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Lazar SM, Challman TD, Myers SM. Etiologic Evaluation of Children with Autism Spectrum Disorder. Pediatr Clin North Am 2024; 71:179-197. [PMID: 38423715 DOI: 10.1016/j.pcl.2023.12.002] [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] [Indexed: 03/02/2024]
Abstract
Autism spectrum disorder (ASD) is clinically and etiologically heterogeneous. A causal genetic variant can be identified in approximately 20% to 25% of affected individuals with current clinical genetic testing, and all patients with an ASD diagnosis should be offered genetic etiologic evaluation. We suggest that exome sequencing with copy number variant coverage should be the first-line etiologic evaluation for ASD. Neuroimaging, neurophysiologic, metabolic, and other biochemical evaluations can provide insight into the pathophysiology of ASD but should be recommended in the appropriate clinical circumstances.
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Affiliation(s)
- Steven M Lazar
- Section of Pediatric Neurology and Developmental Neuroscience, Meyer Center for Developmental Pediatrics & Autism, Baylor College of Medicine - Texas Children's Hospital, 6701 Fannin Street Suite 1250, Houston, TX 77030, USA.
| | - Thomas D Challman
- Geisinger Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, USA
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine, 120 Hamm Drive, Suite 2A, Lewisburg, PA 17837, USA
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2
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Ruffing S, Ullrich C, Flotats-Bastardas M, Poryo M, Meyer S. [Assessment of the importance of neuropediatric diagnostics in the initial clarification of autism]. Wien Med Wochenschr 2023:10.1007/s10354-023-01012-w. [PMID: 37133629 DOI: 10.1007/s10354-023-01012-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: 09/20/2022] [Accepted: 03/08/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND The diagnostics of autism spectrum disorder is complex due to missing biological markers and numerous comorbidities. The aim was to assess the role of neuropediatric diagnostics and to develop a standard operating procedure for a targeted assessment. METHOD All patients presenting to the neuropediatric outpatient clinic at Saarland University Hospital between April 2014 and December 2017 with ICD code F84 pervasive developmental disorders were included. RESULTS A total of 82 patients were included (male 78%, female 22%; mean age 5.9 ± 2.9 years, range 2-16 years). The most frequent examination was electroencephalography (EEG) (74/82; 90.2%) with pathological findings in 33.8% (25/74). Based on the history and/or EEG epilepsy was diagnosed in 19.5% (16/82). Magnetic resonance imaging (MRI) was performed in 49/82 (59.8%) patients, 22/49 (44.9%) showed at least 1 cerebral abnormality and definite pathologies could be detected in 63.6% (14/22). A metabolic diagnostic work-up was performed in 44/82 (53.7%) cases and in 5/44 (11.4%) it resulted in a diagnosis or suspicion of a metabolic disease. Genetic testing results were available in 29/82 (35.4%) children and 12/29 (41.4%) showed abnormal results. Delay in motor development was more frequently associated with comorbidities, EEG abnormalities, epilepsy and abnormalities in metabolic and genetic testing. CONCLUSION Neuropediatric examination in cases of suspected autism should include a detailed history, a thorough neurological examination and an EEG. An MRI, comprehensive metabolic and genetic testing are only recommended if clinically indicated.
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Affiliation(s)
- Sarah Ruffing
- Pädiatrische Kardiologie, Universität des Saarlandes, Kirrberger Str., Geb. 9, 66421, Homburg/Saar, Deutschland.
| | - Christine Ullrich
- Klinik für Allgemeine Pädiatrie und Neonatologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Marina Flotats-Bastardas
- Klinik für Allgemeine Pädiatrie und Neonatologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Martin Poryo
- Pädiatrische Kardiologie, Universität des Saarlandes, Kirrberger Str., Geb. 9, 66421, Homburg/Saar, Deutschland
| | - Sascha Meyer
- Klinik für Allgemeine Pädiatrie und Neonatologie, Universität des Saarlandes, Homburg/Saar, Deutschland
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3
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Moravej H, Inaloo S, Nahid S, Mazloumi S, Nemati H, Moosavian T, Nasiri J, Ghasemi F, Alaei MR, Dalili S, Aminzadeh M, Katibeh P, Amirhakimi A, Yazdani N, Ilkhanipoor H, Afshar Z, Hadipour F, Hadipour Z. Inborn Errors of Metabolism Associated With Autism Among Children: A Multicenter Study from Iran. Indian Pediatr 2023. [PMID: 36604934 DOI: 10.1007/s13312-023-2833-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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4
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Yeo XY, Lim YT, Chae WR, Park C, Park H, Jung S. Alterations of presynaptic proteins in autism spectrum disorder. Front Mol Neurosci 2022; 15:1062878. [DOI: 10.3389/fnmol.2022.1062878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Abstract
The expanded use of hypothesis-free gene analysis methods in autism research has significantly increased the number of genetic risk factors associated with the pathogenesis of autism. A further examination of the implicated genes directly revealed the involvement in processes pertinent to neuronal differentiation, development, and function, with a predominant contribution from the regulators of synaptic function. Despite the importance of presynaptic function in synaptic transmission, the regulation of neuronal network activity, and the final behavioral output, there is a relative lack of understanding of the presynaptic contribution to the pathology of autism. Here, we will review the close association among autism-related mutations, autism spectrum disorders (ASD) phenotypes, and the altered presynaptic protein functions through a systematic examination of the presynaptic risk genes relating to the critical stages of synaptogenesis and neurotransmission.
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5
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Wolpert KH, Kim SJ, Kodish I, Uspal NG. Medical Management of Children With Autism in the Emergency Department. Pediatr Emerg Care 2022; 38:332-336. [PMID: 35766926 DOI: 10.1097/pec.0000000000002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Autism spectrum disorder (ASD) is an increasingly prevalent diagnosis characterized by impairment of social communication and behavioral regulation. Children with ASD seek care more frequently in the emergency department (ED) than their neurotypical peers and the approach to medical evaluation of this population requires heightened attention to a variety of factors. Communication with caregivers, attention to environmental stimulation, identification of accommodation needs, and understanding frequently associated medical conditions are important considerations in ED encounters. Gastrointestinal problems, seizure disorders, and metabolic disease are common causes for ED presentation in children with ASD. A high index of suspicion for underlying medical issues must be maintained, even when children with ASD present primarily for behavioral concerns. Autism spectrum disorder (ASD) is an increasingly prevalent diagnosis characterized by impairment of social communication and behavioral regulation. Children with ASD seek care more frequently in the emergency department (ED) than their neurotypical peers and the approach to medical evaluation of this population requires heightened attention to a variety of factors. Communication with caregivers, attention to environmental stimulation, identification of accommodation needs, and understanding frequently associated medical conditions are important considerations in ED encounters. Gastrointestinal problems, seizure disorders, and metabolic disease are common causes for ED presentation in children with ASD. A high index of suspicion for underlying medical issues must be maintained, even when children with ASD present primarily for behavioral concerns.
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Affiliation(s)
- Katherine H Wolpert
- From the Assistant professor, Division of Emergency Medicine, Department of Pediatrics
| | | | | | - Neil G Uspal
- From the Assistant professor, Division of Emergency Medicine, Department of Pediatrics
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6
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Khan ZUN, Chand P, Majid H, Ahmed S, Khan AH, Jamil A, Ejaz S, Wasim A, Khan KA, Jafri L. Urinary metabolomics using gas chromatography-mass spectrometry: potential biomarkers for autism spectrum disorder. BMC Neurol 2022; 22:101. [PMID: 35300604 PMCID: PMC8932302 DOI: 10.1186/s12883-022-02630-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Diagnosis of autism spectrum disorder (ASD) is generally made phenotypically and the hunt for ASD-biomarkers continues. The purpose of this study was to compare urine organic acids profiles of ASD versus typically developing (TD) children to identify potential biomarkers for diagnosis and exploration of ASD etiology. Methods This case control study was performed in the Department of Pathology and Laboratory Medicine in collaboration with the Department of Pediatrics and Child Health, Aga Khan University, Pakistan. Midstream urine was collected in the first half of the day time before noon from the children with ASD diagnosed by a pediatric neurologist based on DSM-5 criteria and TD healthy controls from August 2019 to June 2021. The urine organic acids were analyzed by Gas Chromatography-Mass Spectrometry. To identify potential biomarkers for ASD canonical linear discriminant analysis was carried out for the organic acids, quantified in comparison to an internal standard. Results A total of 85 subjects were enrolled in the current study. The mean age of the ASD (n = 65) and TD groups (n = 20) was 4.5 ± 2.3 and 6.4 ± 2.2 years respectively with 72.3% males in the ASD group and 50% males in the TD group. Parental consanguinity was 47.7 and 30% in ASD and TD groups, respectively. The common clinical signs noted in children with ASD were developmental delay (70.8%), delayed language skills (66.2%), and inability to articulate sentences (56.9%). Discriminant analysis showed that 3-hydroxyisovalericc, homovanillic acid, adipic acid, suberic acid, and indole acetic were significantly different between ASD and TD groups. The biochemical classification results reveal that 88.2% of cases were classified correctly into ASD& TD groups based on the urine organic acid profiles. Conclusion 3-hydroxy isovaleric acid, homovanillic acid, adipic acid, suberic acid, and indole acetic were good discriminators between the two groups. The discovered potential biomarkers could be valuable for future research in children with ASD.
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Affiliation(s)
- Zaib Un Nisa Khan
- Department of Pathology and Laboratory Medicine AKU, Section of Chemical Pathology, Karachi, Pakistan
| | - Prem Chand
- Department of Pediatrics & Child Health AKU, Karachi, Pakistan
| | - Hafsa Majid
- Department of Pathology and Laboratory Medicine AKU, Section of Chemical Pathology, Karachi, Pakistan
| | - Sibtain Ahmed
- Department of Pathology and Laboratory Medicine AKU, Section of Chemical Pathology, Karachi, Pakistan
| | - Aysha Habib Khan
- Department of Pathology and Laboratory Medicine AKU, Section of Chemical Pathology, Karachi, Pakistan
| | - Azeema Jamil
- Department of Pathology and Laboratory Medicine AKU, Section of Chemical Pathology, Karachi, Pakistan
| | - Saba Ejaz
- Department of Pathology and Laboratory Medicine AKU, Section of Chemical Pathology, Karachi, Pakistan
| | - Ambreen Wasim
- Department of Pathology and Laboratory Medicine AKU, Karachi, Pakistan
| | | | - Lena Jafri
- Department of Pathology and Laboratory Medicine AKU, Section of Chemical Pathology, Karachi, Pakistan.
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Bam S, Buchanan E, Mahony C, O'Ryan C. DNA Methylation of PGC-1α Is Associated With Elevated mtDNA Copy Number and Altered Urinary Metabolites in Autism Spectrum Disorder. Front Cell Dev Biol 2021; 9:696428. [PMID: 34381777 PMCID: PMC8352569 DOI: 10.3389/fcell.2021.696428] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/05/2021] [Indexed: 12/12/2022] Open
Abstract
Autism spectrum disorder (ASD) is a complex disorder that is underpinned by numerous dysregulated biological pathways, including pathways that affect mitochondrial function. Epigenetic mechanisms contribute to this dysregulation and DNA methylation is an important factor in the etiology of ASD. We measured DNA methylation of peroxisome proliferator-activated receptor-gamma coactivator-1 alpha (PGC-1α), as well as five genes involved in regulating mitochondrial homeostasis to examine mitochondrial dysfunction in an ASD cohort of South African children. Using targeted Next Generation bisulfite sequencing, we found differential methylation (p < 0.05) at six key genes converging on mitochondrial biogenesis, fission and fusion in ASD, namely PGC-1α, STOML2, MFN2, FIS1, OPA1, and GABPA. PGC-1α, the transcriptional regulator of biogenesis, was significantly hypermethylated at eight CpG sites in the gene promoter, one of which contained a putative binding site for CAMP response binding element 1 (CREB1) (p = 1 × 10–6). Mitochondrial DNA (mtDNA) copy number, a marker of mitochondrial function, was elevated (p = 0.002) in ASD compared to controls and correlated significantly with DNA methylation at the PGC-1α promoter and there was a positive correlation between methylation at PGC-1α CpG#1 and mtDNA copy number (Spearman’s r = 0.2, n = 49, p = 0.04) in ASD. Furthermore, DNA methylation at PGC-1α CpG#1 and mtDNA copy number correlated significantly (p < 0.05) with levels of urinary organic acids associated with mitochondrial dysfunction, oxidative stress, and neuroendocrinology. Our data show differential methylation in ASD at six key genes converging on PGC-1α-dependent regulation of mitochondrial biogenesis and function. We demonstrate that methylation at the PGC-1α promoter is associated with elevated mtDNA copy number and metabolomic evidence of mitochondrial dysfunction in ASD. This highlights an unexplored role for DNA methylation in regulating specific pathways involved in mitochondrial biogenesis, fission and fusion contributing to mitochondrial dysfunction in ASD.
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Affiliation(s)
- Sophia Bam
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Erin Buchanan
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Caitlyn Mahony
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
| | - Colleen O'Ryan
- Department of Molecular and Cell Biology, University of Cape Town, Cape Town, South Africa
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8
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Perinatal Factors in Newborn Are Insidious Risk Factors for Childhood Autism Spectrum Disorders: A Population-based Study. J Autism Dev Disord 2021; 52:52-60. [PMID: 33625618 DOI: 10.1007/s10803-021-04921-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
We analyzed claims data from the Taiwan National Health Insurance database, which contains data of 23.5 million Taiwan residents. We included children born after January 1, 2000 who had received a diagnosis of autism spectrum disorders (ASD). Patients who were not diagnosed with ASD were included in the control group. The ASD prevalence was 517 in 62,051 (0.83%) children. Neonatal jaundice, hypoglycemia, intrauterine growth retardation (IUGR), and craniofacial anomalies (CFA) differed significantly between the ASD and control groups. After logistic regressive analysis, the adjusted odds ratios of IUGR, CFA, neonatal hypoglycemia, and neonatal jaundice were 8.58, 7.37, 3.83, and 1.32, respectively. Those insidiously perinatal risk factors, namely CFA, IUGR, neonatal hypoglycemia, and neonatal jaundice, could increase the risk of ASD.
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9
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Alkhalidy H, Abushaikha A, Alnaser K, Obeidat MD, Al-Shami I. Nutritional Status of Pre-school Children and Determinant Factors of Autism: A Case-Control Study. Front Nutr 2021; 8:627011. [PMID: 33681277 PMCID: PMC7933547 DOI: 10.3389/fnut.2021.627011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022] Open
Abstract
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder triggered by several factors, including those of genetic and environmental nature. ASD can alter communication, behavior, and children's nutritional status, placing them at high risk for nutritional imbalances. Therefore, this study aims to assess preschool autistic children's nutritional status as compared to that of Typically Developing (TD) children of the same age. The study also revealed some of the ASD risk factors among the Jordanian population. It included 52 ASD and 51 TD children (3-6 years), and considered sociodemographic, obstetric, and nutritional factors of the two groups, stratified by gender. Nutritional status was evaluated through a comprehensive questionnaire, 3-day food record, and anthropometric and biochemical measurements. Differences between groups were identified using the chi-square and independent-sample t-test. The logistic regression model was used after the adjustment of confounders to detect an autistic child's determinants. The study showed little difference between ASD and TD children with respect to nutrients' intake inadequacy and biochemical-nutritional deficiencies, but did reveal gender-based differences. Autistic girls were at higher risk of inadequate carbohydrate intake, while autistic boys were at higher risk of inadequate vitamin E, vitamin K, and fluoride compared to TD children. More autistic children had been treated in neonatal care units after birth than had TD children. The regression analysis revealed that lower maternal education level (OR, 12.25; 95% CI, 1.18-126.91), vaginal delivery (OR, 0.273; 95% CI, 0.105-0.712), family history of autism (OR, 0.189; 95% CI, 0.059-0.612), and taking dietary supplements during pregnancy (OR, 4.665; 95% CI, 1.158-18.79) were all determinants of ASD in children. In conclusion, maternal nutrition, postnatal conditions, and nutritional status might be contributors to ASD in children. Pre-school children are at high risk for developing nutritional deficiencies. It is therefore important to maintain optimal nutritional status in pregnant patients, and in children after delivery and during early childhood. Future studies that investigate the role of nutrient deficiencies and nutritional interventions in ASD are necessary. Also required are studies that focus on gender differences in the prevalence of ASD, types and severity of symptoms, and ASD nutrition-related problems.
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Affiliation(s)
- Hana Alkhalidy
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Amal Abushaikha
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Khadeejah Alnaser
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad D. Obeidat
- Department of Animal Production, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Islam Al-Shami
- Department of Clinical Nutrition and Dietetics, Faculty of Allied Health Science, The Hashemite University, Zarqa, Jordan
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Bjørklund G, Pivina L, Dadar M, Meguid NA, Semenova Y, Anwar M, Chirumbolo S. Gastrointestinal alterations in autism spectrum disorder: What do we know? Neurosci Biobehav Rev 2020; 118:111-120. [DOI: 10.1016/j.neubiorev.2020.06.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/21/2020] [Accepted: 06/28/2020] [Indexed: 02/07/2023]
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11
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Canda E, Kalkan Uçar S, Çoker M. Biotinidase Deficiency: Prevalence, Impact And Management Strategies. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2020; 11:127-133. [PMID: 32440248 PMCID: PMC7211084 DOI: 10.2147/phmt.s198656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/05/2020] [Indexed: 12/23/2022]
Abstract
Biotinidase deficiency is an autosomal recessive inherited neurocutaneous disorder. Clinically untreated patients with BD can present with variable neurological and dermatological signs, such as seizures, hypotonia, feeding problems, developmental delay, hearing loss, optic atrophy ataxia, alopecia, and skin rash. Clinical findings of patients with partial BD reported in the literature show that it can occur from infancy to adulthood. Outcomes of newborn screening programs support the fact that biotin treatment started after birth prevents patients with biotinidase deficiency from developing symptoms. Presence of late-onset cases with different clinical findings indicates that there is still much to learn about BD.
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Affiliation(s)
- Ebru Canda
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Sema Kalkan Uçar
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Mahmut Çoker
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
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12
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Horvath GA, Stowe RM, Ferreira CR, Blau N. Clinical and biochemical footprints of inherited metabolic diseases. III. Psychiatric presentations. Mol Genet Metab 2020; 130:1-6. [PMID: 32122747 DOI: 10.1016/j.ymgme.2020.02.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 01/17/2023]
Abstract
Psychiatric symptoms are common manifestations in many inborn errors of metabolism (IEMs), ranging from attention deficit, anxiety and mood and behavioral disorders to psychosis. Furthermore, IEMs represent a significant percentage of all autism cases. We reviewed and updated the list of metabolic disorders known to be associated with various psychiatric manifestations and found more than 100 relevant IEMs. This represents the third of a series of articles attempting to create and maintain a comprehensive list of clinical and metabolic differential diagnoses according to organ system involvement.
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Affiliation(s)
- Gabriella A Horvath
- Department of Pediatrics, Division of Biochemical Genetics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada; Adult Metabolic Diseases Clinic, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Robert M Stowe
- Departments of Psychiatry and Neurology (Medicine) and Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada.
| | - Carlos R Ferreira
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Nenad Blau
- Dietmar-Hopp Metabolic Center, University Children's Hospital, Heidelberg, Germany; Division of Metabolism, Children's Hospital, Zürich, Switzerland.
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Al-Dewik N, Al-Jurf R, Styles M, Tahtamouni S, Alsharshani D, Alsharshani M, Ahmad AI, Khattab A, Al Rifai H, Walid Qoronfleh M. Overview and Introduction to Autism Spectrum Disorder (ASD). ADVANCES IN NEUROBIOLOGY 2020; 24:3-42. [PMID: 32006355 DOI: 10.1007/978-3-030-30402-7_1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder generally manifesting in the first few years of life and tending to persist into adolescence and adulthood. It is characterized by deficits in communication and social interaction and restricted, repetitive patterns of behavior, interests, and activities. It is a disorder with multifactorial etiology. In this chapter, we will focus on the most important and common epidemiological studies, pathogenesis, screening, and diagnostic tools along with an explication of genetic testing in ASD.
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Affiliation(s)
- Nader Al-Dewik
- Clinical and Metabolic Genetics Section, Pediatrics Department, Hamad General Hospital (HGH), Women's Wellness and Research Center (WWRC) and Interim Translational Research Institute (iTRI), Hamad Medical Corporation (HMC), Doha, Qatar. .,College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar. .,Faculty of Health and Social Care Sciences, Kingston University, St. George's University of London, London, UK.
| | - Rana Al-Jurf
- Department of Biomedical Science, College of Health Science, Qatar University, Doha, Qatar
| | - Meghan Styles
- Health Profession Awareness Program, Health Facilities Development, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sona Tahtamouni
- Child Development Center, Hamad Medical Corporation, Doha, Qatar
| | - Dalal Alsharshani
- College of Health and Life Sciences, Hamad Bin Khalifa University (HBKU), Doha, Qatar
| | - Mohammed Alsharshani
- Diagnostic Genetics Division (DGD), Department of Laboratory Medicine and Pathology (DLMP), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Amal I Ahmad
- Qatar Rehabilitation Institute (QRI), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Azhar Khattab
- Qatar Rehabilitation Institute (QRI), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Hilal Al Rifai
- Department of Pediatrics and Neonatology, Newborn Screening Unit, Hamad Medical Corporation, Doha, Qatar
| | - M Walid Qoronfleh
- Research and Policy Department, World Innovation Summit for Health (WISH), Qatar Foundation, Doha, Qatar
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14
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Hartman RE, Patel D. Dietary Approaches to the Management of Autism Spectrum Disorders. ADVANCES IN NEUROBIOLOGY 2020; 24:547-571. [PMID: 32006373 DOI: 10.1007/978-3-030-30402-7_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This chapter reviews the literature surrounding autism spectrum disorders (ASD) and their relation to gastrointestinal (GI), behavioral, neurological, and immunological functioning. Individuals with ASD often have poor GI health, including bowel motility issues, autoimmune and/or other adverse responses to certain foods, and lack of necessary nutrient absorption. These issues may be caused or exacerbated by restrictive behavioral patterns (e.g., preference for sweet and salty foods and/or refusal of healthy foods). Those individuals with GI issues tend to demonstrate more behavioral deficits (e.g., irritability, agitation, hyperactivity) and also tend to have an imbalance in overall gut microbiome composition, thus corroborating several studies that have implicated brain-gut pathways as potential mediators of behavioral dysfunction.We examine the literature regarding dietary approaches to managing ASDs, including elimination diets for gluten, casein, or complex carbohydrates, a ketogenic diet, and a low oxalate diet. We also explore the research examining dietary supplements such as fatty acids, pro- and prebiotics, vitamins, minerals, glutathione, phytochemicals, and hormones. The research on dietary approaches to managing ASDs is limited and the results are mixed. However, a few approaches, such as the gluten-free/casein-free diet, fatty acid supplementation, and pre/probiotics have generally demonstrated improved GI and associated behavioral symptoms. Given that GI issues seem to be overrepresented in ASD populations, and that GI issues have been associated with a number behavioral and neurological deficits, dietary manipulation may offer a cheap and easily implemented approach to improve the lives of those with ASD.
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Affiliation(s)
- Richard E Hartman
- Department of Psychology, Loma Linda University, Loma Linda, CA, USA.
| | - Dhira Patel
- Department of Psychology, Loma Linda University, Loma Linda, CA, USA
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15
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ElObeid T, Moawad J, Shi Z. Importance of Nutrition Intervention in Autistic Patients. ADVANCES IN NEUROBIOLOGY 2020; 24:535-545. [PMID: 32006372 DOI: 10.1007/978-3-030-30402-7_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Along with the issues of inflated social and financial burden associated with autism spectrum disorder (ASD), specific treatment for this disorder has also not been developed. Having a thorough look at previous trials done to treat autism, we find that nutrition intervention had been used frequently as a complementary form of therapy. Indeed, an early diagnosis of nutrition deficiency and metabolic disorders done concomitantly with accurate therapeutic interventions can be a cornerstone for improving cognitive and behavioral aptitudes of people with autism. Several studies have showed that increasing the intake of specific nutrients can reduce the symptoms and comorbidities associated with autism. Consequently, nutrition intervention and appropriate supplementation can be crucial in managing and treating autism. This paper will discuss recent literature on the significance of metabolic aspects in autistic disorder and highlight the influence of nutrition intervention on the symptoms of autism.
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Affiliation(s)
- Tahra ElObeid
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar.
| | - Joyce Moawad
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
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Rivell A, Mattson MP. Intergenerational Metabolic Syndrome and Neuronal Network Hyperexcitability in Autism. Trends Neurosci 2019; 42:709-726. [PMID: 31495451 PMCID: PMC6779523 DOI: 10.1016/j.tins.2019.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/17/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022]
Abstract
We review evidence that suggests a role for excessive consumption of energy-dense foods, particularly fructose, and consequent obesity and insulin resistance (metabolic syndrome) in the recent increase in prevalence of autism spectrum disorders (ASD). Maternal insulin resistance, obesity, and diabetes may predispose offspring to ASD by mechanisms involving chronic activation of anabolic cellular pathways and a lack of metabolic switching to ketosis resulting in a deficit in GABAergic signaling and neuronal network hyperexcitability. Metabolic reprogramming by epigenetic DNA and chromatin modifications may contribute to alterations in gene expression that result in ASD. These mechanistic insights suggest that interventions that improve metabolic health such as intermittent fasting and exercise may ameliorate developmental neuronal network abnormalities and consequent behavioral manifestations in ASD.
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Affiliation(s)
- Aileen Rivell
- Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Mark P Mattson
- Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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17
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El Fotoh WMMA, El Naby SAA, Abd El Hady NMS. Autism Spectrum Disorders: The Association with Inherited Metabolic Disorders and Some Trace Elements. A Retrospective Study. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2019; 18:413-420. [DOI: 10.2174/1871527318666190430162724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/10/2018] [Accepted: 04/12/2019] [Indexed: 01/19/2023]
Abstract
<P>Background: Autism Spectrum Disorders (ASD) as a considerable health obstacle in kids
is characterized by compromised social collaboration and stereotyped behavior. Autism is triggered by
an interactive impact of environmental and genetic influences. Presumably, some inborn errors of metabolism
are implicated in a sector of developmental disabilities. Also, several trace elements may
have an important role in human behavior and neurological development. This study was designed to
verify the frequency of inherited metabolic disorders and/or trace element abnormalities in children
with ASD.
</P><P>
Methods: In a retrospective analytical study, 320 children diagnosed with ASD according to the DSM-V
criteria and Childhood Autism Rating Scale criteria were enrolled in this study. Serum ammonia,
blood lactate, and arterial blood gases, plasma amino acid profile by tandem mass spectrophotometry,
and a urinary organic acid assay were performed in all the patients. Likewise, the estimation of a number
of trace elements in the form of serum lead, mercury, copper, and plasma zinc was done in all the
patients.
</P><P>
Results: A total of 320 children with ASD, inherited metabolic disorders were identified in eight
(2.5%) patients as follows: seven (2.19%) patients with phenylketonuria, and one (0.31%) patient with
glutaric aciduria type 1. Regarding the trace element deficiency, sixteen (5%) patients presented low
plasma zinc level, five (1.56%) children presented a high serum copper level, two (0.62%) children
presented a high serum lead level and only one (0.31%) autistic child presented high serum mercury
level. Electroencephalogram (EEG) abnormalities were reported in 13.12% and Magnetic Resonant
Imaging (MRI) abnormalities in 8.43% of cases.
</P><P>
Conclusion: Screening for metabolic diseases and trace elements is required in all children diagnosed
with ASD irrespective of any apparent clinical attributes of metabolic complaints and trace elements
discrepancies.</P>
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Affiliation(s)
| | - Sameh Abdallah Abd El Naby
- Department of Pediatrics, Faculty of Medicine, Menoufia University Hospitals, Shebin ElKoum - Menofia, Egypt
| | - Nahla M. Said Abd El Hady
- Department of Pediatrics, Faculty of Medicine, Menoufia University Hospitals, Shebin ElKoum - Menofia, Egypt
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18
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Pichitpunpong C, Thongkorn S, Kanlayaprasit S, Yuwattana W, Plaingam W, Sangsuthum S, Aizat WM, Baharum SN, Tencomnao T, Hu VW, Sarachana T. Phenotypic subgrouping and multi-omics analyses reveal reduced diazepam-binding inhibitor (DBI) protein levels in autism spectrum disorder with severe language impairment. PLoS One 2019; 14:e0214198. [PMID: 30921354 PMCID: PMC6438570 DOI: 10.1371/journal.pone.0214198] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 03/08/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The mechanisms underlying autism spectrum disorder (ASD) remain unclear, and clinical biomarkers are not yet available for ASD. Differences in dysregulated proteins in ASD have shown little reproducibility, which is partly due to ASD heterogeneity. Recent studies have demonstrated that subgrouping ASD cases based on clinical phenotypes is useful for identifying candidate genes that are dysregulated in ASD subgroups. However, this strategy has not been employed in proteome profiling analyses to identify ASD biomarker proteins for specific subgroups. METHODS We therefore conducted a cluster analysis of the Autism Diagnostic Interview-Revised (ADI-R) scores from 85 individuals with ASD to predict subgroups and subsequently identified dysregulated genes by reanalyzing the transcriptome profiles of individuals with ASD and unaffected individuals. Proteome profiling of lymphoblastoid cell lines from these individuals was performed via 2D-gel electrophoresis, and then mass spectrometry. Disrupted proteins were identified and compared to the dysregulated transcripts and reported dysregulated proteins from previous proteome studies. Biological functions were predicted using the Ingenuity Pathway Analysis (IPA) program. Selected proteins were also analyzed by Western blotting. RESULTS The cluster analysis of ADI-R data revealed four ASD subgroups, including ASD with severe language impairment, and transcriptome profiling identified dysregulated genes in each subgroup. Screening via proteome analysis revealed 82 altered proteins in the ASD subgroup with severe language impairment. Eighteen of these proteins were further identified by nano-LC-MS/MS. Among these proteins, fourteen were predicted by IPA to be associated with neurological functions and inflammation. Among these proteins, diazepam-binding inhibitor (DBI) protein was confirmed by Western blot analysis to be expressed at significantly decreased levels in the ASD subgroup with severe language impairment, and the DBI expression levels were correlated with the scores of several ADI-R items. CONCLUSIONS By subgrouping individuals with ASD based on clinical phenotypes, and then performing an integrated transcriptome-proteome analysis, we identified DBI as a novel candidate protein for ASD with severe language impairment. The mechanisms of this protein and its potential use as an ASD biomarker warrant further study.
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Affiliation(s)
- Chatravee Pichitpunpong
- M.Sc. Program in Clinical Biochemistry and Molecular Medicine, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Surangrat Thongkorn
- PhD Program in Clinical Biochemistry and Molecular Medicine, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Songphon Kanlayaprasit
- PhD Program in Clinical Biochemistry and Molecular Medicine, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Wasana Yuwattana
- B.Sc. Program in Medical Technology, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Waluga Plaingam
- College of Oriental Medicine, Rangsit University, Pathum Thani, Thailand
| | - Siriporn Sangsuthum
- Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Wan Mohd Aizat
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Syarul Nataqain Baharum
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Tewin Tencomnao
- Age-related Inflammation and Degeneration Research Unit, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Valerie Wailin Hu
- Department of Biochemistry and Molecular Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Tewarit Sarachana
- Age-related Inflammation and Degeneration Research Unit, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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19
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Hsu RH, Chien YH, Hwu WL, Chang IF, Ho HC, Chou SP, Huang TM, Lee NC. Genotypic and phenotypic correlations of biotinidase deficiency in the Chinese population. Orphanet J Rare Dis 2019; 14:6. [PMID: 30616616 PMCID: PMC6323711 DOI: 10.1186/s13023-018-0992-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/28/2018] [Indexed: 12/29/2022] Open
Abstract
Biotinidase deficiency is an autosomal recessive disorder that affects the endogenous recycling and release of biotin from dietary protein. This disease was thought to be rare in East Asia. In this report, we delineate the phenotype of biotinidase deficiency in our cohort. The genotypes and phenotypes of patients diagnosed with biotinidase deficiency from a medical center were reviewed. The clinical manifestations, laboratory findings, and molecular test results were retrospectively analyzed. A total of 6 patients were evaluated. Three patients (50%) were diagnosed because of a clinical illness, and the other three (50%) were identified by newborn screening. In all patients, the molecular results confirmed the BTD mutation. The three patients with clinical manifestations had an onset of seizure at the age of 2 to 3 months. Two patients had respiratory problems (one with apnea under bilevel positive airway pressure (BiPAP) therapy at night, and the other with laryngomalacia). Hearing loss and eye problems were found in one patient. Interestingly, cutaneous manifestations including skin eczema, alopecia, and recurrent fungal infection were less commonly seen compared to cases in the literature. None of the patients identified by the newborn screening program developed symptoms. Our findings highlight differences in the genotype and phenotype compared with those in Western countries. Patients with biotinidase deficiency benefit from newborn screening programs for early detection and management.
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Affiliation(s)
- Rai-Hseng Hsu
- Department of Medical Genetics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
- Department of Pediatrics, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi Dist., Taipei, 11031 Taiwan
| | - Yin-Hsiu Chien
- Department of Medical Genetics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
| | - Wuh-Liang Hwu
- Department of Medical Genetics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
| | - I-Fan Chang
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
| | - Hui-Chen Ho
- Taipei Institute of Pathology, No.146, Sec.3, Chongqing N. Rd., Datong Dist., Taipei, 10374 Taiwan
| | - Shi-Ping Chou
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
| | - Tzu-Ming Huang
- Department of Medical Genetics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
| | - Ni-Chung Lee
- Department of Medical Genetics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
- Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Zhongzheng Dist., Taipei, 10041 Taiwan
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20
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Diagnostic and Severity-Tracking Biomarkers for Autism Spectrum Disorder. J Mol Neurosci 2018; 66:492-511. [DOI: 10.1007/s12031-018-1192-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 09/25/2018] [Indexed: 01/06/2023]
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21
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Cashin A, Buckley T, Trollor JN, Lennox N. A scoping review of what is known of the physical health of adults with autism spectrum disorder. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2018; 22:96-108. [PMID: 27623754 DOI: 10.1177/1744629516665242] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Little research has been carried out on the physical health of people with autism spectrum disorder (ASD). From the studies conducted with both children and adults, few studies have moved beyond retrospective record analysis and survey and conducted health assessment. The majority of the studies are from the United States of America with a small number conducted in Europe. A scoping review was conducted to determine what is known of the physical health of adults with ASD and to identify research gaps. In addition to studies of adults, this review includes studies of children to determine possible health trajectories. From the findings, it can be stated with confidence that people with ASD have a high rate of comorbidity and increased risk for chronic disease.
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22
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Sindgikar SP, Shenoy KD, Kamath N, Shenoy R. Audit of Organic Acidurias from a Single Centre: Clinical and Metabolic Profile at Presentation with Long Term Outcome. J Clin Diagn Res 2017; 11:SC11-SC14. [PMID: 29207797 DOI: 10.7860/jcdr/2017/28793.10632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/23/2017] [Indexed: 11/24/2022]
Abstract
Introduction Organic Acidurias (OA) accounts between 10% and 40% of confirmed Inborn Errors of Metabolism (IEM) in India. With prompt recognition and management, better survival but adverse neurodevelopmental outcome is reported. Aim To study the clinical and metabolic presentation, management with immediate and long term outcome of symptomatic children with confirmed OA. Materials and Methods Hospital based study of symptomatic children diagnosed to have OA between 2003 and 2009 and the survivors followed up over next five years. Diagnosis was based on clinical and metabolic presentation and confirmed by spectrometry analyses of urine and blood. Management, immediate outcome, compliance to treatment and recurrence of crises were documented. Neurodevelopmental outcome was assessed in follow up. Mean with Standard Error (Mean ± SE) and frequencies with percentages were calculated. Results Of 72 cases suspected to have IEM, 38 (52.8%) were confirmed of (IEM), and out of which 15 (39.5%) had OA. Methyl malonic acidemia, multiple carboxylase deficiency and Propionic Acidemia (PA) constituted the largest proportion. Neurodevelopmental issues (73.3%) and metabolic crisis (53.3%) were common presenting features. Mean ± SE of ammonia was 639.0±424.1 μg/dl and lactate was 33.6±4.9 mg/dl. Mean pH, bicarbonate, and anion gap was 7.27±0.07, 14.1±2.3 and 17.9±2.3 respectively. Management was protocol based. Death was reported in two cases of PA; other morbidities were seen in five. Recurrent crisis (46.7%) complicated the follow up in survivors. Spasticity, extrapyramidal movement disorder, intellectual subnormality, autism spectrum, attention deficit hyperactivity disorder and sensory neural deafness were seen amongst survivors, in spite of compliance to therapy. Conclusion OA is part of differential diagnosis in sick children and treatment needs to be prompt and specific. Prognosis is guarded even with long term cofactor supplementation in the symptomatic.
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Affiliation(s)
- Seema Pavaman Sindgikar
- Associate Professor, Department of Paediatrics, K S Hegde Medical Academy, NITTE University, Mangalore, Karnataka, India
| | - Krithika Damodar Shenoy
- Intern, Department of Paediatrics, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Nutan Kamath
- Professor, Department of Paediatrics, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Rathika Shenoy
- Professor, Department of Paediatrics, K S Hegde Medical Academy, NITTE University, Mangalore, Karnataka, India
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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.
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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.
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24
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Copy number variations independently induce autism spectrum disorder. Biosci Rep 2017; 37:BSR20160570. [PMID: 28533427 PMCID: PMC6434077 DOI: 10.1042/bsr20160570] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/22/2017] [Accepted: 05/22/2017] [Indexed: 12/13/2022] Open
Abstract
The examination of copy number variation (CNV) is critical to understand the etiology of the CNV-related autism spectrum disorders (ASD). DNA samples were obtained from 64 ASD probands, which were genotyped on an Affymetrix CytoScan HD platform. qPCR or FISH were used as a validation for some novel recurrent CNVs. We further compared the clinical phenotypes of the genes in the Database of Chromosomal Imbalance and Phenotype in Humans Using Ensembl Resources (DECIPHER) database with these overlapping genes. Using vast, readily available databases with previously reported clinically relevant CNVs from human populations, the genes were evaluated using Enrichment Analysis and GO Slim Classification. By using the Ploysearch2 software, we identified the interaction relationship between significant genes and known ASD genes. A total of 29 CNVs, overlapping with 520 genes, including 315 OMIM genes, were identified. Additionally, myocyte enhancer factor 2 family (MEF2C) with two cases of CNV overlapping were also identified. Enrichment analysis showed that the 520 genes are most likely to be related to membrane components with protein-binding functions involved in metabolic processes. In the interaction network of those genes, the known ASD genes are mostly at the core position and the significant genes found in our samples are closely related to the known ASD genes. CNVs should be an independent factor to induce autism. With the strategy of our study, we could find the ASDs candidate genes by CNV data and review certain pathogenesis of this disorder. Those CNVs were associated with ASD and they may contribute to ASD by affecting the ASD-related genes.
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25
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Tiwari S, Kallianpur D, DeSilva KA. Communication Impairments in Children with Inborn Errors of Metabolism: A Preliminary Study. Indian J Psychol Med 2017; 39:146-151. [PMID: 28515550 PMCID: PMC5385742 DOI: 10.4103/0253-7176.203125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Inborn Errors of Metabolism (IEMs) are a group of complex genetic conditions, predominantly affecting the pediatric population. While the understanding and identification of various IEMs has significantly improved over recent times, not much is known about the communication disorders in this population. The present study focused on identification and profiling of communication impairments in children diagnosed with IEMs. METHODS Data was obtained retrospectively from medical records of children visiting a tertiary care hospital over a period of ten years (2005 - 2014). Selected data was reviewed to obtain demographic details, clinical signs/manifestations, laboratory findings, risk factors, developmental disorders and reported communication impairments. RESULTS The findings of the study showed a variety of clinical signs and laboratory findings in children with inborn errors of metabolism. A few of the risk factors observed in the group were consanguinity, sibling death and family history of other disorders. Many children with IEM displayed communication disorders, most common as the delay in speech and language development. CONCLUSIONS The results of this study showed that various communication disorders were seen in almost half of the children with a diagnosis of IEM. Findings are discussed with implications for future research in this direction.
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Affiliation(s)
- Shivani Tiwari
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - Divya Kallianpur
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | - Kelly Ann DeSilva
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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26
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Simons A, Eyskens F, Glazemakers I, van West D. Can psychiatric childhood disorders be due to inborn errors of metabolism? Eur Child Adolesc Psychiatry 2017; 26:143-154. [PMID: 27695954 PMCID: PMC5306168 DOI: 10.1007/s00787-016-0908-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 09/23/2016] [Indexed: 12/19/2022]
Abstract
Many patients who visit a centre for hereditary metabolic diseases remarkably also suffer from a child psychiatric disorder. Those child psychiatric disorders may be the first sign or manifestation of an underlying metabolic disorder. Lack of knowledge of metabolic disorders in child psychiatry may lead to diagnoses being missed. Patients therefore are also at risk for not accessing efficacious treatment and proper counselling. To search the literature for the co-occurrence of child psychiatric disorders, such as ADHD, autism, psychosis, learning disorders and eating disorders and metabolic disorders. A search of the literature was conducted by performing a broad search on PubMed, using the terms "ADHD and metabolic disorders", "autism and metabolic disorders", "psychosis and metabolic disorders", "learning disorders and metabolic disorders", and "eating disorders and metabolic disorders". Based on inclusion criteria (concerning a clear psychiatric disorder and concerning a metabolic disorder) 4441 titles and 249 abstracts were screened and resulted in 71 relevant articles. This thorough literature search provides child and adolescent psychiatrists with an overview of metabolic disorders associated with child psychiatric symptoms, their main characteristics and recommendations for further investigations.
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Affiliation(s)
- A. Simons
- Centre of Heriditary Metabolic Diseases Antwerp (CEMA), University Hospital of Antwerp (UZA), Wilrijkstraat, 2650 Edegem, Belgium ,Collaborative Antwerp Psychiatric Research Institute (CAPRI) Youth, Antwerp, Belgium ,University Child and Adolescent Psychiatry Antwerp, Lindendreef 1, 2020 Antwerp, Belgium
| | - F. Eyskens
- Centre of Heriditary Metabolic Diseases Antwerp (CEMA), University Hospital of Antwerp (UZA), Wilrijkstraat, 2650 Edegem, Belgium
| | - I. Glazemakers
- Collaborative Antwerp Psychiatric Research Institute (CAPRI) Youth, Antwerp, Belgium ,University Child and Adolescent Psychiatry Antwerp, Lindendreef 1, 2020 Antwerp, Belgium ,University of Antwerp (CAPRI), Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - D. van West
- Collaborative Antwerp Psychiatric Research Institute (CAPRI) Youth, Antwerp, Belgium ,University of Brussels, Brussels, Belgium ,University Child and Adolescent Psychiatry Antwerp, Lindendreef 1, 2020 Antwerp, Belgium ,University of Antwerp (CAPRI), Universiteitsplein 1, 2610 Wilrijk, Belgium
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27
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Féron F, Gepner B, Lacassagne E, Stephan D, Mesnage B, Blanchard MP, Boulanger N, Tardif C, Devèze A, Rousseau S, Suzuki K, Izpisua Belmonte JC, Khrestchatisky M, Nivet E, Erard-Garcia M. Olfactory stem cells reveal MOCOS as a new player in autism spectrum disorders. Mol Psychiatry 2016; 21:1215-24. [PMID: 26239292 PMCID: PMC4995547 DOI: 10.1038/mp.2015.106] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/06/2015] [Accepted: 06/15/2015] [Indexed: 12/27/2022]
Abstract
With an onset under the age of 3 years, autism spectrum disorders (ASDs) are now understood as diseases arising from pre- and/or early postnatal brain developmental anomalies and/or early brain insults. To unveil the molecular mechanisms taking place during the misshaping of the developing brain, we chose to study cells that are representative of the very early stages of ontogenesis, namely stem cells. Here we report on MOlybdenum COfactor Sulfurase (MOCOS), an enzyme involved in purine metabolism, as a newly identified player in ASD. We found in adult nasal olfactory stem cells of 11 adults with ASD that MOCOS is downregulated in most of them when compared with 11 age- and gender-matched control adults without any neuropsychiatric disorders. Genetic approaches using in vivo and in vitro engineered models converge to indicate that altered expression of MOCOS results in neurotransmission and synaptic defects. Furthermore, we found that MOCOS misexpression induces increased oxidative-stress sensitivity. Our results demonstrate that altered MOCOS expression is likely to have an impact on neurodevelopment and neurotransmission, and may explain comorbid conditions, including gastrointestinal disorders. We anticipate our discovery to be a fresh starting point for the study on the roles of MOCOS in brain development and its functional implications in ASD clinical symptoms. Moreover, our study suggests the possible development of new diagnostic tests based on MOCOS expression, and paves the way for drug screening targeting MOCOS and/or the purine metabolism to ultimately develop novel treatments in ASD.
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Affiliation(s)
- F Féron
- Inserm CBT 1409, Centre d'Investigations Cliniques en Biothérapie, Marseille, France,Aix Marseille Université, CNRS, NICN UMR 7259, Marseille, France,Faculty of Medicine, Aix Marseille Université, CNRS, NICN UMR 7259, 13344 Marseille, France. E-mail: or
| | - B Gepner
- Aix Marseille Université, CNRS, NICN UMR 7259, Marseille, France
| | - E Lacassagne
- Aix Marseille Université, CNRS, NICN UMR 7259, Marseille, France
| | - D Stephan
- Aix Marseille Université, CNRS, NICN UMR 7259, Marseille, France
| | - B Mesnage
- Aix Marseille Université, CNRS, NICN UMR 7259, Marseille, France
| | - M-P Blanchard
- Aix Marseille Université, CNRS, CRN2M UMR 6231, Marseille, France
| | - N Boulanger
- Aix Marseille Université, TAGC UMR 1090, Marseille, France
| | - C Tardif
- Aix Marseille Université, PsyCLE, EA 3273, Aix en Provence, France
| | - A Devèze
- AP-HM, Département ORL, Marseille, France
| | - S Rousseau
- AP-HM, Département Anesthésie, Marseille, France
| | - K Suzuki
- Gene Expression Laboratory, The Salk Institute for Biological Studies, La Jolla, CA, USA
| | - J C Izpisua Belmonte
- Gene Expression Laboratory, The Salk Institute for Biological Studies, La Jolla, CA, USA
| | - M Khrestchatisky
- Aix Marseille Université, CNRS, NICN UMR 7259, Marseille, France
| | - E Nivet
- Aix Marseille Université, CNRS, NICN UMR 7259, Marseille, France
| | - M Erard-Garcia
- Aix Marseille Université, CNRS, NICN UMR 7259, Marseille, France,Faculty of Medicine, Aix Marseille Université, CNRS, NICN UMR 7259, 13344 Marseille, France. E-mail: or
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Campistol J, Díez-Juan M, Callejón L, Fernandez-De Miguel A, Casado M, Garcia Cazorla A, Lozano R, Artuch R. Inborn error metabolic screening in individuals with nonsyndromic autism spectrum disorders. Dev Med Child Neurol 2016; 58:842-7. [PMID: 27038397 DOI: 10.1111/dmcn.13114] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2016] [Indexed: 12/14/2022]
Abstract
AIM To perform metabolic testing on 406 patients (age range 3-22y [mean 6.71, SD 4.15], 343 males and 63 females) with nonsyndromic autism spectrum disorders (ASD) to assess the diagnostic yield. In addition, we reviewed our hospital's clinical database of 8500 patients who had undergone metabolic testing to be identified for inborn errors of metabolism (IEM), and described the characteristics of those with IEM and nonsyndromic ASD. METHOD Neuropsychological evaluation included the Social Communication Questionnaire and Child Behavior Checklist. For metabolic testing/screening, urine samples were analyzed for the diagnosis of cerebral creatine deficiency syndromes, purine and pyrimidine disorders, amino acid metabolism defects, mucopolysaccharidoses, and organic acidurias. RESULTS The 406 recruited participants fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria of ASD. No biochemical evidence of a metabolic disorder was detected in any of the 406 patients studied. Concerning the retrospective evaluation from the 8500 who had metabolic testing, 464 individuals had a diagnosis of an IEM (394 without the diagnosis of ASD and 70 with ASD diagnosis). Only one individual with IEM had a diagnosis of nonsyndromic ASD at the time of the metabolic study; the metabolic testing had revealed diagnosis of urea-cycle disorder. INTERPRETATION Metabolic testing should be considered in the work-up of individuals with syndromic ASD, but metabolic testing is not cost-effective for individuals with nonsyndromic ASD.
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Affiliation(s)
- Jaume Campistol
- Pediatric Neurology and Clinical Biochemistry Departments, Institut de Recerca Pediátrica, Hospital Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - María Díez-Juan
- Unidad Especializada en Trastornos del Desarrollo, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Laura Callejón
- Unidad Especializada en Trastornos del Desarrollo, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Aroa Fernandez-De Miguel
- Pediatric Neurology and Clinical Biochemistry Departments, Institut de Recerca Pediátrica, Hospital Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Mercedes Casado
- Pediatric Neurology and Clinical Biochemistry Departments, Institut de Recerca Pediátrica, Hospital Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Angels Garcia Cazorla
- Pediatric Neurology and Clinical Biochemistry Departments, Institut de Recerca Pediátrica, Hospital Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
| | - Reymundo Lozano
- Seaver Autism Center for Research and Treatment, Departments of Genetics and Genomic Sciences, Psychiatry, and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rafael Artuch
- Pediatric Neurology and Clinical Biochemistry Departments, Institut de Recerca Pediátrica, Hospital Sant Joan de Déu and CIBERER-ISCIII, Barcelona, Spain
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30
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Khemir S, Halayem S, Azzouz H, Siala H, Ferchichi M, Guedria A, Bedoui A, Abdelhak S, Messaoud T, Tebib N, Belhaj A, Kaabachi N. Autism in Phenylketonuria Patients: From Clinical Presentation to Molecular Defects. J Child Neurol 2016; 31:843-9. [PMID: 26759449 DOI: 10.1177/0883073815623636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/15/2015] [Indexed: 11/15/2022]
Abstract
Autism has been reported in untreated patients with phenylketonuria. The authors aimed to explore autism in 15 Tunisian and 4 Algerian phenylketonuria patients, and report their clinical, biochemical and molecular peculiarities. The Childhood Autism Rating Scale and the Autism Diagnostic Interview-Revised were used for the diagnosis of autism. Five exons of phenylalanine hydroxylase gene (7, 6, 10, 11, and 5) were amplified by polymerase chain reaction and directly sequenced. Among these patients, 15 were suffering from autism at the time of evaluation. Six mutations were identified: p.E280K, p.G352Vfs, IVS10nt11, p.I224T, p.R261Q, and p.R252W. There was no correlation between autism and mutations affecting the phenylalanine hydroxylase gene, but the age of diet onset was the determining factor in autistic symptoms' evolution.
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Affiliation(s)
- Sameh Khemir
- Research Laboratory LR99ES11, Department of Biochemistry, Rabta Hospital and Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
| | - Soumeyya Halayem
- Razi Hospital, Department of Child Psychiatry, La Manouba, Tunisia Faculty of Medicine, Tunis, Tunisia
| | - Hatem Azzouz
- Rabta Hospital, Department of Paediatrics, Tunis, Tunisia
| | - Hajer Siala
- Children Hospital, Laboratory of Biochemistry and Molecular Biology, Tunis, Tunisia
| | | | - Asma Guedria
- Mongi Slim Hospital, Department of Child Psychiatry, La Marsa, Tunisia
| | - Amel Bedoui
- Razi Hospital, Department of Child Psychiatry, La Manouba, Tunisia
| | - Sonia Abdelhak
- Laboratory of Biomedical Genomics and Oncogenetics, LR11IPT05, Institut Pasteur de Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Taieb Messaoud
- Children Hospital, Laboratory of Biochemistry and Molecular Biology, Tunis, Tunisia
| | - Neji Tebib
- Rabta Hospital, Department of Paediatrics, Tunis, Tunisia
| | - Ahlem Belhaj
- Faculty of Medicine, Tunis, Tunisia Mongi Slim Hospital, Department of Child Psychiatry, La Marsa, Tunisia
| | - Naziha Kaabachi
- Research Laboratory LR99ES11, Department of Biochemistry, Rabta Hospital and Faculty of Medicine of Tunis, El Manar University, Tunis, Tunisia
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31
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Chittoor G, Kent JW, Almeida M, Puppala S, Farook VS, Cole SA, Haack K, Göring HHH, MacCluer JW, Curran JE, Carless MA, Johnson MP, Moses EK, Almasy L, Mahaney MC, Lehman DM, Duggirala R, Comuzzie AG, Blangero J, Voruganti VS. GWAS and transcriptional analysis prioritize ITPR1 and CNTN4 for a serum uric acid 3p26 QTL in Mexican Americans. BMC Genomics 2016; 17:276. [PMID: 27039371 PMCID: PMC4818944 DOI: 10.1186/s12864-016-2594-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 03/16/2016] [Indexed: 01/08/2023] Open
Abstract
Background The variation in serum uric acid concentrations is under significant genetic influence. Elevated SUA concentrations have been linked to increased risk for gout, kidney stones, chronic kidney disease, and cardiovascular disease whereas reduced serum uric acid concentrations have been linked to multiple sclerosis, Parkinson’s disease and Alzheimer’s disease. Previously, we identified a novel locus on chromosome 3p26 affecting serum uric acid concentrations in Mexican Americans from San Antonio Family Heart Study. As a follow up, we examined genome-wide single nucleotide polymorphism data in an extended cohort of 1281 Mexican Americans from multigenerational families of the San Antonio Family Heart Study and the San Antonio Family Diabetes/Gallbladder Study. We used a linear regression-based joint linkage/association test under an additive model of allelic effect, while accounting for non-independence among family members via a kinship variance component. Results Univariate genetic analysis indicated serum uric acid concentrations to be significant heritable (h2 = 0.50 ± 0.05, p < 4 × 10−35), and linkage analysis of serum uric acid concentrations confirmed our previous finding of a novel locus on 3p26 (LOD = 4.9, p < 1 × 10−5) in the extended sample. Additionally, we observed strong association of serum uric acid concentrations with variants in following candidate genes in the 3p26 region; inositol 1,4,5-trisphosphate receptor, type 1 (ITPR1), contactin 4 (CNTN4), decapping mRNA 1A (DCP1A); transglutaminase 4 (TGM4) and rho guanine nucleotide exchange factor (GEF) 26 (ARHGEF26) [p < 3 × 10−7; minor allele frequencies ranged between 0.003 and 0.42] and evidence of cis-regulation for ITPR1 transcripts. Conclusion Our results confirm the importance of the chromosome 3p26 locus and genetic variants in this region in the regulation of serum uric acid concentrations.
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Affiliation(s)
- Geetha Chittoor
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC, 28081, USA
| | - Jack W Kent
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Marcio Almeida
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Sobha Puppala
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Vidya S Farook
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Shelley A Cole
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Karin Haack
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Harald H H Göring
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Jean W MacCluer
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Joanne E Curran
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Melanie A Carless
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Matthew P Johnson
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Eric K Moses
- Centre for Genetic Epidemiology and Biostatistics, The University of Western Australia, Perth, WA, Australia
| | - Laura Almasy
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Michael C Mahaney
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Donna M Lehman
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Ravindranath Duggirala
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Anthony G Comuzzie
- Department of Genetics, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - John Blangero
- South Texas Diabetes and Obesity Institute, School of Medicine, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Venkata Saroja Voruganti
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,UNC Nutrition Research Institute, University of North Carolina at Chapel Hill, 500 Laureate Way, Kannapolis, NC, 28081, USA.
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33
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Park HR, Lee JM, Moon HE, Lee DS, Kim BN, Kim J, Kim DG, Paek SH. A Short Review on the Current Understanding of Autism Spectrum Disorders. Exp Neurobiol 2016; 25:1-13. [PMID: 26924928 PMCID: PMC4766109 DOI: 10.5607/en.2016.25.1.1] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/18/2015] [Accepted: 12/30/2015] [Indexed: 12/21/2022] Open
Abstract
Autism spectrum disorder (ASD) is a set of neurodevelopmental disorders characterized by a deficit in social behaviors and nonverbal interactions such as reduced eye contact, facial expression, and body gestures in the first 3 years of life. It is not a single disorder, and it is broadly considered to be a multi-factorial disorder resulting from genetic and non-genetic risk factors and their interaction. Genetic studies of ASD have identified mutations that interfere with typical neurodevelopment in utero through childhood. These complexes of genes have been involved in synaptogenesis and axon motility. Recent developments in neuroimaging studies have provided many important insights into the pathological changes that occur in the brain of patients with ASD in vivo. Especially, the role of amygdala, a major component of the limbic system and the affective loop of the cortico-striatothalamo-cortical circuit, in cognition and ASD has been proved in numerous neuropathological and neuroimaging studies. Besides the amygdala, the nucleus accumbens is also considered as the key structure which is related with the social reward response in ASD. Although educational and behavioral treatments have been the mainstay of the management of ASD, pharmacological and interventional treatments have also shown some benefit in subjects with ASD. Also, there have been reports about few patients who experienced improvement after deep brain stimulation, one of the interventional treatments. The key architecture of ASD development which could be a target for treatment is still an uncharted territory. Further work is needed to broaden the horizons on the understanding of ASD.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Jae Meen Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Hyo Eun Moon
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jinhyun Kim
- Center for Functional Connectomics, Korea Institute of Science and Technology (KIST), Seoul 02792, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea
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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.
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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
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Saad K, Elserogy Y, Abdel Rahman AA, Al-Atram AA, Mohamad IL, ElMelegy TTH, Bjørklund G, El-Houfy AA. ADHD, autism and neuroradiological complications among phenylketonuric children in Upper Egypt. Acta Neurol Belg 2015; 115:657-63. [PMID: 25576444 DOI: 10.1007/s13760-014-0422-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 12/29/2014] [Indexed: 02/05/2023]
Abstract
The aim of this study is to evaluate the neuropsychological status in a cohort of children with early and continuously treated phenylketonuria in Assiut, Upper Egypt. The study was implemented in seventy-eight phenylketonuria (PKU) children. Only 34 patients met the inclusion criteria. Investigated patients were evaluated according to detailed history, neurological examination, Childhood Autism Rating Scale, full scale Intelligence Quotient, attention deficit hyperactivity disorder, electroencephalography and magnetic resonance imaging (MRI). This study concluded that the prognosis for early diagnosed children with PKU treated from the first weeks of life is generally good. However, they are at increased risk for neurological complications and behavioral problems. So, neonatal screening for PKU is highly recommended in Egypt, for early detection and management. In addition, neuropsychological and MRI assessments in PKU children should be done.
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Affiliation(s)
- Khaled Saad
- Department of Pediatrics, Assiut University, Asyût, 71516, Egypt.
| | - Yasser Elserogy
- Department of Neuropsychiatry, Assiut University, Asyût, 71516, Egypt
| | | | | | - Ismail L Mohamad
- Department of Pediatrics, Assiut University, Asyût, 71516, Egypt
| | - Tarek T H ElMelegy
- Department of Clinical Pathology, Assiut University, Asyût, 71516, Egypt
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
| | - Amira A El-Houfy
- Department of Community Health Nursing, Assiut University, Asyût, 71516, Egypt
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36
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Strandqvist A, Haglind CB, Zetterström RH, Nemeth A, von Döbeln U, Stenlid MH, Nordenström A. Neuropsychological Development in Patients with Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase (LCHAD) Deficiency. JIMD Rep 2015; 28:75-84. [PMID: 26545880 DOI: 10.1007/8904_2015_505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Reports on cognitive outcomes in long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) are scarce. We present results from neuropsychological assessments of eight patients diagnosed with LCHADD prior to newborn screening with regard to clinical disease severity. METHODS Intellectual ability and adaptive and executive functions were assessed using age-appropriate Wechsler Scales, Adaptive Behavior Assessment Scales (ABAS), and Behavior Rating Inventory of Executive Function (BRIEF). RESULTS Five patients performed in the normal range on IQ tests but with lower scores on verbal working memory. In addition, they had lower parent-rated adaptive and executive functions.Three patients had intellectual disabilities with IQs below normal and/or autism spectrum disorders. In addition, they had low results on parent-rated adaptive functions. (Two of these patients had epilepsy.) Conclusions: Patients with LCHADD seem to have a specific cognitive pattern, with presentation as intellectual disability and specific autistic deficiencies or a normal IQ with weaknesses in auditive verbal memory and adaptive and executive functions. Future studies are warranted to investigate whether newborn screening programs and early treatment may promote improved neuropsychological development and outcomes.
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Affiliation(s)
- A Strandqvist
- Department of Women and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden.,Department of Psychology, Karolinska University Hospital, Stockholm, Sweden
| | - C Bieneck Haglind
- Department of Women and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden. .,Department of Pediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - R H Zetterström
- Departments of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Nemeth
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Karolinska University Hospital, Stockholm, Sweden
| | - U von Döbeln
- Center for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Laboratory Medicine, Division for Metabolic Diseases, Karolinska Institutet, Stockholm, Sweden
| | - M Halldin Stenlid
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Nordenström
- Department of Women and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden.,Department of Pediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Kiykim E, Zeybek CA, Zubarioglu T, Cansever S, Yalcinkaya C, Soyucen E, Aydin A. Inherited metabolic disorders in Turkish patients with autism spectrum disorders. Autism Res 2015; 9:217-23. [DOI: 10.1002/aur.1507] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 03/14/2015] [Accepted: 05/07/2015] [Indexed: 11/05/2022]
Affiliation(s)
- Ertugrul Kiykim
- Istanbul University Cerrahpasa Medical Faculty; Department of Pediatrics; Division of Nutrition and Metabolism; Istanbul Turkey
| | - Cigdem Aktuglu Zeybek
- Istanbul University Cerrahpasa Medical Faculty; Department of Pediatrics; Division of Nutrition and Metabolism; Istanbul Turkey
| | - Tanyel Zubarioglu
- Istanbul University Cerrahpasa Medical Faculty; Department of Pediatrics; Division of Nutrition and Metabolism; Istanbul Turkey
| | - Serif Cansever
- Istanbul University Cerrahpasa Medical Faculty; Department of Pediatrics; Division of Nutrition and Metabolism; Istanbul Turkey
| | - Cengiz Yalcinkaya
- Istanbul University; Cerrahpasa Medical Faculty; Department of Neurology; Istanbul Turkey
| | - Erdogan Soyucen
- Istanbul University Cerrahpasa Medical Faculty; Department of Pediatrics; Division of Nutrition and Metabolism; Istanbul Turkey
| | - Ahmet Aydin
- Istanbul University Cerrahpasa Medical Faculty; Department of Pediatrics; Division of Nutrition and Metabolism; Istanbul Turkey
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Kałużna-Czaplińska J, Żurawicz E, Struck W, Markuszewski M. Identification of organic acids as potential biomarkers in the urine of autistic children using gas chromatography/mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 966:70-6. [DOI: 10.1016/j.jchromb.2014.01.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 11/15/2022]
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Sokolov O, Kost N, Andreeva O, Korneeva E, Meshavkin V, Tarakanova Y, Dadayan A, Zolotarev Y, Grachev S, Mikheeva I, Varlamov O, Zozulya A. Autistic children display elevated urine levels of bovine casomorphin-7 immunoreactivity. Peptides 2014; 56:68-71. [PMID: 24657283 DOI: 10.1016/j.peptides.2014.03.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/11/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
Elevated concentrations of circulating casomorphins (CM), the exogenous opioid peptides from milk casein, may contribute to the pathogenesis of autism in children. Because several mass spectrometry studies failed to detect casomorphins in autistic children, it was questioned whether these peptides can be detected in body fluids by mass spec. Here we demonstrated, using a novel high sensitivity ELISA method, that autistic children have significantly higher levels of urine CM-7 than control children. The severity of autistic symptoms correlated with concentrations of CM-7 in the urine. Because CMs interact with opioid and serotonin receptors, the known modulators of synaptogenesis, we suggest that chronic exposure to elevated levels of bovine CMs may impair early child development, setting the stage for autistic disorders.
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Affiliation(s)
- Oleg Sokolov
- Mental Health Research Center of RAMS, Moscow, Russia.
| | - Natalya Kost
- Mental Health Research Center of RAMS, Moscow, Russia
| | - Olga Andreeva
- Mental Health Research Center of RAMS, Moscow, Russia
| | | | | | | | | | | | | | | | - Oleg Varlamov
- Oregon National Primate Research Center, OR, United States
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Uptake and Diagnostic Yield of Chromosomal Microarray in an Australian Child Development Clinic. CHILDREN-BASEL 2014; 1:21-30. [PMID: 27417464 PMCID: PMC4939515 DOI: 10.3390/children1010021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/08/2014] [Accepted: 04/23/2014] [Indexed: 01/04/2023]
Abstract
Autism is an etiologically heterogeneous developmental disorder for which the range of genetic investigations has expanded considerably over the past decade. Introduction of chromosomal microarray (CMA) to clinical practice has expanded the range of conditions which pediatricians are able to detect. This study reviewed the utilization, yield and cost of genetic investigations in a sample of children with pervasive developmental disorders (PDD) in an Australian metropolitan child development service. Six hundred and ninety eight patients with PDD were identified from the clinic population. One hundred and ten (15.7%) of the clinic population had undergone investigation with chromosomal microarray, 140 (20.0%) with karyotype (KT), and 167 (23.9%) with Fragile X testing (FRGX). Twelve (10.9%) CMA findings were reported, of which seven (6.3%) were felt to be the likely cause of the child’s clinical features. Five (3.5%) KT findings were reported, of which four (2.9%) were felt to be the likely cause of the child’s clinical features. Two patients (1.2%) were identified with Fragile X expansions. One fifth of the clinic’s recent PDD population had undergone testing with CMA. CMA appears to have increased the diagnostic yield of the genetic investigation of autism, in line with internationally reported levels. Number needed to test (NNT) and cost per incremental diagnosis, were also in line with internationally reported levels.
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41
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Marques F, Brito MJ, Conde M, Pinto M, Moreira A. Autism spectrum disorder secondary to enterovirus encephalitis. J Child Neurol 2014; 29:708-14. [PMID: 24782421 DOI: 10.1177/0883073813508314] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Millions of children are infected by enteroviruses each year, usually exhibiting only mild symptoms. Nevertheless, these viruses are also associated with severe and life-threatening infections, such as meningitis and encephalitis. We describe a 32-month-old patient with enteroviral encephalitis confirmed by polymerase chain reaction in cerebrospinal fluid, with unfavorable clinical course with marked developmental regression, autistic features, persistent stereotypes and aphasia. She experienced slow clinical improvement, with mild residual neurologic and developmental deficits at follow-up. Viral central nervous system infections in early childhood have been associated with autism spectrum disorders but the underlying mechanisms are still poorly understood. This case report is significant in presenting a case of developmental regression with autistic features and loss of language improving on follow-up. To our knowledge, this is the first published report of enterovirus encephalitis leading to an autism spectrum disorder.
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Affiliation(s)
- Filipa Marques
- 1Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central-EPE, Lisbon, Portugal
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42
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Abstract
The autistic spectrum currently encompasses common precocious behaviourally identified constellations of social and communication atypicalities associated with restricted interests and repetitive behavior, together with uneven ability profiles. It is associated with multiple but heterogeneous genetic, functional, and structural variations whose established links with an autistic behavioral phenotype are as yet minimal. Strong evidence of high heritability contrasts with limited determination of genes and modes of transmission involved. Adaptation and outcomes vary widely according to opportunities, accommodation, and co-occurring conditions. With current diagnostic practices, multiple genetic conditions overlap with the autistic spectrum, with potential for confusion arising from phenocopies. Recent advances question the often presumed association between autism and intellectual disability and/or epilepsy. Autism is currently understood as a final common phenotypical pathway resulting from an indefinite number of genetic variations, possibly involving the same information processing pathways, and producing a variant in the way humans perceive, memorize, manipulate, and attribute emotional value to available information. Findings plausibly converge on more optional, rather than typically mandatory, hierarchies of information processing as fundamental to autism. Adaptation of education and employment according to individual strengths and needs, as well as attention to co-occurring conditions as necessary, remains today the best way to assist autistic individuals.
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43
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Spilioti M, Evangeliou AE, Tramma D, Theodoridou Z, Metaxas S, Michailidi E, Bonti E, Frysira H, Haidopoulou A, Asprangathou D, Tsalkidis AJ, Kardaras P, Wevers RA, Jakobs C, Gibson KM. Evidence for treatable inborn errors of metabolism in a cohort of 187 Greek patients with autism spectrum disorder (ASD). Front Hum Neurosci 2013; 7:858. [PMID: 24399946 PMCID: PMC3871708 DOI: 10.3389/fnhum.2013.00858] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 11/25/2013] [Indexed: 12/27/2022] Open
Abstract
We screened for the presence of inborn errors of metabolism (IEM) in 187 children (105 males; 82 females, ages 4–14 years old) who presented with confirmed features of autism spectrum disorder (ASD). Twelve patients (7%) manifested increased 3-hydroxyisovaleric acid (3-OH-IVA) excretion in urine, and minor to significant improvement in autistic features was observed in seven patients following supplementation with biotin. Five diagnoses included: Lesch Nyhan syndrome (2), succinic semialdehyde dehydrogenase (SSADH) deficiency (2), and phenylketonuria (1) (2.7%). Additional metabolic disturbances suggestive of IEMs included two patients whose increased urine 3-OH-IVA was accompanied by elevated methylcitrate and lactate in sera, and 30 patients that showed abnormal glucose-loading tests. In the latter group, 16/30 patients manifested increased sera beta hydroxybutyrate (b-OH-b) production and 18/30 had a paradoxical increase of sera lactate. Six patients with elevated b-OH-b in sera showed improved autistic features following implementation of a ketogenic diet (KD). Five patients showed decreased serum ketone body production with glucose loading. Twelve of 187 patients demonstrated non-specific MRI pathology, while 25/187 had abnormal electroencephalogram (EEG) findings. Finally, family history was positive for 22/187 patients (1st or 2nd degree relative with comparable symptomatology) and consanguinity was documented for 12/187 patients. Our data provide evidence for a new biomarker (3-OH-IVA) and novel treatment approaches in ASD patients. Concise 1 sentence take-home message: Detailed metabolic screening in a Greek cohort of ASD patients revealed biomarkers (urine 3-hydroxyisovaleric acid and serum b-OH-b) in 7% (13/187) of patients for whom biotin supplementation or institution of a KD resulted in mild to significant clinical improvement in autistic features.
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Affiliation(s)
- Martha Spilioti
- First Department of Neurology, AHEPA Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Athanasios E Evangeliou
- Fourth Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Despoina Tramma
- Fourth Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Zoe Theodoridou
- Department of Special Educational Needs, St. Luke's Hospital Thessaloniki, Greece
| | - Spyridon Metaxas
- Second ENT Department, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Eleni Michailidi
- Department of Pediatrics, Medical School, University of Crete Heraklion, Greece
| | - Eleni Bonti
- Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Helen Frysira
- Department of Pediatrics, Athens University Medical School, Agia Sophia Children's Hospital Athens, Greece
| | - A Haidopoulou
- Fourth Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Despoina Asprangathou
- Fourth Department of Pediatrics, Papageorgiou Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Aggelos J Tsalkidis
- Department of Pediatrics, Medical School, University of Thrace Alexandroupolis, Greece
| | - Panagiotis Kardaras
- Third Department of Pediatrics, Hippokration Hospital, Aristotle University of Thessaloniki Thessaloniki, Greece
| | - Ron A Wevers
- Laboratory of Genetic, Endocrine and Metabolic Diseases, Department of Laboratory Medicine, RUNMC Nijmegen, Netherlands
| | - Cornelis Jakobs
- Metabolic Unit, Department of Clinical Chemistry, VU University Medical Center Amsterdam, Netherlands
| | - K Michael Gibson
- Section of Clinical Pharmacology, College of Pharmacy, Washington State University Spokane, WA, USA
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Carbonetto S. A blueprint for research on Shankopathies: a view from research on autism spectrum disorder. Dev Neurobiol 2013; 74:85-112. [PMID: 24218108 DOI: 10.1002/dneu.22150] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/06/2013] [Indexed: 01/21/2023]
Abstract
Autism spectrum disorders (ASD) are associated with mutations in a host of genes including a number that function in synaptic transmission. Phelan McDermid syndrome involves mutations in SHANK3 which encodes a protein that forms a scaffold for glutamate receptors at the synapse. SHANK3 is one of the genes that underpins the synaptic hypothesis for ASD. We discuss this hypothesis with a view to the broader context of ASD and with special emphasis on highly penetrant genetic disorders including Shankopathies. We propose a blueprint for near and longer-term goals for fundamental and translational research on Shankopathies.
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Affiliation(s)
- Salvatore Carbonetto
- Centre for Research in Neuroscience, Department of Neurology, McGill University Health Centre, Montreal, Quebec, H3G1A4, Canada
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45
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Ghaziuddin M, Al-Owain M. Autism spectrum disorders and inborn errors of metabolism: an update. Pediatr Neurol 2013; 49:232-6. [PMID: 23921282 DOI: 10.1016/j.pediatrneurol.2013.05.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 05/28/2013] [Accepted: 05/31/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Autism spectrum disorder is characterized by social communicative deficits with restricted interests occurring in about 1% of the population. Although its exact cause is not known, several factors have been implicated in its etiology, including inborn errors of metabolism. Although relatively uncommon, these disorders frequently occur in countries with high rates of consanguinity and are often associated with behavioral problems, such as hyperactivity and aggression. The aim of this review is to examine the association of autism with these conditions. METHOD A computer-assisted search was performed to identify the most common inborn errors of metabolism associated with autism. RESULTS The following disorders were identified: phenylketonuria, glucose-6-phosphatase deficiency, propionic acidemia, adenosine deaminase deficiency, Smith-Lemli-Opitz syndrome and mitochondrial disorders, and the recently described branched chain ketoacid dehydrogenase kinase deficiency. CONCLUSION The risk of autistic features is increased in children with inborn errors of metabolism, especially in the presence of cognitive and behavioral deficits. We propose that affected children should be screened for autism.
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Affiliation(s)
- Mohammad Ghaziuddin
- University of Michigan, Ann Arbor, Michigan, and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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46
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Ramsey JM, Guest PC, Broek JA, Glennon JC, Rommelse N, Franke B, Rahmoune H, Buitelaar JK, Bahn S. Identification of an age-dependent biomarker signature in children and adolescents with autism spectrum disorders. Mol Autism 2013; 4:27. [PMID: 23915542 PMCID: PMC3751071 DOI: 10.1186/2040-2392-4-27] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/11/2013] [Indexed: 12/30/2022] Open
Abstract
Background Autism spectrum disorders (ASDs) are neurodevelopmental conditions with symptoms manifesting before the age of 3, generally persisting throughout life and affecting social development and communication. Here, we have investigated changes in protein biomarkers in blood during childhood and adolescent development. Methods We carried out a multiplex immunoassay profiling analysis of serum samples from 37 individuals with a diagnosis of ASD and their matched, non-affected siblings, aged between 4 and 18 years, to identify molecular pathways affected over the course of ASDs. Results This analysis revealed age-dependent differences in the levels of 12 proteins involved in inflammation, growth and hormonal signaling. Conclusions These deviations in age-related molecular trajectories provide further insight into the progression and pathophysiology of the disorder and, if replicated, may contribute to better classification of ASD individuals, as well as to improved treatment and prognosis. The results also underline the importance of stratifying and analyzing samples by age, especially in ASD and potentially other developmental disorders.
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Affiliation(s)
- Jordan M Ramsey
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QT, UK.
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47
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Abstract
Most genetic causes of neurodegenerative disorders in childhood are due to neurometabolic disease. There are over 200 disorders, including aminoacidopathies, creatine disorders, mitochondrial cytopathies, peroxisomal disorders and lysosomal storage disorders. However, diagnosis can pose a challenge to the clinician when patients present with non-specific problems like epilepsy, developmental delay, autism, dystonia and ataxia. The variety of specialist tests involved can also be daunting. This review aims to give a practical approach to the investigation and diagnosis of neurometabolic disease from the neonatal period to late childhood while prioritising disorders where there are therapeutic options. In particular, patients who have a complex clinical picture of several neurological and non-neurological features should be investigated.
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Affiliation(s)
- Germaine Pierre
- Division of Women’s and Children’s Services, Bristol Royal Hospital for Children, Level 6, UHBT, Education Centre, Upper Maudlin Street, Bristol BS2 8AE, UK.
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48
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Zafeiriou DI, Ververi A, Dafoulis V, Kalyva E, Vargiami E. Autism spectrum disorders: the quest for genetic syndromes. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:327-66. [PMID: 23650212 DOI: 10.1002/ajmg.b.32152] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 03/01/2013] [Indexed: 11/10/2022]
Abstract
Autism spectrum disorders (ASD) are a heterogeneous group of neurodevelopmental disabilities with various etiologies, but with a heritability estimate of more than 90%. Although the strong correlation between autism and genetic factors has been long established, the exact genetic background of ASD remains unclear. A number of genetic syndromes manifest ASD at higher than expected frequencies compared to the general population. These syndromes account for more than 10% of all ASD cases and include tuberous sclerosis, fragile X, Down, neurofibromatosis, Angelman, Prader-Willi, Williams, Duchenne, etc. Clinicians are increasingly required to recognize genetic disorders in individuals with ASD, in terms of providing proper care and prognosis to the patient, as well as genetic counseling to the family. Vice versa, it is equally essential to identify ASD in patients with genetic syndromes, in order to ensure correct management and appropriate educational placement. During investigation of genetic syndromes, a number of issues emerge: impact of intellectual disability in ASD diagnoses, identification of autistic subphenotypes and differences from idiopathic autism, validity of assessment tools designed for idiopathic autism, possible mechanisms for the association with ASD, etc. Findings from the study of genetic syndromes are incorporated into the ongoing research on autism etiology and pathogenesis; different syndromes converge upon common biological backgrounds (such as disrupted molecular pathways and brain circuitries), which probably account for their comorbidity with autism. This review paper critically examines the prevalence and characteristics of the main genetic syndromes, as well as the possible mechanisms for their association with ASD.
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49
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Konstantynowicz J, Porowski T, Zoch-Zwierz W, Wasilewska J, Kadziela-Olech H, Kulak W, Owens SC, Piotrowska-Jastrzebska J, Kaczmarski M. A potential pathogenic role of oxalate in autism. Eur J Paediatr Neurol 2012; 16:485-91. [PMID: 21911305 DOI: 10.1016/j.ejpn.2011.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 08/21/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although autistic spectrum disorders (ASD) are a strongly genetic condition certain metabolic disturbances may contribute to clinical features. Metabolism of oxalate in children with ASD has not yet been studied. AIM The objective was to determine oxalate levels in plasma and urine in autistic children in relation to other urinary parameters. METHOD In this cross-sectional study, plasma oxalate (using enzymatic method with oxalate oxidase) and spontaneous urinary calcium oxalate (CaOx) crystallization (based on the Bonn-Risk-Index, BRI) were determined in 36 children and adolescents with ASD (26 boys, 10 girls) aged 2-18 years and compared with 60 healthy non-autistic children matched by age, gender and anthropometric traits. RESULTS Children with ASD demonstrated 3-fold greater plasma oxalate levels [5.60 (5th-95th percentile: 3.47-7.51)] compared with reference [(1.84 (5th-95th percentile: 0.50-4.70) μmol/L (p < 0.05)] and 2.5-fold greater urinary oxalate concentrations (p < 0.05). No differences between the two groups were found in urinary pH, citraturia, calciuria or adjusted CaOx crystallization rates based on BRI. Despite significant hyperoxaluria no evidence of kidney stone disease or lithogenic risk was observed in these individuals. CONCLUSIONS Hyperoxalemia and hyperoxaluria may be involved in the pathogenesis of ASD in children. Whether this is a result of impaired renal excretion or an extensive intestinal absorption, or both, or whether Ox may cross the blood brain barrier and disturb CNS function in the autistic children remains unclear. This appears to be the first report of plasma and urinary oxalate in childhood autism.
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Affiliation(s)
- Jerzy Konstantynowicz
- Department of Pediatrics and Developmental Disorders, Medical University of Bialystok, Poland.
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50
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Dhillon S, Hellings JA, Butler MG. Genetics and mitochondrial abnormalities in autism spectrum disorders: a review. Curr Genomics 2012; 12:322-32. [PMID: 22294875 PMCID: PMC3145262 DOI: 10.2174/138920211796429745] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 02/08/2023] Open
Abstract
We review the current status of the role and function of the mitochondrial DNA (mtDNA) in the etiology of autism spectrum disorders (ASD) and the interaction of nuclear and mitochondrial genes. High lactate levels reported in about one in five children with ASD may indicate involvement of the mitochondria in energy metabolism and brain development. Mitochondrial disturbances include depletion, decreased quantity or mutations of mtDNA producing defects in biochemical reactions within the mitochondria. A subset of individuals with ASD manifests copy number variation or small DNA deletions/duplications, but fewer than 20 percent are diagnosed with a single gene condition such as fragile X syndrome. The remaining individuals with ASD have chromosomal abnormalities (e.g., 15q11-q13 duplications), other genetic or multigenic causes or epigenetic defects. Next generation DNA sequencing techniques will enable better characterization of genetic and molecular anomalies in ASD, including defects in the mitochondrial genome particularly in younger children.
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Affiliation(s)
- Sukhbir Dhillon
- Departments of Psychiatry & Behavioral Sciences and Pediatrics, Kansas University Medical Center, Kansas City, Kansas 66160, USA
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