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Almaghrabi MA, Muthaffar OY, Alahmadi SA, Abdulsbhan MA, Bamusa M, Aljezani MA, Bahowarth SY, Alyazidi AS, Aggad WS. GAMT Deficiency Among Pediatric Population: Clinical and Molecular Characteristics and Management. Child Neurol Open 2023; 10:2329048X231215630. [PMID: 38020815 PMCID: PMC10655665 DOI: 10.1177/2329048x231215630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Objective: Analyze the treatment modalities used in real practice by synthesizing available literature. Methods: We reviewed and evaluated 52 cases of GAMT deficiency including 4 novel cases from Saudi Arabia diagnosed using whole-exome sequencing. All data utilized graphical presentation in the form of line charts and illustrated graphs. Results: The mean current age of was 117 months (±29.03) (range 12-372 months). The mean age of disease onset was 28.32 months (±13.68) (range 8 days - 252 months). The most prevalent symptom was developmental delays, mainly speech and motor, seizures, and intellectual disability. The male-to-female ratio was 3:1. Multiple treatments were used, with 54 pharmacological interventions, valproic acid being the most common. Creatinine monohydrate was the prevalent dietary intervention, with 25 patients reporting an improvement. Conclusion: The study suggests that efficient treatment with appropriate dietary intervention can improve patients' health, stressing that personalized treatment programs are essential in managing this disorder.
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Affiliation(s)
- Majdah A. Almaghrabi
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Y. Muthaffar
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sereen A. Alahmadi
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mashael A. Abdulsbhan
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mashael Bamusa
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maram Ahmed Aljezani
- Division of Pediatrics Neurology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Anas S. Alyazidi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Waheeb S. Aggad
- Department of Anatomy, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
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Shen M, Yang G, Chen Z, Yang K, Dong H, Yin C, Cheng Y, Zhang C, Gu F, Yang Y, Tian Y. Identification of novel variations in SLC6A8 and GAMT genes causing cerebral creatine deficiency syndrome. Clin Chim Acta 2022; 532:29-36. [PMID: 35588794 DOI: 10.1016/j.cca.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 04/24/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
Cerebral creatine deficiency syndromes (CCDSs) are a group of rare mendelian disorders mainly characterized by intellectual disability, movement anomaly, behavior disorder and seizures. SLC6A8, GAMT, and GATM are known genes responsible for CCDS. In this study, seven pediatric patients with developmental delay were recruited and submitted to a series of clinical evaluation, laboratory testing, and genetic analysis. The clinical manifestations and core biochemical indications of each child were basically consistent with the diagnosis of CCDS. Genetic diagnosis determined that all patients were positive for SLC6A8 or GAMT variation. A total of 12 variants were identified in this cohort, including six novel ones. The frequency of these variants, the Revel scores and the conservatism of the affected amino acids support their pathogenicity. Our findings expanded the mutation spectrum of CCDS disorders, and provided solid evidence for the counseling to affected families.
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Affiliation(s)
- Ming Shen
- Research Center for Translational Medicine Laboratory, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Guangming Yang
- Research Center for Translational Medicine Laboratory, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Zhehui Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Kai Yang
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Hui Dong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Chengliang Yin
- Medical Big Data Research Center, Medical Innovation Research Division of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yuxuan Cheng
- Birth Defects Prevention and Control Technology Research Center, Medical Research and Innovation Department, Chinese PLA General Hospital, Beijing, China
| | - Chunyan Zhang
- Birth Defects Prevention and Control Technology Research Center, Medical Research and Innovation Department, Chinese PLA General Hospital, Beijing, China
| | - Fangyan Gu
- Clinical Biobank Center, Medical Innovation Research Division of Chinese PLA General Hospital, Beijing, China
| | - Yanling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yaping Tian
- Birth Defects Prevention and Control Technology Research Center, Medical Research and Innovation Department, Chinese PLA General Hospital, Beijing, China
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Intellectual Disability and Brain Creatine Deficit: Phenotyping of the Genetic Mouse Model for GAMT Deficiency. Genes (Basel) 2021; 12:genes12081201. [PMID: 34440375 PMCID: PMC8391262 DOI: 10.3390/genes12081201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/23/2021] [Accepted: 07/25/2021] [Indexed: 11/17/2022] Open
Abstract
Guanidinoacetate methyltransferase deficiency (GAMT-D) is one of three cerebral creatine (Cr) deficiency syndromes due to pathogenic variants in the GAMT gene (19p13.3). GAMT-D is characterized by the accumulation of guanidinoacetic acid (GAA) and the depletion of Cr, which result in severe global developmental delay (and intellectual disability), movement disorder, and epilepsy. The GAMT knockout (KO) mouse model presents biochemical alterations in bodily fluids, the brain, and muscles, including increased GAA and decreased Cr and creatinine (Crn) levels, which are similar to those observed in humans. At the behavioral level, only limited and mild alterations have been reported, with a large part of analyzed behaviors being unaffected in GAMT KO as compared with wild-type mice. At the cerebral level, decreased Cr and Crn and increased GAA and other guanidine compound levels have been observed. Nevertheless, the effects of Cr deficiency and GAA accumulation on many neurochemical, morphological, and molecular processes have not yet been explored. In this review, we summarize data regarding behavioral and cerebral GAMT KO phenotypes, and focus on uncharted behavioral alterations that are comparable with the clinical symptoms reported in GAMT-D patients, including intellectual disability, poor speech, and autistic-like behaviors, as well as unexplored Cr-induced cerebral alterations.
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Rostami P, Hosseinpour S, Ashrafi MR, Alizadeh H, Garshasbi M, Tavasoli AR. Primary creatine deficiency syndrome as a potential missed diagnosis in children with psychomotor delay and seizure: case presentation with two novel variants and literature review. Acta Neurol Belg 2020; 120:511-516. [PMID: 31222513 DOI: 10.1007/s13760-019-01168-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022]
Abstract
Creatine is the main source of energy for the brain. Primary creatine deficiency syndromes (PCDSs) are inborn error of metabolism of creatine synthesis. Symptoms of central nervous system involvement are the most common clinical manifestations in these disorders. We reviewed medical records of all genetically confirmed patients diagnosed by whole exome sequencing who were referred to Myelin and Neurodegenerative Disorders Clinic, Children's Medical Center, Tehran, Iran, from May 2016 to Dec 2018. A literature review was conducted on clinical and genomic variability of PCDS to compare our patients with previously reported cases. We report two patients with creatine deficiency among a cohort of 550 registered cases out of which 200 patients had a genetically confirmed neurodegenerative disorder diagnosis. The main complain in the first patient with creatine transporter (CRTR) deficiency was seizure and genetic study in this patient identified a novel hemizygote variant of "c.92 > T; p.Pro31Leu" in the first exon of SLC6A8 gene. The second patient with guanidinoacetate methyltransferase (GAMT) deficiency had an unknown motor and speech delay as the striking manifestation and molecular assay revealed a novel homozygote variant of "c.134G > A; p.Trp45*" in the first exon of GAMT gene. PCDSs usually are associated with nonspecific neurologic symptoms. The first presented case had a mean delayed diagnosis of 5 years. Therefore, in children with unexplained neurologic features including developmental delay and/or regression, mental disability and repeated seizures without any significant findings in metabolic studies, PCDSs can be considered as a differential diagnosis and molecular analysis can be helpful for the precise diagnosis and treatment.
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Affiliation(s)
- Parastoo Rostami
- Division of Pediatric Endocrinology and Metabolism, Growth and Development Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Hosseinpour
- Myelin Disorders Clinic (Iranian Neurometabolic Registry), Pediatric Neurology Division, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Ashrafi
- Myelin Disorders Clinic (Iranian Neurometabolic Registry), Pediatric Neurology Division, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Houman Alizadeh
- Division of Pediatric Radiology, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Garshasbi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Teheran, Iran.
| | - Ali Reza Tavasoli
- Myelin Disorders Clinic (Iranian Neurometabolic Registry), Pediatric Neurology Division, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Sun WH, Zhuang DY, Wang Y, Xiao FF, Wu MY, Dong XR, Zhang P, Wang HJ, Zhou WH, Wu BB. [Clinical features and SLC6A8 gene mutations of cerebral creatine deficiency syndrome I: an analysis of two families]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:482-487. [PMID: 32434645 PMCID: PMC7389393 DOI: 10.7499/j.issn.1008-8830.2002012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
This article reports the clinical and genetic features of two cases of cerebral creatine deficiency syndrome I (CCDSI) caused by SLC6A8 gene mutations. Both children were boys. Boy 1 (aged 2 years and 10 months) and Boy 2 (aged 8 years and 11 months) had the clinical manifestations of delayed mental and motor development, and convulsion. Their older brothers had the same symptoms. The mother of the boy 1 had mild intellectual disability. The genetic analysis showed two novel homozygous mutations, c.200G>A(p.Gly67Asp) and c.626_627delCT(p.Pro209Argfs*87), in the SLC6A8 gene on the X chromosome, both of which came from their mothers. These two novel mutations were rated as possible pathogenic mutations and were not reported in the literature before. This study expands the mutation spectrum of the SLC6A8 gene and has great significance in the diagnosis of boys with delayed development, and epilepsy.
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Affiliation(s)
- Wei-Hua Sun
- Pediatric Research Institute, Children's Hospital, Fudan University, Shanghai 201102, China.
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