Autism Around the World Symposium 2010 May 6-8, 2010 Zayed University Dubai, United Arab Emirates

1. Biomedical Treatments for Autism 101: An Introduction to Scientifically Based Medical Treatment Options Autism Around the WorldSymposium 2010May 6-8, 2010Zayed University Dubai, United Arab Emirates Lauren W. Underwood, PhD

2. ***Disclaimer: The information provided today is for educational purposes only, and should notbe used in place of profession medical and/or nutritional supervision. If medical advice is needed, this service should be given by a licensed medical provider. I do not receive any financial remuneration for anythingmentioned or referred to in this presentation. Lauren W. Underwood, PhD

3. My training and employment. . . • M.S. in Biology from Tulane University, New Orleans, LA • Ph.D. in Cell and Molecular Biology from Tulane University, New Orleans, LA • NIH Training Grant in Vision Research, LSU Eye Center, New Orleans, LA • Day job: Sr. Research Scientist, NASA SSC Lauren W. Underwood, PhD

4. Work related to autism . . . • Independent Consultant, Developmental Delay Consultant • Autism One Mentor • USAAA Scientific Advisory board • IHA Scientific Advisory board • CARD IRB

5. Aparent of child recovering from autism But most importantly, . . . Lauren W. Underwood, PhD

6. What is Autistic Spectrum Disorder? A developmental disability resulting from a neurological disorder . . . Lauren W. Underwood, PhD

7. That affects normal functioning of the brain . . .

8. … affecting children in a spectrum of ways . . .

9. . . . children with autism behave in a spectrum of ways . . .

10. Autistic Spectrum Disorder • Abnormal development of • Communication skills • Social skills • Reasoning Lauren W. Underwood, PhD

11. The tough part about autism is that… No one will tell you that there is something that will definitively work . . .

12. Autism is treatable! • Recent research shows that autism is treatable • Early interventions lead to the best outcomes • Be aware of symptoms, and begin addressing them as soon as possible There is still not a “cure”, but there are many treatments to consider

13. Educate yourself . . .empower yourself with knowledge! • You know your child best • Learn about the disorder • Learn about treatments • Make intelligent choices about what would work best for your child—for it is a spectrum disorder, affecting each child differently Lauren W. Underwood, PhD

14. Consider pursuing 3 major treatment areas: • Biomedical/Health • Behavior/education & social interventions • Sensory issues Lauren W. Underwood, PhD

15. Interventions go “hand-in-hand” • Therapies or interventions are designed to remedy specific symptoms in each individual. • The best-studied therapies include educational/behavioral, sensory and biomedicalinterventions. Although these interventions do not cure autism, they often bring about substantial improvement Lauren W. Underwood, PhD

16. My goal as an educator, • 1. Biology • Anatomy and cell biology • 2. Immunology • 3. Biochemistry • 4. Describe what can goes wrong with these systems Lauren W. Underwood, PhD

17. Then, the reasoning behind what can go wrong with these systems . . . explain how issues with these systems can affect behavior and behavioral intervention

18. . . . To enable you to understand some of the biological approaches currently available for the treatment of the medical condition described as autism, . . . .so if you choose you can consider applying them responsibly Lauren W. Underwood, PhD

19. What does biomedical approach mean? • The application of the natural, biological and physiological sciences to clinical medicine Lauren W. Underwood, PhD

20. Why consider biomedical approaches for the treatment of autism? There is literature in peer review journals and other related sources that suggests that there are several biomedical interventions that . . . can behelpful for the treatment of the symptoms in manyautistic spectrum disorder children Lauren W. Underwood, PhD

21. http://www.pediatrics.org/cgi/content/full/120/5/1162

22. http://aappolicy.aappublications.org/cgi/reprint/pediatrics;107/5/1221.pdfhttp://aappolicy.aappublications.org/cgi/reprint/pediatrics;107/5/1221.pdf

23. Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals with ASD: A Consensus Report Buie et al, 2010, Pediatrics;125;S1-S18 http://www.pediatrics.org/cgi/content/full/125/Supplement_1/

24. Abstract- Buie et al; Pediatrics;125;S1-S18 “….The consensus expert opinion of the panel was that individuals with ASDs deserve the same thoroughness and standard of care in the diagnostic workup and treatment of gastrointestinal concerns as should occur for patients without ASDs. Care providers should be aware that problem behavior in patients with ASDs may be the primary or sole symptom of the underlying medical condition, including some gastrointestinal disorders. For these patients, integration of behavioral and medical care may be most beneficial. Priorities for future research are identified to advance our understanding and management of gastrointestinal disorders in persons with ASDs.”

25. The Science • The body is made up of specific systems, including skeletal, circulatory, immune, cardiovascular, nervous, digestive • Digestive system • Anatomy and function • Food allergies/food intolerances • Leaky gut/intestinal dysbiosis • Immune system function • Basic biochemistry

26. Digestive System • Mouth • Stomach • Small intestine-absorption • Duodenum • Jejunum • Ileum • Large intestine/Colon • Rectum • Liver • Pancreas-secretes enzymes and hormones

27. Digestion-function of the digestive tract • Digests food • Absorbs nutrients • Carries vitamins and nutrients into bloodstream • Chemical detoxification • Excretion

28. Small Intestine Cross Section • Serosa • Connective tissue • Muscularis Externa • Inner circular and outer longitudinal fibers (muscle cells) • Submucosa • Connective tissue • Blood vessels • Mucousa • Epithelial cells • Lamina propria • Muscularis mucosa Lauren W. Underwood, PhD

29. Intestinal epithelial cell layer: histological view Lauren W. Underwood, PhD

30. How do you get nutrients from foods? Protein Foods are made up of proteins When foods are eaten and properly digested, proteins are broken down by enzymes into peptides Peptides are then further broken down into amino acids Amino acids are the building blocks of life

31. What is a peptide A little biochemistry . . . . Lauren W. Underwood, PhD

32. Peptides are made up of amino acids that are linked together . . . Peptides are linked together to form proteins Lauren W. Underwood, PhD

33. What’s an Amino Acid? Amino acids are the building blocks of life Lauren W. Underwood, PhD

34. H S H C H H O C C H N O H H There are 20 amino acids the amino acid-Cysteine CYSTEINE Lauren W. Underwood, PhD

35. What can go wrong with the GI? • “Leaky gut” • Intestinal dysbiosis • Constipation • Diarrhea • Enterocolitis • Allergy

36. “Leaky Gut” Definition: an abnormal or unfavorable increase in intestinal permeability The intestinal lining is supposed to be protective barrier between the gut and the bloodstream Lauren W. Underwood, PhD

37. Tight gap junctions Lauren W. Underwood, PhD

38. 1. What is “leaky-gut”? Definition: an abnormal or unfavorable increase in intestinal permeability • Epithelia are either 'tight' or 'leaky' • The intestinal lining is supposed to be the protective barrier between the gut and the bloodstream

39. Leaky Gut/Increased permeability • If the intestinal lining becomes damaged-it is possible for incompletely digested proteins and/or other by-products to “leak” through the intestinal lining • They can be recognized as foreign by the immune system, and/or “leak” into bloodstream Lauren W. Underwood, PhD

40. How do you treat “leaky gut”? • Cleanse the gut of toxins • Avoid the non-food foods: sugars, refined carbohydrates, fatty foods. • Enhance the flow of digestive secretions /enzymes. • Provide proper nutrition to the body • Supplements diet: vitamins, anti-oxidants,, probiotics Lauren W. Underwood, PhD

41. What is intestinal dysbiosis? Intestinal flora-yeast and bacteria -are part of GI track • Intestinal dysbiosis occurs when there is an overgrowth/imbalance of intestinal flora(s) Lauren W. Underwood, PhD

42. 2. Dysbiosis • Intestinal flora (yeast and bacteria) are a normal part of digestive track • Intestinal dysbiosis occurs when there is an overgrowth/imbalance of intestinal flora(s) • Dysbiosis results from • Increased use of antibiotics, steroids, etc. • Poor diet • Diets high in sugar • Stress • Immune system dysregulation

44. How do your treat intestinal dysbiosis? • Try laboratory testing to determine pathogen: • Yeast, clostridia, or unfavorable bacteria • Discuss Rx or OTC treatments with your physician Lauren W. Underwood, PhD

45. a. Constipation/ b. Diarrhea • Constipation-having a bowel movement fewer than three times per week • Stools are usually hard, dry, small in size, and difficult to eliminate. • Can be painful to have a bowel movement and • often experience straining, bloating, and the sensation of a full bowel • Diarrhea-frequent loose or liquid bowel movements (often associated with infection, allergy and food intolerances)

46. c. Enterocolitis • Inflammation [itis](due to infection or irritation) that affects part or all of the intestines (the small [entero]and/or large [col] intestines) • Hyperplasia-general term for an increase in the number of the cells of an organ or tissue causing it to increase in size • Endoscopy-looking inside, the human body for medical reasons, by inserting a small scope in the body

47. Ileonodular Hyperplasia Normal Terminal Ileum

48. Consequences of intestinaldysbiosis or “leaky gut”-if left untreated • Nutrients and vitamins aren’t absorbed properly---vitamin deficiencies • Intestinal distress • Food allergies are created • Detoxification is compromised • Bacteria and yeast can be mobilized • Formation of antibodies you might not want---because of immune dysregulation Lauren W. Underwood, PhD

50. 3. Allergy • A large part of the immune system is located in or near the intestinal tract-to helps prevent microorganisms in the intestine from entering into the rest of the body • 1st line of defense against pathogens  • Defects in the immune system can lead to gastrointestinal problems • Therefore, the most obvious place for an allergic reaction to food to take place is in the GI track • Reactions can range from acute to chronic • Food allergies vs. food sensitivies