Mitochondria are essential for the activity, function and viability of eukaryotic cells and mitochondrial dysfunction is involved in the pathogenesis of acute kidney injury (AKI) and chronic kidney disease, as well as in abnormal kidney repair after AKI. Multiple quality control mechanisms, including antioxidant defence, protein quality control, mitochondrial DNA repair, mitochondrial dynamics, mitophagy and mitochondrial biogenesis, have evolved to preserve mitochondrial homeostasis under physiological and pathological conditions. Loss of these mechanisms may induce mitochondrial damage and dysfunction, leading to cell death, tissue injury and, potentially, organ failure. Accumulating evidence suggests a role of disturbances in mitochondrial quality control in the pathogenesis of AKI, incomplete or maladaptive kidney repair and chronic kidney disease. Moreover, specific interventions that target mitochondrial quality control mechanisms to preserve and restore mitochondrial function have emerged as promising therapeutic strategies to prevent and treat kidney injury and accelerate kidney repair. However, clinical translation of these findings is challenging owing to potential adverse effects, unclear mechanisms of action and a lack of knowledge of the specific roles and regulation of mitochondrial quality control mechanisms in kidney resident and circulating cell types during injury and repair of the kidney.
Mitochondria are essential for cell viability but are highly susceptible to injury or damage.
Mitochondrial homeostasis depends on multiple quality control mechanisms, including antioxidant defence, protein quality control, mitochondrial DNA repair, mitochondrial dynamics, mitophagy and mitochondrial biogenesis.
Loss of mitochondrial quality control may induce mitochondrial damage and dysfunction, leading to cell death, tissue injury and possible organ failure.
Acute kidney injury (AKI) is characterized by sublethal and lethal damage to kidney tubules and incomplete or maladaptive kidney repair after AKI leads to kidney fibrosis and eventually chronic kidney disease (CKD).
Mitochondrial dysfunction has a critical role in the pathogenesis of AKI, abnormal kidney repair and CKD.
Modulation of mitochondrial quality control is a promising therapeutic approach to preventing and treating AKI and CKD and to accelerating kidney repair.
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The authors declare no competing interests.
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- Electron transport chain
(ETC). A series of four protein complexes (complex I–IV) embedded in the inner mitochondrial membrane that transfer electrons from electron donors to electron acceptors via redox reactions. This process drives the transfer of protons across the inner mitochondrial membrane to produce ATP.
- Hyperfused mitochondria
A network of elongated and highly connected mitochondria, which can result from increased fusion and/or reduced fission, and represent an adaptive response against stress.
- Oxidative phosphorylation
(OXPHOS). A metabolic process in which the energy transferred by electrons from electron donors to electron acceptors through the electron transport chain via redox reactions drives the transport of protons across the inner mitochondrial membrane to generate a potential energy gradient. ATP synthase uses this energy to transform ADP into ATP in a phosphorylation reaction.
- Fenton reaction
A catalytic process that converts hydrogen peroxide (H2O2) into highly reactive hydroxyl free radicals in the presence of ferrous iron (Fe(II)).
- Mitochondrial cristae
Folds of the inner mitochondrial membrane that increase the surface area in which oxidative phosphorylation can occur and thus enhance the capacity of the mitochondrion to synthesize ATP.
- Cristae junctions
Narrow, neck-like structures that connect the cristae membranes to the inner mitochondrial membrane. Cristae junctions act as a diffusion barrier that maintains the asymmetric protein composition between the inner mitochondrial membrane and cristae membranes and limits the diffusion of molecules, such as cytochrome c, from the intracristae space into the intermembrane space.
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Tang, C., Cai, J., Yin, XM. et al. Mitochondrial quality control in kidney injury and repair. Nat Rev Nephrol (2020). https://doi.org/10.1038/s41581-020-00369-0