Objective Aceruloplasminemia is an iron metabolic disorder caused by mutations in the ceruloplasmin gene. It is characterized by progressive neurodegeneration in association with iron accumulation. Excess iron functions as a potent catalyst of biologic oxidation. Previously we showed that an increased iron concentration is associated with the products of lipid peroxidation in the serum, cerebrospinal fluid, and brain tissues. To clarify the free radical-mediated tissue injury caused by intracellular iron accumulation through mitochondrial dysfunction. Patients and MethodsWehave measure brain oxygen and glucose metabolisms using positron emission tomography (PET) and examined brains at autopsy for iron contents and activities of the mitochondrial respiratory chain in two affected patients whohad different truncation mutations of the ceruloplasmin gene. Results PET showed a marked decrease in glucose and oxygen consumption in the entire brain of aceruloplasminemia patients, with a preponderance of metabolic reduction in basal ganglia. Enzymeactivities in the mitochondrial respiratory chain of the basal ganglia were reduced to approximately 45% and 42%respectively for complexes I and IV. Aninverse relationship was shown between the amounts of iron accumulated and the levels of mitochondrial enzymeactivities in all the brain regions examined. Conclusion Iron-mediated free radicals maycontribute to the impairment of mitochondrial energy metabolism in aceruloplasminemia. (Internal Medicine 41: 186-190, 2002)