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Role of mitochondrial Ca2+ in stroke: From molecular mechanism to treatment strategy (Review)

  • Authors:
    • Yanlin Liu
    • Wenjie Jin
    • Huixin Zhou
    • Xiaomei Wang
    • Hongbin Ren
    • Xibing Yang
    • Kaitao Luo
    • Xiaobing Dou
  • View Affiliations / Copyright

    Affiliations: Department of Acupuncture and Moxibustion, Jiaxing Hospital of Traditional Chinese Medicine Affiliated with Zhejiang Chinese Medical University, Jiaxing, Zhejiang 314001, P.R. China, School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, Jiangsu 211166, P.R. China, Rehabilitation Medicine Center, Jiaxing Hospital of Traditional Chinese Medicine Affiliated with Zhejiang Chinese Medical University, Jiaxing, Zhejiang 314000, P.R. China, Department of Acupuncture and Moxibustion, Jiaxing Hospital of Traditional Chinese Medicine Affiliated with Zhejiang Chinese Medical University, Jiaxing, Zhejiang 314001, P.R. China, School of Life Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310000, P.R. China
    Copyright: © Liu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 271
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    Published online on: July 28, 2025
       https://doi.org/10.3892/mmr.2025.13636
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Abstract

Mitochondria serve a pivotal role in the pathological mechanisms of stroke, particularly in the regulation of intracellular calcium homeostasis. Stroke‑induced ischemia and reperfusion injury frequently result in disruptions of mitochondrial calcium ion (Ca2+) transport, characterized by Ca2+ overload. This imbalance directly impairs mitochondrial function and triggers neuronal death. Mitochondrial Ca2+ transport involves calcium influx, primarily mediated by the mitochondrial calcium uniporter (MCU) complex, and efflux, primarily through the sodium‑calcium exchanger (NCLX), making this mechanism a critical therapeutic target in stroke. The present review systematically explores the central role of mitochondrial Ca2+ transport in ischemia/reperfusion injury, with an in‑depth analysis of its pathological mechanisms in cellular energy metabolism, oxidative stress and apoptotic signaling pathways. Additionally, this review summarizes recent advancements in therapeutic strategies targeting mitochondrial Ca2+ transport, including MCU inhibitors, NCLX activators, antioxidant therapies and combination treatments. It also highlights the potential of Ca2+ signaling for early stroke diagnosis and reviews progress in dynamic monitoring technologies for mitochondrial Ca2+, such as fluorescence probes and super‑resolution microscopy. Despite significant progress in basic research, challenges remain in translating these findings into clinical applications. Future efforts should focus on elucidating the regulatory mechanisms of mitochondrial Ca2+, developing diagnostic tools and optimizing therapeutic interventions to improve stroke prognosis and enhance the quality of life of patients.
View Figures

Figure 1

Structure of the MCU complex. The
core pore-forming protein MCU mediates Ca2+ influx into
the matrix. This process is regulated by the EMRE subunit and the
MICU1/MICU2 heterodimer, which serve as gatekeepers to maintain
calcium homeostasis. MCU, mitochondrial calcium uniporter; EMRE,
essential MCU regulator; MICU, mitochondrial calcium uptake; D,
Aspartate residue; E, Glutamate residue.

Figure 2

Calcium efflux pathways.
Mitochondrial calcium efflux mechanisms, including the NCLX, Panx1,
KCa, and NHE, which cooperatively regulate intracellular calcium
homeostasis. NCLX, sodium-calcium exchanger; Panx1, pannexin 1;
KCa, calcium-activated potassium channels; NHE, sodium ion/hydrogen
ion exchanger; Ca2+, calcium ion; Na+, sodium
ion; H+, hydrogen ion.

Figure 3

Pathological mechanisms of
mitochondrial calcium transport in stroke. Schematic overview of
stroke-induced calcium overload leading to mitochondrial
dysfunction. Excessive Ca2+ influx via the MCU and
impaired efflux disrupt mitochondrial membrane potential, generate
ROS, trigger mPTP opening, and release apoptotic factors such as
AIF and Cyt c, resulting in neuronal death. MCU, mitochondrial
calcium uniporter; NCLX, sodium-calcium exchanger; ROS, reactive
oxygen species; AIF, apoptosis-inducing factor; Cyto C, cytochrome
c; mPTP, mitochondrial permeability transition pore.
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Copy and paste a formatted citation
Spandidos Publications style
Liu Y, Jin W, Zhou H, Wang X, Ren H, Yang X, Luo K and Dou X: Role of mitochondrial Ca<sup>2+</sup> in stroke: From molecular mechanism to treatment strategy (Review). Mol Med Rep 32: 271, 2025.
APA
Liu, Y., Jin, W., Zhou, H., Wang, X., Ren, H., Yang, X. ... Dou, X. (2025). Role of mitochondrial Ca<sup>2+</sup> in stroke: From molecular mechanism to treatment strategy (Review). Molecular Medicine Reports, 32, 271. https://doi.org/10.3892/mmr.2025.13636
MLA
Liu, Y., Jin, W., Zhou, H., Wang, X., Ren, H., Yang, X., Luo, K., Dou, X."Role of mitochondrial Ca<sup>2+</sup> in stroke: From molecular mechanism to treatment strategy (Review)". Molecular Medicine Reports 32.4 (2025): 271.
Chicago
Liu, Y., Jin, W., Zhou, H., Wang, X., Ren, H., Yang, X., Luo, K., Dou, X."Role of mitochondrial Ca<sup>2+</sup> in stroke: From molecular mechanism to treatment strategy (Review)". Molecular Medicine Reports 32, no. 4 (2025): 271. https://doi.org/10.3892/mmr.2025.13636
Copy and paste a formatted citation
x
Spandidos Publications style
Liu Y, Jin W, Zhou H, Wang X, Ren H, Yang X, Luo K and Dou X: Role of mitochondrial Ca<sup>2+</sup> in stroke: From molecular mechanism to treatment strategy (Review). Mol Med Rep 32: 271, 2025.
APA
Liu, Y., Jin, W., Zhou, H., Wang, X., Ren, H., Yang, X. ... Dou, X. (2025). Role of mitochondrial Ca<sup>2+</sup> in stroke: From molecular mechanism to treatment strategy (Review). Molecular Medicine Reports, 32, 271. https://doi.org/10.3892/mmr.2025.13636
MLA
Liu, Y., Jin, W., Zhou, H., Wang, X., Ren, H., Yang, X., Luo, K., Dou, X."Role of mitochondrial Ca<sup>2+</sup> in stroke: From molecular mechanism to treatment strategy (Review)". Molecular Medicine Reports 32.4 (2025): 271.
Chicago
Liu, Y., Jin, W., Zhou, H., Wang, X., Ren, H., Yang, X., Luo, K., Dou, X."Role of mitochondrial Ca<sup>2+</sup> in stroke: From molecular mechanism to treatment strategy (Review)". Molecular Medicine Reports 32, no. 4 (2025): 271. https://doi.org/10.3892/mmr.2025.13636
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