Mutations of the mitochondrial genome (mtDNA) underlie a substantial portion of mitochondrial disease burden. These disorders are currently incurable and effectively untreatable, with heterogeneous penetrance, presentation and prognosis. To address the lack of effective treatment for these disorders, we exploited a recently developed mouse model that recapitulates common molecular features of heteroplasmic mtDNA disease in cardiac tissue: the m.5024C>T tRNAAla mouse. Through application of a programmable nuclease therapy approach, using systemically administered, mitochondrially targeted zinc-finger nucleases (mtZFN) delivered by adeno-associated virus, we induced specific elimination of mutant mtDNA across the heart, coupled to a reversion of molecular and biochemical phenotypes. These findings constitute proof of principle that mtDNA heteroplasmy correction using programmable nucleases could provide a therapeutic route for heteroplasmic mitochondrial diseases of diverse genetic origin.

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Data availability

All next-generation sequencing data generated in the present study are available from the BioProject database using accession PRJNA479953. All other datasets and materials are available from the corresponding authors upon reasonable request.

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This work was supported by the Medical Research Council (MC_U105697135 and MC_UU_00015/4 to M.M., MC_UU_12022/6 to C.F. and MC_UU_00015/5 to M.Z.), ERC Advanced Grant (FP7-322424 to M.Z.), NRJ-Institut de France (to M.Z.) and the Max Planck Society (to J.B.S.). P.R.-G. was supported by ‘Fundação para a Ciência e a Tecnologia’ (PD/BD/105750/2014). We acknowledge the important contribution to model development made by N.-G. Larsson, which was essential to this work. We are grateful to the personnel at Phenomics Animal Care Facility, Cambridge, UK, for their technical support in managing our mouse colonies. We are grateful to M. Rice, Phenomics Animal Care Facility, for technical assistance with viral administration. We thank R. Dirksen (MPI, Cologne, Germany) for isolation and immortalization of the MEFs. All FACS experiments were performed at the NIHR BRC Cell Phenotyping Hub, Cambridge, UK, by C. Bowman, E. Perez, J. Markovic Djuric and A. Petrunkina-Harrison.

Author information


  1. MRC Mitochondrial Biology Unit, University of Cambridge, Cambridge, UK

    • Payam A. Gammage
    • , Carlo Viscomi
    • , Christopher A. Powell
    • , Lindsey Van Haute
    • , Beverly J. McCann
    • , Pedro Rebelo-Guiomar
    • , Raffaele Cerutti
    • , Massimo Zeviani
    •  & Michal Minczuk
  2. Max Planck Institute for Biology of Ageing, Cologne, Germany

    • Marie-Lune Simard
    •  & James B. Stewart
  3. MRC Cancer Unit, University of Cambridge, Cambridge, UK

    • Ana S. H. Costa
    • , Edoardo Gaude
    •  & Christian Frezza
  4. Graduate Program in Areas of Basic and Applied Biology (GABBA), University of Porto, Porto, Portugal

    • Pedro Rebelo-Guiomar
  5. Sangamo Therapeutics Inc., Richmond, CA, USA

    • Lei Zhang
    •  & Edward J. Rebar


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P.A.G. designed the research, performed biochemical, in vitro and in vivo experiments, analyzed the data and wrote the paper. C.V. performed the in vivo experiments. M.-L.S. contributed to model characterization. A.S.H.C. and E.G. performed the mass spectrometry-based metabolomic experiments and analyzed the data. C.A.P. and L.V.H. performed biochemical experiments and analyzed the data. B.J.M. performed biochemical and immunofluorescence experiments. P.R.-G. and R.C. performed the histological experiments. L.Z. designed and assembled the ZFP library. E.J.R. oversaw the ZFP library preparation. M.Z. oversaw the in vivo experiments. C.F. oversaw the mass spectrometry-based metabolomic experiments. J.B.S. provided cell and mouse models and contributed to model characterization. M.M. oversaw the project and co-wrote the paper, with all authors’ involvement.

Competing interests

E.J.R. and L.Z. are full-time employees of Sangamo Therapeutics.

Corresponding authors

Correspondence to Payam A. Gammage or Michal Minczuk.

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