Energetic costs of cellular and therapeutic control of stochastic mtDNA populations

Mitochondrial DNA (mtDNA) copy numbers fluctuate over time due to stochastic cellular dynamics. Understanding mtDNA dynamics and the accumulation of mutations is vital for understanding mitochondrial-related diseases. Here, we use stochastic modelling to derive general results for the impact of cellular control on mtDNA populations, the cost to the cell of different mtDNA states, and the optimisation of therapeutic control of mtDNA populations. We provide theoretical evidence that an increasing mtDNA variance can increase the energetic cost of maintaining a tissue, that intermediate levels of heteroplasmy can be more detrimental than homoplasmy even for a dysfunctional mutant, that heteroplasmy distribution (not mean alone) is crucial for the success of gene therapies, and that long-term rather than short intense gene therapies are more likely to beneficially impact mtDNA populations. New experiments validate our predictions on heteroplasmy dependence of therapeutic outcomes.