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Fecal Microbiota Transplantation in Children with Autism
Youran Li1, Pei Xiao1, Hongfang Ding2
1Department of Gastroenterology, Hepatology and Nutrition, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
Purpose:
This research aimed to explore the clinical efficacy of fecal microbiota transplantation (FMT) in treating children with autism spectrum disorder (ASD).
Methods:
In this single-arm prospective study, every participant received FMT therapy, followed by an 8-week follow-up. Children unable to swallow lyophilized capsules (Caps) received fecal solution through transendoscopic enteral tube (TET) or nasal jejunal tube (NJT) approaches. All participants underwent assessments of ASD core symptoms, gastrointestinal (GI) symptoms and sleep status initially, after treatment and during follow-up. The study outcomes included the changes in scores of the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), Gastrointestinal Symptoms Rating Scale (GSRS) and Sleep Disturbance Scale for Children (SDSC), as well as the adverse events (AEs).
Results:
98 participants were involved, consisting of 80 males and 18 females, with a median age of 7 years. 73 children received the FMT in the form of Caps, while 13 patients underwent the procedure through TET and 12 patients via NJT. Improvements were observed in all outcome measures for Caps and NJT groups at both the post-treatment and 8-week follow-up evaluations. Adjusted between-group analyses at post-treatment and follow-up showed that Caps and NJT group had greater reduction in ABC, CARS and SRS scores compared with TET group, while NJT group had greater reduction in SDSC scores compared with Caps and TET group. The incidence of AEs was 8.2% in the Caps group, 23.1% in the TET group, and 8.3% in the NJT group, with no serious AEs reported.
Conclusion:
FMT treatment can improve the core symptoms, GI symptoms and sleep disturbances in children with ASD. The upper GI tract routes, including Caps and NJT, may be more effective and safe compared to the lower GI tract route of TET.
Insights
Fecal microbiota transplantation (FMT) improved autism spectrum disorder (ASD) core symptoms, GI issues, and sleep problems in children. Upper gastrointestinal delivery methods like capsules and NJT were more effective and safer than lower GI routes.
Area of Science:
- Pediatric Gastroenterology
- Neurodevelopmental Disorders
- Microbiome Research
Background:
- Autism spectrum disorder (ASD) presents complex challenges, including core behavioral, gastrointestinal (GI), and sleep disturbances.
- Fecal microbiota transplantation (FMT) is an emerging therapeutic strategy with potential to modulate the gut microbiome and impact ASD symptoms.
Purpose of the Study:
- To evaluate the clinical efficacy of FMT in improving core symptoms, GI issues, and sleep disturbances in children diagnosed with ASD.
- To compare the safety and effectiveness of different FMT delivery methods: oral capsules (Caps), transendoscopic enteral tube (TET), and nasal jejunal tube (NJT).
Main Methods:
- A single-arm prospective study involving 98 children with ASD (median age 7 years).
- Participants received FMT via Caps, TET, or NJT, with assessments at baseline, post-treatment, and 8-week follow-up.
- Evaluated changes in Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), Gastrointestinal Symptoms Rating Scale (GSRS), and Sleep Disturbance Scale for Children (SDSC), alongside adverse events (AEs).
Main Results:
- Significant improvements were observed in ASD core symptoms, GI symptoms, and sleep quality across all FMT groups (Caps, TET, NJT) post-treatment and at follow-up.
- The Caps and NJT groups showed greater reductions in ABC, CARS, and SRS scores compared to the TET group.
- The NJT group demonstrated superior improvement in SDSC scores compared to Caps and TET groups, with low incidence of generally mild AEs.
Conclusions:
- FMT is a promising treatment for improving core symptoms, GI problems, and sleep disturbances in children with ASD.
- Upper gastrointestinal delivery routes (Caps, NJT) appear more effective and safer than the lower GI route (TET) for FMT in this pediatric population.
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