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Immune Disorders and Autism Live Chat with Dr. Patterson

Paul Patterson, Ph.D., answered questions about the New York Times opinion piece on autism and immune dysfunction and related topics. He continued to answer questions that went unanswered during our chat time on his own personal blog, infectiousbehavior.wordpress.com. For more on the topic, please read an Autism Speaks news report about the New York Times piece here.

Bio: Paul Patterson, Ph.D., a professor of biological sciences at California Institute of Technology, is researching the links between immune function and autism. He is the author of “Infectious Behavior: Brain-Immune Connections in Autism, Schizophrenia, and Depression.”

2:56
 
Comment From Elda Yambao

What would you advice pregnant women about their diet/lifestyle to avoid the risks of autism for their baby?

2:58
  Elda hang tight! We are beginning momentarily!
3:04
  This is Paul Patterson. I'm a professor at the California Institute of Technology in Pasadena California. Our group works on a mouse model of a risk factor for autism, maternal infection. I published a book on the issues to be covered today called, "Infectious Behavior: Brain-Immune Connections in Autism, Schizophenia and Depression". Updates on this material and answers to queries are on the book blog: infectiousbehavior.wordpress.com. I'll do my best to answer all questions, but will not be able to make specific recommendations regarding medicines, etc.
3:04
  Hi everyone, welcome to the webchat! I am Dr. Alycia Halladay, Director of Research for Environmental Sciences at Autism Speaks. Hopefully I can also answer your questions and concerns, but most of the responses will come from the expert Dr. Patterson.
3:05
 
Comment From Caroline Greco

Hi, my name is Caroline Greco. I have a son who will be 21 and is Autistic & has Asbergers. I have Multiple Sclerosis. Is there any correlation to each other? I know the both are Autoimmune Diseases.

3:08
  Hi Elda, this is a good question and one that we get quite often. First, follow the advice of your doctor and take a prenatal vitamin, including one with DHA. You may also need an iron supplement. Follow your doctor's advice on the proper level of nutrients during your pregnancy. Please see the recent blog about avoiding environmental exposures in pregnancy:http://www.autismspeaks.org/blog/2012/04/06/avoiding-environmental-hazards-during-pregnancy
3:11
  Caroline, there are several studies showing that women who have an autoimmune disease are at a slightly higher risk for having a child with autism. These studies involve hundreds or thousands of cases in order to reach statistical significance. Thus it is impossible to say that any one autism case is due to autoimmune disease. PHP
3:12
  Here is a question we received in advance from Brian: 
Hi Paul Patterson – 
The crux of the NYT article as I read it was that a state of inflammation could be a participating agent in autism pathogensis, at least in a subset of children with autism. The animal models from your group and others would seem to be evidence that an acute immune challenge could have this capability. Similarly, epidemiology indicates that states of chronic, low grade inflammation are also a risk factor for having a child with autism. 

My question is, if a lifestyle characterized by increased inflammation is a risk factor for being the parent of a child with autism, how can this inform us on the question of autism incidence? This is a notoriously difficult question to address with any precision, but at the very least, do you think that it is safe to say that if conditions like asthma or metabolic syndrome are risk factors for autism, then therefore, some component of our observed increase in children with autism are the result of an actual change in incidence, as opposed to the result of diagnostic changes and greater awareness? 

3:12
  HI Brian, Glad to hear you are following our work and keeping up with this rapidly developing field. I think you are asking if the demonstrated rise in autoimmune diseases such as asthma, Type 1 diabetes, multiple sclerosis and Crohn's disease parallels the rise in ASD diagnosis? In the July 27, 2012 post (entitled parasite treatment for multiple sclerosis and ...) on my blog (infectiousbehavior.wordpress.com) I showed a figure that demonstrates the increase in asthma rising dramatically from the early 80s thru the mid 90s, when the graph ends. Diabetes rose continually starting in the early 70s thru the present day. MS and Croh's diseae started their rises earlier than that. Thus, there is a crude correspondence between the contemporary rise in ASD diagnosis and these disorders. This is the reason for making the connection between the epidemiological finding of increased risk for ASD in moms with autoimmune disease and the increase in overall ASD diagnosis. 
Incidentally, the graph I just referred to also shows an amazing drop in infectious diseaes (measles, mumps, TB, Rheumatic fever) that parallels very nicely the rise in autoimmune diseases. This is part of the basis for implicating the hygiene hypothesis in the context of ASD. This idea is taken up in more detail in my book, "Infectious Behavior: Brain Immune Connections in Autism, Schizophrenia and Depression" PHP
3:13
 
Comment From Luanne McCabe

My son is 13 years old. He has serious digestive issues. What are some cutting edge treatments. I would love to discuss with his GI doctor. He is given Mirolax 2X a day for 2 years. I don't feel that this is helping. In fact, it's making him worst! Why can't they crack this nut? Help!

3:13
  Hi Luanne, this is Alycia from Autism Speaks. A group of pediatricians and gastrointestinal specialists have developed a consensus paper that may be useful for your GI doctor to read on how to manage GI individuals with ASD. You can read more here: 
http://www.autismspeaks.org/about-us/press-releases/pediatrics-gastrointestinal-consensus-statement-recommendations-provide-firs
3:14
  Here is another advance question from Peggy: 
My son has PANDAS which I have viewed as a Venn Diagram intersecting with Autism. We see an Autism/Immune Dysfunction Dr. who found very high titers to HHV-6, Mycoplasma, and Strep along with Food Allergies where we never saw any symptoms. Anti-virals, and Antibiotics have put him at 100% but still difficulty with allergies and IGG. 

My question is if Inflammatory Diseases have doubled since the 80's and Autism exponentially, is anyone looking at the link between the changes of our food supply with GMO's introduced in the 90's? 

Those changes too could add a silent layer of inflammation to the womb beginning the layers of stress on the child's immune system. 

3:14
 
Comment From Emily Willingham

Can you address the nature of the subset of autistic people who might have an immune component to the condition and what the research points to as characteristics of this subset?

3:14
  Peggy, Good to hear that your son's PANDAS was well treated with antibiotics. For those not familiar with this disorder, it comes on rather suddenly in kids, who typically exhibit tics and obsessive behaviors. The disorder is thought to arise from an infection, such as strep, and the immune system makes antibodies against the pathogen, and some of these antibodies happen to cross react with and bind parts of the nervous system. This immune reaction may be the reason for the abnormal behaviors. Getting rid of the pathogen then lowers the immune activation level and the behaviors are ameliorated. Work with animal models has supported this sequence of events. 
Back to your question, is anyone looking at the link between GMO-related foods and the rise in ASD diagnosis? I'm not aware any such studies, but they could be going on and not published yet. This could be easily tested in animals, of course, if there was a reason to suspect certain GMOs as being relevant. Cheers, PHP 
3:19
 
Comment From ranjana

i have a son who is severe autistic , but i still didn't got a proper diagnose where i took him she diagnose him what i said to her, i'm facing lots of challenge in my life because he doesn't eat doesn't sleep, doesn't talk, he will go school this sep but at home we r facing lots of problem with him i have no resource pl help

3:20
  Hi Ranjana - Autism Response Team (ART) members are specially trained to connect families with information, resources and opportunities. Call us at 888-288-4762 or en Español 888-772-9050, or email familyservices@autismspeaks.org. Or check out our webpage http://www.autismspeaks.org/family-services/autism-response-team
3:21
  Here's an advance question from Caroline: 
I am 49 years old & I have Multiple Sclerosis. My son who is 20 years old has Autism & Aspergers. Is it possible because I have M.S..(an autoimmune disease) that that's why my son is Autistic? 
I have had M.S. since I was 14 in 1977. The doctors didn't know what was wrong until I HAD an MRI in 1986 which was pretty new back then. Is it possible because of the MS my son is Autistic? He's doing very well now. He's at Pace University in NYC in a Program for students with Autism & Aspergers. 
3:22
 
Comment From Laureen Forman

Significant studies have come out over this summer which is pointing that Autism is a medical disease and these kids are sick. What is the plan to start looking at getting real medical treatments into practice as we don't have 30 years to wait.

3:22
  Dear Caroline, You are correct in that mothers with autoimmune disorders are at higher risk for having a child with ASD. However, the risk is not large, so any individual case cannot be attributed to the autoimmune condition. These epidemiological studies that discover such risk factors utilize hundreds or thousands of cases in order to make statistically significant conclusions. Thus, individual cases cannot be definitely tied to such risk factors. Good to hear that you son is doing very well! PHP 
 
3:22
  Hi Laureen, this is Alycia. We agree that many times important research findings do not reach clinicians fast enough. The Autism Treatment Network was specifically developed and funded to address medical issues in children who are affected with autism, including some mentioned here (GI, sleep) as well as to share this information with doctors all over the world. Not everyone lives near an ATN, and it is important to share information and discoveries. Parents become the best advocates for their child, sometimes informing doctors of the most recent research. Please continue to do so.
3:24
  HI Emily, I spoke to this question on my book blog (infectiousbehavior.wordpress.com) earlier but here is a short answer. I like the work of Tony Persico in Rome who has grouped ASD cases by their symptoms. He finds that about 18% of his cases belong to an "immune-related" group. I can send you those papers if you email me. Then there are the ASD cases with GI disorders, many of which are likely to have an immune connection. Two studies have found a strikingly high proportion of ASD cases with "leaky gut", in which molecules in the gut leak into the blood - these molecules are too large to leak into the circulation in typical people. Estimates of this subset of ASD subsets range from 50-70%! Interestingly, we find leaky gut in our mouse model of the maternal immune activation risk factor for autism. We also find in these mice abnormalities in the immune cells in the blood, as is seen in human autism. The proportion of human ASD cases that display abnormal immune cells in their blood is not entirely clear at this point, but it is very significant - higher than 20%.Cheers, PHP
3:24
  Hey everyone! We are getting such great questions - we are trying our best to get everything answered!
3:27
 
Comment From JaysmumUK

Good Evening Dr. Patterson and Dr. Halladay. I would like to ask you about the emerging treatment for Autism and autoimmunity, GCMAF and whether you think it can help with immune dysregulation.

3:29
  JaysmumUK: I'm not familiar with GCMAF, unfortunately. PHP
3:32
 
Comment From Christina

With the current research, I'm so confused and I'm not sure how best to try and help my son recover from his suffering with Autism. One article says that Autism is caused by a lack of intestinal parasites, and that introducing parasites will fix him. Then at Autism One I was told I need to give him bleach enemas to kill the parasites causing his Autism. This seems so contradictory. Help me understand which one is logical according to the science?

3:32
  Christina, thank you for your question. This is Alycia. The NY Times editorial included a section of the promise of whipworm therapy. So far, this therapy has not been shown to be effective in children with autism, however, there are promising findings in other diseases and an ongoing study at Albert Einstein School of Medicine. Dr. Patterson discuss this in his book blog. You should definitely talk to your doctor about this before you begin. Bleach enemas are not safe and you should not begin that therapy.
3:34
 
Comment From LeAnn

I have a soon to be 20 yr old son. He wasn't diagnosed until 1 month before graduating h.s I got him in college last year but he only lasted 1 mo. He graduated with high honors and is very smart, but now he is home and doesn't think he needs a job and doesn't want to take classes. I am at a loss and don't know what to do anymore. I want him to start taking control and start doing things on his own. Any suggestions?

3:34
  Hi LeAnn - The Autism Response Team (ART) members are specially trained to connect families with information, resources and opportunities. Call us at 888-288-4762 or en Español 888-772-9050, or email familyservices@autismspeaks.org. Or check out our webpage http://www.autismspeaks.org/family-services/autism-response-team
3:35
  Here's another advance question: 
Why are inflammation and oxidative stress not routinely explored and treated if present in different subgroups of ASD children?
3:35
  Hi, this is Alycia. In some ongoing research studies, and in the Autism Treatment Network, markers of immune function are studied to determine their role to autism and specific autism subtypes. The conclusions are sometimes not very clear. More research is needed on valid markers and their relevance to ASD.
3:36
  Emily, re your final question; I was not aware that Simon is using the same Danish samples, but that is very cool if he is. Yes, the potential interplay between androgens and inflammatory molecules would be a really important area for study in animals, given the male bias in ASD. Interestingly, we do see sex biases in some of our animal results in the maternal immune activation model. Thx for a key question. PHP
3:38
 
Comment From Buffy

OOps...let me try again. Hello! My daughter is 2 and was just diagnosed with Autism at the beginning of August. She was conceived via donor egg, was in cryo for 1 year and then implanted in my best friend as a gestational surrogate. My friend had gestational diabetes during the pregnancy at 35weeks. As I try to understand your research and my own daughter's autism is it the genetic piece, the pregnancy piece or all of it put together?

3:38
  Hi Buffy, this is a great question and while not related to the immune system I know many parents have similar concerns about the role of genetics and the environment. The best science and the agreement of researchers is that genetics and environmental factors change the risk of a child being diagnosed with autism. in some cases of ASD, the weight is heavier on the genetics. This includes disorders like Phelan McDermid Syndrome, Rett Syndrome, and Fragile X. You should read Martha Herbert's blog on risk vs. cause, I hope it helps, Alyciahttp://www.autismspeaks.org/blog/2012/04/18/risk-vs-cause
3:39
 
Comment From Shannon Johnson

I was wondering if your research has demonstrated that maternal immune issues/infections might make offspring more susceptible to PANDAS/PANS?

3:46
  HI Shannon, As mentioned above (and as you know) Pandas typically occurs in older kids, with a sudden onset attack of symptoms, and these symptoms are not typically seen in autism. However, the connection with the immune system in both of these disorders is intriguing. In fact, the author of the wonderful book on Pandas, "Saving Sammy", Beth Moloney has suggested the idea that perhaps maternal infection might disturb the immune system of the offspring such that the child would be more susceptible to making autoantibodies against his/her brain. This would be testable in mice, if only there weren't ever decreasing levels of research available - the NH budget will take a super heavy hit when the country falls off the famous "financial cliff" in Jan. Fortunately, Autism Speaks has funded my group as well as many others to keep the field afloat for the time being.
3:47
 
Comment From Patrice Gilbert

If the problems alledgedly begin in the womb, then why don't the problems show up until later? Wouldn't the child behave atypically from birth? Doesn't the health of the father also play a part?

3:48
 
Comment From Manal

My daughter who is 18 years old is running an autism awareness programm because of my sister's daughter who is as old as her and is autistic, we need some guidance for early signs and how to take care dring pregnancy to minimize chances of autistic children

3:48
  Hi Manal, this is Alycia, congratulations and thank you on helping raise awareness of ASD. Our website has a lot of information about early detection and diagnosis, including screening tools for ASD.http://www.autismspeaks.org/what-autism/learn-signs. Good luck!
3:50
  We are getting so many great questions - we are trying to narrow answers down to immune dysfunction. If you have any other questions related to autism please visit our Family Services Page as well as our Autism Response Team!http://www.autismspeaks.org/family-services/autism-response-team
3:54
 
Comment From sandra Brown

Good afternoon Doctors, and thank you for your time today. I had my son at age 40, and have no current diagnosis of any specific auto-immune disorder, but have had consistent positive ANA results. Family hx of Lupus and RA. My 8 yr old son is high-functioning ASD. My question is whether there is a risk of my sons fathering autisic children, or does the effect seem primarily related to a female lineage? Two older boys born in my 20's have no ASD dx.

3:54
  Hi Sandra, this is Alycia. There have been studies to suggest that family history of autoimmune disorders like lupus increases risk of ASD, but as Martha Herbert explains in her blog "risk vs. cause", one environmental factor alone does not cause ASD. There have been studies studying paternal and maternal influences in ASD without a consistent conclusion - in other words, it could be either. 

If your sons have a concern about a particular genetic risk factor, they may want to see a genetic counselor. You can find one here:www.nsgc.org

Good luck.

3:56
 
Comment From Stephanie

Hi my name is Stephanie, i have a 5 yr old son who has trouble sleeping. There are times he will wake up at night screaming, or sometimes it is hard for him to fall asleep, there are also times were he will sleep for 3 hrs and stay up until 5 am. I have tried everything that i kno. I have tried the soothing muci, craddling him in my arms. I dont know what else to do. He was diagnosed with spectrum autism.. Please i need your help

3:57
  Hi Stephanie, your concerns about sleep are not unusual. Many people on this webchat are also expressing the same frustration! Autism Speaks has published a toolkit on managing sleep behaviors, here it is: http://www.autismspeaks.org/science/science-news/new-autism-speaks-sleep-strategies-guide. Good luck!!!
3:58
  Patrice, Given the risk factor of maternal infection, it is likely that some subset of ASD begins in the womb. How would that lead to abnormal behaviors in the child. With the support of Autism Speaks, Elaine Hsiao, Wei-Li Wu and Howard Yang are researching this question in our mouse model. Steve Smith, a previous student in the group, found that a specific protein, IL-6, is produced in the pregnant mouse in order to fight infection, and this protein is critical in mediating the effects on the offspring. Elaine found that IL-6 acts on the placenta, altering the endocrine function of that organ. Wei-Li is finding that IL-6 is also acting on the fetal brain. So the story so far is that the mother needs IL-6 to fight infection, but that this protein can affect the placenta and the brain, which then leads to problems in the brain, and in the immune system, and even problems in the gastrointestinal tract. IL-6 is also prominent in the GI and immune systems of these offspring!
4:02
 
Comment From Shannon Johnson

Hi Dr. Patterson,

4:02
 
Comment From Kay

What lab tests show inflammation in autistic individuals? Is there an elevated sed rate in autism?

4:04
  Kay, Lab tests can show abnormalities in the ASD immune system. You or your doctor can find these results in papers by Judy van de Water at the Univ of Calif at Davis.
4:04
 
Comment From Luanne McCabe

My son is 13 years old. He lives at The Center For Discovery in Monticello. He has severe digestive issues. They have him on mirolax; 2X per day for 2 years. This is a "band aid," not a solution for his problem. Are there any cutting edge treatments I could discuss with his GI doctor?

4:05
  Luanne, I'm sorry but I can't answer specific questions about medications. PHP
4:08
 
Comment From kristie harmon

I had a torn placenta when I was pregnant with her could that be why she has Autism>

4:10
  Kristie, Plancenal damage can cause many problems, but it would depend on what caused the problem and at what time during gestation it occurred. Placental abnormalities have been found in ASD cases in one small report. Much more research should be done on this, particularly in light of the paper by Elaine Hsiao of our group. PHP
4:14
  Sorry, they have to shut this site down now. I'll be happy to answer the remaining questions (just those related to the immune connection, not those related to specific treatment options tho) on my book blog: infectiousbehavior.wordpress.com