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Reductions In Autism Symptoms Two Years After Fecal Transplants

Two years ago a study was published showing good results in 18 children with autism who received fecal transplants. Fecal transplants involves giving stool (along with all the microbes in the stool) from a healthy donor to a recipient. After getting fecal transplants, the children (ages 7 to 16) had significant improvements in their gastrointestinal symptoms (e.g. abdominal pain, indigestion, diarrhea, and constipation, and stools), autism related symptoms, and in their gut microbes.

But how did they do long-term? The short answer: great. In fact, the children continued to improve over the next 2 years. Most of their gut symptoms continued to improve, their autism symptoms continued to improve, and their gut microbes kept improving over time - with significant increases in bacterial diversity (considered good), and with more Bifidobacteria and Prevotella. A professional evaluator found an average 45% reduction in core autism symptoms (language, social interaction and behavior) at two years after the initial treatment (compared with before the original treatment).

It has long been known that many persons with Autism Spectrum Disorders (ASD) experience chronic gastrointestinal (GI) symptoms, and research shows that children with ASD have distinctive gut microbiomes (as compared to neurotypical children). Researchers believe there is a link between the gut and brain (the gut-brain axis), so a therapeutic approach could be to "modify" the gut microbes. Which is what the researchers did - in a 10 week process they call Microbiota Transfer Therapy (MTT). First they gave antibiotics, then a bowel cleanse, a stomach-acid suppressant, a fecal transplant (FMT) followed by many days of low purified doses taken orally.

From Science Daily: Autism symptoms reduced nearly 50 percent two years after fecal transplant

According to the Centers for Disease Control and Prevention, about one in every 59 children in the U.S. is diagnosed with autism, up from one in every 150 in 2000. 

One promising avenue of autism research involves the gut microbiome, which is the collection of microbes that lives in our intestines and helps us in many ways including digestion of our food, training our immune system and preventing overgrowth of harmful bacteria. Recent research suggests our gut microbiomes also affect brain communication and neurological health. Worldwide, interest is growing in the idea that changes in normal gut microbiota may be responsible for triggering a vast range of diseases.

In a new study, "Long-term benefit of Microbiota Transfer Therapy in Autism Symptoms and Gut Microbiota," published in Scientific Reports, Arizona State University researchers Rosa Krajmalnik-Brown, Ph.D., James Adams, Ph.D, and lead author Dae-Wook Kang, Ph.D, demonstrate long-term beneficial effects for children diagnosed with ASD through a revolutionary technique known as Microbiota Transfer Therapy (MTT), a special type of fecal transplant originally pioneered by Dr. Thomas Borody, an Australian gastroenterologist. Remarkably, improvements in gut health and autism symptoms appear to persist long after treatment.

At two years post-treatment, most of the initial improvements in gut symptoms remained. In addition, parents reported a slow steady reduction of ASD symptoms during treatment and over the next two years. A professional evaluator found a 45% reduction in core ASD symptoms (language, social interaction and behavior) at two years post-treatment compared to before treatment began.

Roughly 30-50% of all people with autism have chronic gastrointestinal (GI) problems, primarily constipation and/or diarrhea that can last for many years. That chronic discomfort and pain can cause irritability, decreased attention and learning, and negatively impact behavior.

Based on his experience with his patients, Borody led the design of the clinical treatment used at ASU for this study. The MTT approach involves 10 weeks of treatment, including pre-treatment with vancomycin, a bowel cleanse, a stomach acid suppressant, and fecal microbiota transfer daily for seven to eight weeks.

The ASU team compared differences in the microbiome of children with autism compared to typically developing children. At the start of the study, children with autism were found to have lower diversity in their respective gut microbes and were depleted of certain strains of helpful bacteria, such as Bifidobacteria and Prevotella. "Kids with autism are lacking important beneficial bacteria, and have fewer options in the bacterial menu of important functions that bacteria provide to the gut than typically developing kids," Krajmalnik-Brown said.

FMT treatment substantially increased microbial diversity and the presence of helpful bacteria in the gut, such as Bifidobacteria and Prevotella. After two years, diversity was even higher and the presence of beneficial microbes remained.

"This is a world-first discovery that when we treated the gut bacteria in these children during our clinical trial two years ago to reset their microbiome with FMT, positive results are still continuing to be improving two years from the original treatments. I would call it the highest improvement in a cohort that anyone has achieved for autism symptoms," said Borody.

Professional evaluation revealed a 45% decrease in ASD symptoms compared to baseline. Researchers note that although there may be some placebo effect, much of that effect appears to be real. At the start of the study, 83% of participants were rated as "severe" autism. At the end of the study, only 17% were "severe," 39% were "mild/moderate," and 44% were below the cut-off for mild ASD.

All of the participants in the study exhibited chronic GI symptoms from infancy, including chronic constipation and/or chronic diarrhea. The treatment benefits extended beyond their physical symptoms, even causing some parents to note how much their children's behavior had improved over time.

"It is very unusual to see steady gradual improvement after the conclusion of any treatment," said Adams. "We only conducted the long-term follow-up study after several families told us that their child was continuing to improve significantly." Krajmalnik-Brown stated that the data suggests that the MTT intervention transformed the gut environment into a healthier status, leading to long-term benefit on both GI and ASD symptoms.

Adams said many of the participants in the trial shared common traits, including birth by C-section, reduced breastfeeding, increased antibiotics, and low fiber intake by the mother and child, all of which lead to limited biodiversity in their gut bacteria. Due to the open label nature of the study and the small sample size used, more research is needed in order to verify the usefulness of MTT as a therapeutic.

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