Human liver peroxisomal alanine:glyoxylate aminotransferase (AGT) is a pyridoxal 5-phosphate (PLP)-dependent enzyme that converts glyoxylate into glycine. AGT deficiency causes primary hyperoxaluria type 1 (PH1), a rare autosomal recessive disorder, due to a marked increase in hepatic oxalate production. Normal human AGT exists as two polymorphic variants: the major (AGT-Ma) and the minor (AGT-Mi) allele. AGT-Mi causes the PH1 disease only when combined with some mutations. In this study, the molecular basis of the synergism between AGT-Mi and F152I mutation has been investigated through a detailed biochemical characterization of AGT-Mi and the Phe 152 variants combined either with the major (F152I-Ma, F152A-Ma) or the minor allele (F152I-Mi). Although these species show spectral features, kinetic parameters, and PLP binding affinity similar to those of AGT-Ma, the Phe 152 variants exhibit the following differences with respect to AGT-Ma and AGT-Mi: (i) pyridoxamine 5-phosphate (PMP) is released during the overall transamination leading to the conversion into apoenzymes, and (ii) the PMP binding affinity is at least 200 -1400-fold lower. Thus, Phe 152 is not an essential residue for transaminase activity, but plays a role in selectively stabilizing the AGT-PMP complex, by a proper orientation of Trp 108 , as suggested by bioinformatic analysis. These data, together with the finding that apoF152I-Mi is the only species that at physiological temperature undergoes a time-dependent inactivation and concomitant aggregation, shed light on the molecular defects resulting from the association of the F152I mutation with AGTMi, and allow to speculate on the responsiveness to pyridoxine therapy of PH1 patients carrying this mutation.The human liver peroxisomal alanine:glyoxylate aminotransferase (AGT) 2 is a pyridoxal 5Ј-phosphate (PLP)-dependent enzyme of clinical relevance in that its deficiency is associated with primary hyperoxaluria type 1 (PH1), a rare genetic disease characterized by progressive renal failure due to accumulation of insoluble calcium oxalate (1). In the peroxisomes of normal human hepatocytes, AGT is responsible for conversion of glyoxylate to glycine. This can be considered to be a detoxification reaction because its disfunction in PH1 allows glyoxylate to build up and to convert to oxalate. The two most common normal intragenic haplotypes of the AGT gene (AGXT) are referred to as the major and minor alleles (AGT-Ma and AGT-Mi). AGT-Mi differs from AGT-Ma by two coding sequence polymorphisms (P11L and I340M) and a non-coding duplication in intron 1. These polymorphisms have no clinical significance on their own, but they enhance the deleterious effects of several common PH1 mutations that occur on the same allele (2). This combination generates polymorphic variants characterized by impairments in the stability, localization, and/or rate of dimerization (2). The 2.5-Å resolution structure of human AGT in complex with the competitive inhibitor aminooxyacetic acid reveals that the enzyme is a dimer. Ea...