Cited by 990Mitochondrial Function and PathologyGenetics, Aging, and Longevity in Model OrganismsAutophagy in Disease and Therapy

The DOI matches its Crossref record; 311 of the 311 references it cites were found in a registry or an index; 9 of the 309 sources its claims cite were checked for support.

Mitochondrial and metabolic dysfunction in ageing and age-related diseases

Open access

Abstract

Organismal ageing is accompanied by progressive loss of cellular function and systemic deterioration of multiple tissues, leading to impaired function and increased vulnerability to death. Mitochondria have become recognized not merely as being energy suppliers but also as having an essential role in the development of diseases associated with ageing, such as neurodegenerative and cardiovascular diseases. A growing body of evidence suggests that ageing and age-related diseases are tightly related to an energy supply and demand imbalance, which might be alleviated by a variety of interventions, including physical activity and calorie restriction, as well as naturally occurring molecules targeting conserved longevity pathways. Here, we review key historical advances and progress from the past few years in our understanding of the role of mitochondria in ageing and age-related metabolic diseases. We also highlight emerging scientific innovations using mitochondria-targeted therapeutic approaches. This Review discusses the role of mitochondria in metabolism and how mitochondria contribute to age-related metabolic diseases. This knowledge might guide us in designing therapies targeting metabolic disorders to extend human health span and lifespan. The rate of ageing is coordinated, at least in part, by conserved genetic and biochemical pathways. A complex network of interactions between longevity pathways reveals an intricate regulation of mitochondrial physiology during ageing. Cellular metabolism interconnects the nine hallmarks of ageing, and deregulation of energy metabolism by environmental variations is an essential process leading to mitochondrial dysfunction during ageing. A better understanding of mitochondrial dysfunction during ageing and age-related metabolic diseases will provide fundamental knowledge to develop therapies to combat late-life morbidities. Human longitudinal studies will be essential to understand individuals’ risk of diseases much earlier in life, and will inform health choices and medical care options. The rate of ageing is coordinated, at least in part, by conserved genetic and biochemical pathways. A complex network of interactions between longevity pathways reveals an intricate regulation of mitochondrial physiology during ageing. Cellular metabolism interconnects the nine hallmarks of ageing, and deregulation of energy metabolism by environmental variations is an essential process leading to mitochondrial dysfunction during ageing. A better understanding of mitochondrial dysfunction during ageing and age-related metabolic diseases will provide fundamental knowledge to develop therapies to combat late-life morbidities. Human longitudinal studies will be essential to understand individuals’ risk of diseases much earlier in life, and will inform health choices and medical care options.

Overview

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Written from the paper’s full text.

TL;DR

This review argues that mitochondria are central to ageing and age-related metabolic diseases through energy supply–demand imbalance, ROS, mtDNA mutations, senescence, inflammation, and crosstalk with conserved longevity pathways. It surveys lifestyle, pharmacological, NAD⁺-boosting, mitochondrial uncoupler, and mitochondria-targeted antioxidant interventions, while noting that many mechanisms and clinical translations remain unresolved.

Key findings

  • Mitochondrial dysfunction is linked to metabolic syndrome, type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease, vascular disease, and chronic inflammation. In islets from patients with T2DM, PGC1α expression was reduced by 90%, and PGC1α silencing in healthy human islets reduced insulin secretion.
  • mtDNA variation and copy number are associated with metabolic disease: the 16189T>C substitution in the D-loop is associated with obesity and T2DM in European and Asian populations; haplogroup N9A is likely protective against metabolic syndrome in Japanese women and against T2DM in Japanese and Korean populations; patients with metabolic syndrome show reduced mtDNA copies in peripheral blood and adipose tissue.
  • Interventions targeting mitochondrial physiology show mixed evidence: resveratrol improves mitochondrial function, reduces inflammation, and decreases lipid levels in patients with obesity; nicotinamide riboside at 2,000 mg per day was safe but did not improve insulin sensitivity or whole-body glucose metabolism in patients with obesity and insulin resistance; MitoQ improves vascular ageing in middle-aged and older adults aged 60–79 years; elamipretide reverses mitochondrial dysfunction in ageing human muscle.
  • The mtDNA mutator mouse accumulates mtDNA mutations and recapitulates premature ageing signs, including reduced lifespan, reduced fertility, anaemia, sarcopenia, osteoporosis, hair greying, hair loss, hearing loss, and elevated lactate; however, the role of mtDNA mutations as a primary ageing driver remains debated because mutation levels in normal aged tissues may be below the threshold needed to affect mitochondrial function.

Methods

  • Narrative review; no primary data are generated. It synthesizes mechanistic, preclinical, and clinical literature on mitochondrial and metabolic dysfunction in ageing and age-related diseases.
  • Covers conserved longevity pathways (IIS, mTOR, AMPK, sirtuins), mitochondrial dysfunction mechanisms (mtDNA mutations, genomic instability, cellular senescence, epigenetic alterations), age-related metabolic disorders, and therapeutic approaches.
  • Main analysis is qualitative synthesis, with figures and a table summarizing approaches targeting mitochondria and their clinical stage.

Limitations

  • Stated: how important mitochondria are to the ageing process remains under debate; the role of mtDNA mutations as a primary driver is still debated; mechanisms behind calorie restriction-driven longevity extension are poorly understood; further elucidation is needed for senescence, p66Shc, mTOR inhibition, and mtDNA epigenetics.
  • Stated: preclinical challenges include adequate disease modelling when considering biological age; clinical challenges include focusing on specific pathologies because of multi-organ functional decay during ageing.
  • Evident: as a narrative review, it does not report a systematic search, risk-of-bias assessment, or quantitative synthesis, so conclusions rely on selected cited studies.

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Integrity signals

Registry

Crossref · 10.1038/s41574-021-00626-7

Cites

311 of 311 references verified0 citation errors · 0 not checkable

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Claims the paper makes

223 Not checked yet · 23 Own interpretation · 4 No basis given · 3 Supported · 3 Partly supported · accuracy not yet measured

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  • It may state two separate claims as one. 129
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Citations

Cites

Show all 309 references

Research works printed but not linked: 2

  1. Wallace, D. C. The human mitochondrion and pathophysiology of aging and age-related diseases. in Molecular Biology of Aging 1st edn (eds. Guarente, L., Partridge, L. & Wallace, D. C.) 1–38 (Cold Spring Harbor Laboratory Press, 2008).
  2. Litvinova, L. S., Kirienkova, E. V., Mazunin, I. O., Vasilenko, M. A. & Fattakhov, N. S. Pathogenesis of insulin resistance in metabolic obesity. Biochem. Suppl. B Biomed. Chem. 8, 192–202 (2014).

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Metadata

Authors
Amorim, J. A., Coppotelli, G., Rolo, A. P., Palmeira, C. M., Ross, J. M., & Sinclair, D. A.
Affiliations
  • Harvard University (US)
  • Centro de Neurociências e Biologia Celular (PT)
Corresponding author
Sinclair, David A.
Venue
Nature Reviews Endocrinology
Published
2022-02-10
Volume
18
Issue
4
Pages
243-258
ISSN
  • 1759-5029 (ISSN-L)
  • 1759-5037
OpenAlex
W4211154726
Cited by
990
References
309
Citations by year
2026: 225 · 2025: 302 · 2024: 252 · 2023: 159 · 2022: 52
FWCI
19.91
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Journal of Media Literacy Education (submittedVersion, cc-by)
Funders
  • National Institute on Aging (R01AG028730, R00AG055683)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK100263)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Mitochondrial Function and Pathology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Aging › Genetics, Aging, and Longevity in Model Organisms
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Autophagy in Disease and Therapy
Keywords
mitochondrial dysfunction, metabolic dysfunction, aging, age-related diseases, energy homeostasis, caloric restriction, physical activity, longevity pathways, neurodegenerative diseases, cardiovascular disease, metabolic disorders
MeSH terms
Aging, Energy Metabolism, Humans, Metabolic Diseases, Mitochondria, Caloric Restriction

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