Mutations in the FKBP14 gene encoding FKBP22 (FK506 Binding Protein 22 kDa) cause kyphoscolioticEhlers-Danlos Syndrome (kEDS). The first clinical report showed that a lack of FKBP22 protein due to mutations causing nonsense-mediated decay of the mRNA leads to a wide spectrum of clinical phenotypes including progressive kyphoscoliosis, joint hypermobility, hypotonia, hyperelastic skin, hearing loss and aortic rupture. Our previous work showed that these phenotypic features could be correlated with the functions of FKBP22, which preferentially binds to type III, VI and X collagens, but not to type I, II or V collagens. We also showed that FKBP22 catalyzed the folding of type III collagen through its prolyl isomerase activity and acted as a molecular chaperone for type III collagen. Recently, a novel missense mutation Met48Lys in FKBP22 was identified in a patient with kEDS. In this report, we expand the list of substrates of FKBP22 and also demonstrate that the Met48Lys mutation diminishes the activities of FKBP22, indicating that pathology can arise from absence of FKBP22, or partial loss of its function.Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder mainly characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Thirteen subtypes were classified in the 2017 EDS Nosology 1 and the kyphoscoliotic EDS (kEDS) was recognized as one subtype demonstrating a broader clinical spectrum of phenotypes with major and minor defined criteria. Congenital hypotonia, congenital or early onset kyphoscoliosis, and generalized joint hypermobility with dislocations/subluxations are the major features, and the minor features include skin hyperextensibility, easily bruised skin, rupture/aneurysm of a medium-sized arteries, and osteopenia/osteoporosis among others 1 . While the musculoskeletal symptoms are found in disorders caused by mutations in extracellular matrix (ECM) proteins, in particular collagen which is the most abundant protein in humans 2,3 , kEDS results from the deficiency of two proteins participating in collagen biosynthesis in the rough Endoplasmic Reticulum (rER): the post-translational modifying enzyme Lysyl Hydroxylase 1 (LH1 encoded by PLOD1) 4,5 and the peptidyl-prolyl cis/trans isomerase (PPIase) family protein FK506-binding protein 22 kDa (FKBP22 encoded by FKBP14) 6,7 . The lack of these proteins changes the collagen biosynthetic molecular ensemble in the rER 8-10 , which can lead to the secretion of structurally and/or functionally abnormal collagens 11,12 . Therefore, EDS causative mutations are not restricted to genes coding for ECM molecules but also include genes coding for proteins required for ECM biosynthesis and processing.Proteins are biosynthesized inside the cells following the central dogma that protein information stored in DNA is first transcribed to messenger RNA (mRNA) which is then translated into protein 13,14 . Missense mutations affect this central dogma and alter protein biogenesis in different ways. Depending upon the location of the mu...