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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 3

Variant FLAD1R542*/R542* is lethal, FLAD1A418V/R542* has a severe phenotype, and FLAD1A418V/ A418V has a moderate one.

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Variant FLAD1R542*/R542* is lethal, FLAD1A418V/R542* has a severe phenot...
(A) Number of different FLAD1 genotypes at the blastocyst stage (left panel) and at birth (right panel) after mating of heterozygous FLAD1wt/R542* mice. Red corresponds to the homozygous mutants FLAD1R542*/R542*, blue corresponds to heterozygotes FLAD1wt/R542*, while green corresponds to the WT. (B) Uterus of the mice pregnant by embryos of genotype FLAD1R542*/R542*, FLAD1wt/R542*, and FLAD1wt. Embryos that were later genotyped as homozygous FLAD1R542*/R542* are marked by arrows. (C) The weight of male mice (6 months old) depends on genotype. The green corresponds to the WT (n = 11), the gray to FLAD1A418V/A418V (n = 12), and the red to FLAD1A418V/R542* (n = 9) mice. P = 0.0057, Kruskal-Wallis statistic = 10.33 by Kruskal-Wallis test with the Benjamini-Krieger-Yekutieli correction for multiple comparisons. (D) Grip strength of mice (male, 6 months) is dependent on the genotype. The color code is the same as for C (WT n = 12, FLAD1A418V/A418V n = 12, FLAD1A418V/R542* n = 8). P = 0.0147, Kruskal-Wallis statistic = 8.439 by Kruskal-Wallis test with the Benjamini-Krieger-Yekutieli correction for multiple comparisons. (E) Immunoblotting of the adrenal gland extracts with anti-FLAD1 (upper panels) or anti-GAPDH (lower panel, loading control) antibodies. The FLAD1 genotypes of the mice analyzed are indicated above the lanes as follows: WT (n = 3, 4 months, male), A418V (n = 3, 4 months, male), and A418V/R542* (n = 3, 4 months, male).

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