Autism symptoms are relieved by fecal microbiota transplantation

reference

kang DW, Adams JB, Gregory AC, et al. Microbiota transfer therapy changes the ecosystem of the intestine and improves gastrointestinal and autism symptoms: an open study. microbiom . January 23, 2017; 5 (1): 10.

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prospective, open, uncontrolled pilot study

participant

eighteen children between the ages of 7 and 16 with an autism spectrum disorder (ASD) and moderate to severe gastrointestinal (GI) problems. Twenty age and gender-adapted neurotypical children without GI diseases were observed as a comparison group during this time.

primary result measurements

1. The primary endpoint was the change in the GI symptoms, measured by the parents based on a revised version of the gastrointestinal symptom rating Scale (GSRS). The response was defined as at least 50 %reduction in the average GSR.
2. The secondary result was the change in the neuropsychosocial symptoms, measured by a professional expert with the autism diagnostic Interview revised (ADI-R) and the Childhood autism rating scale (cars) and from the parents with the parent global impressions III (pgi-III), the aberrant Beor Behavior Checklist (ABC), The Social Responsiveness Scale (SRS) and the Vineland Adaptive Behavior Scale II (Vabs-II).
3. The authors also examined the bacterial intestinal microbiomas of the ASD and neurotypical children at the beginning of the course and 10 more times during the experiment and the viral microbiome on 2 points.

medication and dosage study

The procedure consisted of:

• vancomycin 40 mg/kg oral every day in 3 doses divided (
• omeprazole 20 mg oral daily for 62 days (starting on the 12th day of Vancomycin treatment until the 74th day, the last day of the FMT)
• macrogol-polyethylene glycol (variable dose depending on body weight) only on day 15 (one day after the last vancomycin dose)
• oral fecal microbiota transplantation (FMT). FMT material was produced by filtering the sifted human chair under N2 gas to 250 microns and then centrifuged at 6,000 XG to create a pellet that consists of> 99 % bacteria. The participants were practically randomized into 1 of 2 groups:
• Group 1: Oral/Oral Administration: 2.5 trillions from faeces from feces, suspended in chocolate milk, milk set or juice, orally administered in 3 separate doses on day 16 and then 2.5 billion from faecal cells, suspends in chocolate, Milk replacement or juice once a day on the days of 18-74.
• Group 2: Rectal/Oral administration: 2.5 trillions from faeces, suspended in glyzer and normal saline, administered rectally on day 16, then 2.5 billion from feces from faeces, suspended in chocolate milk, milk or juice, once a day oral administered days 18-74.

important knowledge

population analysis

The ASD group included more people who were released by Caesarean section, in infancy a non-standard infant food and suffered from food allergies and eczema, but there were no differences between the ASD group and the neurotypical group in terms of age, sex distribution and body mass index or antibiotic consumption in the first 4 years of life. Children with ASD had a significantly shorter breastfeeding duration and slightly lower fiber consumption than neurotypical children. Mothers of children with ASD took an average of 6.2 grams of fiber per day (± 1.3 g), while mothers of neurotypical children took an average of 8.6 grams per day (± 1.3 g). This was a statistically significant difference ( p <0.01)

shipping method

There were no significant differences in the clinical results between the initial oral FMT and the initial rectal rectal ft.

Security and tolerance

All subjects in the ASD group ended the 18-week treatment and observation period. The only identified side effect was a temporary increase in hyperactivity and aggression at the beginning of vancomycin treatment.

Change of gastrointestinal symptoms

There were significant ( p <0.001) improvement in abdominal pain, digestive disorders, diarrhea and constipation according to the GSRS assessed by the parents. These improvements even remained significant 8 weeks after the end of the treatment. Sixteen of the 18 (89 %) children with ASD achieved a reduction in the average GSR by more than 50 %, which was the limit for response.

Change of neuropsychosocial symptoms

There was a significant ( p <0.001) 22 % acceptance of the professionally evaluated cars scores from the starting value to the end of the treatment, without regression in the 8 weeks after treatment.

GI and neuropsychosocial symptoms slowly improved over the 10-week FMT period and stopped during the 8-week follow-up.

There were significant changes in the PGI-III ( p <0.001), SRS ( p <0.001), ABC ( p <0.01) and Vabs-II ( p <0.001). Vabs-II, which evaluates communication, everyday and socialization skills, found that the average developmental age has increased by 1.4 years in all subdomain areas.

chair analysis

At the beginning of the study, the ASD group had a significantly less diverse fauma microbiome than the neurotypical group, but at the end of the study, the two groups were not statistically different: 15/16 Responder and 1/2 non-responder in the ASD group had as different faecal microbiomas as those in the neurotypical group.

feces from the ASD group at the end of the treatment and 8 weeks after the end of the treatment showed at least partially transplantation of the donor's bacterial community. The changes in the fecal microbioma of the ASD group included a fourfold increase bifidobacterium and significant increases in prevotella and desulfovibri . bifidobacterium and Prevotella have long been considered possible courageists in the ASD population, but Desulfovibri is generally considered to be coming or pathogen; The importance of this increase is unknown.

practice implications

In an earlier open study with 8 vancomycin for ASS children, the neuropsychosocial symptoms improved according to cars and other scales. However, the improvement was lost 2 weeks after the end of the treatment. In contrast, ^{1 In the study checked here, the gastrointestinal and neuropsychosocial symptoms slowly improved over the 10-week FMT period and continued during the 8-week follow-up. This persistent benefit compared to a similar study makes it less likely that the benefit observed in this open study was the placebo or regression on the mean.}

Legal guidelines in relation to FMT limit North American clinicians to this, only patients with a crostridium difficile infection who do not respond to standard therapies. An oral FMT solution as the one used here is expensive, time-consuming and requires a certain scientific and technical skill to produce it at home, which was an insurmountable obstacle for all my patients, with the exception of some who were also ready and able to correctly filter, centrifug.

On the other hand, FMT retention inlets are much cheaper at home, less time-consuming and hardly require more scientific or technical know-how than many food recipes. FMT inlets at home are carried out at home about 10,000 times in the United States alone.

Improper FMT screening or preparation techniques may lead to damage, but the communication of the safe home FMT technology and the facilitation of the FMT donation screening can lead to a safe home FMT. ^{3 I helped to facilitate hundreds of FMT storage in my practice and the species and Frequencies of side effects that I have observed do not differ from the types and frequencies of side effects reported in clinical studies.}

The results of this study are fascinating and promising. Families of ASD patients, especially those with regressive autism, are often willing to try everything that can help without harming their child. You can meet families who want to try to improve GI and neuropsychosocial pathology with FMT at their ASD child. It is important that practitioners who come into contact with these patients are familiar with techniques in order to facilitate a safe FMT at home with screened donors, or know how they properly transfer to the patient if this is not the case.