Cancer immunotherapy, including immune checkpoint blockade and adoptive cell therapies such as CAR-T cells, has revolutionized oncology by unleashing the patient’s own immune system against malignant cells. Yet resistance remains a major clinical challenge, leading to attenuated efficacy or outright treatment failure in a substantial fraction of patients. The review’s central thesis is that this resistance cannot be understood without examining metabolism. Tumor cells must satisfy escalating energy and biosynthetic demands as they proliferate, and they do so by rewiring their metabolic programs, a process known as metabolic reprogramming. Because mitochondria sit at the hub of cellular energy metabolism, governing oxidative phosphorylation, the tricarboxylic acid cycle, and the production of signaling metabolites, they are uniquely positioned to influence how tumors interact with the immune system.

The technical logic of the review rests on a well-established metabolic dichotomy. Many cancer cells favor aerobic glycolysis, the so-called Warburg effect, fermenting glucose into lactate even in the presence of oxygen. This shift, coordinated in part by hypoxia-inducible factor 1-alpha and enzymes such as hexokinase 2, floods the tumor microenvironment with lactic acid, which suppresses the function of cytotoxic T cells and natural killer cells. At the same time, other tumor populations maintain or even enhance mitochondrial oxidative phosphorylation, supported by fatty acid oxidation and mitochondrial dynamics proteins such as DRP1, MFN1, and OPA1, which control fission and fusion of the organelle network. The balance between these states shapes nutrient availability, oxygen tension, and the accumulation of oncometabolites such as 2-hydroxyglutarate, produced by mutant isocitrate dehydrogenase, which can epigenetically reprogram both tumor and immune cells.

One of the most consequential mechanisms described is the suppression of tumor immunogenicity and antigen presentation. For the immune system to recognize a cancer cell, that cell must display tumor-derived peptides on major histocompatibility complex class I molecules. The review highlights evidence that mitochondrial metabolic states influence this process, and that targeting mitochondria-related pathways can boost the immunogenicity and antigen-presentation efficiency of tumor cells. Mitochondria also supply the energy and biosynthetic precursors required for antigen processing, and mitochondrial stress can release damage-associated molecular patterns, including mitochondrial DNA that activates the cGAS-STING pathway, a cytosolic surveillance system that triggers type I interferon signaling and strengthens antitumor immune responses. When tumors dampen these signals, they effectively dim the alarm beacons that would otherwise recruit immune effector cells.

The review then turns to the immune cells themselves, whose function is exquisitely dependent on mitochondrial fitness. Effector T cells rely on oxidative phosphorylation and a reserve of spare respiratory capacity to sustain their killing function, and they depend on mitochondrial calcium handling through the mitochondrial calcium uniporter and store-operated calcium entry to fuel activation. As T cells become exhausted in the tumor microenvironment, they lose mitochondrial mass and membrane potential, a transition accompanied by shifts in transcriptional programs governed by factors such as TCF1 and Foxp3. Regulatory T cells, by contrast, thrive in the lactate-rich, nutrient-poor tumor milieu, exploiting fatty acid oxidation to maintain their immunosuppressive identity. Myeloid-derived suppressor cells and tumor-associated macrophages similarly undergo mitochondrial metabolic shifts that reinforce their suppressive functions, collectively building a metabolic wall around the tumor.

Mitochondrial dynamics and quality control emerge as recurring themes in the resistance story. The review discusses mitophagy, the selective autophagic removal of damaged mitochondria, orchestrated by proteins such as PINK1, Parkin, BNIP3, and optineurin, alongside the mitochondrial unfolded protein response mediated by proteases such as LON and the signaling axis involving OMA1. Tumor cells can use these pathways to clear damaged organelles, reduce reactive oxygen species accumulation, and survive immune pressure. Conversely, excessive mitochondrial fission driven by DRP1 has been linked to T cell exhaustion, while interventions that restore mitochondrial fusion or promote mitophagy in T cells, for example with compounds such as urolithin A, have been reported to rejuvenate antitumor immunity. Tunneling nanotubes and cell-in-cell structures add a further layer of complexity, allowing mitochondria and their metabolites to be exchanged between tumor cells and immune cells in direct physical contact.

The translational heart of the review lies in its catalog of mitochondria-targeted interventions designed to reverse immunotherapy resistance. By enhancing tumor cell immunogenicity, promoting immunogenic cell death, and improving antigen presentation, these strategies aim to make tumors more visible to the immune system. By bolstering immune effector function, for instance through metabolic support of T cells and natural killer cells, they aim to sharpen the immune attack itself. The authors discuss agents that modulate oxidative phosphorylation, inhibit fatty acid oxidation through targets such as carnitine palmitoyltransferase 1a, manipulate mitochondrial reactive oxygen species, and exploit the cGAS-STING pathway to convert mitochondrial damage into immune activation. Nanotechnology also features in the discussion, with materials such as black phosphorus nanosheets proposed as vehicles for delivering mitochondrial stress to tumor cells while sparing healthy tissue.

Combination strategies receive particular attention as the most clinically plausible path forward. The review suggests that pairing mitochondria-targeted metabolic agents with immune checkpoint inhibitors targeting PD-1, PD-L1, and CTLA-4 could convert immunologically cold tumors into responsive ones, and that adoptive cell therapies such as CAR-T cells might be engineered or preconditioned to maintain mitochondrial fitness, extending their persistence and memory formation within the hostile tumor microenvironment. The authors emphasize that timing, dosing, and patient selection will be critical, because systemic metabolic interventions risk harming the very immune cells they are meant to empower. Biomarkers of mitochondrial function, from circulating metabolites to measures of spare respiratory capacity in patient T cells, may eventually guide which patients benefit from which metabolic combination.

The authors are careful to frame their work as a conceptual framework rather than a clinical prescription. Much of the evidence they synthesize comes from preclinical models, and the review acknowledges that the metabolic plasticity of tumors, their ability to switch between glycolytic and oxidative states, makes single-target approaches vulnerable to escape. Off-target toxicity is a genuine concern, since mitochondria are essential to every cell in the body, and the field still lacks standardized ways to measure mitochondrial reprogramming in human tumors in real time. Nevertheless, the systematic mapping of mitochondria-mediated resistance mechanisms, from oncometabolite accumulation and impaired antigen presentation to T cell exhaustion and suppressive myeloid reprogramming, provides researchers with a structured agenda for mechanistic studies and drug development.

What makes this review resonate beyond the specialist literature is the reframing it offers. For decades, mitochondria were studied in cancer primarily as survivors of apoptotic resistance or as suppliers of building blocks for growth. The work of Gong, Xia, Wu, Zhu, Lv, Mei, and their colleagues consolidates a decade of scattered findings into a single narrative in which the organelle that powers life also powers the tumor’s ability to hide. If mitochondria-targeted strategies can be translated safely into the clinic, they could address one of immunotherapy’s most frustrating failures: patients whose tumors are rich in potential targets but metabolically armored against immune recognition. The next phase of research, moving from mechanism to validated combination trials, will determine whether rewiring the tumor’s power supply becomes a standard partner to checkpoint blockade in the oncology clinic.

Subject of Research: Mitochondrial metabolic reprogramming in tumor immune evasion and immunotherapy resistance

Article Title: Mitochondrial metabolic reprogramming drives tumor immune evasion: regulatory mechanisms and targeting strategies

Article References: Gong, W., Xia, L., Wu, S., Zhu, X., Lv, Y., & Mei, C. (2026). Mitochondrial metabolic reprogramming drives tumor immune evasion: regulatory mechanisms and targeting strategies. Journal of Translational Medicine. https://doi.org/10.1186/s12967-026-08972-8

Image Credits: AI Generated

DOI: 10.1186/s12967-026-08972-8

Keywords: mitochondria, metabolic reprogramming, tumor immune evasion, immunotherapy resistance, cancer metabolism, immune checkpoint blockade, mitophagy, oxidative phosphorylation, tumor microenvironment, T cell exhaustion, cGAS-STING, CAR-T cells