On January 25 and 26, the first ever Autism and Immunology Workshop took place in Pasadena, Calif. on the campus of the California Institute of Technology. Organized by Cure Autism Now, and co-sponsored by Autism Speaks and a donation from Mr. Peter Emch, 26 scientists gathered to discuss the involvement
of the immune system in autism. The group was assembled to evaluate the findings and to galvanize the field of autism to focus on this underdeveloped area of research.
The meeting spanned multiple research domains, and brought together scientists working in clinical research, epidemiology, cellular and molecular biology, as well as model systems of inflammation and autism. All of these areas touched on the investigation of the functions and regulation of the immune system, both within the body and the brain. Workshop attendees ranged from experts in immunology from outside the field of autism or those just entering the field, to researchers who have been working in autism for many years. Many of the latter commented that this meeting was a long time coming.
As an introduction to the Workshop, meeting scientific co-chair and pediatric neurologist from Kennedy Krieger Institute, Andy Zimmerman, M.D., explained that he sees "children with autism and their families present with findings that are not always related just to brain functioning. Regulation of the immune system is something we have needed to explore in much more depth." Along with Dr. Zimmerman, the scientists serving as meeting co-chairs were Cure Autism Now Science Director Sophia Colamarino, Ph.D.; Paul H. Patterson, Ph.D., from California Institute of Technology; and Carlos Pardo, M.D. from Johns Hopkins University.
Throughout the day and a half research meeting, scientists (many of whom had never met), shared their data, debated and critically discussed the need for future autism research in the field of immunology. The morning of the first day was devoted to summary talks that provided the context for the meeting and introduced outsiders to autism. This was followed by a series of 10 minute research "datablitzes" that gave the attendees a sense of the areas now being explored in immunologic aspects of autism. Datablitz presenters included Drs. Mady Hornig, Dennis O'Dell, Cynthia Molloy, Harumi Jyonouchi, Robert Fujinami, Angela Vincent, Steven Maier, Lisa Boulanger and Mil Jonakait.
To emphasize collaborative thought, the rest of the meeting was devoted to in-depth discussions. The attendees were split into two breakout groups - one that focused on the next steps in clinical immunological research and another that focused on identifying areas of immune system biology that may be relevant to understanding the pathology of autism. Both groups were asked to consider what it is we already know about the intersection of immunology and autism, what we need to know, and what the next steps in research should be. Meeting co-chair Dr. Paul Patterson noted that "this discussion was a breath of fresh air that stimulated many new ideas for experiments, even to the point of considering potential therapeutics."
Although the past decade has produced several studies examining abnormal peripheral immune regulation in autism, the results have varied (largely due to small sample size, the lack of perfectly matched controls, and incompletely-characterized subjects). As presented by attendees at this meeting, several larger, well-controlled studies are now underway, including those of Judy Van de Water, Ph.D. and Paul Ashwood, Ph.D. at the M.I.N.D. Institute, and of Susan Swedo, M.D., at the National Institutes of Health Intramural Autism Research Program. Just one of the many hypotheses currently being investigated is whether the regressive form of autism, which accounts for roughly 20% of the cases, may be an autism subtype that particularly involves immunological activation.
Among the major areas of interest identified by the researchers are the role of maternal factors and prenatal immune stimuli in the development of autism, the expansion of key studies showing evidence of brain inflammation in patients with autism, and further development of model systems that can be used to link immunological stimuli with altered brain development and behavior. The researchers pointed out that these models are especially important for immediate development of therapeutic strategies if abnormal immune regulation ends up being a central factor in even a subset of individuals with autism.
Throughout the course of the meeting, the distinguished experts from outside disease fields (including multiple sclerosis, HIV, arthritis, and infectious diseases) shared with the autism experts the problems that their own fields had experienced, especially those that had slowed their progress. They cautioned the autism researchers to consider such issues as whether the immunological findings are primary or secondary to the development of autism (i.e., the cause of autism or a reaction to it), and exhorted the autism researchers to further characterize the immune mechanisms within the brains of individuals with autism. In addition, a theme that reiterated throughout the meeting was that to make progress, research must take into account that there are likely many different types of autism, and only a special subgroup of these may be related to immune activation.
Beyond just advising Cure Autism Now and Autism Speaks on the nature of future immunology research, the Workshop served a more immediate purpose of uniting many different researchers who had previously been working individually. Cure Autism Now grantee Lisa Boulanger, Ph.D., enthusiastically commented that "I found it tremendously informative and productive, and I'm already emailing people I met there about information, preprints, reagents, and potential collaborations, all sparked by the sessions." Moreover, several groups currently using similar experimental models have already begun discussions of when they can meet again to continue sharing their data and lessons learned.
The Workshop was intended to be a small, discussion-based meeting that would help advance our understanding of autism by beginning to focus the field on these important issues. "Conferences like this are expanding the boundaries of autism," explained CAN grantee Dr. Ashwood. In addition, the recommendations discussed will be prepared for publication in a scientific journal in order to disseminate the ideas more widely. At the conclusion of the conference, meeting attendee Dr. Swedo thanked the organizers by remarking that "This was one think tank that really accomplished its purpose – it made us think!"