Fifteen-year follow-up of Italian families affected by arginine glycine amidinotransferase deficiency.
Arginine:glycine amidinotransferase deficiency (AGAT-d) is a very rare inborn error of creatine synthesis mainly characterized by absence of brain Creatine (Cr) peak, intellectual disability, severe language impairment and behavioural disorder and susceptible to supplementary Cr treatment per os. Serial examinations by magnetic resonance spectroscopy are required to evaluate Cr recovery in brain during treatment of high doses of Cr per os, which have been proved beneficial and effective in treating main clinical symptoms. A long term study with detailed reports on clinical, neurochemical and neuropsychological outcomes of the first Italian patients affected by AGAT-d here reported can represent a landmark in management of this disorder thus enhancing medical knowledge and clinical practice.



We have evaluated the long term effects of Cr supplementation management in four Italian patients affected by AGAT-d, correlating specific treatments with serial clinical, biochemical and magnetic resonance spectroscopy examinations as well as the neuropsychological outcome by standardized developmental scales. Consecutive MRS examinations have confirmed that Cr depletion in AGAT-d patients is reversible under Cr supplementation. Cr treatment is considered safe and well tolerated but side effects, including weight gain and kidney stones, have been reported.



Early treatment prevents adverse developmental outcome, while patients diagnosed and treated at an older age showed partial but significant cognitive recovery with clear improvements in adaptive functioning.
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128, Pisa, Italy. rbattini@fsm.unipi.it.
Roberta
R
Battini
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128, Pisa, Italy.
M Grazia
MG
Alessandrì
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128, Pisa, Italy.
Claudia
C
Casalini
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128, Pisa, Italy.
Manuela
M
Casarano
Department of Developmental Neuroscience, MRI Laboratory, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy.
Michela
M
Tosetti
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56128, Pisa, Italy.|Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Giovanni
G
Cioni
D000293:Adolescent; D000579:Amidinotransferases / Q000172:deficiency*; D000592:Amino Acid Metabolism, Inborn Errors / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D003401:Creatine / Q000008:administration & dosage / Q000627:therapeutic use*; D002658:Developmental Disabilities / Q000188:drug therapy; D019587:Dietary Supplements; D004334:Drug Administration Schedule; D005190:Family; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008607:Intellectual Disability / Q000188:drug therapy*; D007558:Italy; D008297:Male; D013064:Speech Disorders / Q000188:drug therapy*; D055815:Young Adult
D000579:Amidinotransferases; D003401:Creatine
AGAT deficiency; Creatine supplementation; Creatine synthesis defect; Longterm outcome; Magnetic resonance spectroscopy