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. 2023 Dec;65(12):1596-1606.
doi: 10.1111/dmcn.15659. Epub 2023 May 28.

Autism spectrum disorder and GABA levels in children with succinic semialdehyde dehydrogenase deficiency

Itay Tokatly Latzer  1   2 , Ellen Hanson  3   4 , Mariarita Bertoldi  5 , Àngeles García-Cazorla  6 , Melissa Tsuboyama  1 , Paul MacMullin  1 , Alexander Rotenberg  1   7 , Jean-Baptiste Roullet  8 , Phillip L Pearl  1 ; SSADH Deficiency Investigators Consortium
Collaborators, Affiliations
Free article

Autism spectrum disorder and GABA levels in children with succinic semialdehyde dehydrogenase deficiency

Itay Tokatly Latzer et al. Dev Med Child Neurol. 2023 Dec.
Free article

Abstract

Aim: To elucidate the etiological aspects of autism spectrum disorder (ASD) in succinic semialdehyde dehydrogenase deficiency (SSADHD), related to dysregulation of γ-aminobutyric acid (GABA) and the imbalance of excitatory and inhibitory neurotransmission.

Method: In this prospective, international study, individuals with SSADHD underwent neuropsychological assessments, as well as biochemical, neurophysiological, and neuroimaging evaluations.

Results: Of the 29 individuals (17 females) enrolled (median age [IQR] 10 years 5 months [5 years 11 months-18 years 1 month]), 16 were diagnosed with ASD. ASD severity significantly increased with age (r = 0.67, p < 0.001) but was inversely correlated with plasma GABA (r = -0.67, p < 0.001) and γ-hydroxybutyrate levels (r = -0.538, p = 0.004), and resting motor threshold as measured by transcranial magnetic stimulation (r = -0.44, p = 0.03). A discriminative analysis indicated that an age older than 7 years 2 months (p = 0.004) and plasma GABA levels less than 2.47 μM (p = 0.01) are the threshold values beyond which the likelihood of ASD presenting in individuals with SSADHD is increased.

Interpretation: ASD is prevalent but not universal in SSADHD, and it can be predicted by lower levels of plasma GABA and GABA-related metabolites. ASD severity in SSADHD increases with age and the loss of cortical inhibition. These findings add insight into the pathophysiology of ASD and may facilitate its early diagnosis and intervention in individuals with SSADHD.

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