Background:The human V-ATPase a3 subunit mutation, R444L, causes infantile malignant osteopetrosis. Results: In mouse, the R444L equivalent, R445L, causes endoplasmic reticulum retention, misprocessing, and defective trafficking of a3 to the plasma membrane. Conclusion: Arginine 444/445 plays a critical role in mammalian a3 folding, or stability. Significance: R444L a3 infantile malignant osteopetrosis is a protein folding disease that may be amenable to protein rescue therapy.