1. Introduction
Coenzyme Q, (CoQ, ubiquinone), is a lipidic molecule present in the three domains of life. From a biochemical point of view, it is formed by a highly hydrophobic polyisoprenoid tail with a variable number of isoprene units depending on the species (10 in humans, thus called CoQ
10) attached to a benzoquinone head with redox properties [
1]. CoQ is of paramount importance because of its universal role in the respiratory chain as an electron carrier. However, additional functions have been proposed [
1,
2,
3,
4]. In bacteria, it has been associated with other processes such as response to oxidative stress, formation of disulphide bonds and regulation of gene expression [
5,
6], whereas in eukaryotes a plethora of both mitochondrial and extramitochondrial functions have been identified.
For instance, CoQ accepts electrons from dehydrogenases enzymes located in the mitochondria, hence it is involved in multiple metabolic pathways, including biosynthesis of pyrimidines, sulphide detoxification and oxidation of fatty acids, proline and branched chain amino acids [
7]. It also regulates the mitochondrial permeability transition pore (mPTP) and uncoupling proteins (UCPs) [
2]. In all cell membranes also including mitochondria and plasma lipoproteins, it functions as an antioxidant, protecting against lipid peroxidation and reducing other antioxidants, such as vitamin E and ascorbate [
8,
9]. Additionally, CoQ promotes membrane stability and protects against ferroptosis [
10,
11].
CoQ biosynthesis is a highly conserved process that takes place in the inner mitochondrial membrane in eukaryotes and the cytosol in prokaryotes [
12]. Despite the early discovery of CoQ in the 50s [
13,
14], there is still a limited understanding of its biosynthesis process which includes several transmembrane and peripheral membrane proteins, hydrophobic intermediates, unidentified components and, at least in yeasts and mammals, the existence of a biosynthetic complex known as CoQ-synthome or complex Q. The proteins involved in CoQ biosynthesis are generally known as Ubi proteins in prokaryotes and COQ proteins in eukaryotes [
1,
3,
15]. Thirteen proteins encoded in the nucleus genome take part in this pathway in humans: COQ2, COQ3, COQ4, COQ5, COQ6, COQ7, COQ8A (ADCK3), COQ8B (ADCK4), COQ9, COQ10A, COQ10B, PDSS1 (DPS1) and PDSS2 (DLP1) [
4]. Mutations in some of these proteins (COQ2, COQ4, COQ6, COQ7, COQ8A, COQ8B, PDSS1 and PDSS2) have been related to primary CoQ deficiency in humans that encompasses rare autosomal recessive diseases characterized by a wide heterogeneity of symptoms, severity and age of onset, mainly affecting organs with high energy needs, such as brain, inner ear, muscles, heart and kidneys [
1,
3].
COQ2 protein or 4-hydroxybenzoate polyprenyltransferase (EC 2.5.1.39) is a transmembrane protein inserted in the inner mitochondrial membrane that participates in the second step in CoQ synthesis that is the condensation of the benzoquinone head and the polyisoprenoid tail [
1,
3,
16,
17]. Finally, the head undergoes a series of modifications: three hydroxylations catalyzed in humans by COQ6 (C5 hydroxylation), COQ7 (C6 hydroxylation) and COQ4 (C1 hydroxylation); three methylations performed by COQ3 (C5 and C6 O-methylations) and COQ5 (C2 methylation); and a decarboxylation recently associated with COQ4 (C1 decarboxylation). All these enzymes are peripheral membrane proteins located in the matrix side of the inner mitochondrial membrane [
1,
3,
18].
In humans, the CoQ-synthome is thought to be constituted by the enzymes involved in head modification (COQ3, COQ4, COQ5, COQ6 and COQ7), together with other COQ proteins (COQ8A, COQ8B and COQ9), lipids (CoQ intermediates and phospholipids), cofactors and metal ions. It seems that this organization permits that CoQ intermediates are channelled from one enzyme to the next, reducing the risk of leakage. However, it is still unknown how CoQ-synthome, constituted mainly by peripherally-associated proteins, comes into contact with the membrane-embedded intermediates, tightly located into the inner mitochondrial membrane [
3]. COQ2 could function as an anchor site for CoQ-synthome as proposed in yeast by Tran & Clarke (2007) [
19], making the substrates accessible to the head-modifying enzymes and, thus, solving potential transport problems associated with the hydrophobic nature of CoQ intermediates [
3]. Nevertheless, no experimental 3D structure of human COQ2 is available to date, which hinders progress in understanding the function of this protein. Structural data on COQ2 and determining the position and structural effect of pathological mutations would, therefore, provide a valuable insight into CoQ biosynthesis and pathogenicity of primary CoQ deficiency.
Taking advantage of the AlphaFold Protein Structure Database [
20], our aim was to use a human COQ2 structural model in order to predict potential binding sites for its substrates, para-hydroxybenzoate (PHB) and decaprenyl diphosphate (DPP), in a homology-based manner, searching for significant homologs in the Protein Data Bank (PDB) that contain ligands structurally similar to these molecules. Further, we determined the location of the human missense single nucleotide mutations leading to one amino acid substitutions affecting COQ2 activity and generating mitochondrial disease, and their effect on COQ2 structure.
4. Discussion
The tertiary structure prediction from aminoacidic sequence has always been a major challenge in bioinformatics, but recent advances in artificial intelligence have brought about a revolution in this field [
43]. AlphaFold2 is a machine learning method that not only predicts protein structures with high accuracy using both evolutionary and geometric information, but also associates a confidence value on a residue level. This is possible thanks to an innovative architecture based on artificial neural networks [
39,
40]. This technology was applied to all known sequences and the AlphaFold Protein Structure Database currently holds more than 200 million predicted structures [
20], including hCOQ2.
Our goal was to leverage the homologous relationship of hCOQ2 to other members of the UbiA family with ligand containing experimentally solved structures, including UbiA homologs from the thermophilic archaea
A. pernix (ApUbiA) and
A. fulgidus (AfUbiA), a DGGGPase enzyme from another archaeum,
M. jannaschii (MjDGGGPase), and a UBIAD1 homolog from the chinese hamster,
C. griseus (CgUBIAD1). Proteins from the UbiA family are integral prenyltransferases responsible for the synthesis of a wide range of molecules: CoQ and other quinones such as menaquinone and plastoquinone, vitamin E, chlorophyll, heme, secondary metabolites, components of the cell wall in mycobacteria and membrane lipids in archaea [
17,
44,
45].
hCOQ2 is predicted to contain nine transmembrane regions connected by loops, with the N-terminus facing the matrix side and the C-terminus the intermembrane space. This topology was previously reported by Desbats et al. (2016), except that a different isoform of the protein was used in their analysis [
46]. The hCOQ2 gene has four possible start codons and the isoform obtained from the transcript generated from the most downstream ATG (called ATG4), used in the present study, is the most common one, with 371 amino acids [
1,
46]. Moreover, the AlphaFold model for hCOQ2 shows with a high confidence that it is an all-helical protein organized in a channel-like structure with a central cavity, which is consistent with the PDB structures of the homologous proteins ApUbiA, AfUbiA, MjDGGGPase and CgUBIAD1: 4OD5_A, 4TQ3_B, 6M31_A and 8DJM_B, respectively [
17,
38,
41,
42]. When the AlphaFold model is superposed to these structures, the RMSD values are generally globally good, despite the low similarity in their sequences. On the contrary, the highest RMSD value by far is obtained, as expected, with 7Q21_f, structure of the cytochrome c oxidase subunit from
C. glutamicum, because it is the only selected homolog that does not belong to the UbiA family.
It is noteworthy that the superposition of UbiA homologs from archaea to hCOQ2 provides lower RMSD values than the homolog from the only mammal, the chinese hamster. In this case the technique used for structure determination must be taken into consideration. The structure of the archaeal proteins was determined by X-ray crystallography, which usually yields a higher resolution than electron microscopy, used for 8DJM_B. The exception is 4OD5_A, solved by X-ray diffraction, but with the worst resolution among all the selected structures. This could explain why 4TQ3_B (AfUbiA) provides the lowest RMSD value instead of 4OD5_A (ApUbiA), even when the second one is closer, in sequence, to hCOQ2 [
44]. It is also interesting that, according to previous phylogenetic and clustering studies, the UbiA/COQ2 cluster is more distant to MenA/UBIAD1 than to AfUbiA or MjDGGGPase [
17,
44], suggesting an earlier divergence of UbiA/COQ2 and MenA/UBIAD1.
Another important observation is that the HHpred output includes 4OD4_A, the apo-state structure of ApUbiA, but not 4OD5_A, the same structure but bound to ligands, because it only takes into consideration the most similar structure for a given protein, the representative, to avoid redundancy. In future approaches, the relationship between the structure and the nature of the ligands would help to discover the binding motives of other representative of the CoQ-synthome. Another problem is that a small number of significant homologs with solved structures was identified and, therefore, the information obtained from them is limited, which is not surprising given that transmembrane structure determination is a challenging matter [
47].
The members of the UbiA family catalyse the transfer of hydrophobic chains derived from isoprene or phytol to other compounds that act as acceptors, generally aromatic molecules, providing hydrophobicity [
48]. hCOQ2 is responsible for the addition of an isoprenoid chain (DPP in humans) to PHB, which is the precursor of CoQ’s redox-active head. The search for similar ligands bound to the selected structures yielded nine molecules with a Tanimoto coefficient of at least 0.3 when compared to 5TR, a molecule resembling the substrate DPP. The most similar ligands are GPP, precursor of DPP that can be used in vitro by EcUbiA [
38,
49], and GST, a non-metabolizable analogue of GPP [
38], followed by other molecules with long linear chains and an artificial derivative of cholesterol, among others.
When the structures 4TQ3_B (AfUbiA) and 4OD5_A (ApUbiA), containing GPP and GST, respectively, are superposed to hCOQ2, these ligands are found inside the central cavity, with the PPi group positioned towards the matrix side and two Mg2+ ions nearby, in the proximity of the motifs located on the matrix loops and two residues mutated in primary CoQ deficiency patients (Arg147 and Ala252). It has been proposed that the motifs found in the matrix loops play an important role in substrate binding and/or activity, probably involving the coordination of the Mg
2+ ions that bridge the CoQ tail precursor with the Asp residues in the motifs and are necessary for the reaction with PHB [
17,
38,
41,
42]. We speculate that these residues are essential for the stability of the interaction with the isoprenoid tail explaining why these mutations are incompatible with the life [
50].
On the contrary, mutations affecting residues Arg147 and Ala252 [
46], located on the matrix side of hCOQ2, are found in CoQ-deficient patients [
1]. The equivalent residue of Arg147 in ApUbiA is predicted to be involved in recognition of the PPi group in the polyisoprenoid chain and mutating its counterpart in EcUbiA causes a drastic reduction in the enzymatic activity. Meanwhile, Ala252 is next to residue Tyr251, whose counterpart in ApUbiA is thought to be close to the C1 atom of the isoprenoid chain [
38]. Furthermore, pathogenic variants p.Arg147His and p.Ala252Val were previously proposed to disrupt the interaction with the PPi group and one of the Mg
2+ ions, respectively [
44]. p.Arg147His was found in heterozygosis together with another mutation, p.Asn178Ser, in a 2-year-old boy who suffered steroid-resistant nephrotic syndrome (SRNS) [
51], while p.Ala252Val was present in twins with a wide range of symptoms that died a few months after their births [
52].
6M31_B provides information related to ligands around the lateral portal defined by transmembrane regions S1 and S9. This opening may be responsible for product release into the inner mitochondrial membrane in eukaryotes or the plasma membrane in prokaryotes [
17,
38,
41]. If hCOQ2 really acts as an anchor site for the CoQ-synthome in humans, it is possible that the product of this protein is not released immediately to the inner mitochondrial membrane and instead stays inside the cavity, being the redox head further modified by the other COQ polypeptides until the last product, CoQ
10, is finally released through the lateral portal. The lateral portal has been observed in ApUbiA, AfUbiA and MjDGGGPase, in accordance with the idea proposed by Chen et al. (2022) that binding of the substrate induces the opening of the portal [
41].
Conversely, none of the ligands bound to the selected structures were similar to the aromatic substrate, PHB, which could indicate that proteins of the UbiA family display a higher specificity for linear substrates. It is also worth noting that some alternative aromatic substrates have been suggested in different organisms, including para-aminobenzoic acid in yeast and phenolic compounds such as kaempferol, resveratrol and p-coumaric acid in mammals [
12]. Taken into consideration that different substrates of the aromatic head can successfully bind to isoprene tail, the specificity for the aromatic substrate seems to be less strong than for the isoprene tail. This allows for different head substrates to have been considered in the treatment of CoQ
10 deficiency due to dysfunction of head-modifier CoQ-synthome members [
1,
53]. Further, this interaction must occur in the matrix side of hCOQ2 permitting the interaction of this part of the molecule with the head-modifying enzymes in the CoQ-synthome. This is consistent with the hypothesis that hCOQ2 functions as an anchor site for the CoQ-synthome and with docking studies published by Herebian et al. (2017) [
50], but does not agree with the putative binding site of this ligand in 4OD5_A (ApUbiA) [
38], a residue located in a central position inside the cavity that is equivalent to one of the amino acids mutated in primary CoQ deficiency patients, Arg123 [
1]. Mutating the counterpart of this residue in EcUbiA has a negative impact on both the enzymatic activity and the interaction with PHB. However, our results reveal that the lateral chain of Arg123 clashes with PHB when 4OD5_A is superposed to the AlphaFold model of hCOQ2, which is in line with the ideas of Huang et al. (2014), who concluded that the structure of AfUbiA does not support this binding site for the aromatic substrate because it lies too close to the polyprenyl chain [
42]. There are also ligands in the proximity of Arg123 in structure 6M31_B. This residue, therefore, could interact instead with the linear substrate, which may explain its importance, whereas the pHB binding site could lie elsewhere. For instance, Herebian et al. (2017) have proposed alternative binding sites for this ligand in different positions of the central cavity [
50]. Alternatively, it could simply mean that there are differences between members of the UbiA family concerning the binding site of the aromatic substrate and explaining the different aromatic substrates able to be used by hCOQ2.
Interestingly, the different mutations studied did not produce great changes in the structure of the protein. Some of them produced small alterations in the loop between S6 and S7 and the N-terminal region, both on the matrix side. Taken into consideration their pathogenic effect due by the disruption of the activity of hCOQ2, these small modifications can be associated with a loss of interaction with the rest of the members of the CoQ-synthome. Further experiments in this sense must be performed since, to date, the whole structure of the CoQ-synthome has been elusive.
Figure 1.
Ligands with a Tanimoto coefficient bigger than 0.3 when compared to 5TR. The chemical structure, the component identifier in the PDB Component Dictionary and the value of the Tanimoto coefficient for each ligand are displayed.
Figure 1.
Ligands with a Tanimoto coefficient bigger than 0.3 when compared to 5TR. The chemical structure, the component identifier in the PDB Component Dictionary and the value of the Tanimoto coefficient for each ligand are displayed.
Figure 2.
Multiple sequence alignment of human COQ2 (hCOQ2) and some homologs from different organisms, including UbiA from E. coli (EcUbiA), UbiA homolog from A. pernix (ApUbiA), UbiA homolog from A. fulgidus (AfUbiA), DGGGPase from M. jannaschii (MjDGGGPase), UBIAD1 homolog from C. griseus (CgUBIAD1), COQ2 from Pan troglodytes (PtCOQ2), COQ2 from Mus musculus (MmCOQ2), COQ2 from Danio rerio (DrCOQ2), COQ2 from Drosophila melanogaster (DmCOQ2), COQ2 from Caenorhabditis elegans (CeCOQ2), PPT1 from Arabidopsis thaliana (AtPPT1) and COQ2 from Saccharomyces cerevisiae (ScCOQ2). The degree of sequence conservation is indicated in shades of blue: dark (> 80%), medium (> 60%) and light (> 40%). Conserved motifs are represented in pink boxes. Residues located in the proximity of the PPi group and the C1 atom of the tail precursor are denoted by green and purple dots, respectively. The residue associated with PHB binding is depicted with an orange dot.
Figure 2.
Multiple sequence alignment of human COQ2 (hCOQ2) and some homologs from different organisms, including UbiA from E. coli (EcUbiA), UbiA homolog from A. pernix (ApUbiA), UbiA homolog from A. fulgidus (AfUbiA), DGGGPase from M. jannaschii (MjDGGGPase), UBIAD1 homolog from C. griseus (CgUBIAD1), COQ2 from Pan troglodytes (PtCOQ2), COQ2 from Mus musculus (MmCOQ2), COQ2 from Danio rerio (DrCOQ2), COQ2 from Drosophila melanogaster (DmCOQ2), COQ2 from Caenorhabditis elegans (CeCOQ2), PPT1 from Arabidopsis thaliana (AtPPT1) and COQ2 from Saccharomyces cerevisiae (ScCOQ2). The degree of sequence conservation is indicated in shades of blue: dark (> 80%), medium (> 60%) and light (> 40%). Conserved motifs are represented in pink boxes. Residues located in the proximity of the PPi group and the C1 atom of the tail precursor are denoted by green and purple dots, respectively. The residue associated with PHB binding is depicted with an orange dot.
Figure 3.
Topology of COQ2. Transmembrane helices predicted by MEMSAT are represented by pink boxes.
Figure 3.
Topology of COQ2. Transmembrane helices predicted by MEMSAT are represented by pink boxes.
Figure 4.
AlphaFold prediction model for COQ2. The colours represent the per-residue confidence score for the prediction: dark blue (very high, pLDDT > 90), light blue (confident, 90 > pLDDT > 70), yellow (low, 70 > pLDDT > 50) and orange (very low, pLDDT < 50). Figure taken from the AlphaFold Protein Structure Database [
20].
Figure 4.
AlphaFold prediction model for COQ2. The colours represent the per-residue confidence score for the prediction: dark blue (very high, pLDDT > 90), light blue (confident, 90 > pLDDT > 70), yellow (low, 70 > pLDDT > 50) and orange (very low, pLDDT < 50). Figure taken from the AlphaFold Protein Structure Database [
20].
Figure 5.
Secondary structure and disordered regions prediction for COQ2. Helices predicted by PSIPRED are indicated in pink. Putative disordered regions according to DISOPRED are depicted by blue or green boxes.
Figure 5.
Secondary structure and disordered regions prediction for COQ2. Helices predicted by PSIPRED are indicated in pink. Putative disordered regions according to DISOPRED are depicted by blue or green boxes.
Figure 6.
COQ2 structural model (positions 60-354). Residues mutated in primary CoQ deficiency patients are represented as spheres and labelled in black. Conserved motifs are coloured in pink. Transmembrane helices S1 and S9, delimiting the putative lateral portal, are indicated in sky blue.
Figure 6.
COQ2 structural model (positions 60-354). Residues mutated in primary CoQ deficiency patients are represented as spheres and labelled in black. Conserved motifs are coloured in pink. Transmembrane helices S1 and S9, delimiting the putative lateral portal, are indicated in sky blue.
Figure 7.
Potentially interesting ligands modelled into the COQ2 structural model. The conserved motifs and the lateral portal are depicted in pink and sky blue, respectively, while residues associated with primary CoQ deficiency are shown as spheres. The mutated residues that lie close to a potentially interesting ligand are labelled in black. The superposed structures of the homologous proteins were removed for clarity. (a) GPP in cyan and two Mg2+ ions in green from 4TQ3_B. (b) GST and pHB in yellow and two Mg2+ ions in green from 4OD5_A. (c) MPG and LDA in blue and a Mg2+ ion in green from 6M31_B. (d) Y01 and AJP in green from 8DJM_B.
Figure 7.
Potentially interesting ligands modelled into the COQ2 structural model. The conserved motifs and the lateral portal are depicted in pink and sky blue, respectively, while residues associated with primary CoQ deficiency are shown as spheres. The mutated residues that lie close to a potentially interesting ligand are labelled in black. The superposed structures of the homologous proteins were removed for clarity. (a) GPP in cyan and two Mg2+ ions in green from 4TQ3_B. (b) GST and pHB in yellow and two Mg2+ ions in green from 4OD5_A. (c) MPG and LDA in blue and a Mg2+ ion in green from 6M31_B. (d) Y01 and AJP in green from 8DJM_B.
Figure 8.
Structural superposition of variants associated with primary CoQ deficiency to the COQ2 model. Each structure is represented in a different colour: p.Ser96Asn (yellow), p.Arg123His (pink), p.Met132Arg (grey), p.Arg147His (cyan), p.Asn178Ser (blue), p.Cys228Arg (red), p.Leu236Phe (green), p.Thr244Ile (teal), p.Tyr247Cys (magenta), p.Ala252Val (orange), p.Thr275Ala (wheat), p.Gly340Ala (light blue) and wild type (purple).
Figure 8.
Structural superposition of variants associated with primary CoQ deficiency to the COQ2 model. Each structure is represented in a different colour: p.Ser96Asn (yellow), p.Arg123His (pink), p.Met132Arg (grey), p.Arg147His (cyan), p.Asn178Ser (blue), p.Cys228Arg (red), p.Leu236Phe (green), p.Thr244Ile (teal), p.Tyr247Cys (magenta), p.Ala252Val (orange), p.Thr275Ala (wheat), p.Gly340Ala (light blue) and wild type (purple).
Table 1.
List of significant HHpred hits with ligands. The PDB identifier and a description of the protein are displayed. For each ligand, the name and identifier in the PDB Chemical Component Dictionary are included.
Table 1.
List of significant HHpred hits with ligands. The PDB identifier and a description of the protein are displayed. For each ligand, the name and identifier in the PDB Chemical Component Dictionary are included.
PDB ID |
Protein |
Ligands |
4OD5_A |
UbiA homolog from Aeropyrum pernix K1 |
p-hydroxybenzoic acid (PHB) |
Geranyl S-thiolodiphosphate (GST) |
Magnesium ion (MG) |
6M31_B |
Digeranylgeranylglyceryl phosphate synthase from Methanocaldococcus jannaschii DSM 2661 |
[(Z)-octadec-9-enyl] (2R)-2,3-bis(oxidanyl)propanoate (MPG) |
Lauryl dimethylamine-n-oxide (LDA) |
Phosphate ion (PO4) |
Magnesium ion (MG) |
8DJM_B |
UbiA prenyltransferase domain-containing protein from Cricetulus griseus
|
Cholesterol hemisuccinate (Y01) |
Digitonin (AJP) |
4TQ3_B |
UbiA homolog from Archaeoglobus fulgidus DSM 4304 |
Geranyl diphosphate (GPP) |
Magnesium ion (MG) |
7Q21_f |
Cytochrome c oxidase polypeptide 4 from Corynebacterium glutamicum ATCC 13032 |
Phosphatidic acid (7PH) |
Cardiolipin (CDL) |
Tridecane (TRD) |
Table 2.
List of pathogenic and tolerated mutations associated with primary CoQ deficiency and their location in the protein.
Table 2.
List of pathogenic and tolerated mutations associated with primary CoQ deficiency and their location in the protein.
Amino acid modification |
Location |
SIFT prediction |
Ser96Asn |
Transmembrane helix S1 |
Pathogenic |
Arg123His |
Transmembrane helix S2 |
Pathogenic |
Met132Arg |
Loop between S2-S3 (matrix side) |
Pathogenic |
Arg147His |
Loop between S2-S3 (matrix side) |
Pathogenic |
Asn178Ser |
Loop between S3-S4 (intermembrane space side) |
Tolerated |
Cys228Arg |
Loop between S5-S6 (intermembrane space side) |
Pathogenic |
Leu236Phe |
Transmembrane helix S6 |
Pathogenic |
Thr244Ile |
Transmembrane helix S6 |
Tolerated |
Tyr247Cys |
Loop between S6-S7 (matrix side) |
Pathogenic |
Ala252Val |
Loop between S6-S7 (matrix side) |
Pathogenic |
Thr275Ala |
Loop between S6-S7 (matrix side) |
Tolerated |
Gly340Ala |
Transmembrane helix S9 |
Pathogenic |
Table 3.
List of RMSD values obtained by the superposition of the structures containing pathogenic or tolerated mutations related to primary CoQ deficiency to the COQ2 model.
Table 3.
List of RMSD values obtained by the superposition of the structures containing pathogenic or tolerated mutations related to primary CoQ deficiency to the COQ2 model.
Variant |
SIFT prediction |
RMSD (Å) |
p.Ser96Asn |
Pathogenic |
0.183 |
p.Met132Arg |
Pathogenic |
0.199 |
p.Leu236Phe |
Pathogenic |
0.207 |
p.Arg147His |
Pathogenic |
0.210 |
p.Asn178Ser |
Tolerated |
0.225 |
p.Gly340Ala |
Pathogenic |
0.237 |
p.Tyr247Cys |
Pathogenic |
0.246 |
p.Cys228Arg |
Pathogenic |
0.247 |
p.Thr244Ile |
Tolerated |
0.247 |
p.Arg123His |
Pathogenic |
0.256 |
p.Thr275Ala |
Tolerated |
0.257 |
p.Ala252Val |
Pathogenic |
0.268 |