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HSD17B4

hydroxysteroid 17-beta dehydrogenase 4

The HSD17B4 gene encodes the D-bifunctional protein, a peroxisomal enzyme crucial for the breakdown of certain fatty acids within cells. The HSD17B4 gene provides instructions for making the D-bifunctional protein, an enzyme located in peroxisomes.

Chromosome 5q23.1 Various HGNC:5213 Tier C
HSD17B4 5q23.1 p arm q arm 5

HSD17B4 is located on the long (q) arm of chromosome 5, at band 5q23.1. Arm ratio per GRCh38 - banding schematic.

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Overview

The HSD17B4 gene, or hydroxysteroid 17-beta dehydrogenase 4, is responsible for producing the D-bifunctional protein. This protein functions as an enzyme, facilitating essential biochemical reactions within the cell.

Primarily located in peroxisomes, the D-bifunctional protein is involved in the breakdown of fatty acids, a critical metabolic process. Variants in the HSD17B4 gene can impact this function, leading to various inherited conditions.

What the gene does

The D-bifunctional protein, encoded by the HSD17B4 gene, is an enzyme that participates in two key biochemical reactions within peroxisomes. Peroxisomes are organelles containing enzymes that break down numerous substances, including certain fatty acids.

Specifically, the D-bifunctional protein is integral to the peroxisomal fatty acid beta-oxidation pathway. This pathway systematically shortens fatty acid molecules by two carbon atoms at a time. The D-bifunctional protein possesses two distinct regions with enzymatic activity: a hydratase domain and a dehydrogenase domain. These domains execute the second and third steps, respectively, of the beta-oxidation process, ultimately converting fatty acids into acetyl-CoA for cellular reuse.

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Chromosome location

The HSD17B4 gene is situated on chromosome 5, specifically at position 5q23.1. This location refers to the long arm (q) of chromosome 5, in region 2, band 3, sub-band 1. The gene's precise location on the chromosome helps in understanding its genetic context and potential interactions with other nearby genes.

Protein structure

The D-bifunctional protein produced from the HSD17B4 gene consists of 736 amino acids and features several distinct functional regions. It includes a (3R)-hydroxyacyl-CoA dehydrogenase region spanning amino acids 1-305. An Enoyl-CoA hydratase 2 region is located from amino acids 322-622, which encompasses a MaoC-like domain from amino acids 484-600. Additionally, a SCP2 domain is found towards the C-terminus, from amino acids 624-736, and a Microbody targeting signal motif is present at amino acids 734-736.

Domain map · 736 amino acids
(3R)-hydroxyacyl-CoA dehydrogenase (1–305)Enoyl-CoA hydratase 2 (322–622)MaoC-like (484–600)SCP2 (624–736)Microbody targeting signal (734–736)1–305Enoyl-CoA hydratase 2322–622MaoC-like484–6001~368736
Region - functional region
Domain - independent functional unit
Motif - short conserved sequence
🧬 Explore 3D structure on AlphaFold
UniProt:P51659Length:736 aaStructure:AlphaFold

Key variants

Variants in the HSD17B4 gene can alter the function of the D-bifunctional protein, ranging from minor changes to complete loss of function. These genetic changes can affect either one or both of the protein's enzymatic activities. The impact of these variants on protein function can lead to a spectrum of health conditions.

The table below shows the top 10 pathogenic or likely-pathogenic variants currently classified in ClinVar for HSD17B4.
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.1117del
Deletion
p.Cys373fs Pathogenic/Likely pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency
c.1168G>T
single nucleotide variant
p.Gly390Ter Pathogenic/Likely pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency
c.1635dup
Duplication
p.Gln546fs Pathogenic/Likely pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency
c.1768-1G>A
single nucleotide variant
- Pathogenic/Likely pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency
c.343del
Deletion
p.Asp115fs Pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency
c.350A>T
single nucleotide variant
p.Asp117Val Pathogenic/Likely pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency
c.627del
Deletion
p.Val210fs Pathogenic/Likely pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency
c.707T>A
single nucleotide variant
p.Leu236Ter Pathogenic ★★☆☆ Inborn genetic diseases
c.715-1G>A
single nucleotide variant
- Pathogenic/Likely pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency
c.740T>A
single nucleotide variant
p.Leu247Ter Pathogenic/Likely pathogenic ★★☆☆ Bifunctional peroxisomal enzyme deficiency

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 HSD17B4 gene are associated with several inherited conditions, primarily affecting metabolic pathways and neurological function. These include D-bifunctional protein deficiency, a severe neurodegenerative disorder. Additionally, certain HSD17B4 variants are known to cause Perrault syndrome, characterised by hearing loss and ovarian abnormalities in affected individuals.

UK clinical status

The HSD17B4 gene is recognised within the NHS Genomic Medicine Service due to its clinical significance. It is listed as 'green' on multiple NHS England National Genomic Test Directory panels via PanelApp, indicating strong evidence for its gene-disease association. These panels include Monogenic hearing loss (R67), Early onset or syndromic epilepsy, Peroxisomal disorders, and Inherited white matter disorders, among others, highlighting its involvement in a range of complex conditions.

Frequently asked questions

What is the D-bifunctional protein?

The D-bifunctional protein is an enzyme encoded by the HSD17B4 gene. It is located in peroxisomes, where it plays a crucial role in breaking down certain fatty acids through a process called beta-oxidation.

What is D-bifunctional protein deficiency?

D-bifunctional protein deficiency is a severe inherited disorder caused by pathogenic variants in the HSD17B4 gene. It leads to the deterioration of nervous system functions, typically beginning in infancy.

How does HSD17B4 relate to Perrault syndrome?

Certain pathogenic variants in the HSD17B4 gene have been identified as a cause of Perrault syndrome. This condition is characterised by hearing loss in both males and females, and ovarian abnormalities in affected females.

References

  1. McMillan HJ, Worthylake T, Schwartzentruber J. Specific combination of compound heterozygous mutations in 17β-hydroxysteroid dehydrogenase type 4 (HSD17B4) defines a new subtype of D-bifunctional protein deficiency. Orphanet journal of rare diseases. 2012. PMID: 23181892
  2. Pierce SB, Walsh T, Chisholm KM. Mutations in the DBP-deficiency protein HSD17B4 cause ovarian dysgenesis, hearing loss, and ataxia of Perrault Syndrome. American journal of human genetics. 2010. PMID: 20673864
  3. Ferdinandusse S, Denis S, Mooyer PA. Clinical and biochemical spectrum of D-bifunctional protein deficiency. Annals of neurology. 2006. PMID: 16278854
  4. Ferdinandusse S, Ylianttila MS, Gloerich J. Mutational spectrum of D-bifunctional protein deficiency and structure-based genotype-phenotype analysis. American journal of human genetics. 2006. PMID: 16385454
  5. Möller G, van Grunsven EG, Wanders RJ. Molecular basis of D-bifunctional protein deficiency. Molecular and cellular endocrinology. 2001. PMID: 11165012
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 18 October 2026. Content compiled from HGNC · MedlinePlus Genetics · ClinGen · Genomics England PanelApp · NHS National Genomic Test Directory · ClinVar · UniProt · AlphaFold .