Mutations in mitochondrial DNA (mtDNA) accumulate during aging, but their significance to longevity and age-associated disease has been uncertain. Recently, in support of the hypothesis that mtDNA integrity is important, we have shown that age-associated diseases arise more rapidly in mice where mtDNA mutations and increased levels of apoptosis occur at higher rates than normal due to expression of an error-prone mtDNA polymerase. Further studies in this model may provide deeper insights into the relationship between mitochondria, aging, and susceptibility to age-associated diseases, such as cancer. (Cancer Res 2006; 66(15): 7386-9) Mitochondrial DNA Mutations and Aging Mitochondria contain their own f16.5-kb circular DNA encoding essential subunits of the electron transport chain complexes as well as the tRNAs and rRNAs necessary for their translation. Because of the high gene density of the mitochondrial genome, mutations in mitochondrial DNA (mtDNA) have a high likelihood of affecting the expression or coding sequence of mitochondrial genes. This susceptibility to deleterious mutations is offset to an extent by the presence of multiple copies of the mitochondrial genome in every cell.Point mutations and deletions in mtDNA accumulate with age in a wide variety of tissues in multiple species (1-7), and there is evidence to suggest that there can be functional consequences with respect to mitochondrial bioenergetics. Loss of cytochrome c oxidase activity has been correlated with the presence of mtDNA deletions in serial sections of aged muscle fibers (8), and clonal expansion of cytochrome c oxidase-deficient cells bearing pathogenic mtDNA point mutations in aged intestinal crypts has been reported (9). Until recently, however, the association between mtDNA mutations and aging has remained correlative. We (10) and others (11) have now addressed this issue by generating mice that display elevated mtDNA mutation frequencies throughout their tissues [3-11 times higher than wild-type (WT) mice] due to errorprone replication by an exonuclease-deficient derivative of the nuclear-encoded mtDNA polymerase g. These mitochondrial mutator (Polg D257A , herein called D257A) mice display a large array of phenotypes resembling aspects of accelerated aging; these include reduced life span, hair graying and alopecia, cardiac enlargement with functional alterations, muscle loss, reduced fertility, accelerated thymic involution, kyphosis, and decreased bone density, and age-related hearing loss (presbycusis). Additionally, these mice become anemic and display loss of intestinal crypts or disorganized villar structures. The accumulation of mtDNA mutations in D257A mice begins early in development (12), in contrast to observations in human tissues, where substantially increased frequencies of mtDNA mutations do not occur until after the 4th or 5th decade of life (2, 4, 7). In young adult WT mice, we have observed that levels of mtDNA mutations are quite high, averaging 3 to 10 mutations per mtDNA genome in tissues from 5...