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CBS is an essential pyridoxal 5\u2032-phosphate (PLP)-dependent enzyme in the transsulfuration pathway, responsible for combining serine with homocysteine to produce cystathionine, whose activity is enhanced by the allosteric regulator S-adenosylmethionine (SAM). CBS also plays a role in generating hydrogen sulfide (H2S), a gaseous signaling molecule with diverse regulatory functions within the vascular, nervous, and immune systems. In this study, we present the clinical and biochemical characterization of two novel CBS missense mutations that do not respond to pyridoxine treatment, namely c.689T\u2009&amp;gt;\u2009A (L230Q) and 215A\u2009&amp;gt;\u2009T (K72I), identified in a Chinese patient. We observed that the disease-associated K72I genetic variant had no apparent effects on the spectroscopic and catalytic properties of the full-length enzyme. In contrast, the L230Q variant expressed in Escherichia coli did not fully retain heme and when compared with the wild-type enzyme, it exhibited more significant impairments in both the canonical cystathionine-synthesis and the alternative H2S-producing reactions. This reduced activity is consistent with both in vitro and in silico evidence, which indicates that the L230Q mutation significantly decreases the overall protein's stability, which in turn, may represent the underlying cause of its pathogenicity.<\/jats:p>","DOI":"10.1042\/bcj20240012","type":"journal-article","created":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T13:28:52Z","timestamp":1712064532000},"page":"569-585","update-policy":"https:\/\/doi.org\/10.1042\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Biochemical and structural impact of two novel missense mutations in cystathionine \u03b2-synthase gene associated with homocystinuria"],"prefix":"10.1042","volume":"481","author":[{"given":"Duaa W.","family":"Al-Sadeq","sequence":"first","affiliation":[{"name":"1College of Medicine, QU Health, Qatar University, Doha, Qatar"},{"name":"2Biomedical Research Center, Qatar University, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolina","family":"Conter","sequence":"additional","affiliation":[{"name":"3Department of Biotechnology, University of Verona, Verona, Italy"},{"name":"4Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Derio, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelos","family":"Thanassoulas","sequence":"additional","affiliation":[{"name":"1College of Medicine, QU Health, Qatar University, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nader","family":"Al-Dewik","sequence":"additional","affiliation":[{"name":"5Department of Research and Translational and Precision Medicine Research Lab, Women's Wellness and Research Center, Hamad Medical Corporation, and Genomics and Precision Medicine (GPM), College of Health & Life Science (CHLS), Hamad Bin Khalifa University (HBKU), Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bared","family":"Safieh-Garabedian","sequence":"additional","affiliation":[{"name":"1College of Medicine, QU Health, Qatar University, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Alfonso","family":"Mart\u00ednez-Cruz","sequence":"additional","affiliation":[{"name":"4Center for Cooperative Research in Biosciences (CIC bioGUNE), Basque Research and Technology Alliance (BRTA), Bizkaia Technology Park, Derio, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gheyath K.","family":"Nasrallah","sequence":"additional","affiliation":[{"name":"2Biomedical Research Center, Qatar University, Doha, Qatar"},{"name":"6Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7341-0970","authenticated-orcid":false,"given":"Alessandra","family":"Astegno","sequence":"additional","affiliation":[{"name":"3Department of Biotechnology, University of Verona, Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9761-6327","authenticated-orcid":false,"given":"Michail","family":"Nomikos","sequence":"additional","affiliation":[{"name":"1College of Medicine, QU Health, Qatar University, Doha, Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"288","published-online":{"date-parts":[[2024,4,22]]},"reference":[{"key":"2024042213510373900_BCJ-2024-0012C1","doi-asserted-by":"publisher","first-page":"330","DOI":"10.3390\/genes11030330","article-title":"The spectrum of mutations of homocystinuria in the MENA region","volume":"11","year":"2020","journal-title":"Genes"},{"key":"2024042213510373900_BCJ-2024-0012C2","first-page":"1","article-title":"The natural history of homocystinuria due to cystathionine \u03b2-synthase deficiency","volume":"37","year":"1985","journal-title":"Am. 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