Advancing Drug Safety in Drug Development: Bridging Computational Predictions for Enhanced Toxicity Prediction.

The attrition rate of drugs in clinical trials is generally quite high, with estimates suggesting that approximately 90% of drugs fail to make it through the process. The identification of unexpected toxicity issues during preclinical stages is a significant factor contributing to this high rate of failure. These issues can have a major impact on the success of a drug and must be carefully considered throughout the development process. These late-stage rejections or withdrawals of drug candidates significantly increase the costs associated with drug development, particularly when toxicity is detected during clinical trials or after market release. Understanding drug-biological target interactions is essential for evaluating compound toxicity and safety, as well as predicting therapeutic effects and potential off-target effects that could lead to toxicity. This will enable scientists to predict and assess the safety profiles of drug candidates more accurately. Evaluation of toxicity and safety is a critical aspect of drug development, and biomolecules, particularly proteins, play vital roles in complex biological networks and often serve as targets for various chemicals. Therefore, a better understanding of these interactions is crucial for the advancement of drug development. The development of computational methods for evaluating protein-ligand interactions and predicting toxicity is emerging as a promising approach that adheres to the 3Rs principles (replace, reduce, and refine) and has garnered significant attention in recent years. In this review, we present a thorough examination of the latest breakthroughs in drug toxicity prediction, highlighting the significance of drug-target binding affinity in anticipating and mitigating possible adverse effects. In doing so, we aim to contribute to the development of more effective and secure drugs.

Translocation and Confinement of Tetraamines in Adaptable Microporous Cavities.

Metal-Organic Frameworks can be grafted with amines by coordination to metal vacancies to create amine-appended solid adsorbents, which are being considered as an alternative to using aqueous amine solutions for CO2 capture. In this study, we propose an alternative mechanism that does not rely on the use of neutral metal vacancies as binding sites but is enabled by the structural adaptability of heterobimetallic Ti2Ca2 clusters. The combination of hard (Ti4+) and soft (Ca2+) metal centers in the inorganic nodes of the framework enables MUV-10 to adapt its pore windows to the presence of triethylenetetramine molecules. This dynamic cluster response facilitates the translocation and binding of tetraamine inside the microporous cavities to enable the formation of bis-coordinate adducts that are stable in water. The extension of this grafting concept from MUV-10 to larger cavities not restrictive to CO2 diffusion will complement other strategies available for the design of molecular sorbents for decarbonization applications.

Metal Node Control of Brønsted Acidity in Heterobimetallic Titanium-Organic Frameworks.

Compared to indirect framework modification, synthetic control of cluster composition can be used to gain direct access to catalytic activities exclusive of specific metal combinations. We demonstrate this concept by testing the aminolysis of epoxides with a family of isostructural mesoporous frameworks featuring five combinations of homometallic and heterobimetallic metal-oxo trimers (Fe3, Ti3, TiFe2, TiCo2, and TiNi2). Only TiFe2 nodes display activities comparable to benchmark catalysts based on grafting of strong acids, which here originate from the combination of Lewis Ti4+ and Brønsted Fe3+-OH acid sites. The applicability of MUV-101(Fe) to the synthesis of ß-amino alcohols is demonstrated with a scope that also includes the gram scale synthesis of propranolol, a natural ß-blocker listed as an essential medicine by the World Health Organization, with excellent yield and selectivity.

Observation of Exchange Interaction in Iron(II) Spin Crossover Molecules in Contact with Passivated Ferromagnetic Surface of Co/Au(111).

Spin crossover (SCO) complexes sensitively react on changes of the environment by a change in the spin of the central metallic ion making them ideal candidates for molecular spintronics. In particular, the composite of SCO complexes and ferromagnetic (FM) surfaces would allow spin-state switching of the molecules in combination with the magnetic exchange interaction to the magnetic substrate. Unfortunately, when depositing SCO complexes on ferromagnetic surfaces, spin-state switching is blocked by the relatively strong interaction between the adsorbed molecules and the surface. Here, the Fe(II) SCO complex [FeII (Pyrz)2 ] (Pyrz = 3,5-dimethylpyrazolylborate) with sub-monolayer thickness in contact with a passivated FM film of Co on Au(111) is studied. In this case, the molecules preserve thermal spin crossover and at the same time the high-spin species show a sizable exchange interaction of > 0.9 T with the FM Co substrate. These observations provide a feasible design strategy in fabricating SCO-FM hybrid devices.

COVID-19-related changes in outpatient CPAP setup pathways for OSA are linked with decreased 30-day CPAP usage.

The COVID-19 pandemic changed continuous positive airway pressure (CPAP) setup pathways. We evaluated patients commenced on CPAP in 2019 (prepandemic) and 2020 (post-first UK wave). Face-to-face (F2F) setup numbers, with CPAP turned on, decreased from 613 patients (98.9%) in 2019, to 6 (1.1%) in 2020. In 2020, setups were F2F without CPAP turned on (403 (71.1%)), or remote (158 (27.9%)). Prepandemic median CPAP usage at first follow-up was 5.4 (2.7-6.9) hours/night and fell by 0.9 hours/night (95% CI 0.5 to 1.2, p<0.0001) in 2020. We found clinically relevant reductions in CPAP usage with pathway changes post-COVID-19.

Response of Different Grapevine Cultivars to Infection by Lasiodiplodia theobromae and Lasiodiplodia mediterranea.

Botryosphaeria dieback is a grapevine trunk disease that affects all viticulture regions of the world. Species of the genus Lasiodiplodia have been reported as pathogenic toward grapevine in several growing regions and have also been previously reported from Portuguese vineyards. Species in this genus, particularly Lasiodiplodia theobromae, have been reported in previous studies to be more aggressive than other Botryosphaeriaceae species most commonly associated with Botryosphaeria dieback. The aim of this study was to assess the response of some of the more representative cultivars planted throughout Portuguese vineyards, 'Touriga Nacional,' 'Touriga Franca,' 'Alvarinho,' 'Aragonez' (= 'Tempranillo'), and 'Cabernet Sauvignon,' by performing artificial inoculations with Lasiodiplodia spp. collected in different geographic locations worldwide. Two experiments, one that involved inoculating 2-year-old grapevines kept in greenhouse-controlled conditions with six isolates of L. theobromae and one isolate of L. mediterranea and one that involved inoculating 7-year-old field-grown grapevines with two isolates of L. theobromae, were conducted twice. We assessed the response of the cultivars by evaluating the length of lesions caused by the isolates 5 months after inoculation. The results showed that all isolates studied were able to infect the annual shoots because they were always reisolated and produced internal wood discoloration. Significant differences were found for all isolate-cultivar combinations. In both experiments, Touriga Nacional showed the largest lesions and while Aragonez recorded the smallest lesions of the cultivars inoculated with Lasiodiplodia spp. In general, Portuguese isolates were more aggressive than those from Peru, which were mildly aggressive. These results are a first insight into the response of selected Portuguese cultivars to Lasiodiplodia species, which are present in Portugal but not commonly associated with Botryosphaeria dieback. This research contributes to our knowledge of the impact that Botryosphaeria dieback causal agents have on crucial national cultivars, which may help winegrowers not only manage current cultural practices but also optimize decision making when planning new vineyards.

Congenital Disorders of Glycosylation in Portugal-Two Decades of Experience.

OBJECTIVE: To describe the clinical, biochemical, and genetic features of both new and previously reported patients with congenital disorders of glycosylation (CDGs) diagnosed in Portugal over the last 20 years. STUDY DESIGN: The cohort includes patients with an unexplained multisystem or single organ involvement, with or without psychomotor disability. Serum sialotransferrin isoforms and, whenever necessary, apolipoprotein CIII isoforms and glycan structures were analyzed. Additional studies included measurement of phosphomannomutase (PMM) activity and analysis of lipid-linked oligosaccharides in fibroblasts. Sanger sequencing and massive parallel sequencing were used to identify causal variants or the affected gene, respectively. RESULTS: Sixty-three individuals were diagnosed covering 14 distinct CDGs; 43 patients diagnosed postnatally revealed a type 1, 14 a type 2, and 2 a normal pattern on serum transferrin isoelectrofocusing. The latter patients were identified by whole exome sequencing. Nine of them presented also a hypoglycosylation pattern on apolipoprotein CIII isoelectrofocusing, pointing to an associated O-glycosylation defect. Most of the patients (62%) are PMM2-CDG and the remaining carry pathogenic variants in ALG1, ATP6AP1, ATP6AP2, ATP6V0A2, CCDC115, COG1, COG4, DPAGT1, MAN1B1, SLC35A2, SRD5A3, RFT1, or PGM1. CONCLUSIONS: Portuguese patients with CDGs are presented in this report, some of them showing unique clinical phenotypes. Among the 14 genes mutated in Portuguese individuals, 8 are shared with a previously reported Spanish cohort. However, regarding the mutational spectrum of PMM2-CDG, the most frequent CDG, a striking similarity between the 2 populations was found, as only 1 mutated allele found in the Portuguese group has not been reported in Spain.

Pressure Tunable Electronic Bistability in Fe(II) Hofmann-like Two-Dimensional Coordination Polymer [Fe(Fpz)2Pt(CN)4]: A Comprehensive Experimental and Theoretical Study.

A comprehensive experimental and theoretical study of both thermal-induced spin transition (TIST) as a function of pressure and pressure-induced spin transition (PIST) at room temperature for the two-dimensional Hofmann-like SCO polymer [Fe(Fpz)2Pt(CN)4] is reported. The TIST studies at different fixed pressures have been carried out by magnetic susceptibility measurements, while PIST studies have been performed by means of powder X-ray diffraction, Raman, and visible spectroscopies. A combination of the theory of elastic interactions and numerical Monte Carlo simulations has been used for the analysis of the cooperative interactions in TIST and PIST studies. A complete (T, P) phase diagram for the compound [Fe(Fpz)2Pt(CN)4] has been constructed. The critical temperature of the spin transition follows a lineal dependence with pressure, meanwhile the hysteresis width shows a nonmonotonic behavior contrary to theoretical predictions. The analysis shows the exceptional role of the total entropy and phonon contribution in setting the temperature of the spin transition and the width of the hysteresis. The anomalous behavior of the thermal hysteresis width under pressure in [Fe(Fpz)2Pt(CN)4] is a direct consequence of a local distortion of the octahedral geometry of the Fe(II) centers for pressures higher than 0.4 GPa. Interestingly, there is not a coexistence of the high- and low-spin (HS and LS, respectively) phases in TIST experiments, while in PIST experiments, the coexistence of the HS and LS phases in the metastable region of the phase transition induced by pressure is observed for a first time in a first-order gradual spin transition with hysteresis.

Selective Implantation of Diamines for Cooperative Catalysis in Isoreticular Heterometallic Titanium-Organic Frameworks.

We introduce the first example of isoreticular titanium-organic frameworks, MUV-10 and MUV-12, to show how the different affinity of hard Ti(IV) and soft Ca(II) metal sites can be used to direct selective grafting of amines. This enables the combination of Lewis acid titanium centers and available -NH2 sites in two sizeable pores for cooperative cycloaddition of CO2 to epoxides at room temperature and atmospheric pressure. The selective grafting of molecules to heterometallic clusters adds up to the pool of methodologies available for controlling the positioning and distribution of chemical functions in precise positions of the framework required for definitive control of pore chemistry.

Variable Cooperative Interactions in the Pressure and Thermally Induced Multistep Spin Transition in a Two-Dimensional Iron(II) Coordination Polymer.

Two types of experiments conducted to investigate the effect of pressure on the spin crossover (SCO) properties of the 2D Fe(II) coordination polymer formulated {Fe[bipy(ttr)2]}n are reported, namely, (1) magnetic measurements performed at variable temperature and at fixed pressure and (2) visible spectroscopy at variable pressure and fixed temperature. The magnetic experiments carried out under a hydrostatic pressure constraint of 0.04, 0.08, and 0.8 GPa reveal a two-step spin transition behavior. The characteristic critical temperatures of the spin transition are shifted upward in temperature as pressure increases. The slope of the straight-line of the Tc vs P plot, dTc/dP, is 775 K/GPa and 300 K/GPa, for the high temperature and the low temperature steps, respectively. These values are remarkably large and denote the extreme sensitivity of the material to the application of pressure. Indeed, the visible spectroscopic measurements performed at 293 K show that a complete spin transition is induced at pressures as low as 0.4 GPa. Moreover, the pressure-induced spin transition is reversible and shows an asymmetric hysteresis. An analysis of the cooperative interactions of the thermal- and pressure-induced spin transition in the framework of the model of elastic interactions reveals that the elastic energy of the lattice as well as the interaction parameter between the SCO centers change during the course of the spin transition. Consequently, the character of the spin transition varies from abrupt for the high temperature step to continuous for the low temperature step.

Diffusion Control in Single-Site Zinc Reticular Amination Catalysts.

Zn-containing metal-organic frameworks have been used for the first time as heterogeneous catalysts in the amination of C-Cl bonds. The use of extended bis(pyrazolate) linkers can generate highly porous architectures, which favor the diffusion of amines to the confined spaces with respect to other imidazolate frameworks with narrower pore windows. The N4Zn nodes of the Zn-reticular framework show comparable activity to state-of-the-art homogeneous Zn amination catalysts, avoiding the use of basic conditions, precious metals, or other additives. This is combined with long-term activity and stability upon several reaction cycles, without contamination of the reaction product.

Phenotype, treatment practice and outcome in the cobalamin-dependent remethylation disorders and MTHFR deficiency: Data from the E-HOD registry.

AIM: To explore the clinical presentation, course, treatment and impact of early treatment in patients with remethylation disorders from the European Network and Registry for Homocystinurias and Methylation Defects (E-HOD) international web-based registry. RESULTS: This review comprises 238 patients (cobalamin C defect n = 161; methylenetetrahydrofolate reductase deficiency n = 50; cobalamin G defect n = 11; cobalamin E defect n = 10; cobalamin D defect n = 5; and cobalamin J defect n = 1) from 47 centres for whom the E-HOD registry includes, as a minimum, data on medical history and enrolment visit. The duration of observation was 127 patient years. In 181 clinically diagnosed patients, the median age at presentation was 30 days (range 1 day to 42 years) and the median age at diagnosis was 3.7 months (range 3 days to 56 years). Seventy-five percent of pre-clinically diagnosed patients with cobalamin C disease became symptomatic within the first 15 days of life. Total homocysteine (tHcy), amino acids and urinary methylmalonic acid (MMA) were the most frequently assessed disease markers; confirmatory diagnostics were mainly molecular genetic studies. Remethylation disorders are multisystem diseases dominated by neurological and eye disease and failure to thrive. In this cohort, mortality, thromboembolic, psychiatric and renal disease were rarer than reported elsewhere. Early treatment correlates with lower overall morbidity but is less effective in preventing eye disease and cognitive impairment. The wide variation in treatment hampers the evaluation of particular therapeutic modalities. CONCLUSION: Treatment improves the clinical course of remethylation disorders and reduces morbidity, especially if started early, but neurocognitive and eye symptoms are less responsive. Current treatment is highly variable. This study has the inevitable limitations of a retrospective, registry-based design.

Follow-up of fatty acid ß-oxidation disorders in expanded newborn screening era.

Fatty acid ß-oxidation (FAO) disorders have a wide variety of symptoms, not usually evident between episodes of acute decompensations. Cardiac involvement is frequent, and severe ventricular arrhythmias are suspected of causing sudden death. Expanded newborn screening (ENS) for these disorders, hopefully, contribute to prevent potentially acute life-threatening events. In order to characterize acute decompensations observed in FAO-deficient cases identified by ENS, a retrospective analysis was performed, covering a period of 9 years. Demographic data, number/type of acute decompensations, treatment, and follow-up were considered. Eighty-three clinical charts, including 66 medium-chain acyl-CoA dehydrogenase deficiency (MCADD), 5 carnitine-uptake deficiency (CUD), 3 carnitine palmitoyltransferase I and II (CPT I/II) deficiency, 5 very long-chain acyl-CoA dehydrogenase deficiency (VLCADD), and 4 multiple acyl-CoA dehydrogenase deficiency (MADD) cases were reviewed. Nineteen patients had acute decompensations (1 CPT I, 1 CPT II, 3 MADD, 14 MCADD). Six patients developed symptoms previously to ENS diagnosis. Severe clinical manifestations included multiple organ failure, liver failure, heart failure, and sudden death. Long-chain FAO disorders had the highest number of decompensations per patient.Conclusion: Despite earlier diagnosis by ENS, sudden deaths were not avoided and acute decompensations with severe clinical manifestations still occur as well. What is Known: • Severe ventricular arrhythmias are suspected to cause unexpected death in FAO disorders. • Neonatal screening intends to reduce the incidence of severe metabolic crisis and death. What is New: • Acute severe decompensations occurred in FAO disorders diagnosed through neonatal screening. • Sudden deaths were not avoided by starting treatment precociously.

Diversity of settlement-stage reef fishes captured by light-trap in a tropical south-west Atlantic Ocean coastal reef system.

This study reports the results of 5 years of monitoring reef fish post-larvae using light traps in the Bay of Tamandaré, north-east Brazil. An annotated checklist of pre-settlement fish species, their frequency of occurrence and taxonomic characteristics are provided. In total, 4,422 post-larval fishes belonging to 36 families, 56 genera and 76 species were captured. The most species-rich families were Carangidae (7), Lutjanidae (6) and Pomacentridae (4), while the families Gerreidae (30.47%), Holocentridae (16.54%), Blenniidae (12.01%), Labrisomidae (8.36%), Lutjanidae (8.29%) and Acanthuridae (5.95%) were the most abundant. This is the first study of the taxonomic diversity and assemblage structure of settlement-stage reef fishes in the tropical south-west Atlantic Ocean. Although a few common species were not captured due to selectivity of light traps, the composition and taxonomic diversity of this first collection suggests that light traps are useful for studies of the early life history of a wide range of pre-settlement reef fishes.

Pressure Effect Studies on the Spin Transition of Microporous 3D Polymer [Fe(pz)Pt(CN)4].

Pressure effects on the spin transition of the three-dimensional (3D) porous coordination polymer {Fe(pz)[Pt(CN)4]} have been investigated in the interval 105 Pa-1.0 GPa through variable-temperature (10-320 K) magnetic susceptibility measurements and spectroscopic studies in the visible region at room temperature. These studies have disclosed a different behavior of the compound under pressure. In the magnetic experiments, a temperature independent paramagnetic behavior has been observed under 0.4 GPa. In contrast, at room temperature and at 0.8 GPa, a complete HS-to-LS transition has been evidenced. The differences in the magnetic behavior are strongly related with the porous structure of the compound and its capability to adsorb the oil used as pressure transmission media in the magnetic experiments.

High-resolution profiling of stationary-phase survival reveals yeast longevity factors and their genetic interactions.

Lifespan is influenced by a large number of conserved proteins and gene-regulatory pathways. Here, we introduce a strategy for systematically finding such longevity factors in Saccharomyces cerevisiae and scoring the genetic interactions (epistasis) among these factors. Specifically, we developed an automated competition-based assay for chronological lifespan, defined as stationary-phase survival of yeast populations, and used it to phenotype over 5,600 single- or double-gene knockouts at unprecedented quantitative resolution. We found that 14% of the viable yeast mutant strains were affected in their stationary-phase survival; the extent of true-positive chronological lifespan factors was estimated by accounting for the effects of culture aeration and adaptive regrowth. We show that lifespan extension by dietary restriction depends on the Swr1 histone-exchange complex and that a functional link between autophagy and the lipid-homeostasis factor Arv1 has an impact on cellular lifespan. Importantly, we describe the first genetic interaction network based on aging phenotypes, which successfully recapitulated the core-autophagy machinery and confirmed a role of the human tumor suppressor PTEN homologue in yeast lifespan and phosphatidylinositol phosphate metabolism. Our quantitative analysis of longevity factors and their genetic interactions provides insights into the gene-network interactions of aging cells.

Cynomolgus monkeys (Macaca fascicularis) experimentally infected with B19V and hepatitis A virus: no evidence of the co-infection as a cause of acute liver failure.

This study was conducted to analyse the course and the outcome of the liver disease in the co-infected animals in order to evaluate a possible synergic effect of human parvovirus B19 (B19V) and hepatitis A virus (HAV) co-infection. Nine adult cynomolgus monkeys were inoculated with serum obtained from a fatal case of B19V infection and/or a faecal suspension of acute HAV. The presence of specific antibodies to HAV and B19V, liver enzyme levels, viraemia, haematological changes, and necroinflammatory liver lesions were used for monitoring the infections. Seroconversion was confirmed in all infected groups. A similar pattern of B19V infection to human disease was observed, which was characterised by high and persistent viraemia in association with reticulocytopenia and mild to moderate anaemia during the period of investigation (59 days). Additionally, the intranuclear inclusion bodies were observed in pro-erythroblast cell from an infected cynomolgus and B19V Ag in hepatocytes. The erythroid hypoplasia and decrease in lymphocyte counts were more evident in the co-infected group. The present results demonstrated, for the first time, the susceptibility of cynomolgus to B19V infection, but it did not show a worsening of liver histopathology in the co-infected group.

Synthesis of Nanocrystals and Particle Size Effects Studies on the Thermally Induced Spin Transition of the Model Spin Crossover Compound [Fe(phen)2(NCS)2].

Surfactant-free nanocrystals of the model spin-crossover compound [Fe(phen)2(NCS)2] (phen: 1,10-phenanthroline) have been synthesized applying the reverse micelle technique. The morphology of the nanocrystals, characterized by scanning electronic microscopy, corresponds to rhombohedric platelets with dimensions ranging from 203 × 203 × 106 nm to 142 × 142 × 74 nm. Variation of the concentration of the Fe(BF4)2·6H2O salt in the synthesis has been found to have little influence on the crystallite size. In contrast, the solvent-surfactant ratio (ω) is critical for a good particle growth. The spin transition of the nanocrystals has been characterized by magnetic susceptibility measurements and Mössbauer spectroscopy. The nanocrystals undergo an abrupt and more cooperative spin transition in comparison with the bulk compound. The spin transition is centered in the interval of temperature of 175-185 K and is accompanied by 8 K of thermal hysteresis width. The crystallite quality more than the crystallite size is responsible for the higher cooperativity. The magnetic properties of the nanocrystals embedded in organic polymers such as polyethylene glycol, nujol, glycerol, and triton have been studied as well. The spin transition in the nanocrystals is affected by the polymer coating. The abrupt and first-order spin transition transforms into a more continuous spin transition as a result of the chemical pressure asserted by the organic polymers on the Fe(II) centers.

Guest modulation of spin-crossover transition temperature in a porous iron(II) metal-organic framework: experimental and periodic DFT studies.

The synthesis, structure, and magnetic properties of three clathrate derivatives of the spin-crossover porous coordination polymer {Fe(pyrazine)[Pt(CN)4]} (1) with five-membered aromatic molecules furan, pyrrole, and thiophene is reported. The three derivatives have a cooperative spin-crossover transition with hysteresis loops 14-29 K wide and average critical temperatures Tc =201 K (1⋅fur), 167 K (1⋅pyr), and 114.6 K (1⋅thio) well below that of the parent compound 1 (Tc =295 K), confirming stabilization of the HS state. The transition is complete and takes place in two steps for 1⋅fur, while 1⋅pyr and 1⋅thio show 50 % spin transition. For 1⋅fur the transformation between the HS and IS (middle of the plateau) phases occurs concomitantly with a crystallographic phase transition between the tetragonal space groups P4/mmm and I4/mmm, respectively. The latter space group is retained in the subsequent transformation involving the IS and the LS phases. 1⋅pyr and 1⋅thio display the tetragonal P4/mmm and orthorhombic Fmmm space groups, respectively, in both HS and IM phases. Periodic calculations using density functional methods for 1⋅fur, 1⋅pyr, 1⋅thio, and previously reported derivatives 1⋅CS2 , 1⋅I, 1⋅bz(benzene), and 1⋅pz(pyrazine) have been carried out to investigate the electronic structure and nature of the host-guest interactions as well as their relationship with the changes in the LS-HS transition temperatures of 1⋅Guest. Geometry-optimized lattice parameters and bond distances in the empty host 1 and 1⋅Guest clathrates are in general agreement with the X-ray diffraction data. The concordance between the theoretical results and the experimental data also comprises the guest molecule orientation inside the host and intermolecular distances. Furthermore, a general correlation between experimental Tc and calculated LS-HS electronic energy gap was observed. Finally, specific host-guest interactions were studied through interaction energy calculations and crystal orbital displacement (COD) curve analysis.

A frequent splicing mutation and novel missense mutations color the updated mutational spectrum of classic galactosemia in Portugal.

Classic galactosemia is an autosomal recessive disorder caused by deficient galactose-1-phosphate uridylyltransferase (GALT) activity. Patients develop symptoms in the neonatal period, which can be ameliorated by dietary restriction of galactose. Many patients develop long-term complications, with a broad range of clinical symptoms whose pathophysiology is poorly understood. The high allelic heterogeneity of GALT gene that characterizes this disorder is thought to play a determinant role in biochemical and clinical phenotypes. We aimed to characterize the mutational spectrum of GALT deficiency in Portugal and to assess potential genotype-phenotype correlations. Direct sequencing of the GALT gene and in silico analyses were employed to evaluate the impact of uncharacterized mutations upon GALT functionality. Molecular characterization of 42 galactosemic Portuguese patients revealed a mutational spectrum comprising 14 nucleotide substitutions: ten missense, two nonsense and two putative splicing mutations. Sixteen different genotypic combinations were detected, half of the patients being p.Q188R homozygotes. Notably, the second most frequent variation is a splicing mutation. In silico predictions complemented by a close-up on the mutations in the protein structure suggest that uncharacterized missense mutations have cumulative point effects on protein stability, oligomeric state, or substrate binding. One splicing mutation is predicted to cause an alternative splicing event. This study reinforces the difficulty in establishing a genotype-phenotype correlation in classic galactosemia, a monogenic disease whose complex pathogenesis and clinical features emphasize the need to expand the knowledge on this "cloudy" disorder.