Caveolins, Cav1-3, are oligomeric proteins critical for the formation of membrane caveolae that regulate cell physiology. A de novo frameshift mutation (Cav1F160X) in Cav1 (Cav1M) was described in a patient with a progeria-like phenotype, lipodystrophy, and pulmonary hypertension. We hypothesize that Cav1M presents as a dominant negative protein that perturbs cellular physiology, particularly nuclear morphology, mitochondrial function, plasma membrane structure, and exocytic behavior. Transmission electron microscopy (TEM) of patient-derived dermal fibroblasts (Cav1M) showed abnormal nuclear shape, increased rough endoplasmic reticulum, and an increased number of autophagosomes. Cav1M cells present an abnormal mitochondrial size and shape, accompanied by a reduced mitochondrial capacity for energy production detected by Seahorse real-time oximetry analysis. In addition, we observed in the patient’s fibroblasts an altered pattern of Cav1 expression and distribution, with less Cav1 in caveolae membrane fractions, together with a reduced membrane cholesterol concentration and number of caveolae. Electron paramagnetic spectroscopy shows an altered localization of proteins commonly found in caveolae fractions and increased membrane fluidity. Interestingly, Cav1M fibroblasts showed 4-fold increase in exosome secretion. Nanoparticle tracking and TEM analysis revealed a significant reduction in nanoparticle size in Cav1M-derived exosomes. Normal human dermal fibroblasts (HDF) treated to express Cav1M (Cav1M1-159) or exogenously exposed to exosomes isolated from Cav1M fibroblasts showed altered nuclear morphology, exosome secretion profile, proteomics, and miRNA analysis. Our results indicate that mutations in the C-terminus of Cav1 lead to significant cellular alterations at different levels that can lead to morpho-functional features, energetic imbalances, membrane ultrastructure abnormalities, and exosome secretion and signaling alterations. These findings suggest a novel role of Cav1 that links several aspects of cell physiology, from plasma and nuclear membrane dynamics to exocytic behavior, that have potential implications in cellular communication impacting physiology and pathophysiology. 5R01HL091071. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.