FMT and Autism: A Status Report

Over the weekend I read an interesting little article on the status of fecal microbiota transplant as a therapy for treating autism.[i]  It most certainly is one of the more promising treatments:  the two clinical trials so far have had pretty spectacular results.  That’s the good news.  The bad news…well, read to the end of this and you’ll find out!

According to this paper, 30-50% of people with ASD have chronic GI symptoms ranging from constipation to diarrhea, while other studies state that up to 78% actually suffer from issues, if more mild ones are included. (In my personal experience, it’s at least 78%.  Many people don’t report constipation as a problem because they’ve actually come to believe it is normal!)

(One note: The author interchangeably use the two acronyms FMT (fecal microbiota transplant) and IMT (intestinal microbiota transplant).

A few points then of particular interest to me, and, judging by the emails I got when I asked you for your suggestions for posts in the survey I conducted a couple of weeks ago, to you was well:

1. “…two large studies involved treating chronic fatigue patients with a subset of bacteria frown from human stool.  These studies observed response rates of 41% (for 2 consecutive days of therapy) and 70% (2 consecutive days, and 2 additional days if needed) for chronic fatigue symptoms…Similarly, a case report of 6 rounds of IMT resulted in ‘a total resolution of fatigue and depression.’”  I’ve written about chronic fatigue (and its sister illness, fibromyalgia, may times.  These affect an enormous number of people and have absolutely no known treatments.  With results like these, wouldn’t you think research into using FMT would be abounding?)
2. Notice that the longer the FMT goes on, the better the results: those who got 2 treatments did well, but  4 was better, but 6 was the best.  Yes of course we need a lot more data to draw any conclusions but – this is interesting to note in the meantime and leads me elegantly to point #3…
3. I’ve already written about the incredibly successful FMT study on children with autism and how most retained their gains even 2 years later. So just a brief summary to refresh your memories:
   1. The first study was done on 9 children with ASD and gut issues. They were first treated with Vancomycin, an antibiotic that stays in the gut (is non-systemic), which kills much of the existing flora.  They were then given daily doses of purified bacteria from human stool for 3 months, which resulted in “…substantial improvement in bowel function…Parents reported marked improvement in vocabulary, task performance and ability to listen to parents’ requests.”  Other improvements were noted as well.  “Overall, this clinical experience suggested that the GI symptoms in children with ASD are treatable, but that intensive, long-term administration with more diverse microbiota is required.”
   2. The 2^nd trial in autism contained 18 children, and in this case, they were treated (after a round of Vancomycin) first with high doses of the FMT for 1-2 days and then a lower maintenance dose for another 7-8 weeks.  This resulted in “…an approximately 80% reduction of GI symptoms, and a 25% reduction of ASD symptoms by the end of the treatment.”  The children were retested 2 years later and the GI improvements were mostly maintained:  “…59% reduction (compared to pre-treatment).  The ASD symptoms also continued to improve, with a 47% reduction compared to baseline.  Bacterial diversity, which initially was lower than in typically developing children, improved and stayed improved, resembling that of normal peers.
4. The researchers note that compared with controls, children with autism have higher rates of c-section births, shorter duration of breast feeding, and a higher use of oral antibiotics during infancy and lower rates of maternal an d child fiber consumption. And this brings me to one nagging thought of mine, in reading this article…

Toward the end, the authors very briefly mention that other means of modulating the gut flora are being explored, including the casein/gluten free diet and FODMAPS.  The evidence of these diets making any meaningful difference to children with autism is mixed for the former and non-existent for the latter.  I found it extraordinary that even now, there was no mention made of the Specific Carbohydrate Diet which has long ranked as the most beneficial diet for children on the autism spectrum, according to the data presented by the Autism Research Institute…and which as true scientific merit, as I talk about in multiple articles on this blog, like here and here.  I found that enormously disappointing…especially in light of the fact that not all children in the study maintained there gains.  The first thought that went through my head upon reading that trial originally was, “Well, what were those children eating?”  Why would anyone expect them to maintain gut health and bacterial diversity if they went home to a diet of French fries and Chicken McNuggets?
The paper concludes with the researchers’ expert opinion that more research is needed and that “…within five to ten years we anticipate that MTT [microbial transplant therapy] may become commercially available for treating gastrointestinal disorders in children wand adults with ASD, with additional development of optimized microbiota over the following five to ten years.”

That will bring my son to his 45^th birthday, perhaps.

And then they wonder why it is that the victims of these chronic illnesses and their families end up self-treating.

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[i] Adams, JB, Borody, TJ, Kang, D-W, Khoruts, A, Krajmalnik-Brown, R, Sadowsky, MJ. Microbiota transplant therapy and autism: lessons for the clinic. Expert Review of Gastoenterology & Hepatology. 2019;13(11).  https://doi.org/10.1080/17474124.2019.1687293