Albert Einstein – perhaps an Aspie, but not a
TBCB autistic
Today’s post was prompted by a very
matter of fact approach proposed to deal with autism caused when both mother
and father carry a single mutation in the TBCB gene. The unaffected parents produce a
child with a 25% chance of having autism and a very specific movement disorder because the child has mutations in both of its copies of the gene.
The TBCB gene helps make something
called tubulin, which is one of the three main components of the cytoskeleton.
The cytoskeleton plays a role in many
well-known neurodegenerative disorders such as Parkinson's disease, Alzheimer's
disease, Huntington's disease, and amyotrophic lateral sclerosis (ALS).
Disruptions
in tubulin's normal function can impair cellular processes, including those
involved in neuronal signaling and motor control, contributing to movement
disorders. So we should not be surprised that one feature of TBCB autism is a
difficulty in learning how to walk
In non-Jewish populations, the
occurrence of the mutation in TBCB is 5 in 100,000.
In Ashkenazi Jews, the rate is 1 in 80.
The Israeli Health Ministry
incorporated a screening test for the TBCB gene mutation as part of the
national healthcare basket in November, making it accessible to all couples
planning for pregnancy.
As reported in the Times of Israel, the
parents’ options proposed are:
“They
can choose to have an abortion, she said, or to have in-vitro fertilization
with genetic screening, in which only embryos without two abnormal copies of the TBCB gene are put into
the uterus.
The
third option is to keep the pregnancy, she said.
A
year after the child is born, she said, parents will be able to see if their
child has difficulty with motor development.
In
that case, “they can give the child physiotherapy at an early age and help them
develop,” Bratman-Morag said.
The
illness “causes them difficulties with walking, but they can learn to live with
that,” she said.
I don’t think you could be quite so
blunt in other countries. The autism self-advocates would go bananas. Their
worst dreams have actually materialized – "eugenics" has arrived and in Israel of
all places.
The IVF therapy suggested is a very
pragmatic approach. I am really surprised they propose it.
The arguments are similar to those
that surround Down syndrome. In the world’s most advanced countries, like
Denmark and Iceland, almost all DS fetuses are aborted.In the US the number of live births actually went
up, according to the chart below.
The difference with TBCB is that you can test the parents before conception and not just the fetus.
Many genes are tagged as being associated with higher IQ, or higher educational attainment and some of these are also linked to autism.
Like it or not, some groups of people
are cleverer than others, Albert Einstein might have been at the extreme for Ashkenazi Jews, but he comes from a clever genetic group.
These discrete genetic groups are created by what is politely referred to as
endogamy (marrying within the community), biologically it is interbreeding.
Unfortunately, there are also
downsides caused by centuries of interbreeding particularly within a group that
started out relatively small. European royal families famously suffered from
it; in their quest for political alliances they created very unhealthy
bloodlines.The Habsburg dynasty took
marrying their cousins to an extreme in their quest to keep territory and
wealth in the family. This led to infertility, intellectual disability,
physical disability, reduced lifespan and the famous Habsburg pronounced lower
jaw. For American readers, this family were the royalty in Austria-Hungary,
Spain, Holy Roman Empire (Germany etc), Belgium, Luxembourg, Netherlands etc. Very briefly a Habsburg, Maximilian I, was Emperor of Mexico - he was executed by firing squad in 1867.
Ashkenazi Jews are descended from
communities that lived in Central and Eastern Europe in the middle ages. The majority
now live in the United States. Of 11 million people, 6 million live in the
United States. In the world there are another 5 million non-Ashkenazi Jews. In
Israel there are 7 million Jewish people and the largest group is Mizrahi, who
are descended from the Middle East and North Africa.
For Ashkenazi Jews the following
medical conditions are known to be over represented:
About one in
every 40 Ashkenazim has a BRCA mutation; in the general population, the
rate is about one in every 400 people.
GREM1, linked to colon cancer
APC, linked to colon cancer
This
is a wealthy group of people living in a country that looks after the health of
rich people very well. That must be the reason why the group has been so well
studied. I was a little surprised.
The recent research in Israel has
identified the TBCB gene to be an autism gene and that mutations are
substantially more come in Ashkenazi Jews.
The mutation is not more common in the
other Jewish ethic groups (Sephardi, Mizrahi, Ethiopian, Yemenite, Bukharan,
Indian, Kavkazi, Karaite, Cochin, Kaifeng).
Conclusion
I was a little surprised to learn recently
from a chat with a kindergarten teacher who worked in Qatar that many of the
kids already knew who they were going to marry. “He’s my cousin and I am going
to marry him when I grow up,” said the little girl. This kind of arranged
marriage is still common there. Well the Habsburgs also did it, so a European
can hardly judge them.
Consanguineous marriage (cousin
marriage) is alive and well.
Mixing up the gene pool looks to me
like the best way to go.
In ancient times forced mixing was
common. The Vikings used to abduct young women on the raiding trips across
Europe, this continued until the Christianization of Scandinavia between the 9th
and 12th centuries. In the wilder parts of the Balkans there was a
practise called otmitza up until the 1800s, which can be best described as
bride kidnapping, where the bride would be brought from a distant community
over the mountains. In parts of Central Asia the practise of ala kachuu (to take
and flee) continues to this day. In Kyrgyzstan 14% percent of married women say
they were kidnapped. The UNDP have a special program to try and stop it.
When it comes to reducing
neurodevelopmental disorders mixing up the gene pool looks the best option. Modern
technology risks taking society in the opposite direction with online dating apps
matching Aspie girl with Aspie boy to then potentially produce a more severe
kind of autism, but then their bloodlines end. Mother Nature can indeed be
harsh.
I wonder what will be the next genetic
test for autism to join Israel’s “national healthcare basket.” Some people will
like the idea and others will not, but it looks like the future is already
here.
Most of my interactions in the world of treating autism are
with people I have never met, but you cannot help keep learning new things.
I was recently contacted by a mother who is computer
programmer and so used to dealing with “exact sciences.” She had read my book
and noted from it that genetic testing in autism often misses important genes. Her
child’s report stated that there were no mutated autism genes found. She asked if I
know how to analyse the raw data from the testing. That is a bit too technical
for me, though I discovered you can upload that file to ChatGPT for analysis. I
said that all I do is take the 10-20 genes highlighted in the full report and
look them all up, regardless of whether they are obvious autism genes or not.
Back came the very short list and after a couple of minutes “Bingo” there was
the gene. It was not on the lab’s “autism list,” but in the research one of the
genes is described as having potential to cause autism.
In a perfect world the testing lab would have an updated
list that includes all the genes known to cause autism, or indeed intellectual
disability. It is not the exact science the mother is used to, it is sloppy
science. You must dig deeper than you thought would be really necessary.
I did meet, in real life, the parents of a young child with
severe autism a week or two ago. They had tried all sorts of expensive
therapies, from stem cell therapy to GcMAF from Japan. There was a scandal in
the US and Europe a decade ago when GcMAF was marketed to treat cancer, autism
and other conditions. In Japan it is still used in alternative clinics, but it
is not an approved therapy or a regulated drug anywhere.
I was told that in Japan GcMAF is now made from a patient’s own
blood and saw that it is marketed as a "personalized" or
"natural" therapy. The process typically involves isolating the Gc
protein (a vitamin D-binding protein) from the patient’s blood, chemically
modifying it to activate macrophages, and then injecting it back
into the patient. I have no idea if it works.
I dared not ask how much it cost, but I did ask if it
helped. I suggested that in autism the cheapest and safest therapies are often
the most effective.
One reader of this blog remains a fan of the original GcMAF
that was produced by David Noakes' company Immuno Biotech. He later went to
jail in the UK and then in France for selling an unlicensed medical product. In
June 2015 Dr Jeffrey Bradstreet, a well-known autism doctor who used GcMAF, was
found dead the day after his office in Buford, Georgia was raided by the FDA, searching
for evidence of illegal medical practices related to unapproved drugs.
Japan seems to be more “anything goes” when it comes to
alternative medicine. This is probably not what you would have expected. GcMAF
is still marketed there to treat cancer and autism.
Safety
Safety should be the prime concern when treating autism. I
recall being told the key insight a mainstream doctor took away from attending the Brain
Foundation’s autism conference in California a while back was that “you actually can safely
treat autism.”
The GcMAF mother did ask me if it was safe.
Using common existing drugs that have been repurposed for
autism is safe, as long as they are used responsibly and care is taken
regarding interactions and the listed side effects.
Drugs taken orally are often considered inherently safer
than those administered via injection or infusion for several reasons, perhaps
the key one is the barrier of the digestive system.
When drugs are taken by mouth, they pass through the liver
before entering systemic circulation. The liver metabolizes some of the drug,
which can detoxify harmful substances or reduce their potency. This serves as a
protective mechanism. The stomach and intestines have mechanisms to break down
and filter harmful substances, adding another layer of safety.
Injectable drugs require sterile preparation and
administration to avoid infections. Oral drugs are less prone to contamination
since they do not bypass the body's natural barriers.
Gene therapy can be risky, as was shown recently in a trial for Rett syndrome:
Despite the
death, the FDA has allowed Neurogene to forge ahead with the Phase I/II Rett
syndrome trial, but using only the lower 1E15 vg dose of its investigational
gene therapy NGN-401.
Neurogene
revealed in an SEC filing on Thursday that a patient has died in its
Phase I/II Rett syndrome clinical trial after being dosed with its
investigational gene therapy.
The patient
had been treated with the higher, 3E15-vg dose of NGN-401 when they experienced
what was initially described only as a treatment-related serious adverse event (SAE). In
a follow-up announcement on Monday, Neurogene disclosed
that the patient had developed systemic hyperinflammatory syndrome—a known but
severe side effect of adeno-associated virus gene therapies—and was in critical
condition.
The plural of anecdote is data vs The plural of
anecdote is not data
"The plural of anecdote is not data"
is a commonly used phrase in scientific and analytical discussions. It
highlights the idea that individual anecdotes, no matter how numerous, do not
constitute reliable evidence or robust data without proper scientific methods
like controlled observation, experimentation, and statistical analysis.
The phrase the plural of anecdote is not data turns out to
have been a misquote. The original observation, by the political scientist Ray
Wolfinger, was just the opposite: The plural of anecdote is data.
Ray Wolfinger said this to emphasize that anecdotes, when
systematically collected and analyzed, can form the foundation of meaningful
data sets.
Wolfinger's point was not to dismiss the importance of
rigorous scientific methods but rather to highlight that even seemingly small,
subjective observations—when aggregated and scrutinized—can reveal broader
patterns and insights.
This perspective challenges the overly dismissive view of
anecdotes in research, acknowledging their potential as the seeds of inquiry
and evidence in contexts where comprehensive data collection may not yet exist.
Human biology is not an exact science
The phrase "human biology is not an exact science"
reflects the inherent complexity and variability of biological systems,
particularly in humans. Unlike the physical sciences, which often operate under
strict laws and predictable outcomes, human biology involves numerous
interacting factors, such as genetics, environment, lifestyle, and individual
variability. This makes it challenging to predict outcomes with precision.
Key reasons include:
Genetic
diversity: Each person has a unique genetic makeup, leading to
different responses to stimuli, medications, and conditions.
Environmental
influences: Diet, climate, socioeconomic status, and exposure to
toxins vary widely among individuals and populations.
Biological
variability: Even within the same individual, factors like age,
hormonal changes, and microbiome composition can cause variations.
Unpredictable
interactions: Complex systems, such as the immune response or neural
activity, often defy simple cause-and-effect explanations.
As a result, human biology relies on probabilities, trends,
and patterns rather than absolutes, making it a science of approximations and
context-dependent insights.
Again, bumetanide works for some
Our reader A.W. recently completed a trial of bumetanide and
in parallel the pediatrician made a trial on her own 5-year-old granddaughter with
severe autism. Bumetanide did not work for A.W. but it did for the 5-year-old
granddaughter. Notably her speech increased from single words to multiple
words. Continued use will now certainly bring profound benefits as she grows up.
We see that human biology is not an exact science, but the
situation is made worse by diagnostic stupidity. We know that there are many
hundreds of biological dysfunctions leading to the umbrella diagnosis of
autism. All autism is still lumped in together in these supposedly
gold-standard randomized clinical trials. In layman’s terms you have to compare
apples with apples, not apples with kiwis.
As a result, all large randomized clinical trials for core autism symptoms
have failed and will likely continue to do so. Even the large bumetanide trial failed.
Meanwhile some people, now including A.W.’s pediatrician,
will continue effectively treating a small number of children and adults with
autism.
Conclusion
When I presented my take at the recent autism conference in
Abu Dhabi I did have a confrontation with the moderator of my session.
I presented the scientific logic behind treating autism but
what he saw was someone dealing with anecdotes. He said he only believes in
randomized clinical trials. 15 years ago I would also have thought like him—then came my epiphany.
I then learnt the benefit of tinkering with things you supposedly
cannot fix but cannot just throw away and replace.
I do fix many other things. I had Monty’s two electric
scooters in pieces several times recently, the last job was fixing the battery
pack that malfunctioned. I have no previous experience, you just start
tinkering, apply common sense and solve the problem. Having a spare scooter is
an advantage.I can always buy a third
one.
In years only recently gone by you did discard “malfunctioning”
young children into institutions. The doctor would then suggest you try again for another child and
wish you better luck next time. Like buying scooter number two and discarding
the first one.
Nowadays you keep such children at home, leave them untreated, and only later on put
them into mini-institutions (AKA group homes).
I think it pays to tinker (play around fixing things) and
improve functioning as much as possible. There is no guarantee of success, but you do have a fighting chance.
Wonder cures promoted in catchy 60 second videos on TikTok, Facebook and Instagram may not be your best choice.
Both clonidine and guanfacine were raised recently to me,
they have been covered in various earlier posts and in my book. Here is a round-up
of the information.
These two drugs are α2A-adrenergic receptor agonists originally
used to treat high blood pressure. Subsequently many additional uses of these
drugs have been discovered.
I was asked about its use to treat mast cell activation
syndrome (MCAS) and the mechanism by which it achieves this effect is
interesting.
Calming mast cells – the ones that release histamine
during an allergic reaction
Clonidine/guanfacine, as alpha-2 adrenergic agonists,
inhibit mast cells primarily by interacting with the central and peripheral
nervous systems, leading to a decrease in the release of inflammatory
mediators. Its mechanism involves stimulating alpha-2 adrenergic receptors,
which in turn suppresses the release of norepinephrine and other
neurotransmitters.
In terms of mast cell stabilization, clonidine/guanfacine is
thought to reduce intracellular calcium levels and inhibit the degranulation
process that releases histamine and other pro-inflammatory substances. Lower
intracellular calcium prevents the activation of key signaling pathways that
normally trigger mast cell activation and degranulation.
This stabilizing effect helps prevent excessive allergic and
inflammatory responses, making clonidine/guanfacine beneficial in conditions
where such inhibition is useful.
Clonidine/guanfacine have some calcium channel-blocking
properties, though they are not classified as a traditional calcium channel
blocker. By indirectly lowering intracellular calcium levels, clonidine/guanfacine
inhibit the signaling pathways that lead to mast cell degranulation and the
release of inflammatory mediators. The end result is a reduction in cellular
excitability and a dampening of the inflammatory response, including mast cell
stabilization.
Clearly, you could just go directly to a calcium channel
blocker like verapamil.
Clonidine/guanfacine and indeed verapamil are not seen as
first line treatments for MCAS but may well be beneficial.
Conventional First-Line Treatments for MCAS
Antihistamines
H1 blockers (e.g., cetirizine, loratadine) to manage
allergic-type symptoms like itching, hives, and flushing.
H2 blockers (e.g., famotidine, ranitidine) to control
gastrointestinal symptoms and histamine release in the stomach.
Mast Cell Stabilizers
Cromolyn sodium is often considered one of the most
effective mast cell stabilizers for MCAS, especially for gastrointestinal
symptoms.
Ketotifen, another mast cell stabilizer with antihistamine
properties, can also be helpful.
Rupatadine and azelastine are also potentially beneficial as
mast cell stabilizers.
Leukotriene Inhibitors
Medications like montelukast can help manage symptoms
related to leukotrienes, which are other mediators released by mast cells.
Aspirin
Aspirin can play a role in managing MCAS, particularly in
controlling specific symptoms like flushing, hives, and inflammation. Its
primary action in MCAS involves inhibiting prostaglandin D2 (PGD2), which is
one of the inflammatory mediators released by mast cells and contributes to the
vascular symptoms seen in MCAS.
Sleep disorders
Some people with autism do not sleep well.
Clonidine/guanfacine can help some individuals fall asleep
faster and stay asleep longer by promoting relaxation and calming overactivity
in the brain.
It is sometimes used in pediatric populations, such as
children with autism or ADHD, to help with sleep initiation and minimize
frequent nighttime awakenings.
Clonidine/guanfacine, being alpha-2 adrenergic agonists, lower
the activity of the sympathetic nervous system (the fight-or-flight response).
Clonidine/guanfacine is typically prescribed at a low dose
for sleep, as higher doses can lead to daytime drowsiness. Taking clonidine at
night, about 30-60 minutes before bed, is common practice.
Guanfacine has a longer half-life than clonidine, which
means it provides a more sustained effect throughout the night and may lead to
fewer night-time awakenings. This can be particularly useful for individuals
who need consistent support for sleep through the night.
Tics
Clonidine/guanfacine have long been used off-label to treat
Tourette’s syndrome, which is a tic disorder.
Clonidine/guanfacine can help manage some stereotypical
behaviors (repetitive, non-functional behaviors) in individuals with autism,
when these behaviors are driven by hyperactivity, impulsivity, or anxiety.
Clonidine/guanfacine helps manage tics by calming the
nervous system, modulating norepinephrine release, reducing stress, and helping
with impulse control.
This effect has been noted by our reader AW.
Self-injurious behavior (SIB)
Self-injurious behavior (SIB) is usually considered the
worst feature of autism. It becomes a learned behavior which can be very hard
to extinguish.
Clonidine/guanfacine is on the long list of sometimes
effective therapies. Take a note of this!
Clonidine has a limited evidence
base for use in the management of behavioural problems in patients with ASD.
Most evidence originates from case reports. Given the paucity of pharmacological options for
addressing challenging behaviours in ASD patients, a clonidine trial may be an
appropriate and cost-effective pharmaceutical option for this population.
The genes involved in ADHD, autism, bipolar and
schizophrenia are overlapping, so it is not surprising that many people are now
being diagnosed with both ADHD and autism.
What I find very odd is that people with ADHD line up for
medical treatment, but most people with comorbid autism think there cannot be a
medical treatment for their autism because it is just how their brain is
“wired-up differently.” It is hard to reconcile these views - both conditions are clearly treatable.
Most ADHD treatments are stimulants. Medications like
methylphenidate (Ritalin, Concerta) and amphetamine-based drugs (Adderall,
Vyvanse) are typically considered first-line treatments for ADHD. They work by
increasing levels of dopamine and norepinephrine in the brain, which help
improve focus, attention, and impulse control in people with ADHD.
Not all individuals with ADHD can tolerate stimulants, and
in some cases, they may experience unwanted side effects like anxiety, sleep
disturbances, or increased irritability.
The most common non-stimulant options are Clonidine and
Guanfacine. They does not directly increase dopamine or norepinephrine but
instead reduces norepinephrine release, promoting a calming effect.
Atomoxetine (Strattera) is a selective norepinephrine
reuptake inhibitor (NRI), which increases norepinephrine in the brain by
blocking its reuptake.
After years of off-label use in by 2010 both clonidine and guanfacine
were FDA approved for use in ADHD.
Conclusion
As I mentioned to one reader, we should take note that both clonidine
and guanfacine are approved for use in children (with ADHD) and so there is
plenty of safety information and dosage guidance.
The effective dose for MCAS, sleep disorders, tics and SIB
may well vary from person to person but the safe boundaries are well
established from ADHD.
In general, guanfacine tends to be better tolerated than clonidine.
AW might note that guanfacine can cause sleep problems,
including insomnia or vivid dreams.
Here is a useful list I found:
Common Side Effects:
Sedation/Drowsiness: Like clonidine, guanfacine can cause
drowsiness, especially during the initial stages of treatment or when the dose
is increased.
Fatigue: Many people report feeling fatigued or tired when
starting guanfacine, which can affect daytime functioning.
Low Blood Pressure (Hypotension): Guanfacine also lowers
blood pressure, potentially leading to dizziness or light-headedness,
particularly when standing up quickly.
Dry Mouth: This is another common side effect, similar to
clonidine, and may cause discomfort.
Headache: Some people experience headaches, especially when
starting treatment.
Stomach Problems (e.g., abdominal pain, constipation):
Gastrointestinal side effects can occur in some individuals, such as
constipation or stomach discomfort.
Irritability and Mood Swings: In some cases, guanfacine may
cause irritability or emotional instability.
Less Common but Serious Side Effects:
Bradycardia (slow heart rate): As with clonidine, guanfacine
can cause a slow heart rate, which could be concerning for individuals with
underlying heart issues.
Rebound Hypertension: Discontinuing guanfacine too abruptly
can cause rebound hypertension (a sudden increase in blood pressure), so it
should be tapered gradually under a healthcare provider’s guidance.
Sleep disturbances: In some cases, though less common than
with clonidine, guanfacine can cause sleep problems, including insomnia or
vivid dreams.
Some people do not like South Park, but it is a good example
of genuine inclusion
The number of children with autism and intellectual
disability continues to rise and this is putting a strain on government
resources in many parts of the world. Increasing budgets can never match the
increased perception of needs.
In spite of the vast amounts of money being spent very
little attention is given to evaluating what gives the best results.
In the US it has long been put forward that the earlier the
intervention starts the better the results will be and often it is stated that
40 hours a week of one-to-one therapy is needed.This view is generally limited to the
US.
ABA therapy became a big business in the US and many
providers are now owned by private equity investors.
I did point out that in the book the Politics of Autism, the
author recounts her discussions with the founding father of ABA, Ivar Lovaas, that revealed he had rigged his clinical studies by excluding those children
who did not respond to his 40 hours a week therapy from the final results. He just dropped them before the end of the trial. This would totally invalidate his conclusions.
Research shows some autistic
children may get more treatment hours than needed.
The JAMA Pediatrics study
looked at the relationship between the amount of intervention provided (hours
per day, duration, and cumulative intensity) and the outcomes for young
autistic children. Researchers analyzed data from 144 studies involving more
than 9,000 children, making it one of the most comprehensive analyses of its
kind.
Contrary to what many have long believed, the study found
no significant association between the amount of intervention and improved
developmental outcomes. As the authors write, “health professionals
recommending interventions should be advised that there is little robust
evidence supporting the provision of intensive intervention.”
A total of 144 studies including
9038 children (mean [SD] age, 49.3 [17.2] months; mean [SD] percent males,
82.6% [12.7%]) were included in this analysis. None of the meta-regression
models evidenced a significant, positive association between any index of
intervention amount and intervention effect size when considered within
intervention type.
Conclusions and Relevance Findings
of this meta-analysis do not support the assertion that intervention effects
increase with increasing amounts of intervention. Health professionals recommending interventions should
be advised that there is little robust evidence supporting the provision of
intensive intervention.
Some parents in the US get to the bizarre situation where their child can receive 40 hours of ABA for free, but if they say they want only 20 hours because they have other activities for the rest of the week, this is refused. It is the full 40 hours or none.
School segregation
Segregation is a word with negative connotations, but it is used when it comes to the merits of inclusive education versus special schools.
There are many ways in which schools are segregated,
including
By sex
It is still very common to have separate boys' schools and girls' schools in many countries
By religion
Religious schools are common in
both public and private sectors
By ethnicity
This was widely practiced in the United States and South Africa. The legacy of these policies is still evident today.
By ability
Selecting pupils by academic
level is very common.
By disability
Segregation of those with
learning disabilities into special schools or special classes within a
mainstream school is widespread.
By socioeconomic status
Segregation by the ability to pay
is common all over the world. In parts of the world there is no schooling for
those whose family cannot afford it.
Homeschooling
In parts of the world
homeschooling is legal and thriving. The US has by far the largest contingent,
with 6% of children home-schooled.In
Germany it is illegal.
What is the best type of school for level 3 autism?
There is no “best” choice.
From the parents' perspective, some are desperate for their
child to attend a special(ist) school and some are desperate not to attend such
a school.
Some parents choose to home school.
Some parents look for some kind of hybrid solution.
Most parents just take what is given to them.
Inclusion vs segregation
The key issue here is whether the child is “includable”. It
is fashionable in Western countries to be anti-segregation and pro inclusion.
Some children are not includable and some school
environments are hostile rather than welcoming.Even some children with level 1 autism struggle to cope in mainstream
school.
Monty was lucky and completed all his schooling in a
mainstream school with very small class sizes, about 12 pupils. He had his own
teaching assistant throughout. Two of his former assistants later became class
teachers at his school. We paid for the school and the assistants.
Had Monty attended a school with 30 children in the class
with 3 other special needs kids, each with their own teaching assistant, the
result would not have been so good.
As you can see it is a question of “inclusion in what”
versus “segregation in what”.
What is the purpose of “school”
If you talk to parents of older children you will discover
that over the years their view of schooling changes. It is an illusion, one
grandfather told me. For many schooling is just daycare for the pupil and
respite care for the parents.
Some parents do not want their child to be just taught daily
living skills, they want the academic curriculum.
Some schools teach non-verbal children an alternative method
of communication, whereas other do not bother.
It is not surprising that the result is often nobody is
satisfied.
Peter’s idea about schooling for level 3 autism
I would require all children with level 3 autism to be
taught at primary/elementary school a means of communication. Remarkably this
is not done.
Proactive parents have been doing this for decades at home,
but what if your parents are not proactive?
I read the other day that a mother commented that her
non-verbal 7 year old daughter would greatly benefit from an augmentative
communication device, but that the council/municipality did not want to provide
one. In previous decades these were expensive devices, but nowadays these are
just apps that you install on an iPad, or android device. Some of these apps
are even free !!
Clearly, I would ensure all pupils with level 3 autism were
screened and treated for any type of treatable intellectual disability, the
most common one being elevated chloride inside neurons, which was the case for
Monty.
I recently was contacted by a parent who, after trying to help his son for 7 years, has finally had success by increasing his dose of leucovorin (calcium folinate). Now his son responds to verbal instructions like "wash your hands".
Some of these children, once under medical treatment, will
be able to follow much of the core academic curriculum and be genuinely included
in mainstream classes. That was the outcome for Monty, now aged 21.
Children who remain with a lower IQ should not be in classes
that teach academic concepts far above their level of understanding. This is
pointless and will just lead to frustration.
One non-verbal child I know, who cannot read or write is “taught”
a second language at school. How about teaching him a first language?
Children should be taught in groups of similar
ability/functioning level, rather than grouping them by age. I thought this
would be just common sense, but not in the world of education.
If the material has not been mastered there is no point
moving forward, just repeat it. After 15 years at school there should have been
measurable progress.
Beware of prompt-dependence and assistant-dependence. Skills
learned at school need to be such that the child can apply them independently
and can generalize them to new situations. Some wealthy schools provide very
high levels of support and this risks that the child will become an adult
dependent on a similar level of support. This is an example of “too much of a
good thing”.
The services “cliff-edge”
Some people with autism, and their families, receive very
considerable support for two decades and become dependent on it. At some point
in early adulthood these supports may get abruptly withdrawn.
In other parts of the world, there was only ever very
minimal support and the family became more self-reliant and so do not
experience such a cliff-edge. The family and the young adult learnt to cope.
Level 1 autism / Asperger’s
This post is about level 3 autism, but I am always surprised
how many people with level 1 autism write to me so here are some thoughts on
them.
You would think that all people with level 1 autism should
be able to thrive in mainstream education these days. There is so much in the
media, or social media, about accommodating differences and promoting the “able
disabled” who are featured everywhere, so how come kids at school are still
bullying/tormenting their classmates who are 1% different. Times have not really
changed as much as we might have thought.
Most kids with level 3 autism love going to school.Monty adored it.
Many kids with level 1 autism clearly hate it.
During my time helping to run my children’s school one of
the things teachers told me was that kids are actually very supportive of those
who are clearly disabled but will delight in picking on kids who are a tiny
bit different.
The net result is that many children with level 1 autism thoroughly
enjoyed their on-line education during the pandemic away from all that awkwardness
at school.
Many parents whose child goes to a special school for autism
or Down syndrome are completely unaware that there are also some special schools for level 1 autism. It greatly surprised me.
Conclusion
The idea of trying to educate children with level 3 autism
is relatively new. In the recent past they were just put aside in institutions and forgotten
about.Today much is possible, but a lot
comes down to who the parents are and where they happen to live.
The Education for All Handicapped Children Act (EAHCA) of
1975 (later renamed the Individuals with Disabilities Education Act, or IDEA,
in 1990) was the major turning point in the US. This ultimately opened the door to a flood of ABA, paid for by private health insurance, but only in the US.
My doctor mother once commented to me that we had shown that such
children can be taught and can genuinely learn. This was a combination of personalized medicine and personalized learning.
Good things don’t just happen, you have to make them happen.
The outcome in level 3 autism is hugely variable
and that is rather sad.
This blog is full of clinical trials
that use existing drugs that are repurposed to treat autism. One constant issue
is whether the trial drug is free from side effects. Generally speaking side effects
tend not to be a problem, but there always can be exceptions.
I was recently contacted by the
parents of a two year old with a single gene (monogenic) type of autism and
they want to treat their child to improve his outcome.This is the youngest case I have encountered.
With monogenic autisms you often have
clear indications from a very early age that something unusual is present. Once
you have a diagnosis you quickly discover what issues the child is going to
face. You therefore have a good idea of what will happen if you do nothing.
Some other two year olds have delayed speech and other signs of autism, but within a
couple of years develop normally – it was a case of delayed maturation.
I noted long ago that American autism
doctors tend to want to treat younger patients with supplements rather than
drugs.
The reality is that the sooner you
start to correct a severe biological dysfunction the better the outcome will
be. We even see that some treatments are only effective if given to toddlers.
This makes perfect sense although it may be uncomfortable to accept.
I was looking for supporting evidence
for very early intervention. I found a glowing report of the treatment of a 2
year old with Fragile X syndrome using Metformin. I am amazed Fragile X still
remains untreated in most cases.
On examination at age 2 years, typical
physical features of FXS were observed,
and baseline laboratory findings were normal (see Table Table1).1). He was started on metformin
at 25 mg of the liquid form that is 100 mg/ml at dinner, and his dose was
gradually increased to 200 mg twice a day (bid) over 1 year (see Table
Table1).1). After initiation of metformin, his sleep disturbance resolved, only
occasionally awakening once for roughly 30 min. Two weeks after initiation, he went from stacking 3–4
blocks to stacking a tower of 11 or more blocks; within a few more weeks, he
began building more complex structures comprised of different size blocks.
He showed marked improvement in self‐help and motor activities, including
toilet training, clearing the table and loading the dishwasher, brushing his
own teeth, dressing independently, and learning how to make toast. His preschool teachers, who were
unaware of metformin treatment, told his mother that “it's like something just
clicked or he just woke up. He's a whole different kid.”
Some drugs including bumetanide are
already safely given to babies.
Nonetheless, it is a brave step to
start treatment in a two year old. I did connect the parents to a reader of
this blog whose child has the same syndrome but is a few years older.
Today’s post was prompted by the news
that the child is already showing improvements from the first therapy, which is
a small dose of clemastine. In this syndrome there is a mutation in TCF4 and there
is impaired myelination and very likely activated microglia (the brain’s immune
cells). The near immediate beneficial effect cannot be on myelination, but it
could be resetting microglia to the resting state.
Other genes very recently raised have
been TRIT1 and PSMB9; neither of these are classed as autism genes, but
evidently can cause it. Mutations in TRIT1 cause a problem in the mitochondria
and PSMB9 mutations cause the immune system to misbehave.It looks like both can lead to an autism
diagnosis.
A common issue parents encounter is
that often the interest shown by researchers and clinicians stops at the point
of diagnosis. What really matters is what to do next. Only very rarely will
such “experts” suggest what to do next.
It looks like there nearly always are
therapeutic avenues to pursue after such a diagnosis. It should be noted that
even in single gene (monogenic) autisms there are varying levels of response to
the same therapy. We saw this a while back with the new FDA approved therapy
for Rett syndrome – it works for some, but not for others.
Treating self injurious behavior (SIB) in
idiopathic autism
I recently received feedback from
several parents who have had success in treating SIB based on ideas in this
blog.
Verapamil came up again as successful.
Pioglitazone, at a low dose of 7.5mg,
was the game changer for one child.
Ibuprofen worked in another case, but
this cannot be used long term. Celecoxib should be better tolerated and in
theory should be as effective. Time will tell.
More people are trying the add-on
therapy of a small dose of taurine.
Macroautophagy as a cause of impaired
cognition
Impaired autophagy came up recently in
two people’s genetic testing results. There is a lot in this blog about
autophagy and dementia/mild cognitive impairment.
Today we have a paper that links
impaired autophagy with impaired cognition.
Twenty years ago severe autism
generally also meant impaired cognition. Nowadays it does not; you can have
severe autism with normal cognition.
There are various different types of
autophagy but in general it is all about collecting bits of cellular garbage
that might clog things up. As we get older this intracellular garbage
collection process works less well and then diseases like Alzheimer’s follow
decades later.
Impaired autophagy may contribute to
impaired cognition at any age. Most research concerns dementia treatment, or
other conditions affecting older people like Huntington’s disease.
There is little focus on younger
populations, even though we know that children with Down syndrome are prone to
get early onset Alzheimer’s. Treating young people with Down syndrome to
improve autophagy might bring both short and long term benefits.
Autism spectrum disorder (ASD) represents a
complex of neurological and developmental disabilities characterized by
clinical and genetic heterogeneity. While the causes of ASD are still unknown, many ASD risk factors are found
to converge on intracellular quality control mechanisms that are essential for
cellular homeostasis, including the autophagy-lysosomal degradation pathway.
Studies have reported impaired autophagy in ASD human brain and ASD-like
synapse pathology and behaviors in mouse models of brain autophagy deficiency,
highlighting an essential role for defective autophagy in ASD pathogenesis. To
determine whether altered autophagy in the brain may also occur in peripheral
cells that might provide useful biomarkers, we assessed activities of autophagy
in lymphoblasts from ASD and control subjects. We find that lymphoblast
autophagy is compromised in a subset of ASD participants due to impaired
autophagy induction. Similar changes in autophagy are detected in postmortem
human brains from ASD individuals and in brain and peripheral blood mononuclear
cells from syndromic ASD mouse models. Remarkably, we find a strong correlation between impaired
autophagy and intellectual disability in ASD participants. By depleting
the key autophagy gene Atg7 from different brain cells, we provide further
evidence that autophagy deficiency causes cognitive impairment in mice. Together, our findings suggest
autophagy dysfunction as a convergent mechanism that can be detected in
peripheral blood cells from a subset of autistic individuals, and that
lymphoblast autophagy may serve as a biomarker to stratify ASD patients for the
development of targeted interventions.
There are different types of autophagy
and there are some overlaps.
·mTOR dependent (Fasting or Rapamycin)
·AMPK dependent (Spermidine)
·P53 dependent (no simple therapies)
·Calcium signalling dependent (Verapamil)
The OTC way to increase autophagy is
to use Spermidine, which is made from wheat germ or rice germ. Studies in
humans are rather mixed and I think the dose is likely far too low. Supplements
tend to contain about 1mg; I suspect you need much more to have an impact. You
can indeed grow your own wheat sprouts which are highly nutritious and a rich
source of spermidine. You can eat them raw or even in smoothies. 100 g of
sprouts contains 10-15mg of spermidine.
The most researched calcium channel
drug to induce autophagy is Verapamil, from my son’s original autism Polypill.
My takeaway continues to be to look for convergent mechanisms, like impaired autophagy, myelination, microglial activation etc that commonly occur in severe autism, of any origin. You then try and treat these likely dysfunctions rather than getting overly focused on individual genes.
Having read
the literature, it looked to me that anyone over 50 years old is likely to benefit
from a little extra Taurine, but it certainly was not clear whether it would
make my 21 year old’s autism better or worse. I went ahead and ordered some to
investigate.
In theory
one of the many effects of Taurine is negative. Taurine does affect the KCC2 transporter
that takes chloride out of neurons the “wrong” way. The other effects include
on calcium homeostasis, which we know is disturbed in most autism.
N = 2 Trial
Subject
#1 (Peter)
I took 2g a
day for a month and noticed no effect at all, other than some mild GI
irritation.
In adults
the long-term effects are numerous and varied throughout the body. Even the
cells that remodel your bones (osteoblasts and osteoclasts) have special
taurine transporters, whose sole role is to let taurine inside – taurine makes the
osteoblasts work harder, while encouraging osteoclasts to take a break. The net
effect should be stronger bones. As you get
older your natural levels of taurine fall substantially. There are taurine-rich
foods you can eat and if you engage in strenuous exercise your liver starts making
more taurine.
Subject
#2 (Monty)
There is a
clear contradiction when it comes to Taurine and sleep. Many energy drinks
contain Taurine to keep you alert, but in theory Taurine should be calming and
many people take it add bedtime to improve sleep.
Monty, aged
21 with ASD, likes getting up early and going to bed early.
Adding 2g a
day of Taurine at breakfast shifted his circadian rhythms, so that he now goes
to bed at a time typical for a 21 year old, but still wants to get up at 7am. Monty even fell asleep on the sofa watching TV late one night, something big brother often does. Indeed, Monty received a nod of approval when big brother discovered him in the early hours.
The most
beneficial change has been on his spring and summertime aggression. This has
been controlled for years using an L-type calcium channel blocker. This does
not resolve the allergy at all, but it “switches off” the consequential
anxiety/aggression. With the addition of allergy therapies and the
immunomodulation of Pioglitazone (in peak allergy season) the problem behaviors
are controlled.
It appears
that Taurine has a similar anti-anxiety/aggression effect. Maybe its effect
on calcium channels and broader calcium homeostasis is the reason why. Anyway,
it works – simple, cheap, OTC and effective.It has no effect on allergy, in case you are wondering.
Conclusion
Taurine can
be bought as a bulk powder for very little money. It is not like those numerous
expensive supplements that would cost you several hundred dollars/euros/pounds
a year.
If you have your
own “healthspan polytherapy”, to ward off high blood pressure, high cholesterol,
type 2 diabetes, dementia, arthritis, osteoporosis etc, consider spending a few
pennies more and add a scoop of taurine.
The people who
write to me and tell me how Verapamil has transformed life at home, by banishing
aggression and self-injurious behaviors, should seriously consider a trial of
Taurine.
Today’s post
should be of wide interest because it concerns the potential benefit from the
OTC supplement taurine. There is a section at the end answering a query about
mutations in the KAT6A gene.
Taurine is
an amino acid and it is found in abundance in both mother’s milk and formula
milk.It has long been used as a supplement by some
people with autism. It is finally going to be the subject of a clinical trial in
autism and not surprisingly that will be in China - nowadays home to much
autism research.
Taurine is
also a key ingredient in energy drinks like Red Bull.
In a study
of children with autism a third had low levels of taurine. Since taurine has
anti-oxidant activity, children with ASD with low taurine concentrations were
then examined for abnormal mitochondrial function. That study suggests that taurine
may be a valid biomarker in a subgroup of ASD.
Taurine has
several potential benefits to those with autism and it is already used to treat
a wide variety of other conditions, some of which are relevant to autism. One
example is its use in Japan to improve mitochondrial function in a conditional
called MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and
stroke-like episodes).
The effects
that are suggested to relate to some types of autism include:-
·Activating GABAA
receptors, in the short term
·Down regulating
GABAA receptors, after long term use
·Reduce NMDA mediated activation of calcium
channels
·Protective effect on mitochondria and
upregulating Complex 1
·Improving
the quality of the gut microbiota
If you have
a pet you may know that taurine is widely given to cats and dogs. All cat food
has taurine added and some breeds of dog need supplementation.
Taurine is
crucial for several bodily functions in pets, including:
Heart Health: Taurine helps regulate heart rhythm and improves heart
muscle function. It can help prevent a type of heart disease called dilated
cardiomyopathy (DCM) in both cats and dogs.
Vision: Taurine plays a role in maintaining healthy vision and can prevent
retinal degeneration, a serious eye disease.
Immune System Function: Taurine may help boost the immune system and fight off
infections.
From China
we have the following recent study showing a benefit in the BTBR model of
autism:
Effective treatment of patients
with autism spectrum disorder (ASD) is still absent so far. Taurine exhibits
therapeutic effects towards the autism-like behaviour in ASD model animals.
Here, we determined the mechanism of taurine effect on hippocampal neurogenesis
in genetically inbred BTBR T+tf/J (BTBR)
mice, a proposed model of ASD. In this ASD mouse model, we explored the effect
of oral taurine supplementation on ASD-like behaviours in an open field test,
elevated plus maze, marble burying test, self-grooming test, and three-chamber
test. The mice were divided into four groups of normal controls (WT) and models
(BTBR), who did or did not receive 6-week taurine supplementation in water (WT,
WT+ Taurine, BTBR, and BTBR+Taurine). Neurogenesis-related effects were
determined by Ki67 immunofluorescence staining. Western blot analysis was
performed to detect the expression of phosphatase and tensin homologue deleted
from chromosome 10 (PTEN)/mTOR/AKT pathway-associated proteins. Our results showed that taurine
improved the autism-like behaviour, increased the proliferation of
hippocampal cells, promoted PTEN expression, and reduced phosphorylation of
mTOR and AKT in hippocampal tissue of the BTBR mice. In conclusion, taurine
reduced the autism-like behaviour in partially inherited autism model mice,
which may be associated with improving the defective neural precursor cell
proliferation and enhancing the PTEN-associated pathway in hippocampal tissue.
A trial in
humans with autism is scheduled in Guizhou, China. In this trial they seem to
believe the benefit may come from modification to the gut microbiota.
In the treatment of autism spectrum disorders (ASD),
medication is only an adjunct, and the main treatment modalities are education
and behavioral therapy. People with autism incur huge medical and educational
costs, which puts a great financial burden on families. Taurine is one of the
abundant amino acids in tissues and organs, and plays a variety of
physiological and pharmacological functions in nervous, cardiovascular, renal,
endocrine and immune systems. A large number of studies have shown that taurine
can improve cognitive function impairment under various physiological or
pathological conditions through a variety of mechanisms, taurine can increase
the abundance of beneficial bacteria in the intestine, inhibit the growth of
harmful bacteria, and have a positive effect on intestinal homeostasis. This
study intends to analyze the effect of taurine supplementation on ASD, and
explore the possible mechanism by detecting intestinal symptoms, intestinal
flora, markers of oxidative stress and clinical symptoms of ASD.
Taurine granules mixed with corn starch and white sugar, 0.4g
in 1 bag, taken orally. One time dosage: 1 bag each time for 1-2 years old, 3
times a day, 1.5 bags each time for 3-5 years old, 3 times a day, 2 bags each
time for 6-8 years old, 3 times a day, 2.5-3 bags each time for 9-13 years old,
3 to 4 bags each time for children and adults over 14 years old, 3 times a day.
The use of taurine is strictly in accordance with the specifications of Chinese
Pharmacopoeia.
Taurine is a key functional amino acid with many functions in
the nervous system. The effects of taurine on cognitive function have aroused
increasing attention. First, the fluctuations of taurine and its transporters
are associated with cognitive impairments in physiology and pathology. This may
help diagnose and treat cognitive impairment though mechanisms are not fully
uncovered in existing studies. Then, taurine supplements in cognitive impairment of different physiologies,
pathologies and toxicologies have been demonstrated to significantly improve
and restore cognition in most cases. However, elevated taurine level in
cerebrospinal fluid (CSF) by exogenous administration causes cognition
retardations only in physiologically sensitive period between the perinatal to
early postnatal period. In this review, taurine levels are summarized in
different types of cognitive impairments. Subsequently, the effects of taurine
supplements on cognitions in physiology, different pathologies and toxication
of cognitive impairments (e.g. aging, Alzheimer' disease, streptozotocin
(STZ)-induced brain damage, ischemia model, mental disorder, genetic diseases
and cognitive injuries of pharmaceuticals and toxins) are analyzed. These data suggest that taurine
can improve cognition function through multiple potential mechanisms (e.g.
restoring functions of taurine transporters and γ-aminobutyric acid (GABA) A
receptors subunit; mitigating neuroinflammation; up-regulating Nrf2 expression
and antioxidant capacities; activating Akt/CREB/PGC1α pathway, and further
enhancing mitochondria biogenesis, synaptic function and reducing oxidative
stress; increasing neurogenesis and synaptic function by pERK; activating PKA
pathway). However, more mechanisms still need explorations.
Although ER stress
assumes an important role in the cytoprotective actions of taurine in the
central nervous system (CNS), another important mechanism affecting the CNS is
the neuromodulatory activity of taurine. Toxicity in the CNS commonly occurs
when an imbalance develops between excitatory and inhibitory neurotransmitters.
GABA is one of the dominant inhibitory neurotransmitters, therefore, reductions
in either the CNS levels of GABA or the activity of the GABA receptors can
favor neuronal hyperexcitability. Taurine serves as a weak agonist of the GABAA, glycine and
NMDA receptors Therefore, taurine can partially substitute for GABA by
causing inhibition of neuronal excitability. However, the regulation of the
GABAA receptor by taurine is complex. While acute taurine administration activates the
GABAA receptor, chronic taurine feeding promotes the
downregulation of the GABAA receptorand the upregulation of glutamate
decarboxylase, the rate-limiting step in GABA biosynthesis. Therefore, complex
interactions within the GABAeric system, as well as in the glycine and NMDA
receptors, largely define the actions of taurine in the CNS.
Taurine
is one of the most abundant free amino acids especially in excitable tissues,
with wide physiological actions. Chronic supplementation of taurine in drinking water to mice increases
brain excitability mainly through alterations in the inhibitory GABAergic
system. These changes include elevated expression level of glutamic acid
decarboxylase (GAD) and increased levels of GABA. Additionally we reported that GABAA receptors were down
regulated with chronic administration of taurine. Here, we investigated
pharmacologically the functional significance of decreased / or change in
subunit composition of the GABAA receptors by determining the threshold for
picrotoxin-induced seizures. Picrotoxin, an antagonist of GABAA receptors that
blocks the channels while in the open state, binds within the pore of the
channel between the β2 and β3 subunits. These are the same subunits to which
GABA and presumably taurine binds.
Methods
Two-month-old
male FVB/NJ mice were subcutaneously injected with picrotoxin (5 mg kg-1) and
observed for a) latency until seizures began, b) duration of seizures, and c)
frequency of seizures. For taurine treatment, mice were either fed taurine in
drinking water (0.05%) or injected (43 mg/kg) 15 min prior to picrotoxin
injection.
Results
We
found that taurine-fed mice are resistant to picrotoxin-induced seizures when
compared to age-matched controls, as measured by increased latency to seizure,
decreased occurrence of seizures and reduced mortality rate. In the
picrotoxin-treated animals, latency and duration were significantly shorter
than in taurine-treated animas. Injection of taurine 15 min before picrotoxin
significantly delayed seizure onset, as did chronic administration of taurine
in the diet. Further, taurine treatment significantly increased survival rates
compared to the picrotoxin-treated mice.
Conclusions
We
suggest that the elevated threshold for picrotoxin-induced seizures in
taurine-fed mice is due to the reduced binding sites available for picrotoxin
binding due to the reduced expression of the beta subunits of the GABAA
receptor. The delayed effects of picrotoxin after acute taurine injection may
indicate that the two molecules are competing for the same binding site on the
GABAA receptor. Thus, taurine-fed
mice have a functional alteration in the GABAergic system. These include:
increased GAD expression, increased GABA levels, and changes in subunit
composition of the GABAA receptors. Such a finding is relevant in conditions
where agonists of GABAA receptors, such as anesthetics, are administered.
Taurine
as used in Japan to treat MELAS (mitochondrial myopathy, encephalopathy, lactic
acidosis and stroke-like episodes)
This medicine improves mitochondrial dysfunction related to cell
energy production etc., and suppresses stroke-like episodes.
It is usually used for prevention of stroke-like episodes of MELAS
(mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like
episodes).
·Your dosing schedule prescribed by your doctor
is (( to be written by a
healthcare professional))
·In general, take as following dose according to your weight, 3 times a day
after meals. If you weigh less than 15 kg, take 1.02 g (1 g of the active
ingredient) at a time. If your weight ranges 15 kg to less than 25 kg, take
2.04 g (2 g) at a time. If your weight ranges 25 kg to less than 40 kg, take
3.06 g (3 g) at a time. If you weigh 40 kg and more, take 4.08 g (4 g) at a
time. Strictly follow the instructions.
·If you miss a dose, take the missed a dose as soon as possible. However,
if it is almost time for the next dose, skip the missed a dose and continue
your regular dosing schedule. You should never take two doses at one time.
·If you accidentally take more than your prescribed dose, consult with
your doctor or pharmacist.
·Do not stop taking this medicine unless your doctor instructs you to do
so.
Contemporary research has found that people
with autism spectrum disorder (ASD) exhibit aberrant immunological function,
with a shift toward increased cytokine production and unusual cell function.
Microglia and astroglia were found to be significantly activated in
immuno-cytochemical studies, and cytokine analysis revealed that the macrophage
chemoattractant protein-1 (MCP-1), interleukin 6 (IL-6), tumor necrosis factor
α (TNF-α), and transforming growth factor β-1 (TGFB-1), all generated in the
neuroglia, constituted the most predominant cytokines in the brain. Taurine
(2-aminoethanesulfonic acid) is a promising therapeutic molecule able to
increase the activity of antioxidant enzymes and ATPase, which may be
protective against aluminum-induced neurotoxicity. It can also stimulate
neurogenesis, synaptogenesis, and reprogramming of proinflammatory M1
macrophage polarization by decreasing mitophagy (mitochondrial autophagy) and
raising the expression of the markers of the anti-inflammatory and pro-healing
M2 macrophages, such as macrophage mannose receptor (MMR, CD206) and
interleukin 10 (IL-10), while lowering the expression of the M1 inflammatory
factor genes. Taurine also induces autophagy, which is a mechanism that is
impaired in microglia cells and is critically associated with the
pathophysiology of ASD. We hypothesize here that taurine could reprogram the
metabolism of M1 macrophages that are overstimulated in the nervous system of
people suffering from ASD, thereby decreasing the neuroinflammatory process
characterized by autophagy impairment (due to excessive microglia activation),
neuronal death, and improving cognitive functions. Therefore, we suggest that
taurine can serve as an important lead for the development of novel drugs for
ASD treatment.
Autism spectrum disorders (ASD) are a complex
sequelae of neurodevelopmental disorders which manifest in the form of
communication and social deficits. Currently, only two agents, namely
risperidone and aripiprazole have been approved for the treatment of ASD, and
there is a dearth of more drugs for the disorder. The exact pathophysiology of
autism is not understood clearly, but research has implicated multiple pathways
at different points in the neuronal circuitry, suggesting their role in ASD.
Among these, the role played by neuroinflammatory cascades like the NF-KB and
Nrf2 pathways, and the excitotoxic glutamatergic system, are said to have a
bearing on the development of ASD. Similarly, the GPR40 receptor, present in
both the gut and the blood brain barrier, has also been said to be involved in
the disorder. Consequently, molecules which can act by interacting with one or
multiple of these targets might have a potential in the therapy of the
disorder, and for this reason, this study was designed to assess the binding
affinity of taurine, a naturally-occurring amino acid, with these target
molecules. The same was scored against these targets using in-silico docking
studies, with Risperidone and Aripiprazole being used as standard comparators.
Encouraging docking scores were obtained for taurine across all the selected
targets, indicating promising target interaction. But the affinity for targets
actually varied in the order NRF-KEAP > NF-κB > NMDA > Calcium channel
> GPR 40. Given the potential implication of these
targets in the pathogenesis of ASD, the drug might show promising results in
the therapy of the disorder if subjected to further evaluations.
Taurine is a sulfur-containing amino acid which
is not incorporated into protein. However, taurine has various critical
physiological functions including development of the eye and brain,
reproduction, osmoregulation, and immune functions including anti-inflammatory
as well as anti-oxidant activity. The causes of autistic spectrum disorder
(ASD) are not clear but a high heritability implicates an important role for
genetic factors. Reports also implicate oxidative stress and inflammation in
the etiology of ASD. Thus, taurine, a well-known antioxidant and regulator of
inflammation, was investigated here using the sera from both girls and boys
with ASD as well as their siblings and parents. Previous reports regarding
taurine serum concentrations in ASD from various laboratories have been
controversial. To address the potential role of taurine in ASD, we collected
sera from 66 children with ASD (males: 45; females: 21, age 1.5-11.5 years,
average age 5.2 ± 1.6) as well as their unaffected siblings (brothers: 24;
sisters: 32, age 1.5-17 years, average age 7.0 ± 2.0) as controls of the
children with ASD along with parents (fathers: 49; mothers: 54, age 28-45
years). The sera from normal adult controls (males: 47; females: 51, age 28-48
years) were used as controls for the parents. Taurine concentrations in all
sera samples were measured using high performance liquid chromatography (HPLC)
using a phenylisothiocyanate labeling technique. Taurine concentrations from
female and male children with ASD were 123.8 ± 15.2 and 145.8 ± 8.1 μM,
respectively, and those from their unaffected brothers and sisters were 142.6 ±
10.4 and 150.8 ± 8.4 μM, respectively. There was no significant difference in
taurine concentration between autistic children and their unaffected siblings.
Taurine concentrations in children with ASD were also not significantly
different from their parents (mothers: 139.6 ± 7.7 μM, fathers: 147.4 ± 7.5
μM). No significant difference was observed between adult controls and parents
of ASD children (control females: 164.8 ± 4.8 μM, control males: 163.0 ± 7.0
μM). However, 21 out of 66
children with ASD had low taurine concentrations (<106 μM). Since
taurine has anti-oxidant activity, children with ASD with low taurine
concentrations will be examined for abnormal mitochondrial function. Our data
imply that taurine may be a valid biomarker in a subgroup of ASD.
Taurine is a naturally occurring
sulfur-containing amino acid that is found abundantly in excitatory tissues,
such as the heart, brain, retina and skeletal muscles. Taurine was first
isolated in the 1800s, but not much was known about this molecule until the
1990s. In 1985, taurine was first approved as the treatment among heart failure
patients in Japan. Accumulating
studies have shown that taurine supplementation also protects against
pathologies associated with mitochondrial defects, such as aging, mitochondrial
diseases, metabolic syndrome, cancer, cardiovascular diseases and neurological
disorders. In this review, we will provide a general overview on the
mitochondria biology and the consequence of mitochondrial defects in
pathologies. Then, we will discuss the antioxidant action of taurine,
particularly in relation to the maintenance of mitochondria function. We will
also describe several reported studies on the current use of taurine
supplementation in several mitochondria-associated pathologies in humans.
Taurine
is known not as a radical scavenger. Several potential mechanisms by which
taurine exerts its antioxidant activity in maintaining mitochondria health
include: taurine conjugates with uridine on mitochondrial tRNA to form a
5-taurinomethyluridine for proper synthesis of mitochondrial proteins
(mechanism 1), which regulates the stability and functionality of respiratory
chain complexes; taurine reduces superoxide generation by enhancing the
activity of intracellular antioxidants (mechanism 2); taurine prevents calcium
overload and prevents reduction in energy production and the collapse of
mitochondrial membrane potential (mechanism 3); taurine directly scavenges HOCl
to form N-chlorotaurine in inhibiting a pro-inflammatory response (mechanism
4); and taurine inhibits mitochondria-mediated apoptosis by preventing caspase
activation or by restoring the Bax/Bcl-2 ratio and preventing Bax translocation
to the mitochondria to promote apoptosis (mechanism 5).
Taurine
Forms a Complex with Mitochondrial tRNA
Taurine
Reduces Superoxide Generation in the Mitochondria
Taurine therapy, therefore, could potentially
improve mitochondrial health, particularly in mitochondria-targeted
pathologies, such as cardiovascular diseases, metabolic diseases, mitochondrial
diseases and neurological disorders. Whether the protective mechanism on
mitochondria primarily relies on the taurine modification of mitochondrial tRNA
requires further investigation.
Taurine
and the gut microbiota
We now regularly in the
research see that you can make changes in the gut microbiota to treat medical
conditions. I think the most interesting was the discovery that the ketogenic
diet, used for a century to treat epilepsy, actually works via the high fat
diet changing the bacteria that live in your gut; it has nothing at all to do
with ketones. UCLA are developing a bacteria product that will mimic the effect
of this diet.
We should not be surprised
to see that one mode of action put forward for Taurine is changes it makes in
the gut microbiota.It is this very
mechanism that the Chinese researchers think is relevant to its benefit in
autism.
The paper below is not
about autism, but it is about Taurine’s effect on the gut microbiota.
Taurine,
an abundant free amino acid, plays multiple roles in the body, including bile
acid conjugation, osmoregulation, oxidative stress, and inflammation
prevention. Although the relationship between taurine and the gut has been
briefly described, the effects of taurine on the reconstitution of intestinal
flora homeostasis under conditions of gut dysbiosis and underlying mechanisms
remain unclear. This study examined the effects of taurine on the intestinal
flora and homeostasis of healthy mice and mice with dysbiosis caused by
antibiotic treatment and pathogenic bacterial infections. The results showed that taurine
supplementation could significantly regulate intestinal microflora, alter fecal
bile acid composition, reverse the decrease in Lactobacillus abundance, boost
intestinal immunity in response to antibiotic exposure, resist colonization by
Citrobacter rodentium, and enhance the diversity of flora during infection.
Our results indicate that taurine has the potential to shape the gut microbiota
of mice and positively affect the restoration of intestinal homeostasis. Thus,
taurine can be utilized as a targeted regulator to re-establish a normal
microenvironment and to treat or prevent gut dysbiosis.
Conclusion
Your body
can synthesize taurine from other amino acids, particularly cysteine, with the
help of vitamin B6. In most cases, this internal production is enough to meet
your daily needs for basic bodily functions.
Infants and
some adults may need taurine added to their diet.
Based on the
small study in humans, about a third of children with autism have low levels of
taurine in their blood.
Is extra
taurine going to provide a benefit to the other two thirds?
Taurine looks
easy to trial. It is normally taken three times a day after a meal. Each dose
would be 0.4g to 4g depending on weight and what the purpose was. The 2 year
olds in the Chinese autism trial will be taking 0.4g three times a day.
Japanese adults with mitochondrial disease (MELAS) are taking 4g three times a
day.
One can oF Red Bull contains 1g of taurine. Most supplements contain 0.5 to 1g. This is a
similar dose to what is given to pet cats and dogs. Just like Red Bull contains B vitamins, so do the taurine products for cats and dogs.
Some of the
effects will be immediate, while others will take time to show effect. For
example there can potentially be an increase in mitochondrial biogenesis. I
expect any changes in gut bacteria would also take a long time to get established.
The effect
via GABA on increasing brain excitability is an interesting one for people
taking bumetanide for autism, where the GABA developmental switch did not take
place. Based on the research you could argue that it will be beneficial or
indeed harmful.
What I can
say is that in Monty, aged 20 with ASD and taking bumetanide for 12 years, he
responded very well on the rare occasions he drank Red Bull.
-------
Vitamin
B5 and L carnitine for KATA6A Syndrome
I was asked
about KATA6A syndrome recently.This
syndrome is researched by Dr Kelley, the same doctor who coined the term Autism
secondary to mitochondrial dysfunction (AMD).
KAT6A
Research and Treatment An Update by Richard I Kelley , MD, PHD
Some kids
with KATA6A, like Peter below, respond very well to Dr Kelley’s mito cocktail.
Here’s my experience with the mitochondrial cocktail:
– At 4 weeks after the start of the cocktail, Peter became
potty-trained during the day without any training. He pulled his pull up off,
refused to put it back on.
-At 2 months, Peter started riding his bike with no training
wheels and playing soccer. He became able to kick the ball and run after it
till he scores.
-At 2.5 months, he started skiing independently. I used to
try to teach how to ski since he was 3yo. I used to spend hours and hours
picking him up off the snow with no result. I tried different kind of
reinforcers (food,..) with no result. After the cocktail, he just went down the
hill by himself, He can ski independently now and knows how to make turns.
-At 2-3 months, I started noticing an increased strength in
playing ice hockey and street hockey with a better understanding of the game.
His typing ability improved too, he used to have severe apraxia while typing
(type the letter next to the letter he wants to type…).
-At 3-4 months, Peter’s fingers on the piano became stronger,
he became able to play harder songs with less training and less frustration. I
also noticed an increase in “common sense” like for example putting his
backpack in the car instead of throwing it on the floor next to the car and
riding the car without his backpack. Another example, when we go to the public
library, he knows by himself that he has to go to the children section, and
walks independently without showing him directions to the play area inside the
children section. In the past, he used to grab books the time he enters the
library, throw a tantrum on the floor. The most important milestone is that
Peter started to say few words that I can understand.
-At 11 months, Peter became potty-trained at night. His
speech is slowly getting clearer. His fine and gross motor skills are still
getting better.
Some readers
of this blog have been in touch with Dr Kelley and he does give very thorough replies.
Generally
speaking, the therapies for mitochondrial diseases/dysfunctions seem to be
about avoiding it getting worse, rather than making dramatic improvements. In
the case of Peter (above) the effects do look dramatic. There are many other ideas
in the research that do not seem to have been translated into therapy.
A study from
two years ago does suggest that vitamin B5 and L carnitine should be trialed.
Mutations in several genes involved in the
epigenetic regulation of gene expression have been considered risk alterations
to different intellectual disability (ID) syndromes associated with features of
autism spectrum disorder (ASD). Among them are the pathogenic variants of the
lysine-acetyltransferase 6A (KAT6A) gene, which causes KAT6A syndrome. The KAT6A enzyme participates in
a wide range of critical cellular functions, such as chromatin remodeling, gene
expression, protein synthesis, cell metabolism, and replication. In this
manuscript, we examined the pathophysiological alterations in fibroblasts
derived from three patients harboring KAT6A mutations. We addressed survival in
a stress medium, histone acetylation, protein expression patterns, and
transcriptome analysis, as well as cell bioenergetics. In addition, we evaluated the therapeutic
effectiveness of epigenetic modulators and mitochondrial boosting agents, such
as pantothenate and L-carnitine, in correcting the mutant phenotype.
Pantothenate and L-carnitine treatment increased histone acetylation and
partially corrected protein and transcriptomic expression patterns in mutant
KAT6A cells. Furthermore, the cell bioenergetics of mutant cells was
significantly improved. Our
results suggest that pantothenate and L-carnitine can significantly improve the
mutant phenotype in cellular models of KAT6A syndrome.
Next, we analyzed the expression changes of
specific genes in treated and untreated conditions. We found that the
expression levels of downregulated genes in the mutant KAT6A fibroblasts, such
as KAT6A, SIRT1, SIRT3, NAMPT1, Mt-ND6, NDUFA9, PANK2, mtACP, PDH (E1 subunit α2), KGDH (E2 subunit), SOD1, SOD2,
and GPX4 were
significantly restored after pantothenate and L-carnitine treatment. The
proteins encoded by these genes are involved in acetylation-deacetylation
pathways, CoA metabolism, mitochondria, and antioxidant enzymes, all of which
are critical for intracellular processes in embryonic and childhood
development.
KAT6A acts
as a master regulator by fine-tuning gene expression through chromatin
modifications, so we should expect it to have wide ranging effects. All the
closest interactions are will other genes that modify gene expression.
KAT6A mutations are indeed linked to
microcephaly, a condition characterized by a smaller than average head circumference.
Most autism is associated with
hyperactive pro-growth signalling pathways; only a minority is associated with the opposite and this would fit with
microcephaly, which is typical in KAT6A.
Microcephaly is a very common feature
of Rett syndrome.
Among the features of KAT6A syndrome
there will be overlaps with other syndromes.
Dr Kelley analyses amino acids looking
for mitochondrial dysfunction. He has found this present in KAT6A, but this is
only one treatable feature of the syndrome.
Targeting growth signaling pathways
might well be worth pursuing. You would be looking a what works in other people
with smaller heads.
I wrote quite a lot about IGF-1
previously in this blog.
It would be highly plausible that
these related therapies might be of benefit. The easy one to try is cGPMax,
because it is sold OTC. IGF-1 itself might be beneficial, you would have to
find a helpful endocrinologist to trial it.
All the therapies of idiopathic autism
could be trialed.
If the child has a paradoxical
reaction to any benzodiazepine drug, then you know that bumetanide is likely to
be beneficial.
Since mitochondrial function is
impaired in KAT6A, taurine is another thing to trial.
