Mitochondrial metabolism, respiration, and ATP production necessitate ion transport across the inner mitochondrial membrane. Leucine zipper-EF-hand containing transmembrane protein 1 (Letm1), one of the genes deleted in Wolf-Hirschhorn syndrome, encodes a putative mitochondrial Ca 2+ /H + antiporter. Cellular Letm1 knockdown reduced Ca 2+ mito uptake, H + mito extrusion and impaired mitochondrial ATP generation capacity. Homozygous deletion of Letm1 in mice resulted in embryonic lethality before day 6.5 of embryogenesis and ∼50% of the heterozygotes died before day 13.5 of embryogenesis. The surviving heterozygous mice exhibited altered glucose metabolism, impaired control of brain ATP levels, and increased seizure activity. We conclude that loss of Letm1 contributes to the pathology of Wolf-Hirschhorn syndrome in humans and may contribute to seizure phenotypes by reducing glucose oxidation and other specific metabolic alterations. . Calcium-mediated signal transduction across the inner mitochondrial membrane (IMM) links increased metabolic demand to ATP production rate because Ca 2+ regulates key metabolic enzymes, metabolite transporters, and the F 1 F 0 H + -ATPase (1, 2). Excessive Ca 2+ accumulation reduces mitochondrial membrane potential (ΔΨ mito ), impairs ATP production, precipitates phosphate, and triggers cell death. Ca 2+ extrusion across the IMM represents a significant energy cost at normal ΔΨ mito (∼−180 mV) and thus mitochondrial Ca 2+ (Ca 2+ mito ) signaling is tightly controlled under physiological conditions (3-5).The mitochondrial Ca 2+ uniporter (MCU), a highly Ca 2+ -selective channel (6), dominates fast Ca 2+ mito uptake when [Ca 2+ ] cyto is high, significantly buffers extramitochondrial Ca 2+ , and depolarizes ΔΨ mito (7,8). Because the MCU's V max is orders of magnitude higher than that of Ca 2+ mito exchange mechanisms, repetitive high Ca 2+ cyto elevations trigger Ca 2+ mito overload and can lead to the mitochondrial permeability transition (9, 10). Free [Ca 2+ ] mito in intact cells usually fluctuates below the micromolar range, suggesting that Ca 2+ exchangers are crucial for maintaining Ca 2+ mito homeostasis at low Ca 2+ cyto levels to preserve mitochondrial homeostasis and bioenergetics. The Na + /Ca 2+ exchanger, Ca 2+ /H + antiporter, and potentially others, control Ca 2+ across the IMM. Mitochondrial transporters and channels are rapidly being identified (11).We previously performed a genome-wide RNAi screen in Drosophila S2 cells that identified Letm1 (leucine zipper-EFhand containing transmembrane protein 1) as a mitochondrial Ca 2+ /H + antiporter (12). Letm1 is an evolutionarily conserved, ubiquitously expressed IMM protein. Heterozygous deletion of a chromosomal region containing Letm1 is associated with WolfHirschhorn syndrome (WHS), a disease characterized by craniofacial defects, growth and mental retardation, muscle hypotonia, congenital heart defects, and seizures (13). In the current study, we generated Letm1-deficient mice and found that Letm1 knockdown reduced Ca...