Depletion of mitochondrial DNA in leucocytes harbouring the 3243A->G mtDNA mutation

Background

The 3243A→G MTTL1 mutation is the most common heteroplasmic mitochondrial DNA (mtDNA) mutation associated with disease. Previous studies have shown that the percentage of mutated mtDNA decreases in blood as patients get older, but the mechanisms behind this remain unclear.

Objectives and method

To understand the dynamics of the process and the underlying mechanisms, an accurate fluorescent assay was established for 3243A→G heteroplasmy and the amount of mtDNA in blood with real‐time polymerase chain reaction was determined. The amount of mutated and wild‐type mtDNA was measured at two time points in 11 subjects.

Results

The percentage of mutated mtDNA decreases exponentially during life, and peripheral blood leucocytes in patients harbouring 3243A→G are profoundly depleted of mtDNA.

Conclusions

A similar decrease in mtDNA has been seen in other mitochondrial disorders, and in 3243A→G cell lines in culture, indicating that depletion of mtDNA may be a common secondary phenomenon in several mitochondrial diseases. Depletion of mtDNA is not always due to mutation of a nuclear gene involved in mtDNA maintenance.The 3243A→G MTTL1 gene mutation of mitochondrial DNA (mtDNA) is the most common heteroplasmic pathogenic mtDNA mutation and is found in approximately 1 in 6000 of the general population.¹ Although first described in mitochondrial encephalomyopathy with lactic acidosis and stroke‐like episodes (MELAS), the phenotypic spectrum is extremely diverse, including isolated diabetes and deafness, hypertrophic cardiomyopathy and retinitis pigmentosa.² The clinical variability can be explained partly by tissue‐specific differences in the percentage of mutated mtDNA.^3,4Intriguingly, the percentage of mutated mtDNA is consistently lower in peripheral blood than in post‐mitotic tissues such as skeletal muscle and brain.^3,5 Serial measurements in the same subject have shown that the percentage of the 3243A→G mutation in blood decreases over time,^6,7 but the reasons for this are not clear. One possibility is that vegetative segregation in rapidly proliferating leucocyte precursors leads to high percentages of mutated mtDNA in some cells. This causes a biochemical defect of the respiratory chain, which either impairs the further proliferation of that cell lineage or leads to cell death.⁷ This would ultimately lead to a decrease in the percentage of mutated mtDNA in the daughter cells present in the peripheral blood. However, it is currently not known whether the biochemical defect is primarily because of high amounts of mutated mtDNA,⁸ low amounts of wild‐type mtDNA⁹ or a combination of both.To advance our understanding of this process, we developed and validated a highly sensitive fluorescent assay to measure the changes in heteroplasmy over time, and also measured the absolute amount of mutated and wild‐type mtDNA in 11 subjects known to harbour 3243A→G.