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Liu N, Sun Q. Laboratory Diagnosis of Cerebral Creatine Deficiency Syndromes by Determining Creatine and Guanidinoacetate in Plasma and Urine. Methods Mol Biol 2022; 2546:129-140. [PMID: 36127584 DOI: 10.1007/978-1-0716-2565-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cerebral creatine deficiency syndromes are caused by the dysfunctional creatine biosynthesis or transport and comprise three hereditary neurodevelopmental defects including arginine-glycine amidinotransferase (AGAT), guanidinoacetate methyltransferase (GAMT), and creatine transporter deficiencies. All conditions are characterized by seizures, intellectual disability, and behavioral abnormalities. Laboratory diagnosis of these disorders relies on the determination of creatine and guanidinoacetate concentrations in both plasma and urine. Here we describe a rapid quantitative UPLC/MS/MS method for the simultaneous determination of these analytes using a normal-phase HILIC column after analyte derivatization. The approach is suitable for neonatal screening follow-ups and monitoring of the treatment for creatine deficiency syndromes.
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Affiliation(s)
- Ning Liu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
- Baylor Genetics, Houston, TX, USA
| | - Qin Sun
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA.
- Baylor Genetics, Houston, TX, USA.
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Baharom S, De Matteo R, Ellery S, Della Gatta P, Bruce CR, Kowalski GM, Hale N, Dickinson H, Harding R, Walker D, Snow RJ. Does maternal-fetal transfer of creatine occur in pregnant sheep? Am J Physiol Endocrinol Metab 2017; 313:E75-E83. [PMID: 28325734 DOI: 10.1152/ajpendo.00450.2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 01/03/2023]
Abstract
Our aim was to determine the disposition of creatine in ovine pregnancy and whether creatine is transferred across the placenta from mother to fetus. Pregnant ewes received either 1) a continuous intravenous infusion of creatine monohydrate or saline from 122 to 131 days gestation, with maternal and fetal arterial blood and amniotic fluid samples collected daily for creatine analysis and fetal tissues collected at necropsy at 133 days for analysis of creatine content, or 2) a single systemic bolus injection of [13C]creatine monohydrate at 130 days of gestation, with maternal and fetal arterial blood, uterine vein blood, and amniotic fluid samples collected before and for 4 h after injection and analyzed for creatine, creatine isotopic enrichment, and guanidinoacetic acid (GAA; precursor of creatine) concentrations. Presence of the creatine transporter-1 (SLC6A8) and l-arginine:glycine amidinotransferase (AGAT; the enzyme synthesizing GAA) proteins were determined by Western blots of placental cotyledons. The 10-day creatine infusion increased maternal plasma creatine concentration three- to fourfold (P < 0.05) without significantly changing fetal arterial, amniotic fluid, fetal tissues, or placental creatine content. Maternal arterial 13C enrichment was increased (P < 0.05) after bolus [13C]creatine injection without change of fetal arterial 13C enrichment. SLC6A8 and AGAT proteins were identified in placental cotyledons, and GAA concentration was significantly higher in uterine vein than maternal artery plasma. Despite the presence of SLC6A8 protein in cotyledons, these results suggest that creatine is not transferred from mother to fetus in near-term sheep and that the ovine utero-placental unit releases GAA into the maternal circulation.
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Affiliation(s)
- Syed Baharom
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia
- Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Robert De Matteo
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia
| | - Stacey Ellery
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
| | - Paul Della Gatta
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Clinton R Bruce
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Greg M Kowalski
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Nadia Hale
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
| | - Hayley Dickinson
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
| | - Richard Harding
- Department of Anatomy and Developmental Biology, Monash University, Melbourne, Australia
| | - David Walker
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia; and
| | - Rodney J Snow
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia;
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Marques EP, Wyse ATS. Guanidinoacetate Methyltransferase Deficiency. JOURNAL OF INBORN ERRORS OF METABOLISM AND SCREENING 2016. [DOI: 10.1177/2326409816669371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Eduardo P. Marques
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angela T. S. Wyse
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Joncquel-Chevalier Curt M, Voicu PM, Fontaine M, Dessein AF, Porchet N, Mention-Mulliez K, Dobbelaere D, Soto-Ares G, Cheillan D, Vamecq J. Creatine biosynthesis and transport in health and disease. Biochimie 2015; 119:146-65. [DOI: 10.1016/j.biochi.2015.10.022] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/27/2015] [Indexed: 12/31/2022]
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Akiyama T, Osaka H, Shimbo H, Nakajiri T, Kobayashi K, Oka M, Endoh F, Yoshinaga H. A Japanese adult case of guanidinoacetate methyltransferase deficiency. JIMD Rep 2013; 12:65-9. [PMID: 23846910 DOI: 10.1007/8904_2013_245] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/12/2013] [Accepted: 05/26/2013] [Indexed: 01/13/2023] Open
Abstract
Guanidinoacetate methyltransferase (GAMT) deficiency is a rare disorder of creatine synthesis resulting in cerebral creatine depletion. We present a 38-year-old patient, the first Japanese case of GAMT deficiency. Developmental delay started after a few months of age with a marked delay in language, which resulted in severe intellectual deficit. She showed hyperactivity and trichotillomania from childhood. Epileptic seizures appeared at 18 months and she had multiple types of seizures including epileptic spasms, brief tonic seizures, atypical absences, complex partial seizures with secondary generalization, and "drop" seizures. They have been refractory to multiple antiepileptic drugs. Although there have been no involuntary movements, magnetic resonance imaging revealed T2 hyperintense lesions in bilateral globus pallidi. Motor regression started around 30 years of age and the patient is now able to walk for only short periods. Very low serum creatinine levels measured by enzymatic method raised a suspicion of GAMT deficiency, which was confirmed by proton magnetic resonance spectroscopy and urinary guanidinoacetate assay. GAMT gene analysis revealed that the patient is a compound heterozygote of c.578A>G, p.Gln193Arg and splice site mutation, c.391G>C, p.Gly131Arg, neither of which have been reported in the literature. We also identified two aberrant splice products from the patient's cDNA analysis. The patient was recently started on supplementation of high-dose creatine and ornithine, the effects of which are currently under evaluation. Although rare, patients with developmental delay, epilepsy, behavioral problems, and movement disorders should be vigorously screened for GAMT deficiency, as it is a treatable disorder.
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Affiliation(s)
- Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan,
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Imbard A, Blom HJ, Schlemmer D, Barto R, Czerkiewicz I, Rigal O, Muller F, Benoist JF. Methylation metabolites in amniotic fluid depend on gestational age. Prenat Diagn 2013; 33:848-55. [PMID: 23613283 DOI: 10.1002/pd.4142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Methylation metabolism is essential for fetus development. However, normative data for amniotic fluid (AF) concentrations of methylation metabolites at different gestational ages are lacking. We aimed to determine in AF reference values of 14 intermediates involved in methylation. METHODS Two hundred sixty-eight AFs sampled between 14 and 39 weeks of gestation were retrospectively selected in our AF bank. Next, we measured methionine (Met)-cycle intermediates [S-adenosyl Met (AdoMet), S-adenosyl-l-homocysteine (AdoHcy), total Hcy, Met, and methyl malonic acid] and methyl donors and methyl acceptors (betaine, dimethylglycine, sarcosine, free and total choline, free and total ethanolamine, creatine, and guanidinoacetate) by liquid chromatography coupled with tandem mass spectrometry. RESULTS Reference ranges according to gestational age were determined for each parameter. Strong correlations between metabolites directly connected in their metabolic pathway and between total Hcy and betaine were observed. CONCLUSION Methionine, an essential amino acid required for protein synthesis, is the only parameter that dramatically decreases with gestational age. The AdoMet/AdoHcy ratio exponentially increases from 25 weeks of gestation, which could reflect increasing methylation capacities. The negative correlation between betaine and total Hcy together with a constant betaine to dimethylglycine ratio during gestation suggests that betaine may be used as a methyl donor during fetal life.
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Affiliation(s)
- Apolline Imbard
- Biochemistry Hormonology Laboratory, AP-HP Hôpital Robert Debré, Paris, France.
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Diagnosis of creatine metabolism disorders by determining creatine and guanidinoacetate in plasma and urine. Methods Mol Biol 2010; 603:175-85. [PMID: 20077070 DOI: 10.1007/978-1-60761-459-3_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Creatine metabolism disorders include a creatine transporter deficiency, as well as, deficiencies of two enzymes involved in creatine synthesis, arginine-glycine amidinotransferase (AGAT) and guanidinoacetate methyltransferase (GAMT). Laboratory diagnosis of these disorders relies on the determination of creatine and guanidinoacetate in both plasma and urine. Here we describe a rapid HPLC/MS/MS method for these measurements using a normal phase HILIC column after analyte derivatization.
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Deficiencia cerebral de creatina: primeros pacientes españoles con mutaciones en el gen GAMT. Med Clin (Barc) 2009; 133:745-9. [DOI: 10.1016/j.medcli.2009.06.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 06/25/2009] [Indexed: 11/24/2022]
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Carling RS, Hogg SL, Wood TC, Calvin J. Simultaneous determination of guanidinoacetate, creatine and creatinine in urine and plasma by un-derivatized liquid chromatography-tandem mass spectrometry. Ann Clin Biochem 2008; 45:575-84. [DOI: 10.1258/acb.2008.008029] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Creatine plays an important role in the storage and transmission of phosphate-bound energy. The cerebral creatine deficiency syndromes (CCDS) comprise three inherited defects in creatine biosynthesis and transport. They are characterized by mental retardation, speech and language delay and epilepsy. All three disorders cause low-creatine signal on brain magnetic resonance spectroscopy (MRS); however, MRS may not be readily available and even when it is, biochemical tests are required to determine the underlying disorder. Methods Analysis was performed by liquid chromatography-tandem mass spectrometry in positive ionization mode. Samples were analysed underivatized using a rapid ‘dilute and shoot’ approach. Chromatographic separation of the three compounds was achieved. Stable isotope internal standards were used for quantification. Results Creatine, creatinine and guanidinoacetate were measured with a 2.5 minute run time. For guanidinoacetate, the standard curve was linear to at least 5000 μmol/L and for creatine and creatinine it was linear to at least 25 mmol/L. The lower limit of quantitation was 0.4 μmol/L for creatine and guanidinoacetate and 0.8 μmol/L for creatinine. Recoveries ranged from 86% to 106% for the three analytes. Intra- and inter-assay variation for each analyte was <10% in both urine and plasma. Conclusion A tandem mass spectrometric method has been developed and validated for the underivatized determination of guanidinoacetate, creatine and creatinine in human urine and plasma. Minimal sample preparation coupled with a rapid run time make the method applicable to the routine screening of patients with suspected CCDS.
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Affiliation(s)
- R S Carling
- Biochemical Genetics Unit, Box 247, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - S L Hogg
- Biochemical Genetics Unit, Box 247, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - T C Wood
- Biochemical Genetics Laboratory, Greenwood Genetic Center, 125 Gregor Mendel Circle, Greenwood SC 29646, USA
| | - J Calvin
- Biochemical Genetics Unit, Box 247, Addenbrookes Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Almeida LS, Vilarinho L, Darmin PS, Rosenberg EH, Martinez-Muñoz C, Jakobs C, Salomons GS. A prevalent pathogenic GAMT mutation (c.59G>C) in Portugal. Mol Genet Metab 2007; 91:1-6. [PMID: 17336114 DOI: 10.1016/j.ymgme.2007.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2006] [Revised: 01/09/2007] [Accepted: 01/10/2007] [Indexed: 11/17/2022]
Abstract
Guanidinoacetate methyltransferase (GAMT) deficiency (MIM 601240), an autosomal recessive disorder of creatine biosynthesis, presents with mental retardation, extrapyramidal symptoms, autistic-like behavior and epilepsy. Other hallmarks are cerebral creatine deficiency, increased levels of guanidinoacetate in body fluids and mutations in the GAMT gene. Creatine supplementation partially restores cerebral creatine content. Worldwide, 29 patients have been identified and 15 different mutations have been reported in the GAMT gene. Ten out of these 29 patients are of Portuguese origin. Likely, a founder effect and a high carrier rate in Portugal exist, since in 17 out of the 20 Portuguese alleles the c.59G>C; p.Trp20Ser mutation was found. We investigated the carrier rate of the c.59G>C; p.Trp20Ser mutation in different regions of Portugal and confirmed the pathogenic nature of this missense mutation by transient transfections. Anonymous bloodspots (1002) were screened for the presence of the c.59G>C; p.Trp20Ser mutation by SNaPshot (Single Nucleotide Polymorphism Multiplex Kit). Eight carriers of c.59G>C; p.Trp20Ser were detected of which four are derived from the Archipelagos. This suggests that the carrier rate of the c.59G>C; p.Trp20Ser mutation is relatively high in these islands, as well as in other parts of Portugal. It also implies that newborn screening in these regions is warranted for this treatable disorder.
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Affiliation(s)
- L S Almeida
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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Almeida LS, Rosenberg EH, Martinez-Muñoz C, Verhoeven NM, Vilarinho L, Jakobs C, Salomons GS. Overexpression of GAMT restores GAMT activity in primary GAMT-deficient fibroblasts. Mol Genet Metab 2006; 89:392-4. [PMID: 16899382 DOI: 10.1016/j.ymgme.2006.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 06/15/2006] [Accepted: 06/15/2006] [Indexed: 10/24/2022]
Abstract
Guanidinoacetate methyltransferase deficiency (MIM 601240) is an autosomal recessive disorder of creatine biosynthesis. Patients present with mental retardation, extrapyramidal symptoms, autistic-like behavior, epilepsy, cerebral creatine deficiency and increased levels of guanidinoacetate. So far 15 mutations have been reported, including six missense variants that are highly likely to be pathogenic mutations. To prove that mutations in the GAMT gene are responsible for GAMT deficiency we overexpressed the GAMT open reading frame in GAMT-deficient fibroblasts by stable transfection. In addition, HeLa cells were transiently transfected with the same expression vector. In contrast to mock transfectants transfection of primary GAMT-deficient fibroblasts with wild-type GAMT results in the restoration of GAMT activity as measured by GC-MS using stable isotope labeled substrates. Moreover, the expression of the GAMT-EGFP fusion protein was analyzed by Western blot, confirming the presence of GAMT fusion protein, both in the stable as well as in the transient transfectants. Here, we prove that mutations in the GAMT gene are responsible for GAMT deficiency, since overexpression of the GAMT open reading frame restores GAMT activity in GAMT-deficient fibroblasts. Furthermore, the transient transfection of HeLa cells will be important for functional analysis of variants of unknown consequence (i.e., missense mutations).
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Affiliation(s)
- L S Almeida
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam, The Netherlands
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Almeida LS, Rosenberg EH, Verhoeven NM, Jakobs C, Salomons GS. Are cerebral creatine deficiency syndromes on the radar screen? FUTURE NEUROLOGY 2006. [DOI: 10.2217/14796708.1.5.637] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Cerebral creatine deficiency syndromes (CCDS) are responsible for a considerable proportion of the population affected with mental retardation. CCDS are caused by either an inborn error of the proteins involved in creatine biosynthesis or in the creatine transporter. Besides mental retardation, the clinical characteristics of CCDS are speech and language delay, epilepsy and features of autism. CCDS can be diagnosed by proton magnetic resonance spectroscopy of the brain and/or by biochemical and molecular analysis. Treatment of the defects in creatine biosynthesis has yielded favorable outcomes, while treatments for creatine transporter deficiency are still under investigation at this time. The relatively large contribution of the CCDS to the monogenic causes of mental retardation emphasizes the importance of including CCDS in the differential diagnosis of mental retardation of unknown etiology. Pathophysiology is not yet unravelled, although it is known that creatine plays an important role in energy storage and transmission. Moreover, in vitro data indicate that creatine acts as a neuromodulator in the brain.
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Affiliation(s)
- Lígia S Almeida
- VU University Medical Center, Department of Clinical Chemistry, Metabolic Unit, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Efraim H Rosenberg
- VU University Medical Center, Department of Clinical Chemistry, Metabolic Unit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Nanda M Verhoeven
- VU University Medical Center, Department of Clinical Chemistry, Metabolic Unit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Cornelis Jakobs
- VU University Medical Center, Department of Clinical Chemistry, Metabolic Unit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Gajja S Salomons
- VU University Medical Center, Department of Clinical Chemistry, Metabolic Unit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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