Familial dysautonomia (FD), a devastating hereditary sensory and autonomic neuropathy, results from an intronic mutation in the IKBKAP gene that disrupts normal mRNA splicing and leads to tissue-specific reduction of IKBKAP protein (IKAP) in the nervous system. To better understand the roles of IKAP in vivo, an Ikbkap knockout mouse model was created. Results from our study show that ablating Ikbkap leads to embryonic lethality, with no homozygous Ikbkap knockout (Ikbkap ؊/؊ ) embryos surviving beyond 12.5 days postcoitum. Morphological analyses of the Ikbkap ؊/؊ conceptus at different stages revealed abnormalities in both the visceral yolk sac and the embryo, including stunted extraembryonic blood vessel formation, delayed entry into midgastrulation, disoriented dorsal primitive neural alignment, and failure to establish the embryonic vascular system. Further, we demonstrate downregulation of several genes that are important for neurulation and vascular development in the Ikbkap ؊/؊ embryos and show that this correlates with a defect in transcriptional elongation-coupled histone acetylation. Finally, we show that the embryonic lethality resulting from Ikbkap ablation can be rescued by a human IKBKAP transgene. For the first time, we demonstrate that IKAP is crucial for both vascular and neural development during embryogenesis and that protein function is conserved between mouse and human.IKBKAP (encoding IB kinase-associated protein, also called Elongator protein 1) is the gene mutated in hereditary sensory and autonomic neuropathy type III, or familial dysautonomia (FD). All FD patients carry at least one copy of a splicing mutation in IKBKAP, which causes aberrant exon skipping and subsequent tissue-specific reduction of protein expression in FD patients (1,41,42). The IKBKAP gene is highly conserved across species, with the human and mouse proteins (IKAP and Ikap, respectively) sharing more than 80% amino acid homology (12). The IKBKAP protein, IKAP, was first reported to act as a scaffolding protein for the IB kinase complex (11). Recent studies, however, have shown that IKAP does not play a role in NF-B (nuclear factor B) signaling, but rather, it is a subunit of the human Elongator complex, which is important for efficient transcriptional elongation (19,28,36).FD (or Riley-Day syndrome) is one of the best known recessive hereditary neuropathies, with an extremely high carrier frequency in the Ashkenazi Jewish population, which ranges from 1 in 17 to 1 in 28 depending on the country of origin (29,33,42). Clinical characteristics of FD include diminished tear secretion, dysphagia, esophageal and gastric dysmotility, gastroesophageal reflux, spinal curvature, postural hypotension, blotching, excessive sweating, and decreased deep-tendon reflexes (2). Fatality in FD patients is high, and only half survive to 40 years of age. Clinical reports have shown that the failure of autonomic function is one of the major causes of death (21). To date, three FD-causing mutations have been identified in the IKBKAP gene: a...