Archive for June 3rd, 2018

Fecal Transplant as an Autism Treatment

Sunday, June 3rd, 2018

The prestigious New England Journal of Medicine recently published an article entitled, Fecal Microbiota Transplantation for Primary Clostridium Difficile Infection. It is likely that parents of children with ASD, who exhibit gastrointestinal difficulties, will ask, “Can we use this to help Junior recover?”

The answer is a complicated, “Maybe. But, more research is needed.”

The study looked specifically at ‘C. diff’ – one strain of bacteria, not to be confused with parasites, fungi, viri, or other nasty cooties. The follow up was a mere 70 days. In children with yeast or other such distress, recurrence may appear weeks, months, or even years later.

Recent Literature
According to the Fecal Transplant Foundation, the treatment, “was first documented in 4th century China, known as “yellow soup”… there has never been a single, serious side effect reported…”

2010
Pyrosequencing study of fecal microflora of autistic and control children
Dr. Feingold, “examined the fecal microbial flora of 33 subjects with various severities of autism with gastrointestinal symptoms, 7 siblings not showing autistic symptoms and eight non-sibling control subjects… The results provide… a compelling picture of unique fecal microflora of children with autism with gastrointestinal symptomatology.”

2012
This review concluded that FMT, “is now arguably the most effective form of Clostridium difficile eradication… potential value in ulcerative colitis… as well as previous unexpected applications, such as obesity, diabetes and several neurologic disorders.”

2013
Fecal Microbiota Transplantation: Indications, Methods, Evidence, and Future Directions
“Most institutions utilize fresh feces, have adopted an approach of using highly filtered human microbiota mixed with a cryoprotectant and then frozen… with dramatic shifts in recipient gut microbial communities noted after transplantation… The route of administration … can be naso-duodenal, transcolonoscopic, or enema based…”

2014
A research paper that summarizes, “FMT is a highly effective cure for RCDI (recurrent Clostridium difficile infection), but increased knowledge of the intestinal microbiota in health maintenance, as well as controlled trials of FMT in a wide range of disorders are needed before FMT can be accepted and applied clinically.”

2015
Fecal microbiota transplantation broadening its application beyond intestinal disorders
The authors covered earlier works and noted, “FMT is a promising approach in the manipulation of the intestinal microbiota and has potential applications in a variety of extra-intestinal conditions associated with intestinal dysbiosis.”

2017
Microbiota Transfer Therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study
A rather complicated 2-1/2 month protocol resulted in, “an approximately 80% reduction of GI symptoms at the end of treatment, including significant improvements in symptoms of constipation, diarrhea, indigestion, and abdominal pain. Improvements persisted 8 weeks after treatment… behavioral ASD symptoms improved significantly and remained improved 8 weeks after treatment ended. “

Discussion
Signs and symptoms of gastro-intestinal distress ought to be present when seeking such treatment. This may appear obvious, but oft-times the gut has already been addressed and healed. Or, the primary cause(s) of the autism may originate from elsewhere, such as metabolic, genetic, toxins, etc. This complicated intervention may be superfluous.

One potential harm of fecal transplantation is The Unknown. What might the tiny viri, of which we know little – other than their ability to transform cells (cancer, cell death, immunity) – do to the recipient as regards potential long term danger?

Another risk is The Known. Can transferring bacteria from one person to another cause harm (immediate or delayed), due to allergy or other incompatibility?

Prior to his untimely demise a few years ago, in a personal communication with the intrepid Dr. Jeffrey Bradstreet, he lamented that the process was extremely resource intensive (to assure safety) and subject to recurrences, after as little as 3 months.

Conclusion
Earlier, Dr. Feingold noted, “If the unique microbial flora is found to be a causative or consequent factor in this type of autism, it may have implications with regard to a specific diagnostic test, its epidemiology, and for treatment and prevention.” FMT research helps enforce the gut-brain connection that has been noted in autism since Dr. Leo Kanner described the condition 80 years ago (although his Freudian underpinnings seem to have obfuscated his patients’ GI issues).

Autism consists of a variety of mysterious signs and symptoms. In all of the studies performed to date, there is a relatively short followup period, not necessarily reflective of an affected child’s time frame. It is difficult to ascertain whether regression, aggression, poor sleep, diarrhea, constipation, sensory overload, etc. are due to a specific organism or a different mechanism. Accurate knowledge the intestinal microbiota is paramount to assess efficacy and prevention of recurrence.

As costs, resources and safety become established with other disease entities, and practitioners learn how to effectively administer the protocol, this type of treatment may take a more prominent role in treatment of Autism Spectrum Disorder.

* My previous article on this subject appears here.

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