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Prevalence of Creatine Deficiency Syndromes in Children With Nonsyndromic Autism
Andreas Schulze1, Margaret Bauman2, Anne Chun-Hui Tsai3
1Genetics 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; andreas.schulze@sickkids.ca.
Insights
This study found a very low prevalence of creatine deficiency syndromes (CDS) in children with autism spectrum disorder (ASD). Creatine metabolites in urine did not significantly differ between children with ASD and healthy controls.
Area of Science:
- Neurobiology
- Metabolic Disorders
- Developmental Pediatrics
Background:
- Creatine deficiency syndromes (CDS) are potentially treatable conditions that may influence autism neurobiology.
- Investigating the prevalence of CDS in children with autism spectrum disorder (ASD) is crucial for understanding potential therapeutic targets.
Purpose of the Study:
- To determine the prevalence of creatine deficiency syndromes (CDS) in a cohort of children diagnosed with autism spectrum disorder (ASD).
Main Methods:
- A prospective multicenter study involving 443 children with ASD.
- Urine and plasma creatine metabolite analysis using liquid chromatography-tandem mass spectrometry and high-performance liquid chromatography.
- Genetic testing for GAMT, GATM, and SLC6A8 genes and in vivo brain proton magnetic resonance spectroscopy.
Main Results:
- Zero cases of CDS were identified in 443 children with ASD, yielding a prevalence of <7 in 1000 (95% confidence interval: 0-0.0068).
- No significant differences in urinary creatine metabolites were observed between the ASD group and 128 healthy controls.
Conclusions:
- The prevalence of CDS in children with non-syndromic ASD is very low.
- No clear association was found between creatine metabolites and autism in this study population.
- Higher prevalence of CDS may be expected in children with ASD exhibiting severe developmental delay, seizures, or movement disorders.
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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