Deficiency of cytochrome c oxidase (COX) is associated with significant pathology in humans. However, the consequences for organogenesis and early development are not well understood. We have investigated these issues using a zebrafish model. COX deficiency was induced using morpholinos to reduce expression of CoxVa, a structural subunit, and Surf1, an assembly factor, both of which impaired COX assembly. Reduction of COX activity to 50% resulted in developmental defects in endodermal tissue, cardiac function, and swimming behavior. Cellular investigations revealed different underlying mechanisms. Apoptosis was dramatically increased in the hindbrain and neural tube, and secondary motor neurons were absent or abnormal, explaining the motility defect. In contrast, the heart lacked apoptotic cells but showed increasingly poor performance over time, consistent with energy deficiency. The zebrafish model has revealed tissue-specific responses to COX deficiency and holds promise for discovery of new therapies to treat mitochondrial diseases in humans.Cytochrome c oxidase (COX) 2 is the terminal enzyme in the mitochondrial respiratory chain. Embedded in the inner mitochondrial membrane, COX couples the vectoral movement of protons across the inner membrane to the transfer of electrons from reduced cytochrome c to molecular oxygen. Mammalian COX consists of 13 subunits, 10 of which (COXIV-COXVIII) are encoded by nuclear DNA. The other three subunits (COXI, COXII, and COXIII) are encoded by the mitochondrial DNA (mtDNA) and constitute the hydrophobic/catalytic core of the enzyme. Assembly of COX is a complicated process involving multiple assembly factors and chaperones, including COX10 -11, COX15-20, COX23, SCO1, SCO2, and SURF1 (1). Deficiency in COX activity is associated with significant pathology usually affecting highly metabolic tissues, including brain, muscle, and eyes (2, 3). For example, COX deficiency is commonly associated with Leigh syndrome, an early-onset disorder resulting in progressive central nervous system degeneration and early lethality (4, 5). The majority of cases of COX-deficient Leigh syndrome are a result of mutations in SURF1, which encodes a COX assembly factor (6, 7). Mutations in SURF1 impair the incorporation of subunit II, resulting in a buildup of an early COX assembly intermediate, decrease in other COX subunits, and a decrease in COX activity (8 -11). COX deficiency may also be complicated by cardiac pathology, including hypertrophic and dilated cardiomyopathies (12, 13), and conduction defects (14).COX deficiency is detrimental during the prenatal period as well. The incidence of this disorder has prompted the application of COX activity assays to prenatal samples obtained by chorionic villus biopsy and amniocentesis in specific cases (15,16). Prenatal diagnostics of this type have preparatory value for parents and physicians and may also be used to explain previous pregnancy losses (17). However, our incomplete understanding of the metabolic requirements of different tissues and ...