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Mitochondrial DNA (mtDNA) mutations accumulate in both mitotic and post-mitotic somatic tissues of normal individuals with age. They clonally expand within individual cells and cause mitochondrial dysfunction. In contrast, in patients with inherited disease-causing mtDNA mutations the mutation load decreases in mitotic tissues over time, whereas the mutations load in post-mitotic tissues remains relatively stable. The mechanisms underlying this decrease in mitotic tissues, and whether mitochondrial function is restored at the tissue level are unknown. Here, using a combination of homogenate tissue and single crypt/muscle fibre pyrosequencing we have shown a decrease in the mutation load of the germline heteroplasmic m.5024C>T mutation in multiple mitotic tissues of a mouse model of inherited mitochondrial disease (C5024T mice). We have then usedin silicopredictions to model the cellular dynamics of mtDNA mutation load in mitotic and post mitotic tissues. We demonstrate that: (1) the rate of m.5024C>T decrease correlates with the rate of tissue turnover; (2) the mutation load decrease is not associated with changes in overall cellular proliferation and apoptosis within the mitotic colonic epithelium; instead, it could be due to an upper limit of m.5024C>T load in stem cell populations; (3) the m.5024C>T mutation load is maintained in post-mitotic tissues over time with a consistent load amongst individual muscle fibres; (4)in silicomodelling supports a scenario where genetic drift is accelerated in mitotic tissues by high levels of mtDNA replication coupled with mtDNA segregation at cell division. This study has advanced our understanding of the dynamics of mtDNA mutations and phenotype development in patients with mtDNA disease.Author SummaryHealthy individuals randomly accumulate pathogenic mtDNA mutations with age in dividing cells, causing mitochondrial dysfunction. Interestingly, patients with mitochondrial disease show a relative decrease in the loads of inherited mtDNA mutations in some dividing cells over time. The mechanisms underlying this decrease are unknown. Here we show a decrease in the load of the germline heteroplasmic m.5024C>T mutation in dividing cells and tissues of a mouse model of mitochondrial disease. In contrast, the mutation load in non-dividing cells and tissue remains stable. Our data are consistent with the hypothesis that a higher frequency of mtDNA replication in dividing cells, coupled with stem cells having an upper tolerance limit for m.5024C>T, causes an overall decrease in m.5024C>T load at the tissue level.