Amyotrophic lateral sclerosis is a fatal neurodegenerative disease that affects motor neurons. The recruitment of autophagy (macroautophagy) and mitochondrial dysfunction are documented in amyotrophic lateral sclerosis patients and experimental models expressing mutant forms of Cu, Zn superoxide dismutase (SOD1) protein, but their impact in the disease remains unclear. Hypoxia is a stress closely related to the disease in patients and mutant SOD1 mice; in individual cells, hypoxia activates autophagy and regulates mitochondrial metabolism as fundamental adaptive mechanisms. Our aim was to examine whether mutant SOD1 changed this response. Hypoxia (1% O 2 for 22 h) caused greater loss of viability and more marked activation of caspase 3/7 in the motor neuronal NSC-34 cell line stably transfected with the G93A mutant human SOD1 (G93A-NSC) than in the one with the wild-type SOD1 (WT-NSC) or in untransfected NSC-34. In the G93A-NSC cells, there was a more marked accumulation of the LC3-II autophagy protein, attributable to autophagic stress; 3-methyladenine, which acts on initiation of autophagy, fully rescued G93A-NSC viability and reduced the activation of caspase 3/7 indicating this was a secondary event; the metabolic handling of hypoxia was inappropriate possibly contributing to the autophagic stress. Our findings evidentiate that the G93A mutation of SOD1 profoundly altered the adaptive metabolic response to hypoxia and this could increase the cell susceptibility to this stress. Keywords: 3-methyladenine, amyotrophic lateral sclerosis, autophagy, Cu, Zn superoxide dismutase, hypoxia, mitochondria. Amyotrophic lateral sclerosis (ALS) is the most common adult-onset motor neuron neurodegenerative disease; it is rapidly fatal and has no therapy (Robberecht and Philips 2013). ALS is traditionally classified into familial and sporadic ALS (FALS and SALS), which are clinically very similar. FALS is caused by mutations in a heterogeneous group of genes; approximately 2% of ALS patients have mutations in the Cu, Zn superoxide dismutase (SOD1) gene; more than 150 different mutations, distributed in all the exons coding for the protein, have been reported to be pathogenic; their pathophysiological role is not clear, however, the mechanism(s) of toxicity is independent of the dismutase activity (Duffy et al. 2011;Robberecht and Philips 2013). In vitro and in vivo models over-expressing mutant forms of SOD1 are widely used for deciphering the neurodegenerative mechanisms involved in ALS.Hypoxia is a risk factor for neurodegenerative diseases including Alzheimer's disease, the main cause of dementia, (Zhang and Le 2010) and it is a stress which is closely related Received November 18, 2013; revised manuscript received December 13, 2013; accepted December 17, 2013. Address correspondence and reprint requests to Lavinia Cantoni, Laboratory of Molecular Pathology, IRCCS-Istituto di Ricerche Farmacologiche "Mario Negri", Via G. La Masa 19, 20156 Milan, Italy. E-mail: lavinia.cantoni@marionegri.it 1 These authors cont...