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Cerebral creatine deficiencies (CCDs) are a small group of inherited disorders that result from defects in creatine biosynthesis and transport. Commonly affected tissues include the brain and muscles. There are three distinct CCDs. The most common is creatine transporter deficiency (CTD), an X-linked disorder caused by pathogenic variants in creatine transporter SLC6A8. The main symptoms of CTD are intellectual disability and developmental delay, and these are caused by a lack of creatine in the brain, due to the defective transporter. There are also two enzymatic defects of creatine biosynthesis, arginine:glycine amidinotransferase deficiency, caused by variants in GATM gene and guanidinoacetate methyltransferase deficiency, caused by variants in GAMT gene. The two single enzyme defects are both inherited in an autosomal recessive manner.
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