Molecular basis and clinical implications of TANGO2 deficiency disorder

TANGO2 deficiency disorder (TDD) is an ultrarare, autosomal recessive disease characterized by neuromuscular impairment, intellectual disability, and recurrent metabolic crises leading to life-threatening ventricular arrhythmias. Intrafamilial phenotypic variability and overlapping manifestations with other metabolic diseases complicate timely and accurate diagnosis. This review summarizes the clinical spectrum and emerging molecular mechanisms of TDD, integrating insights from structural biology and experimental disease models. Evidence suggests that high-dose vitamin B complex supplementation can reduce the frequency of metabolic crises and improve neurocognitive outcomes, underscoring the importance of early diagnosis and intervention. By integrating recent advances, this review aims to provide a thorough understanding of TANGO2 deficiency, identify key unmet needs, and define future research priorities.