The apparent increase in autism prevalence over the past decade has driven this disorder into the focus of our nation. This attention has led to a race for the cure, so to speak, a desperate search for a silver bullet to unlock the secrets of autism and cure its wide-ranging symptoms.

But this race is futile. Autism is extremely complex with both genetic and environmental factors, and no single treatment is likely to benefit everyone with autism or improve more than a few of its many symptoms. Searching for a silver bullet is not only pointless but also dangerous, as some of the proposed cure-alls may actually hurt more than they help.

The Food and Drug Administration recently released a consumer update warning families against false claims of cures for autism. Some of the treatments under question include removing important metals from the body in a process known as chelation and an ingestible “miracle mineral solution,” which turned out to be bleach. In the report, the FDA warns that these treatments are not only largely ineffective but could also lead to “serious and life-threatening outcomes.”

When the treatments above have proven fruitless, doctor-salesmen in Panama and other foreign countries have offered up therapies usually reserved for cancer treatment, such as stem cell and bone marrow transplants. These highly invasive, unregulated treatments are only informed by the preliminary results of exploratory animal studies published over the last few years. Although a clinical trial for stem cell therapy in autism is underway, a reminder is needed: autism is not cancer, and it will not be treated effectively if viewed as such.

Even an FDA-approved medication for aggression and irritability in autism, risperidone, has come into question for serious side effects. According to recent studies, this antipsychotic drug may cause metabolic dysfunction and significant weight gain, while only providing behavioral benefits for some individuals. A recent study exploring the combined results of many other studies led to the conclusion that risperidone and a similar drug, aripiprazole, have “substantial adverse effects and that each compound has a specific secondary effect profile that should be taken into account in treatment decision-making.”

The available treatments for autism, whether quack or FDA-approved, have a skewed cost-benefit ratio, in which the risk of harmful side effects outweighs the chance of true benefits. Scientists need to take treatment research back to the core symptoms of autism, especially social communication deficits. The utility of combo-therapies, in which medication and behavioral therapy are given together, should be further explored.

Treatments should stem not from a trial and error approach, but from a bottom-up approach, in which core symptoms and their potential underlying mechanisms inspire treatment ideas. Ultimately scientists and physicians need to focus solely on research-driven, patient-centered treatments. Any supposed silver bullet is really just a shot in the dark.

​[This post was originally published at my previous blog, Neurolore.]

Women have been encouraged to take folate supplements during pregnancy since the early 1990s, but a new study suggests that men may also need to avoid folate deficiency for the sake of their future children.

“Currently prevention of birth defects is directed at the mother yet the male contributes 50 percent of the heritable information,” says Sarah Kimmins, associate professor of reproductive biology at McGill University and principal investigator of a new study published December 2013 in Nature Communications. “This mode of thinking that it’s all up to the mother to ensure the health of the offspring is outdated, as research is suggesting that a father’s reproductive health may be equally as important.”

In their study, Kimmins and her colleagues explored how reduced dietary folate, also known as folic acid or vitamin B9, might affect male mice and their offspring. Folate is known to influence DNA methylation, the addition of a group of atoms containing one carbon and three hydrogens to the region of a gene that determines whether it is turned on or off. Through changes in DNA methylation, environmental factors, such as diet, are capable of causing changes in gene expression without altering the genetic code. These changes, called epigenetic modifications, can be passed from one generation to the next.

“This epigenetic information is dynamic and, unlike your DNA, can be altered by what you eat, smoke, and possibly even fear and stress,” says Kimmins.

The authors first exposed male mice to either a folate-sufficient diet, with the normal amount of folate a mouse needs to be healthy, or a folate-deficient diet, with only 14 percent of the normal amount of folate, from before birth through adulthood.
They then examined the reproductive health of these males and found that the folate-deficient mice had reduced fertility and that their offspring were less likely to survive as embryos. Additionally, the offspring of folate-deficient mice displayed developmental abnormalities, ranging from skeletal malformations in the skull, spine and limbs to muscular defects.

They also found 57 gene regions with altered methylation in the sperm of folate-deficient mice. Interestingly, these changes occurred primarily in genes related to development, the function of the brain and other organs, as well as genes associated with cancer and neurological conditions, such as autism and schizophrenia.

Furthermore, these epigenetic changes were transferred to the next generation of mice. The authors found that hundreds of genes within the placentas from the offspring of folate-deficient mice were expressed differently from those of folate-sufficient mice. Importantly, two of these genes were part of the original group of 57 genes that demonstrated altered methylation patterns.

These findings suggest that the sperm epigenome may be modified by the paternal diet, and that the effects of these changes have the potential to be passed onto future offspring. However, a mechanism behind the effect of diet on sperm DNA methylation is not yet clear, and there is the potential for alternative explanations of the findings.

“It may be speculated that some of the developmental defects observed in their study can be the result of inappropriate cellular metabolism and not necessarily an affected methylome,” says Rocio Rivera, assistant professor of developmental epigenetics at the University of Missouri.

This study also provides support for the idea that offspring are vulnerable to environmental conditions experienced not only by their mother during pregnancy, but also by their father before conception. Another recently published study has also demonstrated epigenetic changes related to paternal experience, in which fear associated with a specific scent was transferred from a male mouse to his offspring and even his grand-offspring.

Additionally, the altered gene expression and birth defects observed in the offspring of folate-deficient mice demonstrate a potential role of paternal folate levels in development. Although this study examined mice, the findings indicate the need for exploring the effects of folate deficiency in men.

“Even if a man eats enough folate, if he is overweight, or obese, or has a genetic mutation in an enzyme in the folate pathway . . . there is strong possibility that the sperm epigenome will be abnormal much like we saw in the mouse model,” says Kimmins.

In future studies, Kimmins and her colleagues plan to study folate levels in normal weight, overweight and obese men and follow the development of their children. Although the motherly reminder to take vitamins seems clichéd, it may turn out that folate supplements and good overall health may be just as important for future dads as it is for future moms.

References:

Lambrot R., Xu C., Saint-Phar S., Chountalos G., Cohen T., Paquet M., Suderman M., Hallett M. & Kimmins S. (2013). Low paternal dietary folate alters the mouse sperm epigenome and is associated with negative pregnancy outcomes, Nature Communications, PMID: 24326934
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Dias B.G. & Ressler K.J. (2013). Parental olfactory experience influences behavior and neural structure in subsequent generations, Nature Neuroscience, PMID: 24292232

[This post, which appeared on my previous blog, Neurolore,  was originally submitted as part of my application for the 2014 AAAS Science & Technology Mass Media Fellowship.]

In Singapore, a highly developed, first-world country, autism awareness and educational support may be sorely lacking.

Over lunch today at the International Meeting for Autism Research in Atlanta, I sat next to Lela Iuorno from Singapore. Her eight-year-old son, Luca, has autism. Iuorno is at IMFAR hoping to learn more about available pharmacological and behavioral interventions for her son. She is particularly invested in autism research, as she is not only Luca’s parent but also his behavioral aide in school.

Behavioral aides, referred to as “shadow support” in Singapore, are not typically available in the school systems in Singapore. In fact, Iuorno has spent a lot of time trying to convince public schools in Singapore to provide access to behavioral aides in the classroom.

“It’s a lot of fighting,” she said. When Luca had attended three different schools before he finished preschool, Iuorno decided to take the reigns herself. She now attends school alongside Luca 5 days a week, providing the assistance he needs to stay focused during his classes. She works nights and weekends to offset the lost income she would have if she wasn’t serving as Luca’s aide. She’s constantly working to do what’s best for her son, she said.

“I feel like a one woman army,” she said.

Another obstacle Iuorno has encountered in Singapore is a lack of understanding amongst teachers and students about what autism actually is. There is a common misconception that autism is a temporary condition. Teachers have told Iuorno that when Luca “gets better” his experience at school will improve.

Additionally, students like Luca who have autism but do not display obvious behavioral symptoms, such as outbursts, are assumed to be fine. Thus, their individual barriers to learning are largely ignored.

“These children can’t survive [in public schools],” she said. Yet, there are few private special education schools in Singapore, and, of the ones that exist, getting in is difficult.

Despite its developed status, Singapore lacks well-organized special education systems for autism, in which trained behavioral aides are available. But, more importantly, Iuorno believes Singapore is in need of accurate awareness about autism and its heterogeneous symptoms. This unawareness is hurting the education of children like Luca.

“It’s true and it’s sad,” Iuorno said.

​[This post was originally published at my previous blog, Neurolore.]