Intercellular Mitochondrial Transfer and Mitochondrial Transplantation in Cardiovascular Disease

Mitochondria have traditionally been regarded as intracellular powerhouses; however, they are now recognized as dynamic intercellular signaling organelles capable of moving between cells to coordinate tissue adaptation and repair. This Review examines the emergence of mitochondria transfer as a fundamental mechanism of cardiovascular communication, integrating current evidence for the exchange of intact mitochondria, mitochondrial DNA, and mitochondrial components among cardiomyocytes, endothelial cells, vascular smooth muscle cells, fibroblasts, and immune cells. We discuss the major routes of mitochondria transfer, including tunneling nanotubes, extracellular vesicles, gap junction-associated pathways, and extracellular mitochondrial release, together with the molecular machinery governing mitochondrial trafficking, such as MIRO proteins, TRAK adaptors, and cytoskeletal motor complexes. By reshaping cellular bioenergetics, redox homeostasis, metabolic signaling, and innate immune responses, transferred mitochondria exert profound effects on cardiovascular homeostasis and disease, influencing ischemia-reperfusion injury, heart failure, vascular remodeling, and inflammatory vascular disorders. We further evaluate recent advances in mitochondria transplantation, engineered mitochondrial donor platforms, and emerging imaging technologies that enable tracking of mitochondrial fate in vivo. Finally, we propose an integrated mechanistic framework in which the biological consequences of mitochondria transfer and mitochondria transplantation are determined by donor-recipient compatibility, mitochondrial quality, and the surrounding microenvironment, thereby explaining their context-dependent protective, maladaptive, and immunomodulatory effects. By identifying critical gaps in molecular mechanisms, methodological standardization, and clinical validation, this Review outlines a roadmap for translating mitochondria-based therapeutic strategies into precision cardiovascular medicine.