23Transition metals are co-factors for a wide range of vital enzymes, and are directly or indirectly 24 involved in the response against reactive oxygen species (ROS), which can damage cellular 25 components. Their altered homeostasis has been studied in neurodegenerative disorders such as 26Alzheimer's disease (AD), Parkinson's disease (PD) and Amyotrophic Lateral Sclerosis (ALS), but 27 no data are available on rarer conditions. 28We aimed at studying the role of essential trace elements in Ataxia-Telengiectasia (A-T), a rare 29 form of paediatric autosomal recessive cerebellar ataxia with altered antioxidant response. We 30 found an increased level of copper (Cu, p=0.0002), and a reduced level of zinc (Zn, p=0.0002) in 31 the blood of patients (n. 16) compared to controls, using inductively coupled plasma mass 32 spectrometry (ICP-MS). Other trace elements involved in the oxidative stress response, such as 33 manganese (Mn) and selenium (Se) were unaltered. Cu/Zn-dependent superoxide dismutase 34 (SOD1) was shown to have a 30% reduction in gene expression and 40% reduction in enzyme 35 activity upon analysis of lymphoblastoid cell lines of patients (Student's t-test, p=0.0075). We also 36 found a 30% reduction of Mn-SOD (SOD2; Student's t-test, p=0.02), probably due to a feedback 37 regulatory loop between the two enzymes. The expression of antioxidant enzymes, such as 38 erythrocyte glutathione peroxidase (GPX1), and SOD2 was unaltered, whereas catalase (CAT) was 39 increased in A-T cells, both at the mRNA level and in terms of enzyme activity (~25%). Enhanced 40 CAT expression can be attributed to the high ROS status, which induces CAT transcription. 41