The G M2 gangliosidoses are caused by mutations in the genes encoding the ␣-(Tay-Sachs) or -(Sandhoff) subunits of heterodimeric -hexosaminidase A (Hex A), or the G M2 activator protein (AB variant), a substratespecific co-factor for Hex A. Although the active site associated with the hydrolysis of G M2 ganglioside, as well as part of the binding site for the ganglioside-activator complex, is associated with the ␣-subunit, elements of the -subunit are also involved. Missense mutations in these genes normally result in the mutant protein being retained in the endoplasmic reticulum and degraded. The mutations associated with the B1-variant of Tay-Sachs are rare exceptions that directly affect residues in the ␣-active site. We have previously reported two sisters with chronic Sandhoff disease who were heterozygous for the common HEXB deletion allele. Cells from these patients had higher than expected levels of mature -protein and residual Hex A activity, ϳ20%. We now identify these patients' second mutant allele as a C1510T transition encoding a -Pro 504 3 Ser substitution. Biochemical characterization of Hex A from both patient cells and cotransfected CHO cells demonstrated that this substitution (a) decreases the level of heterodimer transport out of the endoplasmic reticulum by ϳ45%, (b) lowers its heat stability, (c) does not affect its K m for neutral or charged artificial substrates, and (d) lowers the ratio of units of ganglioside/ units of artificial substrate hydrolyzed by a factor of 3. We concluded that the -Pro 504 3 Ser mutation directly affects the ability of Hex A to hydrolyze its natural substrate but not its artificial substrates. The effect of the mutation on ganglioside hydrolysis, combined with its effect on intracellular transport, produces chronic Sandhoff disease.