Can the gut microbiome help us treat autism?

Can the gut bacteria help us to fight autism? According to a recently published study, introducing bacteria from healthy individuals into the gut of the children diagnosed with autism spectrum disorders (ASD) can markedly improve not only gut function but also the severity of ASD symptoms.

ASD affect social interactions and communication, characterized by restricted, repetitive patterns of behavior, and activities. Currently, no cure exists for ASD treatment, but some medicines are available and can help with symptoms like depression, seizures, and insomnia. Due to the limited treatment options, scientists are looking for novel ways to treat autism and recently the role of the bacteria which live in our gut, is under evaluation as a new target for treatment. Children with ASD often suffer from gastrointestinal  disorders, suggesting that the gut-brain axis is regulating ASD. In fact, there is some evidence in the literature where the severity of such disorders was linked with ASD severity.

Among the first observations supporting a role for the gut bacteria, stem from germ-free mice (mice born without being exposed to bacteria) which showed depressive-like behavior. Several studies showed that this abnormality can be corrected through colonization with gut bacteria.  In humans, several previous studies have reported differences in the composition of the gut bacteria when comparing children with and without ASD. Hence, the question which arises is can we change these bacteria in a way to change also disease activity?  

In 2017 a study called “Microbiota Transfer Therapy alters the gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study,” published in Microbiome journal, showed evidence that gut bacteria can potentially be used in autism treatment. During this study, researchers used the microbes which were present in the feces of healthy individuals without ASD and transplanted them to children with ASD. This treatment not only reduced gut problems but also improved autism symptoms.

The rationale behind this treatment is that beneficial bacteria from healthy individuals will be introduced in the gut of the children with ASD, correcting microbial disbalances and improving their gut function. However, the question in studies that target microbiota is whether the improvements are transient or have a long-lasting effect.

Two years after the first publication of the microbiota transfer therapy, the authors published the follow-up results from the same group of children and demonstrate that the beneficial effects from fecal transplantation, in both gut problems and ASD symptoms were persistent. In addition, both parents and a professional evaluator reported a slow but steady reduction of core ASD symptoms (language, social interaction, and behavior)  during treatment and over the next two years.

These findings are highly promising for microbiota transplantation as a non-pharmacological treatment for children with ASD with gastrointestinal problems. However, as authors write in their article the cure is not there yet and “We recommend future research including double-blind, placebo-controlled randomized trials with a larger cohort.” Emphasizing the necessity to understand better the mechanism first of the fecal microbiota transfer before it can be applied it as a treatment.

 

Further reading:

Dae-Wook Kang et al. 2019. “Long-term benefit of Microbiota Transfer Therapy on autism symptoms and gut microbiota”, Scientific Reports, 9. https://www.nature.com/articles/s41598-019-42183-0

Dae-Wook Kang et al. 2017. “Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study”. Microbiome, 5. https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-016-0225-7

 

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Whenever I ask my patients, if they are eating their “5 a day”, the immediate answer is “Yes, sure”. However, sometimes I´m not sure if their “Yes, sure” belongs to their real eating behavior or if it is more like wishful thinking. This question applies for a broad range of behavior, like taking the stairs instead of the elevator, having enough sleep, walking the 10.000 steps a day etc.. But how can we be sure what people really do in their everyday life?

The answer is: Ambulatory Assessment

Ambulatory Assessment is the state of the art method for assessing current emotional states, feelings, and behavior in the natural environment of an individual’s everyday life. Equipped with smartphones and accelerometers, it is feasible to track how individuals feel at specific moments, what they are eating across a day and how they physically behave in real time and real life. Electronic e-diaries, provided by an App, prompt individuals whenever an event occur or randomly several times a day. Especially in patient groups with attention deficits, prompting short questionnaires several times a day show better recall than an extensive end-of-day questionnaire.

In the past, food-diaries were based on unhandy and retrospective paper-pencil-questionnaires or computer input. Nowadays, new technological opportunities pave the way to e-food-diaries on smartphones, enabling an immediate and flexible input capability. The design of e-food-diary-apps may be different, i.e., by photos, drop-down-menu, text, or voice records. Important is the documentation of what and how much the participants eat and drink and a database that can be connected to an international or national food code for data analysis.

In the Eat2beNICE research project, we assess food intake every time participants eat or drink by a drop-down-menu that leads from general to very detailed food-items and asks for general meal portions and amounts every time participants eat and drink across the day. If a participant cannot find a particular food-item, he or she has the opportunity to enter a free text message or to record a voice message. If participants forget to enter some foods and drinks across the day, they will receive a reminder in the evening to add forgotten items. This procedure enables very accurate tracking of participant’s food intake in our study.

To sum up, thanks to modern technology we can now accurately measure what a person feels, does and eats throughout the day. Of course, the design of an e-food-diary on the smartphone depends on the projects’- and samples’ requirements. Overall, it has to be easy to use, easy to implement in daily life and to be fun for the participants to obtain a high level of compliance and a high-quality database.

REFERENCES:
Ebner-Priemer, U. W., & Trull, T. J. (2009). Ambulatory Assessment: An Innovative and Promising Approach for Clinical Psychology. European Psychologist, 14, 109–119. https://doi.org/10.1027/1016-9040.14.2.109.

Engel, S. G., Crosby, Ross, Thomas, G., Bond, D., Lavender, J. M., Mason, T., . . . Wonderlich, Stephen. (2016). Ecological Momentary Assessment in Eating Disorder and Obesity Research: a Review of the Recent Literature. Current Psychiatry Reports, 18, 37. https://doi.org/10.1007/s11920-016-0672-7.

Fuller, N. R., Fong, M., Gerofi, J., Ferkh, F., Leung, C., Leung, L., . . . Caterson, I. D. (2017). Comparison of an electronic versus traditional food diary for assessing dietary intake-A validation study. Obesity Research & Clinical Practice, 11, 647–654. https://doi.org/10.1016/j.orcp.2017.04.001.

Smyth, J., Wonderlich, S., Crosby, R., Miltenberger, R., Mitchell, J., & Rorty, M. (2001). The use of ecological momentary assessment approaches in eating disorder research. The International Journal of Eating Disorders, 30, 83–95.

Stein, K. F., & Corte, C. M. (2003). Ecologic momentary assessment of eating-disordered behaviors. The International Journal of Eating Disorders, 34, 349–360. https://doi.org/10.1002/eat.10194.

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