Editing Mitochondrial disease (section)

==Treatments==
Although research is ongoing, treatment options are currently limited; [[vitamin]]s are frequently prescribed, though the evidence for their effectiveness is limited.<ref>{{cite journal |vauthors=Marriage B, Clandinin MT, Glerum DM |title=Nutritional cofactor treatment in mitochondrial disorders |journal=J Am Diet Assoc |volume=103 |issue=8 |pages=1029–38 |year=2003 |pmid=12891154 |doi=10.1016/S0002-8223(03)00476-0}}</ref>
[[Pyruvate]] has been proposed in 2007 as a treatment option.<ref>{{cite journal |vauthors=Tanaka M, Nishigaki Y, Fuku N, Ibi T, Sahashi K, Koga Y |title=Therapeutic potential of pyruvate therapy for mitochondrial diseases |journal=Mitochondrion |volume=7 |issue=6 |pages=399–401 |year=2007 |pmid= 17881297 |doi=10.1016/j.mito.2007.07.002}}</ref> [[N-acetyl cysteine]] reverses many models of mitochondrial dysfunction.<ref>{{cite journal | author = Frantz MC, Wipf P | date = Jun 2010 | title = Mitochondria as a target in treatment | journal = Environ Mol Mutagen | volume = 51 | issue = 5| pages = 462–75 | doi = 10.1002/em.20554 | pmid = 20175113 | pmc = 2920596 | bibcode = 2010EnvMM..51..462F }}</ref> 

=== Mood disorders ===
In the case of mood disorders, specifically [[bipolar disorder]], it is hypothesized that [[N-acetyl-cysteine]] (NAC), [[acetyl-L-carnitine]] (ALCAR), [[S-Adenosyl methionine|S-adenosylmethionine]] (SAMe), [[coenzyme Q10]] (CoQ10), [[alpha-lipoic acid]] (ALA), [[creatine monohydrate]] (CM), and [[Melatonin as a medication and supplement|melatonin]] could be potential treatment options.<ref>{{cite journal |vauthors=Nierenberg, Andrew A, Kansky, Christine, Brennan, Brian P, Shelton, Richard C, Perlis, Roy, Iosifescu, Dan V |title=Mitochondrial modulators for bipolar disorder: A pathophysiologically informed paradigm for new drug development |journal=Australian & New Zealand Journal of Psychiatry |volume=47 |issue=1 |pages=26–42 |year=2012 |doi=10.1177/0004867412449303|pmid=22711881 |s2cid=22983555 }}</ref>

===Gene therapy prior to conception===
[[Mitochondrial replacement therapy]] (MRT), where the [[nuclear DNA]] is transferred to another healthy egg cell leaving the defective [[mitochondrial DNA]] behind, is an [[IVF]] treatment procedure.<ref name="Tachibana2009">{{cite journal|vauthors = Tachibana M, Sparman M, Sritanaudomchai H, Ma H, Clepper L, Woodward J, Li Y, Ramsey C, Kolotushkina O, (([[Shoukhrat Mitalipov|Mitalipov S]])) |title=Mitochondrial gene replacement in primate offspring and embryonic stem cells |journal=Nature |volume=461 |issue=7262 |pages=367–372 |date=September 2009 |pmid=19710649 |doi=10.1038/nature08368 |pmc=2774772|bibcode=2009Natur.461..367T }}</ref> Using a similar [[pronuclear transfer]] technique, researchers at [[Newcastle University]] led by [[Douglass Turnbull]] successfully transplanted healthy DNA in human eggs from women with mitochondrial disease into the eggs of women donors who were unaffected.<ref>{{cite news |last=Boseley |first=Sarah |title=Scientists reveal gene-swapping technique to thwart inherited diseases |newspaper=Guardian |date=2010-04-14 |url=https://www.theguardian.com/science/2010/apr/14/scientists-gene-swap-technique-disease |location=London}}</ref><ref name="Craven2010">{{cite journal|last1=Craven|first1=Lyndsey|last2=Tuppen|first2=Helen A.|last3=Greggains|first3=Gareth D.|last4=Harbottle|first4=Stephen J.|last5=Murphy|first5=Julie L.|last6=Cree|first6=Lynsey M.|last7=Murdoch|first7=Alison P.|last8=Chinnery|first8=Patrick F.|last9=Taylor|first9=Robert W.|last10=Lightowlers|first10=Robert N.|last11=Herbert|first11=Mary|last12=Turnbull|first12=Douglass M.|author-link12=Douglass Turnbull|title=Pronuclear transfer in human embryos to prevent transmission of mitochondrial DNA disease|journal=Nature|volume=465|issue=7294|year=2010|pages=82–85|pmid=20393463|pmc=2875160|doi=10.1038/nature08958|bibcode=2010Natur.465...82C}} {{open access}}</ref> In such cases, ethical questions have been raised regarding biological motherhood, since the child receives genes and gene regulatory molecules [[three-parent baby#Ethics|from two different women]]. Using genetic engineering in attempts to produce babies free of mitochondrial disease is controversial in some circles and raises important [[three-parent baby#Ethics|ethical issues]].<ref>{{cite news|title=UK urged to permit IVF procedure to prevent fatal genetic diseases |newspaper=The Guardian |date=2015-04-30 |url=https://www.theguardian.com/science/2015/jan/30/experts-urge-uk-permit-ivf-procedure-prevent-fatal-genetic-diseases-mitochondrial |location=London}}</ref><ref>{{cite news|title=Three parent baby law is 'irresponsible' says Church of England ahead of vote |newspaper=The Telegraph |date=2015-04-30 |url=https://www.telegraph.co.uk/news/science/11377992/Three-parent-baby-law-is-irresponsible-says-Church-of-England-ahead-of-vote.html |location=London}}</ref> A male baby was born in Mexico in 2016 from a mother with Leigh syndrome using MRT.<ref>{{Cite news|url=https://www.newscientist.com/article/2107219-exclusive-worlds-first-baby-born-with-new-3-parent-technique/|title=Exclusive: World's first baby born with new "3 parent" technique|last=Hamzelou|first=Jessica|date=2016-09-27|newspaper=New Scientist|language=en-US|access-date=2016-11-26}}</ref>

In September 2012 a public consultation was launched in the UK to explore the ethical issues involved.<ref>{{cite news|title=Regulator to consult public over plans for new fertility treatments|url=https://www.theguardian.com/science/2012/sep/17/genetics-embryo-dna-mitochondrial-disease|access-date=8 October 2012|newspaper=The Guardian|date=2012-09-17|location=London|first=Ian|last=Sample}}</ref> Human genetic engineering was used on a small scale to allow infertile women with genetic defects in their [[mitochondria]] to have children.<ref name="bbc">
{{cite news|url=http://news.bbc.co.uk/1/hi/sci/tech/1312708.stm|title=  Genetically altered babies born|access-date=2008-04-26| date=2001-05-04| work=BBC News}}
</ref> 
In June 2013, the [[United Kingdom]] government agreed to develop legislation that would legalize the 'three-person [[IVF]]' procedure as a treatment to fix or eliminate mitochondrial diseases that are passed on from mother to child. The procedure could be offered from 29 October 2015 once regulations had been established.<ref name=Regulation572>[http://www.legislation.gov.uk/uksi/2015/572/contents/made The Human Fertilisation and Embryology (Mitochondrial Donation) Regulations 2015 No. 572]</ref><ref>{{cite news| url=https://www.bbc.co.uk/news/health-23079276 | work=BBC News | title=UK government backs three-person IVF | date=27 June 2013}}</ref><ref>Knapton, Sarah (1 March 2014) [https://web.archive.org/web/20140228005600/http://www.telegraph.co.uk/science/science-news/10665553/Three-parent-babies-could-be-born-in-Britain-next-year.html 'Three-parent babies' could be born in Britain next year] The Daily Telegraph Science News, Retrieved 1 March 2014</ref>
[[Embryo]]nic mitochondrial transplant and [[protofection]] have been proposed as a possible treatment for inherited mitochondrial disease, and [[allotopic expression]] of mitochondrial proteins as a radical treatment for mtDNA mutation load.

In June 2018 Australian Senate's Senate Community Affairs References Committee recommended a move towards legalising [[Mitochondrial replacement therapy]] (MRT). Research and clinical applications of MRT were overseen by laws made by federal and state governments. State laws were, for the most part, consistent with federal law. In all states, legislation prohibited the use of MRT techniques in the clinic, and except for Western Australia, research on a limited range of MRT was permissible up to day 14 of embryo development, subject to a license being granted. In 2010, the Hon. Mark Butler MP, then Federal Minister for Mental Health and Ageing, had appointed an independent committee to review the two relevant acts: the ''Prohibition of Human Cloning for Reproduction Act 2002'' and the ''Research Involving Human Embryos Act 2002''. The committee's report, released in July 2011, recommended the existing legislation remain unchanged

Currently, human clinical trials are underway at GenSight Biologics (ClinicalTrials.gov # NCT02064569) and the University of Miami (ClinicalTrials.gov # NCT02161380) to examine the safety and efficacy of mitochondrial gene therapy in Leber's hereditary optic neuropathy.