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Deoxynucleoside Therapy for Thymidine Kinase 2-Deficient Myopathy.

Abstract：

OBJECTIVE:Thymidine kinase 2, encoded by the nuclear gene TK2, is required for mitochondrial DNA maintenance. Autosomal recessive TK2 mutations cause depletion and multiple deletions of mtDNA that manifest predominantly as a myopathy usually beginning in childhood and progressing relentlessly. We investigated the safety and efficacy of deoxynucleoside monophosphate and deoxynucleoside therapies. METHODS:We administered deoxynucleoside monophosphates and deoxynucleoside to 16 TK2-deficient patients under a compassionate use program. RESULTS:In 5 patients with early onset and severe disease, survival and motor functions were better than historically untreated patients. In 11 childhood and adult onset patients, clinical measures stabilized or improved. Three of 8 patients who were nonambulatory at baseline gained the ability to walk on therapy; 4 of 5 patients who required enteric nutrition were able to discontinue feeding tube use; and 1 of 9 patients who required mechanical ventilation became able to breathe independently. In motor functional scales, improvements were observed in the 6-minute walk test performance in 7 of 8 subjects, Egen Klassifikation in 2 of 3, and North Star Ambulatory Assessment in all 5 tested. Baseline elevated serum growth differentiation factor 15 levels decreased with treatment in all 7 patients tested. A side effect observed in 8 of the 16 patients was dose-dependent diarrhea, which did not require withdrawal of treatment. Among 12 other TK2 patients treated with deoxynucleoside, 2 adults developed elevated liver enzymes that normalized following discontinuation of therapy. INTERPRETATION:This open-label study indicates favorable side effect profiles and clinical efficacy of deoxynucleoside monophosphate and deoxynucleoside therapies for TK2 deficiency. ANN NEUROL 2019;86:293-303.

journal_name

Ann Neurol

journal_title

Annals of neurology

authors

Domínguez-González C,Madruga-Garrido M,Mavillard F,Garone C,Aguirre-Rodríguez FJ,Donati MA,Kleinsteuber K,Martí I,Martín-Hernández E,Morealejo-Aycinena JP,Munell F,Nascimento A,Kalko SG,Sardina MD,Álvarez Del Vayo C,Serrano

doi

10.1002/ana.25506

subject

Has Abstract

pub_date

2019-08-01 00:00:00

pages

293-303

issue

eissn

0364-5134

issn

1531-8249

journal_volume

pub_type

杂志文章,多中心研究

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Deoxynucleoside Therapy for Thymidine Kinase 2-Deficient Myopathy.