Hepatic steatosis is associated with mitochondrial oxidative alterations. This study aimed to characterize in a choline-deficient model of rat fatty liver whether this oxidative imbalance is related to an impairment of the capacity of ATP synthesis both under fed conditions and after starvation, which may sensitize mitochondria to oxidative injury. Mitochondria were isolated from normal and fatty livers of fed or 18-hour fasted rats. Oxidative injury was evaluated by measuring the mitochondrial content of thiobarbituric reactive substances, protein carbonyls, glutathione, and protein sulfhydryls. The mitochondrial F 0 F 1 -ATP synthase content, tissue ATP concentration, and liver histology were also determined. Compared with normal liver, under fed conditions, fatty livers showed a greater mitochondrial content of oxidized lipids and proteins together with a low concentration of sulfhydryls and glutathione. The mitochondrial catalytic -F 1 subunit of the F 0 F 1 -ATP synthase was about 35% lower in fatty livers. Hepatic ATP was also significantly reduced in fatty liver. Starvation exacerbated mitochondrial oxidative injury in both groups but to a greater extent in fatty livers. In the steatotic group, fasting induced a significant decrease of the ATP levels, which was accompanied by a 70% fall of the catalytic -F 1 subunit. These data indicate that the mitochondrial oxidative alterations in fatty livers are associated with an important reduction of the F 0 F 1 -ATP synthase. These changes, which are greatly exacerbated after starvation, may account for the reduced synthesis of the hepatic ATP observed in the presence of fatty infiltration. (HEPATOLOGY 2001;33:808-815.)Hepatic steatosis without concomitant inflammation or fibrosis, is usually considered a benign condition. However, fatty degeneration increases the sensitivity of the liver to several types of injury, such as those due to ischemia-reperfusion 1 or drug toxicity. 2 Fatty infiltration is associated with a number of intracellular disorders, which can be either a cause or a consequence of lipid accumulation. 3 Among them, mitochondrial abnormalities related to an increased generation of reactive oxygen species have been described in human steatosis of various etiology (alcoholic 4 and nonalcoholic steatohepatitis, 5 iron, 6 or copper 7 overload) and in several experimental models of fatty liver, including alcohol administration 8 and drug toxicity. 2,9 Mitochondrial oxidative injury has been also described in conditions of chronic administration of commonly used drugs, such as valproate 10 or amiodarone, 11 the hepatic metabolites of which are known to interfere with mitochondrial respiration and fatty acid metabolism, thus producing fatty degeneration.Oxidative metabolism in mitochondria represent the main source of energy for the cells. Alterations of specific mitochondrial functions may, therefore, lead to an impaired production of ATP and a reduced uptake of substrates for mitochondrial metabolism 12 and eventually limit resistance and survival o...