Long-Chain 3-Hydroxyl-acyl-CoA Dehydrogenase (LCHAD) Deficiency​, Trifunctional Protein (TFP) Deficiency

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HADHA

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Introduction

The HADHA gene, hydroxyacyl-CoA dehydrogenase trifunctional multienzyme complex subunit alpha, is located on chromosome 2p23.3 and has 20 exons spanning ~52kb (1, 2). It encodes the 764 amino acid alpha subunit of the mitochondrial trifunctional protein (TFP), which catalyzes the last three steps of mitochondrial beta-oxidation of long-chain fatty acids (2-4).​

The mitochondrial membrane-bound heterocomplex is composed of four alpha and four beta subunits, with the alpha subunit catalyzing the 3-hydroxyacyl-CoA dehydrogenase and enoyl-CoA hydratase activities (1). Among the enzymes involved in the beta-oxidation pathway, the trifunctional enzyme exhibits specificity for long-chain fatty acids (6).

In addition, the alpha subunit of TFP participates in cardiolipin remodeling, and TFP physically interacts with mitochondrial respiratory chain complex 1 (7-9). Resemblance of TFP deficiency to mitochondrial respiratory chain disorders (e.g., elevated lactic acid, cardiomyopathy, polyneuropathy, retinopathy) may be explained by these functional and physical interactions of TFP with the respiratory chain (7).

Independently of the subunit beta, the trifunctional enzyme subunit alpha/HADHA also has a monolysocardiolipin acyltransferase activity. It acylates monolysocardiolipin into cardiolipin, a major mitochondrial membrane phospholipid which plays a key role in apoptosis and supports mitochondrial respiratory chain complexes in the generation of ATP (6-7).

Variants in this gene result in trifunctional protein deficiency or LCHAD deficiency (1-5). In LCHAD deficiency, there is an isolated deficiency of the dehydrogenase activity with normal hydratase activity and moderately decreased thiolase activity (59% of control) (10).​

More than 111 disease-causing variants in the HADHA gene have been identified and are represented in this database (11). The variants occur across the entire length of the gene and include frameshift, splice site, copy-number, nonsense and missense variants (11).

Variant List

To see more information, click on the Variant in the table. Hover on the Variant in the table to see its location on the gene. For more information on table headers, HGVS nomenclature, and ACMG classification please use the following links here.​​

Gene Structure
Variant IDVariantAmino Acid ChangeGene SymbolVariant TypeEffect TypeDisplay ACMG CallDisease SubtypeTimes Observed RangePhenotypePMIDLocation
HADHA_0001c.1480-?_*615+?dupGain (Exons 15-20)HADHAUncertain SignificanceLCHAD/TFP<3
HADHA_0002c.?p.Val412LeuHADHAUncertain SignificanceLCHAD/TFP<314630990
HADHA_0003c.2281T>Gp.Phe761ValHADHASNVMissenseLikely PathogenicLCHAD/TFP6-10Absent deep tendon r....33638202, 35433174Exon 20
HADHA_0004c.2225_2228dupp.Phe744Thrfs*10HADHAInsertionFrameshiftPathogenicLCHAD/TFP<3Liver dysfunction12237653, 21549624Exon 20
HADHA_0005c.2200A>Tp.Lys734*HADHASNVNonsensePathogenicLCHAD/TFP<3Exon 20
HADHA_0006c.2198T>Cp.Leu733ProHADHASNVMissenseUncertain SignificanceLCHAD/TFP<38739956Exon 20
HADHA_0007c.2146+6_2146+18delIntronicHADHADeletionSplice regionUncertain SignificanceLCHAD/TFP<321549624Intron 19
HADHA_0008c.2132dupp.Pro712Alafs*26HADHADuplicationFrameshiftPathogenicLCHAD/TFP<39266371Exon 19
HADHA_0009c.2131C>Ap.Pro711ThrHADHASNVMissenseUncertain SignificanceLCHAD/TFP30+Exon 19
HADHA_0010c.2114T>Ap.Val705AspHADHASNVMissenseLikely PathogenicLCHAD/TFP<326109258Exon 19
HADHA_0011c.2107G>Ap.Gly703ArgHADHASNVMissensePathogenicLCHAD/TFP3-5Developmental delay,....21103935, 26109258, 34878152Exon 19
HADHA_0012c.2102A>Gp.Asp701GlyHADHASNVMissenseLikely PathogenicLCHAD/TFP<314630990, 22030098, 24064340, 26907176, 30912279Exon 19
HADHA_0013c.2099delp.Gly700Glufs*30HADHADeletionFrameshiftPathogenicLCHAD/TFP3-5Hypoglycemia, Rhabdomyolysis32978841, 35383965Exon 19
HADHA_0014c.2077A>Gp.Ile693ValHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Exon 19
HADHA_0015c.2063G>Ap.Cys688TyrHADHASNVMissenseUncertain SignificanceLCHAD/TFP<321549624Exon 19
HADHA_0016c.2059delp.Met687Cysfs*43HADHADeletionFrameshiftPathogenicLCHAD/TFP<3Decreased body weigh....27652820, 30682426Exon 19
HADHA_0017c.2027G>Tp.Arg676LeuHADHASNVMissenseUncertain SignificanceLCHAD/TFP3-5Exercise intolerance, Muscle weakness, Myalgia24305961, 28283530Exon 19
HADHA_0018c.2027G>Ap.Arg676HisHADHASNVMissenseLikely PathogenicLCHAD/TFP6-10Abnormality of the l....10352164, 11427448, 15902556, 21549624, 26109258Exon 19
HADHA_0019c.2026C>Tp.Arg676CysHADHASNVMissenseLikely PathogenicLCHAD/TFP<3Cardiac-other10352164, 14630990Exon 19
HADHA_0020c.2020dupp.Gln674Profs*11HADHADuplicationFrameshiftPathogenicLCHAD/TFP30+Exon 19
HADHA_0021c.2005T>Gp.Ser669AlaHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Exon 19
HADHA_0022c.2000+5G>CIntronicHADHASNVSplice regionUncertain SignificanceLCHAD/TFP<3Intron 18
HADHA_0023c.2000+1G>AIntronicHADHASNVSplice donorPathogenicLCHAD/TFP<314630990Intron 18
HADHA_0024c.1981_1999delp.Leu661Serfs*12HADHADeletionFrameshiftPathogenicLCHAD/TFP<321549624Exon 18
HADHA_0025c.1990_1991delp.Lys664Valfs*2HADHADeletionFrameshiftPathogenicLCHAD/TFP<321549624Exon 18
HADHA_0026c.1967delp.Leu656*HADHADeletionFrameshiftPathogenicLCHAD/TFP3-5Abnormal liver morphology, Liver dysfunction10352164, 18045290, 21549624Exon 18
HADHA_0027c.1915_1918delp.Tyr639Argfs*4HADHADeletionFrameshiftPathogenicLCHAD/TFP<335281663Exon 18
HADHA_0028c.1893delp.Lys631Asnfs*13HADHADeletionFrameshiftPathogenicLCHAD/TFP<3Exon 18
HADHA_0029c.1828C>Gp.Arg610GlyHADHASNVMissenseLikely PathogenicLCHAD/TFP6-10Absent deep tendon r....21103935, 33638202, 35433174Exon 17
HADHA_0030c.1795G>Ap.Val599MetHADHASNVMissenseUncertain SignificanceLCHAD/TFP<314630990Exon 17
HADHA_0031c.1793_1794delp.His598Argfs*33HADHADeletionFrameshiftPathogenicLCHAD/TFP3-5Abnormality of metab....11855930, 12442268, 29519241Exon 17
HADHA_0032c.1712T>Cp.Leu571ProHADHASNVMissensePathogenicLCHAD/TFP3-5Anxiety, Dilated car....24305961, 26109258, 29124685, 32463482Exon 17
HADHA_0033c.1690-2A>GIntronicHADHASNVSplice acceptorPathogenicLCHAD/TFP<3Cardiomyopathy, Decr....23430857Intron 16
HADHA_0034c.1689+2T>GIntronicHADHASNVSplice donorPathogenicLCHAD/TFP6-10Abnormality of metab....17143551, 27014569, 28515471, 29519241Intron 16
HADHA_0035c.1678C>Tp.Arg560*HADHASNVNonsensePathogenicLCHAD/TFP11-20Abnormal liver morph....10352164, 11427448, 14630990, 16040264, 16876451, 16996288, 20589231, 21549624, 22030098, 24064340, 27491397, 30912279, 32463482, 33123633, 8865274Exon 16
HADHA_0036c.1663_1665delp.Met555delHADHADeletionDeletionUncertain SignificanceLCHAD/TFP<321549624Exon 16
HADHA_0037c.1664T>Gp.Met555ArgHADHASNVMissenseUncertain SignificanceLCHAD/TFP<334732400Exon 16
HADHA_0038c.1646G>Cp.Arg549ThrHADHASNVMissenseUncertain SignificanceLCHAD/TFP<334578803Exon 16
HADHA_0039c.1620+2_1620+6delIntronicHADHADeletionSplice donorPathogenicLCHAD/TFP<3Cardiac-other, Gait,....10352164, 16040264, 32999401Intron 15
HADHA_0040c.1561_1562delp.Thr521Glnfs*19HADHADeletionFrameshiftPathogenicLCHAD/TFP<330682426Exon 15
HADHA_0041c.1533dupp.Ile512Tyrfs*29HADHADuplicationFrameshiftPathogenicLCHAD/TFP<321549624Exon 15
HADHA_0042c.1528G>Cp.Glu510GlnHADHASNVMissensePathogenicLCHAD/TFP30+Abnormal liver morph....10352164, 10384386, 10518281, 10789927, 11045847, 11241049, 11427446, 11427448, 11719334, 11773547, 11855930, 12162610, 12208138, 12237653, 12413376, 12660866, 12745572, 12809642, 12872842, 14605499, 14630990, 15902556, 16040264, 16183823, 16297647, 16876451, 16996288, 17160563, 17431731, 18045290, 18162058, 18240871, 18408953, 18662835, 19399638, 19852779, 20363656, 20583174, 20589231, 20659813, 21103935, 21549624, 22030098, 22473002, 22494076, 22859334, 23430524, 23430857, 23798014, 23868323, 24064340, 24305961, 25141826, 26109258, 26545880, 26653362, 26676313, 26907176, 27117294, 27334895, 27491397, 27590926, 27652820, 27769081, 28245050, 28392417, 28871440, 29268767, 30029694, 30364125, 30682426, 30912279, 30990523, 31025818, 32253025, 32463482, 32581083, 32706845, 32793418, 32928639, 32978841, 32999401, 33123633, 33204595, 33638202, 34578803, 34732400, 35281663, 35383965, 35677112, 35782617, 35822088, 36109795, 7811722, 7846063, 8294091, 8736409, 8739956, 8809345, 8865274, 8871579, 8938697, 9003853, 9266371, 9403664, 9539533, 9593380Exon 15
HADHA_0043c.1493A>Gp.His498ArgHADHASNVMissenseLikely PathogenicLCHAD/TFP<3Decreased body weigh....27117294, 33638202Exon 15
HADHA_0044c.1480-139C>GIntronicHADHASNVIntronicUncertain SignificanceLCHAD/TFP<3Abnormality of metab....30747351Intron 14
HADHA_0045c.1393_1479delp.Pro467_Ile495delHADHADeletionDeletionLikely PathogenicLCHAD/TFP<326109258Exon 14
HADHA_0046c.1433C>Tp.Ala478ValHADHASNVMissenseUncertain SignificanceLCHAD/TFP<321549624Exon 14
HADHA_0047c.1432delp.Ala478Leufs*17HADHADeletionFrameshiftPathogenicLCHAD/TFP<335383965Exon 14
HADHA_0048c.1432G>Cp.Ala478ProHADHASNVMissenseUncertain SignificanceLCHAD/TFP<321549624Exon 14
HADHA_0049c.1418C>Ap.Ala473AspHADHASNVMissenseUncertain SignificanceLCHAD/TFP<332999401Exon 14
HADHA_0050c.1336_1393delp.Glu446*HADHACopy Number LossPathogenicLCHAD/TFP<3Exercise intolerance, Muscle weakness, Myalgia24305961Exon 13-14, Intron 13
HADHA_0051c.1392+1G>AIntronicHADHASNVSplice donorPathogenicLCHAD/TFP3-5Abnormality of metab....27014569, 28515471, 35758105Intron 13
HADHA_0052c.1381delp.Glu461Lysfs*2HADHADeletionFrameshiftPathogenicLCHAD/TFP<321549624Exon 13
HADHA_0053c.1336G>Ap.Glu446LysHADHASNVMissenseLikely PathogenicLCHAD/TFP<326109258Exon 13
HADHA_0054c.1220+2T>CIntronicHADHASNVSplice donorPathogenicLCHAD/TFP<312237653, 12413376Intron 12
HADHA_0055c.1220+1G>CIntronicHADHASNVSplice donorPathogenicLCHAD/TFP<3Liver dysfunction21103935Intron 12
HADHA_0056c.1196G>Ap.Arg399GlnHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Exon 12
HADHA_0057c.1195C>Tp.Arg399*HADHASNVNonsensePathogenicLCHAD/TFP<3Peripheral neuropathy21549624, 33638202Exon 12
HADHA_0058c.1132C>Tp.Gln378*HADHASNVNonsensePathogenicLCHAD/TFP3-5Liver dysfunction10352164, 11241049, 16040264, 16297647, 22030098, 24064340, 30912279, 7846063, 8809345Exon 12
HADHA_0059c.1108G>Ap.Gly370ArgHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Congestion, Edema, M....35782617Exon 12
HADHA_0060c.1086-3_1092delIntronicHADHADeletionSplice acceptorPathogenicLCHAD/TFP<311241049, 21549624Exon 12, Intron 11
HADHA_0061c.1072C>Ap.Gln358LysHADHASNVMissenseBenignLCHAD/TFP3-5Gastrointestinal-other15533621, 22494076, 22746996, 26109258, 35383965Exon 11
HADHA_0062c.1058_1059delinsTp.Lys353Ilefs*19HADHADelinsFrameshiftPathogenicLCHAD/TFP<3Areflexia, Blindness....21549624, 32253025Exon 11
HADHA_0063c.1029C>Ap.Tyr343*HADHASNVNonsensePathogenicLCHAD/TFP<3Exon 11
HADHA_0064c.1025T>Cp.Leu342ProHADHASNVMissenseLikely PathogenicLCHAD/TFP<3Decreased body weigh....27117294, 9266371Exon 11
HADHA_0065c.982G>Ap.Gly328ArgHADHASNVMissenseLikely PathogenicLCHAD/TFP<3Gastrointestinal-other26109258, 35383965Exon 11
HADHA_0066c.975+6C>TIntronicHADHASNVSplice regionUncertain SignificanceLCHAD/TFP30+Intron 10
HADHA_0067c.975G>ASilentHADHASNVSilentUncertain SignificanceLCHAD/TFP<3Exon 10
HADHA_0068c.955G>Ap.Gly319SerHADHASNVMissenseLikely PathogenicLCHAD/TFP<3Absent deep tendon r....30682426, 33638202Exon 10
HADHA_0069c.919-2A>GIntronicHADHASNVSplice acceptorPathogenicLCHAD/TFP<3Malaise/fatigue, Mya....15902556Intron 9
HADHA_0070c.918+6T>GIntronicHADHASNVSplice regionUncertain SignificanceLCHAD/TFP<321549624Intron 9
HADHA_0071c.918+1G>AIntronicHADHASNVSplice donorPathogenicLCHAD/TFP3-521549624, 26109258Intron 9
HADHA_0073c.914T>Cp.Ile305ThrHADHASNVMissenseLikely PathogenicLCHAD/TFP<3Exon 9
HADHA_0072c.914T>Ap.Ile305AsnHADHASNVMissensePathogenicLCHAD/TFP11-20Abnormal liver morph....10352164, 2019931, 21549624, 26109258, 29268767, 32253025, 34578803, 9739053Exon 9
HADHA_0074c.896C>Ap.Pro299HisHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Exon 9
HADHA_0075c.871C>Tp.Arg291*HADHASNVNonsensePathogenicLCHAD/TFP6-10Abnormal liver morph....10352164, 18485779, 2019931, 23798014, 9739053Exon 9
HADHA_0076c.859delp.Glu287Lysfs*16HADHADeletionFrameshiftPathogenicLCHAD/TFP<330682426Exon 9
HADHA_0077c.845T>Ap.Val282AspHADHASNVMissenseLikely PathogenicLCHAD/TFP3-5Dehydration, Dysarth....10352164, 14630990, 7748366, 9739053Exon 9
HADHA_0078c.761_764delp.Lys254Argfs*14HADHADeletionFrameshiftPathogenicLCHAD/TFP<321103935Exon 8
HADHA_0079c.731C>Tp.Ala244ValHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Malaise/fatigue, Mya....15902556Exon 8
HADHA_0080c.703C>Tp.Arg235TrpHADHASNVMissensePathogenicLCHAD/TFP11-20Absent deep tendon r....19433283, 21549624, 28871440, 32928639, 33638202, 34578803, 34878152Exon 8
HADHA_0081c.677-3T>CIntronicHADHASNVUncertain SignificanceLCHAD/TFP<3Intron 7
HADHA_0082c.676+2T>CIntronicHADHASNVSplice donorPathogenicLCHAD/TFP<321549624Intron 7
HADHA_0083c.602T>Cp.Met201ThrHADHASNVMissenseUncertain SignificanceLCHAD/TFP<333638202Exon 7
HADHA_0084c.574-2A>GIntronicHADHASNVSplice acceptorPathogenicLCHAD/TFP6-10Dilated cardiomyopathy10352164, 11241049, 11427448, 14630990Intron 6
HADHA_0085c.573+9_573+10insTIntronicHADHAInsertionIntronicUncertain SignificanceLCHAD/TFP<322746996Intron 6
HADHA_0086c.556C>Gp.Gln186GluHADHASNVMissenseLikely PathogenicLCHAD/TFP3-5Developmental delay,....24305961, 35758105Exon 6
HADHA_0087c.539C>Tp.Pro180LeuHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Distal muscle weakness, Peripheral neuropathy32657593Exon 6
HADHA_0088c.509G>Ap.Gly170AspHADHASNVMissenseLikely PathogenicLCHAD/TFP<311427448Exon 6
HADHA_0089c.479_482delinsAATAp.Ile160_Gln763delinsLysHADHADelinsNonsenseLikely PathogenicLCHAD/TFP3-5Cardiac arrest, Hypo....10352164, 16876451, 16996288, 20589231, 27491397, 28871440, 32928639Exon 6
HADHA_0091c.453+1G>TIntronicHADHASNVSplice donorPathogenicLCHAD/TFP<3Exercise intolerance....30682426Intron 5
HADHA_0090c.453+1G>AIntronicHADHASNVSplice donorPathogenicLCHAD/TFP<3Dilated cardiomyopat....35281663Intron 5
HADHA_0092c.446G>Tp.Gly149ValHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Anxiety, Dilated car....29124685Exon 5
HADHA_0093c.442G>Ap.Gly148ArgHADHASNVMissenseUncertain SignificanceLCHAD/TFP<321549624Exon 5
HADHA_0094c.389T>Cp.Leu130ProHADHASNVMissenseLikely PathogenicLCHAD/TFP3-5Cardiomyopathy12442268, 14630990Exon 5
HADHA_0095c.361C>Tp.Gln121*HADHASNVNonsensePathogenicLCHAD/TFP<3Cardiac-other28515471Exon 5
HADHA_0096c.341A>Gp.Gln114ArgHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Exon 5
HADHA_0097c.325G>Ap.Ala109ThrHADHASNVMissenseUncertain SignificanceLCHAD/TFP<3Exon 5
HADHA_0098c.315-1G>AIntronicHADHASNVSplice acceptorPathogenicLCHAD/TFP<319852779Intron 4
HADHA_0099c.315-2A>TIntronicHADHASNVSplice acceptorPathogenicLCHAD/TFP<3Cardiomyopathy, Liver dysfunction10352164, 14630990Intron 4
HADHA_0100c.278C>Gp.Ser93*HADHASNVNonsensePathogenicLCHAD/TFP<334578803Exon 4
HADHA_0101c.274_278delp.Ser92Lysfs*10HADHADeletionFrameshiftPathogenicLCHAD/TFP21-30Abnormality of metab....10352164, 11241049, 12237653, 12413376, 12809642, 16040264, 16876451, 16996288, 20589231, 21549624, 24064340, 27491397, 28392417, 30912279, 33204595, 33638202, 34578803Exon 4
HADHA_0102c.266T>Gp.Val89GlyHADHASNVMissenseUncertain SignificanceLCHAD/TFP<321103935Exon 4
HADHA_0103c.180_180+5delinsATIntronicHADHADelinsSplice donorPathogenicLCHAD/TFP3-5Abnormal liver morph....10400133, 30682426, 33638202Exon 3, Intron 3
HADHA_0104c.180+3A>GIntronicHADHASNVSplice regionLikely PathogenicLCHAD/TFP11-20Abnormal liver morph....10352164, 10400133, 14630990, 22030098, 22746996, 23868323, 26109258, 27491397, 29268767, 30682426, 30912279, 33123633, 7738175, 8651282Intron 3
HADHA_0105c.180+1G>AIntronicHADHASNVSplice donorPathogenicLCHAD/TFP3-5Arrhythmia, Cardiac-....10352164, 14630990, 7738175, 8651282Intron 3
HADHA_0106c.162delp.Asn55Thrfs*7HADHADeletionFrameshiftPathogenicLCHAD/TFP<3Liver dysfunction12237653Exon 3
HADHA_0107c.157C>Tp.Arg53*HADHASNVNonsensePathogenicLCHAD/TFP<320659813Exon 3
HADHA_0108c.138dupp.Gly47Argfs*9HADHADuplicationFrameshiftPathogenicLCHAD/TFP<321549624Exon 3
HADHA_0109c.72delp.Tyr24*HADHADeletionFrameshiftPathogenicLCHAD/TFP<314630990Exon 2
HADHA_0110c.58delp.Arg20Alafs*17HADHADeletionFrameshiftPathogenicLCHAD/TFP<334578803Exon 1
HADHA_0111c.13C>Tp.Arg5TrpHADHASNVMissenseUncertain SignificanceLCHAD/TFP30+Exon 1
    Notes:
  • * Click the PMID number to go to the corresponding publication.
  • * All variants are referencing NM_000182.4 and NM_000182.5 and there is no change between these versions with respect to the coding sequence.
  • * Genomic coordinates are calculated based on variant data provided: in some cases coordinates are estimated in order to allow users to sort the variants linearly, by approximation.
    Definition of acronyms:
  • "*": Referenced a stop codon insertion when listed under amino acid change.
  • ACMG: American College of Medical Genetics and Genomics
  • CNV: Copy number variant which here describes a change 100 DNA nucleotides or larger.
  • SNV: Single DNA nucleotide variant
  • del: Deletion
  • dup: Duplication
  • fs: Frameshift
  • ins: Insertion

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