Mdfic, short for MyoD family inhibitor domain containing protein, is a transcriptional regulator that binds to PIEZO1/2 channels, regulating their inactivation [1]. It also plays a role in myogenic processes as it is involved in the regulation of myogenic transcription factors [3]. Additionally, Mdfic has connections to various signaling pathways and biological processes, such as integrin β1 activation which is crucial for collective cell migration during lymphatic vessel valve development [2].

In central conducting lymphatic anomaly (CCLA), biallelic pathogenic variants in MDFIC were identified in seven individuals from six independent families. A mouse model of human MDFIC truncation variants showed that homozygous mutant mice died perinatally with chylothorax, and had profound mispatterning in the lymphatic vasculature and major defects in lymphatic vessel valve development [2]. Also, a 13-year-old female patient with CCLA associated with an MDFIC mutation suffered from a severe group A Streptococcus sepsis, suggesting that the MDFIC mutation may contribute to the severe clinical course of sepsis, potentially affecting the immune system both indirectly via CCLA and directly through influencing transcriptional activity in immune cells [4].

In conclusion, Mdfic is essential in regulating PIEZO channel inactivation and myogenic processes. The gene knockout mouse models for Mdfic have revealed its crucial role in CCLA and associated immune-related complications, such as group A Streptococcus sepsis. These findings contribute to understanding the genetic and mechanistic basis of related diseases, which may facilitate the development of new therapeutic approaches.