Mitochondrial Dynamics as Determinants of Cancer Drug Resistance: A Systematic Review

Mitochondria continuously undergo fission and fusion processes, and this dynamic balance is essential for maintaining proper cellular function. Disruption of this balance can lead to cellular dysfunction, making cancer cells more resistant, increasing their metastatic potential, and promoting tumor growth. In this review, we examine how dysregulation of proteins involved in mitochondrial dynamics contributes to drug resistance. We also discuss emerging therapeutic strategies aimed at correcting mitochondrial dysfunction to enhance the effectiveness of cancer therapies.

This review synthesizes recent research on mitochondrial dynamics in cancer. It focuses on key proteins DRP1, MFN1, MFN2, and OPA1 and their roles in mitochondrial fission, fusion, and clearance. The review also integrates current understanding of these processes at the cellular level with emerging findings from studies on drug-resistant cancers.

When proteins such as DRP1, MFN1, MFN2, and OPA1 are dysregulated, cancer cells develop mechanisms to survive treatments. These cells alter mitochondrial function, affecting energy production, reactive oxygen species management, and susceptibility to apoptosis. In drug-resistant tumors, mitochondria undergo dynamic remodeling, fusing or dividing depending on cellular requirements. Additionally, mitophagy removes damaged mitochondria while preserving functional ones, further enhancing the survival and resilience of these cells.

When mitochondria undergo such adaptations, cancer cells can survive hostile environments and evade conventional therapies. Targeting these processes offers therapeutic opportunities: inhibitors of DRP1 can prevent abnormal mitochondrial fission, while modulation of OPA1 or other fusion proteins can restore healthy mitochondrial structure and promote apoptosis. By focusing on mitochondrial dynamics, new strategies emerge to overcome drug resistance by disrupting cancer cell metabolism and organelle homeostasis.

This review underscores the potential of mitochondrial dynamics as a promising new target in cancer therapy. Examining the regulation of mitochondrial fission and fusion, the clearance of damaged mitochondria, and the dysregulation of key proteins reveals potential therapeutic opportunities. Furthermore, recent drugs that modulate these processes offer strategies to enhance the durability of cancer treatments and overcome drug resistance.