Medication absorption for children with autism

Research indicates that medication absorption in children with autism should be examined more closely due to the connection between autism and gastrointestinal issues.

Recent research has revealed that many children and adults with autism experience gastrointestinal symptoms and that such symptoms can impact the absorption and availability of medications.

Because approximately 35% of people with autism take at least one psychotropic medication to help control their symptoms, the authors of a Journal of Clinical Pharmacology commentary are calling for a formal evaluation of the potential relationship between gastrointestinal symptoms and the effectiveness of autism medications. Alternative modes of drug administration may be needed to provide more effective therapy for patients.

"Admittedly, there are a number of variables that can influence medication response but given how common gastrointestinal issues are for those with autism, it seems the relationship should be examined more closely," said senior author Dr. Maria Valdovinos.

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Research shows that children with autism have different bacteria in their guts

A study looked into the bacteria that children with autism have in their gut and concluded it is in different concentrations than the bacteria found in children without autism.

Children with autism spectrum disorders (ASD) have significantly different concentrations of certain bacterial-produced chemicals, called metabolites, in their feces compared to children without ASD. This research, presented at the annual meeting of the American Society for Microbiology, provides further evidence that bacteria in the gut may be linked to autism.

"Most gut bacteria are beneficial, aiding food digestion, producing vitamins, and protecting against harmful bacteria. If left unchecked, however, harmful bacteria can excrete dangerous metabolites or disturb a balance in metabolites that can affect the gut and the rest of the body, including the brain," says Dae-Wook Kang of the Biodesign Institute of Arizona State University, an author on the study.

Increasing evidence suggests that children with ASD have altered gut bacteria. In order to identify possible microbial metabolites associated with ASD Kang and his colleagues looked for and compared the compounds in fecal samples from children with and without ASD. They found that children with ASD had significantly different concentrations of seven of the 50 compounds they identified.

"Most of the seven metabolites could play a role in the brain, working as neurotransmitters or controlling neurotransmitter biosynthesis," says Kang. "We suspect that gut microbes may alter levels of neurotransmitter-related metabolites affecting gut-to-brain communication and/or altering brain function."

Children with ASD had significantly lower levels of the metabolites homovanillate and N,N-dimethylglycine. Homovanillate is the breakdown product of dopamine (a major neurotransmitter), indicating an imbalance in dopamine catabolism (the breaking down in living organisms of more complex substances into simpler ones with the release of energy). N,N-dimethylglycine is a building block for proteins and neurotransmitters, and has been used to reduce symptoms of ASD and epileptic seizures.

The glutamine/glutamate ratio was significantly higher in children with ASD. Glutamine and glutamate are further metabolized to gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. An imbalance between glutamate and GABA transmission has been associated with ASD-like behaviors such as hyper-excitation.

Using next-generation sequencing technology, the researchers also were able to detect hundreds of unique bacterial species and confirmed that children with ASD harbored distinct and less diverse gut bacterial composition.

"Correlations between gut bacteria and neurotransmitter-related metabolites are stepping stones for a better understanding of the crosstalk between gut bacteria and autism, which may provide potential targets for diagnosis or treatment of neurological symptoms in children with ASD," says Kang.

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New and odd ideas for treating autism symptoms.

Fasten your seatbelt - new and unusual autism treatments (???): hot baths and worm eggs, were presented at a recent meeting  to help with autism symptoms. 

I was asked what I thought of these treatments... My impression, from a medical  standpoint is..."YIKES", "OMG" and "You are kidding, right?". 

It goes without saying, but Ill say it....I DO NOT recommend these therapies.   1) There does not seem to be biologic plausibility. 2) This is not nearly convincing data. 3) There may be dangers in these treatments (the picture of the child sitting alone in the bath is intended to be alarming).  

http://www.autism-watch.org/ is still a good site. 

Hardly a nihilist on therapeutics, I look forward to more data on effective treatments.    - JR

A new study shows that two unusual treatment approaches may have beneficial effects on the symptoms of autism in children and adults with the disorder. Using a hot bath to raise body temperature and thereby mimic the effects of infection, or using worm eggs to stimulate the production of immunoregulatory factors in the gut to diminish inflammatory signals, both attenuated symptoms of autism. These findings support the idea that disruption of systems in the body that control inflammation may contribute to the disorder. The study was presented at the American College of Neuropsychopharmacology (ACNP) Annual Meeting.

Approximately 1 in 88 children are afflicted with autism spectrum disorder (ASD). A prevailing hypothesis of ASD is that a hyperactive immune system, resulting in elevated levels of inflammation, may contribute to the disorder. Consistent with this possibility, it is known that approximately one third of those with ASD show a clinical improvement in symptoms in response to a fever.

In a new study led by Eric Hollander MD, a professor at Albert Einstein College of Medicine in New York, the effects of two novel treatment approaches that modify aspects of inflammation were tested on ASD symptoms.

First, as fever may trigger the release of protective anti-inflammatory signals in the body, the effects of raising body temperature to mimic fever on ASD symptoms were assessed. It was found that children with ASD and a history of positive behavioral response to fever had improved social behaviors when bathed each day in a hot tub at 102oF compared with water at 98 oF.

Second, using a more unusual approach, adults with ASD were treated for 12 weeks with Trichuris suis ova (TSO), which are the eggs of the worm helminth trichura (whip worm). This worm is safe in humans as it does not multiply in the host, is not transmittable by contact, and is cleared spontaneously. However, the worms can inhibit immune-mediated responses and diminish inflammation.

The subjects for this study were 10 high functioning ASD patients who were able to give informed consent and who had a history of allergies or a family history of immune-inflammatory illness. Patients were treated for 12 weeks with the worm eggs (2500 eggs every two weeks) but were also subjected to a 12 week placebo phase in a randomized order. It was found that adults with ASD had improvement in repetitive and ritualistic behaviors in response to treatment with the worm eggs.

This is not the first time that worm eggs have been used successfully to treat diseases, particularly immune-related diseases, in humans such as Crohn's Disease. As noted by Dr. Hollander, "TSO has been shown to improve various immune inflammatory illness by shifting the ratio of T regulator/T helper cells and their respective cytokines.."

The findings support the idea that inflammation may contribute to the symptoms of autism, at least in some individuals, and highlight novel treatment approaches. However, as noted by Dr. Hollander, the small sample size and unusual treatment approach means that caution should be exercised when interpreting the studies:

"Future studies in autism spectrum disorders are needed to replicate and expand these findings, and to study younger subjects with more severe irritability."

Nevertheless, the findings raise the intriguing possibility that approaches designed to module immune responses in ASD patients may be future treatment approaches for the disorder.

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Study: Gut Bacteria Levels Lower in Children with Autism

A study claims that children with autism have lower levels of bacteria in the gut which makes them more susceptible to harmful bacteria.

A link may exist between autism and bacteria in a child's digestive tract, a small new study suggests.

Researchers analyzed gut bacteria in fecal samples from 20 children with autism and 20 children without the disorder. The children with autism had significantly fewer types of gut bacteria, which potentially could make them more vulnerable to harmful bacteria.

The study also found that children with autism had significantly lower amounts of three types of important gut bacteria.

Autism, a neurodevelopmental disorder that can range from mild to severe, affects social and communication skills.

The new study appears July 3 in the journal PLoS One.

"One of the reasons we started addressing this topic is the fact that autistic children have a lot of [gastrointestinal] problems that can last into adulthood," study leader Rosa Krajmalnik-Brown, a researcher at Arizona State University's Biodesign Institute, said in a university news release. "Studies have shown that when we manage these problems, their behavior improves dramatically."

This type of research could lead to new ways to treat autism-associated gastrointestinal problems, and improve diagnosis, prevention and treatment of autism, the study authors said.

Previous research has shown that gut bacteria plays a role in a wide range of important functions, including digestion, controlling body weight, immune response regulation and the production of neurotransmitters that affect the brain and behavior.

Although this study showed a potential link between gut bacteria and autism, it did not prove a cause-and-effect relationship.

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