Novel ETF dehydrogenase mutations in a patient with mild glutaric aciduria type II and complex II-III deficiency in liver and muscle

J Inherit Metab Dis. 2010 Dec;33 Suppl 3(0 3):S481-7. doi: 10.1007/s10545-010-9246-8. Epub 2010 Nov 19.


We describe a 22-year-old male who developed severe hypoglycemia and lethargy during an acute illness at 4 months of age and subsequently grew and developed normally. At age 4 years he developed recurrent vomiting with mild hyperammonemia and dehydration requiring frequent hospitalizations. Glutaric aciduria Type II was suspected based upon biochemical findings and managed with cornstarch, carnitine and riboflavin supplements. He did not experience metabolic crises between ages 4-12 years. He experienced recurrent vomiting, mild hyperammonemia, and generalized weakness associated with acute illnesses and growth spurts. At age 18 years, he developed exercise intolerance and proximal muscle weakness leading to the identification of multiple acyl-CoA dehydrogenase and complex II/III deficiencies in both skeletal muscle and liver. Subsequent molecular characterization of the ETFDH gene revealed novel heterozygous mutations, p.G274X:c.820 G > T (exon 7) and p.P534L: c.1601 C > T (exon 12), the latter within the iron sulfur-cluster and predicted to affect ubiquinone reductase activity of ETFDH and the docking of ETF to ETFDH. Our case supports the concept of a structural interaction between ETFDH and other enzyme partners, and suggests that the conformational change upon ETF binding to ETFDH may play a key role in linking ETFDH to II/III super-complex formation.

Publication types

  • Case Reports

MeSH terms

  • Biomarkers / blood
  • Biomarkers / urine
  • DNA Mutational Analysis
  • Electron Transport Complex II / chemistry
  • Electron Transport Complex II / deficiency*
  • Electron Transport Complex II / genetics
  • Electron Transport Complex II / metabolism
  • Electron Transport Complex III / chemistry
  • Electron Transport Complex III / deficiency*
  • Electron Transport Complex III / genetics
  • Electron Transport Complex III / metabolism
  • Electron-Transferring Flavoproteins / chemistry
  • Electron-Transferring Flavoproteins / deficiency
  • Electron-Transferring Flavoproteins / genetics*
  • Exons
  • Genetic Predisposition to Disease
  • Heterozygote
  • Humans
  • Iron-Sulfur Proteins / chemistry
  • Iron-Sulfur Proteins / deficiency
  • Iron-Sulfur Proteins / genetics*
  • Liver / enzymology*
  • Male
  • Metabolism, Inborn Errors / diagnosis
  • Metabolism, Inborn Errors / enzymology
  • Metabolism, Inborn Errors / genetics*
  • Mitochondrial Diseases / diagnosis
  • Mitochondrial Diseases / enzymology
  • Mitochondrial Diseases / genetics*
  • Molecular Docking Simulation
  • Multiple Acyl Coenzyme A Dehydrogenase Deficiency / diagnosis
  • Multiple Acyl Coenzyme A Dehydrogenase Deficiency / enzymology
  • Multiple Acyl Coenzyme A Dehydrogenase Deficiency / genetics*
  • Muscle, Skeletal / enzymology*
  • Mutation*
  • Oxidoreductases Acting on CH-NH Group Donors / chemistry
  • Oxidoreductases Acting on CH-NH Group Donors / deficiency
  • Oxidoreductases Acting on CH-NH Group Donors / genetics*
  • Phenotype
  • Protein Binding
  • Protein Conformation
  • Young Adult


  • Biomarkers
  • Electron-Transferring Flavoproteins
  • Iron-Sulfur Proteins
  • Electron Transport Complex II
  • Oxidoreductases Acting on CH-NH Group Donors
  • electron-transferring-flavoprotein dehydrogenase
  • Electron Transport Complex III

Supplementary concepts

  • Glutaric aciduria 2
  • Mitochondrial Complex II Deficiency
  • Mitochondrial Complex III Deficiency