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Removal of noxious metabolites is centered on combating lactic acidosis, but extends to other metabolites. Attempts to bypass blocks in the respiratory chain by administration of electron acceptors have not been successful, but this may be amenable to genetic engineering. Administration of metabolites and cofactors is the mainstay of real-life therapy and is especially important in disorders due to primary deficiencies of specific compounds, such as carnitine or coenzyme Q10. There is increasing interest in the administration of reactive oxygen species scavengers both in primary mitochondrial diseases and in neurodegenerative diseases directly or indirectly related to mitochondrial dysfunction. Aerobic exercise and physical therapy prevent or correct deconditioning and improve exercise tolerance in patients with mitochondrial myopathies due to mitochondrial DNA (mtDNA) mutations. Gene therapy is a challenge because of polyplasmy and heteroplasmy, but interesting experimental approaches are being pursued and include, for example, decreasing the ratio of mutant to wild-type mitochondrial genomes (gene shifting), converting mutated mtDNA genes into normal nuclear DNA genes (allotopic expression), importing cognate genes from other species, or correcting mtDNA mutations with specific restriction endonucleases. Germline therapy raises ethical problems but is being considered for prevention of maternal transmission of mtDNA mutations. Preventive therapy through genetic counseling and prenatal diagnosis is becoming increasingly important for nuclear DNA-related disorders. Progress in each of these approaches provides some glimmer of hope for the future, although much work remains to be done.<\/jats:p>","DOI":"10.1007\/s10540-007-9041-4","type":"journal-article","created":{"date-parts":[[2007,5,7]],"date-time":"2007-05-07T15:55:17Z","timestamp":1178553317000},"page":"125-137","update-policy":"https:\/\/doi.org\/10.1042\/crossmark_policy","source":"Crossref","is-referenced-by-count":94,"title":["Mitochondrial Diseases: Therapeutic Approaches"],"prefix":"10.1042","volume":"27","author":[{"given":"Salvatore","family":"DiMauro","sequence":"first","affiliation":[{"name":"4-420 College of Physicians and Surgeons, Department of Neurology, Columbia University Medical Center, 630 West 168th Street, NewYork, NY 10032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelangelo","family":"Mancuso","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, University of Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"288","published-online":{"date-parts":[[2007,6,13]]},"reference":[{"key":"9041_CR1","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1002\/ana.410130620","volume":"13","author":"RJ Allen","year":"1983","unstructured":"Allen RJ, DiMauro S, Coulter DL, Papadimitriou A, Rothenberg SP (1983) Kearns-Sayre syndrome with reduced plasma and cerebrospinal fluid folate. 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