Microbiota Transfer Therapy Improves Gastrointestinal and Autism Symptoms

by | Nov 5, 2018 | 2017, Autism, Brain Health, Infant and Children's Health

Written by Angeline A. De Leon, Staff Writer. Microbial Transfer Therapy significantly decreased symptoms of abdominal pain, indigestion, diarrhea, and constipation and increased the relative abundance of Bifidobacterium and Prevotella, bacterial species in the eighteen participating children with autism spectrum disorder compared to the control group.

autism - brain healthThe prevalence of autism spectrum disorders (ASDs), a group of disorders characterized by impaired communication and social interaction, is estimated to be about 1-2% among children worldwide 1. The etiology of ASD, like many complex disorders, is thought to involve a combination of genetic and environmental factors. More recently, studies suggest a relationship between severity of ASD and the presence of various gastrointestinal (GI) symptoms, including constipation and diarrhea 2-4. Compared with healthy children, children with ASD exhibit altered gut bacteria profiles 5,6, with lower levels of fermentative bacteria and less bacterial diversity in general 7. Abnormal intestinal permeability has also been observed in ASD patients and their first-degree relatives, compared with heathy controls 8. One study found that administration of oral vancomycin (an antibiotic treatment for Clostridium difficile acting at the gut-level) in children with ASD was associated with temporary reduction of GI and ASD symptoms 9. Fecal microbiota transplant (FMT), also known as stool transplant, seeks to rebalance gut microbiota in those with a GI condition by transplanting the fecal bacteria of a healthy donor into the intestinal tract of the sick recipient. Given evidence indicating the capacity of FMT therapy to improve GI disorders 10, researchers at Arizona State University examined whether a modified FMT protocol, Microbiota Transfer Therapy (MTT), could improve GI symptoms and ASD-related symptoms in children with an ASD diagnosis.

In an open-label clinical trial 11, a total of 18 children with ASD (aged 7-16 years) and moderate to severe GI problems were recruited, along with a control group of 20 age- and gender-matched healthy, neurotypical children. ASD children participated in the following MTT protocol: 14 days of oral vancomycin treatment; 12-24 hour fasting with bowel cleansing; repopulation of the gut microbiota through oral or rectal administration of a high initial dose of Standardized Human Gut Microbiota (SHGM, > 99% bacteria); and daily lower maintenance doses with a stomach acid suppressant for 7-8 weeks (to increase survival of SHGM through stomach). At baseline and 8 weeks following the treatment period, researchers administered the Gastrointestinal Symptom Rating Scale (GSRS), Parent Global Impression-III (PGI-III), Childhood Autism Rating Scale (CARS), Aberrant Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and Vineland Adaptive Behavior Scale II (VABS-II). Parents were also instructed to complete daily stool records (DSR) daily during the treatment period. Control children were monitored but not treated over the 18-week period.

Analyses revealed significant improvement in GSRS score (p < 0.001), specifically for symptoms of abdominal pain, indigestion, diarrhea, and constipation, with average GSRS score decreasing by 82% by the end of treatment. On the DSR, the number of days with abnormal stools significantly also decreased (p = 0.002). Improvement in ASD-related behaviors was evident following MTT, based on PGI-II (p < 0.001), CARS (p < 0.001), SRS (p < 0.001), and ABC scores (p < 0.01). Bacterial sequencing analyses indicated significant increases in overall bacterial diversity in ASD children by the end of treatment (p < 0.05), with specific increases in the relative abundance of Bifidobacterium and Prevotella, bacterial species thought to be lacking in autistic children 7,12.

Based on study findings, MTT appears to effectively improve both the GI issues reported in ASD children, as well as ASD-symptoms. In addition, MTT was associated with increased phylogenetic diversity of gut bacteria in ASD children, shifting the microbiota profile of ASD children closer to that of their healthy, neurotypical peers. Given the exploratory, observational nature of the present study, follow-up research using a blinded design with a placebo control arm and a larger sample size would be valuable. Also, understanding the degree to which vancomycin and proton pump inhibitors, agents known to alter gut flora 13,14, influenced the changes in microbiota observed at the end of treatment would be important for future studies.

Source: Kang D, Adams JB, Gregory AC, et al. Microbiota transfer therapy alters gut ecosystem and improves gastrointestinal and autism symptoms: an open-label study. Microbiome. 2017; 5: 10. DOI: 10.1186/s40168-016-0225-7.

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)(http://creativecommons.org/publicdomain/zero/1.0/)

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Posted November 5, 2018.

Angeline A. De Leon, MA, graduated from the University of Illinois at Urbana-Champaign in 2010, completing a bachelor’s degree in psychology, with a concentration in neuroscience. She received her master’s degree from The Ohio State University in 2013, where she studied clinical neuroscience within an integrative health program. Her specialized area of research involves the complementary use of neuroimaging and neuropsychology-based methodologies to examine how lifestyle factors, such as physical activity and meditation, can influence brain plasticity and enhance overall connectivity.

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