Neuroradiological signs of encephalopathy in children with autism spectrum disorders associated with genetic deficiency of the folate cycle
Keywords:
immunodiagnostics, immunotherapy, neuropsychiatric disorders, children, diagnostics, therapySynopsis
One of the important advances in psychiatry and neurology in recent years is the elucidation of the association between genetic deficiency of the folate cycle (GDFC) and autism spectrum disorders (ASD) in children. The evidence for such an association is based on the results of at least five meta-analyses of randomized controlled clinical trials and a number of additional randomized controlled trials, the results of which are still not systematized. It has been shown that GDFC leads to the development of a number of typical biochemical disorders, which cause a state of a special form of immunodeficiency and associated persistent oxidative stress, systemic inflammation, including hyperproduction of tumor necrosis factor alpha (TNF-alpha) and other pro-inflammatory cytokines with neurotoxic effects, opportunistic neurotropic infections, including those caused by herpes viruses 6 (HHV-6) and 7 types (HHV-7), and anti-brain autoimmune reactions to neuronal autoantigens and myelin. It seems obvious that these three currently known immune-dependent mechanisms of cerebral damage are important in the development of encephalopathy in GDFC, one of the clinical manifestations of which is ASD, but the general concept of the pathogenesis of the disease is still not properly formulated. Since most of the studied pathways of CNS damage in GDFC are immune-mediated, they suggest a specific violation of the neuroimmune interface as a model for forming encephalopathy in such cases, which can be used in planning and conducting further clinical studies in the outlined direction.
References
Mal’tsev, D. V. (2018). Rasshirennyi kliniko-laboratornyi fenotip pri geneticheski determinirovannom narushenii folatnogo tsikla u detei s rasstroistvami spektra autizma. Mizhnarodnyi Nevrologichnyi Zhurnal, 5 (99). Available at: http://www.mif-ua.com/archive/article/46599
Cabanlit, M., Wills, S., Goines, P., Ashwood, P., Van de Water, J. (2007). Brain‐Specific Autoantibodies in the Plasma of Subjects with Autistic Spectrum Disorder. Annals of the New York Academy of Sciences, 1107 (1), 92–103. https://doi.org/10.1196/annals.1381.010
Campbell, A., Hogestyn, J. M., Folts, C. J., Lopez, B., Pröschel, C., Mock, D., Mayer-Pröschel, M. (2017). Expression of the Human Herpesvirus 6A Latency-Associated Transcript U94A Disrupts Human Oligodendrocyte Progenitor Migration. Scientific Reports, 7 (1). https://doi.org/10.1038/s41598-017-04432-y
Chen, L., Shi, X.-J., Liu, H., Mao, X., Gui, L.-N., Wang, H., Cheng, Y. (2021). Oxidative stress marker aberrations in children with autism spectrum disorder: a systematic review and meta-analysis of 87 studies (N = 9109). Translational Psychiatry, 11 (1). https://doi.org/10.1038/s41398-020-01135-3
DeLong, G. R., Bean, S. C., Brown, F. R. (1981). Acquired Reversible Autistic Syndrome in Acute Encephalopathic Illness in Children. Archives of Neurology, 38 (3), 191–194. https://doi.org/10.1001/archneur.1981.00510030085013
Dop, D., Marcu, I., Padureanu, R., Niculescu, C., Padureanu, V. (2020). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (Review). Experimental and Therapeutic Medicine, 21 (1). https://doi.org/10.3892/etm.2020.9526
Ghaziuddin, M., Tsai, L. Y., Eilers, L., Ghaziuddin, N. (1992). Brief report: Autism and herpes simplex encephalitis. Journal of Autism and Developmental Disorders, 22 (1), 107–113. https://doi.org/10.1007/bf01046406
Gillberg, I. C. (1991). Autistic Syndrome with Onset at Age 31 Years: Herpes Encephalitis as a Possible Model for Childhood Autism. Developmental Medicine & Child Neurology, 33 (10), 920–924. https://doi.org/10.1111/j.1469-8749.1991.tb14804.x
González Toro, M. C., Jadraque Rodríguez, R., Sempere Pérez, Á., Martínez Pastor, P., Jover Cerdá, J., Gómez Gosálvez, F. A. (2013). Encefalitis antirreceptor de NMDA: dos casos pediátricos. Revista de Neurología, 57 (11), 504–508. https://doi.org/10.33588/rn.5711.2013272
Guo, B.-Q., Li, H.-B., Ding, S.-B. (2020). Blood homocysteine levels in children with autism spectrum disorder: An updated systematic review and meta-analysis. Psychiatry Research, 291, 113283. https://doi.org/10.1016/j.psychres.2020.113283
Haghiri R., Mashayekhi F., Bidabadi E., Salehi Z. Analysis of methionine synthase (rs1805087) gene polymorphism in autism patients in Northern Iran // Acta Neurobiol. Exp. (Wars). – 2016. – Vol. 76(4). – P. 318–323. doi: 10.21307/ane–2017–030.
Hardan, A. Y., Fung, L. K., Frazier, T., Berquist, S. W., Minshew, N. J., Keshavan, M. S., Stanley, J. A. (2016). A proton spectroscopy study of white matter in children with autism. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 66, 48–53. https://doi.org/10.1016/j.pnpbp.2015.11.005
Hegarty, J. P., Gengoux, G. W., Berquist, K. L., Millán, M. E., Tamura, S. M., Karve, S. et al. (2019). A pilot investigation of neuroimaging predictors for the benefits from pivotal response treatment for children with autism. Journal of Psychiatric Research, 111, 140–144. https://doi.org/10.1016/j.jpsychires.2019.02.001
Kiani, R., Lawden, M., Eames, P., Critchley, P., Bhaumik, S., Odedra, S., Gumber, R. (2015). Anti-NMDA-receptor encephalitis presenting with catatonia and neuroleptic malignant syndrome in patients with intellectual disability and autism. BJPsych Bulletin, 39 (1), 32–35. https://doi.org/10.1192/pb.bp.112.041954
Li, Y., Qiu, S., Shi, J., Guo, Y., Li, Z., Cheng, Y., Liu, Y. (2020). Association between MTHFR C677T/A1298C and susceptibility to autism spectrum disorders: a meta-analysis. BMC Pediatrics, 20 (1). https://doi.org/10.1186/s12887-020-02330-3
Lindhout, I. A., Murray, T. E., Richards, C. M., Klegeris, A. (2021). Potential neurotoxic activity of diverse molecules released by microglia. Neurochemistry International, 148, 105117. https://doi.org/10.1016/j.neuint.2021.105117
Marseglia, L. M., Nicotera, A., Salpietro, V., Giaimo, E., Cardile, G., Bonsignore, M. et al. (2015). Hyperhomocysteinemia and MTHFR Polymorphisms as Antenatal Risk Factors of White Matter Abnormalities in Two Cohorts of Late Preterm and Full Term Newborns. Oxidative Medicine and Cellular Longevity, 2015, 1–8. https://doi.org/10.1155/2015/543134
Masi, A., Quintana, D. S., Glozier, N., Lloyd, A. R., Hickie, I. B., Guastella, A. J. (2014). Cytokine aberrations in autism spectrum disorder: a systematic review and meta-analysis. Molecular Psychiatry, 20 (4), 440–446. https://doi.org/10.1038/mp.2014.59
Mead, J., Ashwood, P. (2015). Evidence supporting an altered immune response in ASD. Immunology Letters, 163 (1), 49–55. https://doi.org/10.1016/j.imlet.2014.11.006
Shaik Mohammad, N., Sai Shruti, P., Bharathi, V., Krishna Prasad, C., Hussain, T., Alrokayan, S. A. et al. (2016). Clinical utility of folate pathway genetic polymorphisms in the diagnosis of autism spectrum disorders. Psychiatric Genetics, 26 (6), 281–286. https://doi.org/10.1097/ypg.0000000000000152
Monge Galindo, L., Pérez Delgado, R., López Pisón, J., Lafuente Hidalgo, M., Ruiz del Olmo Izuzquiza, I., Peña Segura, J. L. (2010). Mesial temporal sclerosis in paediatrics: its clinical spectrum. Our experience gained over a 19-year period. Revista de Neurología, 50 (6), 341–348. https://doi.org/10.33588/rn.5006.2009448
Nepal, G., Shing, Y. K., Yadav, J. K., Rehrig, J. H., Ojha, R., Huang, D. Y., Gajurel, B. P. (2020). Efficacy and safety of rituximab in autoimmune encephalitis: A meta‐analysis. Acta Neurologica Scandinavica, 142 (5), 449–459. https://doi.org/10.1111/ane.13291
Nicolson, G. L., Gan, R., Nicolson, N. L., Haier, J. (2007). Evidence for Mycoplasma ssp., Chlamydia pneunomiae, and human herpes virus‐6 coinfections in the blood of patients with autistic spectrum disorders. Journal of Neuroscience Research, 85 (5), 1143–1148. https://doi.org/10.1002/jnr.21203
Pavone, V., Praticò, A. D., Parano, E., Pavone, P., Verrotti, A., Falsaperla, R. (2012). Spine and brain malformations in a patient obligate carrier of MTHFR with autism and mental retardation. Clinical Neurology and Neurosurgery, 114 (9), 1280–1282. https://doi.org/10.1016/j.clineuro.2012.03.008
Pinillos Pisón, R., Llorente Cereza, M. T., López Pisón, J., Pérez Delgado, R., Lafuente Hidalgo, M., Martínez Sapiñá, A., Peña Segura, J. L. (2009). Congenital infection by cytomegalovirus. A review of our 18 years' experience of diagnoses. Revista de Neurología, 48 (7), 349–353. https://doi.org/10.33588/rn.4807.2008391
Poppe, M., Brück, W., Hahn, G., Weißbrich, B., Heubner, G., Goebel, H., Todt, H. (2001). Fulminant Course in a Case of Diffuse Myelinoclastic Encephalitis – A Case Report. Neuropediatrics, 32 (1), 41–44. https://doi.org/10.1055/s-2001-12214
Pu, D., Shen, Y., Wu, J. (2013). Association between MTHFR Gene Polymorphisms and the Risk of Autism Spectrum Disorders: A Meta‐Analysis. Autism Research, 6 (5), 384–392. https://doi.org/10.1002/aur.1300
Rai, V. (2016). Association of methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism with autism: evidence of genetic susceptibility. Metabolic Brain Disease, 31 (4), 727–735. https://doi.org/10.1007/s11011-016-9815-0
Saberi, A., Akhondzadeh, S., Kazemi, S. (2018). Infectious agents and different course of multiple sclerosis: a systematic review. Acta Neurologica Belgica, 118 (3), 361–377. https://doi.org/10.1007/s13760-018-0976-y
Sadeghiyeh, T., Dastgheib, S. A., Mirzaee-Khoramabadi, K., Morovati-Sharifabad, M., Akbarian-Bafghi, M. J., Poursharif, Z. et al. (2019). Association of MTHFR 677C>T and 1298A>C polymorphisms with susceptibility to autism: A systematic review and meta-analysis. Asian Journal of Psychiatry, 46, 54–61. https://doi.org/10.1016/j.ajp.2019.09.016
Sakamoto, A., Moriuchi, H., Matsuzaki, J., Motoyama, K., Moriuchi, M. (2015). Retrospective diagnosis of congenital cytomegalovirus infection in children with autism spectrum disorder but no other major neurologic deficit. Brain and Development, 37 (2), 200–205. https://doi.org/10.1016/j.braindev.2014.03.016
Scott, O., Richer, L., Forbes, K., Sonnenberg, L., Currie, A., Eliyashevska, M., Goez, H. R. (2013). Anti–N-Methyl-D-Aspartate (NMDA) Receptor Encephalitis. Journal of Child Neurology, 29 (5), 691–694. https://doi.org/10.1177/0883073813501875
Singh, V. K., Lin, S. X., Newell, E., Nelson, C. (2002). Abnormal measles-mumps-rubella antibodies and CNS autoimmunity in children with autism. Journal of Biomedical Science, 9 (4), 359–364. https://doi.org/10.1007/bf02256592
Strunk, T., Gottschalk, S., Goepel, W., Bucsky, P., Schultz, C. (2002). Subacute leukencephalopathy after low‐dose intrathecal methotrexate in an adolescent heterozygous for the MTHFR C677T polymorphism. Medical and Pediatric Oncology, 40 (1), 48–50. https://doi.org/10.1002/mpo.10192
Venâncio, P., Brito, M. J., Pereira, G., Vieira, J. P. (2014). Anti-N-methyl-D-aspartate Receptor Encephalitis with Positive Serum Antithyroid Antibodies, IgM Antibodies Against Mycoplasma pneumoniae and Human Herpesvirus 7 PCR in the CSF. Pediatric Infectious Disease Journal, 33 (8), 882–883. https://doi.org/10.1097/inf.0000000000000408
Wipfler, P., Dunn, N., Beiki, O., Trinka, E., Fogdell-Hahn, A. (2018). The Viral Hypothesis of Mesial Temporal Lobe Epilepsy – Is Human Herpes Virus-6 the Missing Link? A systematic review and meta-analysis. Seizure, 54, 33–40. https://doi.org/10.1016/j.seizure.2017.11.015

