Disorders of flavin adenine dinucleotide metabolism: MADD and related deficiencies

Int J Biochem Cell Biol. 2021 Mar:132:105899. doi: 10.1016/j.biocel.2020.105899. Epub 2020 Dec 3.


Multiple acyl-coenzyme A dehydrogenase deficiency (MADD), or glutaric aciduria type II (GAII), is a group of clinically heterogeneous disorders caused by mutations in electron transfer flavoprotein (ETF) and ETF-ubiquinone oxidoreductase (ETFQO) - the two enzymes responsible for the re-oxidation of enzyme-bound flavin adenine dinucleotide (FADH2) via electron transfer to the respiratory chain at the level of coenzyme Q10. Over the past decade, an increasing body of evidence has further coupled mutations in FAD metabolism (including intercellular riboflavin transport, FAD biosynthesis and FAD transport) to MADD-like phenotypes. In this review we provide a detailed description of the overarching and specific metabolic pathways involved in MADD. We examine the eight associated genes (ETFA, ETFB, ETFDH, FLAD1, SLC25A32 and SLC52A1-3) and clinical phenotypes, and report ∼436 causative mutations following a systematic literature review. Finally, we focus attention on the value and shortcomings of current diagnostic approaches, as well as current and future therapeutic options for MADD and its phenotypic disorders.

Keywords: ETF; ETFDH; FAD; Glutaric aciduria type II; Multiple acyl-CoA dehydrogenase deficiency; Riboflavin homeostasis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Flavin-Adenine Dinucleotide / metabolism*
  • Humans
  • Multiple Acyl Coenzyme A Dehydrogenase Deficiency / genetics
  • Multiple Acyl Coenzyme A Dehydrogenase Deficiency / metabolism*
  • Mutation
  • Phenotype


  • Flavin-Adenine Dinucleotide