Therapeutic Manipulation of mtDNA Heteroplasmy: A Shifting Perspective. Issue 7 (July 2020) - Jackson, Christopher B.
Abstract : Mutations of mitochondrial DNA (mtDNA) often underlie mitochondrial disease, one of the most common inherited metabolic disorders. Since the sequencing of the human mitochondrial genome and the discovery of pathogenic mutations in mtDNA more than 30 years ago, a movement towards generating methods for robust manipulation of mtDNA has ensued, although with relatively few advances and some controversy. While developments in the transformation of mammalian mtDNA have stood still for some time, recent demonstrations of programmable nuclease-based technology suggest that clinical manipulation of mtDNA heteroplasmy may be on the horizon for these largely untreatable disorders. Here we review historical and recent developments in mitochondrially targeted nuclease technology and the clinical outlook for treatment of hereditary mitochondrial disease. Highlights: Organelle-targeted nucleases allow specific destruction of mutant mtDNA. In combination with adeno-associated viruses, these nucleases allow organ-specific changes in mtDNA heteroplasmy. Recent data have provided early proof of principle for gene therapy of incurable mtDNA disorders using these engineered enzymes.