CFAP58 is a testis-enriched cilia- and flagella-associated protein essential for sperm flagellar axoneme assembly and midpiece integrity, with bi-allelic loss-of-function variants causing multiple morphological abnormalities of the sperm flagella (MMAF) and male infertility in humans and recapitulated in knockout and knock-in mice (PMID:32791035, PMID:40675161). The protein localizes throughout the sperm flagellum, concentrating at the mid-piece, and its loss reduces axonemal markers (SPAG6, SPEF2) and the mitochondrial sheath protein HSP60 while disrupting central pair microtubule assembly (PMID:32791035, PMID:40675161). Structurally, CFAP58 forms a heterodimer with CCDC146/MBO2 within a conserved L-shaped axonemal element that interconnects inner dynein arms with regulatory complexes and is required for normal ciliary waveform (PMID:38568782). Beyond the axoneme, CFAP58 acts in the intra-manchette/intra-flagellar transport pathway through physical interactions with IFT88 and CCDC42, stabilizing CCDC42 to support manchette-dependent sperm head shaping (PMID:38602507). CFAP58 co-localizes with ODF2/Cenexin and modulates Notch signaling during primary cilium elongation, extending its role to ciliogenesis beyond the male germline (PMID:31904090).