Molecular and clinical characterization of the myopathic form of mitochondrial DNA depletion syndrome caused by mutations in the thymidine kinase (TK2) gene

Mol Genet Metab. Sep-Oct 2013;110(1-2):153-61. doi: 10.1016/j.ymgme.2013.07.009. Epub 2013 Jul 17.


Mitochondrial DNA (mtDNA) depletion syndromes (MDSs) are a clinically and molecularly heterogeneous group of mitochondrial cytopathies characterized by severe mtDNA copy number reduction in affected tissues. Clinically, MDSs are mainly categorized as myopathic, encephalomyopathic, hepatocerebral, or multi-systemic forms. To date, the myopathic form of MDS is mainly caused by mutations in the TK2 gene, which encodes thymidine kinase 2, the first and rate limiting step enzyme in the phosphorylation of pyrimidine nucleosides. We analyzed 9 unrelated families with 11 affected subjects exhibiting the myopathic form of MDS, by sequencing the TK2 gene. Twelve mutations including 4 novel mutations were detected in 9 families. Skeletal muscle specimens were available from 7 out of 11 subjects. Respiratory chain enzymatic activities in skeletal muscle were measured in 6 subjects, and enzymatic activities were reduced in 3 subjects. Quantitative analysis of mtDNA content in skeletal muscle was performed in 5 subjects, and marked mtDNA content reduction was observed in each. In addition, we outline the molecular and clinical characteristics of this syndrome in a total of 52 patients including those previously reported, and a total of 36 TK2 mutations are summarized. Clinically, hypotonia and proximal muscle weakness are the major phenotypes present in all subjects. In summary, our study expands the molecular and clinical spectrum associated with TK2 deficiency.

Keywords: Myopathic mtDNA depletion syndrome; Thymidine kinase 2 gene.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • DNA, Mitochondrial / genetics*
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Mitochondrial Diseases / genetics*
  • Mitochondrial Diseases / pathology
  • Muscle, Skeletal / enzymology
  • Muscular Diseases / genetics*
  • Muscular Diseases / pathology
  • Mutation*
  • Pedigree
  • Sequence Analysis, DNA
  • Thymidine Kinase / genetics*


  • DNA, Mitochondrial
  • thymidine kinase 2
  • Thymidine Kinase

Supplementary concepts

  • Mitochondrial DNA Depletion Syndrome, Myopathic Form