19To support cell survival, mitochondria must balance energy production with oxidative stress. Inner 20 ear hair cells are particularly vulnerable to oxidative stress; thus require tight mitochondrial regulation. 21 We identified a novel molecular regulator of the hair cells' mitochondria and survival: Pregnancy-22 associated plasma protein-aa (Pappaa). Hair cells in zebrafish pappaa mutants exhibit mitochondrial 23 defects, including elevated mitochondrial calcium, transmembrane potential, and reactive oxygen 24 species (ROS) production and reduced antioxidant expression. In pappaa mutants, hair cell death is 25 enhanced by stimulation of mitochondrial calcium or ROS production and suppressed by a 26 mitochondrial ROS scavenger. As a secreted metalloprotease, Pappaa stimulates extracellular insulin-27 like growth factor 1 (IGF1) bioavailability. We found that the pappaa mutants' enhanced hair cell loss 28 can be suppressed by stimulation of IGF1 availability and that Pappaa-IGF1 signaling acts post-29 developmentally to support hair cell survival. These results reveal Pappaa as an extracellular regulator 30 of hair cell survival and essential mitochondrial function. 31 32Without a sufficient regenerative capacity, a nervous system's form and function critically depends 33 on the molecular and cellular mechanisms that support its cells' longevity. Neural cell survival is 34 inherently challenged by the nervous system's high energy demand, which is required to support basic 35 functions, including maintaining membrane potential, propagating electrical signals, and coordinating 36 the release and uptake of neurotransmitters (Halliwell, 2006; Kann and Kovács, 2007; Howarth et al., 37 2012). Metabolic energy is primarily supplied by mitochondrial oxidative phosphorylation (Kann and 38 Kovács, 2007). Although this process is essential to cell survival, a cytotoxic consequence is the 39 generation of reactive oxygen species (ROS). Oxidative stress caused by ROS accumulation damages 40 vital cell components including DNA, proteins, and lipids (Schieber and Chandel, 2014). Neural cells 41 are particularly vulnerable to oxidative stress due not only to their energy demand and thereby ROS 42 production, but also to their relatively insufficient antioxidant capacity (Halliwell, 1992). This 43 heightened susceptibility to oxidative stress-mediated cell death is believed to underlie aging and 44 neurodegenerative disorders, including Alzheimer's disease (AD), Parkinson's disease (PD), and 45 Amyotrophic lateral sclerosis (ALS) (Perry et al., 2002; Barber et al., 2006; Mattson and Magnus, 46 2006; Blesa et al., 2015). 47 Hair cells of the inner ear are a population of neural cells that are particularly susceptible to 48 oxidative stress-induced death (Gonzalez-Gonzalez, 2017) These specialized sensory cells relay sound 49 and balance information to the central nervous system. Hair cell death or damage, which is irreversible 50 in mammals, is the primary cause of hearing loss, and is exacerbated by ag...