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FA2H

fatty acid 2-hydroxylase

The *FA2H* gene provides instructions for an enzyme crucial in modifying fatty acids, which are vital components for proper neurological function and myelin formation. The *FA2H* gene encodes the enzyme fatty acid 2-hydroxylase, which plays a critical role in the nervous system by hydroxylating fatty acids.

Chromosome 16q23.1 Various HGNC:21197 Tier C
FA2H 16q23.1 p arm q arm 16

FA2H is located on the long (q) arm of chromosome 16, at band 16q23.1. Arm ratio per GRCh38 - banding schematic.

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Overview

The *FA2H* gene contains the genetic code for an enzyme called fatty acid 2-hydroxylase. This enzyme is vital for altering fatty acids, which are fundamental building blocks of many lipids found in the body. Specifically, it adds a hydroxyl group to fatty acid chains, producing 2-hydroxylated fatty acids. These specialised fatty acids are crucial for the nervous system's proper structure and function, particularly for creating myelin.

What the gene does

The fatty acid 2-hydroxylase enzyme, produced from the *FA2H* gene, is responsible for a critical modification of fatty acids. It catalyses the attachment of a hydroxyl group (-OH) to the second carbon atom of a fatty acid chain. This process generates 2-hydroxylated fatty acids.

These modified fatty acids are particularly important for the synthesis of myelin, a protective, fatty layer that insulates nerve fibres. Myelin enables quick and efficient transmission of electrical signals throughout the nervous system. The areas of the brain and spinal cord that are rich in myelin are referred to as white matter. Therefore, effective functioning of the *FA2H* enzyme is essential for maintaining healthy myelin and ensuring proper nerve impulse conduction.

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Chromosome location

The *FA2H* gene is found on chromosome 16, specifically at position 16q23.1. This location refers to the long arm (q arm) of chromosome 16. It contains the genetic information for a protein consisting of 372 amino acids.

Protein structure

The FA2H protein, comprising 372 amino acids, features two distinct functional regions. It contains a Cytochrome b5 heme-binding domain, located between amino acids 8 and 86. Additionally, a prominent Fatty acid hydroxylase domain is present, spanning amino acids 219 to 361. These domains are critical for the enzyme's catalytic activity in fatty acid modification.

Domain map · 372 amino acids
Cytochrome b5 heme-binding (8–86)Fatty acid hydroxylase (219–361)Cytochrome b5 heme-bin8–86Fatty acid hydroxylase219–3611~186372
Domain - independent functional unit
🧬 Explore 3D structure on AlphaFold
UniProt:Q7L5A8Length:372 aaStructure:AlphaFold

Key variants

Genetic changes within the *FA2H* gene can modify the activity of the fatty acid 2-hydroxylase enzyme. These variations can include single base pair changes, or larger deletions or insertions. Such genetic alterations may lead to reduced enzyme activity or the production of an enzyme that does not function correctly, thereby disrupting the normal production of 2-hydroxylated fatty acids and impacting myelin formation.

The table below shows the top 10 pathogenic or likely-pathogenic variants currently classified in ClinVar for FA2H.
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.363+2T>C
single nucleotide variant
- Pathogenic/Likely pathogenic ★★☆☆ Hereditary spastic paraplegia 35
c.379C>T
single nucleotide variant
p.Arg127Ter Pathogenic/Likely pathogenic ★★☆☆ Hereditary spastic paraplegia 35
c.506+1G>C
single nucleotide variant
- Pathogenic/Likely pathogenic ★★☆☆ Spastic paraplegia
c.589C>T
single nucleotide variant
p.Arg197Ter Pathogenic/Likely pathogenic ★★☆☆ Hereditary spastic paraplegia 35
c.704G>A
single nucleotide variant
p.Arg235His Pathogenic/Likely pathogenic ★★☆☆ Hereditary spastic paraplegia 35
c.806G>A
single nucleotide variant
p.Arg269His Pathogenic/Likely pathogenic ★★☆☆ Spastic paraplegia
c.822del
Deletion
p.Val275fs Pathogenic/Likely pathogenic ★★☆☆ Hereditary spastic paraplegia 35
c.888del
Deletion
p.Gly298fs Pathogenic ★★☆☆ Spastic paraplegia
c.911dup
Duplication
p.Leu305fs Pathogenic ★★☆☆ Hereditary spastic paraplegia 35
c.941_945del
Deletion
p.Thr314fs Pathogenic/Likely pathogenic ★★☆☆ Spastic paraplegia

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

Variations in the *FA2H* gene are associated with several inherited neurological disorders, often characterised by progressive neurodegeneration. One notable condition is Spastic paraplegia type 35 (AR), an autosomal recessive disorder. These conditions typically involve problems with movement and vision that can begin in childhood or adolescence and may worsen over time.

  • Spastic paraplegia type 35
    Neurogenetics
    AR
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UK clinical status

The *FA2H* gene is included in several UK NHS Genomic Medicine Service national test panels, indicating its clinical relevance for diagnosing inherited conditions. It is part of panels for Ataxia and cerebellar anomalies - childhood onset, Dystonia, chorea or related movement disorder, childhood onset, Early onset dystonia, Hereditary neuropathy or pain disorder, Hereditary spastic paraplegia, Hereditary spastic paraplegia, adult onset, Hereditary spastic paraplegia, childhood onset, Likely inborn error of metabolism, Structural basal ganglia disorders, Undiagnosed metabolic disorders, and White matter disorders and cerebral calcification - childhood onset.

Frequently asked questions

What is the primary role of the FA2H gene?

The *FA2H* gene provides instructions for an enzyme called fatty acid 2-hydroxylase, which modifies fatty acids. These modified fatty acids are crucial for the proper formation of myelin, the protective covering around nerve cells.

What health conditions are associated with FA2H gene variants?

Variations in the *FA2H* gene are linked to inherited neurological conditions, including Spastic paraplegia type 35 (AR). These conditions typically affect movement and vision due to neurodegeneration.

Is FA2H testing available through the NHS?

Yes, the *FA2H* gene is assessed within several UK NHS Genomic Medicine Service national test panels, particularly those related to neurological disorders, metabolic conditions, and childhood-onset conditions.

References

  1. Gregory A, Hayflick SJ. Genetics of neurodegeneration with brain iron accumulation. Current neurology and neuroscience reports. 2011. PMID: 21286947
  2. Dick KJ, Eckhardt M, Paisán-Ruiz C. Mutation of FA2H underlies a complicated form of hereditary spastic paraplegia (SPG35). Human mutation. 2010. PMID: 20104589
  3. Kruer MC, Paisán-Ruiz C, Boddaert N. Defective FA2H leads to a novel form of neurodegeneration with brain iron accumulation (NBIA). Annals of neurology. 2010. PMID: 20853438
  4. Schneider SA, Bhatia KP. Three faces of the same gene: FA2H links neurodegeneration with brain iron accumulation, leukodystrophies, and hereditary spastic paraplegias. Annals of neurology. 2010. PMID: 21031573
  5. Edvardson S, Hama H, Shaag A. Mutations in the fatty acid 2-hydroxylase gene are associated with leukodystrophy with spastic paraparesis and dystonia. American journal of human genetics. 2008. PMID: 19068277
  6. Alderson NL, Rembiesa BM, Walla MD. The human FA2H gene encodes a fatty acid 2-hydroxylase. The Journal of biological chemistry. 2004. PMID: 15337768
  7. Adam MP, Bick S, Mirzaa GM. Fatty Acid Hydroxylase-Associated Neurodegeneration. 1993. PMID: 21735565
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 27 September 2026. Content compiled from HGNC · MedlinePlus Genetics · ClinGen · Genomics England PanelApp · NHS National Genomic Test Directory · ClinVar · UniProt · AlphaFold .