Introduction
Mutations in mitochondrial DNA (mtDNA) are responsible for a wide variety of diseases with prominent neurological or neuromuscular phenotypes (1–3). Most somatic cells contain hundreds to thousands of copies of mtDNA and, in the majority of patients with mitochondrial DNA diseases, two different populations of mtDNA co-exist, wild-type and mutant, a condition known as mtDNA heteroplasmy. The proportions of wild-type and mutant genomes can vary greatly among tissues of patients, as a result of replicative segregation of mtDNA, and this is, in part, responsible for the tissue-specific features of these diseases. The most striking examples of this phenomenon are seen in sporadic patients with mitochondrial myopathies who have apparently inherited new germline mutations. This includes patients with large-scale mtDNA deletions and Kearns-Sayre syndrome (KSS) (4) and patients with myopathies associated with tRNA point mutations (5–8) or microdeletions in protein–coding genes (9). In these patients, mutant mtDNAs are abundant (usually predominant) in affected skeletal muscles but rare or undetectable in unaffected tissues like peripheral blood cells or fibroblasts.
These disorders are slowly progressive and this is thought to be due to an increase in the proportion of mutant mtDNAs in skeletal muscle with age. There is direct evidence for such an age-related increase in the case of large-scale mtDNA deletions (10) and for a tRNAleu(CUN) point mutation (8), and suggestive evidence for other tRNA mutations (11). This shift in mtDNA genotype is associated with an increased proportion of cytochrome c oxidase (COX)-negative muscle fibres and a worsening clinical course. The molecular mechanism responsible for selection of mutant mtDNAs in skeletal muscle remains unknown; however, it is probably related to a futile attempt by the cell to restore the required oxidative phosphorylation function.
As a result of this selection, an increasingly large difference develops between the mtDNA genotype of mature muscle fibres and the satellite cell population. Satellite cells are mononuclear, committed myogenic cells that remain dormant for most of their lives, but are reactivated as needed for muscle growth and repair (12). As in other unaffected cell types, mutant mtDNAs are often undetectable in satellite cells cultured from affected muscles of these patients (7,8,13,14). This is the case primarily in patients with new germline mtDNA mutations in whom the overall load of mutant mtDNAs would be expected to be relatively small at birth (7). On the basis of these observations, we raised the possibility of elimination of the mutant mtDNA genotype from skeletal muscle by encouraging regeneration of mature muscle fibres from satellite cells (7). We tested this idea in a sporadic patient with a tRNA mutation and a KSS phenotype, and demonstrate that regenerating muscle fibres are positive for COX activity and essentially homoplasmic for wild-type mtDNA.