This is the paper showing probiotic therapy works in the mouse model of an autism risk factor.
Our collaborator at Arizona State University, James Adams, has put together a useful summary and analysis (with references) of the incredibly diverse array of autism treatments out there – including many pharmaceuticals, diets, dietary supplements, chelation, hyperbaric oxygen, etc. This is intended for the lay public.
Another fascinating feature of this PDF is a table showing the results of ratings of all of these treatments obtained from surveys of >27,000 parents of autistic kids. Such results must be taken with a grain of salt because these are not double blind clinical trials but rather the opinions of parents on the benefits and drawbacks of treatments they have tried. Thus, there is the risk of a placebo effect. Nonetheless, there are so many negative ratings on this list that the placebo effect may not be such a big problem – altho it could still be relevant to particular treatments. I reprint this summary table below. Altho it may be too small read all the entries, below the table I’ve picked out some of the points that are of particular interest to me.
I’m struck by the nearly total failure of the plethora of pharmaceuticals; we knew this before, but seeing so many in one table is impressive. One bright spot is the apparent success of two anti-fungals, Diflucan and Nystatin. These were used selectively, where indicated by evidence of infection. In my opinion, this points to the gut microbiota. In this same context, it is surprising to find that antibiotics failed, as I know of two double blind studies that showed positive effects of antibiotics on ASD symptoms, altho the symptoms returned after the antibiotic was discontinued. Maybe the latter finding is the reason for the negative rating. A really impressive finding in this survey is the marked success of a variety of special diets. 8 of these were rated very highly. Similarly, many dietary supplements were rated highly, the best being fatty acids. On the other hand, I was quite surprised to see that both chelation and hyperbaric oxygen treatments were rated highly. The section on the latter treatment summarizes situations in which it can be quite dangerous, and the lack of strong support from double blind studies. The same caveats apply to chelation.
A paper just out from the Shenzen Beike Cell Engineering Research Institute in Guangdong, China presents the first results of a proof-of-concept, safety trial of stem cell (SC) injections in 37 autistic children. The justification for this intervention is primarily that animal studies of various inflammatory conditions can be ameliorated by SC therapies, and there is good evidence of immune dysregulation in autism (as well as Rett, OCD, PANDAS and Tourette). It is not suggested that the SCs will populate the brain and participate in the circuitry.
Two types of cells were used: human cord blood mononuclear cells and umbilical cord-derived mesenchymal SCs. The first group of patients initially received the cord blood cells by intravenous infusion and then, at 5-7 day intervals, they received 3 more injections by the intrathecal (spinal) route. They also received behavioral therapy. The second group of patients two cord blood intravenous and intrathecal injections each, followed by two umbilical SC intrathecal injections. This group is termed the combination group. They also received behavioral therapy. The third group of patients received only behavioral therapy.
The drawbacks in this study are that it was non-randomized, open-label (everyone knew who received which treatment), conducted at a single center, primarily by people who were employees at the company that produces these SCs (Beike Cell Engineering Research Inst). Thus, we can’t take the autism-related results too seriously, but we can probably rely on the results related to safety – they report that none of the 23 subjects that received multiple injections of these (foreign) cells displayed signs of toxicity or changes in blood biochemistry over the 6 months of the study. This bodes well for future studies of this kind.
Regarding the behavioral data, they did not use the gold standard ADOS method of scoring autism symptoms. Rather, they used the descriptive CARS, ABC Chinese Version, and the CGI (global) scales. In all of these 3 measures, the combination treatment group showed improvement over the control group. The single, cord blood treatment group was somewhat intermediate in efficacy. The large grain of salt is, as mentioned above, the folks doing the evaluations were aware of the treatment used on each patient. Plus, the number of subjects in each group was small (but not minuscule!). No doubt, these results will push this group and other SC labs and companies to move forward with further testing, hopefully double-blind!
As discussed in my book, stress promotes inflammation and immune dysfunction, as well as anxiety. A new and very complete paper from John Sheridan and colleagues at Ohio State University provides evidence that stress also induces an influx of immune cells into the brain, and that this causes anxiety symptoms. They stressed mice by putting an aggressive intruder into their cage for 2 hours each night for 1, 3 or 6 nights. This intruder subdues the residents and makes them subordinate, but does not injure them. Increasing the days of this stress causes and increase in anxiety in the resident mice, as measured in separate assays (not in the presence of an intruder) by their reluctance to enter the center of an open field and their reluctance to go from a dark box into the light. These are some of the standard ways of measuring anxiety in mice. Increasing the days of stress also causes an increase in immune cells called monocytes in the blood. Using a genetic labeling technique, the investigators went on to show that some of the monocytes then entered the brain, where they became macrophages. Moreover, the parts of the brain where these invading cells are found are the areas known to control anxiety behavior.
This entry into the brain is caused by chemokine signals eminating from the brain itself, and if these signals are blocked, the immune cells do not enter the brain and, importantly, the mice do not display anxiety. That is, if mice who cannot do this chemokine signaling are placed in this highly stressful situation, they do not become anxious and their brains do not display the invading immune cells. The suggestion is then that the stressed brain recruits immune cells to do something that leads to anxiety. This ‘something’ could certainly involve cytokines, as stress increases cytokines in the brain, and cytokines can induce anxiety. But why recruiting macrophages is necessary when the brain’s own cells can produce those cytokines is a mystery. Perhaps the recruited immune cells are also carrying out another function that is helpful (or harmful?) in dealing with social stress. What this might be remains mysterious. It is also not clear how long these invaders remain the brain after the stress is over. Creepy?
Major depressive disorder (MDD) is quite common and can be very disabling if not treated properly. However, fewer than 40% of patients achieve remission with their initial treatment. In the case of ineffective therapy, those patients often then experience months of trials using various different selective serotonin reuptake inhibitors (SSRIs), or they move on to other psychotherapists, or they drop out of treatment attempts altogether, which can be disastrous. Therefore, it would be of great importance if an objective, quantitative test were available to guide the patient towards the optimal treatment direction at the outset. Helen Mayberg and colleagues at Emory University in Atlanta have recently published an important step forward in this direction. They measured brain glucose metabolism by PET (positron emission tomography) imaging in a series of MDD patients before any form of treatment was started. They then randomly assigned the patients to either of two groups: treatment with a standard anti-depression medication (SSRI) or treatment with evidence-based psychotherapy. Of the 38 patients with clear outcomes, 12 responded well to cognitive behavioral therapy, 11 to SSRI treatment, 9 did not respond to psychotherapy, and 6 did not respond to the SSRI. They then asked whether glucose metabolism in various parts of the brain clearly corresponded to these 4 patient groups. In fact, measurement of the metabolism in the right anterior insula was able to discriminate among the groups: Lower metabolism was associated with remission in response to psychotherapy and no remission in response to SSRI treatment, while higher metabolism was associated with remission in response to SSRI treatment and no response to psychotherapy. If this finding can be reproduced in a large, prospective trial, it would mean, first, that new MDD patients could be assigned to the treatment path that is appropriate for them and with the best chance to succeed., and second, it would argue that these two groups of patients have a distinct neurophysiological basis for their MDD.
Incidentally, Mayberg has also spearheaded the use of deep brain stimulation for MDD that is resistant to any type of standard treatment. While this approach is deeply invasive, it appears to be quite promising for those patients who have run out of other treatment options.
Some of the classes I taught in Uganda in June –