Peripheral Inflammatory Markers in Autism Spectrum Disorder and Attention Deficit/Hyperactivity Disorder at Adolescent Age

Severe manifestation of plasma cell mucositis in a patient with autism spectrum disorder: A unique overlap illustrating challenges with diagnosis and management

Plasma cell mucositis (PCM) is a rare inflammatory condition affecting the oral tissues, often triggered by allergens or inflammation. Autism spectrum disorder (ASD), a neurodevelopmental condition, poses unique challenges in oral care and hygiene due to behavioral and sensory issues. These conditions have not previously been reported in concert but may share risk factors including through the development of inflammation. We present a case of severe PCM in a 23-year-old male with ASD, illustrating diagnostic complexities and management strategies. The patient presented with widespread and severe lesions, raising the possibility of underlying causes. After multiple interventions, including topical steroids and trigger avoidance, the patient achieved near-complete resolution of the oral lesions. Immunohistochemical and serological investigations suggested an underlying monoclonal gammopathy, warranting hematological evaluation. Our case shows how PCM and ASD can affect each other, highlighting the importance of understanding how these conditions interact, and the need for tailored approaches to oral health in this population. Further research is needed to elucidate any pathophysiological or risk-based link between ASD and inflammatory oral conditions and to refine management strategies for PCM in patients with neurodevelopmental disorders.

Seven psychiatric traits and the risk of increased carotid intima-media thickness: a Mendelian randomization study

Background

Numerous observational studies have suggested an association between psychiatric traits and carotid intima-media thickness (cIMT). However, whether these associations have a causal relationship remains unknown, largely due to issues of reverse causality and potential confounders. This study aims to elucidate the potential causal role of psychiatric traits in the risk of arterial injury as measured by cIMT.

Methods

We utilized instrumental variables for attention deficit/hyperactivity disorder (ADHD, n = 226,534), bipolar disorder (n = 353,899), major depressive disorder (n = 142,646), post-traumatic stress disorder (n = 174,494), obsessive-compulsive disorder (n = 9,725), autism spectrum disorder (n = 173,773), and anxiety disease (n = 17,310), derived from the largest corresponding genome-wide association studies (GWAS). Summary statistics for cIMT associations were obtained from a meta-analysis combining GWAS data from the Cohorts for Heart and Aging Research in Genomic Epidemiology consortia (n = 71,128) and the UK Biobank study (n = 45,185). The inverse-variance weighted method served as the primary analytical tool, supplemented by additional statistical methods in the secondary analyses to corroborate the findings. Adjustments were made according to the Bonferroni correction threshold.

Results

The Mendelian randomization analyses indicated a suggestive causal link between genetically predicted ADHD and cIMT (beta = 0.05; 95% confidence interval, 0.01-0.09; p = 0.018). Sensitivity analyses largely concurred with this finding. However, no significant associations were found between other psychiatric traits and cIMT.

Conclusions

This study provides insights into the risk effect of ADHD on cIMT, suggesting that arteriopathy and potential associated complications should be considered during the treatment and monitoring of patients with ADHD.

Childhood neurodivergent traits, inflammation and chronic disabling fatigue in adolescence: a longitudinal case-control study

OBJECTIVES

To test whether inflammatory processes link the expression of childhood neurodivergent traits to chronic disabling fatigue in adolescence.

DESIGN

Longitudinal case-control study.

SETTING

We analysed data from The Avon Longitudinal Study of Parents and Children (ALSPAC).

PARTICIPANTS

8115 and 8036 children of the ALSPAC cohort at ages 7 and 9 years, respectively, 4563 of whom also completed self-report measures at age 18 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed if children scoring above screening threshold for autism/attention deficit hyperactivity disorder (ADHD) at ages 7 and 9 years had increased risk of chronic disabling fatigue at age 18 years, computing ORs and CIs for effects using binary logistic regression. Mediation analyses were conducted to test if an inflammatory marker (interleukin 6 (IL-6)) at age 9 years linked neurodivergent traits to chronic disabling fatigue at age 18 years.

RESULTS

Children with neurodivergent traits at ages 7 and 9 years were two times as likely to experience chronic disabling fatigue at age 18 years (likely ADHD OR=2.18 (95% CI=1.33 to 3.56); p=0.002; likely autism OR=1.78 (95% CI=1.17 to 2.72); p=0.004). Levels of IL-6 at age 9 were associated with chronic disabling fatigue at age 18 (OR=1.54 (95% CI=1.13 to 2.11); p=0.006). Inflammation at age 9 years mediated effects of neurodivergent traits on chronic disabling fatigue (indirect effect via IL-6: ADHD b=1.08 (95% CI=1.01 to 1.15); autism b=1.06; (95% CI=1.03 to 1.10)). All effects remained significant when controlling for the presence of depressive symptoms.

CONCLUSIONS

Our results indicate higher risk of chronic disabling fatigue for children with neurodivergent traits, likely linked to higher levels of inflammation. The implementation of transdiagnostic screening criteria to inform support strategies to counteract risk early in life is recommended.

Inflammatory Hematological Ratios in Adolescents with Mental Disorders: A Scoping Review

BACKGOUND

Inflammatory hematological ratios (IHRs), such as neutrophil to lymphocyte, monocyte to lymphocyte, and platelet to lymphocyte ratios, are associated with mental disorders, symptoms severity, and the disease phase. Evidence from the studies in adult patients has been summarized in systematic reviews and meta-analyses. The results of the studies in adolescents remain poorly systematized.

AIM

To summarize the findings from the studies that investigated the relationship of IHRs with mental disorders in adolescent patients.

METHODS

This scoping review included studies of IHRs in patients aged 10-19 years with mental disorders (other than anorexia nervosa), published in English by December 31, 2023. The search for relevant papers was performed in MEDLINE. The studies were categorized into two groups: studies with external controls (healthy adolescents) and studies with internal controls (patients in different phases of mental disorder, with or without self-harm/suicidal behaviors).

RESULTS

A total of 11 studies were included in the review (all cross-sectional ones). The results of these studies demonstrate that 1) adolescents with mental disorders (major depressive disorder, psychotic disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, substance use disorders) have higher IHR values than individuals of the same age without corresponding disorders (5 studies); 2) IHR values are positively correlated with the severity of psychopathological symptoms (1 study); 3) higher IHR values are associated with the phase of the mental disorder - manic episode in bipolar disorder (1 study) and exacerbation of psychosis in psychotic disorders (1 study); and 4) higher IHR values are associated with self-harm/suicidal behaviors - suicide attempts (1 study) and non-suicidal self-injury (1 study).

CONCLUSION

IHRs are associated with mental disorders in adolescents, and higher IHR values are associated with a more severe/acute clinical presentation (severity of symptoms, mania, acute psychosis, self-harm/suicidal behaviors). Further studies of higher methodological quality are needed to evaluate the diagnostic and prognostic value of IHRs as biomarkers of mental disorders in adolescence.

A review of common influencing factors and possible mechanisms associated with allergic diseases complicating tic disorders in children

Over the past few decades, the incidence of childhood allergic diseases has increased globally, and their impact on the affected child extends beyond the allergy itself. There is evidence of an association between childhood allergic diseases and the development of neurological disorders. Several studies have shown a correlation between allergic diseases and tic disorders (TD), and allergic diseases may be an important risk factor for TD. Possible factors influencing the development of these disorders include neurotransmitter imbalance, maternal anxiety or depression, gut microbial disorders, sleep disturbances, maternal allergic status, exposure to tobacco, and environmental factors. Moreover, gut microbial disturbances, altered immunological profiles, and DNA methylation in patients with allergic diseases may be potential mechanisms contributing to the development of TD. An in-depth investigation of the relationship between allergic diseases and TD in children will be important for preventing and treating TD.

Exosomes in the Diagnosis of Neuropsychiatric Diseases: A Review

Exosomes are 30-150 nm small extracellular vesicles (sEVs) which are highly stable and encapsulated by a phospholipid bilayer. Exosomes contain proteins, lipids, RNAs (mRNAs, microRNAs/miRNAs, long non-coding RNAs/lncRNAs), and DNA of their parent cell. In pathological conditions, the composition of exosomes is altered, making exosomes a potential source of biomarkers for disease diagnosis. Exosomes can cross the blood-brain barrier (BBB), which is an advantage for using exosomes in the diagnosis of central nervous system (CNS) diseases. Neuropsychiatric diseases belong to the CNS diseases, and many potential diagnostic markers have been identified for neuropsychiatric diseases. Here, we review the potential diagnostic markers of exosomes in neuropsychiatric diseases and discuss the potential application of exosomal biomarkers in the early and accurate diagnosis of these diseases. Additionally, we outline the limitations and future directions of exosomes in the diagnosis of neuropsychiatric diseases.

Central Causation of Autism/ASDs via Excessive [Ca2+]i Impacting Six Mechanisms Controlling Synaptogenesis during the Perinatal Period: The Role of Electromagnetic Fields and Chemicals and the NO/ONOO(-) Cycle, as Well as Specific Mutations

The roles of perinatal development, intracellular calcium [Ca2+]i, and synaptogenesis disruption are not novel in the autism/ASD literature. The focus on six mechanisms controlling synaptogenesis, each regulated by [Ca2+]i, and each aberrant in ASDs is novel. The model presented here predicts that autism epidemic causation involves central roles of both electromagnetic fields (EMFs) and chemicals. EMFs act via voltage-gated calcium channel (VGCC) activation and [Ca2+]i elevation. A total of 15 autism-implicated chemical classes each act to produce [Ca2+]i elevation, 12 acting via NMDA receptor activation, and three acting via other mechanisms. The chronic nature of ASDs is explained via NO/ONOO(-) vicious cycle elevation and MeCP2 epigenetic dysfunction. Genetic causation often also involves [Ca2+]i elevation or other impacts on synaptogenesis. The literature examining each of these steps is systematically examined and found to be consistent with predictions. Approaches that may be sed for ASD prevention or treatment are discussed in connection with this special issue: The current situation and prospects for children with ASDs. Such approaches include EMF, chemical avoidance, and using nutrients and other agents to raise the levels of Nrf2. An enriched environment, vitamin D, magnesium, and omega-3s in fish oil may also be helpful.

Neuroplasticity of children in autism spectrum disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that encompasses a range of symptoms including difficulties in verbal communication, social interaction, limited interests, and repetitive behaviors. Neuroplasticity refers to the structural and functional changes that occur in the nervous system to adapt and respond to changes in the external environment. In simpler terms, it is the brain's ability to learn and adapt to new environments. However, individuals with ASD exhibit abnormal neuroplasticity, which impacts information processing, sensory processing, and social cognition, leading to the manifestation of corresponding symptoms. This paper aims to review the current research progress on ASD neuroplasticity, focusing on genetics, environment, neural pathways, neuroinflammation, and immunity. The findings will provide a theoretical foundation and insights for intervention and treatment in pediatric fields related to ASD.

Defects in AMPAR trafficking and microglia activation underlie socio-cognitive deficits associated to decreased expression of phosphodiesterase 2 a

Phosphodiesterase 2 A (PDE2A) is an enzyme involved in the homeostasis of cAMP and cGMP and is the most highly expressed PDE in human brain regions critical for socio-cognitive behavior. In cerebral cortex and hippocampus, PDE2A expression level is upregulated in Fmr1-KO mice, a model of the Fragile X Syndrome (FXS), the most common form of inherited intellectual disability (ID) and autism spectrum disorder (ASD). Indeed, PDE2A translation is negatively modulated by FMRP, whose functional absence causes FXS. While the pharmacological inhibition of PDE2A has been associated to its pro-cognitive role in normal animals and in models of ID and ASD, homozygous PDE2A mutations have been identified in patients affected by ID, ASD and epilepsy. To clarify this apparent paradox about the role of PDE2A in brain development, we characterized here Pde2a+/- mice (homozygote animals being not viable) at the behavioral, cellular, molecular and electrophysiological levels. Pde2a+/- females display a milder form of the disorder with reduced cognitive performance in adulthood, conversely males show severe socio-cognitive deficits throughout their life. In males, these phenotypes are associated with microglia activation, elevated glutathione levels and increased externalization of Glutamate receptor (GluR1) in CA1, producing reduced mGluR-dependent Long-term Depression. Overall, our results reveal molecular targets of the PDE2A-dependent pathway underlying socio-cognitive performance. These results clarify the mechanism of action of pro-cognitive drugs based on PDE2A inactivation, which have been shown to be promising therapeutic approaches for Alzheimer's disease, schizophrenia, FXS as well as other forms of ASD.

Red Blood Cell Distribution Width: A Potential Inexpensive Marker for Disease Activity in Patients with Rheumatic Diseases; Scoping Review

Background

Rheumatic diseases encompass a diverse group of autoimmune disorders that affect the joints and connective tissues. The red blood cell distribution width (RDW) has been widely investigated as an inflammatory marker. This scoping review aimed to explore the potential utility of RDW as an inexpensive marker for disease activity in patients with rheumatic diseases. By summarizing the available evidence, we aimed to determine whether RDW can serve as a reliable and accessible indicator of disease activity in these patients.

Methods

A comprehensive search was systematically performed across electronic databases, encompassing PubMed, Embase, and Web of Science. Studies have explored the relationship between RDW and disease activity in rheumatic diseases. Data extraction focused on the study characteristics, methodologies, and findings related to RDW as a disease activity marker.

Results

After removing duplicates, the initial search yielded 25 relevant studies. These studies encompassed a variety of rheumatic diseases, with rheumatoid arthritis being the most frequently studied condition. The association between RDW and disease activity was assessed by using various disease activity indices and clinical parameters. While some studies have reported a significant correlation between elevated RDW and disease activity, others have yielded inconclusive results.

Conclusion

From this review, we concluded that RDW is an inexpensive potential marker for the evaluation of disease activity in rheumatic diseases. RDW is promising as an inexpensive and readily available marker; however, its clinical utility in assessing disease activity in rheumatic conditions warrants more rigorous investigation through well-designed prospective studies.