Autism and immune dysfunction: don't forget your roots?

You're going to have to humour me a little with this post based on this opinion piece by Moises Velasquez-Manoff which appeared in the New York Times recently. I normally try and stick to discussing peer-reviewed published research on this blog but given the content of this article titled: "An immune disorder at the root of autism" (no question mark by the way), I couldn't resist having a more detailed look at some of the discussions which do include reference to some peer-reviewed research.

So what does it say?

• Well, quite a lot of things which quite a few other people have been saying for sometime, albeit all condensed into a single essay. Primary is the potential for some involvement of the immune system in cases of autism. Nothing too novel there really. 
• A chronic state of inflammation being present in some cases of autism. Again, something that has been previously covered from a few directions. 
• Microglia (and astroglia) potentially involved? Microglia are fast becoming one of the Hollywood royalty of autism research. 
• Maternal inflammation vis-à-vis Paul Patterson and his mouse models and the possible link to autism. Indeed I stumbled upon this paper* by Prof. Patterson (full-text) summarising this area of work quite nicely. 
• Autoimmunity, as in the presence of autoantibodies to important things like brain, linked to cases of autism. Remembering that autoimmunity covers other potentially important areas too.
• A corresponding 'increase' in autism and also other autoimmune conditions alongside some mention of Dr Kevin Becker (see here). 
• The hygiene hypothesis and the 'use it or lose it' sentiments of immune function. 
• Helminthic therapy and its possible applications for some cases of autism.

I don't think I've missed anything out. The main message seems to be that increasing autism rates seem to be correlated with population increases in hygiene and less exposure to bacterial and viral infections and the knock-on effects to immune function. Actually this is not the first time that Mr Velasquez-Manoff has talked about some of these concepts are per this article from 2008 on worm therapy for inflammatory bowel disease (IBD) which is also the topic of his book (no plug intended).

There is no doubt that this is an interesting article which has some degree of support (published scientific support) behind elements of it. Outside of the journalist flair that accompanies the article - "perhaps one-third, and very likely more — looks like a type of inflammatory disease" (evidence please!) autism and immune function is an area of great research interest and speculation. Still however questions remain about how widespread immune dysfunction is in autism, the chicken or egg question of which came first: autism or immune dysfunction, and indeed whether immunological issues are a core part of autism, some cases of autism, or perhaps just another face of comorbidity.

[Update 31 August 2012: In response to some discussion about the lack of scientific references accompanying the article by Moises Velasquez-Manoff, the author has posted a reference source list on his website].

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Patterson P. Maternal infection and immune involvement in autism. Trends in Molecular Medicine. 2011; 17: 389-394.