Twinkle, encoded by C10orf2 is required for mtDNA replication.
C10orf2 sequencing revealed 3 different variants identified in 3 of the 12 patients with multiple mtDNA deletions and CPEO.
In silico prediction showed p.G655D variant is potentially pathogenic.
Sequencing of C10orf2 is mandatory patients with CPEO and mtDNA multiple deletions for proper prognosis and family counselling.