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Mitochondrial DNA (mtDNA) and mitochondrial proteins constitute the essential genetic and functional components of the mitochondria, the primary site of cellular energy production via oxidative phosphorylation (OXPHOS) [1, 7]. The human mitochondrial genome is a circular, double-stranded DNA molecule that encodes 13 essential subunits of the electron transport chain, along with 22 tRNAs and 2 rRNAs required for their translation [1, 18]. Mitochondrial proteins encompass these 13 mtDNA-encoded subunits as well as over 1,000 nuclear-encoded proteins that are imported into the organelle to regulate metabolism, calcium homeostasis, and the initiation of apoptosis [16, 17]. Dysfunction in mtDNA or mitochondrial proteins is the underlying cause of primary mitochondrial diseases, such as Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS), and is increasingly implicated in cancer, neurodegeneration, and metabolic syndrome [5, 9, 18]. Therapeutic strategies include the use of mitochondria-targeted antioxidants like MitoQ to reduce oxidative stress, or cardiolipin-stabilizing peptides like elamipretide to restore membrane integrity [1, 4]. Conversely, many drugs exhibit off-target "mitotoxicity," such as nucleoside reverse transcriptase inhibitors (NRTIs) that cause mtDNA depletion by inhibiting DNA polymerase gamma, or certain antibiotics that interfere with mitochondrial protein synthesis [12, 15, 19].
Drugs targeting these components act by inhibiting mitochondrial protein synthesis, causing mitochondrial DNA depletion through polymerase gamma inhibition, stabilizing mitochondrial membranes, or scavenging organelle-specific reactive oxygen species [1, 12, 15, 19].
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