Brief reportThe level of arabinitol in autistic children after probiotic therapy
Introduction
Autism spectrum disorder (ASD), first reported in 1943, which is a complex developmental disability, impairs social interaction and communication. A child with autism has difficulty interacting with others, shows little interest in others, and lacks social awareness. Autism is more prevalent among boys than girls, with the ratio estimated at 4:1 [1], [2]. Autism is a multifactorial disorder; several factors must be considered when determining the case. These factors include complex genetic interactions, nutritional deficiencies or overloads, pre- and postnatal exposure to chemicals or viruses, errors during the embryonic neural tube closure process, dysfunctional immune systems, and allergies [3], [4], [5], [6]. Recent studies have correlated gut dysfunction with ASD and suggested a possible role of the gastrointestinal (GI) microflora in symptomatology and/or severity of symptoms in autistic children [7], [8]. Many autistic children experience severe dietary/or GI problems including abdominal pain, constipation, diarrhea, and bloating. These symptoms may be due to the disruption of the indigenous gut flora promoting the overgrowth of potentially pathogenic microorganism [8].
No treatment can successfully treat autism. However, some behavioral symptoms can be improved in autistic children. Most therapists and parents use a combination of interventions and techniques to treat autism. A variety of complementary approaches have been developed; some are widely accepted whereas others are quite controversial. The parents of autistic children know that only intensive and early intervention can help to achieve the best outcomes. There are reports of significant recovery from autism using various complementary/alternative medicine and therapies. The parents of autistic children are willing to try complementary/alternative medicine treatments, especially those that are non-invasive and without harmful side effects. Alternative and complementary therapies used for ASD include special diets (casein-free diet, gluten-free diet, digestive enzyme supplements), chelation, music therapy, auditory integration therapy, sensory integration therapy, hyperbaric oxygen therapy, traditional Chinese medicine, and acupuncture [9], [10]. Moreover, antifungal drug therapy may be a promising therapeutic method for the treatment of autism. Organic acid testing appears to be a useful diagnostic test to indicate an overgrowth of yeast and bacteria in the GI tract of children with autism [11]. D-arabinitol (DA) is a metabolite of most pathogenic Candida species and its extraction in urine is elevated in autistic patients [12], [13]. In literature, a rapid non-culture-based diagnostic method utilizing the DA/L-arabinitol (LA) ratio as a chemical marker of invasive candidiasis is described [14], [15]. For an unequivocal identification of DA, it is essential that the gas detector possesses adequate sensitivity and specificity. The use of gas chromatograph (GC) coupled with mass spectrometer (MS) is the most suitable. MS is superior to other GC detectors, because in addition to retention times, it uses specific ions formed in the ion source for identification [16]. Treatment of Candida albicans using probiotics was described by Hatakka et al. [17] and Koll et al. [18].
In this study, a simple method for quantification and monitoring of DA and DA/LA enantiomers ratio in urine by capillary GC/MS was used. The aim of the present study was to find out whether there are tangible differences between DA and ratio DA/LA in the urine of autistic children before and after probiotic treatment.
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Patients
The study was restricted to children with the diagnosis of autism in compliance with the criteria detailed in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) [19]. All overnight urine samples were collected from 22 autistic children (4–10 y) who underwent rehabilitation in the Navicula Centre in Lodz. All autistic children were assessed and diagnosed by clinicians specializing in the diagnosis and management of autistic children from the
Results
In data relating to GI problems, dietary characteristics and the use of antibiotics (last year) were collected for the study group from individual questionnaires (Table 1).
The presented method was applied to the analysis and the monitoring of urine samples collected from 22 autistic children before (A) and after the probiotic therapy (A1). In the case of groups A and A1, the level of DA in urine is significantly different (P < 0.05). The level of DA is significantly higher in the urine of
Discussion
Probiotics were defined by the Food Agricultural Organization/World Health Organization as live microorganisms which, when administered in adequate amounts (in food or as a dietary supplement), have health benefits on the host (improving the microbiologic balance in the intestinal tract) [22]. Most probiotics are bacteria similar to those found naturally in human guts, especially in those of breastfed infants (who have natural protection against many diseases). Most often, the bacteria come
Conclusion
The results presented in this article suggest that the probiotic therapy may be effective in reducing the level of DA and DA/LA ratio in the urine of children with autism. They are in line with the findings of Romeo et al., who evaluated the efficiency of probiotics in the prevention of gastrointestinal colonization by Candida species [23].
Acknowledgments
This publication is supported by the Ministry of Science (Grant number NN 204 316234).
References (26)
- et al.
Communicative abilities in autism: evidence for attentional deficits
Brain Lang
(2001) - et al.
White matter structure in autism: preliminary evidence from diffusion tensor imaging
Biol Psych
(2004) - et al.
Separation and quantification by gas chromatography-mass spectrometry of arabinitol enantiomers to aid the differential diagnosis of disseminated candidiadis
J Chrom
(1990) - et al.
Autism: an emerging public health problem
Public Health Rep
(2003) - et al.
The environment as an etiologic factor in autism: a new direction for research
Environ Health Perspect
(2000) - et al.
Determination of tryptophan in urine of autistic and healthy children by gas chromatography/mass spectrometry
Med Sci Monit
(2010) - et al.
Determination of homovanillic acid and vanillylmandelic acid in urine of autistic children by gas chromatography/mass spectrometry
Med Sci Monit
(2010) - et al.
Metabolic markers and gastrointestinal symptoms in children with autism and related disorders
J Pediatr Gastroenterol Nutr
(2000) - et al.
Differences between the gut microflora of children with autistic spectrum disorders and that of healthy children
J Med Microbiol
(2005) Counseling families who choose complementary and alternative medicine for their child with chronic illness or disability
Pediatrics
(2001)