Mitochondrial diseases affect 1:10,000 people worldwide, with a further 1:6,000 at risk of developing symptoms, and can be caused by mutations in the nuclear genome or by mutations within/deletion of mitochondrial DNA (mtDNA). There is currently no therapy for patients with these diseases. In addition, mitochondrial dysfunction can be considered contributory or causal for other neurological diseases, such that therapies that improve mitochondrial function may have widereaching benefi ts. This chapter summarizes cell-and animal-based attempts to fi nd a therapy by modulating major mitochondrial pathways including mitochondrial biogenesis, fi ssion, fusion and altering metabolic intermediates, mitophagy and the mammalian target of rapamycin (mTOR) pathway. Clinical trials currently in progress include drugs that are direct or indirect antioxidants, a mitogenesis activator, an antiapoptotic compound and a compound that improves electron transport chain effi ciency.