Otto Warburg first proposed that cancer originated from irreversible injury to mitochondrial respiration, but the structural basis for this injury has remained elusive. Cardiolipin (CL) is a complex phospholipid found almost exclusively in the inner mitochondrial membrane and is intimately involved in maintaining mitochondrial functionality and membrane integrity. Abnormalities in CL can impair mitochondrial function and bioenergetics. We used shotgun lipidomics to analyze CL content and composition in highly purified brain mitochondria from the C57BL/6J (B6) and VM/Dk (VM) inbred strains and from subcutaneously grown brain tumors derived from these strains to include an astrocytoma and ependymoblastoma (B6 tumors), a stem cell tumor, and two microgliomas (VM tumors). Major abnormalities in CL content or composition were found in all tumors. The compositional abnormalities involved an abundance of immature molecular species and deficiencies of mature molecular species, suggesting major defects in CL synthesis and remodeling. The tumor CL abnormalities were also associated with significant reductions in both individual and linked electron transport chain activities. A mathematical model was developed to facilitate data interpretation. Otto Warburg first proposed that the prime cause of cancer was impaired energy metabolism (1, 2). This impairment involved irreversible injury to cellular respiration that was followed in time by a gradual dependence on fermentation (glycolytic) energy to compensate for the energy lost from respiration. Cell viability requires a constant delta G′ of ATP hydrolysis of approximately 257 kJ/mol (3, 4). Most normal mammalian cells achieve this level of useable energy through respiration, whereas tumor cells achieve this level through a combination of respiration and glycolysis (2, 5). Indeed, elevated glycolysis is the metabolic hallmark of nearly all tumors, including brain tumors, and is the basis for tumor imaging using labeled glucose analogs (5-8). Much controversy has surrounded the Warburg theory, however, largely over issues regarding the Pasture effect and aerobic glycolysis (9-14). Numerous structural and biochemical abnormalities occur in tumor cell mitochondria that could compromise function, thus forcing a reliance on glycolysis for cell survival (5,6,9,(15)(16)(17). Although several prior studies have evaluated the lipid composition of tumor mitochondria (18)(19)(20)(21)(22)(23)(24)(25), no prior studies have evaluated both the content and the composition of cardiolipin (CL) in highly purified mitochondria isolated from brain tumors and from their orthotopic host tissue.CL (1,3-diphosphatidyl-sn -glycerol) is a complex mitochondrial-specific phospholipid that regulates numerous enzyme activities, especially those related to oxidative phosphorylation and coupled respiration (26-31). CL binds complexes I, III, IV, and V and stabilizes the super complexes (I/III/IV and II/III/IV), demonstrating an absolute requirement of CL for catalytic activity of these enzyme comp...