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Ouabbou S, He Y, Butler K, Tsuang M. Inflammation in Mental Disorders: Is the Microbiota the Missing Link? Neurosci Bull 2020; 36:1071-1084. [PMID: 32592144 PMCID: PMC7475155 DOI: 10.1007/s12264-020-00535-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 03/18/2020] [Indexed: 01/15/2023] Open
Abstract
Research suggests that inflammation is important in the pathophysiology of mental disorders. In addition, a growing body of evidence has led to the concept of the microbiota-gut-brain axis. To understand the potential interactions, we begin by exploring the liaison between the immune system and mental disorders, then we describe the evidence that the microbiota impact the immune response in the developing brain. Next, we review the literature that has documented microbiome alterations in major mental disorders. We end with a summary of therapeutic applications, ranging from psycho-biotics to immunomodulatory drugs that could affect the microbiota-gut-brain axis, and potential treatments to alleviate the adverse effects of antipsychotics. We conclude that there is promising evidence to support the position that the microbiota plays an important role in the immunological pathophysiology of mental disorders with an emphasis on psychotic disorders and mood disorders. However, more research is needed to elucidate the mechanisms.
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Affiliation(s)
- Sophie Ouabbou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, and Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, 00290, Helsinki, Finland
- Cellular and Molecular Biology Research Centre, University of Costa Rica, San José, 11501, Costa Rica
| | - Ying He
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, and Hunan Key Laboratory of Psychiatry and Mental Health, The Second Xiangya Hospital of Central South University, Changsha, Hunan, 410011, China.
- Center for Behavioral Genomics, Department of Psychiatry, Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
| | - Keith Butler
- Center for Behavioral Genomics, Department of Psychiatry, Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ming Tsuang
- Center for Behavioral Genomics, Department of Psychiatry, Institute for Genomic Medicine, University of California San Diego, La Jolla, CA, 92093, USA
- Harvard Institute of Psychiatric Epidemiology and Genetics, Harvard School of Public Health, Boston, MA, 02115, USA
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Shariati A, Aslani HR, Shayesteh MR, Taghipour A, Nasser A, Safari H, Alizade-Sani M, Dehghan A, Azimi T. Are Viruses and Parasites Linked to Celiac Disease? A Question that Still has no Definite Answer. Curr Pharm Biotechnol 2019; 20:1181-1193. [DOI: 10.2174/1389201020666190828124924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/01/2019] [Accepted: 08/07/2019] [Indexed: 12/17/2022]
Abstract
Celiac Disease (CD) is a complex autoimmune enteropathy of the small intestine that commonly
occurs in genetically predisposed individuals due to intake of gluten and related proteins. Gluten
consumption, duration of breast-feeding, various infections, especially frequent intestinal infections,
vaccinations and use of antibiotics can be linked to CD. It is predicted that it affects 1% of the
global population and its incidence rate is increasing. Most of the people with the HLA-DQ2 or HLADQ8
are at a higher risk of developing this disease. The link between infections and autoimmune diseases
has been very much considered in recent years. In several studies, we explained that pathogenic
and non-pathogenic microorganisms might have multiple roles in initiation, exacerbation, and development
of Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). In various studies,
the relationship between infections caused by viruses, such as Epstein-Barr Virus (EBV), Rotavirus,
Hepatitis C (HCV), Hepatitis B virus (HBV), Cytomegalovirus (CMV), and Influenza virus, and parasites
including Giardia spp. and Toxoplasma gondii with CD has been raised. However, increasing evidence
proposes that some of these microorganisms, especially helminths, can also have protective and
even therapeutic roles in the CD process. Therefore, in order to determine the role of microorganisms
in the process of this disease, we attempted to summarize the evidence suggesting the role of viral and
parasitic agents in pathogenesis of CD.
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Affiliation(s)
- Aref Shariati
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid R. Aslani
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad R.H. Shayesteh
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Taghipour
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ahmad Nasser
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Safari
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmood Alizade-Sani
- Food Safety and Hygiene Division, Environmental Health Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amin Dehghan
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Taher Azimi
- Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Typical and atypical antipsychotics are the first-line treatments for schizophrenia, but these classes of drugs are not universally effective, and they can have serious side effects that impact compliance. Antipsychotic drugs generally target the dopamine pathways with some variation. As research of schizophrenia pathophysiology has shifted away from a strictly dopamine-centric focus, the development of new pharmacotherapies has waned. A field of inquiry with centuries-old roots is gaining traction in psychiatric research circles and may represent a new frontier for drug discovery in schizophrenia. At the forefront of this investigative effort is the immune system and its many components, pathways and phenotypes, which are now known to actively engage the brain. Studies in schizophrenia reveal an intricate association of environmentally-driven immune activation in concert with a disrupted genetic template. A consistent conduit through this gene-environmental milieu is the gut-brain axis, which when dysregulated can generate pathological autoimmunity. In this review, we present epidemiological and biochemical evidence in support of an autoimmune component in schizophrenia and depict gut processes and a dysbiotic microbiome as a source and perpetuator of autoimmune dysfunction in the brain. Within this framework, we review the role of infectious agents, inflammation, gut dysbioses and autoantibody propagation on CNS pathologies such as neurotransmitter receptor hypofunction and complement pathway-mediated synaptic pruning. We then review the new pharmacotherapeutic horizon and novel agents directed to impact these pathological conditions. At the core of this discourse is the understanding that schizophrenia is etiologically and pathophysiologically heterogeneous and thus its treatment requires individualized attention with disease state variants diagnosed with objective biomarkers.
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Affiliation(s)
| | | | - Robert H Yolken
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Porcelli B, Verdino V, Ferretti F, Bizzaro N, Terzuoli L, Cinci F, Bossini L, Fagiolini A. A study on the association of mood disorders and gluten-related diseases. Psychiatry Res 2018; 260:366-370. [PMID: 29241120 DOI: 10.1016/j.psychres.2017.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 12/21/2022]
Abstract
Our study aimed to evaluate the presence of antibodies related to gluten intolerance in patients with mood disorders. A total of 60 patients with a diagnosis of bipolar disorder or depressive disorder were recruited. Fourty-eight subjects randomly selected among unrelated family members were included as controls. Celiac disease-associated antibodies were assayed both in the patients and controls. Mean values of IgA/IgG anti-gliadin antibodies, IgA/IgG anti-deamidated gliadin peptide antibodies and IgA anti-transglutaminase (tTG) antibodies were not different between patients and controls. However, a significant difference was found for anti-tTG IgG antibodies. Even if both in controls and in patients the mean anti-tTG IgG value was below the cutoff, the estimates produced by the statistical model showed that each unit increase in the anti-tTG IgG antibody value corresponded to an approximately 5% increased chance of having a mood disorder. The patient group showed a more frequent presence of symptoms associated to non-celiac gluten sensitivity. However, as there was neither any correlation between antibody levels and gastrointestinal symptoms, nor with the intensity of the psychiatric symptoms, it may be conceivable that the increase in anti-tTG IgG antibodies is not disorder-related but possibly an outcome of the psychiatric disorder itself.
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Affiliation(s)
- Brunetta Porcelli
- Department of Medical Biotechnologies, University of Siena, Clinical Pathology Laboratory, University Hospital of Siena, Siena, Italy.
| | - Valeria Verdino
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Fabio Ferretti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, S. Antonio Hospital, Tolmezzo, Italy
| | - Lucia Terzuoli
- Department of Medical Biotechnologies, University of Siena, Clinical Pathology Laboratory, University Hospital of Siena, Siena, Italy
| | - Francesca Cinci
- Department of Medical Biotechnologies, University of Siena, Clinical Pathology Laboratory, University Hospital of Siena, Siena, Italy
| | - Letizia Bossini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Reginia A, Kucharska-Mazur J, Jabłoński M, Budkowska M, Dołȩgowska B, Sagan L, Misiak B, Ratajczak MZ, Rybakowski JK, Samochowiec J. Assessment of Complement Cascade Components in Patients With Bipolar Disorder. Front Psychiatry 2018; 9:614. [PMID: 30538645 PMCID: PMC6277457 DOI: 10.3389/fpsyt.2018.00614] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 11/01/2018] [Indexed: 12/14/2022] Open
Abstract
Introduction: The immune system is undoubtedly involved in the pathogenesis of various psychiatric disorders, such as schizophrenia, bipolar disorder, or depression. Although its role is not fully understood, it appears that this area of research can help to understand the etiology of mental illness. One of the components of the human immune system is the complement system, which forms a part of the innate immune response. Physiologically, except for its essential protective role, it is a vital element in the regeneration processes, including neurogenesis. To date, few studies have tried to clarify the role of the complement cascade in mental disorders. Materials and Methods: We evaluated concentrations of C3a, C5a, and C5b-9 complement cascade components in the peripheral blood of 30 patients suffering from bipolar disorder (BD) for at least 10 years, in euthymia, who were not treated with lithium salts. In addition, we divided our study sample into BD type I (BD-I, 22 persons), and BD type II (BD-II, 8 patients). The control group consisted of 30 healthy volunteers matched for age, sex, BMI, and smoking habits. Results: Compared to healthy controls, BD patients had elevated concentrations of all the investigated components. Furthermore, in patients with BD-II, we observed higher concentrations of C5b-9 as compared to patients with BD-I. However, there was a significant effect of BD diagnosis only on the levels of C3a and C5a but not on the level of C5b-9 after adjustment for potential confounding factors. Conclusions: Increased concentrations of components C3a and C5a of the complement system in the investigated group as compared to healthy controls suggest involvement of the complement cascade in the pathogenesis of BD, and provides further evidence of immune system dysregulation in BD patients.
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Affiliation(s)
- Artur Reginia
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | | | - Marcin Jabłoński
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Marta Budkowska
- Department of Medical Analytics, Pomeranian Medical University, Szczecin, Poland
| | - Barbara Dołȩgowska
- Department of Laboratory Medicine, Pomeranian Medical University, Szczecin, Poland
| | - Leszek Sagan
- Department of Neurosurgery, Pomeranian Medical University, Szczecin, Poland
| | - Błazej Misiak
- Department of Genetics, Wroclaw Medical University, Wrocław, Poland
| | - Mariusz Z Ratajczak
- Stem Cell Institute at James Graham Brown Cancer Center, University of Louisville, Louisville, KY, United States
| | - Janusz K Rybakowski
- Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
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Kannan G, Gressitt KL, Yang S, Stallings CR, Katsafanas E, Schweinfurth LA, Savage CLG, Adamos MB, Sweeney KM, Origoni AE, Khushalani S, Bahn S, Leweke FM, Dickerson FB, Yolken RH, Pletnikov MV, Severance EG. Pathogen-mediated NMDA receptor autoimmunity and cellular barrier dysfunction in schizophrenia. Transl Psychiatry 2017; 7:e1186. [PMID: 28763062 PMCID: PMC5611729 DOI: 10.1038/tp.2017.162] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/09/2017] [Accepted: 06/13/2017] [Indexed: 12/15/2022] Open
Abstract
Autoantibodies that bind the N-methyl-D-aspartate receptor (NMDAR) may underlie glutamate receptor hypofunction and related cognitive impairment found in schizophrenia. Exposure to neurotropic pathogens can foster an autoimmune-prone environment and drive systemic inflammation leading to endothelial barrier defects. In mouse model cohorts, we demonstrate that infection with the protozoan parasite, Toxoplasma gondii, caused sustained elevations of IgG class antibodies to the NMDAR in conjunction with compromised blood-gut and blood-brain barriers. In human cohorts, NMDAR IgG and markers of barrier permeability were significantly associated with T. gondii exposure in schizophrenia compared with controls and independently of antipsychotic medication. Combined T. gondii and NMDAR antibody seropositivity in schizophrenia resulted in higher degrees of cognitive impairment as measured by tests of delayed memory. These data underscore the necessity of disentangling the heterogeneous pathophysiology of schizophrenia so that relevant subsets eligible for NMDAR-related treatment can be identified. Our data aid to reconcile conflicting reports regarding a role of pathological NMDAR autoantibodies in this disorder.
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Affiliation(s)
- G Kannan
- Department of Psychiatry, Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Program in Cellular and Molecular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K L Gressitt
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - S Yang
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C R Stallings
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - E Katsafanas
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - L A Schweinfurth
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - C L G Savage
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - M B Adamos
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - K M Sweeney
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - A E Origoni
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - S Khushalani
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - S Bahn
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - F M Leweke
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - F B Dickerson
- Sheppard Pratt Health System, Stanley Research Program, Baltimore, MD, USA
| | - R H Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M V Pletnikov
- Department of Psychiatry, Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Molecular Immunology and Microbiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - E G Severance
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Tomaka J, Karakuła-Juchnowicz H, Morylowska-Topolska J, Dzikowski M, Juchnowicz D, Flis M, Siek A, Próchnicki M. Review paper. Gluten-related disorders and schizophrenia - potential linking mechanisms, diagnostic and therapeutic challenge. CURRENT PROBLEMS OF PSYCHIATRY 2017. [DOI: 10.1515/cpp-2017-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
More and more evidence confirms the theory that the intake of cereal products containing gluten may play an important role in the pathogenesis of many diseases. There are also premises indicating the relationship between the so-called gluten-related diseases and the development and course of mental disorders, including schizophrenia.
The aim of this article is to review the literature on the potential relationship between the consumption of gluten and schizophrenia, considering the etiopathogenesis and the role of gluten-free diet in the treatment of schizophrenia.
Methods: There were analysed available research papers in PubMed and Google Scholar with the key words: schizophrenia, gluten- related disorders, allergy to grain products, celiac disease, microbiota, immune system, exorphins and time span: 1960-2016 .
Conclusions: Existing research results indicate a possible relationship between diet rich in grain products with high gluten content and the occurrence or exacerbation of schizophrenia symptoms. However, further studies are necessary to: 1) identify groups of patients for whom the consumption of cereal products (gluten) is associated with a particular risk of schizophrenia exacerbation, 2) determine the mechanisms relating the consumption of gluten with the mental state of schizophrenic patients, 3) get the possible benefits of implementing gluten-free diet in patients with schizophrenia.
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Affiliation(s)
- Joanna Tomaka
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin , Poland
| | - Hanna Karakuła-Juchnowicz
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin , Poland
- Department of Clinical Neuropsychiatry, Medical Universtiy in Lublin , Poland
| | | | - Michał Dzikowski
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin , Poland
| | - Dariusz Juchnowicz
- Department of Psychiatric Nursing, Medical University of Lublin , Poland
| | - Marta Flis
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin , Poland
| | - Aleksandra Siek
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin , Poland
| | - Michał Próchnicki
- I Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin , Poland
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Ergün C, Urhan M, Ayer A. A review on the relationship between gluten and schizophrenia: Is gluten the cause? Nutr Neurosci 2017; 21:455-466. [PMID: 28393621 DOI: 10.1080/1028415x.2017.1313569] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Schizophrenia is a chronic disease that possesses various clinical manifestations. It presents rather heterogeneous characteristics with respect to onset type, symptoms, and the course of the disease. Although the lifetime prevalence is as low as 1%, it can cause serious disability. Thus, it is very important to develop efficient treatment methods. In some studies, it is hypothesized that removing gluten from the diet leads to a significant improvement in disease symptoms. Epidemiological studies revealed that the prevalence of celiac disease among schizophrenic patients is almost two times higher than that of the general population. OBJECTIVE In this review, we evaluate the effects of gluten and celiac disease on the onset of schizophrenia. Efficacy of gluten-free diet applications, antibody response against gluten, and the interaction of the brain-gut axis and the presence of common genetic points are also investigated. METHODS Without any publication date restriction, Pubmed database searches were made for 'schizophrenia, gluten, gliadin, celiac disease, exorphin, brain-gut axis, psychiatric disorders.' The keywords and the articles about the schizophrenia-celiac disease relationship are included in our review. RESULTS Several studies presented evidence to suggest that symptoms associated with schizophrenia were minimized when gluten was excluded from patients' diets. Immunological searches revealed that most schizophrenic patients with increased anti-gliadin antibodies did not possess celiac disease; yet, the presence of increased antibodies against gliadin can be the share point of the immunological abnormalities found in both of the diseases. DISCUSSION There were no consistent results in the clinical, immunological, microbiological, and epidemiological studies that investigated the relationship between schizophrenia and celiac disease. This presents a need for a larger scale study to confirm the presence of this suggested correlation between schizophrenia and celiac disease. The underlying mechanisms between the two diseases should be explored.
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Affiliation(s)
- Can Ergün
- a Faculty of Health Sciences, Department of Nutrition and Dietetics , Bahçeşehir University , Beşiktaş, Istanbul , Turkey
| | - Murat Urhan
- b Manisa Mental Health and Diseases Hospital , Şehitler Street, 45020 Manisa , Turkey
| | - Ahmet Ayer
- b Manisa Mental Health and Diseases Hospital , Şehitler Street, 45020 Manisa , Turkey
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Hand TW. The Role of the Microbiota in Shaping Infectious Immunity. Trends Immunol 2016; 37:647-658. [PMID: 27616558 DOI: 10.1016/j.it.2016.08.007] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023]
Abstract
Humans are meta-organisms that maintain a diverse population of microorganisms on their barrier surfaces, collectively named the microbiota. Since most pathogens either cross or inhabit barrier surfaces, the microbiota plays a critical and often protective role during infections, both by modulating immune system responses and by mediating colonization resistance. However, the microbiota can also act as a reservoir for opportunistic microorganisms that can 'bloom', significantly complicating diseases of barrier surfaces by contributing to inflammatory immune responses. This review discusses our current understanding of the complex interactions between the host, its microbiota, and pathogenic organisms, focusing in particular on the intestinal mucosa.
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Affiliation(s)
- Timothy W Hand
- Richard King Mellon Institute for Pediatric Research, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, PA 15224, USA.
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10
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Severance EG, Yolken RH, Eaton WW. Autoimmune diseases, gastrointestinal disorders and the microbiome in schizophrenia: more than a gut feeling. Schizophr Res 2016; 176:23-35. [PMID: 25034760 PMCID: PMC4294997 DOI: 10.1016/j.schres.2014.06.027] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 06/17/2014] [Accepted: 06/19/2014] [Indexed: 12/12/2022]
Abstract
Autoimmunity, gastrointestinal (GI) disorders and schizophrenia have been associated with one another for a long time. This paper reviews these connections and provides a context by which multiple risk factors for schizophrenia may be related. Epidemiological studies strongly link schizophrenia with autoimmune disorders including enteropathic celiac disease. Exposure to wheat gluten and bovine milk casein also contribute to non-celiac food sensitivities in susceptible individuals. Co-morbid GI inflammation accompanies humoral immunity to food antigens, occurs early during the course of schizophrenia and appears to be independent from antipsychotic-generated motility effects. This inflammation impacts endothelial barrier permeability and can precipitate translocation of gut bacteria into systemic circulation. Infection by the neurotropic gut pathogen, Toxoplasma gondii, will elicit an inflammatory GI environment. Such processes trigger innate immunity, including activation of complement C1q, which also functions at synapses in the brain. The emerging field of microbiome research lies at the center of these interactions with evidence that the abundance and diversity of resident gut microbiota contribute to digestion, inflammation, gut permeability and behavior. Dietary modifications of core bacterial compositions may explain inefficient gluten digestion and how immigrant status in certain situations is a risk factor for schizophrenia. Gut microbiome research in schizophrenia is in its infancy, but data in related fields suggest disease-associated altered phylogenetic compositions. In summary, this review surveys associative and experimental data linking autoimmunity, GI activity and schizophrenia, and proposes that understanding of disrupted biological pathways outside of the brain can lend valuable information regarding pathogeneses of complex, polygenic brain disorders.
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Affiliation(s)
- Emily G. Severance
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 1105, Baltimore, MD 21287-4933 U.S.A
| | - Robert H. Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 1105, Baltimore, MD 21287-4933 U.S.A
| | - William W. Eaton
- Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, U.S.A
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11
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Severance EG, Yolken RH. Role of Immune and Autoimmune Dysfunction in Schizophrenia. HANDBOOK OF BEHAVIORAL NEUROSCIENCE 2016; 23:501-516. [PMID: 33456427 PMCID: PMC7173552 DOI: 10.1016/b978-0-12-800981-9.00029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In this chapter, we review data in support of the concept that immune system dysregulation is the most plausible explanation that reconciles gene by environmental interactions in schizophrenia. Early investigations of this topic demonstrated aspects of aberrant activation of humoral immunity, including autoimmunity, associated with schizophrenia, whereas current research efforts have expanded this theme to include elements of innate immunity. Advances in our understanding of inflammation and molecules of both the adaptive and innate immune system and their functional roles in standard brain physiology provide an important context by which schizophrenia might arise as the result of the coupling of immune and neurodevelopmental dysregulation.
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12
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Abstract
Genetic and environmental studies implicate immune pathologies in schizophrenia. The body's largest immune organ is the gastrointestinal (GI) tract. Historical associations of GI conditions with mental illnesses predate the introduction of antipsychotics. Current studies of antipsychotic-naïve patients support that gut dysfunction may be inherent to the schizophrenia disease process. Risk factors for schizophrenia (inflammation, food intolerances, Toxoplasma gondii exposure, cellular barrier defects) are part of biological pathways that intersect those operant in the gut. Central to GI function is a homeostatic microbial community, and early reports show that it is disrupted in schizophrenia. Bioactive and toxic products derived from digestion and microbial dysbiosis activate adaptive and innate immunity. Complement C1q, a brain-active systemic immune component, interacts with gut-related schizophrenia risk factors in clinical and experimental animal models. With accumulating evidence supporting newly discovered gut-brain physiological pathways, treatments to ameliorate brain symptoms of schizophrenia should be supplemented with therapies to correct GI dysfunction.
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Affiliation(s)
- Emily G Severance
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 1105, Baltimore, MD, 21287-4933, USA,
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13
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Porcelli B, Verdino V, Bossini L, Terzuoli L, Fagiolini A. Celiac and non-celiac gluten sensitivity: a review on the association with schizophrenia and mood disorders. AUTOIMMUNITY HIGHLIGHTS 2014; 5:55-61. [PMID: 26000156 PMCID: PMC4389040 DOI: 10.1007/s13317-014-0064-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/01/2014] [Indexed: 12/26/2022]
Abstract
An association between many psychiatric and gluten-related disorders has been known for some time. In the case of schizophrenia and mood disorders, the major psychiatric disorders, there is much evidence, not without contradictions, of a possible association between schizophrenia and celiac disease. The association between mood disorders and gluten-related disorders, especially celiac disease, has only been studied for depression, often coupled with anxiety, and very recently for bipolar disorder. Since non-celiac gluten sensitivity is now known to be different from celiac disease, many studies have shown that gluten sensitivity is also associated with major psychiatric disorders. Here we review the literature on the association between schizophrenia/mood disorders and celiac disease/gluten sensitivity, pointing out the differences between these associations.
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Affiliation(s)
- Brunetta Porcelli
- Biochemistry Division, Department of Medical Biotechnologies, Siena University, Polo Scientifico Universitario di San Miniato Via Alcide De Gasperi 2, 53100 Siena, Italy
| | - Valeria Verdino
- Psychiatry Division, Department of Molecular and Developmental Medicine, Siena University, Policlinico Le Scotte Viale Bracci 1, 53100 Siena, Italy
| | - Letizia Bossini
- Psychiatry Division, Department of Molecular and Developmental Medicine, Siena University, Policlinico Le Scotte Viale Bracci 1, 53100 Siena, Italy
| | - Lucia Terzuoli
- Biochemistry Division, Department of Medical Biotechnologies, Siena University, Polo Scientifico Universitario di San Miniato Via Alcide De Gasperi 2, 53100 Siena, Italy
| | - Andrea Fagiolini
- Psychiatry Division, Department of Molecular and Developmental Medicine, Siena University, Policlinico Le Scotte Viale Bracci 1, 53100 Siena, Italy
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14
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Severance EG, Gressitt KL, Buka SL, Cannon TD, Yolken RH. Maternal complement C1q and increased odds for psychosis in adult offspring. Schizophr Res 2014; 159:14-9. [PMID: 25195065 PMCID: PMC4177507 DOI: 10.1016/j.schres.2014.07.053] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 07/22/2014] [Accepted: 07/29/2014] [Indexed: 01/15/2023]
Abstract
The presence of maternal antibodies to food and infectious antigens may confer an increased risk of developing schizophrenia and psychosis in adult offspring. Complement factor C1q is an immune molecule with multiple functions including clearance of antigen-antibody complexes from circulation and mediation of synaptic pruning during fetal brain development. To determine if maternal C1q was associated with offspring schizophrenia and psychosis, we evaluated 55 matched case-control maternal serum pairs from the National Collaborative Perinatal Project. Sample pairs were composed of mothers whose offspring developed psychoses as adults and those whose offspring were free from psychiatric disease. Matching criteria for offspring included birth date, delivery hospital, race, and gender, with further matching based on mother's age. IgG markers of C1q, bovine milk casein, egg ovalbumin, and wheat gluten were measured with enzyme-linked immunosorbent assays. C1q levels were compared to food antigen IgG and to previously generated data for C-reactive protein, adenovirus, herpes simplex viruses, influenza viruses, measles virus, and Toxoplasma gondii. C1q was significantly elevated in case mothers with odds ratios of 2.66-6.31 (conditional logistic regressions, p ≤ 0.008-0.05). In case mothers only, C1q was significantly correlated with antibodies to both food and infectious antigens: gluten (R(2)=0.26, p ≤ 0.004), herpes simplex virus type 2 (R(2)=0.21, p ≤ 0.02), and adenovirus (R(2)=0.25, p ≤ 0.006). In conclusion, exposure to maternal C1q activity during pregnancy may be a risk factor for the development of schizophrenia and psychosis in offspring. Prenatal measurement of maternal C1q may be an important and convergent screening tool to identify potentially deleterious immune activation from multiple sources.
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Affiliation(s)
- Emily G. Severance
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 1105, Baltimore, MD 21287-4933 U.S.A,Correspondence: Emily G. Severance, , tel: +1 410-614-3918, fax: +1 410-955-3723
| | - Kristin L. Gressitt
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 1105, Baltimore, MD 21287-4933 U.S.A
| | - Stephen L. Buka
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, U.S.A
| | - Tyrone D. Cannon
- Department of Psychology, 2 Hillhouse Avenue, Yale University, New Haven, CT, U.S.A
| | - Robert H. Yolken
- Stanley Division of Developmental Neurovirology, Department of Pediatrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Blalock 1105, Baltimore, MD 21287-4933 U.S.A
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15
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Zhang XX, Zhang NZ, Tian WP, Zhou DH, Xu YT, Zhu XQ. First report of Toxoplasma gondii seroprevalence in pet parrots in China. Vector Borne Zoonotic Dis 2014; 14:394-8. [PMID: 24866015 DOI: 10.1089/vbz.2013.1522] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Toxoplasmosis, caused by the obligate intracellular protozoan parasite Toxoplasma gondii, has become a serious public health problem worldwide. T. gondii can infect almost all warm-blooded animals, including parrots. However, little is known of T. gondii infection in parrots in China. Antibodies against T. gondii in 311 parrots including 202 Budgerigars (Melopsittacus undulatus), 26 Lovebirds (Agapornis sp.), 22 Cockatiels (Nymphicus hollandicus), and 61 Alexandrine Parakeets (Psittacula eupatria) in the cities of Beijing and Weifang in north China were tested using the modified agglutination test (MAT). Twenty-six (8.36%) out of 311 serum samples were positive for T. gondii at the cutoff of 1:5. Among the four species, a higher seroprevalence of T. gondii was found in Cockatiels (13.64%, 95% confidence interval [CI] 0.00-27.98), although the difference was not statistically significant (p=0.61). Seropositivity rates against T. gondii in male parrots (10.43%, 95% CI 5.74-15.12) were not statistically different from that in female parrots (6.08%, 95% CI 2.23-9.93, p=0.17). The seropositivity of T. gondii in parrots from Weifang and Beijing was 11.11% (95% CI 6.13-16.09) and 5.70% (95% CI 2.08-9.31), respectively. The seroprevalence varied in parrots of different age groups, ranging from 5.71% (95% CI 1.27-10.15) to 13.00% (95% CI 6.41-19.69), however, the difference among age groups was not statistically significant (p=0.12). The seroprevalence of T. gondii infection in parrots in summer (11.63%, 95% CI 6.84-16.42) was significantly higher than in spring (4.32%, 95% CI 0.94-7.70, p=0.02). The results of the present survey indicated that parrots in China are exposed to T. gondii. To our knowledge, this is the first report of T. gondii seroprevalence in parrots in China.
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Affiliation(s)
- Xiao-Xuan Zhang
- 1 State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute , Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, PR China
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16
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The role of microbes and autoimmunity in the pathogenesis of neuropsychiatric illness. Curr Opin Rheumatol 2014; 25:488-795. [PMID: 23656715 DOI: 10.1097/bor.0b013e32836208de] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To illustrate how microbes might participate in the pathogenesis of neuropsychiatric illness by triggering the production of autoantibodies that bind to brain targets. RECENT FINDINGS Some studies link exposure to infectious agents to development of brain disorders; others have identified autoantibodies in individuals with these conditions without finding evidence of pathogens. Neither line of work demonstrates consistent associations between a specific neuropsychiatric disease and a particular environmental trigger or immune marker. Growing evidence suggests that the microbiome conditions host immunity to microbes and xenobiotics, and regulates autoimmune responses that can affect the central nervous system (CNS). The presence of CNS receptors for cytokines and other immune molecules underscores the importance of brain-immune crosstalk in maintaining normal function. An increased prevalence of familial autoimmunity, exposure to pathogens prenatally and postnatally, and findings of antibrain antibodies is common in disorders as diverse as schizophrenia, obsessive-compulsive disorder and autism, and suggests that differences in exposure timing and genetic vulnerability toward autoimmunity are important determinants of neuropsychiatric outcomes. SUMMARY Microbes, both pathogenic and commensal, can induce autoantibodies that bind to brain and affect behavior in susceptible hosts. Interventions that correct the microbial balance or diminish autoantibody binding may be effective in diverse neuropsychiatric conditions mediated by autoimmunity.
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Discordant patterns of bacterial translocation markers and implications for innate immune imbalances in schizophrenia. Schizophr Res 2013; 148:130-7. [PMID: 23746484 PMCID: PMC3732507 DOI: 10.1016/j.schres.2013.05.018] [Citation(s) in RCA: 164] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/13/2013] [Accepted: 05/15/2013] [Indexed: 01/01/2023]
Abstract
The origin of inflammation in psychiatric disorders is not well understood. The translocation of commensal microbiota across the gastrointestinal barrier can result in a persistent state of low-grade immune activation and/or inflammation. We measured serological surrogate markers of bacterial translocation (soluble CD14 (sCD14) and lipopolysaccharide binding protein (LBP)) in two psychiatric cohorts and compared these levels to C-reactive protein (CRP), body mass index (BMI), and food-related and autoimmune antibodies. The two cohorts were composed of the following: (1) n=141 schizophrenia, n=75 bipolar disorder, n=78 controls; (2) n=78 antipsychotic-naïve first-episode schizophrenia, n=38 medicated first-episode schizophrenia. sCD14 seropositivity conferred a 3.1-fold increased odds of association with schizophrenia (multivariate regressions, OR=3.09, p<0.0001) compared to controls. Case-control differences in sCD14 were not matched by LBP. Quantitative levels of LBP, but not sCD14, correlated with BMI in schizophrenia (R(2)=0.21, p<0.0001). sCD14 and LBP also exhibited some congruency in schizophrenia with both significantly correlated with CRP (R(2)=0.26-0.27, p<0.0001) and elevated in females compared to males (p<0.01). Antipsychotic treatment generally did not impact sCD14 or LBP levels except for significant correlations, especially sCD14, with gluten antibodies in antipsychotic-naïve schizophrenia (R(2)=0.27, p<0.0001). In bipolar disorder, sCD14 levels were significantly correlated with anti-tissue transglutaminase IgG (R(2)=0.37, p<0.001). In conclusion, these bacterial translocation markers produced discordant and complex patterns of activity, a finding that may reflect an imbalanced, activated innate immune state. Whereas both markers may upregulate following systemic exposure to Gram-negative bacteria, non-lipopolysaccharide-based monocyte activation, autoimmunity and metabolic dysfunction may also contribute to the observed marker profiles.
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18
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Belkaid Y, Bouladoux N, Hand TW. Effector and memory T cell responses to commensal bacteria. Trends Immunol 2013; 34:299-306. [PMID: 23643444 PMCID: PMC3733441 DOI: 10.1016/j.it.2013.03.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 02/08/2023]
Abstract
Barrier surfaces are home to a vast population of commensal organisms that together encode millions of proteins; each of them possessing several potential foreign antigens. Regulation of immune responses to this enormous antigenic load represents a tremendous challenge for the immune system. Tissues exposed to commensals have developed elaborate systems of regulation including specialized populations of resident lymphocytes that maintain barrier function and limit potential responses to commensal antigens. However, in settings of infection and inflammation these regulatory mechanisms are compromised and specific effector responses against commensal bacteria can develop. This review discusses the circumstances controlling the fate of commensal specific T cells and how dysregulation of these responses could lead to severe pathological outcomes.
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Affiliation(s)
- Yasmine Belkaid
- Mucosal Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Disease, NIH, Bethesda 20892, USA.
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19
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Whiteley P, Shattock P, Knivsberg AM, Seim A, Reichelt KL, Todd L, Carr K, Hooper M. Gluten- and casein-free dietary intervention for autism spectrum conditions. Front Hum Neurosci 2013; 6:344. [PMID: 23316152 PMCID: PMC3540005 DOI: 10.3389/fnhum.2012.00344] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 12/14/2012] [Indexed: 01/31/2023] Open
Abstract
Dietary intervention as a tool for maintaining and improving physical health and wellbeing is a widely researched and discussed topic. Speculation that diet may similarly affect mental health and wellbeing particularly in cases of psychiatric and behavioral symptomatology opens up various avenues for potentially improving quality of life. We examine evidence suggestive that a gluten-free (GF), casein-free (CF), or gluten- and casein-free diet (GFCF) can ameliorate core and peripheral symptoms and improve developmental outcome in some cases of autism spectrum conditions. Although not wholly affirmative, the majority of published studies indicate statistically significant positive changes to symptom presentation following dietary intervention. In particular, changes to areas of communication, attention, and hyperactivity are detailed, despite the presence of various methodological shortcomings. Specific characteristics of best- and non-responders to intervention have not been fully elucidated; neither has the precise mode of action for any universal effect outside of known individual cases of food-related co-morbidity. With the publication of controlled medium- and long-term group studies of a gluten- and casein-free diet alongside more consolidated biological findings potentially linked to intervention, the appearance of a possible diet-related autism phenotype seems to be emerging supportive of a positive dietary effect in some cases. Further debate on whether such dietary intervention should form part of best practice guidelines for autism spectrum conditions (ASCs) and onward representative of an autism dietary-sensitive enteropathy is warranted.
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Affiliation(s)
- Paul Whiteley
- ESPA Research, The Robert Luff Laboratory, Unit 133i Business and Innovation CentreSunderland, UK
| | - Paul Shattock
- ESPA Research, The Robert Luff Laboratory, Unit 133i Business and Innovation CentreSunderland, UK
| | - Ann-Mari Knivsberg
- National Centre for Reading Education and Research, University of StavangerStavanger, Norway
| | | | - Karl L. Reichelt
- Department of Pediatric Research, Rikshospitalet Medical Centre, University of OsloOslo, Norway
| | - Lynda Todd
- ESPA Research, The Robert Luff Laboratory, Unit 133i Business and Innovation CentreSunderland, UK
| | - Kevin Carr
- ESPA Research, The Robert Luff Laboratory, Unit 133i Business and Innovation CentreSunderland, UK
| | - Malcolm Hooper
- ESPA Research, The Robert Luff Laboratory, Unit 133i Business and Innovation CentreSunderland, UK
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