This study describes three novel homozygous missense mutations (S75R, S201Y, and D204N) in the 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) lyase gene, which caused 3-hydroxy-3-methylglutaric aciduria in patients from Germany, England, and Argentina. Expression studies in Escherichia coli show that S75R and S201Y substitutions completely abolished the HMG-CoA lyase activity, whereas D204N reduced catalytic efficiency to 6.6% of the wild type. We also propose a threedimensional model for human HMG-CoA lyase containing a (␣) 8 (TIM) barrel structure. The model is supported by the similarity with analogous TIM barrel structures of functionally related proteins, by the localization of catalytic amino acids at the active site, and by the coincidence between the shape of the substrate (HMG-CoA) and the predicted inner cavity. The three novel mutations explain the lack of HMG-CoA lyase activity on the basis of the proposed structure: in S75R and S201Y because the new amino acid residues occlude the substrate cavity, and in D204N because the mutation alters the electrochemical environment of the active site. We also report the localization of all missense mutations reported to date and show that these mutations are located in the -sheets around the substrate cavity.3-Hydroxy-3-methylglutaric aciduria (MIM246450) is a rare autosomal recessive metabolic disorder appearing in the 1st year of life. Acute episodes include vomiting, lethargy, hypotonia, and apnea, sometimes evolving to coma (1, 2). Laboratory tests reveal metabolic acidosis with severe hypoketotic hypoglycemia on fasting or during acute illness, hyperammonemia, and abnormal liver function tests. The disease is fatal in about 20% of cases (3) although the symptoms are milder after childhood. Preliminary diagnosis is based on the excretory pattern of organic acids in urine, which include 3-hydroxy-3-methylglutaric, 3-hydroxyisovaleric, 3-methylglutaconic, 3-methylglutaric, and 3-methylcrotonic acids (1, 4).