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A familial case of FLAD1 protein deficiency associated with impaired adrenal steroidogenesis
Olga A. Averina, Natalia Yu. Kalinchenko, Vitaly A. Ioutsi, Andrey V. Pirogov, Alexander V. Bogachev, Oleg A. Permyakov, Vitaly S. Buev, Ekaterina A. Guseva, Anastasia V. Priymak, Olga A. Bazhanova, Mariia A. Emelianova, Olga O. Grigoryeva, Galina V. Baydakova, Maxim A. Abakumov, Vasily N. Manskikh, Olga A. Dontsova, Petr V. Sergiev, Anatoly N. Tiulpakov
Olga A. Averina, Natalia Yu. Kalinchenko, Vitaly A. Ioutsi, Andrey V. Pirogov, Alexander V. Bogachev, Oleg A. Permyakov, Vitaly S. Buev, Ekaterina A. Guseva, Anastasia V. Priymak, Olga A. Bazhanova, Mariia A. Emelianova, Olga O. Grigoryeva, Galina V. Baydakova, Maxim A. Abakumov, Vasily N. Manskikh, Olga A. Dontsova, Petr V. Sergiev, Anatoly N. Tiulpakov
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Research Article Endocrinology Genetics Metabolism

A familial case of FLAD1 protein deficiency associated with impaired adrenal steroidogenesis

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Abstract

The FLAD1 gene codes for flavin adenine dinucleotide (FAD) synthase. FAD is a cofactor for many redox enzymes involved in vital processes from respiration to signal transduction. In this work, we described a clinical case of 2 siblings carrying compound heterozygous mutations in the FLAD1 gene resulting in the substitutions A418V and R542* at the protein level. The patients demonstrate adrenal insufficiency, which has not previously been associated with FLAD1 protein defects. To verify that adrenal insufficiency is caused by FLAD1 mutations, we created a personalized mouse model carrying the mutations found in the patients. The mutation in the FLAD1 gene, leading to the A418V substitution, appeared viable in the homozygous state, with minimal difference from the WT. The FLAD1 gene mutation leading to the R542* truncation is lethal when homozygous. The mouse model of the compound heterozygous FLAD1A418V/R542* mutations recapitulated the physiological, biochemical, and endocrine manifestations of FLAD1 mutations in patients. The mouse model created demonstrates the causal effect of FLAD1 mutations on the described pathology and potentially paves the way for understanding the disease’s molecular mechanism and developing better therapies.

Authors

Olga A. Averina, Natalia Yu. Kalinchenko, Vitaly A. Ioutsi, Andrey V. Pirogov, Alexander V. Bogachev, Oleg A. Permyakov, Vitaly S. Buev, Ekaterina A. Guseva, Anastasia V. Priymak, Olga A. Bazhanova, Mariia A. Emelianova, Olga O. Grigoryeva, Galina V. Baydakova, Maxim A. Abakumov, Vasily N. Manskikh, Olga A. Dontsova, Petr V. Sergiev, Anatoly N. Tiulpakov

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Figure 4

Metabolite quantity in mice with mutated FLAD1.

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Metabolite quantity in mice with mutated FLAD1.
(A) FAD content in mouse...
(A) FAD content in mouse tissues, such as the adrenal gland, brain, liver, and heart extracts, as marked above the corresponding bars. Green corresponds to the WT (n = 6, 4 months, male), gray to the homozygous FLAD1A418V/A418V mutation (n = 6, 4 months, male), and red to the compound heterozygous FLAD1A418V/R542* mice (n = 6, 4 months, male). FAD concentration is normalized by protein content (BCA), pmol/mg protein. P < 0.0001, Kruskal-Wallis statistic = 14.58 for adrenal gland; P = 0.7484, Kruskal-Wallis statistic = 0.6371 for brain; P = 0.0061, Kruskal-Wallis statistic = 8.846 for liver; P = 0.2899, Kruskal-Wallis statistic = 2.575 for heart by Kruskal-Wallis test with the Benjamini-Krieger-Yekutieli correction for multiple comparisons. (B) Blood spot concentration of acyl carnitines (indicated above the graphs), whose concentration is most affected by FLAD1 variants. The color code, the same as for A, is indicated on the graph; n = 6 for all groups presented (except FLAD1A418V/A418V group in AC C4 being n = 5). P < 0.0001, Kruskal-Wallis statistic = 13.07 for AC C4; P < 0.0001, Kruskal-Wallis statistic = 13.66 AC C5; P = 0.0002, Kruskal-Wallis statistic = 12.12 for AC C6; P < 0.0001, Kruskal-Wallis statistic = 12.54 AC C8; P < 0.0001, Kruskal-Wallis statistic = 12.13 AC C10; P = 0.0003, Kruskal-Wallis statistic = 11.66 AC C10:1; P < 0.0001, Kruskal-Wallis statistic = 12.94 AC C12 by Kruskal-Wallis test with the Benjamini-Krieger-Yekutieli correction for multiple comparisons. (C) Frequency of male copulation as measured by the average number of vaginal plugs observed per male per day (10 days total). Green corresponds to the WT (n = 8, 4 months, male), gray to the homozygous FLAD1A418V/A418V mutation (n = 8, 4 months, male), and red to the compound heterozygous FLAD1A418V/R542* mice (n = 8, 4 months, male). No statistically significant difference was observed between the groups (χ2 = 1.103, df = 2, P = 0.576). (D) Estrous cycle length, days (totally 14 days measured, daily). Green color corresponds to the WT (n = 7, 4 months, female), gray color to the homozygous FLAD1A418V/A418V mutation (n = 7, 4 months, female), and red to the compound heterozygous FLAD1A418V/R542* mice (n = 7, 4 months, female). P = 0.0322, Kruskal-Wallis statistic = 6.516 by Kruskal-Wallis test with the Benjamini-Krieger-Yekutieli correction for multiple comparisons.

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