New Research on Autism Points to a Novel ‘Gut’ Disease in Some Kids

By Mary Ann Roser for the New York Times

A maverick British scientist who now works in Austin has completed anew study on autism that links the disease to a novel intestinal illness. The research, which will be published in this month’s issue of theJournal of Clinical Immunology that is expected to come out today, opens thedoor to testing treatments for some autistic children, including a diet thatforbids dairy products and certain grains.

Dr. Andy Wakefield, whose earlier work caused a furor by suggestingan association between a common childhood vaccine and autism, said heconsiders the latest research groundbreaking.

The study by Wakefield and three collaborators builds on previousresearch connecting autism and the gut.

But it goes several steps further: It identifies a new inflammatoryintestinal disease in some children who appear normal but regress intoautism; it suggests the intestinal disease is viral, thus giving clues aboutthe nature of this type of autism; and it provides new targets for treatingautism in some children.

“This now gives us the basis of what is driving that disease and whatwe can do to treat many children” who regress into autism, said Wakefield,who is setting up a research, education and treatment center for autisticchildren in Austin called the Thoughtful House. ”

We hope this will form the basis for a new clinical trial.”Nationally known autism expert Dr. Timothy Buie, a pediatrician specializingin gastrointestinal disorders at Massachusetts General Hospital forChildren, called the research a welcome extension of Wakefield’s earlierwork into the relationship between autism and gastrointestinal symptoms,such as constipation and diarrhea. Buie is among the researchers studyingbowel disease and autism, but he said it’s too early to gauge thesignificance of Wakefield’s findings.

Autism is a complex disorder that usually emerges during the first three years of life and affects the ability to communicate, reason andinteract with others. Some type of autism is diagnosed in one in 166 individuals, according to the U.S. Centers for Disease Control andPrevention. According to the Autism Society of America, rates are soaringand could rise from 1.5 million Americans to 4 million in the next decade.

Autism is classified as a neurological disorder, but scientists don’tknow what causes it or how to cure it.

Though the new research expands the understanding of autism in aselect group of children, “the jury is still out” on whether it extends to alarger group, said Buie, who also is on the Harvard Medical School faculty.”We’re a long way from saying that these changes at the gut level are whatis causing the autism.” Dr. David Baskin, a professor of neurosurgery andanesthesiology at Baylor College of Medicine in Houston, said the study”adds to a growing body of knowledge concerning children with autism andposes a number of important questions to be answered with additional research.” Wakefield and his colleagues studied 86 children in England, including 21 with autism. They found that the autistic children hadsignificantly more cells of a certain type in their digestive tracts associated with an intestinal inflammation causing them chronic problems. Eleven of those children were on some dietary restrictions involving dairy products, gluten (grains, such as wheat and rye), or both. Theirparents said the children functioned better, physically and mentally,according to the study.

Those children also had fewer inflammatory chemicalsin their intestines than those not on restricted diets, the study says. The study recommends more research on the restricted diet. Autisticchildren across the country have been known to try it. “It’s really rather remarkable the differences I have seen in some children,” said Peter Bell, executive director and chief executive officer of Cure Autism Now, an advocacy organization in Los Angeles that supports autism research. But Bell said the diet had no effect on his autistic son, now 11. Wakefield said the study also suggests that some drugs might help,but the paper does not recommend any. In

an interview, Wakefield saidRemicade, used to treat Crohn’s disease and rheumatoid arthritis, meritsfurther study. The Food and Drug Administration issued warnings about Remicade afterit was linked to lymphoma, malignancies and heart failure. Wakefield said hedidn’t want to mention the drug because he didn’t want patients clamoringfor it until it’s been thoroughly tested for autism. The gut’s connection to the disorder has gained credence in the lastfive to 10 years, Bell said, although people outside the autism communitymight not know that.

Wakefield said the study found that the type of gastrointestinalillness the autistic children exhibited, though different than otherinflammatory bowel diseases, is “similar to what we would see in HIVpatients.” “That’s important,” he said, “because it’s a rationale forlooking for a viral cause for autism.” Wakefield received internationalnotoriety following a 1998 article he published in the Lancet, a prestigiousBritish medical journal, in which parents reported that they thought themeasles, mumps and rubella vaccine, known as MMR, could be linked to autismand a bowel disease in some children.

Though Wakefield said it was important to report what parents weresaying, he insists he is a big vaccine supporter. However, he does favorseparating the MMR into individual shots because the combination might harmsome children. Earlier this year, 10 of the 13 authors of the Lancet reportdisavowed the interpretation that MMR might cause autism. Wakefield was notone of them and was singled out in a “60 Minutes” report on the subject Oct.24 for fueling anti-vaccine hysteria. (The new study does not discussvaccines.)

The Lancet said it would not have published the 1998 study had itknown that Wakefield was helping parents of autistic children gatherscientific information for a lawsuit over the MMR vaccine. The Legal AidBoard in England had paid the hospital where Wakefield worked $90,000 forhis help.

Wakefield said last week that he didn’t get any money and didn’t doanything unethical. Although some of the same parents in the lawsuit alsowere involved in the Lancet study, Wakefield said, the Lancet paper was notdone to “propagate a lawsuit.” As the MMR vaccine controversy raged,Wakefield resigned under pressure from his job as an assistant professor of experimental gastroenterology at the Royal Free Hospital Medical School in London in 2001.

He has been in the process of relocating to Austin for thepast 18 months, he said, and plans to open the Thoughtful House in January. The center will start with clinical services for autistic childrenand will gradually expand to a school. It also will do research studies. Mary Ann Roser writes for the Austin American-Statesman.

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