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Published on: February 8, 2019
Folate receptor alpha autoantibodies in children with autism spectrum disorder
Phichaya Phunsawat1, Wararat Chiangjong1, Somchai Chutipongtanate1
1Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Autoantibodies blocking folate transport are present in a third of children with autism. This folate receptor alpha autoantibody (FRAA) status is linked to reduced adaptive functioning in these children.
Area of Science:
- Neuroscience
- Immunology
- Developmental Pediatrics
Background:
- Autism spectrum disorder (ASD) is increasingly linked to autoimmune factors.
- Folate receptor alpha autoantibodies (FRAA) can impede folate transport across the blood-brain barrier, potentially causing cerebral folate deficiency syndrome.
Purpose of the Study:
- To determine the prevalence of FRAA in Thai children diagnosed with autism.
- To assess the relationship between FRAA positivity and the severity of autism symptoms and adaptive functioning.
Main Methods:
- Serum samples from 89 children (ages 2-15) with autism were tested for FRAA.
- Clinical symptom severity was assessed using the Childhood Autism Rating Scale-Second Edition (CARS-2).
- Adaptive functioning was evaluated using the Vineland Adaptive Behavior Scales (VABS).
Main Results:
- 33.7% of children with autism tested positive for FRAA.
- FRAA-positive children exhibited significantly lower VABS scores for overall adaptive behavior and communication compared to FRAA-negative children.
- No significant association was found between FRAA levels and autism symptom severity as measured by CARS-2 scores.
Conclusions:
- Folate receptor alpha autoantibodies are present in a notable percentage of children with autism.
- FRAA positivity in children with autism correlates with impaired adaptive functioning, particularly in communication skills.
Background:
Recent research indicates that a number of children with autism generate folate receptor alpha autoantibodies (FRAA), which block transportation of folate across the blood-brain barrier, resulting in cerebral folate deficiency syndrome. Plasma FRAA detection permits precision diagnosis and potentially beneficial folinic acid treatment in FRAA-positive children with autism.
Objectives:
To investigate FRAA prevalence in Thai children with autism and evaluate the associations between FRAA-positive status, clinical symptom severity, and adaptive functioning.
Methods:
FRAA level was determined in serum samples from 89 children with autism between 2 and 15 years (69 males, 20 females, mean age 7.9 years, SD 3.8). The Childhood Autism Rating Scale-Second Edition (CARS-2) and the Vineland Adaptive Behavior Scales (VABS) were used to evaluate clinical symptom severity and adaptive functioning, respectively.
Results:
Of 89 children, 30 (33.7%) were FRAA-positive. FRAA-positive children with autism had significantly poorer mean VABS Adaptive Behavior Composite scores (p = 0.02) and Communication scores (p = 0.02) than FRAA-negative children with autism. There was no association between FRAA level and clinical symptom severity (CARS-2 score) (p = 0.09).
Conclusions:
The findings demonstrate the presence of FRAA in children with autism and that FRAA status is associated with poorer adaptive functioning.
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