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ETHE1

ETHE1 persulfide dioxygenase

The ETHE1 gene provides instructions for an enzyme crucial for breaking down sulfide within mitochondria, playing a vital role in cellular energy production and preventing toxicity. The ETHE1 gene encodes an enzyme called ETHE1 persulfide dioxygenase, which is primarily active within the mitochondria, the cell's powerhouses.

Chromosome 19q13.31 Autosomal recessive HGNC:23287 Tier C
ETHE1 19q13.31 p arm q arm 19

ETHE1 is located on the long (q) arm of chromosome 19, at band 19q13.31. Arm ratio per GRCh38 - banding schematic.

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Overview

The ETHE1 gene, fully known as ETHE1 persulfide dioxygenase, is responsible for producing a mitochondrial enzyme. This enzyme plays a critical role in the metabolic pathway that breaks down sulfide (H2S), a molecule naturally produced in the body and by gut bacteria.

While sulfide is necessary at low concentrations for normal cellular functions, its accumulation to high levels can be harmful. The ETHE1 enzyme's activity is therefore essential for maintaining healthy cellular environments, especially within the mitochondria, where it contributes to energy production and prevents cellular damage.

What the gene does

The ETHE1 enzyme is primarily active in the mitochondria, the organelles responsible for generating most of the chemical energy needed to power a cell's biochemical reactions. Its main function is to participate in the breakdown of sulfide, a molecule that can be toxic if it builds up. Sulfide is a byproduct of normal metabolic processes within the body's tissues and is also released by bacteria in the gastrointestinal system.

At physiological levels, sulfide is important for various cellular functions. However, when sulfide levels become elevated, it can disrupt numerous cellular activities. For instance, excess sulfide can inhibit cytochrome C oxidase (COX), an enzyme complex crucial for the final steps of energy production in mitochondria. The ETHE1 enzyme helps prevent this inhibition by converting toxic sulfide into less harmful compounds, thereby ensuring efficient mitochondrial energy production and overall cellular health.

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Chromosome location

The ETHE1 gene is located on chromosome 19, specifically at position 19q13.31. This designation indicates that the gene resides on the long (q) arm of chromosome 19, within region 13 and sub-band 31.

Protein structure

The ETHE1 protein consists of 254 amino acids. Domain architecture has not been experimentally characterised in detail for this protein.

Key variants

Genetic variations, or variants, in the ETHE1 gene can alter the function of the ETHE1 enzyme. These changes can reduce the enzyme's ability to process sulfide effectively, leading to its accumulation in cells and tissues. Such variants are typically inherited in an autosomal recessive manner, meaning a person must inherit two copies of a pathogenic variant (one from each parent) to be affected by an associated condition.

The table below shows the top 10 pathogenic or likely-pathogenic variants currently classified in ClinVar for ETHE1.
View all on ClinVar →

Sample of pathogenic variants

10 pathogenic / likely-pathogenic variants from ClinVar, ranked by review status (expert-panel-reviewed first). This is a sample; recurrent founder variants in a specific population may not appear here - see the full ClinVar listing via the link above.

Variant (HGVS) Protein change Classification Evidence Associated condition
c.487C>T
single nucleotide variant
p.Arg163Trp Pathogenic ★★★☆ Ethylmalonic encephalopathy
c.488G>A
single nucleotide variant
p.Arg163Gln Pathogenic ★★★☆ Ethylmalonic encephalopathy
c.505+1G>A
single nucleotide variant
- Pathogenic ★★★☆ Ethylmalonic encephalopathy
c.505+1G>T
single nucleotide variant
- Pathogenic ★★★☆ Ethylmalonic encephalopathy
c.604dup
Duplication
p.Val202fs Pathogenic ★★★☆ Ethylmalonic encephalopathy
c.189del
Deletion
p.Gln63fs Pathogenic/Likely pathogenic ★★☆☆ Ethylmalonic encephalopathy
c.388del
Deletion
p.Arg130fs Pathogenic/Likely pathogenic ★★☆☆ Ethylmalonic encephalopathy
c.43C>T
single nucleotide variant
p.Gln15Ter Pathogenic/Likely pathogenic ★★☆☆ Ethylmalonic encephalopathy
c.596-1G>A
single nucleotide variant
- Pathogenic/Likely pathogenic ★★☆☆ Ethylmalonic encephalopathy
c.702_703del
Deletion
p.Gln235fs Pathogenic/Likely pathogenic ★★☆☆ Ethylmalonic encephalopathy

Evidence stars indicate ClinVar review status. Individual variant interpretation should always be performed by a qualified clinical laboratory - many variants remain classified as Variants of Uncertain Significance (VUS) pending more research.

Associated conditions

Pathogenic variants in the ETHE1 gene are primarily associated with ethylmalonic encephalopathy. This rare, severe condition affects multiple body systems, including the nervous system, blood vessels, and intestines. Symptoms can include developmental delay, unusual movements, skin rashes characterised by small red spots (petechiae), and blue discolouration of the hands and feet (acrocyanosis).

No disease links recorded for this gene in our reference set.

Inheritance pattern

Conditions caused by pathogenic ETHE1 variants typically follow autosomal recessive inheritance.

Carrier parent 1 altered copy Carrier parent 1 altered copy Affected Carrier Carrier Unaffected Affected Carrier Unaffected Circles = females · Squares = males

When both parents are carriers, each child has a 25% chance of being affected, 50% of being a carrier, and 25% of being unaffected.

Carrier frequency by population How common is heterozygous ETHE1 carrier status across ancestry groups?

UK clinical status

The ETHE1 gene is recognised in the UK's National Health Service (NHS) Genomic Medicine Service pathways. It is listed as 'green' on several NHS Genomic England PanelApp panels, indicating strong evidence for its association with human disease. These panels include DDG2P, Early onset or syndromic epilepsy, Intellectual disability, Likely inborn error of metabolism (R98), Mitochondrial disorders, Possible mitochondrial disorder, nuclear genes (R63), Structural basal ganglia disorders, and Undiagnosed metabolic disorders.

Frequently asked questions

What is the primary role of the ETHE1 gene?

The ETHE1 gene provides instructions for making an enzyme that is crucial for detoxifying sulfide within the mitochondria. This enzyme helps break down sulfide, preventing its accumulation to toxic levels that could interfere with cellular energy production.

What happens if the ETHE1 gene is not working correctly?

If the ETHE1 gene is not functioning properly, it can lead to an accumulation of sulfide in the body. High levels of sulfide are toxic to cells, particularly in the mitochondria, which can disrupt energy production and cause damage to various tissues and organs, leading to conditions like ethylmalonic encephalopathy.

How is ethylmalonic encephalopathy inherited?

Ethylmalonic encephalopathy caused by ETHE1 variants is inherited in an autosomal recessive manner. This means an individual must inherit two copies of a pathogenic ETHE1 variant, one from each parent, to develop the condition. Parents who each carry one copy of the variant are typically unaffected themselves but have a 25% chance with each pregnancy of having a child with the condition.

References

  1. Pettinati I, Brem J, McDonough MA. Crystal structure of human persulfide dioxygenase: structural basis of ethylmalonic encephalopathy. Human molecular genetics. 2015. PMID: 25596185
  2. Tiranti V, Zeviani M. Altered sulfide (H(2)S) metabolism in ethylmalonic encephalopathy. Cold Spring Harbor perspectives in biology. 2013. PMID: 23284046
  3. Di Meo I, Fagiolari G, Prelle A. Chronic exposure to sulfide causes accelerated degradation of cytochrome c oxidase in ethylmalonic encephalopathy. Antioxidants & redox signaling. 2011. PMID: 20812865
  4. Tiranti V, Viscomi C, Hildebrandt T. Loss of ETHE1, a mitochondrial dioxygenase, causes fatal sulfide toxicity in ethylmalonic encephalopathy. Nature medicine. 2009. PMID: 19136963
  5. Tiranti V, Briem E, Lamantea E. ETHE1 mutations are specific to ethylmalonic encephalopathy. Journal of medical genetics. 2006. PMID: 16183799
  6. Tiranti V, D'Adamo P, Briem E. Ethylmalonic encephalopathy is caused by mutations in ETHE1, a gene encoding a mitochondrial matrix protein. American journal of human genetics. 2004. PMID: 14732903
Educational content. This page is not medical or genetic advice, is not individually reviewed by a clinician for each reader, and should not replace a consultation with a qualified healthcare professional or genetic counsellor. If you are considering genetic testing or acting on a test result, book a consultation.
Data sources Last updated 13 September 2026. Content compiled from HGNC · MedlinePlus Genetics · ClinGen · Genomics England PanelApp · NHS National Genomic Test Directory · ClinVar · UniProt · AlphaFold .