Embryogenesis is regulated by a number of complex signaling cascades, which are critical for normal development. One such pathway begins with a secreted protein called “SONIC HEDGEHOG”(SHH [MIM 600725]), which sets off a chain of events in target cells, leading to the activation and repression of target genes by transcription factors in the Gli family. Dysregulation of the Sonic hedgehog–Patched–Gli (Shh-Ptch-Gli) pathway leads to several human diseases, including birth defects and cancers.

Elements of the Shh-Ptch-Gli pathway are highly conserved, indicating its essential role in development. However, Shh signaling is also apparently susceptible to evolutionary pressures. Thus, Shh signaling has been adapted to serve tremendously diverse functions in a wide array of animal models, in both embryonic and adult life. Shh and the downstream molecules involved in signal transduction vary, to some extent, between animals, as well. Although a great deal can be learned from the study of animal models, it is essential to not assume that what is true in one model system is necessarily true in another. Thus, this review focuses specifically on our current understanding of the Shh-Ptch-Gli pathway and its clinical significance in humans.