From the energy factory to the intercellular communication medium: the emerging role of intercellular mitochondrial transfer and mitochondrial transplantation therapy in diabetes and diabetic complications

Diabetes is a global chronic metabolic disorder that frequently results in multiple chronic complications. However, current therapeutic agents for diabetes and its complications fail to alleviate the core pathological process of mitochondrial dysfunction in affected target organs, rendering them incapable of fundamentally retarding the progression of these complications. Mitochondrial transfer is a novel type of intercellular communication. Mitochondria can be transferred between cells and improve mitochondrial dysfunction in either the donor cell or the recipient cell. Accumulating evidence indicates that mitochondrial transfer exerts multiple regulatory effects to delay the progression of diabetes and its complications, including promoting insulin secretion, improving insulin resistance, facilitating the migration of vascular endothelial cells, and enhancing mitochondrial function in renal parenchymal cells. This review systematically summarizes the characteristics and molecular mechanisms of mitochondrial transfer, explores its pathophysiological implications in diabetes and related complications, and briefly discusses the application prospects of mitochondrial transplantation therapy in the management of diabetes and its complications based on the mitochondrial transfer theory. This review offers valuable insights and novel research directions for the design of innovative therapeutic strategies targeting diabetes and its complications.