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Nutr Neurosci. 2019 May;22(5):302-305. doi: 10.1080/1028415X.2017.1385176. Epub 2017 Oct 3.

Benefits and drawbacks of guanidinoacetic acid as a possible treatment to replenish cerebral creatine in AGAT deficiency.

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a Applied Bioenergetics Lab, Faculty of Sport and PE , University of Novi Sad , Lovcenska 16, Novi Sad 21000 , Serbia.
b University of Belgrade School of Medicine , Belgrade , Serbia.


Arginine-glycine amidinotransferase (AGAT) deficiency is a rare inherited metabolic disorder that severely affects brain bioenergetics. Characterized by mental retardation, language impairment, and behavioral disorders, AGAT deficiency is a treatable condition, where long-term creatine supplementation usually restores brain creatine levels and improves its clinical features. In some cases of AGAT deficiency, creatine treatment might be somewhat limited due to possible shortcomings in performance and transport of creatine to the brain. Guanidinoacetic acid (GAA), a direct metabolic precursor of creatine, has recently been suggested as a possible alternative to creatine to tackle brain creatine levels in experimental medicine. AGAT patients might benefit from oral GAA due to upgraded bioavailability and convenient utilization of the compound, while possible drawbacks (e.g. brain methylation issues, neurotoxicity, and hyperhomocysteinemia) should be accounted as well.


AGAT deficiency; Bioavailability; Creatine; Guanidinoacetic acid; Neurotoxicity

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