Mitochondrial ecosystem restoration in Alzheimer’s disease: from mechanisms to multi-target therapeutic strategies

Alzheimer’s disease (AD), the most prevalent cause of dementia, lacks definitive cures despite decades of research focused on amyloid-beta (Aβ) and tau pathologies. Emerging evidence positions mitochondrial dysfunction not merely as a downstream consequence, but as the epicenter linking aging, metabolic failure, and neuroinflammation in AD pathogenesis. This study synthesizes the latest advances in mitochondrial-targeted therapies, framing them within a “Mitochondrial Ecological Restoration” perspective. I analyze the molecular mechanisms by which mitochondrial-targeted therapies modulate oxidative stress, mitochondrial dynamics, mitophagy and neuroinflammation, and evaluate their translational potential. Accumulating evidence indicates that strategies ranging from antioxidants (e.g., MitoQ) to mitophagy enhancement (e.g., Spautin-1) and biogenesis activation (e.g., PGC-1α Activator) have demonstrated efficacy in preclinical models. These interventions theoretically interrupt the pathological cycle between proteotoxicity and bioenergetic crisis. While challenges in blood-brain barrier (BBB) penetration and target specificity persist, the field is shifting from single-target scavenging to combinatorial ecosystem repair. Future success will require precise delivery systems, early biomarkers, and a paradigm shift toward treating the neuron as a metabolic ecosystem, though substantial translational challenges remain.