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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 5

FLAD1 variants lead to adrenal insufficiency and hypoglycemia.

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FLAD1 variants lead to adrenal insufficiency and hypoglycemia.
(A) Cort...
(A) Corticosterone concentration in blood plasma at steady state (pale colors, bars 1, 3, 5) and after ACTH (synacthen) stimulation (bright colors, bars 2, 4, 6); the data is presented in nM. Green corresponds to the WT (bars 1, 2, n = 12, 3 months, male), gray color corresponds to FLAD1A418V/A418V (bars 3, 4, n = 12, 3 months, male), while red color corresponds to the FLAD1A418V/R542* (bars 5, 6, n = 12, 3 months, male) mice. Statistical analysis was performed using a mixed-effects model (REML): significant effects of ACTH (synacthen) stimulation [F(1,15) = 83.50, P < 0.0001], Genotype [F(2,33) = 19.58, P < 0.0001], and ACTH×Genotype interaction [F(2,15) = 17.58, P = 0.0001]. Post hoc: 2-stage linear step-up procedure of Benjmini, Krieger, and Yekutieli (5 families, q = 0.05). (B) Aldosterone concentration in blood plasma at steady state (pale colors, bars 1, 3, 5) and after ACTH (synacthen) stimulation (bright colors, bars 2, 4, 6); the data is presented in nM. Green corresponds to the WT (bars 1, 2, n = 12, 3 months, male), gray corresponds to FLAD1A418V/A418V (bars 3, 4, n = 12, 3 months, male), while red corresponds to the FLAD1A418V/R542* (bars 5, 6, n = 12, 3 months, male) mice. Statistical analysis was performed using a mixed-effects model (REML): significant effects of ACTH (synacthen) stimulation [F(1,15) = 236.0, P < 0.0001], Genotype [F(2,33) = 48.21, P < 0.0001], and ACTH×Genotype interaction [F(2,15) = 73.90, P < 0.0001]. Post hoc: Benjamini, Krieger, and Yekutieli procedure (5 families, q = 0.05). (C) POMC mRNA quantitation by qPCR in the pituitary gland extracts, normalized by mRNA GAPDH. Log scale, arbitrary units. P = 0.034, Kruskal-Wallis statistic = 6.671 by Kruskal-Wallis test with the Benjamini-Krieger-Yekutieli correction for multiple comparisons. (D) H&E staining of adrenal gland samples from the WT (left panel, 4 months, male), FLAD1A418V/A418V (central panel, 4 months, male), and FLAD1A418V/R542* (right panel, 4 months, male) mice. Scale bar: 1mm. The cortex and medulla zones are marked. (E) Time course of the blood glucose concentration (mM) in mice following i.p. injection of 0.75 mU/g mouse weight after 4 hours of fasting. Time points 0, 15, 30, 45, 60, and 120 minutes are indicated below the graphs. Mice genotypes are shown above the graphs: WT (left part, n = 6, male, 3 months), FLAD1A418V/A418V (central part, n = 6, male, 3 months), and FLAD1A418V/R542* (right part, n = 6, male, 3 months) mice. Data are shown as mean ± 95% CI. Multiple comparisons were corrected using the 2-stage linear step-up procedure of Benjamini, Krieger, and Yekutieli (q = 0.05).

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