Oxidative phosphorylation in creatine transporter deficiency

X-linked creatine transporter deficiency (CTD) is one of the three types of cerebral creatine deficiency disorders. CTD arises from pathogenic variants in the X-linked geneSLC6A8.We report the first phosphorus (P-31) MRS study of patients with CTD, where both phosphocreatine and total creatine concentrations were found to be markedly reduced. Despite the diminished role of creatine and phosphocreatine in oxidative phosphorylation in CTD, we found no elevation of lactate or lowered pH, indicating that the brain energy supply still largely relied on oxidative metabolism. Our results suggest that mitochondrial function is a potential therapeutic target for CTD.

Automated summary

X-linked creatine transporter deficiency (CTD) is a condition caused by pathogenic variants in the X-linked gene SLC6A8, leading to reduced phosphocreatine and total creatine concentrations. Despite the diminished role of creatine and phosphocreatine in oxidative phosphorylation in CTD, our study found no elevation of lactate or lowered pH, indicating that the brain still largely relies on oxidative metabolism for energy supply. Our results suggest that mitochondrial function could be a potential therapeutic target for CTD.