Molecular insight into mitochondrial DNA depletion syndrome in two patients with novel mutations in the deoxyguanosine kinase and thymidine kinase 2 genes

• Published in: Molecular genetics and metabolism Vol. 84; no. 1; pp. 75 - 82
• Main Authors: Wang, Liya, Limongelli, Anna, Vila, Maya R., Carrara, Franco, Zeviani, Massimo, Eriksson, Staffan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2005
• Subjects: Child, Preschool; Chromatography, Gel; Deoxyguanosine kinase; DNA Primers; DNA, Complementary - genetics; DNA, Mitochondrial - genetics; DNA, Mitochondrial - metabolism; Enzyme kinetic; Fatal Outcome; Female; Humans; Infant, Newborn; Liver - pathology; Male; Mitochondrial DNA depletion; Mitochondrial DNA depletion syndrome; Mitochondrial Myopathies - genetics; Mitochondrial Myopathies - pathology; Muscle, Skeletal - pathology; Mutagenesis; Mutagenesis, Site-Directed; Mutation; Mutation - genetics; Phosphotransferases (Alcohol Group Acceptor) - genetics; Phosphotransferases (Alcohol Group Acceptor) - metabolism; Reverse Transcriptase Polymerase Chain Reaction; Thymidine Kinase - genetics; Thymidine Kinase - metabolism; Thymidine kinase 2; Mitochondrial DNA depletion; Thymidine kinase 2; Mitochondrial DNA depletion syndrome; Mutagenesis; Mutation; Enzyme kinetic; Deoxyguanosine kinase
• ISSN: 1096-7192; 1096-7206
• DOI: 10.1016/j.ymgme.2004.09.005

Thymidine kinase 2 (TK2) and deoxyguanosine kinase (dGK) are the two key enzymes in mitochondrial DNA (mtDNA) precursor synthesis. Deficiencies in TK2 or dGK activity, due to genetic alteration, have been shown to cause tissue-specific depletion of mtDNA. In the case of TK2 deficiency, affected individuals suffer severe myopathy and, in the case of dGK deficiency, devastating liver or multi-systemic disease. Here, we report clinical and biochemical findings from two patients with mtDNA depletion syndrome. Patient A was a compound heterozygote carrying the previously reported T77M mutation and a novel mutation (R161K) in the TK2 gene. Patient B carried a novel mutation (L250S) in the dGK gene. The clinical symptoms of patient A included muscular weakness and exercise intolerance due to a severe mitochondrial myopathy associated with a 92% reduction in mtDNA. There was minimal involvement of other organs. Patient B suffered from rapidly progressive, early onset fatal liver failure associated with profoundly decreased mtDNA levels in liver and, to a lesser extent, in skeletal muscle. Site-directed mutagenesis was used to introduce the mutations detected in patients A and B into the TK2 and dGK cDNAs, respectively. We then characterized each of these recombinant enzymes. Catalytic activities of the three mutant enzymes were reduced to about 2–4% for TK2 and 0.5% for dGK as compared to the wild-type enzymes. Altered competition between dCyd and dThd was observed for the T77M mutant. The residual activities of the two mitochondrial enzymes correlated directly with disease development.