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Published on: April 1, 2022
Beyond Supportive Care: Mitochondria as a Strategic Therapeutic Avenue in Acute Pancreatitis
Serge Chooklin1, Serhii Chuklin2
1Surgical Center, Saint Paraskeva Medical Center, Lviv, Ukraine. chooklin_serge@hotmail.com.
Purpose:
To synthesize experimental and clinical evidence on mitochondria-targeted strategies in acute pancreatitis (AP) and evaluate the potential of interventions that preserve or restore mitochondrial function to reduce pancreatic injury and systemic complications.
Methods:
We conducted a narrative review of PubMed, Scopus, and Google Scholar through 2025, focusing on preclinical and clinical studies assessing mitochondrial structure/function or interventions targeting mitochondrial pathways in AP. Outcomes included mitochondrial membrane potential (ΔΨm), ATP content, mitochondrial reactive oxygen species (mtROS), mitochondrial permeability transition pore (mPTP) opening, calcium handling, mitophagy and biogenesis markers (e.g., PINK1/Parkin, PGC-1α/NRF1/TFAM), and cell death, with selective inclusion of early clinical data.
Results:
Multiple mitochondria-targeted strategies consistently mitigated pancreatic injury in cellular and animal models of AP. Bioenergetic support with L-carnitine, NAD+ precursors, coenzyme Q10, deoxyarbutin, and melatonin restored ATP levels and stabilized ΔΨm, while ΔΨm preservation and mPTP modulation by irisin, cyclosporine/NIM811, and TRO40303 limited necrosis. Redox modulation using Nrf2 activators (sulforaphane, paeonol, hydroxytyrosol, curcumin), MitoTEMPO, tiron, and hydrogen-rich saline reduced mtROS production and inflammasome activation, although MitoQ and SkQ1 showed mixed or adverse effects. Restraining pathological calcium flux through ruthenium red-mediated MCU inhibition prevented Ca2+-induced mitochondrial collapse, and enhancement of organelle quality control via rapamycin, urolithin A, selenium, and trehalose promoted mitophagy and mitochondrial biogenesis. Several interventions also attenuated extra-pancreatic organ injury. However, evidence remains predominantly preclinical, heterogeneous, and limited by challenges in targeted delivery across the hemato-pancreatic barrier.
Conclusion:
Mitochondria-targeted therapies offer a mechanistically grounded strategy to reduce AP severity. Key priorities include optimizing pharmacokinetics and targeting, harmonizing experimental and clinical endpoints, and conducting rigorously designed clinical trials to translate preclinical benefits into meaningful patient outcomes.
Insights
Mitochondria-targeted therapies show promise for acute pancreatitis (AP) by preserving mitochondrial function and reducing injury. Further research is needed to optimize delivery and conduct clinical trials for patient benefit.
Area of Science:
- Biochemistry
- Cell Biology
- Pharmacology
Background:
- Mitochondrial dysfunction plays a critical role in the pathogenesis of acute pancreatitis (AP).
- Targeting mitochondria offers a promising therapeutic avenue to mitigate pancreatic injury and systemic complications in AP.
Purpose of the Study:
- To review and synthesize evidence on mitochondria-targeted strategies for AP.
- To evaluate interventions aimed at preserving or restoring mitochondrial function to reduce AP severity.
Main Methods:
- A narrative review of preclinical and clinical studies was performed.
- Searched databases included PubMed, Scopus, and Google Scholar.
- Evaluated outcomes related to mitochondrial structure, function, and targeted interventions in AP models.
Main Results:
- Mitochondria-targeted strategies demonstrated efficacy in reducing pancreatic injury in preclinical models.
- Interventions included bioenergetic support, redox modulation, calcium flux control, and enhancement of organelle quality control.
- Some agents showed mixed or adverse effects, and delivery across the hemato-pancreatic barrier remains a challenge.
Conclusions:
- Mitochondria-targeted therapies provide a mechanistically sound approach to managing AP.
- Optimizing drug delivery, standardizing endpoints, and conducting robust clinical trials are crucial for translating findings into patient care.
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