Linking Metabolic and Mitochondrial Stress to Regulated Cell Death and Inflammatory Organ Injury in Sepsis
Abstract Sepsis is increasingly viewed as a disorder of inflammatory, metabolic, and mitochondrial homeostasis, but the path from metabolic disturbance to regulated cell death (RCD) and organ injury remains incompletely defined. Human studies show clinically meaningful metabolic and bioenergetic heterogeneity, while experimental models link mitochondrial stress, inflammatory signaling, membrane disruption, and pathway-specific RCD to tissue dysfunction. This review asks how evidence can be moved from co-occurrence toward mechanism. We synthesize findings across systemic metabolic phenotypes, cell-intrinsic immunometabolism, mitochondrial stress, RCD execution, membrane failure, inflammatory cargo release, organ injury, and therapeutic relevance. Apoptosis has the strongest direct human support as a non-lytic route of immune-cell depletion and epithelial loss; pyroptosis, ferroptosis, necroptosis, and PANoptosis are supported mainly by sepsis-relevant models and remain context dependent. Stronger mechanistic inference requires aligned measurements of metabolic flux, mitochondrial state, RCD execution, membrane integrity, extracellular cargo, host-defense effects, and tissue outcomes within matched cellular, organ, model, and temporal contexts. This framework separates association, susceptibility, execution, inflammatory release, tissue consequence, and therapeutic relevance when interpreting links among metabolic stress, mitochondrial stress, and RCD in sepsis.