Evaluation of the Efficiency of Some Mitochondrial Function Biomarkers in the Differential Diagnosis of Autism Spectrum Disorder Using Performance Characteristic Curve (ROC) Analysis Method

Background & Aims: Autism disorder is a neurodevelopmental disorder whose symptoms are mainly in the early months of life, especially between 12 and 24 months and in general, up to 3years of age, and due to severe and persistent deficiencies in communication and interactions. Social, communication skills, limited, inflexible, and repetitive patterns appear in behavior, activities, and interests, as well as cognitive and functional disorders. However, what has been studied so far has shown that mitochondria play an essential role in degenerative diseases, and its various effects are mainly through the cellular redox mode by mitochondria and through oxidation and reduction of NADH. H+ and NAD + are maintained; Are interconnected. Abnormal accumulation of oxygen/nitrogen reaction species and superoxide formation can lead to oxidative stress and their accumulation may damage cellular structures. Superoxide is also immediately converted to hydrogen peroxide by superoxide dismutase enzymes. The presence of hydrogen peroxide may be toxic to cells. The brain, on the other hand, is one of the main consumers of oxygen, and mitochondria are the largest source of energy for the normal functioning of brain cells, and as a result, large amounts of reactive oxygen species accumulate in several areas of the brain. However, at least in some cases, there are relatively weak protection mechanisms. Because of this, the brain may be very sensitive to attacks related to the accumulation of radicals. In addition, mitochondria play an important role in calcium homeostasis, signaling, and regulation of apoptosis. Also, growing nerve cells have a vital need for oxidative phosphorylation for important growth processes, and the immature brain is uniquely vulnerable to defects in bioenergy capacity; Thus, mitochondrial disorders may lead to a variety of developmental neurological disorders . In general, conducting such research is of particular importance, especially given the growing number of patients with autism spectrum disorders and the various challenges in the timely and accurate differential diagnosis of these disorders. In this regard, after reviewing the literature and the existing research background, it was found that so far in our country, no research has been conducted to evaluate the biomarkers of mitochondrial function in people with autism spectrum disorder. Methods: To conduct the present applied research, among children and adolescents with autism spectrum disorder in Tehran, among patients with nausea (51people), 10affected children and 10healthy children were randomly selected and divided into two experimental and control groups. Were divided. The required data were then used through demographic information questionnaires, history and medical records, Gilliam-2 Autism Rating Scale and laboratory kits. Finally, the data were analyzed using the rock curve. Results: The results presented in Table2 and the value of AUC= 0.890, it can be said that the ability to test or test creatine phosphokinase (CPKMB) in the diagnosis of ASD disorder is in the category or "good and close to excellent level." Also since the probability value is equal to 0.0032; It can be said that this result is significant and can be cited at the level of significance of five percent (and even one percent). Based on the findings, the number of cutting points is also equal to>24.0, which shows; Based on the diagnostic test (CPKMB), people with creatine phosphokinase levels greater than 24.0 units can be identified; He was considered a person with symptoms of autism. Individuals whose test scores are less than 24.0 are also identified as asymptomatic or healthy. Based on the information in Table3 and the value obtained for the curve surface (AUC= 1.000), it can be said that the ability of the Lactate test to diagnose this disorder is complete and "excellent" and shows that this test has a very good performance in the field. It is the correct identification and determination of healthy people with disorders. The numerical value of the cutting point is also equal to>21.5, which shows; Based on the Lactate diagnostic test, those whose lactate level is more than 21.5 units can be identified; Considered people with autism spectrum disorder. Those whose test results are less than 21.5 units are also considered healthy. Based on the data in Table4 and the value obtained for the subsurface (AUC= 0.790), it can be said that the ability of the Pyruvate test to diagnose ASD is "relatively good". Accordingly, since the probability value of Pvalue is equal to 0.0284, it can be said that this result is significant and can be cited at the level of significance of five percent and even one percent. The numerical value of the cut-off point for this experiment is equal to <0.865, which indicates; Based on the Pyruvate diagnostic test, people with a pyruvate score of less than 0.865 can be considered a person with ASD. Those for whom the number obtained is more than 0.865 units are also recognized as healthy. Based on the information in Table5 and the value obtained for the cut-off point (AUC= 0.970), it can be said that the ability of the L:P test to diagnose this disorder is "excellent" and efficient. Accordingly, at the significance level of five percent and one percent, since the probability value or Pvalue is equal to 0.0004; It can be said that this result is meaningful and worthy of citation. The numerical value of the cut-off point in this test is equal to>31.05, which shows; Based on the L:P diagnostic test, those with a lactate to pyruvate or L:P ratio greater than 31.05 can be considered as having symptoms of ASD. Those with an L: P score of less than 31.05 are also considered healthy. Based on the results of Table 6 and AUC = 0.765, it can be said that the ability of Creatinine test to diagnose autism spectrum disorder is in the category of "relatively good". Since the probability value P for this test (creatinine biomarker test) is 0.0452; It can be said that this result, at the level of significance of five percent, is significant and worthy of citation. Obviously, this result, at a significance level of one percent, is not worthy of citation and significance. Conclusion: The studied biomarkers have high and very good diagnostic power and efficiency in the field of accurate and early assessment and diagnosis of autism spectrum disorders (especially in severity levels 2 and 3), and they can be used along with other diagnostic biomarkers, along with other measurement methods. Evaluated and diagnosed this disorder, and in the first three years of the child's development, as a golden and very sensitive and important period of diagnosis and treatment of autism, achieved a more accurate differential diagnosis and education, rehabilitation and treatment or improvement of symptoms at the most appropriate time. Possibly, he started and achieved better results in this regard. Also, according to the results of evaluation and measurement of biomarkers of mitochondrial function in each diagnosed individual, based on the new and valuable approach of "Molecular Psychology and Molecular Psychiatry", one of the new and appropriate methods for each individual (including individual or personal molecular medicine) to modify And used to improve mitochondrial dysfunction (for example, drug therapy to regulate serum levels of the aforementioned molecules in the patient to a normal level and reduce related symptoms), and finally, to reduce the symptoms and relative treatment of the person with autism.