Human mitochondrial diseases have been associated recently with mitoch
ondrial DNA mutations, duplications and deletions which impair the pro
tein synthesis of the mitochondrial subunits of the respiratory chain
complexes. A constant feature is the coincident presence of the mutate
d and wild type genomes which provide heteroplasmy. The clinical expre
ssion of these diseases depends on the relative expression of each kin
d of mitochondrial DNA in the various tissues, which in turn affects t
he production of ATP in these tissues. Research on nuclear gene produc
ts interfering with mtDNA or with its gene products is the next step t
owards understanding the etiology of these diseases.