The human isoform 2 of pantothenate kinase (PanK2) is localized to the mitochondria, and mutations in this protein are associated with a progressive neurodegenerative disorder. PanK2 inhibition by acetyl-CoA is so stringent (IC50 < 1 M) that it is unclear how the enzyme functions in the presence of intracellular CoA concentrations. Palmitoylcarnitine was discovered to be a potent activator of PanK2 that functions to competitively antagonize acetyl-CoA inhibition. Acetyl-CoA was a competitive inhibitor of purified PanK2 with respect to ATP. The interaction between PanK2 and acetylCoA was stable enough that a significant proportion of the purified protein was isolated as the PanK2⅐acetyl-CoA complex. The longchain acylcarnitine activation of PanK2 explains how PanK2 functions in vivo, by providing a positive regulatory mechanism to counteract the negative regulation of PanK2 activity by acetyl-CoA. Our results suggest that PanK2 is located in the mitochondria to sense the levels of palmitoylcarnitine and up-regulate CoA biosynthesis in response to an increased mitochondrial demand for the cofactor to support -oxidation.carnitine ͉ coenzyme A ͉ -oxidation ͉ pantothenate kinase-associated neurodegeneration P antothenate kinase (PanK) catalyzes the first and ratecontrolling step in the biosynthesis of CoA (for review, see ref. 1). In humans, there are three genes that express four isoforms of PanK. PanK1␣ and 1 arise from the use of alternate initiation exons of the PANK1 gene (2, 3), and the PANK3 gene produces a single polypeptide (4). The PANK2 gene differs from the others in that it encodes a protein that is targeted to the mitochondria (5-7). The PanK2 protein translated from the most 5Ј start site is sequentially cleaved at two sites by mitochondrial processing peptidases, generating a long-lived 48-kDa mature protein (5). Two shorter PanK2 isoforms have been described, one of which also localizes to mitochondria (7), whereas the second does not because of the lack of targeting sequences (6). A common feature of all PanK proteins is that they are feedback inhibited by CoA thioesters (1); however, the isoforms are distinguished by their unique sensitivities to the CoA thioester pool (2-4, 8). A fourth gene, PANK4, lacks the essential catalytic glutamate residue present in all other enzymes (9) and may not be a functional PanK.The PanK2 isoform is the focus of much current research because mutations in the human PANK2 gene give rise to PanK-associated neurodegeneration (PKAN), an inherited autosomal recessive disease (10). PKAN patients constitute a subset of those diagnosed with neurodegeneration with brain iron accumulation, formerly known as Hallervorden-Spatz syndrome (11). PKAN patients have a pathological accumulation of iron in the basal ganglia and a combination of motor symptoms in the forms of dystonia, dysarthria, intellectual impairment, and gait disturbance (11). Early-onset patients have a rapidly progressive disease, and late-onset patients have a slowly progressive, atypical disease, where park...