Alterations of the melatonin pathway have been suggested as susceptibility factors to developmental disorders, and especially to ASD [15–17, 19–23]. The mechanisms leading to ASMT/melatonin deficit in humans are most likely diverse, including genetic/epigenetic alterations. The impact of melatonin deficit on sleep and on the susceptibility to developmental disorders (such as ASD or ID) also remains unclear. It may involve its role as a circadian synchronizer and sleep inducer, its effects on synaptic plasticity, and/or its antioxidant properties [8, 14, 19, 24, 25]. Melatonin deficit may also alter and/or desynchronize many physiological processes, and indirectly exacerbate other pathological processes.
We could identify predicted deleterious variants in a subgroup of patients with ID, including two deleterious splice site variants of ASMT found only in patients with ID. The splice site mutation in intron 7 (IVS7+1G>T) was never observed before. The splice site mutation in intron 5 (IVS5+2T>C) was previously identified in patients with ASD and reported to be more frequent in patients compared to controls (6/749 vs 1/861; p = 0.04) [17, 20, 22]. In addition, biochemical studies indicated that several of the variants, although present at the heterozygous state, were associated with low ASMT activity and might thus impair melatonin synthesis in vivo. These results were consistent with the biochemical studies performed by Melke et al. on families carrier of the L298F and IVS5+2T>C mutations and presenting with a dramatic decrease in ASMT activity and blood melatonin concentration . Nevertheless, despite these interesting findings, we could not detect ASMT mutation enrichment in patients with ID compared to the controls. Our results were similar to those previously reported in patients with ASD, for whom no significant enrichment in ASMT rare variants was found [17, 20, 22], although melatonin deficit is very frequently associated with this condition [15, 16], and is correlated with low ASMT activity in vivo . Low ASMT activities were also observed in BLCL of some controls subjects who did not carry a coding mutation of ASMT. Low ASMT activity can thus be observed even in the absence of coding mutations. For example, SNPs within the promoter were associated with low ASMT mRNA levels [17, 21].
Several limitations exist in this study. First, the sample of patients with ID was initially collected for the identification of X-linked genes (e.g. families with multiple affected males). Therefore, this population is not representative of the broad diversity of patients with ID and is negatively biased for the identification of mutations in the ASMT gene, located on the pseudo-autosomal region 1 (PAR1) shared by the X and Y chromosomes. Another limitation is the sparse information that we could collect about sleep disorders. Further studies will be required to establish the precise link between ASMT variants, melatonin levels and sleep disorders.