Naturally occurring mutants of membrane and secretory proteins are often associated with the pathogenesis of human diseases. Here, we describe the molecular basis of a novel phenotype of congenital sucrase-isomaltase deficiency (CSID), a disaccharide malabsorption disorder of the human intestine in which several structural features and functional capacities of the brush-border enzyme complex sucrase-isomaltase (SI) are affected. The cDNA encoding SI from a patient with CSID reveals a mutation in the isomaltase subunit of SI that results in the substitution of a cysteine by an arginine at amino acid residue 635 (C635R). When this mutation is introduced into the wild type cDNA of SI a mutant enzyme, SI C635R , is generated that shows a predominant localization in the endoplasmic reticulum. Nevertheless, a definite localization of SI C635R in the Golgi apparatus and at the cell surface could be also observed. Epitope mapping with conformation-specific mAbs protease sensitivity assays, and enzymatic activity measurements demonstrate an altered folding pattern of SI C635R that is responsible for a substantially increased turnover rate and an aberrant sorting profile. Thus, SI C635R becomes distributed also at the basolateral membrane in contrast to wild type SI. Concomitant with the altered sorting pattern, the partial detergent extractability of wild type SI shifts to a complete detergent solubility with Triton X-100. The mutation has therefore affected an epitope responsible for the apical targeting fidelity of SI. Altogether, the combined effects of the C635R mutation on the turnover rate, function, polarized sorting, and detergent solubility of SI constitute a unique and novel pathomechanism of CSID.The utilization of misfolding-related diseases has proven to be invaluable in dissection of the molecular mechanisms of protein transport and has unraveled several intriguing cell biological phenomena, such as in cases of congenital sucrase-isomaltase deficiency (CSID).3 This intestinal autosomal recessive disorder is characterized by the absence of the sucrase and most of the maltase digestive activity within the sucraseisomaltase (SI) enzyme complex. The isomaltase activity varies from absent to normal (1). Clinically, the disease is manifested as an osmoticfermentative diarrhea upon ingestion of disaccharides and oligosaccharides (2). Analysis of this disorder at the molecular and subcellular levels has unraveled a number of phenotypes of CSID, which are characterized by perturbations in the intracellular transport, polarized sorting, aberrant processing, and defective function of SI (3-5). A few examples have been also reported, in which the misfolded protein products may escape the quality control system, instead of being either degraded or retained in the ER. A mutation at the position 620 of SI (L620P), for example, has been identified as one of the possible genetic modifications occurring in the CSID (6). Although this mutant is mainly found to be localized in the ER, it can be at least partially expressed als...