{"id":86042,"date":"2024-11-14T14:07:30","date_gmt":"2024-11-14T05:07:30","guid":{"rendered":"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/"},"modified":"2026-07-12T21:26:27","modified_gmt":"2026-07-12T12:26:27","slug":"4q21_deletion_syndrome","status":"publish","type":"post","link":"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en","title":{"rendered":"4q21 Deletion Syndrome"},"content":{"rendered":"\n<p><strong>If a chromosomal test or a prenatal screening result mentioned &#8220;4q21 deletion syndrome,&#8221; it&#8217;s natural to feel uneasy about a term you&#8217;re hearing for the first time.<\/strong><\/p>\n\n\n\n<p><strong>Here is the short answer. 4q21 deletion syndrome is a chromosomal condition caused by a congenital loss of part of the long arm of chromosome 4, in the q21 region, and only a very small number of cases have been reported worldwide.<\/strong> The features reported most often include growth delay, low muscle tone (hypotonia), delayed or absent speech development, and a distinctive facial appearance.<\/p>\n\n\n\n<p>This article walks through the chromosomal change and the genes involved, the difference from the often-confused &#8220;distal 4q deletion syndrome,&#8221; the main symptoms reported in the literature, the inheritance pattern, the relationship with prenatal diagnosis and <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a>, the path to a confirmed diagnosis, and treatment and outlook. We draw on public and academic sources such as GARD (the U.S. National Institutes of Health&#8217;s Genetic and Rare Diseases Information Center) and peer-reviewed papers. Because reliable information on this rare condition is limited, let&#8217;s go through it one point at a time.<\/p>\n\n\n\n<div class=\"info-box\" style=\"margin:1.5em 0;padding:1.2em 1.4em;background:#f3f8ff;border-left:5px solid #5b9bd5;border-radius:8px;\">\n<p style=\"font-weight:bold;margin-bottom:0.6em;\">\ud83d\udca1 What this article covers<\/p>\n<ul style=\"margin:0;padding-left:1.2em;\">\n<li>What kind of chromosomal change 4q21 deletion syndrome is (the genes involved, including PRKG2 and RASGEF1B, and the typical size of the deletion)<\/li>\n<li>How it differs from the often-confused &#8220;distal 4q deletion syndrome&#8221;<\/li>\n<li>The main symptoms reported, including growth delay, low muscle tone, and absent speech<\/li>\n<li>The inheritance pattern (usually de novo) and what it means for future pregnancies<\/li>\n<li>When this condition is, and isn&#8217;t, covered by prenatal diagnosis or <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a><\/li>\n<li>How treatment is approached, and what the long-term outlook and follow-up look like<\/li>\n<\/ul>\n<\/div>\n\n\n\n\n\n\n<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_85 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">\u76ee\u6b21<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#1_What_Is_4q21_Deletion_Syndrome_The_Chromosomal_Change_Behind_It\" >1. What Is 4q21 Deletion Syndrome? (The Chromosomal Change Behind It)<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#The_Roles_of_PRKG2_RASGEF1B_and_HNRNPDHNRNPDL\" >The Roles of PRKG2, RASGEF1B, and HNRNPD\/HNRNPDL<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#2_How_It_Differs_from_the_Often-Confused_%E2%80%9CDistal_4q_Deletion_Syndrome%E2%80%9D\" >2. How It Differs from the Often-Confused &#8220;Distal 4q Deletion Syndrome&#8221;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#3_Main_Symptoms\" >3. Main Symptoms<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#4_How_Genes_Correspond_to_Symptoms\" >4. How Genes Correspond to Symptoms<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#5_Cause_and_Inheritance_Pattern_Usually_De_Novo\" >5. Cause and Inheritance Pattern (Usually De Novo)<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#De_Novo_Spontaneous_Cases\" >De Novo (Spontaneous) Cases<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#What_Parental_Testing_Confirms\" >What Parental Testing Confirms<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#6_Relationship_with_Prenatal_Diagnosis_and_NIPT\" >6. Relationship with Prenatal Diagnosis and NIPT<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#7_The_Path_to_a_Confirmed_Diagnosis\" >7. The Path to a Confirmed Diagnosis<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#Chromosomal_Microarray_Analysis_CMA\" >Chromosomal Microarray Analysis (CMA)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#Parental_Testing_and_Brain_Imaging\" >Parental Testing and Brain Imaging<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#Evaluation_After_Birth\" >Evaluation After Birth<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#8_Treatment_and_Support\" >8. Treatment and Support<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#9_Outlook\" >9. Outlook<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#10_Support_for_Your_Family_and_Planning_for_a_Future_Pregnancy\" >10. Support for Your Family, and Planning for a Future Pregnancy<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#Frequently_Asked_Questions\" >Frequently Asked Questions<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#Are_4q21_deletion_syndrome_and_distal_4q_deletion_syndrome_the_same_condition\" >Are 4q21 deletion syndrome and distal 4q deletion syndrome the same condition?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#How_common_is_this_condition\" >How common is this condition?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#Can_NIPT_detect_this_condition\" >Can NIPT detect this condition?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#Is_it_inherited_Could_it_affect_a_future_pregnancy\" >Is it inherited? Could it affect a future pregnancy?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-22\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#What_test_confirms_the_diagnosis\" >What test confirms the diagnosis?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-23\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\/#Ive_heard_speech_may_not_develop_Does_that_always_happen\" >I&#8217;ve heard speech may not develop. Does that always happen?<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"1_What_Is_4q21_Deletion_Syndrome_The_Chromosomal_Change_Behind_It\"><\/span><strong>1. What Is 4q21 Deletion Syndrome? (The Chromosomal Change Behind It)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>4q21 deletion syndrome is a contiguous gene syndrome caused by a congenital, partial loss of the long arm of chromosome 4, around the q21.21-q21.3 region.<\/strong> It is also written as &#8220;4q21 microdeletion syndrome&#8221; or &#8220;del(4)(q21).&#8221; It has been recognized as a distinct syndrome since it was first described in the medical journal Journal of Medical Genetics (published by the British Medical Association) in 2010.<\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20522426\/\" target=\"_blank\" rel=\"noopener\">That 2010 report<\/a> analyzed nine cases with overlapping deletions and found a shared minimal region of 1.37 Mb (megabases) containing five genes: PRKG2, RASGEF1B, HNRNPD, HNRNPDL, and ENOPH1. A later <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27604828\/\" target=\"_blank\" rel=\"noopener\">2016 case report<\/a> described the smallest deletion documented so far, at 761 kb (kilobases), narrowing down the likely causative genes even further.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_Roles_of_PRKG2_RASGEF1B_and_HNRNPDHNRNPDL\"><\/span><strong>The Roles of PRKG2, RASGEF1B, and HNRNPD\/HNRNPDL<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>PRKG2 encodes a protein (cGMP-dependent protein kinase type II) that is active in the brain and cartilage. RASGEF1B encodes a protein involved in shaping neuronal projections. The 2016 report identified these two genes as strongly linked to intellectual disability and absent speech.<\/p>\n\n\n\n<p>HNRNPD and HNRNPDL, on the other hand, have been linked to growth delay and low muscle tone. Because the exact genes lost depend on the size and location of the deletion, the combination and severity of symptoms can vary considerably between individuals, even when the diagnosis is the same &#8220;4q21 deletion syndrome.&#8221;<\/p>\n\n\n\n<p><a href=\"https:\/\/rarediseases.info.nih.gov\/diseases\/17181\/chromosome-4q21-deletion-syndrome\" target=\"_blank\" rel=\"noopener\">GARD (the Genetic and Rare Diseases Information Center at the U.S. National Institutes of Health)<\/a>, which compiles information on rare conditions, describes this syndrome as a chromosomal disorder involving distinctive facial features, progressive growth delay, severe intellectual disability, and absent or markedly delayed speech. GARD lists conditions affecting fewer than 1,000 people in the United States as rare diseases, and 4q21 deletion syndrome falls into an extremely rare category even by that standard, with only a handful of cases reported worldwide.<\/p>\n\n\n\n    <a href=\"\/nipt\/12p12-1-microdeletion-syndrome\/\" class=\"blog-card\">\n      <div class=\"blog-card-content\">\n          <div class=\"blog-card-title\">12p12.1\u5fae\u5c0f\u6b20\u5931\u75c7\u5019\u7fa4 <\/div>\n          <div class=\"blog-card-excerpt\">SOX5\u3001SLCO1B1\u3001KCNJ8\u3001ABCC9\u3001KRAS\u306e\u907a\u4f1d\u5b50\u5909\u7570\u306f\u3001\u30e9\u30e0\u30fb\u30b7\u30a7\u30fc\u30d5\u30a1\u30fc\u75c7\u5019\u7fa4\u3001\u30ed\u30fc\u30bf\u30fc\u75c7\u5019\u7fa4\u3001\u30ab\u30f3\u30c8\u30a5\u30fc\u75c7\u5019\u7fa4\u3001\u30d6\u30eb\u30ac...<\/div>\n      <\/div>\n    <\/a>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"2_How_It_Differs_from_the_Often-Confused_%E2%80%9CDistal_4q_Deletion_Syndrome%E2%80%9D\"><\/span><strong>2. How It Differs from the Often-Confused &#8220;Distal 4q Deletion Syndrome&#8221;<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>Even when two conditions both involve the long arm of chromosome 4, a different deletion location means a different name and a different set of symptoms.<\/strong> In particular, be sure to distinguish this condition clearly from &#8220;distal 4q deletion syndrome,&#8221; in which the very end of the chromosome is lost.<\/p>\n\n\n\n<figure class=\"wp-table-block\"><table><thead><tr><th>Comparison<\/th><th>4q21 Deletion Syndrome (this article)<\/th><th>Distal 4q Deletion Syndrome<\/th><\/tr><\/thead><tbody><tr><td>Location of the deletion<\/td><td>An &#8220;interstitial deletion&#8221; &mdash; a middle segment of the long arm (around the q21 region) is lost<\/td><td>A &#8220;terminal deletion&#8221; &mdash; the very end of the long arm (around q33 to the tip) is lost<\/td><\/tr><tr><td>Main genes involved<\/td><td>PRKG2, RASGEF1B, HNRNPD, HNRNPDL, and others<\/td><td>Genes located further toward the terminal end, such as HAND2 and TBR1<\/td><\/tr><tr><td>How often it is reported<\/td><td>An extremely rare condition with only a small number of cases reported worldwide<\/td><td>A relatively well-documented type among 4q deletions<\/td><\/tr><tr><td>Characteristic symptoms<\/td><td>Severe intellectual disability, absent or delayed speech, progressive growth delay<\/td><td>Tends to involve heart defects and skeletal abnormalities of the limbs<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>Because both conditions are described with the same &#8220;4q&#8221; notation, it&#8217;s easy to assume they are the same disease just from reading a test result. Only a chromosomal microarray analysis (CMA), which pinpoints the exact location and size of the deletion, can confirm which of the two conditions is present. You may also find it helpful to read <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/distal-4q-deletion-syndrome\/\">our article explaining distal 4q deletion syndrome in detail<\/a>. Always review the exact coordinates listed in your test report together with your physician.<\/p>\n\n\n\n<p>Wolf-Hirschhorn syndrome (4p16.3 deletion syndrome) is another well-known condition involving chromosome 4. It results from a loss at the end of the short arm (p), which is a different arm entirely from the long arm (q) affected in 4q21 deletion syndrome. The similar-sounding names make the two easy to confuse, but keeping in mind that they involve different genes and different symptoms will make it easier to follow your doctor&#8217;s explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"3_Main_Symptoms\"><\/span><strong>3. Main Symptoms<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>The core features reported are growth delay, severe intellectual disability, and absent or markedly delayed speech, and how they present varies considerably from person to person.<\/strong> Based on case reports to date, the main features are as follows.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Low muscle tone in the newborn period: Reports describe infants who feel unusually soft from birth and have difficulty feeding.<\/li>\n\n\n\n<li>Progressive growth delay: In many reported cases, height and weight increasingly lag behind as the child grows.<\/li>\n\n\n\n<li>Severe psychomotor developmental delay: Motor skills and overall development are delayed.<\/li>\n\n\n\n<li>Absent or markedly delayed speech: Reports describe cases where receptive language (understanding) is relatively preserved even though expressive speech barely develops.<\/li>\n\n\n\n<li>Distinctive facial features: Reported features include a broad forehead, frontal bossing, downslanting eyelid folds (palpebral fissures), wide-set eyes (hypertelorism), and a low nasal bridge.<\/li>\n<\/ul>\n\n\n\n<p>Some cases also report brain structural differences such as enlarged ventricles, seizures, cleft palate or Pierre Robin sequence, skeletal features (such as scoliosis or fused toes), and traits associated with autism spectrum disorder. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23913759\/\" target=\"_blank\" rel=\"noopener\">A 2013 case report published in a U.S. medical genetics journal<\/a> described one case in which the deleted region included the SCD5 gene and the child had cleft palate and Pierre Robin sequence. Because so few cases have been documented overall, none of these features occurs in every case.<\/p>\n\n\n\n<p>It&#8217;s important to check each child&#8217;s own combination of symptoms and identify the support they need as they grow. For more on developmental characteristics, see our article on <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/nipt-autism-developmental-disorders-detection\/\">NIPT and autism\/developmental disorders<\/a>.<\/p>\n\n\n\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"4_How_Genes_Correspond_to_Symptoms\"><\/span><strong>4. How Genes Correspond to Symptoms<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>Which symptoms are more likely to appear depends on which combination of genes is included in the deletion.<\/strong> The table below summarizes the main correspondences reported in the 2016 study.<\/p>\n\n\n\n<figure class=\"wp-table-block\"><table><thead><tr><th>Gene<\/th><th>Symptoms mainly associated<\/th><\/tr><\/thead><tbody><tr><td>PRKG2<\/td><td>Intellectual disability, absent\/delayed speech, growth delay (involvement in cartilage formation)<\/td><\/tr><tr><td>RASGEF1B<\/td><td>Intellectual disability, absent\/delayed speech (involvement in neurodevelopment)<\/td><\/tr><tr><td>HNRNPD \/ HNRNPDL<\/td><td>Growth delay, low muscle tone<\/td><\/tr><tr><td>ENOPH1<\/td><td>May influence the overall phenotype in combination with other genes<\/td><\/tr><tr><td>SCD5 (in some cases)<\/td><td>Reported in association with cleft palate and Pierre Robin sequence in at least one case<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>The size of the reported deletions ranges from about 0.76 Mb (760,000 base pairs) to nearly 5 Mb, depending on the case. When the deletion is small and involves only certain genes, cases without growth delay have also been reported &mdash; so the size of the deletion does not always correspond directly to how severe the symptoms are.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"5_Cause_and_Inheritance_Pattern_Usually_De_Novo\"><\/span><strong>5. Cause and Inheritance Pattern (Usually De Novo)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>Most cases reported to date have arisen from a spontaneous (de novo) genetic change.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"De_Novo_Spontaneous_Cases\"><\/span><strong>De Novo (Spontaneous) Cases<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>During the formation of eggs or sperm, or in the earliest cell divisions after fertilization, a copy error can occur by chance. It has nothing to do with anything the mother ate, did, or was exposed to during pregnancy, or with her work. In my own consultations, I always make a point of telling parents that there is nothing they need to blame themselves for.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"What_Parental_Testing_Confirms\"><\/span><strong>What Parental Testing Confirms<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Once a child&#8217;s diagnosis is confirmed, both parents are usually offered chromosomal microarray testing to check whether the change is de novo. In rare cases, a parent carries a balanced structural rearrangement (such as a balanced translocation) that can be passed on to a child in an unbalanced form, so this step is an important part of understanding the risk for future pregnancies accurately. If you&#8217;re concerned about a future pregnancy, genetic counseling with a certified clinical geneticist or genetic counselor is available.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"6_Relationship_with_Prenatal_Diagnosis_and_NIPT\"><\/span><strong>6. Relationship with Prenatal Diagnosis and NIPT<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>4q21 deletion syndrome is not covered by basic <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> panels. It only comes into consideration with an expanded test that also screens for microdeletions.<\/strong><\/p>\n\n\n\n<p>Standard, basic <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> mainly screens for numerical changes in chromosomes &mdash; trisomy 21, 18, and 13. Some plans also include a few relatively common microdeletions, such as 22q11.2 deletion syndrome (DiGeorge syndrome), but an ultra-rare interstitial deletion like 4q21 deletion syndrome is often not set up as an individual target item at all. Hiro Clinic <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> offers an expanded panel covering 143 microdeletion and microduplication regions, and a rare deletion like this one can be picked up within that expanded framework. Always confirm in advance exactly which conditions are covered by the specific plan you are considering.<\/p>\n\n\n\n<p>It&#8217;s worth keeping in mind that <strong><a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> is, by design, a non-definitive screening test<\/strong>. The <a href=\"https:\/\/www.jsog.or.jp\/news\/pdf\/NIPT_kaiteishishin.pdf\" target=\"_blank\" rel=\"noopener\">guidelines on NIPT<\/a> issued by the Japan Society of Obstetrics and Gynecology also state that <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> results remain within the scope of a screening test and do not constitute a definitive diagnosis. Expanded <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> panels that include microdeletions are also known to have somewhat more limited analytical and clinical validity compared with the basic panel.<\/p>\n\n\n\n<p>If <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> returns a positive finding for a microdeletion involving the 4q21 region, the first step is genetic counseling to understand what the result means. From there, you and your partner can discuss and decide together whether to pursue a confirmatory chromosomal microarray analysis (CMA) through amniocentesis. Because this is an extremely rare condition, it&#8217;s best to avoid drawing firm conclusions right after a positive result and instead work through the next steps one at a time with a specialist.<\/p>\n\n\n\n<p>Many people feel torn about whether to have the test at all. On X (formerly Twitter), one user, <a href=\"https:\/\/x.com\/chiisunmon\" target=\"_blank\" rel=\"noopener\">@chiisunmon<\/a>, wrote (in Japanese) about having hesitated over whether to have <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a>, and how a negative result ended up being reassuring; she and her husband had deliberately decided not to plan out in advance how they would respond to a positive result, agreeing instead to &#8220;think it through when the time comes.&#8221; Choosing to hold off on deciding your response and first make space to absorb the result, rather than settling on an answer beforehand, is one legitimate way to approach it, in my view.<\/p>\n\n\n\n<p>Support systems and how a facility connects you to confirmatory testing after a concerning result can vary from clinic to clinic. On X, another user, <a href=\"https:\/\/x.com\/okupanxc4o\" target=\"_blank\" rel=\"noopener\">@okupanxc4o<\/a>, wrote (in Japanese) that after receiving genetic counseling at her maternity clinic and learning that accuracy and support can differ between accredited and non-accredited facilities, she decided to discuss the choice with her husband. You can check which facilities are accredited through the <a href=\"https:\/\/jams-prenatal.jp\/\" target=\"_blank\" rel=\"noopener\">Japan Association of Medical Sciences&#8217; prenatal testing accreditation committee<\/a>.<\/p>\n\n\n\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"7_The_Path_to_a_Confirmed_Diagnosis\"><\/span><strong>7. The Path to a Confirmed Diagnosis<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>A confirmed diagnosis relies primarily on chromosomal microarray analysis (CMA), a precise genetic test.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Chromosomal_Microarray_Analysis_CMA\"><\/span><strong>Chromosomal Microarray Analysis (CMA)<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>This test can detect tiny deletions, from a few hundred kb up to several Mb, that conventional microscope-based karyotyping (G-banding) would miss. It is performed on amniotic fluid before birth or on a blood sample after birth, and it maps precisely where the deletion begins and ends. That range is exactly what allows doctors to distinguish this condition from distal 4q deletion syndrome, discussed earlier.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Parental_Testing_and_Brain_Imaging\"><\/span><strong>Parental Testing and Brain Imaging<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Testing both parents&#8217; blood can determine whether the change is de novo or stems from a balanced structural rearrangement. If seizures or structural brain differences are suspected, imaging such as a head MRI is also performed.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Evaluation_After_Birth\"><\/span><strong>Evaluation After Birth<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>After diagnosis, the child&#8217;s overall condition is assessed through developmental testing, growth-curve monitoring, a physical examination, and brain imaging when needed. Regular, ongoing follow-up is essential here.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"8_Treatment_and_Support\"><\/span><strong>8. Treatment and Support<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>There is currently no treatment that reverses the underlying chromosomal loss, but developmental support and condition-specific medical management can help each child grow and thrive in their own way.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Developmental support (early intervention)<\/strong>: Physical therapy (PT), occupational therapy (OT), and speech-language therapy (ST) help support motor, language, and daily-living development.<\/li>\n\n\n\n<li><strong>Growth monitoring<\/strong>: Growth curves are tracked continuously, with nutritional support or an endocrine work-up added when needed.<\/li>\n\n\n\n<li><strong>Managing seizures and brain differences<\/strong>: When present, a pediatric neurologist is involved, managing seizures with anti-seizure medication and monitoring with imaging over time.<\/li>\n\n\n\n<li><strong>Choosing an educational setting<\/strong>: Families work with local education support centers to choose the right setting &mdash; a special-needs school, a special-needs classroom, or a resource room &mdash; based on the child&#8217;s individual needs.<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img decoding=\"async\" width=\"640\" height=\"425\" src=\"\/nipt\/wp-content\/uploads\/2024\/11\/5136740_s.jpg\" alt=\"Every child is different, and that is a good thing\" class=\"wp-image-87472\"\/><\/figure><\/div>\n\n\n<p>Because the combination and severity of symptoms differ from child to child, there is no single fixed course that &#8220;always&#8221; happens with this condition. A pediatric neurologist, a geneticist, and, when needed, a speech-language therapist and other specialists work together to build a support plan tailored to each child, one step at a time.<\/p>\n\n\n\n<p>The time and financial burden of therapy and clinic visits is not small. Make use of local welfare services, disability certification programs, and patient support groups so that your family doesn&#8217;t have to carry it alone.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"9_Outlook\"><\/span><strong>9. Outlook<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>Intellectual disability and delayed speech are reported to persist long-term in many cases, but starting early intervention and continuing it consistently can make a meaningful difference to quality of life.<\/strong><\/p>\n\n\n\n<p>In reported cases, severe intellectual disability and absent speech tend to persist when the deletion includes PRKG2 or RASGEF1B. On the other hand, cases with a smaller deletion affecting only certain genes have sometimes been reported to have comparatively milder symptoms.<\/p>\n\n\n\n<p>With so few cases documented, it is difficult at this point in the research to make firm statements about the long-term course. What matters most, in my view, is regular developmental assessment, starting early intervention as soon as possible, and the steady accumulation of day-to-day support &mdash; that is the realistic path to preserving quality of life.<\/p>\n\n\n\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"10_Support_for_Your_Family_and_Planning_for_a_Future_Pregnancy\"><\/span><strong>10. Support for Your Family, and Planning for a Future Pregnancy<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p><strong>The isolation that comes with an ultra-rare condition can be considerable, but genetic counseling, patient groups, and public support services are all resources you can lean on.<\/strong><\/p>\n\n\n\n<p>It can be hard to find another family nearby dealing with the same condition. Even so, you can still connect with other families affected by chromosome-related rare conditions and access specialized genetic counseling support. Medical management is best left to your doctors and therapy team; a family&#8217;s role, as I see it, is to celebrate each small step of progress your child makes, together.<\/p>\n\n\n\n<p>Public resources such as Japan&#8217;s national <a href=\"https:\/\/www.rehab.go.jp\/ddis\/\" target=\"_blank\" rel=\"noopener\">Center for Developmental Disorders Information and Support<\/a> and the <a href=\"https:\/\/www.nanbyou.or.jp\/\" target=\"_blank\" rel=\"noopener\">Japan Intractable Diseases Information Center<\/a>, which compiles information on rare conditions, can also be a valuable source of support.<\/p>\n\n\n\n<p>If you&#8217;d like to learn more about other microdeletion syndromes or chromosomal conditions that are easily confused with this one, the following may also help.<\/p>\n\n\n\n    <a href=\"\/nipt\/6q24-q25-deletion-syndrome\/\" class=\"blog-card\">\n      <div class=\"blog-card-content\">\n          <div class=\"blog-card-title\">6q24-q25\u6b20\u5931\u75c7\u5019\u7fa4(6q24-q25 Deletion Syndrome) <\/div>\n          <div class=\"blog-card-excerpt\">\u67d3\u8272\u4f536q24q25\u9818\u57df\u306b\u4f4d\u7f6e\u3059\u308b\u907a\u4f1d\u5b50\uff08PEX3\u3001PLAGL1\u3001HYMAI\u3001STX11\u3001EPM2A\u3001GRM1\u3001SYNE1\u3001ARID1B\u3001S...<\/div>\n      <\/div>\n    <\/a>\n\n\n\n<p>If you&#8217;re concerned about microdeletions in general, our article on <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/nipt-microdeletion-risks\/?lang=en\">the risks associated with subtle chromosomal changes<\/a> may also be useful.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-16018d1d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/line-registration\/?lang=en\" target=\"_blank\" rel=\"noopener\">Free Consultation via LINE<\/a><\/div>\n<\/div>\n\n\n\n<p>If you&#8217;re considering <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> for a future pregnancy, how far you extend coverage into microdeletions will shape which plan is right for you. If you&#8217;re not sure which plan fits your situation, try our <strong><a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/plan-finder\/?lang=en\">Plan Finder<\/a><\/strong>. Phone consultations are also available; feel free to reach us at <a href=\"tel:0120169629\">0120-169-629<\/a>.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-16018d1d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/mypage-nipt-reservation.hiro-clinic.or.jp\/registration\" target=\"_blank\" rel=\"noopener\">Book Your NIPT Appointment<\/a><\/div>\n\n\n\n<div class=\"wp-block-button is-style-outline is-style-outline--1\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/plan-finder\/?lang=en\" target=\"_blank\" rel=\"noopener\">Find the Right Test with Plan Finder<\/a><\/div>\n<\/div>\n\n\n\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Frequently_Asked_Questions\"><\/span><strong>Frequently Asked Questions<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Are_4q21_deletion_syndrome_and_distal_4q_deletion_syndrome_the_same_condition\"><\/span>Are 4q21 deletion syndrome and distal 4q deletion syndrome the same condition?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>No, they are distinct conditions. The condition covered in this article is an &#8220;interstitial deletion,&#8221; in which a middle segment of the long arm (around the q21 region) is lost, while distal 4q deletion syndrome is a &#8220;terminal deletion,&#8221; in which the very end of the chromosome is lost. The genes involved and the symptoms that tend to appear also differ, so chromosomal microarray testing is needed to confirm exactly which region is deleted and distinguish the two.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"How_common_is_this_condition\"><\/span>How common is this condition?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>GARD (the Genetic and Rare Diseases Information Center at the U.S. National Institutes of Health) classifies it as a rare disease, defined there as affecting fewer than 1,000 people in the United States. Very few cases have been documented in the academic literature worldwide, so a precise incidence has not yet been established.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Can_NIPT_detect_this_condition\"><\/span>Can NIPT detect this condition?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>It&#8217;s not normally included in a basic <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> panel; it can come into consideration with an expanded panel that also screens for microdeletions. Because <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/\">NIPT<\/a> is a non-definitive screening test, a positive finding needs to be followed up with a confirmatory test such as amniocentesis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Is_it_inherited_Could_it_affect_a_future_pregnancy\"><\/span>Is it inherited? Could it affect a future pregnancy?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Most reported cases arise from a spontaneous (de novo) genetic change, so the recurrence risk for a future pregnancy is generally considered low. In rare instances, though, it can stem from a structural chromosomal rearrangement carried by a parent, so it&#8217;s worth confirming with parental chromosomal microarray testing and genetic counseling.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"What_test_confirms_the_diagnosis\"><\/span>What test confirms the diagnosis?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Chromosomal microarray analysis (CMA) is the main diagnostic test. It can detect tiny deletions that would be missed by conventional microscope-based testing, and parental testing or brain imaging such as an MRI are added when needed.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Ive_heard_speech_may_not_develop_Does_that_always_happen\"><\/span>I&#8217;ve heard speech may not develop. Does that always happen?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p>Not necessarily. The literature includes cases where receptive language (understanding) is preserved even though expressive speech barely develops, but it also includes cases with a smaller deletion where the impact on language development is milder. <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/early-nipt-august-only\/\">Early<\/a> support such as speech-language therapy can help a child build other ways to communicate.<\/p>\n\n\n\n<p><strong>Medically reviewed by: Hiroshi Oka, M.D., Ph.D.<\/strong> \/ Director-General and Labo Director, Hiro Clinic, Fukubikai Medical Corporation. Graduate of Keio University School of Medicine. Licensed physician in both Japan and the United States, and holds a doctorate in medicine. One of a limited number of physicians in Japan to hold Labo Director certification. This article was prepared in line with medical advertising guidelines, referencing public and academic sources such as GARD and the Japan Society of Obstetrics and Gynecology, and peer-reviewed papers (including Journal of Medical Genetics and American Journal of Medical Genetics Part A). Because this is a rare condition with few documented cases, reported frequencies and figures vary across sources. Please consult your physician for decisions about diagnosis and treatment.<\/p>\n\n\n<script type=\"application\/ld+json\">\n{\n  \"@context\": \"https:\/\/schema.org\",\n  \"@type\": \"FAQPage\",\n  \"mainEntity\": [\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Are 4q21 deletion syndrome and distal 4q deletion syndrome the same condition?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"No, they are distinct conditions. The condition covered in this article is an interstitial deletion, in which a middle segment of the long arm (around the q21 region) is lost, while distal 4q deletion syndrome is a terminal deletion, in which the very end of the chromosome is lost. The genes involved and the symptoms that tend to appear also differ, so chromosomal microarray testing is needed to confirm exactly which region is deleted and distinguish the two.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"How common is this condition?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"GARD (the Genetic and Rare Diseases Information Center at the U.S. National Institutes of Health) classifies it as a rare disease, defined there as affecting fewer than 1,000 people in the United States. Very few cases have been documented in the academic literature worldwide, so a precise incidence has not yet been established.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Can NIPT detect this condition?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"It's not normally included in a basic NIPT panel; it can come into consideration with an expanded panel that also screens for microdeletions. Because NIPT is a non-definitive screening test, a positive finding needs to be followed up with a confirmatory test such as amniocentesis.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"Is it inherited? Could it affect a future pregnancy?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Most reported cases arise from a spontaneous (de novo) genetic change, so the recurrence risk for a future pregnancy is generally considered low. In rare instances, though, it can stem from a structural chromosomal rearrangement carried by a parent, so it's worth confirming with parental chromosomal microarray testing and genetic counseling.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"What test confirms the diagnosis?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Chromosomal microarray analysis (CMA) is the main diagnostic test. It can detect tiny deletions that would be missed by conventional microscope-based testing, and parental testing or brain imaging such as an MRI are added when needed.\"\n      }\n    },\n    {\n      \"@type\": \"Question\",\n      \"name\": \"I've heard speech may not develop. Does that always happen?\",\n      \"acceptedAnswer\": {\n        \"@type\": \"Answer\",\n        \"text\": \"Not necessarily. The literature includes cases where receptive language (understanding) is preserved even though expressive speech barely develops, but it also includes cases with a smaller deletion where the impact on language development is milder. Early support such as speech-language therapy can help a child build other ways to communicate.\"\n      }\n    }\n  ]\n}\n<\/script>\n","protected":false},"excerpt":{"rendered":"If a chromosomal tes&#8230;\n <a href=\"https:\/\/www.hiro-clinic.or.jp\/nipt\/4q21_deletion_syndrome\/?lang=en\">\u7d9a\u304d\u3092\u8aad\u3080<\/a>","protected":false},"author":101,"featured_media":87471,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[97],"tags":[],"class_list":["post-86042","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/posts\/86042","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/users\/101"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/comments?post=86042"}],"version-history":[{"count":5,"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/posts\/86042\/revisions"}],"predecessor-version":[{"id":133752,"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/posts\/86042\/revisions\/133752"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/media\/87471"}],"wp:attachment":[{"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/media?parent=86042"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/categories?post=86042"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hiro-clinic.or.jp\/nipt\/wp-json\/wp\/v2\/tags?post=86042"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}