{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:25:38Z","timestamp":1791606338995,"version":"4.3.4"},"reference-count":83,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>Mitochondrial therapeutics have repeatedly fallen short of disease modification, in part because inner-membrane architecture constrains both molecular access and the reversibility of bioenergetic failure. Cardiolipin (CL), the signature phospholipid of the inner mitochondrial membrane, provides a mechanistically cohesive axis that links membrane mechanics to cristae organisation, respiratory-chain supercomplex stability and redox vulnerability. This Review summarises how CL biosynthesis and remodelling shape tissue-specific lipid species and how pathological remodelling can amplify oxidative injury. The MLCL: CL ratio is discussed as a rare lipid biomarker with direct interpretability for diagnosis, stratification and target engagement. Clinical evidence for CL-targeting stabilisers is evaluated to delineate settings in which structural support yields functional benefit and those in which organ-level remodelling limits translation despite improved respiration. Emerging approaches that improve tissue distribution, modulate membrane phase behaviour or rebalance upstream lipid flux are considered alongside trial designs that couple target-proximal readouts to patient-relevant endpoints, paving the way for precision medicine in mitochondrial lipodystrophies.<\/jats:p>","DOI":"10.3389\/fphys.2026.1813119","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T04:48:30Z","timestamp":1780030110000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Cardiolipin remodelling in mitochondrial therapeutics: translational evidence chains from elamipretide to emerging strategies"],"prefix":"10.3389","volume":"17","author":[{"given":"Ke","family":"Di","sequence":"first","affiliation":[{"name":"Heilongjiang University of Chinese Medicine","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusheng","family":"Hu","sequence":"additional","affiliation":[{"name":"Heilongjiang University of Chinese Medicine","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hechen","family":"Sun","sequence":"additional","affiliation":[{"name":"Heilongjiang University of Chinese Medicine","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianwei","family":"Meng","sequence":"additional","affiliation":[{"name":"Heilongjiang University of Chinese Medicine","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingquan","family":"Han","sequence":"additional","affiliation":[{"name":"Heilongjiang Provincial Academy of Traditional Chinese Medicine","place":["Harbin, China"]},{"name":"Heilongjiang Provincial Hospital of Traditional Chinese Medicine","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Qie","sequence":"additional","affiliation":[{"name":"First Affiliated Hospital, Heilongjiang University of Chinese Medicine","place":["Harbin, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"B21","doi-asserted-by":"publisher","first-page":"15491","DOI":"10.1074\/jbc.M116.718510","article-title":"Mechanism for remodeling of the acyl chain composition of cardiolipin catalyzed by Saccharomyces cerevisiae Tafazzin","volume":"291","author":"Abe","year":"2016","journal-title":"J. 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