<h3>Objective:</h3> To investigate the role of lipid dysmetabolism in the neurological phenotype of primary and secondary CoQ<sub>10</sub> deficiencies. <h3>Background:</h3> CoQ<sub>10</sub> is a lipid molecule. Biosynthesis of CoQ<sub>10</sub> and cholesterol are linked via a common upstream pathway, specifically, the first enzyme of CoQ<sub>10</sub> biosynthesis, decaprenyl diphosphate synthase (PDSS1/PDSS2) utilizes geranylgeranyl-diphosphate (GGdP), a substrate generated by the mevalonate pathway, which is responsible for the <i>de novo</i> synthesis of cholesterol. Deficiency of CoQ<sub>10</sub> can be primary, due to a biosynthetic defect, or secondary to proteins not directly related to CoQ<sub>10</sub> biosynthesis. In both forms of CoQ<sub>10</sub> deficiency, there is clinical heterogeneity, but patients often present neurological conditions including Leigh syndrome and cerebellar ataxia. Phenotype variability might be due to molecular heterogenicity, multiple functions of CoQ<sub>10</sub>, and/or tissue-specific mechanisms. The effects of CoQ<sub>10</sub> deficiency on lipid dysmetabolism in these diseases is unknown. <h3>Design/Methods:</h3> We used control and CoQ<sub>10</sub> deficient fibroblasts carrying mutations in PDSS2, COQ8A and APTX, to generate iPSCs, which were differentiated into neurons. To characterize lipid metabolism in the neurons, we performed lipidomics, transcriptional analyses, western blots, immunostaining, and biochemical and molecular assays. To characterize causal relationship between abnormal CoQ<sub>10</sub> and cholesterol metabolism, we pharmacologically manipulated the mevalonate pathway, and its CoQ<sub>10</sub> and cholesterol branches in SH-SY5Y neuronal lines. <h3>Results:</h3> Neurons with primary CoQ<sub>10</sub> deficiency showed significant impairment in fatty acids oxidation, sphingolipids biosynthesis, and cholesterol homeostasis, which were reproduced by inhibition of CoQ<sub>10</sub> deficiency in SH-SY5Y neurons. APTX mutant neurons, a model of secondary CoQ<sub>10</sub> deficiency, showed sphingolipids biosynthesis, and cholesterol homeostasis alterations, which were reproduced by inhibition of the mevalonate pathway in SH-SY5Y neurons. <h3>Conclusions:</h3> Primary and secondary forms of CoQ<sub>10</sub> deficiency are associated with alterations in lipid metabolism including cholesterol biosynthesis in neurons. <b>Disclosure:</b> Dr. Pesini Martin has nothing to disclose. Giacomo Monzio-Compagnoni has nothing to disclose. Miss Barriocanal has nothing to disclose. Dr. Hidalgo Gutierrez has received personal compensation for serving as an employee of Columbia University. Giulio Kleiner has nothing to disclose. Giussepe A Yanez has nothing to disclose. Mohamed Bakkali has nothing to disclose. Dr. Monfrini has nothing to disclose. Yashpal S Chhonker has nothing to disclose. Saba Tadesse has nothing to disclose. Dr. Larrea has nothing to disclose. Dr. Murry has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Finley law. Caterina Mariotti has nothing to disclose. Barbara Castellotti has nothing to disclose. Luis Lopez has nothing to disclose. Alessio Di Fonzo has nothing to disclose. Estela Area-Gomez has nothing to disclose. Catarina M Quinzii has nothing to disclose.
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