Background: Metachromatic leukodystrophy (MLD) is a neurological lysosomal deposit disease that has an impact on public health despite its low incidence in the population. Existing treatments are expensive and inefficient. Few reports in the literature on pathophysiological events related to enzyme deficiency and subsequent accumulation of sulfatides; therefore, the use of metformin as an alternative treatment was evaluated in vitro to counteract the effects. Methodology: An experimental in

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... o study that sought to determine the effect of the use of metformin on the accumulation of sulfates in glycolysis and mitochondrial function in an in vitro model of metachromatic leukodystrophy. Human Schwann cells (CSH) transfected with CRISPR Cas9 and without transfection were treated with different concentrations of sulfatides and metformin. Cell viability was evaluated by MTT and SYTOX Green; mitochondrial and glycolytic function by Seahorse XFe24, determination of reactive oxygen species (ROS) and cell death. Results: In the MTT trials, we found that treatment with different concentrations of sulfates did not affect cell viability. Transfected CSH showed higher cell death and ROS production when exposed to 100 µM sulfatides with a statistically significant difference (p <0.001), compared to nontransfected CSH cells. Sulfatides at concentrations of 10 to 100 µM affect mitochondrial bioenergetics as concentrations increase in transfected cells, in nontransfected cells they respond metabolically to exposure; Furthermore, transfected cells show a decrease in basal respiration and maximum respiration after being exposed to a concentration of 100 µM of sulphates; however, in double treatment of these cells with both sulfates and Metformin, respiration also decreases. Maximum and normal mitochondrial respiratory capacity. Conclusion: This research describes for the first time the generation of transfected CSH and the bioenergetic and mitochondrial effect of sulfates in Schwann cells, treatment with 500 µM of Metformin restores metabolic activity of these cells and decreases ROS production, as well as prevention of cell death.