Probiotic Supplementation Benefits Patients with Autism Spectrum Disorder

by | Nov 2, 2020 | 2020, Autism, Infant and Children's Health, Probiotics

Written by Joyce Smith, BS. In a subset of children with autism spectrum disorder (ASD) and gastrointestinal (GI) symptoms, six months of probiotic supplementation not only improved GI symptoms but improved behavioral profiles as well.

autism - brain healthExisting evidence has shown that children with ASD have more gastrointestinal (GI) symptoms and changes in the stability, diversity and composition of their gut microbiota compared to their typically-developing peers. As well, these children often have increased intestinal barrier permeability accompanied by systemic and intestinal inflammation 1. There is also evidence suggesting that the microbiota-gut-brain axis may be a key modulator of neuropsychiatric health. The gut-brain axis (GBA) is a two-way highway between the central nervous system (CNS) and the enteric nervous system (ENS) of the body. It provides direct and indirect pathways of communication between the cognitive and emotional centers in the brain and the gastrointestinal tract. Evidence points to the involvement of our gut microbiota in a variety of neurological and psychiatric disorders, including Parkinson’s disease, multiple sclerosis, depression, anxiety disorders and autism 2. Our gut microbiota can influence brain function directly or indirectly through short-chain fatty acids (SCFAs), immune stimulation, and gut-barrier permeability and neuroendocrine pathways such as the hypothalamic-pituitary-adrenal axis. The brain can also affect gut function via the vagus nerve. Thus, alterations in gut bacteria can affect neuropsychiatric and neurodevelopmental disorders including ASD 3,4.

The current study was a randomized controlled trial 5 designed to investigate whether the use of probiotics, recently named “psychobiotics”, would restore the  normal gut flora and decrease symptoms in children with ASD by modulating their brain activity and function, thus possibly improving their behavior profiles. Eighty-six ASD preschoolers (mean age, 4.2 years; 84% boys) with and without GI symptoms were randomly assigned to supplementation with the De Simone Formulation (DSF) (n=42) or placebo (n=43) for six months and evaluated with respect to ASD core symptoms, GI symptoms, plasma and fecal inflammatory biomarkers. DSF is a probiotic blend of Streptococcus thermophilus, Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus para-casei, and Lactobacillus delbrueckii subsp. Bulgaricus.

No overall differences were seen between the groups for the primary outcome measure (the Total Autism Diagnostic Observation Schedule-Calibrated Severity Score [ADOS-CSS]). An exploratory secondary analysis was done on subgroups of children with GI symptoms (GI group, n= 30) and without GI symptoms (NGI group, n=55). This analysis revealed that when both groups were treated with probiotics, the NGI group had a significant decline in ADOS scores compared to the placebo group, with a mean reduction of 0.81 in Total ADOS CSS and of 1.14 in Social-Affect ADOS CSS over six months.  This finding is significant in that a mean reduction of 0.81 in Total ADOS CSS and of 1.14 in Social-Affect ADOS CSS over six months constitutes a clinically significant decrease of ASD symptoms 6.  For those ASD children with GI symptoms, the probiotic intervention resulted in significant improvements in GI symptoms and core ASD behaviors such as cognitive functioning and multisensory processing. Mean Total ADOS-CSS scores decreased in the probiotic group (6.84 to 6.190) and increased in the placebo group from (6.97 to 7.00), with a mean change of  (-0.65 vs +0.03, P=0.08) that did not reach significance.

The positive changes found in the GI symptom-free children may be the result of a complex interaction between gastrointestinal problems and adaptive functioning, both of which are connected to the serotonin system v   that enables communication between the brain and nervous system to stabilize mood, feelings of well-being, and happiness and support sleep and digestion. The DSF supplementation resulted in no significant difference in autism severity compared to placebo which is not consistent with some previous findings of significant improvements in ASD symptoms in response to probiotic administration 7,8. Therefore, larger, well-designed studies to ascertain the impact of microbial composition on behavioral and GI symptoms in children with ASD are recommended.

Source: Santocchi, Elisa, Letizia Guiducci, Margherita Prosperi, Sara Calderoni, Melania Gaggini, Fabio Apicella, Raffaella Tancredi et al. “Effects of Probiotic Supplementation on Gastrointestinal, Sensory and Core Symptoms in Autism Spectrum Disorders: A Randomized Controlled Trial.” Frontiers in Psychiatry 11 (2020).

© 2020 Santocchi, Guiducci, Prosperi, Calderoni, Gaggini, Apicella, Tancredi, Billeci, Mastromarino, Grossi, Gastaldelli, Morales and Muratori. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY).

Click here to read the full text study.

Posted November 2, 2020.

Joyce Smith, BS, is a degreed laboratory technologist. She received her bachelor of arts with a major in Chemistry and a minor in Biology from  the University of Saskatchewan and her internship through the University of Saskatchewan College of Medicine and the Royal University Hospital in Saskatoon, Saskatchewan. She currently resides in Bloomingdale, IL.

References:

  1. Azhari A, Azizan F, Esposito G. A systematic review of gut-immune-brain mechanisms in Autism Spectrum Disorder. Dev Psychobiol (2019) 61:752–71. doi: 10.1002/dev.21803
  2. Dinan TG, Cryan JF. Gut microbiota: a missing link in psychiatry. WorldPsychiatry (2020) 19:111–2. doi: 10.1002/wps.20726
  3. Cryan JF, Dinan TG. Mind-altering microorganisms: the impact of the gutmicrobiota on brain and behaviour. Nat Rev Neurosci (2012) 13:701–12. doi:10.1038/nrn3346
  4. Iannone LF, Preda A, Blottiere HM, Clarke G, Albani D, Belcastro V, et alMicrobiota-gut brain axis involvement in neuropsychiatric disorders. ExpertRev Neurother (2019) 19:1037–50. doi: 10.1080/14737175.2019.163876
  5. Santocchi, Elisa, Letizia Guiducci, Margherita Prosperi, Sara Calderoni, Melania Gaggini, Fabio Apicella, Raffaella Tancredi et al. “Effects of Probiotic Supplementation on Gastrointestinal, Sensory and Core Symptoms in Autism 6. Gotham K, Pickles A, Lord C. Standardizing ADOS scores for a measure of severity in autism spectrum disorders. J Autism Dev Disord (2009) 39:693–705. doi: 10.1007/s10803-008-0674-3
  6. Gotham K, Pickles A, Lord C. Standardizing ADOS scores for a measure of severity in autism spectrum disorders. J Autism Dev Disord (2009) 39:693–705. doi: 10.1007/s10803-008-0674-3
  7. Shaaban SY, El Gendy YG, Mehanna NS, El-Senousy WM, El-Feki HSA, Saad K, et al. The role of probiotics in children with autism spectrum disorder: A prospective, open-label study. Nutr Neurosci (2018) 21:676–81. doi:10.1080/1028415X.2017.1347746
  8. West DO ER, Sichel LS, Sichel J. Improvements in Gastrointestinal Symptoms among Children with Autism Spectrum Disorder Receiving the Delpro®Probiotic and Immunomodulator Formulation. Probiotics Health (2013)1:102. doi: 10.4172/2329-8901.1000102