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Al-Beltagi M. Pre-autism: What a paediatrician should know about early diagnosis of autism. World J Clin Pediatr 2023; 12:273-294. [PMID: 38178935 PMCID: PMC10762597 DOI: 10.5409/wjcp.v12.i5.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/07/2023] [Accepted: 09/25/2023] [Indexed: 12/08/2023] Open
Abstract
Autism, also known as an autism spectrum disorder, is a complex neurodevelopmental disorder usually diagnosed in the first three years of a child's life. A range of symptoms characterizes it and can be diagnosed at any age, including adolescence and adulthood. However, early diagnosis is crucial for effective management, prognosis, and care. Unfortunately, there are no established fetal, prenatal, or newborn screening programs for autism, making early detection difficult. This review aims to shed light on the early detection of autism prenatally, natally, and early in life, during a stage we call as "pre-autism" when typical symptoms are not yet apparent. Some fetal, neonatal, and infant biomarkers may predict an increased risk of autism in the coming baby. By developing a biomarker array, we can create an objective diagnostic tool to diagnose and rank the severity of autism for each patient. These biomarkers could be genetic, immunological, hormonal, metabolic, amino acids, acute phase reactants, neonatal brainstem function biophysical activity, behavioral profile, body measurements, or radiological markers. However, every biomarker has its accuracy and limitations. Several factors can make early detection of autism a real challenge. To improve early detection, we need to overcome various challenges, such as raising community awareness of early signs of autism, improving access to diagnostic tools, reducing the stigma attached to the diagnosis of autism, and addressing various culturally sensitive concepts related to the disorder.
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Affiliation(s)
- Mohammed Al-Beltagi
- Department of Pediatric, Faculty of Medicine, Tanta University, Tanta 31511, Algahrbia, Egypt
- Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Dr. Sulaiman Al Habib Medical Group, Manama 26671, Manama, Bahrain
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Mao S, Fan X, Ma Y, Chen Y, Lv J, Yang R. Knowledge and beliefs about autism spectrum disorders among physicians: a cross-sectional survey from China. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001696. [PMID: 36645801 PMCID: PMC9756177 DOI: 10.1136/bmjpo-2022-001696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The incidence of autism spectrum disorders (ASDs) is increasing greatly, with high demands for earlier diagnosis and intervention. However, little is known about ASD knowledge and beliefs among physicians in China. METHODS A questionnaire survey was used to assess the knowledge and beliefs about the diagnosis and management of ASD and 24 beliefs regarding the treatment and prognostic aspects of ASD among physicians of any medical specialty in China. RESULTS A total of 1160 physicians were recruited and surveyed, with an average score of 8.48±2.66 (total of 18 points) for the questionnaire on the main symptoms of ASD and 14.35±3.69 (total of 24 points) for beliefs about ASD. Physicians' age, sex, specialty and practice years were related to their knowledge of identifying patients with ASD. Physicians specialising in paediatrics/psychology/psychiatry scored higher than those specialising in other specialties both in response to diagnostic questions (8.98±2.63 vs 8.30±2.65, p<0.001) and beliefs about ASD (15.57±3.44 vs 13.97±3.97, p<0.001). CONCLUSIONS Knowledge and beliefs about ASD symptoms, diagnosis and treatment are insufficient among physicians in China. Education and training programmes on this topic should be enhanced in physicians of all specialties, especially for male physicians who have short years in practice.
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Affiliation(s)
- Shujiong Mao
- Department of Pediatrics, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoli Fan
- Department of Child Psychology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ye Ma
- Department of Child Psychology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Chen
- Department of Child Psychology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiamin Lv
- Department of Child Psychology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rongwang Yang
- Department of Child Psychology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Gallo R, Stoccoro A, Cagiano R, Nicolì V, Ricciardi R, Tancredi R, Trovato R, Santorelli FM, Calderoni S, Muratori F, Migliore L, Coppedè F. Correlation among maternal risk factors, gene methylation and disease severity in females with autism spectrum disorder. Epigenomics 2022; 14:175-185. [PMID: 35081728 DOI: 10.2217/epi-2021-0494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To detect early-life environmental factors leading to DNA methylation changes of autism spectrum disorder (ASD)-related genes in young ASD females and reveal epigenetic biomarkers of disease severity. Materials & methods: We investigated blood methylation levels of MECP2, OXTR, BDNF, RELN, BCL2, EN2 and HTR1A genes in 42 ASD females. Results: Maternal gestational weight gain correlated with BDNF methylation levels (Bonferroni-corrected p = 0.034), and lack of folic acid supplementation at periconception resulted in higher disease severity in the ASD children (Bonferroni-corrected p = 0.048). RELN methylation levels were inversely correlated with disease severity (Bonferroni corrected p = 0.042). Conclusion: The present study revealed gene-environment interactions and potential epigenetic biomarkers of disease severity in ASD females.
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Affiliation(s)
- Roberta Gallo
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, Via Roma 55, Pisa, 56126, Italy
| | - Andrea Stoccoro
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, Via Roma 55, Pisa, 56126, Italy
| | - Romina Cagiano
- IRCCS Stella Maris Foundation, Calambrone, Pisa, 56128, Italy
| | - Vanessa Nicolì
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, Via Roma 55, Pisa, 56126, Italy
| | - Rosanna Ricciardi
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, Via Roma 55, Pisa, 56126, Italy
| | | | - Rosanna Trovato
- IRCCS Stella Maris Foundation, Calambrone, Pisa, 56128, Italy
| | | | - Sara Calderoni
- IRCCS Stella Maris Foundation, Calambrone, Pisa, 56128, Italy.,Department of Clinical & Experimental Medicine, University of Pisa, Via Roma 55, Pisa, 56126, Italy
| | - Filippo Muratori
- IRCCS Stella Maris Foundation, Calambrone, Pisa, 56128, Italy.,Department of Clinical & Experimental Medicine, University of Pisa, Via Roma 55, Pisa, 56126, Italy
| | - Lucia Migliore
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, Via Roma 55, Pisa, 56126, Italy
| | - Fabio Coppedè
- Department of Translational Research & of New Surgical & Medical Technologies, University of Pisa, Via Roma 55, Pisa, 56126, Italy
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Alsubaie AM, Arita Y, Atwater M, Mahfuz A, Peltier MR. Enhancement of placental inflammation by Dibutyl Phthalate. J Reprod Immunol 2021; 147:103368. [PMID: 34461555 DOI: 10.1016/j.jri.2021.103368] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/11/2021] [Accepted: 08/22/2021] [Indexed: 10/20/2022]
Abstract
Recent studies suggest that women with high exposures to dibutyl phthalate (DBP) are at increased risk for preterm birth, a condition associated with aberrant inflammation in the placenta often caused by subclinical infections. Placental inflammation is also a risk factor for neurodevelopmental disorders whose risk may also be enhanced by DBP. It is unclear, however, if DBP enhances placental inflammation. Therefore, we studied the effects of DBP on the production of biomarkers of placental inflammation and neurodevelopment under basal conditions and a setting of mild infection. Placental explant cultures established from women undergoing elective caesarean delivery were treated with DBP with and without co-stimulation by 107 CFU/mL heat-killed E. coli for 24 h at 37 °C. Conditioned medium was harvested and concentrations of IL-1β, TNF-α, IL-10, HO-1 and BDNF, a biomarker for neurodevelopment, were quantified. DBP significantly enhanced IL-6 production in basal cultures but had no significant on the other biomarkers quantified. Both TNF-α and IL-1β production was enhanced by DBP for cultures co-stimulated with E. coli. Although marginal enhancement of IL-6, and IL-10 were observed for bacteria co-treated cultures, results were either non-monotonic or only approached statistical significance. HO-1 production tended to be reduced at the highest concentration of DBP tested and BDNF production was reduced by DBP in a dose-dependent manner for bacteria-stimulated cultures. These results suggest that DBP enhances basal IL-6 production but has little or no effect on other biomarkers studied. However, DBP enhances IL-1β and TNF-α production but reduces BDNF production by bacteria-stimulated cultures.
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Affiliation(s)
- Aisha Manna Alsubaie
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, Mineola, NY, 11501, United States; Department of Biology, Adelphi University, Garden City, NY, United States
| | - Yuko Arita
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, Mineola, NY, 11501, United States
| | - Matthew Atwater
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, Mineola, NY, 11501, United States; George Washington University, School of Medicine, Washington DC, United States
| | - Ali Mahfuz
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, Mineola, NY, 11501, United States; Texas Christian University University of North Texas Health Science Center School of Medicine, Fort Worth, TX, United States
| | - Morgan R Peltier
- Department of Foundations of Medicine, NYU-Long Island School of Medicine, Mineola, NY, 11501, United States.
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The Alteration of Chloride Homeostasis/GABAergic Signaling in Brain Disorders: Could Oxidative Stress Play a Role? Antioxidants (Basel) 2021; 10:antiox10081316. [PMID: 34439564 PMCID: PMC8389245 DOI: 10.3390/antiox10081316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/22/2022] Open
Abstract
In neuronal precursors and immature neurons, the depolarizing (excitatory) effect of γ-Aminobutyric acid (GABA) signaling is associated with elevated [Cl−]i; as brain cells mature, a developmental switch occurs, leading to the decrease of [Cl−]i and to the hyperpolarizing (inhibitory) effect of GABAergic signaling. [Cl−]i is controlled by two chloride co-transporters: NKCC1, which causes Cl− to accumulate into the cells, and KCC2, which extrudes it. The ontogenetic upregulation of the latter determines the above-outlined switch; however, many other factors contribute to the correct [Cl−]i in mature neurons. The dysregulation of chloride homeostasis is involved in seizure generation and has been associated with schizophrenia, Down’s Syndrome, Autism Spectrum Disorder, and other neurodevelopmental disorders. Recently, much effort has been put into developing new drugs intended to inhibit NKCC1 activity, while no attention has been paid to the origin of [Cl−]i dysregulation. Our study examines the pathophysiology of Cl− homeostasis and focuses on the impact of oxidative stress (OS) and inflammation on the activity of Cl− co-transporters, highlighting the relevance of OS in numerous brain abnormalities and diseases. This hypothesis supports the importance of primary prevention during pregnancy. It also integrates the therapeutic framework addressed to restore normal GABAergic signaling by counteracting the alteration in chloride homeostasis in central nervous system (CNS) cells, aiming at limiting the use of drugs that potentially pose a health risk.
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