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Short-term benefit from oral vancomycin treatment of regressive-onset autism
R H Sandler1, S M Finegold, E R Bolte
1Section of Pediatric Gastroenterology and Nutrition, Rush Children's Hospital, Rush Medical College, Chicago, IL 60612, USA. rushstudy@aol.com
Insights
Antibiotic use may trigger regressive autism in some children by disrupting gut bacteria. A short-term trial showed improvement, suggesting a gut-brain link warrants further study.
Area of Science:
- Neuroscience
- Microbiology
- Pediatrics
Background:
- Autism spectrum disorder (ASD) typically emerges in early infancy.
- A subset of children experiences regressive-onset autism, characterized by developmental regression after a period of normal development.
- Parental reports link regressive autism to prior antibiotic exposure and chronic diarrhea.
Observation:
- This study investigated the hypothesis that gut flora disruption by antibiotics could lead to neurotoxin-producing bacterial colonization in regressive autism.
- Eleven children with regressive-onset autism, defined by specific criteria including antibiotic exposure, diarrhea, skill loss, and autistic features, were enrolled.
- An intervention trial utilized a minimally absorbed oral antibiotic to assess its impact on gut flora and autistic symptoms.
Findings:
- Short-term improvements in autistic symptomatology were observed in 8 out of 10 children, based on blinded videotape evaluations.
- These positive outcomes were largely diminished at follow-up, indicating the antibiotic protocol was not a sustainable therapy.
- The study highlights a potential correlation between gut microbiome alterations and autistic features in a specific subgroup.
Implications:
- The findings suggest a possible gut-brain connection in the pathophysiology of regressive autism.
- Further research into the gut microbiome's role may offer novel insights into autism's underlying mechanisms.
- This could pave the way for future preventative or therapeutic strategies targeting the gut flora in certain children with autism.
Abstract:
In most cases symptoms of autism begin in early infancy. However, a subset of children appears to develop normally until a clear deterioration is observed. Many parents of children with "regressive"-onset autism have noted antecedent antibiotic exposure followed by chronic diarrhea. We speculated that, in a subgroup of children, disruption of indigenous gut flora might promote colonization by one or more neurotoxin-producing bacteria, contributing, at least in part, to their autistic symptomatology. To help test this hypothesis, 11 children with regressive-onset autism were recruited for an intervention trial using a minimally absorbed oral antibiotic. Entry criteria included antecedent broad-spectrum antimicrobial exposure followed by chronic persistent diarrhea, deterioration of previously acquired skills, and then autistic features. Short-term improvement was noted using multiple pre- and post-therapy evaluations. These included coded, paired videotapes scored by a clinical psychologist blinded to treatment status; these noted improvement in 8 of 10 children studied. Unfortunately, these gains had largely waned at follow-up. Although the protocol used is not suggested as useful therapy, these results indicate that a possible gut flora-brain connection warrants further investigation, as it might lead to greater pathophysiologic insight and meaningful prevention or treatment in a subset of children with autism.