Combined Oxidative Phosphorylation Deficiency 19, also known as coxpd19, is related to wolfram syndrome 2 and sideroblastic anemia with b-cell immunodeficiency, periodic fevers, and developmental delay, and has symptoms including respiratory distress An important gene associated with Combined Oxidative Phosphorylation Deficiency 19 is LYRM4 (LYR Motif Containing 4), and among its related pathways/superpathways are Metabolism and Mitochondrial iron-sulfur cluster biogenesis. Affiliated tissues include liver and brain, and related phenotypes are failure to thrive and lactic acidosis