1
|
Alyazidi AS, Muthaffar OY, Shawli MK, Ahmed RA, Aljefri YF, Baaishrah LS, Jambi AT, Alotibi FA. Phenotypic and Molecular Spectrum of Guanidinoacetate N-Methyltransferase Deficiency: An Analytical Study of a Case Series and a Scoping Review of 53 Cases of Guanidinoacetate N-Methyltransferase. J Microsc Ultrastruct 2024; 12:81-90. [PMID: 39006040 PMCID: PMC11245129 DOI: 10.4103/jmau.jmau_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 12/02/2022] Open
Abstract
Background Guanidinoacetate methyltransferase deficiency (GAMT) is an autosomal recessive inborn error of metabolism. A condition that results from a pathogenic variant in the GAMT gene that maps to 19p13.3. The prevalence can be estimated to be up to 1:2,640,000 cases; countries such as Saudi Arabia could have a higher prevalence due to high consanguinity rates. The clinical manifestations that a patient could obtain are broad and start to manifest in the patients' early childhood years. Materials and Methods A thorough review of case reports in January 2022 was conducted. The retrieved literature was screened for demographic data. Patients of all ages were included. Qualitative variables were described as number and percentage (%), and quantitative data were described by the mean and standard deviation. In bivariate data, Chi-square test (χ2) was used and t-test for nonparametric variables. Results Gender distribution was 53% of males and 47% females. Reported age ranged from 8 to 31 months. At the age of onset, 50% of the cases were infants, 28% were toddlers, and 15% were children, concluding that 79% of the reported cases developed symptoms before 5 years old. 68% of the cases developed generalized seizures throughout their life. 84% of the cases expressed a form of developmental delay. 43% of the cases had intellectual disabilities and mental retardation that affected their learning process; most cases required special care. 23% of the affected cases were of consanguineous marriages, and 7% had affected relatives. Conclusion We described four novel case reports, the first to be reported in Saudi Arabia. Seizure was a leading finding in the majority of the cases. Developmental delay was broadly observed. Intellectual delay and language impairments are primary hallmarks. Further understanding and early diagnosis are recommended. Premarital testing of neurogenetic diseases using whole-exome sequencing is probably a future direction, especially in populations with high consanguinity rates.
Collapse
Affiliation(s)
- Anas S. Alyazidi
- Undergraduate Student, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Y. Muthaffar
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed K. Shawli
- Undergraduate Student, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Renad A. Ahmed
- Undergraduate Student, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yara Fahad Aljefri
- Undergraduate Student, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Layan Saleh Baaishrah
- Undergraduate Student, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulaziz T. Jambi
- Undergraduate Student, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad A. Alotibi
- Undergraduate Student, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| |
Collapse
|
2
|
Yıldız Y, Ardıçlı D, Göçmen R, Yalnızoğlu D, Topçu M, Coşkun T, Tokatlı A, Haliloğlu G. Electro-clinical features and long-term outcomes in guanidinoacetate methyltransferase (GAMT) deficiency. Eur J Paediatr Neurol 2024; 49:66-72. [PMID: 38394710 DOI: 10.1016/j.ejpn.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVE To evaluate clinical characteristics and long-term outcomes in patients with guanidinoacetate methyltransferase (GAMT) deficiency with a special emphasis on seizures and electroencephalography (EEG) findings. METHODS We retrospectively analyzed the clinical and molecular characteristics, seizure types, EEG findings, neuroimaging features, clinical severity scores, and treatment outcomes in six patients diagnosed with GAMT deficiency. RESULTS Median age at presentation and diagnosis were 11.5 months (8-12 months) and 63 months (18 months -11 years), respectively. Median duration of follow-up was 14 years. Global developmental delay (6/6) and seizures (5/6) were the most common symptoms. Four patients presented with febrile seizures. The age at seizure-onset ranged between 8 months and 4 years. Most common seizure types were generalized tonic seizures (n = 4) and motor seizures resulting in drop attacks (n = 3). Slow background activity (n = 5) and generalized irregular sharp and slow waves (n = 3) were the most common EEG findings. Burst-suppression and electrical status epilepticus during slow-wave sleep (ESES) pattern was present in one patient. Three of six patients had drug-resistant epilepsy. Post-treatment clinical severity scores showed improvement regarding movement disorders and epilepsy. All patients were seizure-free in the follow-up. CONCLUSIONS Epilepsy is one of the main symptoms in GAMT deficiency with various seizure types and non-specific EEG findings. Early diagnosis and initiation of treatment are crucial for better seizure and cognitive outcomes. This long-term follow up study highlights to include cerebral creatine deficiency syndromes in the differential diagnosis of patients with global developmental delay and epilepsy and describes the course under treatment.
Collapse
Affiliation(s)
- Yılmaz Yıldız
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Turkey.
| | - Didem Ardıçlı
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Turkey
| | - Rahşan Göçmen
- Hacettepe University Faculty of Medicine, Department of Radiology, Turkey.
| | - Dilek Yalnızoğlu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Turkey.
| | - Meral Topçu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Turkey
| | - Turgay Coşkun
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Turkey
| | - Ayşegül Tokatlı
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Turkey.
| | - Göknur Haliloğlu
- Hacettepe University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Neurology, Turkey.
| |
Collapse
|
3
|
Abdennadher M, Inati SK, Rahhal S, Khan O, Bartolini L, Thurm A, Theodore W, Miller JS, Porter FD, Bianconi S. Characterization of seizures and EEG findings in creatine transporter deficiency due to SLC6A8 mutation. Am J Med Genet A 2024; 194:337-345. [PMID: 37850681 DOI: 10.1002/ajmg.a.63418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 10/19/2023]
Abstract
Seizures occur in up to 59% of boys with creatine transporter deficiency (CTD). While seizure phenotypes have been previously described, electroencephalogram (EEG) findings have only been reported in several case reports. In this prospective observational study, we report seizure characteristics and EEG findings in combination with neurobehavioral and SLC6A8 pathogenic variants in twenty males with CTD. Eighteen study participants (SP) underwent video-EEG, and seven had follow-up EEG recordings. Seizures typically occurred by age of 2 years. Thirteen (65%) had non-febrile seizures, requiring anti-seizure medications in nine. Four had febrile seizures. Seizures were bilateral tonic-clonic in 7 SP and focal impaired awareness in 5 SP; often responding to 1 to 2 antiseizure medications. EEG showed slowing in 5 SP, beta activity in 6 SP, and focal/multifocal, and/or generalized epileptiform activity in 9 SP. Follow-up EEGs in 7 SP showed emergence of epileptiform activity in 1 SP, and increased activity in 2 SP. In conclusion, seizures were frequent in our cohort but tended to respond to antiseizure medications. Longitudinal follow up provided further insight into emergence of seizures and EEG abnormalities soliciting future studies with long term follow up. Biomarkers of epileptogenicity in CTD are needed to predict seizures in this population.
Collapse
Affiliation(s)
- Myriam Abdennadher
- Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Sara K Inati
- Neurophysiology of Epilepsy Unit, NINDS, National Institutes of Health, Bethesda, Maryland, USA
| | - Samar Rahhal
- Section on Molecular Dysmorphology, Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Rockville, Maryland, USA
| | - Omar Khan
- Veterans Administration, Washington, District of Columbia, USA
| | - Luca Bartolini
- Hasbro Childrens' Hospital, Brown University, Providence, Rhode Island, USA
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, NIMH, National Institutes of Health, Bethesda, Maryland, USA
| | - William Theodore
- Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, Maryland, USA
| | - Judith S Miller
- Departments of Psychiatry and Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Forbes D Porter
- Section on Molecular Dysmorphology, Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Rockville, Maryland, USA
| | - Simona Bianconi
- Eunice Kennedy Shriver National Institute of Child Health and Development, National Institutes of Health, Rockville, Maryland, USA
- Clinical Genetics, Kaiser Permanente Medical Group of Southern California, La Palma, California, USA
| |
Collapse
|
4
|
Horvat D, Kaminski M, Ma Y. A case of drug-resistant epilepsy and autism with de novo SLC6A8 gene variant. Seizure 2023; 113:16-18. [PMID: 37924775 DOI: 10.1016/j.seizure.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
- David Horvat
- Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889 USA
| | - Matthew Kaminski
- University of Maryland, 1000 Hilltop Cir, Baltimore, MD, 21250 USA
| | - Yitao Ma
- Department of Neurology, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD, 20889 USA.
| |
Collapse
|
5
|
Aghamollaii V, Meshkat S, Bakhtiari S, Alehabib E, Firouzabadi SG, Molaei S, Kruer MC, Darvish H. Guanidinoacetate Methyltransferase Deficiency, a Treatable Neurodevelopmental Disorder. JOURNAL OF PEDIATRIC EPILEPSY 2023. [DOI: 10.1055/s-0042-1760291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AbstractGuanidinoacetate methyltransferase (GAMT) deficiency is an autosomal recessive inborn error of creatine synthesis that results in intellectual disability, epilepsy, expressive language delay, and dystonia. We report data from two siblings with an uncommon GAMT deficiency phenotype and their clinical, biochemical, imaging, and treatment findings. The older sibling had intellectual disability, epilepsy, and generalized dystonia. The younger sibling had intellectual disability and generalized dystonia. After treatment with creatine, verbal fluency improved, as well as dystonia and aggression. This study confirms that in patients with unexplained intellectual disability, epilepsy, and/or movement disorders, GAMT deficiency should be considered. GAMT-associated cerebral creatine deficiency syndrome is a potentially treatable condition and can be identified by elevated levels of guanidinoacetate in plasma or urine or by a significantly decreased creatine peak on magnetic resonance spectroscopy.
Collapse
Affiliation(s)
- Vajiheh Aghamollaii
- Neurology Department, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shakila Meshkat
- Neurology Department, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Bakhtiari
- Barrow Neurological Institute, Phoenix Children's Hospital, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, United States
| | - Elham Alehabib
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Samira Molaei
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael C. Kruer
- Barrow Neurological Institute, Phoenix Children's Hospital, University of Arizona College of Medicine – Phoenix, Phoenix, Arizona, United States
| | - Hossein Darvish
- Cancer Research Center, Department of Medical Genetics, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| |
Collapse
|
6
|
Muacevic A, Adler JR, Lacasse BM, Beggs J, Lou J, Motta FC, Nemzer LR, Worth R, Cravens GD. A Literature Review of Similarities Between and Among Patients With Autism Spectrum Disorder and Epilepsy. Cureus 2023; 15:e33946. [PMID: 36819340 PMCID: PMC9937677 DOI: 10.7759/cureus.33946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
Autism spectrum disorder (ASD) has been shown to be associated with various other conditions, and most commonly, ASD has been demonstrated to be linked to epilepsy. ASD and epilepsy have been observed to exhibit high rates of comorbidity, even when compared to the co-occurrence of other disorders with similar pathologies. At present, nearly one-half of the individuals diagnosed with ASD also have been diagnosed with comorbid epilepsy. Research suggests that both conditions likely share similarities in their underlying disease pathophysiology, possibly associated with disturbances in the central nervous system (CNS), and may be linked to an imbalance between excitation and inhibition in the brain. Meanwhile, it remains unclear whether one condition is the consequence of the other, as the pathologies of both disorders are commonly linked to many different underlying signal transduction mechanisms. In this review, we aim to investigate the co-occurrence of ASD and epilepsy, with the intent of gaining insights into the similarities in pathophysiology that both conditions present with. Elucidating the underlying disease pathophysiology as a result of both disorders could lead to a better understanding of the underlying mechanism of disease activity that drives co-occurrence, as well as provide insight into the underlying mechanisms of each condition individually.
Collapse
|
7
|
Almaghrabi MA, Muthaffar OY, Alahmadi SA, Abdulsbhan MA, Bamusa M, Aljezani MA, Bahowarth SY, Alyazidi AS, Aggad WS. GAMT Deficiency Among Pediatric Population: Clinical and Molecular Characteristics and Management. Child Neurol Open 2023; 10:2329048X231215630. [PMID: 38020815 PMCID: PMC10655665 DOI: 10.1177/2329048x231215630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objective: Analyze the treatment modalities used in real practice by synthesizing available literature. Methods: We reviewed and evaluated 52 cases of GAMT deficiency including 4 novel cases from Saudi Arabia diagnosed using whole-exome sequencing. All data utilized graphical presentation in the form of line charts and illustrated graphs. Results: The mean current age of was 117 months (±29.03) (range 12-372 months). The mean age of disease onset was 28.32 months (±13.68) (range 8 days - 252 months). The most prevalent symptom was developmental delays, mainly speech and motor, seizures, and intellectual disability. The male-to-female ratio was 3:1. Multiple treatments were used, with 54 pharmacological interventions, valproic acid being the most common. Creatinine monohydrate was the prevalent dietary intervention, with 25 patients reporting an improvement. Conclusion: The study suggests that efficient treatment with appropriate dietary intervention can improve patients' health, stressing that personalized treatment programs are essential in managing this disorder.
Collapse
Affiliation(s)
- Majdah A. Almaghrabi
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Y. Muthaffar
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sereen A. Alahmadi
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mashael A. Abdulsbhan
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mashael Bamusa
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maram Ahmed Aljezani
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Anas S. Alyazidi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Waheeb S. Aggad
- Department of Anatomy, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| |
Collapse
|
8
|
Bianchi M, Rossi L, Pierigè F, De Angeli P, Aliano MP, Carducci C, Di Carlo E, Pascucci T, Nardecchia F, Leuzzi V, Magnani M. Engineering new metabolic pathways in isolated cells for the degradation of guanidinoacetic acid and simultaneous production of creatine. Mol Ther Methods Clin Dev 2022; 25:26-40. [PMID: 35317049 PMCID: PMC8917272 DOI: 10.1016/j.omtm.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/19/2022] [Indexed: 11/23/2022]
Abstract
Here we report, for the first time, the engineering of human red blood cells (RBCs) with an entire metabolic pathway as a potential strategy to treat patients with guanidinoacetate methyltransferase (GAMT) deficiency, capable of reducing the high toxic levels of guanidinoacetate acid (GAA) and restoring proper creatine levels in blood and tissues. We first produced a recombinant form of native human GAMT without any tags to encapsulate into RBCs. Due to the poor solubility and stability features of the recombinant enzyme, both bioinformatics studies and extensive optimization work were performed to select a mutant GAMT enzyme, where only four critical residues were replaced, as a lead candidate. However, GAMT-loaded RBCs were ineffective in GAA consumption and creatine production because of the limiting intra-erythrocytic S-adenosyl methionine (SAM) content unable to support GAMT activity. Therefore, a recombinant form of human methionine adenosyl transferase (MAT) was developed. RBCs co-entrapped with both GAMT and MAT enzymes performed, in vitro, as a competent cellular bioreactor to remove GAA and produce creatine, fueled by physiological concentrations of methionine and the ATP generated by glycolysis. Our results highlight that metabolic engineering of RBCs is possible and represents proof of concept for the design of novel therapeutic approaches.
Collapse
Affiliation(s)
- Marzia Bianchi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029, Urbino, Italy
| | - Luigia Rossi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029, Urbino, Italy.,EryDel, Via Antonio Meucci 3, 20091 Bresso, Milan, Italy
| | - Francesca Pierigè
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029, Urbino, Italy
| | - Pietro De Angeli
- Center for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Mattia Paolo Aliano
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029, Urbino, Italy
| | - Claudia Carducci
- Department of Experimental Medicine, Sapienza University, 00161 Rome, Italy
| | - Emanuele Di Carlo
- Department of Experimental Medicine, Sapienza University, 00161 Rome, Italy
| | - Tiziana Pascucci
- Department of Psychology and "Daniel Bovet" Center, Sapienza University, 00184 Rome, Italy.,Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Santa Lucia, 00142 Rome, Italy
| | - Francesca Nardecchia
- Division of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy
| | - Vincenzo Leuzzi
- Division of Child Neurology and Psychiatry, Department of Human Neuroscience, Sapienza University, 00185 Rome, Italy
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029, Urbino, Italy.,EryDel, Via Antonio Meucci 3, 20091 Bresso, Milan, Italy
| |
Collapse
|
9
|
Passi GR, Pandey S, Devi ARR, Konanki R, Jain AR, Bhatnagar S, Tripathi R, Jain V. Cerebral creatine deficiency disorders - A clinical, genetic and follow up study from India. Brain Dev 2022; 44:271-280. [PMID: 34974949 DOI: 10.1016/j.braindev.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/04/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cerebral creatine deficiency syndromes (CCDS) are a group of potentially treatable neurometabolic disorders. The clinical, genetic profile and follow up outcome of Indian CCDS patients is presented. MATERIALS AND METHODS This was a retrospective cohort of CCDS patients seen over six-years. Diagnosis was based either on low creatine peak on proton magnetic resonance spectroscopy (MRS) and/or genetic evaluation. RESULTS Thirteen patients were eligible [8 creatine transporter deficiency (CTD), 4 guanidinoacetate methyltransferase (GAMT) deficiency and 1 could not be classified]. The mean (±SD) age at diagnosis was 7.2(±5.0) years. Clinical manifestations included intellectual disability (ID) with significant expressive speech delay in all. Most had significant behavior issues (8/13) and/or autism (8/13). All had history of convulsive seizures (11/13 had epilepsy; 2 patients only had febrile seizures) and 2/13 had movement disorder. Constipation was the commonest non-neurological manifestation (5/13 patients). Cranial MRI was normal in all CTD patients but showed globus pallidus hyperintensity in all four with GAMT deficiency. MRS performed in 11/13 patients, revealed abnormally low creatine peak. A causative genetic variant (novel mutation in nine) was identified in 12 patients. Three GAMT deficiency and one CTD patient reported neurodevelopmental improvement and good seizure control after creatine supplementation. CONCLUSION Intellectual disability, disproportionate speech delay, autism, and epilepsy, were common in our CCDS patients. A normal structural neuroimaging with easily controlled febrile and/or afebrile seizures differentiated CTD from GAMT deficiency patients who had abnormal neuroimaging and often difficult to control epilepsy and movement disorder.
Collapse
Affiliation(s)
- Gouri Rao Passi
- Department of Pediatrics & Pediatric Neurology, Choithram Hospital & Research Centre, Indore, India
| | - Swati Pandey
- Department of Pediatrics & Pediatric Neurology, Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - Akella Radha Rama Devi
- Department of Genetics and Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, India
| | - Ramesh Konanki
- Department of Genetics and Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, India
| | - Abhishek Ravindra Jain
- Department of Genetics and Pediatric Neurology, Rainbow Children's Hospital, Hyderabad, India
| | - Shweta Bhatnagar
- Department of Radio Diagnosis, Sri Aurobindo Institute of Medical Sciences, Indore, India
| | - Ruchi Tripathi
- Department of Pediatrics & Pediatric Neurology, Choithram Hospital & Research Centre, Indore, India
| | - Vivek Jain
- Department of Pediatrics & Pediatric Neurology, Santokba Durlabhji Memorial Hospital, Jaipur, India.
| |
Collapse
|
10
|
McGinn RJ, Von Stein EL, Summers Stromberg JE, Li Y. Precision medicine in epilepsy. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2022; 190:147-188. [DOI: 10.1016/bs.pmbts.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Boada CM, Grossman SN, Grzeskowiak CL, Dumanis S, French JA. Proceedings of the 2020 Epilepsy Foundation Pipeline Conference: Emerging Drugs and Devices. Epilepsy Behav 2021; 125:108364. [PMID: 34731723 DOI: 10.1016/j.yebeh.2021.108364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/25/2021] [Indexed: 11/17/2022]
Abstract
From August 27-28, 2020 the Epilepsy Foundation hosted the Pipeline Conference, exploring emerging issues related to antiepileptic drug and device development. The conference featured epilepsy therapeutic companies and academic laboratories developing drugs for focal epilepsies, innovations for rare and ultra-rare diseases, and devices both in clinical trials and approved for use. In this paper, we outline the virtual presentations by the authors, including novel data from their development pipeline.
Collapse
Affiliation(s)
- Christina M Boada
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Scott N Grossman
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | | | | | - Jacqueline A French
- Department of Neurology, New York University Langone Health, New York, NY, USA
| |
Collapse
|
12
|
Liu H, Zhu J, Li Q, Wang D, Wan K, Yuan Z, Zhang J, Zou L, He X, Miao J. Untargeted metabolomic analysis of urine samples for diagnosis of inherited metabolic disorders. Funct Integr Genomics 2021; 21:645-653. [PMID: 34585279 DOI: 10.1007/s10142-021-00804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/07/2021] [Accepted: 08/27/2021] [Indexed: 11/30/2022]
Abstract
Metabolomics has become an important tool for clinical research, especially for analyzing inherited metabolic disorders (IMDs). The purpose of this study was to explore the performance of metabolomics in diagnosing IMDs using an untargeted metabolomic approach. A total of 40 urine samples were collected: 20 samples from healthy children and 20 from pediatric patients, of whom 13 had confirmed IMDs and seven had suspected IMDs. Samples were analyzed by Orbitrap mass spectrometry in positive and negative mode alternately, coupled with ultra-high liquid chromatography. Raw data were processed using Compound Discovery 2.0 ™ and then exported for partial least squares discriminant analysis (PLS-DA) by SIMCA-P 14.1. After comparing with m/zCloud and chemSpider libraries, compounds with similarity above 80% were selected and normalized for subsequent relative quantification analysis. The uncommon compounds discovered were analyzed based on the Kyoto Encyclopedia of Genes and Genomes to explore their possible metabolic pathways. All IMDs patients were successfully distinguished from controls in the PLS-DA. Untargeted metabolomics revealed a broader metabolic spectrum in patients than what is observed using routine chromatographic methods for detecting IMDs. Higher levels of certain compounds were found in all 13 confirmed IMD patients and 5 of 7 suspected IMD patients. Several potential novel markers emerged after relative quantification. Untargeted metabolomics may be able to diagnose IMDs from urine and may deepen insights into the disease by revealing changes in various compounds such as amino acids, acylcarnitines, organic acids, and nucleosides. Such analyses may identify biomarkers to improve the study and treatment of IMDs.
Collapse
Affiliation(s)
- Hao Liu
- Newborn Screening Center, Chongqing Health Center for Women and Children, Longshan Road 120th, Yubei District, Chongqing, 401147, People's Republic of China.,Center for Clinical Molecular Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Zhongshan Road 2nd, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Jiang Zhu
- Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Qiu Li
- Chongqing Key Laboratory of Child Nutrition and Health, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Dongjuan Wang
- Center for Clinical Molecular Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Zhongshan Road 2nd, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Kexing Wan
- Center for Clinical Molecular Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Zhongshan Road 2nd, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Zhaojian Yuan
- Center for Clinical Molecular Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Zhongshan Road 2nd, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Juan Zhang
- Center for Clinical Molecular Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Zhongshan Road 2nd, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Lin Zou
- Center for Clinical Molecular Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Zhongshan Road 2nd, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Xiaoyan He
- Center for Clinical Molecular Medicine, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Zhongshan Road 2nd, Yuzhong District, Chongqing, 400014, People's Republic of China.
| | - Jingkun Miao
- Newborn Screening Center, Chongqing Health Center for Women and Children, Longshan Road 120th, Yubei District, Chongqing, 401147, People's Republic of China.
| |
Collapse
|
13
|
Intellectual Disability and Brain Creatine Deficit: Phenotyping of the Genetic Mouse Model for GAMT Deficiency. Genes (Basel) 2021; 12:genes12081201. [PMID: 34440375 PMCID: PMC8391262 DOI: 10.3390/genes12081201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022] Open
Abstract
Guanidinoacetate methyltransferase deficiency (GAMT-D) is one of three cerebral creatine (Cr) deficiency syndromes due to pathogenic variants in the GAMT gene (19p13.3). GAMT-D is characterized by the accumulation of guanidinoacetic acid (GAA) and the depletion of Cr, which result in severe global developmental delay (and intellectual disability), movement disorder, and epilepsy. The GAMT knockout (KO) mouse model presents biochemical alterations in bodily fluids, the brain, and muscles, including increased GAA and decreased Cr and creatinine (Crn) levels, which are similar to those observed in humans. At the behavioral level, only limited and mild alterations have been reported, with a large part of analyzed behaviors being unaffected in GAMT KO as compared with wild-type mice. At the cerebral level, decreased Cr and Crn and increased GAA and other guanidine compound levels have been observed. Nevertheless, the effects of Cr deficiency and GAA accumulation on many neurochemical, morphological, and molecular processes have not yet been explored. In this review, we summarize data regarding behavioral and cerebral GAMT KO phenotypes, and focus on uncharted behavioral alterations that are comparable with the clinical symptoms reported in GAMT-D patients, including intellectual disability, poor speech, and autistic-like behaviors, as well as unexplored Cr-induced cerebral alterations.
Collapse
|
14
|
Ghirardini E, Calugi F, Sagona G, Di Vetta F, Palma M, Battini R, Cioni G, Pizzorusso T, Baroncelli L. The Role of Preclinical Models in Creatine Transporter Deficiency: Neurobiological Mechanisms, Biomarkers and Therapeutic Development. Genes (Basel) 2021; 12:genes12081123. [PMID: 34440297 PMCID: PMC8392480 DOI: 10.3390/genes12081123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 12/12/2022] Open
Abstract
Creatine (Cr) Transporter Deficiency (CTD) is an X-linked metabolic disorder, mostly caused by missense mutations in the SLC6A8 gene and presenting with intellectual disability, autistic behavior, and epilepsy. There is no effective treatment for CTD and patients need lifelong assistance. Thus, the research of novel intervention strategies is a major scientific challenge. Animal models are an excellent tool to dissect the disease pathogenetic mechanisms and drive the preclinical development of therapeutics. This review illustrates the current knowledge about Cr metabolism and CTD clinical aspects, with a focus on mainstay diagnostic and therapeutic options. Then, we discuss the rodent models of CTD characterized in the last decade, comparing the phenotypes expressed within clinically relevant domains and the timeline of symptom development. This analysis highlights that animals with the ubiquitous deletion/mutation of SLC6A8 genes well recapitulate the early onset and the complex pathological phenotype of the human condition. Thus, they should represent the preferred model for preclinical efficacy studies. On the other hand, brain- and cell-specific conditional mutants are ideal for understanding the basis of CTD at a cellular and molecular level. Finally, we explain how CTD models might provide novel insight about the pathogenesis of other disorders, including cancer.
Collapse
MESH Headings
- Animals
- Biomarkers/metabolism
- Brain Diseases, Metabolic, Inborn/metabolism
- Brain Diseases, Metabolic, Inborn/pathology
- Brain Diseases, Metabolic, Inborn/therapy
- Central Nervous System/pathology
- Creatine/deficiency
- Creatine/metabolism
- Disease Models, Animal
- Humans
- Mental Retardation, X-Linked/metabolism
- Mental Retardation, X-Linked/pathology
- Mental Retardation, X-Linked/therapy
- Mice
- Plasma Membrane Neurotransmitter Transport Proteins/deficiency
- Plasma Membrane Neurotransmitter Transport Proteins/metabolism
- Rats
Collapse
Affiliation(s)
- Elsa Ghirardini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, I-56128 Pisa, Italy; (E.G.); (G.S.); (R.B.); (G.C.)
- Institute of Neuroscience, National Research Council (CNR), I-56124 Pisa, Italy; (F.C.); (F.D.V.); (M.P.); (T.P.)
| | - Francesco Calugi
- Institute of Neuroscience, National Research Council (CNR), I-56124 Pisa, Italy; (F.C.); (F.D.V.); (M.P.); (T.P.)
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, I-50135 Florence, Italy
| | - Giulia Sagona
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, I-56128 Pisa, Italy; (E.G.); (G.S.); (R.B.); (G.C.)
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, I-50135 Florence, Italy
| | - Federica Di Vetta
- Institute of Neuroscience, National Research Council (CNR), I-56124 Pisa, Italy; (F.C.); (F.D.V.); (M.P.); (T.P.)
- Department of Biology, University of Pisa, I-56126 Pisa, Italy
| | - Martina Palma
- Institute of Neuroscience, National Research Council (CNR), I-56124 Pisa, Italy; (F.C.); (F.D.V.); (M.P.); (T.P.)
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, I-50135 Florence, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, I-56128 Pisa, Italy; (E.G.); (G.S.); (R.B.); (G.C.)
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126 Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, I-56128 Pisa, Italy; (E.G.); (G.S.); (R.B.); (G.C.)
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126 Pisa, Italy
| | - Tommaso Pizzorusso
- Institute of Neuroscience, National Research Council (CNR), I-56124 Pisa, Italy; (F.C.); (F.D.V.); (M.P.); (T.P.)
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, I-50135 Florence, Italy
| | - Laura Baroncelli
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, I-56128 Pisa, Italy; (E.G.); (G.S.); (R.B.); (G.C.)
- Institute of Neuroscience, National Research Council (CNR), I-56124 Pisa, Italy; (F.C.); (F.D.V.); (M.P.); (T.P.)
- Correspondence:
| |
Collapse
|
15
|
Mazurkiewicz-Bełdzińska M, Del Toro M, Haliloğlu G, Huidekoper HH, Kravljanac R, Mühlhausen C, Andersen BN, Prpić I, Striano P, Auvin S. Managing CLN2 disease: a treatable neurodegenerative condition among other treatable early childhood epilepsies. Expert Rev Neurother 2021; 21:1275-1282. [PMID: 33538188 DOI: 10.1080/14737175.2021.1885374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Neuronal ceroid lipofuscinosis type 2 (CLN2 disease) is a rare pediatric neurodegenerative condition, which is usually fatal by mid-adolescence. Seizures are one of the most common early symptoms of CLN2 disease, but patients often experience language deficits, movement disorders, and behavioral problems. Diagnosis of CLN2 disease is challenging (particularly when differentiating between early-onset developmental, metabolic, or epileptic syndromes), and diagnostic delays often overlap with rapid disease progression. An enzyme replacement therapy (cerliponase alfa) is now available, adding CLN2 disease to the list of potentially treatable disorders requiring a prompt diagnosis. AREAS COVERED Although advances in enzymatic activity testing and genetic testing have facilitated diagnoses of CLN2 disease, our review highlights the presenting symptoms that are vital in directing clinicians to perform appropriate tests or seek expert opinion. We also describe common diagnostic challenges and some potential misdiagnoses that may occur during differential diagnosis. EXPERT OPINION An awareness of CLN2 disease as a potentially treatable disorder and increased understanding of the key presenting symptoms can support selection of appropriate tests and prompt diagnosis. The available enzyme replacement therapy heralds an even greater imperative for early diagnosis, and for clinicians to direct patients to appropriate diagnostic pathways.
Collapse
Affiliation(s)
| | - Mireia Del Toro
- Department of Pediatric Neurology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Göknur Haliloğlu
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hidde H Huidekoper
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ružica Kravljanac
- Institute for Mother and Child Healthcare of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris Mühlhausen
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Göttingen, Germany
| | - Brian Nauheimer Andersen
- Department of Pediatric and Adolescent Medicine, Centre for Rare Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Igor Prpić
- Faculty of Medicine, Clinical Hospital Centre Rijeka, University of Rijeka, Rijeka, Croatia
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Stéphane Auvin
- Pediatric Neurology Department, Rare Epilepsy Center, Université de Paris, Robert Debré University Hospital, Paris, France
| |
Collapse
|
16
|
Yuan L, Wu XJ, Li WC, Zhuo C, Xu Z, Tan C, Ma R, Wang J, Pu J. SLC6A8 Knockdown Suppresses the Invasion and Migration of Human Hepatocellular Carcinoma Huh-7 and Hep3B Cells. Technol Cancer Res Treat 2020; 19:1533033820983029. [PMID: 33356959 PMCID: PMC7780307 DOI: 10.1177/1533033820983029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Liver cancer is considered the sixth most commonly diagnosed cancer and the fourth leading cause of cancer-related deaths worldwide. Currently, there is no specific and effective therapy for hepatocellular carcinoma. Therefore, developing novel diagnostic and therapeutic strategies against hepatocellular carcinoma is of paramount importance. Solute carrier family 6 member 8 (SLC6A8) encodes the solute carrier family 6-8 to transport creatine into cells in a Na+ and Cl-- dependent manner. SLC6A8 deficiency is characterized by intellectual disabilities, loss of speech, and behavioral abnormalities. Of concern, the association of SLC6A8 with hepatocellular carcinoma remains elusive. In this study, we revealed that SLC6A8 knockdown significantly induced apoptosis and suppressed the migration and invasion of Hep3B and Huh-7 cells. These findings depicted the vital role of SLC6A8 in the initiation and progression of human hepatocellular carcinoma.
Collapse
Affiliation(s)
- Lu Yuan
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Xian Jian Wu
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Wen Chuan Li
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Chenyi Zhuo
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - ZuoMing Xu
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Chuan Tan
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - RiHai Ma
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - JianChu Wang
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Jian Pu
- Hepatobiliary Surgery, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| |
Collapse
|
17
|
Fei Y, Shi R, Song Z, Wu J. Metabolic Control of Epilepsy: A Promising Therapeutic Target for Epilepsy. Front Neurol 2020; 11:592514. [PMID: 33363507 PMCID: PMC7753014 DOI: 10.3389/fneur.2020.592514] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/20/2020] [Indexed: 12/16/2022] Open
Abstract
Epilepsy is a common neurological disease that is not always controlled, and the ketogenic diet shows good antiepileptic effects drug-resistant epilepsy or seizures caused by specific metabolic defects via regulating the metabolism. The brain is a vital organ with high metabolic demands, and epileptic foci tend to exhibit high metabolic characteristics. Accordingly, there has been growing interest in the relationship between brain metabolism and epilepsy in recent years. To date, several new antiepileptic therapies targeting metabolic pathways have been proposed (i.e., inhibiting glycolysis, targeting lactate dehydrogenase, and dietary therapy). Promising strategies to treat epilepsy via modulating the brain's metabolism could be expected, while a lack of thorough understanding of the role of brain metabolism in the control of epilepsy remains. Herein, this review aims to provide insight into the state of the art concerning the brain's metabolic patterns and their association with epilepsy. Regulation of neuronal excitation via metabolic pathways and antiepileptic therapies targeting metabolic pathways are emphasized, which could provide a better understanding of the role of metabolism in epilepsy and could reveal potential therapeutic targets.
Collapse
Affiliation(s)
- Yanqing Fei
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ruting Shi
- Department of Rehabilitation, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jinze Wu
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
18
|
Mazziotti R, Cacciante F, Sagona G, Lupori L, Gennaro M, Putignano E, Alessandrì MG, Ferrari A, Battini R, Cioni G, Pizzorusso T, Baroncelli L. Novel translational phenotypes and biomarkers for creatine transporter deficiency. Brain Commun 2020; 2:fcaa089. [PMID: 32954336 PMCID: PMC7472907 DOI: 10.1093/braincomms/fcaa089] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 12/22/2022] Open
Abstract
Creatine transporter deficiency is a metabolic disorder characterized by intellectual disability, autistic-like behaviour and epilepsy. There is currently no cure for creatine transporter deficiency, and reliable biomarkers of translational value for monitoring disease progression and response to therapeutics are sorely lacking. Here, we found that mice lacking functional creatine transporter display a significant alteration of neural oscillations in the EEG and a severe epileptic phenotype that are recapitulated in patients with creatine transporter deficiency. In-depth examination of knockout mice for creatine transporter also revealed that a decrease in EEG theta power is predictive of the manifestation of spontaneous seizures, a frequency that is similarly affected in patients compared to healthy controls. In addition, knockout mice have a highly specific increase in haemodynamic responses in the cerebral cortex following sensory stimuli. Principal component and Random Forest analyses highlighted that these functional variables exhibit a high performance in discriminating between pathological and healthy phenotype. Overall, our findings identify novel, translational and non-invasive biomarkers for the analysis of brain function in creatine transporter deficiency, providing a very reliable protocol to longitudinally monitor the efficacy of potential therapeutic strategies in preclinical, and possibly clinical, studies.
Collapse
Affiliation(s)
- Raffaele Mazziotti
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Florence I-50135, Italy.,Institute of Neuroscience, National Research Council (CNR), Pisa I-56124, Italy
| | | | - Giulia Sagona
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Florence I-50135, Italy.,Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa I-56128, Italy
| | - Leonardo Lupori
- BIO@SNS Lab, Scuola Normale Superiore di Pisa, Pisa I-56125, Italy
| | - Mariangela Gennaro
- Institute of Neuroscience, National Research Council (CNR), Pisa I-56124, Italy
| | - Elena Putignano
- Institute of Neuroscience, National Research Council (CNR), Pisa I-56124, Italy
| | - Maria Grazia Alessandrì
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa I-56128, Italy
| | - Annarita Ferrari
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa I-56128, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa I-56128, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa I-56126, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa I-56128, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa I-56126, Italy
| | - Tommaso Pizzorusso
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Florence I-50135, Italy.,Institute of Neuroscience, National Research Council (CNR), Pisa I-56124, Italy
| | - Laura Baroncelli
- Institute of Neuroscience, National Research Council (CNR), Pisa I-56124, Italy.,Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa I-56128, Italy
| |
Collapse
|
19
|
Galosi S, Nardecchia F, Leuzzi V. Treatable Inherited Movement Disorders in Children: Spotlight on Clinical and Biochemical Features. Mov Disord Clin Pract 2020; 7:154-166. [PMID: 32071932 DOI: 10.1002/mdc3.12897] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 12/15/2019] [Accepted: 01/01/2020] [Indexed: 12/26/2022] Open
Abstract
Background About 80% of monogenic metabolic diseases causing movement disorders (MDs) emerges during the first 2 decades of life, and a number of these conditions offers the opportunity of a disease-modifying treatment. The implementation of enlarged neonatal screening programs and the impressive rapid increase of the identification of new conditions are enhancing our potential to recognize and treat several diseases causing MDs, changing their outcome and phenotypic spectrum. Methods and Findings A literature review of monogenic disorders causing MDs amenable to treatment was conducted focusing on early clinical signs and diagnostic biomarkers. A classification in 3 broad categories based on the therapeutic approach has been proposed. Some disorders result in irreversible neurotoxic lesions that can only be prevented if treated in a presymptomatic stage, and others present with a progressive neurological impairment that a timely diagnosis and treatment may reverse or improve. Some MDs are the result of the failure of intracellular energy supply or altered glucose transport. The treatment in these conditions includes vitamins or a metabolic shift from a carbohydrate to a fatty acid catabolism, respectively. Finally, a group of highly treatable MDs are the result of defects of neurotransmitter metabolism. In these disorders, the supplementation of precursors or mimetics of neurotransmitters can deeply change the disease natural history. Conclusions To prevent serious and irreversible neurological impairment, the diagnostic work-up of MDs in children should consider a number of clinical red flags and biomarkers denoting specifically treatable diseases.
Collapse
Affiliation(s)
- Serena Galosi
- Department of Human Neuroscience Sapienza University Rome Italy
| | | | - Vincenzo Leuzzi
- Department of Human Neuroscience Sapienza University Rome Italy
| |
Collapse
|
20
|
Abstract
Seizures are the most acute evident manifestation of central nervous system dysfunction in neonates. The incidence is higher in very low weight neonates, about 58/100 live births, as opposed to full-term infants, estimated about 3.5/100 live births. Neonatal seizures represent the clinical manifestation of a non-specific disorder of cortical cerebral dysfunction, which could lead to permanent brain injury. The etiology is multifactorial and requires a judicious assessment of each clinical scenario. The diagnosis and its management are further complicated as most neonatal seizures may have very subtle or no clinical changes and the diagnosis may be just based on EEG findings, so-called subclinical. The treatment is dependent on the etiology, but early and opportune intervention can prevent further brain damage and improve prognosis. Although early identification and treatment are essential, the diagnosis of neonatal seizures can be further complicated by the clinical presentations, possible etiologies, and treatments. Nevertheless, research studies and clinical evidence have shown that early treatment with anti-seizure medications can change the outcome.
Collapse
Affiliation(s)
- Edgar Andrade
- Pediatric Neurology, Institute of Pediatric Neurosciences of Florida, Ocala, USA
| | | | - Zakir I Shaikh
- Pediatrics, Surat Municipal Institute of Medical Education and Research, Surat, IND
| | - Alcy R Torres
- Pediatrics, Boston University School of Medicine, Boston, USA
| |
Collapse
|
21
|
Giusti L, Molinaro A, Alessandrì MG, Boldrini C, Ciregia F, Lacerenza S, Ronci M, Urbani A, Cioni G, Mazzoni MR, Pizzorusso T, Lucacchini A, Baroncelli L. Brain mitochondrial proteome alteration driven by creatine deficiency suggests novel therapeutic venues for creatine deficiency syndromes. Neuroscience 2019; 409:276-289. [PMID: 31029731 DOI: 10.1016/j.neuroscience.2019.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/09/2019] [Accepted: 03/12/2019] [Indexed: 01/15/2023]
Abstract
Creatine (Cr) is a small metabolite with a central role in energy metabolism and mitochondrial function. Creatine deficiency syndromes are inborn errors of Cr metabolism causing Cr depletion in all body tissues and particularly in the nervous system. Patient symptoms involve intellectual disability, language and behavioral disturbances, seizures and movement disorders suggesting that brain cells are particularly sensitive to Cr depletion. Cr deficiency was found to affect metabolic activity and structural abnormalities of mitochondrial organelles; however a detailed analysis of molecular mechanisms linking Cr deficit, energy metabolism alterations and brain dysfunction is still missing. Using a proteomic approach we evaluated the proteome changes of the brain mitochondrial fraction induced by the deletion of the Cr transporter (CrT) in developing mutant mice. We found a marked alteration of the mitochondrial proteomic landscape in the brain of CrT deficient mice, with the overexpression of many proteins involved in energy metabolism and response to oxidative stress. Moreover, our data suggest possible abnormalities of dendritic spines, synaptic function and plasticity, network excitability and neuroinflammatory response. Intriguingly, the alterations occurred in coincidence with the developmental onset of neurological symptoms. Thus, cerebral mitochondrial alterations could represent an early response to Cr deficiency that could be targeted for therapeutic intervention.
Collapse
Affiliation(s)
- Laura Giusti
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy; School of Pharmacy, University of Camerino, I-62032 Camerino, Italy
| | - Angelo Molinaro
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, I-50135, Florence, Italy; Institute of Neuroscience, National Research Council (CNR), I-56124, Pisa, Italy
| | - Maria Grazia Alessandrì
- Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, I-56128 Pisa, Italy
| | - Claudia Boldrini
- Department of Pharmacy, University of Pisa, I-56126, Pisa, Italy
| | - Federica Ciregia
- Department of Pharmacy, University of Pisa, I-56126, Pisa, Italy; Department of Rheumatology, GIGA Research, Centre Hospitalier Universitaire (CHU) de Liège, B-4000, Liège, Belgium
| | - Serena Lacerenza
- Department of Pharmacy, University of Pisa, I-56126, Pisa, Italy
| | - Maurizio Ronci
- Department of Medical, Oral and Biotechnological Sciences, University G. d'Annunzio of Chieti-Pescara, I-66100, Chieti, Italy
| | - Andrea Urbani
- Institute of Biochemistry and Clinical Chemistry, Catholic university of the sacred heart, I-00168, Rome, Italy
| | - Giovanni Cioni
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy; Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, I-56128 Pisa, Italy
| | | | - Tommaso Pizzorusso
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, I-50135, Florence, Italy; Institute of Neuroscience, National Research Council (CNR), I-56124, Pisa, Italy
| | - Antonio Lucacchini
- Department of Clinical and Experimental Medicine, University of Pisa, I-56126, Pisa, Italy
| | - Laura Baroncelli
- Institute of Neuroscience, National Research Council (CNR), I-56124, Pisa, Italy; Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, I-56128 Pisa, Italy.
| |
Collapse
|
22
|
McKenna J, Kapfhamer D, Kinchen JM, Wasek B, Dunworth M, Murray-Stewart T, Bottiglieri T, Casero RA, Gambello MJ. Metabolomic studies identify changes in transmethylation and polyamine metabolism in a brain-specific mouse model of tuberous sclerosis complex. Hum Mol Genet 2018; 27:2113-2124. [PMID: 29635516 PMCID: PMC5985733 DOI: 10.1093/hmg/ddy118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/06/2018] [Accepted: 03/29/2018] [Indexed: 12/11/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant neurodevelopmental disorder and the quintessential disorder of mechanistic Target of Rapamycin Complex 1 (mTORC1) dysregulation. Loss of either causative gene, TSC1 or TSC2, leads to constitutive mTORC1 kinase activation and a pathologically anabolic state of macromolecular biosynthesis. Little is known about the organ-specific metabolic reprogramming that occurs in TSC-affected organs. Using a mouse model of TSC in which Tsc2 is disrupted in radial glial precursors and their neuronal and glial descendants, we performed an unbiased metabolomic analysis of hippocampi to identify Tsc2-dependent metabolic changes. Significant metabolic reprogramming was found in well-established pathways associated with mTORC1 activation, including redox homeostasis, glutamine/tricarboxylic acid cycle, pentose and nucleotide metabolism. Changes in two novel pathways were identified: transmethylation and polyamine metabolism. Changes in transmethylation included reduced methionine, cystathionine, S-adenosylmethionine (SAM-the major methyl donor), reduced SAM/S-adenosylhomocysteine ratio (cellular methylation potential), and elevated betaine, an alternative methyl donor. These changes were associated with alterations in SAM-dependent methylation pathways and expression of the enzymes methionine adenosyltransferase 2A and cystathionine beta synthase. We also found increased levels of the polyamine putrescine due to increased activity of ornithine decarboxylase, the rate-determining enzyme in polyamine synthesis. Treatment of Tsc2+/- mice with the ornithine decarboxylase inhibitor α-difluoromethylornithine, to reduce putrescine synthesis dose-dependently reduced hippocampal astrogliosis. These data establish roles for SAM-dependent methylation reactions and polyamine metabolism in TSC neuropathology. Importantly, both pathways are amenable to nutritional or pharmacologic therapy.
Collapse
Affiliation(s)
- James McKenna
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - David Kapfhamer
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| | | | - Brandi Wasek
- Center of Metabolomics, Baylor Scott and White Research Institute, Dallas 75204, TX, USA
| | - Matthew Dunworth
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine, Baltimore, MD 21231, USA
| | - Tracy Murray-Stewart
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine, Baltimore, MD 21231, USA
| | - Teodoro Bottiglieri
- Center of Metabolomics, Baylor Scott and White Research Institute, Dallas 75204, TX, USA
| | - Robert A Casero
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins School of Medicine, Baltimore, MD 21231, USA
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
| |
Collapse
|
23
|
Neuroimaging of Pediatric Metabolic Disorders with Emphasis on Diffusion-Weighted Imaging and MR Spectroscopy: A Pictorial Essay. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0251-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
24
|
Cameron JM, Levandovskiy V, Roberts W, Anagnostou E, Scherer S, Loh A, Schulze A. Variability of Creatine Metabolism Genes in Children with Autism Spectrum Disorder. Int J Mol Sci 2017; 18:ijms18081665. [PMID: 28758966 PMCID: PMC5578055 DOI: 10.3390/ijms18081665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 12/23/2022] Open
Abstract
Creatine deficiency syndrome (CDS) comprises three separate enzyme deficiencies with overlapping clinical presentations: arginine:glycine amidinotransferase (GATM gene, glycine amidinotransferase), guanidinoacetate methyltransferase (GAMT gene), and creatine transporter deficiency (SLC6A8 gene, solute carrier family 6 member 8). CDS presents with developmental delays/regression, intellectual disability, speech and language impairment, autistic behaviour, epileptic seizures, treatment-refractory epilepsy, and extrapyramidal movement disorders; symptoms that are also evident in children with autism. The objective of the study was to test the hypothesis that genetic variability in creatine metabolism genes is associated with autism. We sequenced GATM, GAMT and SLC6A8 genes in 166 patients with autism (coding sequence, introns and adjacent untranslated regions). A total of 29, 16 and 25 variants were identified in each gene, respectively. Four variants were novel in GATM, and 5 in SLC6A8 (not present in the 1000 Genomes, Exome Sequencing Project (ESP) or Exome Aggregation Consortium (ExAC) databases). A single variant in each gene was identified as non-synonymous, and computationally predicted to be potentially damaging. Nine variants in GATM were shown to have a lower minor allele frequency (MAF) in the autism population than in the 1000 Genomes database, specifically in the East Asian population (Fisher’s exact test). Two variants also had lower MAFs in the European population. In summary, there were no apparent associations of variants in GAMT and SLC6A8 genes with autism. The data implying there could be a lower association of some specific GATM gene variants with autism is an observation that would need to be corroborated in a larger group of autism patients, and with sub-populations of Asian ethnicities. Overall, our findings suggest that the genetic variability of creatine synthesis/transport is unlikely to play a part in the pathogenesis of autism spectrum disorder (ASD) in children.
Collapse
Affiliation(s)
- Jessie M Cameron
- Genetics and Genome Biology, Peter Gilgan Center for Research and Learning, Toronto, ON M5G 0A4, Canada.
| | - Valeriy Levandovskiy
- Genetics and Genome Biology, Peter Gilgan Center for Research and Learning, Toronto, ON M5G 0A4, Canada.
| | - Wendy Roberts
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kigour Rd, Toronto, ON M4G 1R8, Canada.
| | - Evdokia Anagnostou
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Holland Bloorview Kids Rehabilitation Hospital, 150 Kigour Rd, Toronto, ON M4G 1R8, Canada.
| | - Stephen Scherer
- Genetics and Genome Biology, Peter Gilgan Center for Research and Learning, Toronto, ON M5G 0A4, Canada.
- The Centre for Applied Genomics and Genetics and Genome Biology, the Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
- McLaughlin Centre and Department of Molecular Genetics, 686 Bay Street, 13th Floor, Peter Gilgan Center for Research and Learning, Toronto, ON M5G 0A4, Canada.
| | - Alvin Loh
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Surrey Place Center, 2 Surrey Place, Toronto, ON M5S 2C2, Canada.
| | - Andreas Schulze
- Genetics and Genome Biology, Peter Gilgan Center for Research and Learning, Toronto, ON M5G 0A4, Canada.
- Department of Paediatrics, University of Toronto, Toronto, ON M5S 1A1, Canada.
- Department of Biochemistry, University of Toronto, Toronto, ON M5S 1A8, Canada.
| |
Collapse
|
25
|
Sharma S, Prasad AN. Inborn Errors of Metabolism and Epilepsy: Current Understanding, Diagnosis, and Treatment Approaches. Int J Mol Sci 2017; 18:ijms18071384. [PMID: 28671587 PMCID: PMC5535877 DOI: 10.3390/ijms18071384] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 12/22/2022] Open
Abstract
Inborn errors of metabolism (IEM) are a rare cause of epilepsy, but seizures and epilepsy are frequently encountered in patients with IEM. Since these disorders are related to inherited enzyme deficiencies with resulting effects on metabolic/biochemical pathways, the term “metabolic epilepsy” can be used to include these conditions. These epilepsies can present across the life span, and share features of refractoriness to anti-epileptic drugs, and are often associated with co-morbid developmental delay/regression, intellectual, and behavioral impairments. Some of these disorders are amenable to specific treatment interventions; hence timely and appropriate diagnosis is critical to improve outcomes. In this review, we discuss those disorders in which epilepsy is a dominant feature and present an approach to the clinical recognition, diagnosis, and management of these disorders, with a greater focus on primarily treatable conditions. Finally, we propose a tiered approach that will permit a clinician to systematically investigate, identify, and treat these rare disorders.
Collapse
Affiliation(s)
- Suvasini Sharma
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi 110001, India.
| | - Asuri N Prasad
- Department of Pediatrics and Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Children's Hospital of Western Ontario and London Health Sciences Centre, London, ON N6A5W9, Canada.
| |
Collapse
|
26
|
Heussinger N, Saake M, Mennecke A, Dörr HG, Trollmann R. Variable White Matter Atrophy and Intellectual Development in a Family With X-linked Creatine Transporter Deficiency Despite Genotypic Homogeneity. Pediatr Neurol 2017; 67:45-52. [PMID: 28065824 DOI: 10.1016/j.pediatrneurol.2016.10.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/02/2016] [Accepted: 10/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The X-linked creatine transporter deficiency (CRTD) caused by an SLC6A8 mutation represents the second most common cause of X-linked intellectual disability. The clinical phenotype ranges from mild to severe intellectual disability, epilepsy, short stature, poor language skills, and autism spectrum disorders. The objective of this study was to investigate phenotypic variability in the context of genotype, cerebral creatine concentration, and volumetric analysis in a family with CRTD. PATIENTS AND METHODS The clinical phenotype and manifestations of epilepsy were assessed in a Caucasian family with CRTD. DNA sequencing and creatine metabolism analysis confirmed the diagnosis. Cerebral magnetic resonance imaging (cMRI) with voxel-based morphometry and magnetic resonance spectroscopy was performed in all family members. RESULTS An SLC6A8 missense mutation (c.1169C>T; p.Pro390Leu, exon 8) was detected in four of five individuals. Both male siblings were hemizygous, the mother and the affected sister heterozygous for the mutation. Structural cMRI was normal, whereas voxel-based morphometry analysis showed reduced white matter volume below the first percentile of the reference population of 290 subjects in the more severely affected boy compared with family members and controls. Normalized creatine concentration differed significantly between the individuals (P < 0.005). CONCLUSIONS There is a broad phenotypic variability in CRTD even in family members with the same mutation. Differences in mental development could be related to atrophy of the subcortical white matter.
Collapse
Affiliation(s)
- Nicole Heussinger
- Department of Pediatrics, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany.
| | - Marc Saake
- Department of Radiology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Angelika Mennecke
- Department of Neuroradiology, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Helmuth-Günther Dörr
- Department of Pediatrics, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Regina Trollmann
- Department of Pediatrics, Friedrich-Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
27
|
Srivastava NK, Mukherjee S, Sinha N. Alteration of phospholipids in the blood of patients with Duchenne muscular dystrophy (DMD): in vitro, high resolution 31P NMR-based study. Acta Neurol Belg 2016; 116:573-581. [PMID: 26861054 DOI: 10.1007/s13760-016-0607-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 01/16/2016] [Indexed: 11/28/2022]
Abstract
In vitro, high-resolution 31P NMR (Nuclear Magnetic Resonance) spectroscopy-based analysis of phospholipids in serum is well recognized in leukemia, lymphoma, non-hematological cancers and renal cell carcinoma. In context of these studies, phospholipids were analyzed in blood of thirty-two (n = 32) patients with Duchenne muscular dystrophy (DMD) (Age, Mean ± SD; 8.0 ± 1.6 years) and sixteen (n = 16) healthy subjects (Age, Mean ± SD; 8.6 ± 2.3 years). Quantity of phosphatidylcholine (PC), phosphatidylethanolamine (PE), phosphatidylinositol (PI), phosphatidylserine (PS) and lyso-phosphatidylcholine (Lys-PC) was significantly higher (p < 0.05) in DMD patients as compared to healthy subjects. There were no significant differences (p > 0.05) observed for the quantity of phospholipids in blood of gene deletion positive cases of DMD as compared to negative gene deletion cases of DMD. Quantity of phospholipids in negative gene deletion cases of DMD patients as well as DMD cases with positive gene deletion was significantly higher (p < 0.05) as compared to normal individuals. The present study distinguishes the patients with DMD from the healthy subjects on the basis of the quantity of phospholipids in blood. These observations may be useful in future for the development of new diagnostic method of DMD.
Collapse
Affiliation(s)
- Niraj Kumar Srivastava
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India.
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110067, India.
| | - Somnath Mukherjee
- School of Life Sciences, Jawaharlal Nehru University, New Delhi, 110067, India
| | - Neeraj Sinha
- Center of Biomedical Research, Sanjay Gandhi Postgraduate Institute of Medical Sciences Campus, Raebareli Road, Lucknow, 226014, India
| |
Collapse
|
28
|
Abstract
Inborn errors of metabolism (IEM) are rare conditions that represent more than 1000 diseases, with a global prevalence of approximately 1:2000 individuals. Approximately, 40%-60% of IEM may present with epilepsy as one of the main neurologic signs. Epilepsy in IEM may appear at any age (fetal, newborn, infant, adolescent, or even adult). Different pathophysiological mechanisms may be responsible for the clinical phenotype, such as disturbances in energy metabolism (mitochondrial and fatty oxidation disorders, GLUT-1, and cerebral creatine deficiency), accumulation of complex molecules (lysosomal storage disorders), toxic mechanisms (organic acidurias and urea cycle disorders), or impairment of neurotransmission. Early diagnosis and, in some cases, an effective treatment may result in an excellent evolution of the IEM, in particularly seizure control. This review attempts to delineate a summary of IEM that may present with seizures or epilepsy and emphasizes the management in treatable conditions.
Collapse
Affiliation(s)
- Jaume Campistol
- From the *Neurology Department, Hospital Sant Joan de Déu, Barcelona University, Barcelona, Spain; Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain; Institute of Pediatric Research, Sant Joan de Déu, Barcelona, Spain.
| |
Collapse
|
29
|
Koob M, Viola A, Le Fur Y, Viout P, Ratiney H, Confort-Gouny S, Cozzone PJ, Girard N. Creatine, Glutamine plus Glutamate, and Macromolecules Are Decreased in the Central White Matter of Premature Neonates around Term. PLoS One 2016; 11:e0160990. [PMID: 27547969 PMCID: PMC4993494 DOI: 10.1371/journal.pone.0160990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
Preterm birth represents a high risk of neurodevelopmental disabilities when associated with white-matter damage. Recent studies have reported cognitive deficits in children born preterm without brain injury on MRI at term-equivalent age. Understanding the microstructural and metabolic underpinnings of these deficits is essential for their early detection. Here, we used diffusion-weighted imaging and single-voxel 1H magnetic resonance spectroscopy (MRS) to compare brain maturation at term-equivalent age in premature neonates with no evidence of white matter injury on conventional MRI except diffuse excessive high-signal intensity, and normal term neonates. Thirty-two infants, 16 term neonates (mean post-conceptional age at scan: 39.8±1 weeks) and 16 premature neonates (mean gestational age at birth: 29.1±2 weeks, mean post-conceptional age at scan: 39.2±1 weeks) were investigated. The MRI/MRS protocol performed at 1.5T involved diffusion-weighted MRI and localized 1H-MRS with the Point RESolved Spectroscopy (PRESS) sequence. Preterm neonates showed significantly higher ADC values in the temporal white matter (P<0.05), the occipital white matter (P<0.005) and the thalamus (P<0.05). The proton spectrum of the centrum semiovale was characterized by significantly lower taurine/H2O and macromolecules/H2O ratios (P<0.05) at a TE of 30 ms, and reduced (creatine+phosphocreatine)/H2O and (glutamine+glutamate)/H2O ratios (P<0.05) at a TE of 135 ms in the preterm neonates than in full-term neonates. Our findings indicate that premature neonates with normal conventional MRI present a delay in brain maturation affecting the white matter and the thalamus. Their brain metabolic profile is characterized by lower levels of creatine, glutamine plus glutamate, and macromolecules in the centrum semiovale, a finding suggesting altered energy metabolism and protein synthesis.
Collapse
Affiliation(s)
- Meriam Koob
- Service de Neuroradiologie, AP-HM Timone, Aix-Marseille Université, Marseille, France
- Service de Radiopédiatrie-Imagerie 2, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France
- Laboratoire ICube, UMR 7357, FMTS, Université de Strasbourg-CNRS, Strasbourg, France
| | - Angèle Viola
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
- * E-mail: (NG); (AV)
| | - Yann Le Fur
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
| | - Patrick Viout
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
| | - Hélène Ratiney
- Laboratoire CREATIS, CNRS UMR 5220, Inserm U1044, Université Claude Bernard Lyon I, INSA-Lyon, Lyon, France
| | - Sylviane Confort-Gouny
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
| | - Patrick J. Cozzone
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
| | - Nadine Girard
- Service de Neuroradiologie, AP-HM Timone, Aix-Marseille Université, Marseille, France
- Aix-Marseille Université, CNRS, Centre de Résonance Magnétique Biologique et Médicale, UMR 7339, Faculté de Médecine la Timone, Marseille, France
- * E-mail: (NG); (AV)
| |
Collapse
|
30
|
Baroncelli L, Molinaro A, Cacciante F, Alessandrì MG, Napoli D, Putignano E, Tola J, Leuzzi V, Cioni G, Pizzorusso T. A mouse model for creatine transporter deficiency reveals early onset cognitive impairment and neuropathology associated with brain aging. Hum Mol Genet 2016; 25:4186-4200. [DOI: 10.1093/hmg/ddw252] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 07/17/2016] [Accepted: 07/18/2016] [Indexed: 01/11/2023] Open
|
31
|
Ostojic SM, Ostojic J, Drid P, Vranes M, Jovanov P. Dietary guanidinoacetic acid increases brain creatine levels in healthy men. Nutrition 2016; 33:149-156. [PMID: 27497517 DOI: 10.1016/j.nut.2016.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/06/2016] [Accepted: 06/01/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Guanidinoacetic acid (GAA) is an experimental dietary additive that might act as a creatine source in tissues with high-energy requirements. In this case study, we evaluated brain levels of creatine in white matter, gray matter, cerebellum, and thalamus during 8 wk oral GAA administration in five healthy men and monitored the prevalence and severity of side effects of the intervention. METHODS Volunteers were supplemented daily with 36 mg/kg body weight (BW) of GAA for the first 4 wk of the intervention; afterward GAA dosage was titrated ≤60 mg/kg BW of GAA daily. At baseline, 4, and 8 wk, the participants underwent brain magnetic resonance spectroscopy, clinical chemistry studies, and open-ended questionnaire for side-effect prevalence and severity. RESULTS Brain creatine levels increased in similar fashion in cerebellum, and white and gray matter after GAA supplementation, with an initial increase of 10.7% reported after 4 wk, and additional upsurge (7.7%) from the weeks 4 to 8 follow-up (P < 0.05). Thalamus creatine levels decreased after 4 wk for 6.5% (P = 0.02), and increased nonsignificantly after 8 wk for 8% (P = 0.09). GAA induced an increase in N-acetylaspartate levels at 8-wk follow-up in all brain areas evaluated (P < 0.05). No participants reported any neurologic adverse event (e.g., seizures, tingling, convulsions) during the intervention. CONCLUSIONS Supplemental GAA led to a region-dependent increase of the creatine pool in the human brain. This might be relevant for restoring cellular bioenergetics in disorders characterized by low brain creatine and functional enzymatic machinery for creatine synthesis, including neurodegenerative diseases, brain tumors, or cerebrovascular disease.
Collapse
Affiliation(s)
- Sergej M Ostojic
- Faculty of Sport and PE, University of Novi Sad, Novi Sad, Serbia; University of Belgrade School of Medicine, Belgrade, Serbia.
| | - Jelena Ostojic
- University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Patrik Drid
- Faculty of Sport and PE, University of Novi Sad, Novi Sad, Serbia
| | - Milan Vranes
- Faculty of Sciences, University of Novi Sad, Novi Sad, Serbia
| | - Pavle Jovanov
- Institute of Food Technology, University of Novi Sad, Novi Sad, Serbia
| |
Collapse
|
32
|
Abstract
While genetic causes of epilepsy have been hypothesized from the time of Hippocrates, the advent of new genetic technologies has played a tremendous role in elucidating a growing number of specific genetic causes for the epilepsies. This progress has contributed vastly to our recognition of the epilepsies as a diverse group of disorders, the genetic mechanisms of which are heterogeneous. Genotype-phenotype correlation, however, is not always clear. Nonetheless, the developments in genetic diagnosis raise the promise of a future of personalized medicine. Multiple genetic tests are now available, but there is no one test for all possible genetic mutations, and the balance between cost and benefit must be weighed. A genetic diagnosis, however, can provide valuable information regarding comorbidities, prognosis, and even treatment, as well as allow for genetic counseling. In this review, we will discuss the genetic mechanisms of the epilepsies as well as the specifics of particular genetic epilepsy syndromes. We will include an overview of the available genetic testing methods, the application of clinical knowledge into the selection of genetic testing, genotype-phenotype correlations of epileptic disorders, and therapeutic advances as well as a discussion of the importance of genetic counseling.
Collapse
Affiliation(s)
- Christelle M El Achkar
- Division of Epilepsy, Department of Neurology, Boston Children's Hospital, and Harvard Medical School, Fegan 9, 300 Longwood Ave, Boston, MA, 02115, USA,
| | | | | | | |
Collapse
|
33
|
Schulze A, Bauman M, Tsai ACH, Reynolds A, Roberts W, Anagnostou E, Cameron J, Nozzolillo AA, Chen S, Kyriakopoulou L, Scherer SW, Loh A. Prevalence of Creatine Deficiency Syndromes in Children With Nonsyndromic Autism. Pediatrics 2016; 137:peds.2015-2672. [PMID: 26684475 DOI: 10.1542/peds.2015-2672] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Creatine deficiency may play a role in the neurobiology of autism and may represent a treatable cause of autism. The goal of the study was to ascertain the prevalence of creatine deficiency syndromes (CDSs) in children with autism spectrum disorder (ASD). METHODS In a prospective multicenter study, 443 children were investigated after a confirmed diagnosis of ASD. Random spot urine screening for creatine metabolites (creatine, guanidinoacetate, creatinine, and arginine) with liquid chromatography-tandem mass spectrometry and second-tier testing with high-performance liquid chromatography methodology was followed by recall testing in 24-hour urines and confirmatory testing by Sanger-based DNA sequencing of GAMT, GATM, and SLC6A8 genes. Additional diagnostic tests included plasma creatine metabolites and in vivo brain proton magnetic resonance spectroscopy. The creatine metabolites in spot urine in the autism group were compared with 128 healthy controls controlled for age. RESULTS In 443 subjects with ASD investigated for CDS, we had 0 events (event: 0, 95% confidence interval 0-0.0068), therefore with 95% confidence the prevalence of CDS is <7 in 1000 children with ASD. The autism and control groups did not vary in terms of creatine metabolites (P > .0125) in urine. CONCLUSION Our study revealed a very low prevalence of CDS in children with nonsyndromic ASD and no obvious association between creatine metabolites and autism. Unlike our study population, we expect more frequent CDS among children with severe developmental delay, speech impairment, seizures, and movement disorders in addition to impairments in social communication, restricted interests, and repetitive behaviors.
Collapse
Affiliation(s)
- Andreas Schulze
- Genetics and Genome Biology, Peter Gilgan Center for Research and Learning, Toronto, Ontario, Canada; Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Ontario, Canada;
| | - Margaret Bauman
- Lurie Center for Autism, MassGeneral Hospital, Boston, Massachusetts; Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Anne Chun-Hui Tsai
- Colorado University Medical School, Aurora, Colorado; Molecular and Medical Genetics, Oregon Health and Sciences University, Portland, Oregon
| | - Ann Reynolds
- Colorado University Medical School, Aurora, Colorado
| | - Wendy Roberts
- Department of Paediatrics, University of Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- Department of Paediatrics, University of Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation, Toronto, Ontario, Canada
| | - Jessie Cameron
- Genetics and Genome Biology, Peter Gilgan Center for Research and Learning, Toronto, Ontario, Canada
| | - Alixandra A Nozzolillo
- Clinical and Translational Science Center, Harvard Medical School, Boston, Massachusetts
| | - Shiyi Chen
- Clinical Research Services, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lianna Kyriakopoulou
- Department of Paediatric Laboratory Medicine, Biochemical Genetics Laboratory, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stephen W Scherer
- Genetics and Genome Biology, Peter Gilgan Center for Research and Learning, Toronto, Ontario, Canada; The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Molecular Genetics and McLaughlin Centre, University of Toronto, Ontario, Canada
| | - Alvin Loh
- Department of Paediatrics, University of Toronto, Ontario, Canada; Surrey Place Center, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Patel H, Lucas X, Bendik I, Günther S, Merfort I. Target Fishing by Cross-Docking to Explain Polypharmacological Effects. ChemMedChem 2015; 10:1209-17. [DOI: 10.1002/cmdc.201500123] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 04/29/2015] [Indexed: 01/18/2023]
|
35
|
Olson HE, Poduri A, Pearl PL. Genetic forms of epilepsies and other paroxysmal disorders. Semin Neurol 2014; 34:266-79. [PMID: 25192505 DOI: 10.1055/s-0034-1386765] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Genetic mechanisms explain the pathophysiology of many forms of epilepsy and other paroxysmal disorders, such as alternating hemiplegia of childhood, familial hemiplegic migraine, and paroxysmal dyskinesias. Epilepsy is a key feature of well-defined genetic syndromes including tuberous sclerosis complex, Rett syndrome, Angelman syndrome, and others. There is an increasing number of single-gene causes or susceptibility factors associated with several epilepsy syndromes, including the early-onset epileptic encephalopathies, benign neonatal/infantile seizures, progressive myoclonus epilepsies, genetic generalized and benign focal epilepsies, epileptic aphasias, and familial focal epilepsies. Molecular mechanisms are diverse, and a single gene can be associated with a broad range of phenotypes. Additional features, such as dysmorphisms, head size, movement disorders, and family history may provide clues to a genetic diagnosis. Genetic testing can impact medical care and counseling. We discuss genetic mechanisms of epilepsy and other paroxysmal disorders, tools and indications for genetic testing, known genotype-phenotype associations, the importance of genetic counseling, and a look toward the future of epilepsy genetics.
Collapse
Affiliation(s)
- Heather E Olson
- Division of Epilepsy, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Annapurna Poduri
- Division of Epilepsy, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Phillip L Pearl
- Division of Epilepsy, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
36
|
High-throughput tandem mass spectrometry multiplex analysis for newborn urinary screening of creatine synthesis and transport disorders, Triple H syndrome and OTC deficiency. Clin Chim Acta 2014; 436:249-55. [DOI: 10.1016/j.cca.2014.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 11/23/2022]
|
37
|
Dulac O, Plecko B, Gataullina S, Wolf NI. Occasional seizures, epilepsy, and inborn errors of metabolism. Lancet Neurol 2014; 13:727-39. [PMID: 24943345 DOI: 10.1016/s1474-4422(14)70110-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Seizures are a common paediatric problem, with inborn errors of metabolism being a rare underlying aetiology. The clinical presentation of inborn errors of metabolism is often associated with other neurological symptoms, such as hypotonia, movement disorders, and cognitive disturbances. However, the occurrence of epilepsy associated with inborn errors of metabolism represents a major challenge that needs to be identified quickly; for some cases, specific treatments are available, metabolic decompensation might be avoided, and accurate counselling can be given about recurrence risk. Some clinical presentations are more likely than others to point to an inborn error of metabolism as the cause of seizures. Knowledge of important findings at examination, and appropriate biochemical investigation of children with seizures of uncertain cause, can aid the diagnosis of an inborn error of metabolism and ascertain whether or not the seizures are amenable to specific metabolic treatment.
Collapse
Affiliation(s)
- Olivier Dulac
- Paris Descartes University, Inserm U1129, Paris, France; CEA, Gif-sur-Yvette, France; Department of Paediatric Neurology, Hôpital Necker-Enfants Malades, AP-HP, Paris, France.
| | - Barbara Plecko
- Department of Child Neurology, University Children's Hospital, University of Zurich, Switzerland
| | | | - Nicole I Wolf
- Department of Child Neurology, VU University Medical Center, Amsterdam, Netherlands; Neuroscience Campus Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
38
|
Reid CA, Mullen S, Kim TH, Petrou S. Epilepsy, energy deficiency and new therapeutic approaches including diet. Pharmacol Ther 2014; 144:192-201. [PMID: 24924701 DOI: 10.1016/j.pharmthera.2014.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 02/08/2023]
Abstract
Metabolic dysfunction leading to epilepsy is well recognised. Dietary therapy, in particular the ketogenic diet, is now considered an effective option. Recent genetic studies have highlighted the central role that metabolism can play in setting seizure susceptibility. Here we discuss various metabolic disorders implicated in epilepsy focusing on energy deficiency due to genetic and environmental causes. We argue that low, uncompensated brain glucose levels can precipitate seizures. We will also explore mechanisms of disease and therapy in an attempt to identify common metabolic pathways involved in modulating seizure susceptibility. Finally, newer therapeutic approaches based on diet manipulation in the context of energy deficiency are discussed.
Collapse
Affiliation(s)
- Christopher A Reid
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia.
| | - Saul Mullen
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - Tae Hwan Kim
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia
| | - Steven Petrou
- Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Centre for Neural Engineering, The University of Melbourne, Parkville, Melbourne, Australia; Department of Electrical Engineering, The University of Melbourne, Parkville, Melbourne, Australia
| |
Collapse
|
39
|
Dickinson H, Ellery S, Ireland Z, LaRosa D, Snow R, Walker DW. Creatine supplementation during pregnancy: summary of experimental studies suggesting a treatment to improve fetal and neonatal morbidity and reduce mortality in high-risk human pregnancy. BMC Pregnancy Childbirth 2014; 14:150. [PMID: 24766646 PMCID: PMC4007139 DOI: 10.1186/1471-2393-14-150] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 04/07/2014] [Indexed: 01/03/2023] Open
Abstract
While the use of creatine in human pregnancy is yet to be fully evaluated, its long-term use in healthy adults appears to be safe, and its well documented neuroprotective properties have recently been extended by demonstrations that creatine improves cognitive function in normal and elderly people, and motor skills in sleep-deprived subjects. Creatine has many actions likely to benefit the fetus and newborn, because pregnancy is a state of heightened metabolic activity, and the placenta is a key source of free radicals of oxygen and nitrogen. The multiple benefits of supplementary creatine arise from the fact that the creatine-phosphocreatine [PCr] system has physiologically important roles that include maintenance of intracellular ATP and acid–base balance, post-ischaemic recovery of protein synthesis, cerebral vasodilation, antioxidant actions, and stabilisation of lipid membranes. In the brain, creatine not only reduces lipid peroxidation and improves cerebral perfusion, its interaction with the benzodiazepine site of the GABAA receptor is likely to counteract the effects of glutamate excitotoxicity – actions that may protect the preterm and term fetal brain from the effects of birth hypoxia. In this review we discuss the development of creatine synthesis during fetal life, the transfer of creatine from mother to fetus, and propose that creatine supplementation during pregnancy may have benefits for the fetus and neonate whenever oxidative stress or feto-placental hypoxia arise, as in cases of fetal growth restriction, premature birth, or when parturition is delayed or complicated by oxygen deprivation of the newborn.
Collapse
Affiliation(s)
| | | | | | | | | | - David W Walker
- The Ritchie Centre, MIMR-PHI Institute of Medical Research, Monash University, 27-31 Wright St,, Clayton, Melbourne 3168 Australia.
| |
Collapse
|
40
|
Akiyama T, Osaka H, Shimbo H, Nakajiri T, Kobayashi K, Oka M, Endoh F, Yoshinaga H. A Japanese adult case of guanidinoacetate methyltransferase deficiency. JIMD Rep 2013; 12:65-9. [PMID: 23846910 DOI: 10.1007/8904_2013_245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/12/2013] [Accepted: 05/26/2013] [Indexed: 01/13/2023] Open
Abstract
Guanidinoacetate methyltransferase (GAMT) deficiency is a rare disorder of creatine synthesis resulting in cerebral creatine depletion. We present a 38-year-old patient, the first Japanese case of GAMT deficiency. Developmental delay started after a few months of age with a marked delay in language, which resulted in severe intellectual deficit. She showed hyperactivity and trichotillomania from childhood. Epileptic seizures appeared at 18 months and she had multiple types of seizures including epileptic spasms, brief tonic seizures, atypical absences, complex partial seizures with secondary generalization, and "drop" seizures. They have been refractory to multiple antiepileptic drugs. Although there have been no involuntary movements, magnetic resonance imaging revealed T2 hyperintense lesions in bilateral globus pallidi. Motor regression started around 30 years of age and the patient is now able to walk for only short periods. Very low serum creatinine levels measured by enzymatic method raised a suspicion of GAMT deficiency, which was confirmed by proton magnetic resonance spectroscopy and urinary guanidinoacetate assay. GAMT gene analysis revealed that the patient is a compound heterozygote of c.578A>G, p.Gln193Arg and splice site mutation, c.391G>C, p.Gly131Arg, neither of which have been reported in the literature. We also identified two aberrant splice products from the patient's cDNA analysis. The patient was recently started on supplementation of high-dose creatine and ornithine, the effects of which are currently under evaluation. Although rare, patients with developmental delay, epilepsy, behavioral problems, and movement disorders should be vigorously screened for GAMT deficiency, as it is a treatable disorder.
Collapse
Affiliation(s)
- Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan,
| | | | | | | | | | | | | | | |
Collapse
|