Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 May 7;17(9):1602.
doi: 10.3390/nu17091602.

Safety and Efficacy of High-Dose Folinic Acid in Children with Autism: The Impact of Folate Metabolism Gene Polymorphisms

Caiyun Zhang  1   2 , Yanlin Chen  3 , Fang Hou  3 , Yanzhi Li  1   2 , Wanxin Wang  1   2 , Lan Guo  1   2 , Caixia Zhang  1   2 , Li Li  3 , Ciyong Lu  1   2
Affiliations
Randomized Controlled Trial

Safety and Efficacy of High-Dose Folinic Acid in Children with Autism: The Impact of Folate Metabolism Gene Polymorphisms

Caiyun Zhang et al. Nutrients. .

Abstract

Background/Objectives: Research on the safety and efficacy of high-dose folinic acid in Chinese children with autism spectrum disorder (ASD) is limited, and the impact of folate metabolism gene polymorphisms on its efficacy remains unclear. This trial aimed to evaluate the safety and efficacy of high-dose folinic acid intervention in Chinese children with ASD and explore the association between folate metabolism gene polymorphisms and efficacy. Methods: A 12-week randomized clinical trial was conducted, including 80 eligible children with ASD, randomly assigned to an intervention group (n = 50) or a control group (n = 30). The intervention group was administered folinic acid (2 mg/kg/day, max 50 mg/day) in two divided doses. Efficacy was measured using the Psycho-Educational Profile, Third Edition (PEP-3) at baseline and 12 weeks by two trained professionals blind to the group assignments. Methylenetetrahydrofolate reductase (MTHFR C677T, MTHFR A1298C), methionine synthase (MTR A2756G), and methionine synthase reductase (MTRR A66G) were genotyped by the gold standard methods in the intervention group. Results: 49 participants in the intervention group and 27 in the control group completed this trial. Both groups showed improvements from baseline to 12 weeks across most outcome measures. The intervention group demonstrated significantly greater improvements in social reciprocity compared to the control group. Children with MTHFR A1298C or MTRR A66G mutations demonstrated greater improvements in various developmental domains than wild type. Folinic acid may be more effective in certain genotype combinations, such as MTHFR C677T and A1298C. No significant adverse effects were observed during the intervention. Conclusions: High-dose folinic acid may be a promising intervention for children with ASD, and its efficacy is associated with folate metabolism gene polymorphisms. High-dose folinic acid intervention may promote better neurodevelopmental outcomes by alleviating folate metabolism abnormalities caused by single or combined mutations in folate metabolism genes.

Keywords: autism; efficacy; folate metabolism gene polymorphisms; folinic acid; safety.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; and the decision to submit the manuscript for publication.

Figures

Figure 1
Figure 1
Flowchart of this study.
Figure 2
Figure 2
Changes in PEP-3 scores by MTHFR A1298C and MTRR A66G genotypes following 12 weeks of folinic acid intervention. Children with the MTHFR A1298C variant (AC/CC) showed greater improvements in the visual-motor imitation (a), social reciprocity (b), the composite score of communication (c) and motor (d) compared to the wild-type. Children with the MTRR A66G variant (AG/GG) also showed greater improvement in cognitive verbal/preverbal (e) and expressive language (f) compared to the wild type.
See this image and copyright information in PMC

References

    1. Wang S.-H., Zhang H.-T., Zou Y.-Y., Cheng S.-M., Zou X.-B., Chen K.-Y. Efficacy and Moderating Factors of the Early Start Denver Model in Chinese Toddlers with Autism Spectrum Disorder: A Longitudinal Study. World J. Pediatr. 2023;19:741–752. doi: 10.1007/s12519-022-00555-z. - DOI - PubMed
    1. Shaw K.A. Early Identification of Autism Spectrum Disorder Among Children Aged 4 Years—Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ. 2023;72:1–15. doi: 10.15585/mmwr.ss7201a1. - DOI - PMC - PubMed
    1. Wang S., Deng H., You C., Chen K., Li J., Tang C., Ceng C., Zou Y., Zou X. Sex Differences in Diagnosis and Clinical Phenotypes of Chinese Children with Autism Spectrum Disorder. Neurosci. Bull. 2017;33:153–160. doi: 10.1007/s12264-017-0102-9. - DOI - PMC - PubMed
    1. Dudley C., Emery J.C.H. The Value of Caregiver Time: Costs of Support and Care for Individuals Living with Autism Spectrum Disorder. 2014. [(accessed on 15 January 2014)]. Available online: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2379633.
    1. Zhao Y., Lu F., Wang X., Luo Y., Zhang R., He P., Zheng X. The Economic Burden of Autism Spectrum Disorder with and without Intellectual Disability in China: A Nationwide Cost-of-Illness Study. Asian J. Psychiatry. 2024;92:103877. doi: 10.1016/j.ajp.2023.103877. - DOI - PubMed

Publication types

MeSH terms

Substances