Overview of GI in ASD Blog Series

Cell-El Ltd. studies stem cell therapy as a possible treatment for immune dysfunction. During the past decade, ASD associated immune dysfunction has been observed in numerous studies. We have also been observing this dysfunction in our diagnostic study of children with ASD as compared with typically developed children. Our working theory is that immune dysfunction is possibly a root cause of ASD behavioral issues. By affecting change at the source at a young age the treatments will hopefully improve the child’s future function and quality of life. Cell-El’s goal is to enable treatments for young children based on our biological diagnostic tool.

In the next two Cell-El blog posts we will hear from Dr. Arthur Krigsman MD, Board certified pediatric gastroenterologist specializing in the evaluation and treatment of children with autism and related disorders. This post has been reprinted as well as edited with permission from Dr. Krigsman. Originally published in Pediatric Gastroenterology Resources Of New York & Texas

Disclaimer: The views, practices and opinions expressed by the individuals in these posts do not necessarily reflect the official policy or position of Cell-El Ltd

Part 1: Gastrointestinal Disease in Children with ASD

By Dr Arthur Krigsman, MD

Evaluation of patients with ASD and co-morbid chronic gastrointestinal symptoms consists of a thorough review of the clinical history, clinical data obtained from the patient’s existing medical records, select laboratory testing, and a patient/parent interview.

Patients in whom this data suggest the presence of gastroesophageal reflux disease, acid-peptic disorder, food allergy, inflammatory bowel disease, allergic/autoimmune esophago-gastro-enteropathy, or autistic enteritis/enterocolitis are often in need of a comprehensive diagnostic survey of the gastrointestinal tract, including gastrointestinal endoscopy and biopsy.

Microscopic examination of biopsy obtained gastrointestinal tissue remains the gold standard in making an accurate diagnosis for purposes of appropriate therapeutic intervention.

There are three traditionally recognized chronic inflammatory diseases of the gastrointestinal tract that together, fall under the larger category of Inflammatory Bowel Disease: ulcerative colitis, Crohn’s Disease, and indeterminate enterocolitis.

Autistic Enterocolitis

Patients with ASD’s appear to suffer from a fourth form of IBD, autistic enterocolitis. Autistic enterocolitis is defined as: inflammation of varying intensity anywhere in the gastrointestinal tract with associated prominent lymphoid nodular hyperplasia, in the setting of autism, and lacking the specific diagnostic features of ulcerative colitis or Crohn’s Disease.

Importantly, unique histochemical and molecular features of ASD-associated bowel inflammation distinguish it from both Crohn’s disease and ulcerative colitis. It’s appearance ONLY in children with the diagnostic features of “autism” suggests that the autism and gastrointestinal disease are related.

Figure 4 Schematic diagram depicting pathological findings in a portion of the gastrointestinal tract of a representative gastrointestinal-symptomatic child with autism spectrum disorder. Courtesy: World Journey of Psychology  Krigsman A, Walker SJ. Gastrointestinal disease in children with autism spectrum disorders: Etiology or consequence? World J Psychiatr 2021; 11(9): 605-618 [PMID: 34631464 DOI: 10.5498/wjp.v11.i9.605]

While the underlying cause of autism-specific intestinal disease is still unknown, it appears to result from an exaggerated, poorly regulated immune response involving the gastrointestinal mucosa, which is the lining of the GI tract.

The most common clinical manifestations of these lesions are diarrhea, abdominal pain, constipation, abdominal distention and growth problems. It is thought that behavioral symptoms traditionally attributed to autism may often in fact be symptoms of gastrointestinal disease or gastrointestinal pain.

Autism & GI Disease: Chicken or Egg?

GI symptoms can precede, coincide with, or appear after the onset of the behavioral, cognitive, or neurological symptoms of autism or autistic regression. A current conceptual model linking the gastrointestinal pathology to cognitive deficits involves a biochemical sequence of events in which luminal contents, which consist primarily of ingested foods and products of microbial degradation, are pathologically absorbed through the highly permeable inflamed intestinal mucosa before they are properly broken down intraluminally into smaller micromolecules.

The absorbed macromolecules then undergo metabolic degradation and processing by pathways not normally employed, resulting in the production of byproducts that may be toxic to the developing brain. Included are immunological responses to these “foreign” absorbed substances. Though ultimately theoretical, this proposed mechanism is supported in its separate steps, both by published scientific data, the observations of clinicians caring for these children, and most importantly, the observations of countless parents.

Help Us Help You

You too can join our team and help us in making a difference in the lives of children with ASD and their families! For the Cell-El study, we are recruiting infants aged 10-18 months not diagnosed with ASD but with a sibling diagnosed with ASD and their mothers. Parents please help spread the word to others and thus enable this important tool to be integrated into Autism treatment as quickly as possible. Additionally, if your child is diagnosed with ASD and between the ages of 2-12 years old and you are planning to take them privately to a clinic offering Stem Cell treatment for ASD, please contact Leah at [email protected] or fill out the form to find out about eligibility to participate in  our diagnostic study.