Weigh and wait: the prospect of mitochondrial gene replacement

Mitochondrial DNA transfer has recently received attention from physicians. The transfer techniques place genetic material from the egg nucleus of a woman with a mitochondrial DNA mutation into a healthy donated egg from which the nuclear DNA was removed. This technology intends to reconstruct a mitochondria-competent egg to produce a baby. Three approaches: (1) pronuclear transfer; (2) metaphase II spindle transfer (ST); and (3) polar body (PB) transfer, have been proposed and applied in animal models with very low levels of heteroplasmy. Because there is no curative treatment for patients with mitochondrial dysfunction, the UK government has allowed the use of this pioneering technique to prevent the transmission of rare and devastating mitochondrial diseases. Despite general safety in the observation period, this technology involves germline modification, raising scientific and ethical questions in the public. In this review, we focus on this unprecedented technology and discuss its clinical application in the future.