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Ahmed MM, Alawna M, Youssef ASA, Amin WM, Alajam RA, Morsy WE, Fayed E, Mohamed AA. Immediate effect of physical activity on the autonomic nervous system in individuals with autism spectrum disorders of different age groups: a randomised trial. BMJ Open Sport Exerc Med 2024; 10:e001822. [PMID: 38617566 PMCID: PMC11015250 DOI: 10.1136/bmjsem-2023-001822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/16/2024] Open
Abstract
Background Autism spectrum disorder (ASD) is one of the most complex neurodevelopmental disorders. It affects almost all human physiological systems. Individuals with ASD often display dysregulation in their autonomic nervous system (ANS), which may elicit differing effects across age groups. Also, studying the ANS missed several important parameters related to ANS. Studying the ANS is crucial in developing adaptive behavioural strategies and maintaining communication abilities and social behaviours. Thus, this study compared the immediate effect of physical activity on the ANS in individuals with ASD in different age groups. Methods 200 participants (106 males and 94 females) took part in a double-blinded randomised design. All participants were divided into four groups according to their age (4-7, 7-10, 10-13 and 14-18 years old). Participants performed a 60 min treadmill walk. The main outcome measurements were heart rate (HR), saturation of peripheral oxygen (SpO2), respiratory rate (RR) and end-tidal carbon dioxide (etCO2). Results Before the study, there were non-significant differences between groups in their physical characteristics (body mass index, Childhood Autism Rating Scale, physical activity level, both parents' existence, aerobic capacity and gender) (p>0.05). At baseline measurements, there were non-significant differences between all groups for all outcome measurements (p>0.05). Immediately after physical activity, there was significant difference between group 1 and other groups (p<0.05), while all other differences were non-significant (p>0.05). At the follow-up (after 15 min of rest), group 1 maintained significant differences with the other groups for all outcome measurements (p<0.05), while there were non-significant differences between the other three groups (p>0.05). Conclusion This study revealed that the SpO2 significantly decreased immediately after the physical activity, while HR, RR and etCO2 significantly increased immediately after physical activity in comparison to the baseline measurements. Contrary to other ANS parameters (SpO2, RR and etCO2), HR in early ages (4-7 years old) was higher after physical activity and remained elevated longer than other ages. The early ages (4-7 years old) take more time to return to the normal status of ANS parameters including SpO2, HR, RR and etCO2. Trial registration number NCT05725733.
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Affiliation(s)
- Mohamed M Ahmed
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Jazan, Saudi Arabia
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Beni-Suef University, Beni Suef, Egypt
| | - Motaz Alawna
- Department of Health Sciences, Faculty of Graduate Studies, Arab American University, Jenin, Palestine, State of
| | - Ahmed S A Youssef
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Beni-Suef University, Beni Suef, Egypt
| | - Wafaa Mahmoud Amin
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Jazan, Saudi Arabia
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ramzi Abdu Alajam
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Jazan, Saudi Arabia
| | - Walaa E Morsy
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Jazan, Saudi Arabia
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Esraa Fayed
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan, Jazan, Saudi Arabia
- Department of Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Ayman A Mohamed
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Beni-Suef University, Beni Suef, Egypt
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Nahda University, Beni Suef, Egypt
- Department of Basic Science for Physical Therapy, Faculty of Physical Therapy, Galala University, Suez, Egypt
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Liu ZY, Wang QQ, Pang XY, Huang XB, Yang GM, Zhao S. Association of congenital heart disease and neurodevelopmental disorders: an observational and Mendelian randomization study. Ital J Pediatr 2024; 50:63. [PMID: 38589916 PMCID: PMC11003105 DOI: 10.1186/s13052-024-01610-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND This study aims to thoroughly study the connection between congenital heart disease (CHD) and neurodevelopmental disorders (NDDs) through observational and Mendelian randomization (MR) designs. METHODS This observational study uses data from the National Survey of Children's Health (2020-2021). Multivariable logistic regression and propensity score matching (PSM) were performed to analyze the association. PSM was used to minimize bias for covariates such as age, race, gender, maternal age, birth weight, concussion or brain injury, preterm birth, cerebral palsy, Down syndrome, and other inherited conditions. In MR analyses, inverse variance-weighted measures, weighted median, and MR-Egger were employed to calculate causal effects. RESULTS A total of 85,314 children aged 0-17 were analyzed in this study. In regression analysis, CHD (p = 0.04), the current heart condition (p = 0.03), and the severity of current heart condition (p < 0.05) had a suggestive association with speech or language disorders. The severity of current heart condition (p = 0.08) has a potential statistically significant association with attention deficit hyperactivity disorder(ADHD). In PSM samples, ADHD(p = 0.003), intellectual disability(p = 0.012), and speech or language disorders(p < 0.001) were all significantly associated with CHD. The severity of current heart condition (p < 0.001) also had a significant association with autism. MR analysis did not find causality between genetically proxied congenital cardiac malformations and the risk of NDDs. CONCLUSIONS Our study shows that children with CHD have an increased risk of developing NDDs. Heart conditions currently and severity of current heart conditions were also significantly associated with these NDDs. In the future, we need to try more methods to clarify the causal relationship between CHD and NDDs.
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Affiliation(s)
- Zhi-Yuan Liu
- Department of Cardiology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
- The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Qiong-Qiong Wang
- Department of Cardiology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Xian-Yong Pang
- Department of Cardiology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
- The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Xiao-Bi Huang
- Department of Cardiology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Gui-Ming Yang
- Department of Cardiology, Anhui Provincial Children's Hospital, Hefei, Anhui, China
| | - Sheng Zhao
- Department of Cardiology, Anhui Provincial Children's Hospital, Hefei, Anhui, China.
- The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China.
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Serrano F, Guffey D, Shekerdemian L, Noll L, Voigt RG, Monteiro S. Early identification of autism spectrum disorder in children with CHD attending a Cardiac Developmental Outcomes Program. Cardiol Young 2024; 34:483-488. [PMID: 37466015 DOI: 10.1017/s1047951123001701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE To determine the prevalence and timing of autism spectrum disorder diagnosis in a cohort of congenital heart disease (CHD) patients receiving neurodevelopmental follow-up and identify associated risk factors. METHOD Retrospective single-centre observational study of 361 children undergoing surgery for CHD during the first 6 months of life. Data abstracted included age at autism spectrum disorder diagnosis, child and maternal demographics, and medical history. RESULTS Autism spectrum disorder was present in 9.1% of children with CHD, with a median age at diagnosis of 34 months and 87.9% male. Prematurity, history of post-operative extracorporeal membrane oxygenation, and seizures were higher among those with autism (p = 0.013, p = 0.023, p = 0.001, respectively). Infants with autism spectrum disorder were older at the time of surgery (54 days vs 13.5 days, p = 0.002), and infants with surgery at ≥ 30 days of age had an increased risk of autism spectrum disorder (OR 2.31; 95% CI =1.12, 4.77, p = 0.023). On multivariate logistic regression analysis, being male (OR 4.85, p = 0.005), surgery ≥ 30 days (OR 2.46, p = 0.025), extracorporeal membrane oxygenation (OR 4.91, p = 0.024), and seizures (OR 4.32, p = 0.003) remained associated with increased odds for autism spectrum disorder. Maternal age, race, ethnicity, and surgical complexity were not associated. CONCLUSIONS Children with CHD in our cohort had more than three times the risk of autism spectrum disorder and were diagnosed at a much earlier age compared to the general population. Several factors (male, surgery at ≥ 30 days, post-operative extracorporeal membrane oxygenation, and seizures) were associated with increased odds of autism. These findings support the importance of offering neurodevelopmental follow-up after cardiac surgery in infancy.
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Affiliation(s)
- Faridis Serrano
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Danielle Guffey
- Baylor College of Medicine, Dan L. Duncan Institute for Clinical and Translational Research, Houston, TX, USA
| | - Lara Shekerdemian
- Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Lisa Noll
- Department of Pediatrics, Division of Psychology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Robert G Voigt
- Department of Pediatrics, Division of Developmental Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sonia Monteiro
- Department of Pediatrics, Division of Developmental Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
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Ehrler M, Bellinger DC, Cassidy AR, Newburger JW, Calderon J. Social cognition and behavioral outcomes in congenital heart disease: profiles and neuropsychiatric comorbidities. Child Neuropsychol 2023; 29:1041-1063. [PMID: 37017255 DOI: 10.1080/09297049.2023.2196398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 03/17/2023] [Indexed: 04/06/2023]
Abstract
Autism spectrum disorders are more prevalent in children with congenital heart disease (CHD) than in the general population. Children with CHD without diagnosed autism are also at increased risk for neurodevelopmental and psychiatric impairments. We characterized social and behavioral outcomes in children with CHD and examined neurodevelopmental and psychiatric comorbidities. Children without diagnosed autism who underwent infant open-heart surgery were eligible. Parent-reports assessed social communication, unusual behaviors, self-regulation, anxiety, and executive function (EF). Neuropsychological tests assessing theory of mind (ToM), working memory, and verbal comprehension were administered. Outcomes were compared to normative data. Linear regressions were estimated with parent-reported scores and ToM abilities as outcomes. Predictors were anxiety symptoms, parent-reported EF, and working memory scores. Covariates were age, parental education, ADHD diagnosis, and verbal comprehension. Clinically relevant comorbidities were identified (N children scoring ≥1SD below the norm). Fifty-six children (10.8 ± 1.8 years) participated virtually. Compared to norms, children with CHD had impaired ToM, more unusual behaviors (p = .002), and less self-regulation (p = .018), but better social communication (p = .014). "Autism-like" traits were positively associated with anxiety symptoms (ß(95% CI) = 0.28(0.08-0.49), p = .008) and worse working memory (ß(95% CI) = -0.36(-0.59-0.13), p = .003). Twenty-one out of 22 children who displayed clinically relevant social and behavioral scores also showed anxiety symptoms (n = 4), impaired EF (n = 7), or both (n = 10). Children with CHD without diagnosed autism have elevated unusual behaviors, lower self-regulation, and impaired ToM. There is a high risk of co-existing anxiety and impaired EF which may increase disease burden. Targeted therapeutic interventions are needed to reduce long-term psychosocial risks in these children.AbbreviationAttention deficit/hyperactivity disorder (ADHD), Autism Spectrum Rating Scale (ASRS), Behavior Rating Inventory of Executive Functions for school-aged children, 2nd Edition (BRIEF-2), cardiopulmonary bypass (CPB), congenital heart disease (CHD), Empathy/Systematizing Quotient Child Version (ESQ-C), Multidimensional Anxiety Scale for Children, 2nd Edition (MASC-2), Social Responsiveness Scale (School-age form), 2nd Edition (SRS-2), theory of mind (ToM), Theory of Mind Task Battery (ToM-TB), Wechsler Intelligence Scale for Children, 5th edition (WISC-V).
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Affiliation(s)
- Melanie Ehrler
- Child Development Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
- Departments of Cardiology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
| | - David C Bellinger
- Departments of Psychiatry, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Neurology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- Departments of Neurology, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Adam R Cassidy
- Departments of Psychiatry, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- Departments of Psychiatry and Psychology & Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jane W Newburger
- Departments of Cardiology, Cardiac Neurodevelopmental Program, Boston Children's Hospital, Boston, MA, USA
- Pediatrics, Harvard Medical School, Harvard University, Boston, USA
| | - Johanna Calderon
- Departments of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
- National Institute of Health and Medical Research, Inserm U1046 PhyMedExp, Cardiac Neurodevelopment Research, University of Montpellier, Montpellier, France
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Delgado C, Ullery MA, Zeng G, Simpson EA, Tanner JP, Kirby RS, Duclos C, Lowry J, Salemi JL. Elevated risk for developmental disabilities in children with congenital heart defects. Birth Defects Res 2023; 115:1708-1722. [PMID: 37681320 DOI: 10.1002/bdr2.2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This study examined risk for developmental disabilities in preschool-aged children with a congenital heart defect (CHD) at the population level. METHODS Statewide birth, birth defects, and preschool developmental disability records were integrated. The final sample included 1,966,585 children (51.0% male). Children were grouped by type(s) of CHD: critical CHD, noncritical CHD, atrial septal defect, or no major birth defects (groups were mutually exclusive). RESULTS Children with a CHD (any type) were at increased risk for developmental disability (any type) (RR 2.08, 95% CI 2.03-2.14, P < .001). Children in the critical CHD, noncritical CHD, and atrial septal defect groups were at increased risk for developmental delay, intellectual disability, language impairment, other health impairment, and any disability. Children in the atrial septal defect group were at increased risk for autism spectrum disorder and speech impairment. For all CHD groups, risk was greatest for other health impairment and intellectual disability. CONCLUSIONS Increased risk for developmental disabilities was identified for children with less severe CHDs as well as for children with more severe (critical) CHDs. All children with CHDs should be closely monitored so that appropriate interventions can be initiated as early as possible to maximize learning outcomes.
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Affiliation(s)
- Christine Delgado
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Mary Anne Ullery
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Guangyu Zeng
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, China
| | | | - J P Tanner
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Russell S Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Chris Duclos
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Joseph Lowry
- Division of Community Health Promotion, Florida Department of Health, Tallahassee, Florida, USA
| | - Jason L Salemi
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
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Ramonfaur D, Zhang X, Garza AP, García-Pons JF, Britton-Robles SC. Hypoplastic Left Heart Syndrome: A Review. Cardiol Rev 2023; 31:149-154. [PMID: 35349498 DOI: 10.1097/crd.0000000000000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hypoplastic left heart syndrome is a rare and poorly understood congenital disorder featuring a univentricular myocardium, invariably resulting in early childhood death if left untreated. The process to palliate this congenital cardiomyopathy is of high complexity and may include invasive interventions in the first week of life. The preferred treatment strategy involves a staged correction with 3 surgical procedures at different points in time. The Norwood procedure is usually performed within the first weeks of life and aims to increase systemic circulation and relieve pulmonary vascular pressure. This procedure is followed by the bidirectional Glenn and the Fontan procedures in later life, which offer to decrease stress in the ventricular chamber. The prognosis of children with this disease has greatly improved in the past decades; however, it is still largely driven by multiple modifiable and nonmodifiable variables. Novel and clever alternatives have been proposed to improve the survival and neurodevelopment of these patients, although they are not used as standard of care in all centers. The neurodevelopmental outcomes among these patients have received particular attention in the last decade in light to improve this very limiting associated comorbidity that compromises quality of life.
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Affiliation(s)
- Diego Ramonfaur
- From the Division of Postgraduate Medical Education, Harvard Medical School, Boston, MA
| | - Xiaoya Zhang
- From the Division of Postgraduate Medical Education, Harvard Medical School, Boston, MA
| | - Abraham P Garza
- Departamento de Medicina, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
| | - José Fernando García-Pons
- División de Ciencias de la Salud, Departamento de Medicina y Nutrición, Universidad de Guanajuato, Guanajuato, México
| | - Sylvia C Britton-Robles
- Departamento de Medicina, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, México
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Feldmann M, Borer J, Knirsch W, Daum MM, Wermelinger S, Latal B. Atypical gaze-following behaviour in infants with congenital heart disease. Early Hum Dev 2023; 181:105765. [PMID: 37079962 DOI: 10.1016/j.earlhumdev.2023.105765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Neurodevelopmental impairments are the most prevalent non-cardiac long-term sequelae in children with complex congenital heart disease (CHD). Deficits include the social-emotional and social-cognitive domains. Little is known about the predecessors of social-cognitive development in infants with CHD during the first year of life. Gaze-following behaviour can be used to measure early social-cognitive abilities. AIMS To assess gaze-following development in infants with CHD compared to healthy controls. STUDY DESIGN Prospective cohort study. PARTICIPANTS Twenty-three infants who underwent neonatal correction for CHD and 84 healthy controls. OUTCOME MEASURES Gaze-following behaviour was assessed by eye tracking at 6 and 12 months. Difference scores for first fixation, fixation frequency and fixation duration towards the gaze-cued object were calculated across 6 trials and compared between groups at both testing time points while adjusting for known confounders. Linear mixed models were calculated to assess the longitudinal trajectory of gaze-following development while accounting for the nested and dependent data structure. RESULTS At 6 months, no difference in gaze-following behaviour between CHD and healthy controls was found. At 12 months, fixation frequency towards the gaze-cued was lower and looking duration was shorter in CHD compared to controls (p = 0.0077; p = 0.0068). Infants with CHD showed less increase with age in the fixation frequency towards the congruent object (p = 0.041) compared to controls. CONCLUSION During the first year of life, gaze-following development diverges in infants with CHD compared to healthy controls. Further research is needed to investigate the clinical relevance of these findings and the association with later social-cognitive development.
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Affiliation(s)
- Maria Feldmann
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Jessica Borer
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland; Pediatric Heart Center, Department of Surgery, University Children's Hospital Zurich, Switzerland
| | - Moritz M Daum
- Department of Psychology, University of Zurich, Zurich, Switzerland; Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Stephanie Wermelinger
- Department of Psychology, University of Zurich, Zurich, Switzerland; Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Beatrice Latal
- Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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Spinazzi NA, Santoro JD, Pawlowski K, Anzueto G, Howe YJ, Patel LR, Baumer NT. Co-occurring conditions in children with Down syndrome and autism: a retrospective study. J Neurodev Disord 2023; 15:9. [PMID: 36864370 PMCID: PMC9979529 DOI: 10.1186/s11689-023-09478-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Down syndrome (DS) is one of the most common genetic causes of intellectual disability, and it is associated with an increased incidence of numerous co-occurring conditions. Autism spectrum disorder (ASD) is common in persons with DS, with rates reported as high as 39%. However, little is known regarding co-occurring conditions in children with both DS and ASD. METHODS A single-center retrospective review of prospective longitudinally collected clinical data was performed. Any patient with a confirmed diagnosis of DS evaluated at a large, specialized Down Syndrome Program in a tertiary pediatric medical center between March 2018 and March 2022 was included. A standardized survey which included demographic and clinical questions was administered during each clinical evaluation. RESULTS In total, 562 individuals with DS were included. The median age was 10 years (IQR: 6.18-13.92). Of this group, 72 (13%) had a co-occurring diagnosis of ASD (DS+ASD). Individuals with DS+ASD were more likely to be male (OR 2.23, CI 1.29-3.84) and had higher odds of a current or prior diagnosis of constipation (OR 2.19, CI 1.31-3.65), gastroesophageal reflux (OR 1.91, CI 1.14-3.21), behavioral feeding difficulties (OR 2.71, CI 1.02-7.19), infantile spasms (OR 6.03, CI 1.79-20.34) and scoliosis (OR 2.73, CI 1.16-6.40). There were lower odds of congenital heart disease in the DS+ASD group (OR 0.56, CI 0.34-0.93). There was no observed difference in prematurity or Neonatal Intensive Care Unit complications between groups. Individuals with DS+ASD had similar odds of having a history of congenital heart defect requiring surgery to those with DS only. Furthermore, there was no difference in rates of autoimmune thyroiditis or celiac disease. There was also no difference in rates of diagnosed co-occurring neurodevelopmental or mental health conditions in this cohort, including anxiety disorders and attention-deficit/hyperactivity disorder. CONCLUSIONS This study identifies a variety of medical conditions which are more frequent in children with DS+ASD than DS alone, providing important information for the clinical management of these patients. Future research should investigate the role of some of these medical conditions in the development of ASD phenotypes, and whether there may be distinct genetic and metabolic contributions towards these conditions.
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Affiliation(s)
- Noemi A Spinazzi
- UCSF Benioff Children's Hospital Oakland, Oakland, CA, 94609, USA.
| | - Jonathan D Santoro
- Division of Neuroimmunology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, 90027, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Katherine Pawlowski
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Gabriel Anzueto
- Division of Developmental and Behavioral Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, 60611, USA.,Feinberg School of Medicine, Northwestern University, Chicago, IL, 60611, USA
| | - Yamini J Howe
- Massachusetts General Hospital Lurie Center for Autism, Lexington, MA, 02421, USA.,Harvard Medical School, Boston, MA, 02115, USA
| | - Lina R Patel
- Department of Psychiatry, Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Nicole T Baumer
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, 02115, USA.,Department of Neurology, Boston Children's Hospital, Boston, MA, 02115, USA
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9
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Patt E, Singhania A, Roberts AE, Morton SU. The Genetics of Neurodevelopment in Congenital Heart Disease. Can J Cardiol 2023; 39:97-114. [PMID: 36183910 DOI: 10.1016/j.cjca.2022.09.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 02/07/2023] Open
Abstract
Congenital heart disease (CHD) is the most common birth anomaly, affecting almost 1% of infants. Neurodevelopmental delay is the most common extracardiac feature in people with CHD. Many factors may contribute to neurodevelopmental risk, including genetic factors, CHD physiology, and the prenatal/postnatal environment. Damaging variants are most highly enriched among individuals with extracardiac anomalies or neurodevelopmental delay in addition to CHD, indicating that genetic factors have an impact beyond cardiac tissues in people with CHD. Potential sources of genetic risk include large deletions or duplications that affect multiple genes, such as 22q11 deletion syndrome, single genes that alter both heart and brain development, such as CHD7, and common variants that affect neurodevelopmental resiliency, such as APOE. Increased use of genome-sequencing technologies in studies of neurodevelopmental outcomes in people with CHD will improve our ability to detect relevant genes and variants. Ultimately, such knowledge can lead to improved and more timely intervention of learning support for affected children.
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Affiliation(s)
- Eli Patt
- Harvard Medical School, Boston, Massachusetts, USA
| | - Asmita Singhania
- School of Medical Sciences, University of Manchester, Manchester, United Kingdom
| | - Amy E Roberts
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sarah U Morton
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
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Cornell E, Blanchard A, Chihuri S, DiGuiseppi CG, Li G. Poisoning-related emergency department visits in children with autism spectrum disorder. Inj Epidemiol 2022; 9:41. [PMID: 36544233 PMCID: PMC9768872 DOI: 10.1186/s40621-022-00402-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, and its prevalence has increased markedly in the past two decades. Research indicates that people with ASD are at increased risk for premature mortality from injuries. Often, children with ASD are prescribed multiple medications, increasing their risk for intentional and unintentional poisonings. We examined the epidemiologic patterns of emergency department (ED)-treated poisonings in children with ASD and the association of ED-treated poisonings with ASD according to common co-occurring conditions. METHODS We analyzed data from the Nationwide Emergency Department Sample for 2016-2018 to estimate the frequencies of ED-treated poisonings among autistic children aged 1-20 years and adjusted odds ratios of ED-treated poisoning associated with ASD in the presence or absence of co-occurring attention-deficit hyperactivity disorder (ADHD) or intellectual disability (ID). The ICD-10-CM external cause-of-injury matrix was utilized to identify poisoning cases. RESULTS During 2016-2018, there were an estimated 523,232 ED visits in children with ASD aged 1-20 years, including 12,152 (2.3%) visits for poisoning. Of ED-treated poisonings in children with ASD, 73.6% were related to pharmaceutical drugs, such as psychotropic medications and prescription opioids, 16.6% were intentional, 36.5% were unintentional, and 47.0% were undetermined. Among children with ASD, those aged 5-9 had the highest odds of poisoning-related ED visits compared to all other age-groups (adjusted OR = 3.41; 95% CI 3.15, 3.68). The odds of poisoning for children with ASD were 59.0% greater than for their peers (adjusted OR = 1.59; 95% CI 1.53, 1.66) and varied significantly with age and co-occurring ADHD or ID. CONCLUSIONS Children with ASD are at a significantly increased risk of poisoning, particularly among those aged 5-9 years. Co-occurring ADHD or ID with ASD further increases the risk of poisoning. Interventions to reduce poisoning in children with ASD should prioritize the safety of prescription medications.
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Affiliation(s)
- Emma Cornell
- grid.21729.3f0000000419368729Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032 USA
| | - Ashley Blanchard
- grid.21729.3f0000000419368729Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, CHN-1-116, New York, NY 10032 USA
| | - Stanford Chihuri
- grid.21729.3f0000000419368729Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA
| | - Carolyn G. DiGuiseppi
- grid.430503.10000 0001 0703 675XDepartment of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop B119, Bldg. 500, Rm. W3138, Aurora, CO 80045 USA
| | - Guohua Li
- grid.21729.3f0000000419368729Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th St, PH5-505, New York, NY 10032 USA
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 622 West 168th St, PH5-505, New York, NY 10032 USA
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11
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Kassa AM, Håkanson CA, Lilja HE. The risk of autism spectrum disorder and intellectual disability but not attention deficit/hyperactivity disorder is increased in individuals with esophageal atresia. Dis Esophagus 2022:doac097. [PMID: 36544426 DOI: 10.1093/dote/doac097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/23/2022] [Indexed: 06/17/2023]
Abstract
Knowledge of neurodevelopmental disorders such as attention deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability (ID) in patients with esophageal atresia (EA) is scarce. The aims of this study were to investigate the prevalence and risk of ADHD, ASD and ID in individuals with EA. Data were obtained from four longitudinal population-based registries in Sweden and analyzed using Cox proportional hazards regression. Patients with EA born in Sweden in 1973-2018 were included together with five controls for each individual with the exposure matched on sex, gestational age at birth, birth year and birth county. Individuals with chromosomal aberrations and syndromes were excluded. In total, 735 individuals with EA and 3675 controls were included. Median age at time of the study was 20 years (3-48). ASD was found in 24 (3.9%), ADHD in 34 (5.5%) and ID in 28 (4.6%) individuals with EA. Patients with EA had a 1.66 times higher risk of ASD (95% confidence interval [CI], 1.05-2.64) and a 3.62 times higher risk of ID (95% CI, 2.23-5.89) compared with controls. The risk of ADHD was not significantly increased. ADHD medication had been prescribed to 88.2% of patients with EA and ADHD and to 84.5% of controls with ADHD. Individuals with EA have a higher risk of ASD and ID than individuals without the exposure. These results are important when establishing follow-up programs for children with EA to allow timely detection and consequentially an earlier treatment and support especially before school start.
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Affiliation(s)
- Ann-Marie Kassa
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Knudsen LV, Sheldrick AJ, Vafaee MS, Michel TM. Diversifying autism neuroimaging research: An arterial spin labeling review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022:13623613221137230. [DOI: 10.1177/13623613221137230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cognition and brain homeostasis depends on cerebral blood flow to secure adequate oxygen and nutrient distribution to the brain tissue. Altered cerebral blood flow has previously been reported in individuals diagnosed with autism spectrum condition in comparison to non-autistics. This phenomenon might suggest cerebral blood flow as a potential biomarker for autism spectrum condition. Major technological advancement enables the non-invasive and quantitative measurement of cerebral blood flow via arterial spin labeling magnetic resonance imaging. However, most neuroimaging studies in autistic individuals exploit the indirect blood oxygen level dependent functional magnetic resonance imaging signal instead. Therefore, this review examines the use of arterial spin labeling to further investigate the neurobiology of the autism spectrum condition. Followed by a comparison of results from molecular imaging and arterial spin labeling studies and a discussion concerning the future direction and potential of arterial spin labeling in this context. We found that arterial spin labeling study results are consistent with those of molecular imaging, especially after considering the effect of age and sex. Arterial spin labeling has numerous application possibilities besides the quantification of cerebral blood flow, including assessment of functional connectivity and arterial transit time. Therefore, we encourage researchers to explore and consider the application of arterial spin labeling for future scientific studies in the quest to better understand the neurobiology of autism spectrum condition. Lay abstract Brain function and health depend on cerebral blood flow to secure the necessary delivery of oxygen and nutrients to the brain tissue. However, cerebral blood flow appears to be altered in autistic compared to non-autistic individuals, potentially suggesting this difference to be a cause and potential identification point of autism. Recent technological development enables precise and non-invasive measurement of cerebral blood flow via the magnetic resonance imaging method referred to as arterial spin labeling. However, most neuroimaging studies still prefer using the physiologically indirect measure derived from functional magnetic resonance imaging. Therefore, this review examines the use of arterial spin labeling to further investigate the neurobiology of autism. Furthermore, the review includes a comparison of results from molecular imaging and arterial spin labeling followed by a discussion concerning the future direction and potential of arterial spin labeling. We found that arterial spin labeling study results are consistent with those of molecular imaging, especially after considering the effect of age and sex. In addition, arterial spin labeling has numerous application possibilities besides the quantification of cerebral blood flow. Therefore, we encourage researchers to explore and consider the application of arterial spin labeling for future scientific studies in the quest to better understand the neurobiology of autism.
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Baribeau DA, Hoang N, Selvanayagam T, Stavropoulos DJ, Costain G, Scherer SW, Vorstman J. Developmental implications of genetic testing for physical indications. Eur J Hum Genet 2022; 30:1297-1300. [PMID: 36068265 PMCID: PMC9626575 DOI: 10.1038/s41431-022-01181-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 08/16/2022] [Indexed: 02/04/2023] Open
Abstract
In children undergoing genetic testing for physical health concerns, we examined how often the results also revealed information about their risk for neurodevelopmental disorders. The study sample consisted of 3056 genetic tests (1686 chromosomal microarrays--CMAs, and 1378 next-generation sequencing--NGS panels) ordered at a tertiary pediatric hospital because of a physical/congenital health problem. Tests ordered to investigate developmental concerns were excluded. Pathogenic, or likely pathogenic variants were manually reviewed for diagnostic likelihood, and for evidence of an association with a neurodevelopmental disorder (e.g., autism or intellectual disability). A total of 169 CMAs (10%) and 232 NGS panels (17%) had likely diagnostic results. More than half (52%) of all diagnostic results had established evidence of a neurodevelopmental disorder association. In summary, there is a high prevalence of neurodevelopmental implications from genetic tests ordered for physical/congenital indications. This broad clinical utility suggests a growing need for genetics-first developmental care pathways.
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Affiliation(s)
- Danielle A Baribeau
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, The University of Toronto, Toronto, ON, Canada
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Ny Hoang
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
| | - Thanuja Selvanayagam
- Department of Genetic Counselling, The Hospital for Sick Children, Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
| | - D James Stavropoulos
- Department of Laboratory Medicine & Pathobiology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Gregory Costain
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
- Division of Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen W Scherer
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada
- The Centre for Applied Genomics, SickKids Research Institute, Toronto, ON, Canada
| | - Jacob Vorstman
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada.
- Department of Psychiatry, The University of Toronto, Toronto, ON, Canada.
- Genetics and Genome Biology, SickKids Research Institute, Toronto, ON, Canada.
- Autism Research Unit, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Abstract
Youth with CHD are at greater risk for neurodevelopmental disorders compared to healthy controls. The aetiology is multi-factorial but includes medical and demographic factors. We sought to characterise the prevalence of neurodevelopmental disorders in patients with CHD. Our population included 206 patients with CHD, aged 3-21, who were referred for neuropsychological evaluation. Neurodevelopmental diagnoses were determined by a licensed psychologist. Rates of neurodevelopmental diagnoses were compared to national prevalence rates. Exploratory analyses (chi-square) examined which medical factors (i.e., cardiac diagnosis, genetic condition, prematurity, seizures, and stroke) were associated with neurodevelopmental diagnosis. There was higher prevalence of neurodevelopmental disorders in CHD when compared to the general population (44%). Rates of attention-deficit/hyperactivity disorder (27.3%), autism spectrum disorder (9.6%), and intellectual disability (5.9%) were notably higher than those seen in the general population (p < .01). Children with a history of aortic obstruction were more likely to be diagnosed with autism (p < .05), and children with genetic conditions were more likely to be diagnosed with an intellectual disability (p < .05). Neurodevelopmental diagnoses were not significantly associated with any other specific medical variables (e.g., cardiac diagnosis, seizures, stroke, prematurity, and antenatal diagnosis). School-aged children were more likely to be diagnosed with any neurodevelopmental disorder and attention-deficit/hyperactivity disorder (31.7%; p < .01) than preschool-age children. In summary, our results confirm that children and adolescents with CHD are at high risk for neurodevelopmental disorders and require ongoing monitoring, care, and support. Children with genetic disorders and those with aortic obstruction may be more at risk for certain neurodevelopmental disorders.
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15
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Grosse SD, Nichols P, Nyarko K, Maenner M, Danielson ML, Shea L. Heterogeneity in Autism Spectrum Disorder Case-Finding Algorithms in United States Health Administrative Database Analyses. J Autism Dev Disord 2022; 52:4150-4163. [PMID: 34581918 PMCID: PMC9077262 DOI: 10.1007/s10803-021-05269-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 12/19/2022]
Abstract
Strengthening systems of care to meet the needs of individuals with autism spectrum disorder (ASD) is of growing importance. Administrative data provide advantages for research and planning purposes, including large sample sizes and the ability to identify enrollment in insurance coverage and service utilization of individuals with ASD. Researchers have employed varying strategies to identify individuals with ASD in administrative data. Differences in these strategies can limit the comparability of results across studies. This review describes implications of the varying strategies that have been employed to identify individuals with ASD in US claims databases, with consideration of the strengths and limitations of each approach.
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Affiliation(s)
- Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA.
| | - Phyllis Nichols
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Kwame Nyarko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Matthew Maenner
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Melissa L Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mail Stop S106-4, Atlanta, GA, 30341, USA
| | - Lindsay Shea
- Policy and Analytics Center, A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA, USA
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Ziegler A, Chung WK. Recent advances in understanding neuro. Curr Opin Genet Dev 2022; 75:101938. [DOI: 10.1016/j.gde.2022.101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/18/2022] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
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Smith JA, Eikenberry SA, Scott KA, Baumer-Harrison C, de Lartigue G, de Kloet AD, Krause EG. Oxytocin and cardiometabolic interoception: Knowing oneself affects ingestive and social behaviors. Appetite 2022; 175:106054. [PMID: 35447163 DOI: 10.1016/j.appet.2022.106054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/22/2022] [Accepted: 04/14/2022] [Indexed: 01/22/2023]
Abstract
Maintaining homeostasis while navigating one's environment involves accurately assessing and interacting with external stimuli while remaining consciously in tune with internal signals such as hunger and thirst. Both atypical social interactions and unhealthy eating patterns emerge as a result of dysregulation in factors that mediate the prioritization and attention to salient stimuli. Oxytocin is an evolutionarily conserved peptide that regulates attention to exteroceptive and interoceptive stimuli in a social environment by functioning in the brain as a modulatory neuropeptide to control social behavior, but also in the periphery as a hormone acting at oxytocin receptors (Oxtr) expressed in the heart, gut, and peripheral ganglia. Specialized sensory afferent nerve endings of Oxtr-expressing nodose ganglia cells transmit cardiometabolic signals via the Vagus nerve to integrative regions in the brain that also express Oxtr(s). These brain regions are influenced by vagal sensory pathways and coordinate with external events such as those demanding attention to social stimuli, thus the sensations related to cardiometabolic function and social interactions are influenced by oxytocin signaling. This review investigates the literature supporting the idea that oxytocin mediates the interoception of cardiovascular and gastrointestinal systems, and that the modulation of this awareness likewise influences social cognition. These concepts are then considered in relation to Autism Spectrum Disorder, exploring how atypical social behavior is comorbid with cardiometabolic dysfunction.
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Affiliation(s)
- Justin A Smith
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Sophia A Eikenberry
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Karen A Scott
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Caitlin Baumer-Harrison
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Guillaume de Lartigue
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA
| | - Annette D de Kloet
- Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Department of Physiology and Functional Genomics, College of Medicine, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Eric G Krause
- Department of Pharmacodynamics, College of Pharmacy, University of Florida, Gainesville, FL, USA; Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida, Gainesville, FL, USA; Evelyn F. and William L. McKnight Brain Institute, University of Florida, Gainesville, FL, USA.
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Abstract
OBJECTIVE Children with CHD may be at increased risk for epilepsy. While the incidence of perioperative seizures after surgical repair of CHD has been well-described, the incidence of epilepsy is less well-defined. We aim to determine the incidence and predictors of epilepsy in patients with CHD. METHODS Retrospective cohort study of patients with CHD who underwent cardiopulmonary bypass at <2 years of age between January, 2012 and December, 2013 and had at least 2 years of follow-up. Clinical variables were extracted from a cardiac surgery database and hospital records. Seizures were defined as acute if they occurred within 7 days after an inciting event. Epilepsy was defined based on the International League Against Epilepsy criteria. RESULTS Two-hundred and twenty-one patients were identified, 157 of whom were included in our analysis. Five patients (3.2%) developed epilepsy. Acute seizures occurred in 12 (7.7%) patients, only one of whom developed epilepsy. Predictors of epilepsy included an earlier gestational age, a lower birth weight, a greater number of cardiac surgeries, a need for extracorporeal membrane oxygenation or a left ventricular assist device, arterial ischaemic stroke, and a longer hospital length of stay. CONCLUSIONS Epilepsy in children with CHD is rare. The mechanism of epileptogenesis in these patients may be the result of a complex interaction of patient-specific factors, some of which may be present even before surgery. Larger long-term follow-up studies are needed to identify risk factors associated with epilepsy in these patients.
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Assimopoulos S, Hammill C, Fernandes DJ, Spencer Noakes TL, Zhou YQ, Nutter LMJ, Ellegood J, Anagnostou E, Sled JG, Lerch JP. Genetic mouse models of autism spectrum disorder present subtle heterogenous cardiac abnormalities. Autism Res 2022; 15:1189-1208. [PMID: 35445787 PMCID: PMC9325472 DOI: 10.1002/aur.2728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 12/13/2022]
Abstract
Autism spectrum disorder (ASD) and congenital heart disease (CHD) are linked on a functional and genetic level. Most work has investigated CHD‐related neurodevelopmental abnormalities. Cardiac abnormalities in ASD have been less studied. We investigated the prevalence of cardiac comorbidities relative to ASD genetic contributors. Using high frequency ultrasound imaging, we screened 9 ASD‐related genetic mouse models (Arid1b(+/−), Chd8(+/−), 16p11.2 (deletion), Sgsh(+/−), Sgsh(−/−), Shank3 Δexon 4–9(+/−), Shank3 Δexon 4–9(−/−), Fmr1(−/−), Vps13b(+/−)), and pooled wild‐type littermates (WTs). We measured heart rate (HR), aorta diameter (AoD), thickness and thickening of the left‐ventricular (LV) anterior and posterior walls, LV chamber diameter, fractional shortening, stroke volume and cardiac output, mitral inflow Peak E and A velocity ratio, ascending aorta velocity time integral (VTI). Mutant groups presented small‐scale alterations in cardiac structure and function compared to WTs (LV anterior wall thickness and thickening, chamber diameter and fractional shortening, HR). A greater number of significant differences was observed among mutant groups than between mutant groups and WTs. Mutant groups differed primarily in structural measures (LV chamber diameter and anterior wall thickness, HR, AoD). The mutant groups with most differences to WTs were 16p11.2 (deletion), Fmr1(−/−), Arid1b(+/−). The mutant groups with most differences from other mutant groups were 16p11.2 (deletion), Sgsh(+/−), Fmr1(−/−). Our results recapitulate the associated clinical findings. The characteristic ASD heterogeneity was recapitulated in the cardiac phenotype. The type of abnormal measures (morphological, functional) can highlight common underlying mechanisms. Clinically, knowledge of cardiac abnormalities in ASD can be essential as even non‐lethal abnormalities impact normal development.
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Affiliation(s)
- Stephania Assimopoulos
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Sickkids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Hammill
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Sickkids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Darren J Fernandes
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Sickkids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tara Leigh Spencer Noakes
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Sickkids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yu-Qing Zhou
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauryl M J Nutter
- Sickkids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,The Centre for Phenogenomics, Toronto, Ontario, Canada
| | - Jacob Ellegood
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Sickkids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Evdokia Anagnostou
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - John G Sled
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Sickkids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Jason P Lerch
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada.,Sickkids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Wellcome Centre for Integrative Neuroimaging, The University of Oxford, Oxford, UK
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20
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Regev O, Hadar A, Meiri G, Flusser H, Michaelovski A, Dinstein I, Hershkovitz R, Menashe I. OUP accepted manuscript. Brain 2022; 145:4519-4530. [PMID: 35037687 PMCID: PMC9762947 DOI: 10.1093/brain/awac008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/30/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Multiple pieces of evidence support the prenatal predisposition of autism spectrum disorder (ASD). Nevertheless, robust data about abnormalities in foetuses later developing into children diagnosed with ASD are lacking. Prenatal ultrasound is an excellent tool to study abnormal foetal development as it is frequently used to monitor foetal growth and identify foetal anomalies throughout pregnancy. We conducted a retrospective case-sibling-control study of children diagnosed with ASD (cases); their own typically developing, closest-in-age siblings (TDS); and typically developing children from the general population (TDP), matched by year of birth, sex and ethnicity to investigate the association between ultrasonography foetal anomalies and ASD. The case group was drawn from all children diagnosed with ASD enrolled at the National Autism Research Center of Israel. Foetal ultrasound data from the foetal anatomy survey were obtained from prenatal ultrasound clinics of Clalit Health Services in southern Israel. The study comprised 659 children: 229 ASD, 201 TDS and 229 TDP. Ultrasonography foetal anomalies were found in 29.3% of ASD cases versus only 15.9% and 9.6% in the TDS and TDP groups [adjusted odds ratio (aOR) = 2.23, 95% confidence interval (CI) = 1.32-3.78, and aOR = 3.50, 95%CI = 2.07-5.91, respectively]. Multiple co-occurring ultrasonography foetal anomalies were significantly more prevalent among ASD cases. Ultrasonography foetal anomalies in the urinary system, heart, and head and brain were the most significantly associated with ASD diagnosis (aORUrinary = 2.08, 95%CI = 0.96-4.50 and aORUrinary = 2.90, 95%CI = 1.41-5.95; aORHeart = 3.72, 95%CI = 1.50-9.24 and aORHeart = 8.67, 95%CI = 2.62-28.63; and aORHead&Brain = 1.96, 95%CI = 0.72-5.30 and aORHead&Brain = 4.67, 95%CI = 1.34-16.24; versus TDS and TDP, respectively). ASD females had significantly more ultrasonography foetal anomalies than ASD males (43.1% versus 25.3%, P = 0.013) and a higher prevalence of multiple co-occurring ultrasonography foetal anomalies (15.7% versus 4.5%, P = 0.011). No sex differences were seen among TDS and TDP controls. ASD foetuses were characterized by a narrower head and a relatively wider ocular-distance versus TDP foetuses (ORBPD = 0.81, 95%CI = 0.70-0.94, and aOROcular distance = 1.29, 95%CI = 1.06-1.57). Ultrasonography foetal anomalies were associated with more severe ASD symptoms. Our findings shed important light on the multiorgan foetal anomalies associated with ASD.
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Affiliation(s)
- Ohad Regev
- Joyce and Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Amnon Hadar
- Clalit Health Services, Beer Sheva, Israel
- Division of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Gal Meiri
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer Sheva, Israel
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hagit Flusser
- Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Analya Michaelovski
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Ilan Dinstein
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Psychology and Brain and Cognition Departments, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Reli Hershkovitz
- Division of Obstetrics and Gynecology, Soroka University Medical Center, Beer Sheva, Israel
| | - Idan Menashe
- Correspondence to: Idan Menashe, PhD Department of Public Health, Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva 8410501, Israel E-mail:
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Autism risk in neonatal intensive care unit patients associated with novel heart rate patterns. Pediatr Res 2021; 90:1186-1192. [PMID: 33603208 PMCID: PMC8371053 DOI: 10.1038/s41390-021-01381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neonatal intensive care unit (NICU) patients are at increased risk for autism spectrum disorder (ASD). Autonomic nervous system aberrancy has been described in children with ASD, and we aimed to identify heart rate (HR) patterns in NICU patients associated with eventual ASD diagnosis. METHODS This retrospective cohort study included NICU patients from 2009 to 2016 with archived HR data and follow-up beyond age 3 years. Medical records provided clinical variables and ASD diagnosis. HR data were compared in infants with and without ASD. RESULTS Of the 2371 patients, 88 had ASD, and 689,016 h of data were analyzed. HR skewness (HRskw) was significantly different between ASD and control infants. Preterm infants at early postmenstrual ages (PMAs) had negative HRskw reflecting decelerations, which increased with maturation. From 34 to 42 weeks PMA, positive HRskw toward accelerations was higher in males with ASD. In 931 males with at least 4 days of HR data, overall ASD prevalence was 5%, whereas 11% in the top 5th HRskw percentile had ASD. CONCLUSION High HRskw in NICU males, perhaps representing autonomic imbalance, was associated with increased ASD risk. Further study is needed to determine whether HR analysis identifies highest-risk infants who might benefit from earlier screening and therapies. IMPACT In a large retrospective single-center cohort of NICU patients, we found that high positive skewness of heart rate toward more accelerations was significantly associated with increased risk of eventual autism spectrum disorder diagnosis in male infants but not in females. Existing literature describes differences in heart rate characteristics in children, adolescents, and adults with autism spectrum disorders, but the finding from our study in NICU infants is novel. Heart rate analysis during the NICU stay might identify, among an inherently high-risk population, those infants with especially high risk of ASD who might benefit from earlier screening and therapies.
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22
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Wester T, Gunnarsdottir A, Skoglund C, Svenningsson A. Attention deficit hyperactivity and autism spectrum disorders in patients with anorectal malformations. Acta Paediatr 2021; 110:3131-3136. [PMID: 34498328 DOI: 10.1111/apa.16100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
AIM To assess the risk of neurodevelopmental disorders in patients with anorectal malformations compared to controls. METHODS This was a population-based cohort study including all patients born in Sweden 1997-2012 with anorectal malformation in the Swedish National Patient Register and five matched controls per patient. Anorectal malformation was the exposure. All individuals were evaluated for the outcomes, attention deficit hyperactivity disorder or autism spectrum disorder in the National Patient Register. Data on drugs for attention deficit hyperactivity disorder were retrieved from the Swedish Prescribed Drug Register and used as proxy for attention deficit hyperactivity disorder. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). Analyses were adjusted for confounders. RESULTS Five hundred and fifteen patients with anorectal malformations and 2560 controls were included. Patients with anorectal malformation had a higher risk of attention deficit hyperactivity disorder (OR 3.01 (95% CI, 1.83-4.95)) and autism spectrum disorders (OR 3.07 (95% CI, 1.62-5.79)) compared to the controls. Significantly more patients with anorectal malformation had been prescribed medication for attention deficit hyperactivity disorder compared to controls (OR 2.26 (95% CI 1.33-3.85)). CONCLUSION Patients with anorectal malformations have a higher risk of attention deficit hyperactivity disorder and autism spectrum disorders than controls.
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Affiliation(s)
- Tomas Wester
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | - Anna Gunnarsdottir
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | | | - Anna Svenningsson
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
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23
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Haffner DN, Bartram LR, Coury DL, Rice CE, Steingass KJ, Moore-Clingenpeel M, Maitre NL. The Autism Detection in Early Childhood Tool: Level 2 autism spectrum disorder screening in a NICU Follow-up program. Infant Behav Dev 2021; 65:101650. [PMID: 34653736 DOI: 10.1016/j.infbeh.2021.101650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Children born preterm are at increased risk for autism spectrum disorder (ASD). However, early diagnosis of ASD is challenging because conventional screening Level 1 tools are less reliable in this population. We sought to determine whether the Autism Detection in Early Childhood (ADEC) and Child Behavior Checklist (CBCL) could accurately identify children at risk for ASD in a NICU Follow-up setting and thus facilitate referral for formal ASD evaluation. METHOD Children aged 18-36 months were recruited from a NICU Follow-up program. All children received presumptive diagnoses based on DSM-5 criteria and were screened for ASD risk with the ADEC and CBCL. Children scoring in the "at risk" range on either tool were referred for a full diagnostic ASD evaluation. RESULTS Sixty-nine patients (median birth weight 1140 g; median gestational age 28 weeks) were included with 18 designated "at risk" for ASD. Nine (13 %) scored "at risk" on the ADEC and 12 (17 %) on the CBCL. Thirteen children underwent diagnostic ASD evaluation with 9 receiving a formal diagnosis of ASD. The ADEC demonstrated the best performance (sensitivity 89 %, specificity 98 %). The CBCL was less sensitive (sensitivity 50 %, specificity 90 %). Requiring elevated scores on both the CBCL and ADEC was specific but not sensitive (sensitivity 33 %, specificity 100 %). CONCLUSION The ADEC performed well in identifying children at risk for ASD within this high-risk NICU cohort, adding benefit as an autism-specific screening tool over the CBCL alone.
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Affiliation(s)
- Darrah N Haffner
- Department of Pediatrics, Division of Pediatric Neurology, Nationwide Children's Hospital, Columbus, OH, USA; Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Lindsay R Bartram
- Department of Pediatrics, Division of Developmental Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Daniel L Coury
- Department of Pediatrics, Division of Developmental Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Courtney E Rice
- Department of Psychiatry and Behavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Katherine J Steingass
- Department of Pediatrics, Division of Developmental Behavioral Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, USA
| | - Nathalie L Maitre
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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24
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Novel treatments for autism spectrum disorder based on genomics and systems biology. Pharmacol Ther 2021; 230:107939. [PMID: 34174273 DOI: 10.1016/j.pharmthera.2021.107939] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a highly heterogeneous neurodevelopmental disorder with a complex underlying genetic architecture. There are currently no known pharmacologic treatments for the core ASD symptoms of social deficits and restricted/ repetitive behavior. However, there are dozens of clinical trials currently underway that are testing the impact of novel and existing agents on core and associated symptoms in ASD. METHODS We present a narrative synthesis of the historical and contemporary challenges to drug discovery in ASD. We then provide an overview of novel treatments currently under investigation from a genomics and systems biology perspective. RESULTS Data driven network and cluster analyses suggest alterations in transcriptional regulation, chromatin remodelling, synaptic transmission, neuropeptide signalling, and/or immunological mechanisms may contribute to or underlie the development of ASD. Agents and upcoming trials targeting each of the above listed systems are reviewed. CONCLUSION Identifying effective pharmacologic treatments for the core and associated symptom domains in ASD will require further collaboration and innovation in the areas of outcome measurement, biomarker research, and genomics, as well as systematic efforts to identify and treat subgroups of individuals with ASD who may be differentially responsive to specific treatments.
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25
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Abstract
Congenital heart disease is the most frequent birth defect and the leading cause of death for the fetus and in the first year of life. The wide phenotypic diversity of congenital heart defects requires expert diagnosis and sophisticated repair surgery. Although these defects have been described since the seventeenth century, it was only in 2005 that a consensus international nomenclature was adopted, followed by an international classification in 2017 to help provide better management of patients. Advances in genetic engineering, imaging, and omics analyses have uncovered mechanisms of heart formation and malformation in animal models, but approximately 80% of congenital heart defects have an unknown genetic origin. Here, we summarize current knowledge of congenital structural heart defects, intertwining clinical and fundamental research perspectives, with the aim to foster interdisciplinary collaborations at the cutting edge of each field. We also discuss remaining challenges in better understanding congenital heart defects and providing benefits to patients.
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Affiliation(s)
- Lucile Houyel
- Unité de Cardiologie Pédiatrique et Congénitale and Centre de Référence des Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 75015 Paris, France.,Université de Paris, 75015 Paris, France
| | - Sigolène M Meilhac
- Université de Paris, 75015 Paris, France.,Imagine-Institut Pasteur Unit of Heart Morphogenesis, INSERM UMR 1163, 75015 Paris, France;
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26
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Cheung MYQ, Roberts C, Scambler P, Stathopoulou A. Setd5 is required in cardiopharyngeal mesoderm for heart development and its haploinsufficiency is associated with outflow tract defects in mouse. Genesis 2021; 59:e23421. [PMID: 34050709 PMCID: PMC8564859 DOI: 10.1002/dvg.23421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/21/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022]
Abstract
Congenital heart defects are a feature of several genetic haploinsufficiency syndromes, often involving transcriptional regulators. One property of haploinsufficient genes is their propensity for network interactions at the gene or protein level. In this article we took advantage of an online dataset of high throughput screening of mutations that are embryonic lethal in mice. Our aim was to identify new genes where the loss of function caused cardiovascular phenotypes resembling the 22q11.2 deletion syndrome models, that is, heterozygous and homozygous loss of Tbx1. One gene with a potentially haploinsufficient phenotype was identified, Setd5, thought to be involved in chromatin modification. We found murine Setd5 haploinsufficiency to be associated with double outlet right ventricle and perimembranous ventricular septal defect, although no genetic interaction with Tbx1 was detected. Conditional mutagenesis revealed that Setd5 was required in cardiopharyngeal mesoderm for progression of the heart tube through the ballooning stage to create a four-chambered heart.
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Affiliation(s)
- Michelle Yu-Qing Cheung
- Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Catherine Roberts
- Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom.,Institute of Medical and Biomedical Education, St. George's, University of London, Cranmer Terrace, London, SW17 0RE, United Kingdom
| | - Peter Scambler
- Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
| | - Athanasia Stathopoulou
- Developmental Biology and Cancer, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom
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27
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McDonald NM, Jeste SS. Beyond Baby Siblings-Expanding the Definition of "High-Risk Infants" in Autism Research. Curr Psychiatry Rep 2021; 23:34. [PMID: 33860866 PMCID: PMC8765326 DOI: 10.1007/s11920-021-01243-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Much of our understanding of early development in children with autism spectrum disorder (ASD) comes from studies of children with a family history of autism. We reviewed the current literature on neurodevelopmental profiles and autism prevalence from other high-risk infant groups to expose gaps and inform next steps. We focused on infants with early medical risk (e.g., preterm birth) and genetic risk (tuberous sclerosis complex [TSC]). RECENT FINDINGS About 7% of very preterm infants are later diagnosed with ASD. Prospective studies of early development outside of familial-risk infants are rare; however, recent work within preterm and TSC infants suggests interesting similarities and differences from infants with a family history of ASD. It is essential that we extend our knowledge of early markers of ASD beyond familial-risk infants to expand our knowledge of autism as it emerges in order to develop better, more individualized early interventions.
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Affiliation(s)
- Nicole M McDonald
- UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Shafali S Jeste
- UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
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28
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Goldstein SA, Goldstein LB. Neurologic complications of congenital heart disease in adults. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:15-22. [PMID: 33632433 DOI: 10.1016/b978-0-12-819814-8.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Congenital heart disease (CHD) is a heterogeneous group of structural abnormalities of the cardiovascular system that are present at birth. Advances in childhood medical and surgical treatment have led to increasing numbers of adults with CHD. Neurological complications of CHD in adults are varied and can include an increased risk of stroke not only related to the underlying congenital defect and its surgical management but also due to atherosclerotic disease associated with advancing age. In addition to cerebrovascular events, CHD in adults is also associated with an increased risk of neurodevelopmental disorders, cognitive impairment, psychiatric disease, and epilepsy. Collaborative multidisciplinary care with contributions from neurologists and cardiologists with expertise in adult CHD is necessary to provide optimal long-term care for this complex and rapidly evolving population.
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Affiliation(s)
- Sarah A Goldstein
- Department of Medicine, Division of Cardiology, Duke University, Durham, NC, United States
| | - Larry B Goldstein
- Department of Neurology, Kentucky Neuroscience Institute, University of Kentucky, Lexington, KY, United States.
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29
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Abstract
Neurodevelopmental impairments have been recognised as a major association of paediatric kidney disease and bladder dysfunction, presenting challenges to clinicians and families to provide reasonable adjustments in order to allow access to investigations and treatments. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterised by impairments in social interaction/communication and repetitive sensory-motor behaviours. Mental health, learning and physical co-morbidities are common. There is emerging evidence that ASD and kidney disease have some overlaps with genetic copy number variants and environmental factors contributing to shared pathogenesis. Prevalence rates of ASD in kidney disease are currently not known. A high index of suspicion of underlying ASD is required when a young person presents with communication difficulties, anxiety or behaviour that challenges, which should then trigger referral for a neurodevelopmental and behavioural assessment. We discuss practical approaches for providing care, which include understanding methods of communication and sensory, behavioural and environmental adaptations.
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30
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Neurological Disorders and Risk of Arrhythmia. Int J Mol Sci 2020; 22:ijms22010188. [PMID: 33375447 PMCID: PMC7795827 DOI: 10.3390/ijms22010188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/19/2020] [Accepted: 12/24/2020] [Indexed: 01/08/2023] Open
Abstract
Neurological disorders including depression, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, autism and epilepsy are associated with an increased incidence of cardiovascular disorders and susceptibility to heart failure. The underlying molecular mechanisms that link neurological disorders and adverse cardiac function are poorly understood. Further, a lack of progress is likely due to a paucity of studies that investigate the relationship between neurological disorders and cardiac electrical activity in health and disease. Therefore, there is an important need to understand the spatiotemporal behavior of neurocardiac mechanisms. This can be advanced through the identification and validation of neurological and cardiac signaling pathways that may be adversely regulated. In this review we highlight how dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis, autonomic nervous system (ANS) activity and inflammation, predispose to psychiatric disorders and cardiac dysfunction. Moreover, antipsychotic and antidepressant medications increase the risk for adverse cardiac events, mostly through the block of the human ether-a-go-go-related gene (hERG), which plays a critical role in cardiac repolarization. Therefore, understanding how neurological disorders lead to adverse cardiac ion channel remodeling is likely to have significant implications for the development of effective therapeutic interventions and helps improve the rational development of targeted therapeutics with significant clinical implications.
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31
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Emberti Gialloreti L, Enea R, Di Micco V, Di Giovanni D, Curatolo P. Clustering Analysis Supports the Detection of Biological Processes Related to Autism Spectrum Disorder. Genes (Basel) 2020; 11:genes11121476. [PMID: 33316975 PMCID: PMC7763205 DOI: 10.3390/genes11121476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 12/27/2022] Open
Abstract
Genome sequencing has identified a large number of putative autism spectrum disorder (ASD) risk genes, revealing possible disrupted biological pathways; however, the genetic and environmental underpinnings of ASD remain mostly unanswered. The presented methodology aimed to identify genetically related clusters of ASD individuals. By using the VariCarta dataset, which contains data retrieved from 13,069 people with ASD, we compared patients pairwise to build “patient similarity matrices”. Hierarchical-agglomerative-clustering and heatmapping were performed, followed by enrichment analysis (EA). We analyzed whole-genome sequencing retrieved from 2062 individuals, and isolated 11,609 genetic variants shared by at least two people. The analysis yielded three clusters, composed, respectively, by 574 (27.8%), 507 (24.6%), and 650 (31.5%) individuals. Overall, 4187 variants (36.1%) were common to the three clusters. The EA revealed that the biological processes related to the shared genetic variants were mainly involved in neuron projection guidance and morphogenesis, cell junctions, synapse assembly, and in observational, imitative, and vocal learning. The study highlighted genetic networks, which were more frequent in a sample of people with ASD, compared to the overall population. We suggest that itemizing not only single variants, but also gene networks, might support ASD etiopathology research. Future work on larger databases will have to ascertain the reproducibility of this methodology.
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Affiliation(s)
- Leonardo Emberti Gialloreti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
- Correspondence:
| | - Roberto Enea
- IMME Research Centre, Via Giotto 43, 81100 Caserta, Italy;
| | - Valentina Di Micco
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (V.D.M.); (P.C.)
| | - Daniele Di Giovanni
- Department of Industrial Engineering, University of Rome Tor Vergata, Via del Politecnico 1, 00133 Rome, Italy;
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; (V.D.M.); (P.C.)
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32
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Verrall CE, Yang JYM, Chen J, Schembri A, d'Udekem Y, Zannino D, Kasparian NA, du Plessis K, Grieve SM, Welton T, Barton B, Gentles TL, Celermajer DS, Attard C, Rice K, Ayer J, Mandelstam S, Winlaw DS, Mackay MT, Cordina R. Neurocognitive Dysfunction and Smaller Brain Volumes in Adolescents and Adults With a Fontan Circulation. Circulation 2020; 143:878-891. [PMID: 33231097 DOI: 10.1161/circulationaha.120.048202] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurocognitive outcomes beyond childhood in people with a Fontan circulation are not well defined. This study aimed to investigate neurocognitive functioning in adolescents and adults with a Fontan circulation and associations with structural brain injury, brain volumetry, and postnatal clinical factors. METHODS In a binational study, participants with a Fontan circulation without a preexisting major neurological disability were prospectively recruited from the Australia and New Zealand Fontan Registry. Neurocognitive function was assessed by using Cogstate software in 107 participants with a Fontan circulation and compared with control groups with transposition of the great arteries (n=50) and a normal circulation (n=41). Brain MRI with volumetric analysis was performed in the participants with a Fontan circulation and compared with healthy control data from the ABIDE I and II (Autism Brain Imaging Data Exchange) and PING (Pediatric Imaging, Neurocognition, and Genetics) data repositories. Clinical data were retrospectively collected. RESULTS Of the participants with a Fontan circulation who had a neurocognitive assessment, 55% were male and the mean age was 22.6 years (SD 7.8). Participants with a Fontan circulation performed worse in several areas of neurocognitive function compared with those with transposition of the great arteries and healthy controls (P<0.05). Clinical factors associated with worse neurocognitive outcomes included more inpatient days during childhood, younger age at Fontan surgery, and longer time since Fontan procedure (P<0.05). Adults with a Fontan circulation had more marked neurocognitive dysfunction than adolescents with a Fontan circulation in 2 domains (psychomotor function, P=0.01 and working memory, P=0.02). Structural brain injury was present in the entire Fontan cohort; the presence of white matter injury was associated with worse paired associate learning (P<0.001), but neither the presence nor severity of infarct, subcortical gray matter injury, and microhemorrhage was associated with neurocognitive outcomes. Compared with healthy controls, people with a Fontan circulation had smaller global brain volumes (P<0.001 in all regions) and smaller regional brain volumes in most cerebral cortical regions (P<0.05). Smaller global brain volumes were associated with worse neurocognitive functioning in several domains (P<0.05). A significant positive association was also identified between global brain volumes and resting oxygen saturations (P≤0.04). CONCLUSIONS Neurocognitive impairment is common in adolescents and adults with a Fontan circulation and is associated with smaller gray and white matter brain volume. Understanding modifiable factors that contribute to brain injury to optimize neurocognitive function is paramount.
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Affiliation(s)
- Charlotte E Verrall
- Heart Centre for Children (C.E.V., J.A., D.S.W.), The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health (C.E.V., D.S.C., J.A., D.S.W., R.C.), University of Sydney, New South Wales, Australia
| | - Joseph Y M Yang
- Neuroscience Advanced Clinical Imaging Suite (NACIS), Department of Neurosurgery (J.Y.M.Y.), The Royal Children's Hospital, Melbourne, Victoria, Australia.,Developmental Imaging (J.Y.M.Y., J.C.), Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jian Chen
- Developmental Imaging (J.Y.M.Y., J.C.), Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | | | | | | | | | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Charles Perkins Centre, Faculty of Medicine and Health (S.M.G., T.W.), University of Sydney, New South Wales, Australia
| | - Thomas Welton
- Sydney Translational Imaging Laboratory, Charles Perkins Centre, Faculty of Medicine and Health (S.M.G., T.W.), University of Sydney, New South Wales, Australia
| | - Belinda Barton
- Children's Hospital Education Research Institute and Kids Neuroscience Centre (B.B.), The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | | | - David S Celermajer
- Sydney Medical School, Faculty of Medicine and Health (C.E.V., D.S.C., J.A., D.S.W., R.C.), University of Sydney, New South Wales, Australia
| | | | | | - Julian Ayer
- Heart Centre for Children (C.E.V., J.A., D.S.W.), The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health (C.E.V., D.S.C., J.A., D.S.W., R.C.), University of Sydney, New South Wales, Australia
| | - Simone Mandelstam
- Department of Cardiac Surgery (Y.d'U.), Medical Imaging (S.M.), The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David S Winlaw
- Heart Centre for Children (C.E.V., J.A., D.S.W.), The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health (C.E.V., D.S.C., J.A., D.S.W., R.C.), University of Sydney, New South Wales, Australia
| | - Mark T Mackay
- Department of Neurology (M.T.M.), The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rachael Cordina
- Sydney Medical School, Faculty of Medicine and Health (C.E.V., D.S.C., J.A., D.S.W., R.C.), University of Sydney, New South Wales, Australia
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33
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Vascular contributions to 16p11.2 deletion autism syndrome modeled in mice. Nat Neurosci 2020; 23:1090-1101. [PMID: 32661394 DOI: 10.1038/s41593-020-0663-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 06/01/2020] [Indexed: 02/08/2023]
Abstract
While the neuronal underpinnings of autism spectrum disorder (ASD) are being unraveled, vascular contributions to ASD remain elusive. Here, we investigated postnatal cerebrovascular development in the 16p11.2df/+ mouse model of 16p11.2 deletion ASD syndrome. We discover that 16p11.2 hemizygosity leads to male-specific, endothelium-dependent structural and functional neurovascular abnormalities. In 16p11.2df/+ mice, endothelial dysfunction results in impaired cerebral angiogenesis at postnatal day 14, and in altered neurovascular coupling and cerebrovascular reactivity at postnatal day 50. Moreover, we show that there is defective angiogenesis in primary 16p11.2df/+ mouse brain endothelial cells and in induced-pluripotent-stem-cell-derived endothelial cells from human carriers of the 16p11.2 deletion. Finally, we find that mice with an endothelium-specific 16p11.2 deletion (16p11.2ΔEC) partially recapitulate some of the behavioral changes seen in 16p11.2 syndrome, specifically hyperactivity and impaired motor learning. By showing that developmental 16p11.2 haploinsufficiency from endothelial cells results in neurovascular and behavioral changes in adults, our results point to a potential role for endothelial impairment in ASD.
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34
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Safa A, Noroozi R, Taheri M, Ghafouri-Fard S. Association Analysis of ANRIL Polymorphisms and Haplotypes with Autism Spectrum Disorders. J Mol Neurosci 2020; 71:187-192. [PMID: 32623644 DOI: 10.1007/s12031-020-01657-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
Abstract
Autism spectrum disorder (ASD) has been shown to have a complex inheritance. Several single-nucleotide polymorphisms (SNPs) have been shown to be associated with risk of this neurodevelopmental disorder. In the current study, we genotyped four SNPs in a genomic hotspot for human disorders. The selected SNPs were located in adjacency of the antisense noncoding RNA in the INK4 locus (ANRIL) and have been shown to be associated with a number of human disorders. Genotyping was performed in 420 ASD cases and 420 normally developed children. After correction of P values for multiple comparisons, there was no significant difference in frequencies of rs1333045, rs1333048, rs4977574, and rs10757278 alleles, genotypes, or haplotypes between ASD children and children with normal development. However, one estimated haplotype (T A A A haplotype corresponding to rs1333045, rs1333048, rs4977574, and rs10757278 SNPs, respectively) tended to be more prevalent among cases compared with controls (OR (95% CI) = 1.77 (1.19-2.64), adjusted P value = 0.07). Besides, the T A G G tended to be less common among ASD cases compared with controls (OR (95% CI) = 0.64 (0.47-0.87), adjusted P value = 0.07). Although we could not detect significant difference in alleles, genotypes, or haplotypes frequencies between cases and controls, the trend toward association between two haplotypes and ASD risk implies that there might be a putative causative variant in the mentioned haplotypes whose association with ASD could be determined in larger cohorts of patients.
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Affiliation(s)
- Amin Safa
- Institute of Research and Development, Duy Tan University, Da Nang, 550000, Vietnam
- Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University, Madrid, Spain
| | - Rezvan Noroozi
- Malopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland
| | - Mohammad Taheri
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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