Guanidinoacetate methyltransferase deficiency is an inherited disorder that primarily affects the brain and muscles. Without early treatment, people with this disorder have neurological problems that are usually severe. These problems include intellectual disability, speech development limited to a few words, and recurrent seizures (epilepsy). Affected individuals may also exhibit autistic behaviors that affect communication and social interaction or self-injurious behaviors such as head-banging. Other features of this disorder can include involuntary movements (extrapyramidal dysfunction) such as tremors or facial tics.

People with guanidinoacetate methyltransferase deficiency may have weak muscle tone and delayed development of motor skills such as sitting or walking. In severe cases they may lose previously acquired skills such as the ability to support their head or to sit unsupported.

Mutations in the GAMT gene cause guanidinoacetate methyltransferase deficiency. The GAMT gene provides instructions for making the enzyme guanidinoacetate methyltransferase. This enzyme participates in the two-step production (synthesis) of the compound creatine from the protein building blocks (amino acids) glycine, arginine, and methionine. Specifically, guanidinoacetate methyltransferase controls the second step of this process. In this step, creatine is produced from another compound called guanidinoacetate. Creatine is needed for the body to store and use energy properly.

GAMT gene mutations impair the ability of the guanidinoacetate methyltransferase enzyme to participate in creatine synthesis, resulting in a shortage of creatine. The effects of guanidinoacetate methyltransferase deficiency are most severe in organs and tissues that require large amounts of energy, especially the brain.

Normal Function

The GAMT gene provides instructions for making the enzyme guanidinoacetate methyltransferase, which is active (expressed) mainly in the liver. This enzyme participates in the two-step production (synthesis) of the compound creatine from the protein building blocks (amino acids) glycine, arginine, and methionine. Specifically, guanidinoacetate methyltransferase controls the second step of this process. In this step, creatine is produced from another compound called guanidinoacetate. Creatine is needed for the body to store and use energy properly. It is involved in providing energy for muscle contraction, and is also important in nervous system functioning.

In addition to its role in creatine synthesis, the guanidinoacetate methyltransferase enzyme is thought to help activate a process called fatty acid oxidation. This process provides an energy source for cells during times of stress when their normal fuel, the simple sugar glucose, is scarce.

Health Conditions Related to Genetic Changes

Guanidinoacetate methyltransferase deficiency

At least 49 mutations in the GAMT gene cause guanidinoacetate methyltransferase deficiency, a disorder that involves intellectual disability and seizures. Most affected individuals of Portuguese ancestry have a particular mutation in which the amino acid tryptophan is replaced by the amino acid serine at position 20 in the enzyme (written as Trp20Ser or W20S).

GAMT gene mutations impair the ability of the guanidinoacetate methyltransferase enzyme to participate in creatine synthesis, resulting in a shortage of creatine. The effects of guanidinoacetate methyltransferase deficiency are most severe in organs and tissues that require large amounts of energy, especially the brain.

Other Names for This Gene

• GAMT_HUMAN
• PIG2
• TP53I2

Genomic Location

• 25% chance that the child will have GAMT deficiency
• 50% chance that the child will be a carrier of GAMT deficiency like the parents
• 25% chance that the child will have two working copies of GAMT, so the child will not have GAMT deficiency and will not be a carrier.

First signs of GAMT deficiency may appear anywhere from 3 months to 3 years of age.

Early signs of the condition may include the following:

• Delayed sitting or walking
• Delayed speech
• Weak muscles
• Uncontrolled movements (tremors or tics)
• Seizures or epilepsy

Newborn screening for GAMT deficiency requires collecting a small amount of blood from your baby’s heel. Screening measures how much guanidinoacetate and creatine are in your baby’s blood. Babies with a high level of guanidinoacetate and low level of creatine might have GAMT deficiency.

What Happens After an Out-of-Range Screening Result?

If your baby’s blood spot screening result for GAMT deficiency is out-of-range, your baby’s health care provider will contact you. Together, you will discuss next steps and follow-up plans.

An out-of-range screening result does not mean that your baby definitely has the condition. It does mean that your baby needs more follow-up testing.

Your baby may need the following tests after an out-of-range screening result:

• Blood tests
• Genetic testing using a blood sample

You should complete any recommended follow-up testing as soon as possible. Babies and children with this condition can have serious health problems if they are not diagnosed and treated quickly.

False-positive newborn screening results for this condition may happen.

Newborn screening helps babies lead healthier lives. If your baby has an out-of-range result, follow up with your health care provider quickly. It is important to follow their instructions. Your baby may need to get treatment right away, even if they are not showing signs or symptoms. In some cases, your baby’s health care provider may decide it is best to watch (monitor) your baby to decide next steps. Careful monitoring and early treatment will help your baby stay as healthy as possible.