582Universidad Nacional Autonoma de MexicoStarted 2022-08-03
Kidney CancerUrologic Malignant DisordersRenal Cell Carcinoma

Von Hippel-Lindau (VHL): Clinical Manifestations, Diagnosis, Management and Molecular Bases of Inherited Renal and Other Urologic Malignant Disorders

RECRUITING
NCT00001238National Cancer Institute (NCI)Started 1990-12-05
Hemangioblastoma of CNSVon Hippel-Lindau Disease

Propranolol and Von Hippel-Lindau Disease

RECRUITING
NCT05424016Phase NAAssistance Publique - Hôpitaux de ParisStarted 2023-01-16
Propranololfollow-up
Lymphoma, Non-HodgkinMultiple MyelomaAdvanced Solid Tumors

TAPUR: Testing the Use of Food and Drug Administration (FDA) Approved Drugs That Target a Specific Abnormality in a Tumor Gene in People With Advanced Stage Cancer

RECRUITING
NCT02693535Phase PHASE2American Society of Clinical OncologyStarted 2016-03-14
PalbociclibSunitinibTemsirolimus
Carcinoma, Renal CellVon Hippel-Lindau Disease

Mechanisms of Somatic Mutation and Tumor Initiation in Pre-malignant Kidney Tubule Cells

RECRUITING
NCT06194669IRCCS San RaffaeleStarted 2023-06-30
Blood and urine sample collection
Clinical Literature
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Key Publications
Landmark & review papers · by relevance
PubMed
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