Xie, X.; Shou, X.; Fan, X.; Li, L.; Ruan, Y.; Li, W.; Shang, W.; Mao, J.

Metaxin-2 (Mtx2) is an evolutionarily conserved mitochondrial outer membrane protein. Mutations in human Mtx2 cause mandibuloacral dysplasia (MADaM), a progeroid disorder. However, the pathologic mechanisms of Mtx2 loss-of-function remain largely unknown. Using Drosophila, we show Mtx2 null mutants exhibit pupal lethality, rescued by Drosophila or human Mtx2, underscoring functional conservation across species. Tissue-specific conditional knockout and rescue experiments reveal muscle as a critical site of dMtx2 action, with alternations of myofibril assembly and myogenic proteins being observed in dMtx2 mutants. Structural and functional mitochondrial abnormalities are also detected, verifying dMtx2\'s function in mitochondrial homeostasis. Notably, Mtx2 deficiency affects beta-barrel protein biogenesis and muscle development in pupa but not in larva, demonstrating Mtx2\'s dynamic regulation in mitochondrial proteostasis and muscle development. Our results elucidate mitochondrial mechanisms driving potential muscle-autonomous defects in MADaM patients and highlights stage-specific Mtx2 function as a prospective therapeutic target for this progeroid syndrome.