Randomised controlled trial of simvastatin treatment for autism in young children with neurofibromatosis type 1 (SANTA)
Background Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground b...
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          | Published in | Molecular autism Vol. 9; no. 1; pp. 12 - 13 | 
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , , , , , | 
| Format | Journal Article | 
| Language | English | 
| Published | 
        London
          BioMed Central
    
        22.02.2018
     BioMed Central Ltd BMC  | 
| Subjects | |
| Online Access | Get full text | 
| ISSN | 2040-2392 2040-2392  | 
| DOI | 10.1186/s13229-018-0190-z | 
Cover
| Abstract | Background
Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes.
Methods
A single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression).
Results
Thirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA (
t
(12) = − 2.12,
p
 = .055), GABA/Glx ratio (
t
(12) = − 2.78,
p
 = .016), and reduced grey nuclei Glx (ANCOVA
p
< 0.05, Mann-Whitney
p
< 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney
p
 < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney
p
 < 0.01). Machine-learning classification of imaging outcomes achieved 79% (
p
 < .05) accuracy differentiating groups at endpoint against chance level (64%,
p
 = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met ‘clinical responder’ criteria for behavioural outcome.
Conclusions
We show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network.
Trial registration
EU Clinical Trial Register (EudraCT) 2012-005742-38 (
www.clinicaltrialsregister.eu
) | 
    
|---|---|
| AbstractList | Background
Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes.
Methods
A single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression).
Results
Thirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA (
t
(12) = − 2.12,
p
 = .055), GABA/Glx ratio (
t
(12) = − 2.78,
p
 = .016), and reduced grey nuclei Glx (ANCOVA
p
< 0.05, Mann-Whitney
p
< 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney
p
 < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney
p
 < 0.01). Machine-learning classification of imaging outcomes achieved 79% (
p
 < .05) accuracy differentiating groups at endpoint against chance level (64%,
p
 = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met ‘clinical responder’ criteria for behavioural outcome.
Conclusions
We show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network.
Trial registration
EU Clinical Trial Register (EudraCT) 2012-005742-38 (
www.clinicaltrialsregister.eu
) Background Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes. Methods A single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression). Results Thirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA (t(12) = - 2.12, p = .055), GABA/Glx ratio (t(12) = - 2.78, p = .016), and reduced grey nuclei Glx (ANCOVA p < 0.05, Mann-Whitney p < 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney p < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney p < 0.01). Machine-learning classification of imaging outcomes achieved 79% (p < .05) accuracy differentiating groups at endpoint against chance level (64%, p = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met 'clinical responder' criteria for behavioural outcome. Conclusions We show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network. Trial registration EU Clinical Trial Register (EudraCT) 2012-005742-38 (www.clinicaltrialsregister.eu) Keywords: Autism, Neurofibromatosis type 1, Neuroimaging, Randomised controlled trial, Statin, Simvastatin Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes. A single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression). Thirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA (t(12) = - 2.12, p = .055), GABA/Glx ratio (t(12) = - 2.78, p = .016), and reduced grey nuclei Glx (ANCOVA p < 0.05, Mann-Whitney p < 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney p < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney p < 0.01). Machine-learning classification of imaging outcomes achieved 79% (p < .05) accuracy differentiating groups at endpoint against chance level (64%, p = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met 'clinical responder' criteria for behavioural outcome. We show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network. Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes. A single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression). Thirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA ( (12) = - 2.12, = .055), GABA/Glx ratio ( (12) = - 2.78, = .016), and reduced grey nuclei Glx (ANCOVA < 0.05, Mann-Whitney < 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney < 0.01). Machine-learning classification of imaging outcomes achieved 79% ( < .05) accuracy differentiating groups at endpoint against chance level (64%, = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met 'clinical responder' criteria for behavioural outcome. We show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network. EU Clinical Trial Register (EudraCT) 2012-005742-38 (www.clinicaltrialsregister.eu). Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes.BackgroundNeurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes.A single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression).MethodsA single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression).Thirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA (t(12) = - 2.12, p = .055), GABA/Glx ratio (t(12) = - 2.78, p = .016), and reduced grey nuclei Glx (ANCOVA p < 0.05, Mann-Whitney p < 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney p < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney p < 0.01). Machine-learning classification of imaging outcomes achieved 79% (p < .05) accuracy differentiating groups at endpoint against chance level (64%, p = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met 'clinical responder' criteria for behavioural outcome.ResultsThirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA (t(12) = - 2.12, p = .055), GABA/Glx ratio (t(12) = - 2.78, p = .016), and reduced grey nuclei Glx (ANCOVA p < 0.05, Mann-Whitney p < 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney p < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney p < 0.01). Machine-learning classification of imaging outcomes achieved 79% (p < .05) accuracy differentiating groups at endpoint against chance level (64%, p = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met 'clinical responder' criteria for behavioural outcome.We show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network.ConclusionsWe show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network.EU Clinical Trial Register (EudraCT) 2012-005742-38 (www.clinicaltrialsregister.eu).Trial registrationEU Clinical Trial Register (EudraCT) 2012-005742-38 (www.clinicaltrialsregister.eu). Abstract Background Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but translational trials with subjects > 8 years using cognition/behaviour outcomes have shown mixed results. This trial breaks new ground by studying statin effects for the first time in younger children with NF1 and co-morbid autism and by using multiparametric imaging outcomes. Methods A single-site triple-blind RCT of simvastatin vs. placebo was done. Assessment (baseline and 12-week endpoint) included peripheral MAPK assay, awake magnetic resonance imaging spectroscopy (MRS; GABA and glutamate+glutamine (Glx)), arterial spin labelling (ASL), apparent diffusion coefficient (ADC), resting state functional MRI, and autism behavioural outcomes (Aberrant Behaviour Checklist and Clinical Global Impression). Results Thirty subjects had a mean age of 8.1 years (SD 1.8). Simvastatin was well tolerated. The amount of imaging data varied by test. Simvastatin treatment was associated with (i) increased frontal white matter MRS GABA (t(12) = − 2.12, p = .055), GABA/Glx ratio (t(12) = − 2.78, p = .016), and reduced grey nuclei Glx (ANCOVA p < 0.05, Mann-Whitney p < 0.01); (ii) increased ASL perfusion in ventral diencephalon (Mann-Whitney p < 0.01); and (iii) decreased ADC in cingulate gyrus (Mann-Whitney p < 0.01). Machine-learning classification of imaging outcomes achieved 79% (p < .05) accuracy differentiating groups at endpoint against chance level (64%, p = 0.25) at baseline. Three of 12 (25%) simvastatin cases compared to none in placebo met ‘clinical responder’ criteria for behavioural outcome. Conclusions We show feasibility of peripheral MAPK assay and autism symptom measurement, but the study was not powered to test effectiveness. Multiparametric imaging suggests possible simvastatin effects in brain areas previously associated with NF1 pathophysiology and the social brain network. Trial registration EU Clinical Trial Register (EudraCT) 2012-005742-38 (www.clinicaltrialsregister.eu)  | 
    
| ArticleNumber | 12 | 
    
| Audience | Academic | 
    
| Author | Webb, Nicholas Cai, Ying Thomas, Owen Garg, Shruti Mellor, Joseph Keane, John Emsley, Richard Jim, Carly Parkes, Laura M Gareth Evans, D. Huson, Sue Stivaros, Stavros Green, Jonathan Morris, Andrew A. Montaldi, Daniela Szumanska-Ryt, Karolina Castellanos, Francisco X. Williams, Stephen Tziraki, Maria Haroon, Hamied A. Silva, Alcino J.  | 
    
| Author_xml | – sequence: 1 givenname: Stavros surname: Stivaros fullname: Stivaros, Stavros organization: Academic Unit of Paediatric Radiology, Royal Manchester Children’s Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre – sequence: 2 givenname: Shruti surname: Garg fullname: Garg, Shruti organization: Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust – sequence: 3 givenname: Maria surname: Tziraki fullname: Tziraki, Maria organization: Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre – sequence: 4 givenname: Ying surname: Cai fullname: Cai, Ying organization: Departments of Neurobiology, Psychiatry and Biobehavioral Sciences and Psychology, Integrative Center for Learning and Memory, Brain Research Institute, Brain Research Institute, University of California – sequence: 5 givenname: Owen surname: Thomas fullname: Thomas, Owen organization: Academic Unit of Radiology, Salford Royal Foundation NHS Trust, Manchester Academic Health Sciences Centre – sequence: 6 givenname: Joseph surname: Mellor fullname: Mellor, Joseph organization: Computer Science, University of Manchester – sequence: 7 givenname: Andrew A. surname: Morris fullname: Morris, Andrew A. organization: Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre – sequence: 8 givenname: Carly surname: Jim fullname: Jim, Carly organization: Manchester Metropolitan University – sequence: 9 givenname: Karolina surname: Szumanska-Ryt fullname: Szumanska-Ryt, Karolina organization: Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre – sequence: 10 givenname: Laura M surname: Parkes fullname: Parkes, Laura M organization: Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre – sequence: 11 givenname: Hamied A. surname: Haroon fullname: Haroon, Hamied A. organization: Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre – sequence: 12 givenname: Daniela surname: Montaldi fullname: Montaldi, Daniela organization: Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre – sequence: 13 givenname: Nicholas surname: Webb fullname: Webb, Nicholas organization: Department of Paediatric Nephrology, Royal Manchester Children’s Hospital, Manchester University NHS Foundation Trust, Academic Health Sciences Centre – sequence: 14 givenname: John surname: Keane fullname: Keane, John organization: Computer Science, University of Manchester – sequence: 15 givenname: Francisco X. surname: Castellanos fullname: Castellanos, Francisco X. organization: Hassenfeld Children’s Hospital at NYU Langone, Nathan S. Kline Institute for Psychiatric Research – sequence: 16 givenname: Alcino J. surname: Silva fullname: Silva, Alcino J. organization: Departments of Neurobiology, Psychiatry and Biobehavioral Sciences and Psychology, Integrative Center for Learning and Memory, Brain Research Institute, Brain Research Institute, University of California – sequence: 17 givenname: Sue surname: Huson fullname: Huson, Sue organization: Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Academic Health Sciences Centre – sequence: 18 givenname: Stephen surname: Williams fullname: Williams, Stephen organization: Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre – sequence: 19 givenname: D. surname: Gareth Evans fullname: Gareth Evans, D. organization: Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Academic Health Sciences Centre – sequence: 20 givenname: Richard surname: Emsley fullname: Emsley, Richard organization: Centre for Biostatistics, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester – sequence: 21 givenname: Jonathan orcidid: 0000-0002-0143-181X surname: Green fullname: Green, Jonathan email: jonathan.green@manchester.ac.uk organization: Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust  | 
    
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29484149$$D View this record in MEDLINE/PubMed | 
    
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| ContentType | Journal Article | 
    
| Contributor | Ellicott, Ruth Wagstaffe, Rose Bethell, Helen Patel, Sonia Acharya, Jamuna Bradbury, Alyson Prem, Catherine Mercatali, Giangiacomo Lewis, Lauren Sharif, Saghira Malik Lam, Wayne Quarrell, Oliver Bassi, Zahabiyah Hupton, Eileen Dobbie, Angus Harrower, Neil Velandy, Srilaxmi Drimer, Ruth Harrison, Emma West, Siobhan Tricker, Karen Kapasi, Akhtar Howard, Elizabeth Vassallo, Grace Eelloo, Judith Splitt, Miranda Moon, Rachel Musson, Susan Jones, Rachel Steiger, Christine Campbell, Suzanne Tobin, Hannah Horridge, Karen Burkitt-Wright, Emma  | 
    
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| Keywords | Neuroimaging Autism Neurofibromatosis type 1 Statin Simvastatin Randomised controlled trial  | 
    
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| PublicationSubtitle | Brain, Cognition and Behavior | 
    
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| Snippet | Background
Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models,... Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models, but... Background Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout models,... Abstract Background Neurofibromatosis 1 (NF1) is a monogenic model for syndromic autism. Statins rescue the social and cognitive phenotype in animal knockout...  | 
    
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| SubjectTerms | Autism Autistic Disorder - blood Autistic Disorder - complications Autistic Disorder - drug therapy Biomarkers - blood Brain - diagnostic imaging Child Complications and side effects Dosage and administration Drug therapy Emerging rare genetic and genomic syndromes in autism and developmental delay Female gamma-Aminobutyric Acid - blood Glutamic Acid - blood Human Genetics Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Male Medicine Medicine & Public Health Mitogen-Activated Protein Kinases - blood Neurofibromatosis Neurofibromatosis 1 - blood Neurofibromatosis 1 - complications Neurofibromatosis 1 - drug therapy Neurofibromatosis type 1 Neuroimaging Neurology Neuropsychology Neurosciences Patient outcomes Pediatrics Psychiatry Psychological aspects Randomised controlled trial Simvastatin Simvastatin - administration & dosage Simvastatin - adverse effects Simvastatin - therapeutic use Statin  | 
    
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| Title | Randomised controlled trial of simvastatin treatment for autism in young children with neurofibromatosis type 1 (SANTA) | 
    
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