Nevertheless, in MSA brains, a reduction in two enzymes involved in CoQ10 synthesis (decaprenyl diphosphate synthase subunit 1—PDSS1 and coenzyme Q5, methyltransferase—COQ5) has been found (Barca et al., 2016; Monzio Compagnoni et al., 2018b). This evidence concerns the gene COQ5 and multiple system atrophy.