Transketolase activity is decreased in deficiency of thiamine, which in general is due to malnutrition. Several diseases are associated with thiamine deficiency, including beriberi, biotin-thiamine-responsive basal ganglia disease (BTBGD), Wernicke–Korsakoff syndrome, and others (see thiamine for a comprehensive listing).
In Wernicke–Korsakoff syndrome, while no mutations could be demonstrated, there is an indication that thiamine deficiency leads to Wernicke–Korsakoff syndrome only in those whose transketolase has a reduced affinity for thiamine. In this way, the activity of transketolase is greatly hindered, and, as a consequence, the entire pentose phosphate pathway is inhibited.
In Transketolase Deficiency, also known as SDDHD (Short Stature, Developmental Delay, and congenital Heart Defects), the disease is caused by an inherited autosomal recessive mutation in the TKT gene. A rare disorder of pentose phosphate metabolism with symptoms apparent in infancy including developmental delay and intellectual disability, delayed or absent speech, short stature, and congenital heart defects. Additional reported features include hypotonia, hyperactivity, stereotypic behavior, ophthalmologic abnormalities, hearing impairment, and variable facial dysmorphism, among others. Laboratory analysis shows elevated plasma and urinary polyols (erythritol, arabitol, and ribitol) and urinary sugar-phosphates (ribose-5-phosphate and xylulose/ribulose-5-phosphate). "Cell extracts from all 5 patients showed absent or low residual TKT activity. Boyle et al. (2016) suggested that the low TKT activity in some tissues, possibly from another protein with the same function, might explain why TKT deficiency is compatible with life even though TKT is an essential enzyme."