3-Hydroxy-3-methylglutaryl-CoA (HMG-CoA) lyase is a key enzyme in the ketogenic pathway that supplies metabolic fuel to extrahepatic tissues. Enzyme deficiency may be due to a variety of human mutations and can be fatal. Diminished activity has been explained based on analyses of recombinant human mutant proteins or, more recently, in the context of structural models for the enzyme. We report the experimental determination of a crystal structure at 2.1 Å resolution of the recombinant human mitochondrial HMG-CoA lyase containing a bound activator cation and the dicarboxylic acid 3-hydroxyglutarate. The enzyme adopts a (␣) 8 barrel fold, and the N-terminal barrel end is occluded. The structure of a physiologically relevant dimer suggests that substrate access to the active site involves binding across the cavity located at the C-terminal end of the barrel. An alternative hypothesis that involves substrate insertion through a pore proposed to extend through the barrel is not compatible with the observed structure. The activator cation ligands included Asn
235; the latter three residues had been implicated previously as contributing to metal binding or enzyme activity. Arg
41, previously shown to have a major effect on catalytic efficiency, is also located at the active site. In the observed structure, this residue interacts with a carboxyl group of 3-hydroxyglutarate, the hydrolysis product of the competitive inhibitor 3-hydroxyglutaryl-CoA required for crystallization of human enzyme. The structure provides a rationale for the decrease in enzyme activity due to clinical mutations, including H233R, R41Q, D42H, and D204N, that compromise active site function or enzyme stability.3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) 2 lyase (EC 4.1.3.4) catalyzes the cleavage of HMG-CoA into acetyl-CoA and acetoacetate (1). Scheme 1 is a key step in ketogenesis (2), which maintains the energy requirements of nonhepatic tissues especially during fasting or starvation. The reaction is also an important step in leucine catabolism (3). Homologous C-C bond cleavage or condensation reactions are catalyzed by various members of the HMG-CoA lyase family of enzymes, which includes homocitrate synthase, isopropylmalate synthase, and 4-hydroxy-2-ketovalerate aldolase (4).The importance of the ketogenic cycle is underscored in hereditary HMG-CoA lyase deficiency, which can result in hypoketotic hypoglycemia and a marked increase in serum levels of several organic acids. Uncontrolled HMG-CoA lyase deficiency is lethal in about 20% of cases and can result in mental retardation, episodes of seizure, and coma (5). Several mutations in the HMG-CoA lyase gene correlating with deficiency have been identified (5), including the following missense mutations: H233R (6), R41Q, D42E, D42H, D42G (7), and recently E279K (8). These mutations have been studied by using our recombinant human lyase protein expression system, providing a more detailed biochemical explanation for the significant consequences of such mutations.The cleavage of HMG-CoA req...