The History of the FRAT® Test

Science is full of delightful and sometimes world-changing discoveries that emerge despite—or even because of—researchers chasing slightly different goals.

That being said, then maybe we can think that science thrives on serendipity — prepared minds stumbling onto things they weren’t looking for! As famed physicist Joseph Henry stated: “The seeds of great discoveries are constantly floating around us, but they only take root in minds well-prepared to receive them.“

Maybe the history of the FRAT^® (Folate Receptor Autoantibody Test) falls into a similar category. Its history and development are certainly fascinating!

The FRAT^® test emerged from decades long research by Dr. Edward Quadros and his colleagues at SUNY Downstate Medical Center, who investigated the role of folate in neurodevelopment and the impact of autoantibodies on folate transport, together with Dr. Vincent Raemakers from Belgium.

The question Dr. Quadro’s lab was looking to answer was quite straightforward but also very complicated. The food supply in the United States is fortified with folic acid (a synthetic B-9 vitamin), in order to prevent neural tube defects; so why is it that women were still having children with neural tube defects? Neural tube defects did decrease after food fortification for folic acid, however, there was still a large among of NTD births post-folate fortification. What in the folate cycle/folate metabolism was causing this? Something was certainly amiss.

With this question in mind, Dr. Edward Quadros came across the first sampling of folate receptor autoantibodies. Folate receptor autoantibodies (FRAAs) were first identified via the FRAT^® test in women with a history of neural tube defect (NTD) pregnancies, suggesting an autoimmune mechanism disrupting folate delivery to the fetus. This was a remarkable finding and published in the New England Journal of Medicine. A new condition contributing to neural tube defects was discovered!

The next step was to look for these folate receptor autoantibodies in children, when the same group came across a large number of children that were regressing in their development. Why was this the case? It seemed that they were developing typically for the first several months after birth, when, out of nowhere, there were major regressions in their development. Symptoms that suddenly occurred without warning included:

• Cognitive impairment (intellectual disability)
• Movement disorders (ataxia, dystonia, chorea)
• Seizures (epilepsy)
• Speech difficulties (delayed or absent speech)
• Autism-like behaviors (social withdrawal, repetitive behaviors)
• Sleep disturbances
• Microcephaly (in some cases)
• Peripheral neuropathy (tingling, weakness)

Basically, this was a developmental delay / regression of some sort (loss of previously acquired skills) with no explained reasoning.

Again, in these cases, FRAAs were linked to what was now going to be defined as cerebral folate deficiency (CFD), which overlapped with symptoms of autism spectrum disorder (ASD). Approximately 70% of children with ASD were testing positive for these antibodies. This was an unexpected and exciting discovery! Again, it seemed that a blockage of folate transport by these autoantibodies was the culprit.

With the discovery of FRAAs in neural tube defects and cerebral folate deficiency, (overlapping with ASD symptoms), it was imperative to develop a commercially available assay (test) that would be able to screen for folate receptor autoantibodies on a mass scale. Again, the purpose was to detect FRAAs via a simple non-invasive blood test, replacing the need for any lumbar punctures to measure cerebrospinal fluid (CSF) folate levels.

Licensed by the Research Foundation for SUNY to Religen Inc, a company focused on neurodevelopmental disorder diagnostics, the test was validated in their CLIA-certified labs and made available globally to the public in 2016. As the test gained prominence, there were other areas of neuropsychiatry and neurodevelopment disorders where FRAT^® was applied. This included:

• Schizophrenia
• Depression
• Epilepsy
• Subfertility
• Multiple Sclerosis
• Parkinson’s Disease

Along with the development of the FRAT^® test, there were other major key scientific milestones which bolstered the science behind folate receptor autoantibodies and their implications in neuropsychiatric and neurodevelopmental disorders.

• Animal Models: Studies in rats showed that FRAAs exposure during pregnancy caused fetal brain malformations and behavioral deficits, reversible with folinic acid treatment.
• Clinical Trials:
  • A 2012 study found that 75% of children with ASD had FRAAs, and those treated with folinic acid showed improvements in language and social interaction8.
  • Follow-up research confirmed FRAAs’ role in subfertility, preterm birth, and neuropsychiatric disorders (e.g., schizophrenia, depression).
  • FDA Clinical trials using FRAT^® and treating with folinic acid are currently ongoing.

FRAT^® has garnered worldwide use as it has become a practical diagnostic to indicate the presence of folate transport impediments. As such, physicians have had much success with its use and their subsequent treatment protocols after receiving FRAT^® results.

• Diagnostic Use: FRAT^® is recommended for:
  • Children with ASD, developmental delays, or seizures.
  • Women with a history of NTD pregnancies or subfertility.
  • Patients with treatment resistance depression, or depression in general.
  • Patients with neurodevelopmental/neurodegenerative disorders.
• Treatment Guidance: Positive results often lead to folinic acid therapy, which bypasses blocked folate receptors. This determination will be made by the physicians after FRAT^® results are provided.

FRAT^® is a fascinating test and so is the science behind it. Beyond its utility in identifying possible folate transport issues, it is a guideline for treatment that can and has benefited thousands upon thousands of patients.

• Research continues on:
  • Maternal FRAAs screening to prevent developmental disorders.
  • Dietary interventions (e.g., dairy avoidance) to reduce antibody production.
  • Genetic and environmental factors influencing FRAAs prevalence.

For more information, please visit www.fratnow.com