Short-chain
quinones are described as potent
antioxidants and in the case of
idebenone have already been under clinical investigation for the treatment of neuromuscular disorders. Due to their analogy to
coenzyme Q10 (
CoQ10), a long-chain
quinone, they are widely regarded as a substitute for
CoQ10. However, apart from their
antioxidant function, this provides no clear rationale for their use in disorders with normal
CoQ10 levels. Using recombinant
NAD(P)H:
quinone oxidoreductase (NQO)
enzymes, we observed that contrary to
CoQ10 short-chain
quinones such as
idebenone are good substrates for both NQO1 and
NQO2. Furthermore, the reduction of short-chain
quinones by NQOs enabled an
antimycin A-sensitive transfer of electrons from cytosolic
NAD(P)H to the mitochondrial respiratory chain in both human
hepatoma cells (HepG2) and freshly isolated mouse hepatocytes. Consistent with the substrate selectivity of NQOs, both
idebenone and
CoQ1, but not
CoQ10, partially restored cellular
ATP levels under conditions of impaired complex I function. The observed cytosolic-mitochondrial shuttling of
idebenone and
CoQ1 was also associated with reduced
lactate production by cybrid cells from
mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (
MELAS) patients. Thus, the observed activities separate the effectiveness of short-chain
quinones from the related long-chain
CoQ10 and provide the rationale for the use of short-chain
quinones such as
idebenone for the treatment of
mitochondrial disorders.