The Role of Mitochondria in Polycystic Kidney Disease

Polycystic kidney disease (PKD) is a genetic disorder characterized by renal cyst formation and progressive renal dysfunction, where inflammation, immune responses, and metabolic dysregulation critically drive disease progression, while emerging evidence increasingly links its pathogenesis to mitochondrial dysfunction. Mitochondria, central to cellular energy production, metabolism, and redox homeostasis, exhibit profound abnormalities in PKD, contributing to disease pathogenesis. Current evidence on mitochondrial mechanisms driving PKD progression includes metabolic reprogramming, oxidative stress, disrupted mitochondrial dynamics, and impaired mitophagy. Polycystic kidney disease is caused by mutations in the PKD1 or PKD2 genes, which encode polycystin 1 and polycystin 2. The formation of dysfunctional polycystins (PC1/PC2) is a key event in the pathogenesis of this disease, triggering impaired calcium signaling, increased production of mitochondrial reactive oxygen species (ROS), and reduced oxidative phosphorylation, thereby promoting cyst growth and fibrosis. Key signaling pathways such as mTORC1 hyperactivation, AMPK suppression, and disrupted calcium homeostasis further exacerbate mitochondrial defects. Emerging therapeutic strategies targeting mitochondrial pathways, such as mitochondrial antioxidants, modulators of mitophagy, calcium signaling regulators, and metabolic reprogramming agents, show promise in preclinical models. However, challenges remain in translating these findings to clinical applications, including drug specificity and minimizing off-target effects. This review underscores mitochondria as pivotal players in PKD pathogenesis and highlights their potential as therapeutic targets to mitigate cystogenesis and disease progression.