Summary. A series of experiments has established the molecular defect in the medium-chain acyl-coenzyme A (CoA) dehydrogenase (MCAD) gene in a family with MCAD deficiency. Demonstration of intra-mitochon drial mature MCAD indistinguishable in size (42.5-kDa) from control MCAD, and of mRNA with the correct size of 2.4 kb, indicated a point-mutation in the coding region of the MCAD gene to be disease-causing. Con sequently, cloning and DNA sequencing of polymerase chain reaction (PCR) amplified complementary DNA (cDNA) from messenger RNA of fibroblasts from the patient and family members were performed. All clones sequenced from the patient exhibited a single base sub _titution from adenine (A) to guanine (G) at position ~85 in the MCAD cDNA as the only consistent base-var iation compared with control cDNA. In contrast, the parents contained cDNA with the normal and the mu tated sequence, revealing their obligate carrier status. Allelic homozygosity in the patient and heterozygosity for the mutation in the parents were established by a modified PCR reaction, introducing a cleavage site for the restriction endonuclease NcoI into amplified geno mic DNA containing G 985 . The same assay consistently revealed A 985 in genomic DNA from 26 control individu als. The A to G mutation was introduced into an E. coli expression vector producing mutant MCAD, which was demonstrated to be inactive, probably because of the in ability to form active tetrameric MCAD. All the experi ments are consistent with the contention that the G 985 mutation, resulting in a lysine to glutamate shift at posi tion 329 in the MCAD polypeptide chain, is the genetic cause of MCAD deficiency in this family. We found the Offprint requests to: N. Gregersen.