About the Test
FRAT® is an acronym for Folate Receptor Autoantibody Test. This blood test measures the presence of autoantibodies to the folate receptor alpha (FRa). If autoantibodies are present, then there is an indication that folate (vitamin B9) is not being properly distributed across the blood brain barrier and into the Cerebrospinal Fluid (CSF). Folate is a critical nutrient for proper neurological growth and function. For more information – CFD Syndrome
FRAT® consists of 2 parts – a blocking assay and a binding assay. “Assay” is the technical laboratory term for a quantitative test of a substance. In other words, the FRAT® “assays” quantify the amount of blocking autoantibodies and binding autoantibodies present. Both types of autoantibodies inhibit the transport of Folate to tissues such as the brain. Blocking autoantibodies directly block the access of Folate to the receptor, while binding autoantibodies are thought to affect the general position of the receptor so that Folate can't get through it and into the tissue properly. Indirectly, the assays inform us about the availability of Folate (and its active form called 5-MTHF) in these tissues.
Some children with Cerebral Folate Deficiency (CFD) or Autism Spectrum Disorder (ASD) or related disorders can have either one of these autoantibodies (blocking or binding) or both. We screen for both categories of autoantibodies to ensure that no positive samples are missed.
There are no large, systematic studies in such children, but a number of publications indicate that some patients with these disorders also have these autoantibodies.
We have a series of checks and balances in place to ensure that all steps in the assay are carried out correctly. Each assay has to be validated using strict criteria. We strive to reduce variability and maintain consistency from one assay to the next. Sometimes an assay needs to be repeated because the result is equivocal or borderline, for reasons not always known.
Autoantibodies tend to fluctuate over time. The causes are not always known. In some cases, the increased intake of cow's milk, or any other type of animal milk, elevates the levels of the autoantibodies and removal of milk from diet tends to lower the levels in some children.
The incidence of autoantibodies in children without neurological disorders is about 2-3%, and in the population at large it tends to increase with age, reaching 10-15% after the age of 65.
Yes, there are many scientific publications available for review. You can obtain these on our website at FratNow.com/publications.
Testing other family members for folate receptor autoantibodies is generally a good idea. Oftentimes, additional family members carry the autoantibodies, although symptoms may vary. We suggest speaking with your physician to determine the best course of action.
Folate receptor autoantibodies do fluctuate from time to time. This may be attributed to diet (exposure to dairy) or immune response at the time of testing. If FRAT® is initially negative and there are still symptoms, it may be recommended to re-test. Please consult your physician.
It is generally recommended to re-test after 6 months of the initial FRAT® test. Please consult your physician.
Sometimes, FRAT® will detect the presence of soluble folate receptor. Although there is no scientifically validated reason why this occurs, some samples will exhibit this condition. It is recommended that you speak to your physician for further information.
Testing other family members for folate receptor autoantibodies is generally a good idea. Oftentimes, additional family members carry autoantibodies, although symptoms may vary. We suggest speaking with your physician to determine the best course of action.
Cerebral folate deficiency syndrome (CFD) is characterized by low levels of folate (vitamin B9) in the cerebrospinal fluid (CSF). CFD syndrome is diagnosed in early childhood and may be associated with developmental delays, intellectual disability, autism spectrum disorder, speech and language impairments, movement disorders, seizures, and behavioral abnormalities. The severity and specific symptoms can vary widely among affected individuals.
CFD syndrome may be caused by genetic mutations that affect the transport of folate in the brain. There is also evidence to suggest that autoantibodies against the folate receptor alpha (FRα) in the brain may be involved in CFD syndrome. FRα is responsible for transporting folate across the blood-brain barrier.
FRAT® screens for autoantibodies against the folate receptor alpha (FRα).
Yes, there are numerous publications that detail the role of folate receptor autoantibodies and Cerebral Folate Deficiency Syndrome. Please visit FratNow.com/Publications for further details.
Generally, your physician may be able to suggest local blood-draw centers in your area, which may include general hospital laboratories that draw blood, or private labs.
Other suggestions would include sourcing a local mobile phlebotomist in your area that can come directly to your home.
Generally, FRAT® kits are received within 3 to 5 business days, depending on your geographical location.
The assays are not simple to perform, and each assay takes five to seven days, because of the need for overnight incubations. Turn-around time is generally 2 to 4 weeks for reports to be sent to your physician.
No, fasting is NOT necessary. If you are taking Folinic Acid or 5-MTHF supplements, please withdraw from these supplements for a period of 48 hours (about 2 days) prior to blood draw.
Yes. If you are taking Folinic Acid or 5-MTHF supplements, please withdraw from these supplements for a period of 48 hours (about 2 days) prior to blood draw. Sometimes, these supplements may affect the quantitative results of FRAT® if they are still in the system.
As a general principle, any prolonged removal of samples from refrigeration can damage the autoantibodies and lead to reductions in their levels. However, the autoantibodies should be stable for 1-2 days at room temperature.
Billing and Insurance
At this time, the tests are not reimbursed by insurance companies. We are working diligently, however, to have these tests covered.
The price for FRAT® is $295.00 for both tests (blocking and binding). We accept all major credit cards and checks for payment.
There is NO cost for the FRAT® test kit. We send that to you free of charge upon ordering. Please note that a physician’s requisition and authorization is required for FRAT® to be processed. Please consult your physician for further information.
Yes, HSA may be accepted. Please check with your provider.