Mitochondrial fatty acid oxidation: a new perspective on metabolic regulation in respiratory diseases

Chronic respiratory diseases pose a major global public health challenge, and the role of metabolic reprogramming in their pathogenesis has attracted increasing attention. Mitochondrial fatty acid oxidation (FAO) is a core energy metabolic pathway that not only fuels pulmonary tissues but also participates in essential physiological processes such as alveolar surfactant synthesis. This review outlines the molecular mechanisms of mitochondrial FAO and focuses on its complex regulatory roles in chronic obstructive pulmonary disease, asthma, pulmonary fibrosis, acute lung injury/acute respiratory distress syndrome, lung cancer, and pulmonary arterial hypertension. We further summarize potential FAO-targeted therapeutic strategies, including small-molecule drugs, exercise and nutritional interventions, and active components of traditional Chinese medicine, based largely on preclinical evidence from animal models and in vitro studies. These findings provide a theoretical framework for future clinical research, though the direct clinical translatability remains to be validated.