Assessment of Creatine Levels in Patients with Vitamin B6-Responsive Gyrate Atrophy Using Magnetic Resonance Spectroscopy after Vitamin B6 Administration | ||
| SVU-International Journal of Medical Sciences | ||
| Article 91, Volume 7, Issue 2, July 2024, Pages 1046-1058 PDF (485.75 K) | ||
| Document Type: Original research articles | ||
| DOI: 10.21608/svuijm.2025.340477.2036 | ||
| Authors | ||
| Amira Mobarak1; Ahmed Elsharkawy2; Rofaida M. Magdy3; Mohamed M. Hassan4; Alaa Mohamed Reda* 2 | ||
| 1Department of Pediatrics (Medical Biochemical Genetics division), Faculty of Medicine, Tanta University, Tanta, Egypt. | ||
| 2Department of Radiodiagnosis, Faculty of Medicine, Tanta University, Tanta, Egypt. | ||
| 3Department of Pediatrics (Metabolic and Genetics Unit), Faculty of Medicine, Sohag University, Sohag, Egypt | ||
| 4Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt. | ||
| Abstract | ||
| Background: Gyrate atrophy of the choroid and retina (GACR) is an autosomal recessive metabolic disorder caused by mutations in the ornithine aminotransferase (OAT) gene. Objectives: The aim was to assess the impact of vitamin B6 administration on the creatine amino acid level in the central nervous system (CNS) in patients with GACR. Patients and methods: This observational study included 10 patients with GACR aged 12 to 18 years old. All patients with B6-responsive GACR and evidence of creatine deficiency were included, regardless of outcome. Exclusion criteria involved non-responsive GACR, renal or hepatic impairment, or creatine supplementation. Patients were selected from Tanta and Sohag University hospitals between 2022 and 2023, and data were gathered through a retrospective review of medical records, including clinical details and investigations such as DBS amino acid profiles and creatine phosphokinase (CPK) assays before and after vitamin B6 administration at doses of 515 ± 62.58 mg/day (400–600 mg/day). Results: Following vitamin B6 treatment, both ornithine and CPK levels significantly decreased (43.4%-53.9%, and 67.9%-70.1%, respectively). Additionally, citrulline and arginine levels significantly increased. When compared to pre-treatment values, the post-treatment creatine peak increased dramatically in the basal ganglia, frontal, and occipital regions of the cerebral cortex, respectively. Conclusions: Vitamin B6 is a crucial component of the gyrate atrophy treatment regimen. It was effective in restoring the creatine level in the CNS and lowering ornithine levels. The MRS is a reliable tool for monitoring of patients with gyrate atrophy. | ||
| Keywords | ||
| Gyrate atrophy; Creatine deficiency; MRS; Ornithine | ||
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