Mutations in CHCHD10, coding for a mitochondrial intermembrane space protein, are a rare cause of autosomal dominant amyotrophic lateral sclerosis (ALS). Mutation-specific toxic gain of function or haploinsuffuciency models have been proposed to explain pathogenicity. To decipher the metabolic dysfunction associated with the haploinsufficient p.R15L variant we integrated transcriptomic, metabolomic and proteomic data sets in patient cells subjected to nutrient stress. Patient cells had a complex I deficiency resulting in an increased NADH/NAD+ ratio, downregulation of the TCA cycle, and a reorganization of one carbon metabolism. This led to phosphorylation of AMPK, activation of an endoplasmic reticulum and mitochondrial unfolded protein response (UPR), and the production of GDF15 and FGF21, which are markers of mitochondrial disease. The endoplasmic reticulum UPR was mediated through the IRE1/XBP1 pathway, and was accompanied by reduced eIF2alpha phosphorylation, dephosphorylation of both JNK isoforms, and up regulation of several dual specific phosphatases. This study demonstrates that loss of CHCHD10 function elicits a striking energy deficit that activates cellular stress pathways, which may underlie the selective vulnerability of motor neurons. ### Competing Interest Statement The authors have declared no competing interest.
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