Gut Microbiome and Autism: Recent Advances and Future Perspectives

Jun Liu, PhD, Mei Zhang, PhD, Xue-Jun Kong, MD

Abstract


Autism spectrum disorder (ASD) is a complex neurological and developmental disorder characterized by impaired communication and social interaction skills, as well as stereotypical repetitive behavioral patterns. Its etiology remains elusive, likely involving a combination of genetic changes and environmental factors. Among them, microbiome dysbiosis of the gastrointestinal (GI) system and its effect on CNS inflammation appears to be an important one. Symptoms of the GI system in patients with ASD are closely associated with primary or secondary changes in microbiome abnormalities of the gut. Moreover, the severities of neurological and behavioral symptom in ASD are determined at least in part by gut microbiome profiles in some subgroups of ASD patients. We review the evidence supporting notions of microbiome dysbiosis in host pathogenesis, especially with respect to diseases of the central nervous system (CNS). Next, we explore the differences in gut microbiome between neurotypical and ASD children, how these differences arise and how alterations in gut microbiome can lead to the pathogenesis or exacerbation ASD symptoms. We also attempt to address current and emerging new strategies of ASD therapeutic interventions that aim at modulating the gut microbiome, including dietary therapies/prebiotics, probiotics/antibiotics, fecal microbiota transplantation, immune therapies, and the use of traditional Chinese medicine.

[N A J Med Sci. 2016;9(3):104-115.   DOI:  10.7156/najms.2016.0903104]


Keywords


Autism, gut microbiome, dysbiosis, gastrointestinal system, gene, central nervous system

Full Text:

PDF

References


Developmental Disabilities Monitoring Network Surveillance Year 2010 Principal Investigators, Centers for Disease Control and Prevention (CDC). Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ. 2014;63:1-21.

Elsabbagh M, Divan G, Koh Y-J, et al. Global prevalence of autism and other pervasive developmental disorders. Autism Res. 2012;5:160-179.

Sun X, Allison C, Matthews FE, et al. Prevalence of autism in mainland China, Hong Kong and Taiwan: a systematic review and meta-analysis. Mol Autism. 2013 4:1. 2013;4:1.

Chaste P, Leboyer M. Autism risk factors: genes, environment, and gene-environment interactions. Dialogues Clin Neurosci. 2012;14:281-292.

Rossignol DA, Frye RE. Mitochondrial dysfunction in autism spectrum disorders: a systematic review and meta-analysis. Mol Psychiatry. 2012;17:290-314.

Frye RE, James SJ. Metabolic pathology of autism in relation to redox metabolism. Biomark Med. 2014;8:321-330.

Frye RE, Rose S, Slattery J, et al. Gastrointestinal dysfunction in autism spectrum disorder: the role of the mitochondria and the enteric microbiome. Microb Ecol Health Dis. 2015;26.

Deweerdt S. Microbiome: A complicated relationship status. Nature. 2014;508:S61-S63.

Hsiao EY, McBride SW, Hsien S, et al. Microbiota modulate behavioral and physiological abnormalities associated with neurodevelopmental disorders. Cell. 2013;155:1451-1463.

Sandler RH, Finegold SM, Bolte ER, et al. Short-term benefit from oral vancomycin treatment of regressive-onset autism. J Child Neurol. 2000;15:429-435.

Rodakis J. An n=1 case report of a child with autism improving on antibiotics and a father's quest to understand what it may mean. Microb Ecol Health Dis. 2015;26.

Shoemark DK, Allen SJ. The microbiome and disease: reviewing the links between the oral microbiome, aging, and Alzheimer's disease. J Alzheimers Dis. 2015;43:725-738.

Sandrini S, Aldriwesh M, Alruways M, Freestone P. Microbial endocrinology: host-bacteria communication within the gut microbiome. J Endocrinol. 2015;225:R21-R34.

Mayer EA. The neurobiology of stress and gastrointestinal disease. Gut. 2000;47:861-869.

Van Felius ID, Akkermans LMA, Bosscha K, et al. Interdigestive small bowel motility and duodenal bacterial overgrowth in experimental acute pancreatitis. Neurogastroenterol Motil. 2003;15:267-276.

Rhee SH, Pothoulakis C, Mayer EA. Principles and clinical implications of the brain-gut-enteric microbiota axis. Nat Rev Gastroenterol Hepatol. 2009;6:306-314.

Lyte M, Li W, Opitz N, et al. Induction of anxiety-like behavior in mice during the initial stages of infection with the agent of murine colonic hyperplasia Citrobacter rodentium. Physiol Behav. 2006;89:350-357.

Stephens RL, Tache Y. Intracisternal injection of a TRH analogue stimulates gastric luminal serotonin release in rats. Am J Physiol Gastrointest Liver Physiol. 1989;256:G377-G383.

Yang H, Stephens RL, Tache Y. TRH analogue microinjected into specific medullary nuclei stimulates gastric serotonin secretion in rats. Am J Physiol Gastrointest Liver Physiol. 1992;262:G216-G222.

Bailey MT, Coe CL. Maternal separation disrupts the integrity of the intestinal microflora in infant rhesus monkeys. Dev Psychobiol. 1999;35:146-155.

Tannock GW, Savage DC. Influences of dietary and environmental stress on microbial populations in the murine gastrointestinal tract. Infect Immun 9:591-598. Infect Immun. 2015;9:591-598.

Lyte M. Microbial endocrinology and infectious disease in the 21st century. Trends Microbiol. 2004;12:14-20.

Groot J, Bijlsma P, Van Kalkeren A, Kiliaan A, Saunders P, Perdue M. Stress-induced decrease of the intestinal barrier function. The role of muscarinic receptor activation. Ann N Y Acad Sci. 2000;915:237-246.

Jacob C, Yang PC, Darmoul D, et al. Mast Cell Tryptase Controls Paracellular Permeability of the Intestine: Role of protease-activated receptor 2 and arrestins. J Biol Chem. 2005;280:31936-31948.

Kiliaan AJ, Saunders PR, Bijlsma PB, et al. Stress stimulates transepithelial macromolecular uptake in rat jejunum. Am J Physiol Gastrointest Liver Physiol. 1998;275:G1037-G1044.

Yates DA, Santos J, Söderholm JD, Perdue MH. Adaptation of stress-induced mucosal pathophysiology in rat colon involves opioid pathways. J Physiol Gastrointest Liver Physiol. 2001;281:G124-G128.

Keita ÅV, Söderholm JD. The intestinal barrier and its regulation by neuroimmune factors. Neurogastroenterol Motil. 2010;22:718-733.

Sudo N, Chida Y, Aiba Y, et al. Postnatal microbial colonization programs the hypothalamic-pituitary-adrenal system for stress response in mice. J Physiol (Lond). 2004;558:263-275.

Neufeld KM, Kang N, Bienenstock J, et al. Reduced anxiety-like behavior and central neurochemical change in germ-free mice. Neurogastroenterol Motil. 2011;23:255-64-e119..

Zola SM, Squire LR, Teng E, et al, Clark RE. Impaired recognition memory in monkeys after damage limited to the hippocampal region. J Neurosci. 2000;20:451-463.

Heijtz RD, Wang S, Anuar F, et al. Normal gut microbiota modulates brain development and behavior. Proc Natl Acad Sci U S A. 2011;108:3047.

Amaral FA, Sachs D, Costa VV, et al. Commensal microbiota is fundamental for the development of inflammatory pain. Proc Natl Acad Sci U S A. 2008;105:2193-2197.

Ganapathy V, Thangaraju M, Prasad PD, et al. Transporters and receptors for short-chain fatty acids as the molecular link between colonic bacteria and the host. Curr Opin Parmacol. 2013;13:869-874.

Bindels LB, Dewulf EM, Delzenne NM. GPR43/FFA2: physiopathological relevance and therapeutic prospects. Trends Pharmacol Sci. 2013;34:226-232.

Ma D, Forsythe P, Bienenstock J. Live Lactobacillus rhamnosus is essential for the inhibitory effect on tumor necrosis factor alpha-induced interleukin-8 expression. Infect Immun. 2004;72:5308-5314.

Söderholm JD, Yang P-C, Ceponis P, et al. Chronic stress induces mast cell-dependent bacterial adherence and initiates mucosal inflammation in rat intestine. Gastroenterology. 2002;123:1099-1108.

Mayer EA, Savidge T, Shulman RJ. Brain-Gut Microbiome Interactions and Functional Bowel Disorders. Gastroenterology. 2014;146:1500-1512.

Westhoff D, Witlox J, Koenderman L, et al. Preoperative cerebrospinal fluid cytokine levels and the risk of postoperative delirium in elderly hip fracture patients. Journal of Neuroinflammation. 2013;10:122.

Lichtenstein P, De Faire U, Floderus B, et al. The Swedish Twin Registry: a unique resource for clinical, epidemiological and genetic studies. J Intern Med. 2002;252:184-205.

Miklossy J. Alzheimer's disease - a neurospirochetosis. Analysis of the evidence following Koch‘s and Hill’s criteria. J Neuroinflammation. 2011;8:90.

Riviere GR, Riviere KH, Smith KS. Molecular and immunological evidence of oral Treponema in the human brain and their association with Alzheimer's disease. Oral Microbiol Immunol. 2002;17:113-118.

Houeland G, Romani A, Marchetti C, et al. Transgenic mice with chronic NGF deprivation and Alzheimer's disease-like pathology display hippocampal region-specific impairments in short- and long-term plasticities. J Neurosci. 2010;30:13089-13094.

Kamer AR, Craig RG, Pirraglia E, et al. TNF-alpha and antibodies to periodontal bacteria discriminate between Alzheimer's disease patients and normal subjects. J Neuroimmunol. 2009;216:92-97.

Conti MZ, Vicini-Chilovi B, Riva M, et al. Odor identification deficit predicts clinical conversion from mild cognitive impairment to dementia due to Alzheimer's disease. Arch Clin Neuropsychol. 2013;28:391-399. doi:10.1093/arclin/act032.

Devanand DP, Michaels-Marston KS, Liu X, et al. Olfactory deficits in patients with mild cognitive impairment predict Alzheimer's disease at follow-up. Am J Psychiatry. 2000;157:1399-1405.

Grant MM, Kolamunne RT, Lock FE, Matthews JB, et al. Oxygen tension modulates the cytokine response of oral epithelium to periodontal bacteria. J Clin Periodontol. 2010;37:1039-1048.

Dickstein JB, Moldofsky H, Hay JB. Brain-blood permeability: TNF-alpha promotes escape of protein tracer from CSF to blood. Am J Physiol Regul Integr Comp Physiol. 2000;279:R148-R151.

Tobinick EL, Gross H. Rapid cognitive improvement in Alzheimer's disease following perispinal etanercept administration. J Neuroinflammation. 2008;5:2.

Weitlauf AS, McPheeters ML, Peters B, et al. Therapies for Children With Autism Spectrum Disorder: Behavioral Interventions Update. Comp Eff Review. 2014;137.

Hallmayer J, Cleveland S, Torres A, et al. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry. 2011;68:1095-1102.

Onore C, Careaga M, Ashwood P. The role of immune dysfunction in the pathophysiology of autism. Brain Behav Immun. 2012;26:383-392.

Buie T, Fuchs GJ, Furuta GT, et al. Recommendations for evaluation and treatment of common gastrointestinal problems in children with ASDs. Pediatrics. 2010;125(Suppl 1):S19-S29.

Krajmalnik-Brown R, Lozupone C, Kang D-W, et al. Gut bacteria in children with autism spectrum disorders: challenges and promise of studying how a complex community influences a complex disease. Microb Ecol Health Dis. 2015;26.

Adams JB, Holloway CE, George F, et al. Analyses of toxic metals and essential minerals in the hair of Arizona children with autism and associated conditions, and their mothers. Biol Trace Elem Res. 2006;110:193-209.

McElhanon BO, McCracken C, Karpen S, et al. Gastrointestinal symptoms in autism spectrum disorder: a meta-analysis. Pediatrics. 2014;133:872-883.

Adams JB, Johansen LJ, Powell LD, et al. Gastrointestinal flora and gastrointestinal status in children with autism -- comparisons to typical children and correlation with autism severity. BMC Gastroenterology. 2011;11:22.

Chaidez V, Hansen RL, Hertz-Picciotto I. Gastrointestinal problems in children with autism, developmental delays or typical development. J Autism Dev Disord. 2014;44:1117-1127.

Kang D-W, Park JG, Ilhan ZE, et al. Reduced incidence of Prevotella and other fermenters in intestinal microflora of autistic children. PloS One. 2013;8:e68322.

Williams BL, Hornig M, Parekh T, Lipkin WI. Application of novel PCR-based methods for detection, quantitation, and phylogenetic characterization of Sutterella species in intestinal biopsy samples from children with autism and gastrointestinal disturbances. MBio. 2012;3.

Angelis MD, Piccolo M, Vannini L, et al. Fecal Microbiota and Metabolome of Children with Autism and Pervasive Developmental Disorder Not Otherwise Specified. PloS One. 2013;8.

Finegold SM, Molitoris D, Song Y, et al. Gastrointestinal microflora studies in late-onset autism. Clin Infec Disc. 2002;35(Suppl 1):S6-S16.

Voreades N, Kozil A, Weir TL. Diet and the development of the human intestinal microbiome. Front Microbiol. 2014;5:494.

Mulle JG, Sharp WG, Cubells JF. The Gut Microbiome: A New Frontier in Autism Research. Curr Psychiatry Rep. 2013;15:337.

Horwood LJ, Fergusson DM. Breastfeeding and later cognitive and academic outcomes. Pediatrics. 1998;101:E9.

Schultz ST, Klonoff-Cohen HS, Wingard DL, et al. Breastfeeding, infant formula supplementation, and Autistic Disorder: the results of a parent survey. Int Breastfeed J. 2006;1:16.

Field D, Garland M, Williams K. Correlates of specific childhood feeding problems. J Paediatr Child Health. 2003;39:299-304.

Williams BL, Hornig M, Buie T, et al. Impaired carbohydrate digestion and transport and mucosal dysbiosis in the intestines of children with autism and gastrointestinal disturbances. PloS One. 2011;6:e24585.

Yatsunenko T, Rey FE, Manary MJ, et al. Human gut microbiome viewed across age and geography. Nature. 2012;486:222-227.

De Filippo C, Cavalieri D, Di Paola M, et al. Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. Proc Natl Acad Sci. 2010;107:14691-14696.

Schnorr SL, Candela M, Rampelli S, et al. Gut microbiome of the Hadza hunter-gatherers. Nat Comms. 2014;5:3654

Malkova NV, Yu CZ, Hsiao EY, Moore MJ, Patterson PH. Maternal immune activation yields offspring displaying mouse versions of the three core symptoms of autism. Brain Behav Immun. 2012;26:607-616.

Naviaux JC, Schuchbauer MA, Li K, et al. Reversal of autism-like behaviors and metabolism in adult mice with single-dose antipurinergic therapy. Transl Psychiatry. 2014;4:e400.

Dillon SM, Lee EJ, Kotter CV, et al. An altered intestinal mucosal microbiome in HIV-1 infection is associated with mucosal and systemic immune activation and endotoxemia. Mucosal Immunol. 2014;7:983-994.

Jyonouchi H, Sun S, Le H. Proinflammatory and regulatory cytokine production associated with innate and adaptive immune responses in children with autism spectrum disorders and developmental regression. J Neuroimmunol. 2001;120:170-179.

Molloy CA, Morrow AL, Meinzen-Derr J, et al. Elevated cytokine levels in children with autism spectrum disorder. J Neuroimmunol. 2006;172:198-205.

Li X, Chauhan A, Sheikh AM, et al. Elevated immune response in the brain of autistic patients. J Neuroimmunol. 2009;207:111-116.

Guinane CM, Cotter PD. Role of the gut microbiota in health and chronic gastrointestinal disease: understanding a hidden metabolic organ. Therap Adv Gastroenterol. 2013;6:295-308.

Shaw W. Increased urinary excretion of a 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), an abnormal phenylalanine metabolite of Clostridia spp. in the gastrointestinal tract, in urine samples from patients with autism and schizophrenia. Nutr Neurosci. 2010;13:135-143.

MacFabe DF. Enteric short-chain fatty acids: microbial messengers of metabolism, mitochondria, and mind: implications in autism spectrum disorders. Microb Ecol Health Dis. 2015;26.

Zheng X, Xie G, Zhao A, et al. The footprints of gut microbial-mammalian co-metabolism. J Proteome Res. 2011;10:5512-5522.

Clayton TA, Baker D, Lindon JC, et al. Pharmacometabonomic identification of a significant host-microbiome metabolic interaction affecting human drug metabolism. Proc Natl Acad Sci. 2009;106:14728-14733.

Alberti A, Pirrone P, Elia M et al. Sulphation deficit in “low-functioning” autistic children: a pilot study. Biol Psychiatry. 1999;46:420-424.

MacFabe DF, Cain NE, Boon F, et al. Effects of the enteric bacterial metabolic product propionic acid on object-directed behavior, social behavior, cognition, and neuroinflammation in adolescent rats: Relevance to autism spectrum disorder. Behav Brain Res. 2011;217:47-54.

Nankova BB, Agarwal R, MacFabe DF, et al. Enteric Bacterial Metabolites Propionic and Butyric Acid Modulate Gene Expression, Including CREB-Dependent Catecholaminergic Neurotransmission, in PC12 Cells - Possible Relevance to Autism Spectrum Disorders. Tsuji Y, ed. PloS One. 2014;9:e103740.

Frye RE, Melnyk S, MacFabe DF. Unique acyl-carnitine profiles are potential biomarkers for acquired mitochondrial disease in autism spectrum disorder. Transl Psychiatry. 2013;3:e220.

James SJ, Cutler P, Melnyk S, et al. Metabolic biomarkers of increased oxidative stress and impaired methylation capacity in children with autism. Am J Clin Nutr. 2004;80:1611-1617.

Stefano GB, Kream RM. Hypoxia defined as a common culprit/initiation factor in mitochondrial-mediated proinflammatory processes. Med Sci Monit. 2015;21:1478-1484.

Stefano GB. Mitochondria and Chloroplasts Shared in Animal and Plant Tissues: Significance of Communication. Med Sci Monit. 2015;21:1507-1511.

van Hellemond JJ, van der Klei A, van Weelden SWH, Tielens AGM. Biochemical and evolutionary aspects of anaerobically functioning mitochondria. Philos Trans R Soc Lond, B, Biol Sci. 2003;358:205-213; discussion 213-215.

Napoli E, Wong S, Hertz-Picciotto I, Giulivi C. Deficits in bioenergetics and impaired immune response in granulocytes from children with autism. Pediatrics. 2014;133:e1405-e1410.

Frye RE, Sequeira JM, Quadros EV, James SJ, Rossignol DA. Cerebral folate receptor autoantibodies in autism spectrum disorder. Mol Psychiatry. 2013;18:369-381.

Frye RE, Rossignol DA. Mitochondrial dysfunction can connect the diverse medical symptoms associated with autism spectrum disorders. Pediatr Res. 2011;69:41R-7R.

Sussman D, Leung RC, Vogan VM, et al. The autism puzzle: Diffuse but not pervasive neuroanatomical abnormalities in children with ASD. Neuroimage Clin. 2015;8:170-179.

Lewis JD, Evans AC, Pruett JR, et al. Network inefficiencies in autism spectrum disorder at 24 months. Transl Psychiatry. 2014;4:e388.

Mattson MP, Gleichmann M, Cheng A. Mitochondria in neuroplasticity and neurological disorders. Neuron. 2008;60:748-766.

Ashwood P, Wills S, Van de Water J. The immune response in autism: a new frontier for autism research. J Leukoc Biol. 2006;80:1-15.

Hsiao EY. Immune dysregulation in autism spectrum disorder. Int Rev Neurobiol. 2013;113:269-302.

Heo Y, Zhang Y, Gao D, Miller VM, Lawrence DA. Aberrant immune responses in a mouse with behavioral disorders. PloS One. 2011;6:e20912.

Le Poul E, Loison C, Struyf S, et al. Functional characterization of human receptors for short chain fatty acids and their role in polymorphonuclear cell activation. J Biol Chem. 2003;278:25481-25489.

Takano T. Role of Microglia in Autism: Recent Advances. Dev Neurosci. 2015;37:195-202.

Czeh M, Gressens P, Kaindl AM. The Yin and Yang of Microglia. Dev Neurosci. 2011;33:199-209.

Chao CC, Hu S, Molitor TW, Shaskan EG, Peterson PK. Activated microglia mediate neuronal cell injury via a nitric oxide mechanism. J Immunol. 1992;149:2736-2741.

Bhat NR, Zhang P, Lee JC, Hogan EL. Extracellular signal-regulated kinase and p38 subgroups of mitogen-activated protein kinases regulate inducible nitric oxide synthase and tumor necrosis factor-alpha gene expression in endotoxin-stimulated primary glial cultures. J Neurosci. 1998;18:1633-1641.

Takeuchi H, Jin S, Wang J, et al. Tumor necrosis factor-alpha induces neurotoxicity via glutamate release from hemichannels of activated microglia in an autocrine manner. J Biol Chem. 2006;281:21362-21368.

Pan X-D, Zhu Y-G, Lin N, et al. Microglial phagocytosis induced by fibrillar β-amyloid is attenuated by oligomeric β-amyloid: implications for Alzheimer's disease. Mol Neurodegener. 2011;6:45.

Fernandes A, Miller-Fleming L, Pais TF. Microglia and inflammation: conspiracy, controversy or control? Cell Mol Life Sci. 2014;7:3969-3985.

Tetreault NA, Hakeem AY, Jiang S, et al. Microglia in the cerebral cortex in autism. J Autism Dev Disord. 2012;42:2569-2584.

Croen LA, Braunschweig D, Haapanen L, et al. Maternal Mid-Pregnancy Autoantibodies to Fetal Brain Protein: The Early Markers for Autism Study. Biological Psychiatry. 2008;64:583-588.

Braunschweig D, Ashwood P, Krakowiak P, et al. Autism: maternally derived antibodies specific for fetal brain proteins. Neurotoxicology. 2008;29:226-231.

Martin LA, Ashwood P, Braunschweig D, Cabanlit M, Van de Water J, Amaral DG. Stereotypies and hyperactivity in rhesus monkeys exposed to IgG from mothers of children with autism. Brain Behav Immun. 2008;22:806-816.

Singer HS, Morris C, Gause C, Pollard M, Zimmerman AW, Pletnikov M. Prenatal exposure to antibodies from mothers of children with autism produces neurobehavioral alterations: A pregnant dam mouse model. J Neuroimmunol. 2009;211:39-48.

Williams KA, Swedo SE. Post-infectious autoimmune disorders: Sydenham's chorea, PANDAS and beyond. Brain Res. 2015;1617:144-154.

David LA, Maurice CF, Carmody RN, et al. Diet rapidly and reproducibly alters the human gut microbiome. Nature. 2014;505:559-563.

Elder JH, Shankar M, Shuster J, Theriaque D, Burns S, Sherrill L. The Gluten-Free, Casein-Free Diet In Autism: Results of A Preliminary Double Blind Clinical Trial. J Autism Dev Disord. 2006;36:413-420.

Whiteley P, Shattock P, Knivsberg A-M, et al. Gluten- and casein-free dietary intervention for autism spectrum conditions. Front Hum Neurosci. 2012;6:344.

Kossoff E, Wang H-S. Dietary Therapies for Epilepsy. Biomed J. 2013;36:2.

Frye RE, Rossignol D, Casanova MF, et al. A review of traditional and novel treatments for seizures in autism spectrum disorder: findings from a systematic review and expert panel. Front Public Health. 2013;1:31.

Brudnak MA, Rimland B, Kerry RE, et al. Enzyme-based therapy for autism spectrum disorders -- is it worth another look? Med Hypotheses. 2002;58:422-428.

MacFabe DF. Short-chain fatty acid fermentation products of the gut microbiome: implications in autism spectrum disorders. Microb Ecol Health Dis. 2012;23.

Suez J, Korem T, Zeevi D, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. 2014;514:181-186.

Palmnäs MSA, Cowan TE, Bomhof MR, et al. Low-Dose Aspartame Consumption Differentially Affects Gut Microbiota-Host Metabolic Interactions in the Diet-Induced Obese Rat. PloS One. 2014;9:e109841.

Martinez FD. The human microbiome. Early life determinant of health outcomes. Ann Am Thorac Soc. 2014;11(Suppl 1):S7-S12.

Kaczmarczyk MM, Miller MJ, Freund GG. The health benefits of dietary fiber: beyond the usual suspects of type 2 diabetes mellitus, cardiovascular disease and colon cancer. Metab Clin Exp. 2012;61:1058-1066.

Shen Q, Zhao L, Tuohy KM. High-level dietary fibre up-regulates colonic fermentation and relative abundance of saccharolytic bacteria within the human faecal microbiota in vitro. Eur J Nutr. 2012;51:693-705.

Etxeberria U, Fernández-Quintela A, Milagro FI, Aguirre L, Martínez JA, Portillo MP. Impact of polyphenols and polyphenol-rich dietary sources on gut microbiota composition. J Agric Food Chem. 2013;61:9517-9533.

Adams CM. Patient report: autism spectrum disorder treated with camel milk. Glob Adv Health Med. 2013;2:78-80.

AL-Ayadhi LY, Elamin NE. Camel Milk as a Potential Therapy as an Antioxidant in Autism Spectrum Disorder (ASD). Evid Based Complement Alternat Med. 2013;602834.

Adams JB, Audhya T, McDonough-Means S, et al. Nutritional and metabolic status of children with autism vs. neurotypical children, and the association with autism severity. Nutr Metab (Lond). 2011;8:34.

Adams JB, Audhya T, McDonough-Means S, et al. Effect of a vitamin/mineral supplement on children and adults with autism. BMC Pediatr. 2011;11:111.

Kuhn M, Bransfield R. Divergent opinions of proper Lyme disease diagnosis and implications for children co-morbid with autism spectrum disorder. Med Hypotheses. 2014;83:321-325.

Kuhn M, Grave S, Bransfield R, Harris S. Long term antibiotic therapy may be an effective treatment for children co-morbid with Lyme disease and autism spectrum disorder. Med Hypotheses. 2012;78:606-615.

Atladóttir HÓ, Henriksen TB, Schendel DE, Parner ET. Autism after infection, febrile episodes, and antibiotic use during pregnancy: an exploratory study. Pediatrics. 2012;130:e1447-e1454.

Mellon AF. Effect of oral antibiotics on intestinal production of propionic acid. Archives of Disease in Childhood. 2000;82:169-172.

Finegold SM. Therapy and epidemiology of autism--clostridial spores as key elements. Med Hypotheses. 2008;70:508-511.

Manev R, Manev H. Aminoglycoside antibiotics and autism: a speculative hypothesis. BMC Psychiatry. 2001;1:5.

Frye RE, Slattery J, MacFabe DF, et al. Approaches to studying and manipulating the enteric microbiome to improve autism symptoms. Microb Ecol Health Dis. 2015;26.

Rao K, Safdar N. Fecal microbiota transplantation for the treatment of Clostridium difficile infection. J Hosp Med. 2016;11:56-61.

Rossen NG, MacDonald JK, de Vries EM, et al. Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review. WJG. 2015;21:5359-5371.

Colman RJ, Rubin DT. Fecal microbiota transplantation as therapy for inflammatory bowel disease: a systematic review and meta-analysis. J Crohns Colitis. 2014;8:1569-1581.

Lai H-C, Young J, Lin C-S, et al. Impact of the gut microbiota, prebiotics, and probiotics on human health and disease. Biomed J. 2014;37:259.

Roberfroid M, Gibson GR, Hoyles L, et al. Prebiotic effects: metabolic and health benefits. BJN. 2010;104 Suppl 2:S1-S63.

Lewis ZT, Shani G, Masarweh CF, et al. Validating bifidobacterial species and subspecies identity in commercial probiotic products. Pediatr Res. 2016;79:445-452.

Bilbo SD, Nevison CD, Parker W. A model for the induction of autism in the ecosystem of the human body: the anatomy of a modern pandemic? Microb Ecol Health Dis. 2015;26:26253.

Elliott DE, Weinstock JV. Helminth-host immunological interactions: prevention and control of immune-mediated diseases. Annals of the New York Academy of Sciences. 2012;1247:83-96.

Parker W. The “hygiene hypothesis” for allergic disease is a misnomer. BMJ. 2014;348:5267.

Xiao S, Fei N, Pang X, et al. A gut microbiota-targeted dietary intervention for amelioration of chronic inflammation underlying metabolic syndrome. FEMS Microbiol Ecol. 2013;87:357-367.

Li H, Zhou M, Zhao A, Jia W. Traditional Chinese medicine: balancing the gut ecosystem. Phytother Res. 2009;23:1332-1335.

Tamimi Al MAHM, Palframan RJ, Cooper JM, Gibson GR, Rastall RA. In vitro fermentation of sugar beet arabinan and arabino-oligosaccharides by the human gut microflora. J Appl Microbiol. 2006;100:407-414.

Wolf G. Gut microbiota: a factor in energy regulation. Nutr Rev. 2006;64:47-50.

Kato M, Ishige A, Anjiki N, et al. Effect of herbal medicine Juzentaihoto on hepatic and intestinal heat shock gene expression requires intestinal microflora in mouse. WJG. 2007;13:2289-2297.

Lee DYW, Kong X. Potential Treatment of Autism with Traditional Chinese Medicine. N A J Med Sci U S A. 2012;5:189-192.

Toyoda T, Nakamura K, Yamada K, et al. SNP analyses of growth factor genes EGF, TGFbeta-1, and HGF reveal haplotypic association of EGF with autism. Biochem Biophys Res Commun. 2007;360:715-720.

Girard S, Tremblay L, Lepage M, Sébire G. IL-1 receptor antagonist protects against placental and neurodevelopmental defects induced by maternal inflammation. J Immunol. 2010;184:3997-4005.

Ashwood P, Krakowiak P, Hertz-Picciotto I, Hansen R, Pessah I, Van de Water J. Elevated plasma cytokines in autism spectrum disorders provide evidence of immune dysfunction and are associated with impaired behavioral outcome. Brain Behav Immun. 2011;25:40-45.

Jyonouchi H, Geng L, Ruby A, Reddy C, Zimmerman-Bier B. Evaluation of an association between gastrointestinal symptoms and cytokine production against common dietary proteins in children with autism spectrum disorders. J Pediatr. 2005;146:605-610.

Reisinger EC, Fritzsche C, Krause R, Krejs GJ. Diarrhea caused by primarily non-gastrointestinal infections. Nat Clin Pract Gastroenterol Hepatol. 2005;2:216-222.


Refbacks

  • There are currently no refbacks.