Our findings revealed that in CSCC patients, the downregulation of TCA-cycle genes such as COX6A1, COX7B, ATP5H, COQ10A, NDUFA1, NDUFA5, NDUFA6, NDUFA8, NDUFA12, and NDUFC1 may be related to molecular changes in cancer cells, reflecting a shift in metabolic pathways37. The gene discussed is NDUFA1; the disease is cancer.