{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T13:49:58Z","timestamp":1762004998846,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2018,3,28]],"date-time":"2018-03-28T00:00:00Z","timestamp":1522195200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Mitochondrial 3-hydroxy-3-methylglutaryl-CoA synthase deficiency (mitochondrial HMG-CoA synthase deficiency or mHS deficiency, OMIM #605911) is an inborn error of metabolism that affects ketone body synthesis. Acute episodes include vomiting, lethargy, hepatomegaly, hypoglycemia and dicarboxylic aciduria. The diagnosis is difficult due to the relatively unspecific clinical and biochemical presentation, and fewer than 30 patients have been described. This work describes three new patients with mHS deficiency and two missense mutations c.334C&gt;T (p.R112W) and c.430G&gt;T (p.V144L) previously not reported. We developed a new method to express and measure the activity of the enzyme and in this work the study is extended to ten new missense variants including those of our patients. Enzymatic assays showed that three of the mutant proteins retained some but seven completely lacked activity. The identification of a patient homozygous for a mutation that retains 70% of enzyme activity opens the door to a new interpretation of the disease by demonstrating that a modest impairment of enzyme function can actually produce symptoms. This is also the first study employing molecular dynamics modelling of the enzyme mutations. We show that the correct maintenance of the dimerization surface is crucial for retaining the structure of the active center and therefore the activity of the enzyme.<\/jats:p>","DOI":"10.3390\/ijms19041010","type":"journal-article","created":{"date-parts":[[2018,3,29]],"date-time":"2018-03-29T05:26:37Z","timestamp":1522301197000},"page":"1010","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Human Mitochondrial HMG-CoA Synthase Deficiency: Role of Enzyme Dimerization Surface and Characterization of Three New Patients"],"prefix":"10.3390","volume":"19","author":[{"given":"Beatriz","family":"Puisac","sequence":"first","affiliation":[{"name":"Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, University of Zaragoza, CIBERER-GCV02 and ISS-Aragon, E-50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0674-6423","authenticated-orcid":false,"given":"I\u00f1igo","family":"Marcos-Alcalde","sequence":"additional","affiliation":[{"name":"Molecular Modelling Group, Center of Molecular Biology \u201cSevero Ochoa\u201d (CSIC-UAM), Cantoblanco, E-28049 Madrid, Spain"},{"name":"Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarc\u00f3n, 28223 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mar\u00eda","family":"Hern\u00e1ndez-Marcos","sequence":"additional","affiliation":[{"name":"Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, University of Zaragoza, CIBERER-GCV02 and ISS-Aragon, E-50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pilar","family":"Tobajas Morlana","sequence":"additional","affiliation":[{"name":"Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, University of Zaragoza, CIBERER-GCV02 and ISS-Aragon, E-50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alina","family":"Levtova","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics, Department of Medicine, CHUM (Centre Hospitalier Universitaire de l\u2019Universit\u00e9 de Montr\u00e9al) and Universit\u00e9 de Montr\u00e9al, Montreal, QC H2X 0A9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Schwahn","sequence":"additional","affiliation":[{"name":"Willink Metabolic Unit, Manchester Centre for Genomic Medicine, Saint Mary\u2019s Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corinne","family":"DeLaet","sequence":"additional","affiliation":[{"name":"H\u00f4pital Universitaire des Enfants Reine Fabiola, Avenue Crocq 15, B-1020 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baiba","family":"Lace","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire de Qu\u00e9bec, Qu\u00e9bec City, QC G1V 4G2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3131-729X","authenticated-orcid":false,"given":"Paulino","family":"G\u00f3mez-Puertas","sequence":"additional","affiliation":[{"name":"Molecular Modelling Group, Center of Molecular Biology \u201cSevero Ochoa\u201d (CSIC-UAM), Cantoblanco, E-28049 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3203-6254","authenticated-orcid":false,"given":"Juan","family":"Pi\u00e9","sequence":"additional","affiliation":[{"name":"Unit of Clinical Genetics and Functional Genomics, Department of Pharmacology-Physiology, School of Medicine, University of Zaragoza, CIBERER-GCV02 and ISS-Aragon, E-50009 Zaragoza, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2018,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s10545-014-9704-9","article-title":"Ketone body metabolism and its defects","volume":"37","author":"Fukao","year":"2014","journal-title":"J. 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