Putting Money on autoimmunity and autism

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I owe a debt of gratitude to Natasa who brought me to the very short and very pay-walled communication by McDougle & Carlezon* discussing neuroinflammation and autism. Whilst the open-accessing of research is seemingly discussed in bulk these days, we are not quite there yet in making science free and accessible to all hence I can't refer you to the full-text paper at this time unfortunately.

No mind, the McDougle communication is brief but discusses some interesting themes, some of which have appeared before on this blog including:

• Kanner's original descriptions of autism describing so much more than just behaviour (see this post)
• The issue of autoimmunity and autism tracking back to the topic of today's post, the paper by John Money and colleagues** from 1971.
• And how mention of the paper that should not be mentioned (in my best Harry Potter voice) reflects the fact "that at least some subtypes [of autism] represent whole-body disorders, offering exciting new possibilities for therapy".

I'm not 100% sure if it is the same person or not but the psychologists out there might recognise the name John Money in relation to the very sad case of the late David Reimer. A quick scan through the scientific literature based on the name Money and other authors listed on the the 1971 paper leads me to believe it is the same person who undertook work on gender identity and who championed the chemical castration of certain types of offenders. I offer no opinion on these ideas by the way.

I've previously done a review of some older research before on this blog and in particular the wonderfully descriptive article by Mary Goodwin and colleagues (see this post) on the very earliest days of the gut-brain axis in cases of autism. Readers should consider this post of a similar ilk and indeed published in the same year and by the same journal.

Money and colleagues present a family study with a few interesting points noted:

• The particular family was one seen at The Johns Hopkins Hospital in Baltimore, USA.
• It presents on a case of autism presenting in a boy called Tommy also diagnosed with Addison's disease and moniliasis - fungal infection related to Candida to you and me.
• Tommy had several brothers (x3), 2 of whom also showed various signs and symptoms of autoimmune diseases including those found with Tommy. 
• The early presentation of Tommy has some interesting features. He was overdue, presented with jaundice, had poor weight gain, issues with bone age and quite a few issues related to his diagnosis of Addison's disease. Tonsilitis with convulsions and coma with seizures "attributed to hypogylcaemia" were all in his clinical notes. 
• His psychological development is equally interesting, going from a child who reportedly smiled at 3 weeks (remember he was overdue) and cooed at 5 weeks to a child with "an air of preoccupation and a secret smile".
• Tommy's siblings were not diagnosed with autism but similarly presented with some notable traits. One of the siblings, Peter, was mis-diagnosed with coeliac (celiac) disease though later diagnosed with malabsoprtion in addition to hypomagnesia. He also presented with rapid hair loss aged 16 years. His psychological report mentions quite a lot of attention-seeking behaviour as well as him being prone to depressive episodes and ideations about suicide. 
• Another sibling, Theodore, was described as presenting with hypocalcemia and eventually diagnosed with diabetes. Behaviour was described as 'autistic' at some points in his development, as well as being reported as "hyperactive, disruptive, short in attention span and imitative". 
• All this was set against a family history of ulcerative colitis (UC) (maternal).

I know some people will probably read through all this and perhaps think its all just coincidence. One family history which, in the grand scheme of things, means very little to the millions of cases of autism past, present and future. Indeed also with only one of the brothers formally diagnosed with autism. I have to say however that accepting the heterogeneity present in autism(s), I'm not one of those people. Simply because quite a few elements of the cases described by Money et al have been mentioned in subsequent research literature with autism in mind pointing to some possible connections.

Don't believe me? Well have a look at papers like this one from Mouridsen and colleagues on maternal UC linked to autism*** and this one from Paul Ashwood and Judy Van de Water**** on autoimmunity appearing alongside cases of autism. Indeed Money and colleagues were also seemingly not convinced that these patterns of presentation in the family was merely a random act either, accepting that science is all about probability rather than absolutes. 

I was also drawn to some discussion made in the paper which referenced the work of the late Curt Dohan, he of the gluten-schizophrenia hypothesis. It appears that Money and colleagues might have had some personal communication with Dohan about their results and indeed how Dohan had "reported finding autoimmune antibody formation to brain and gut tissues in patients with schizophrenic-like symptoms and celiac disease". I don't want to make mountains out of molehills but one does wonder whether there might be a link with cases of autism as per the more recent tissue transglutaminase antibodies findings and perhaps even the folate receptor autoantibodies research. Although by no means am I suggesting autism is schizophrenia or vice-versa, we do know that the two conditions have been known to overlap and there's no reason to suspect that biology, genetics and even epigenetics might not also.

I'm going to finish with another quote from the Money paper: "it is quite possible that the patient's progressive withdrawal into autism, after a perhaps auspicious beginning, represents a developmental deterioration dependent on internal autoimmunizing factors rather than psychosocial factors". Sentiments that at least McDougle & Carlezon seem to be taking quite seriously.

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* McDougle CJ. & Carlezon WA. Neuroinflammation and autism: toward mechanisms and treatments. Neuropsychopharmacology. 2013; 38: 241-242.

** Money J. Autism and autoimmune disease: a family study. J Autism Child Schizophr. 1971; 1: 146-160.

*** Mouridesen SE. et al. Autoimmune diseases in parents of children with infantile autism: a case-control study. Dev Med Child Neurol. 2007; 49: 429-432.

**** Ashood P. & Van de Water J. Is autism an autoimmune disease? Autoimmun Rev. 2004; 3: 557-562.

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Money J, Bobrow NA, & Clarke FC (1971). Autism and autoimmune disease: a family study. Journal of autism and childhood schizophrenia, 1 (2), 146-60 PMID: 5172389