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April 4, 2026Trends in Endocrinology and Metabolism2 citationsOpen Access

Reprogramming the mitochondrial–circadian energy code with incretins

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ENEnzo NisoliMRM. RagniCRChiara Ruocco

Key Points

  • This opinion discusses how mitochondrial and circadian disruptions contribute to obesity and aging, and how improving metabolic flexibility can guide treatment.
  • Examined the roles of GLP-1 and GIP agonists on mitochondrial efficiency.
  • Outlined strategies involving senolytics, mitophagy support, and chrono-entrainment.
  • Proposed node-specific and combination therapies for improved metabolic outcomes.
  • Restoring mitochondrial-circadian integrity may improve metabolic flexibility.
  • Incretins could enhance mitochondrial efficiency in multiple tissues.
  • Combination strategies may delay age-related metabolic decline.

Abstract

Mitochondrial dysfunction, circadian disruption, and the accumulation of senescent cells converge to impair metabolic flexibility, a unifying phenotype of obesity and aging. We frame obesity as a nutrient-driven and aging as a time-driven expression of a disrupted mitochondrial-circadian energy code, with shared outputs: impaired substrate switching and flattened energy rhythms. This opinion argues that restoring code integrity, indexed clinically by gains in metabolic flexibility, should guide therapy. Beyond appetite and glycemia, GLP-1 (glucagon-like peptide-1) and dual GLP-1/GIP (glucose-dependent insulinotropic polypeptide) agonists may enhance mitochondrial efficiency, support circadian alignment, and temper prosenescent signaling across target tissues (muscle, liver, adipose, islets, and brain). We outline how node-specific and combination strategies (senolytics/senomorphics, mitophagy/NAD+ support, and chrono-entrainment) could reprogram systemic energy coordination, improve durability of response, and delay age-related metabolic decline.

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Cite This Study

Nisoli et al. (2026) studied this question.

synapsesocial.com/papers/69d0a9c8659487ece0fa4315https://doi.org/10.1016/j.tem.2026.02.011
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