Cleanrooms and autism?

The paper by Scott Faber and colleagues [1] (open-access) is the topic of today's post and the idea that a cleanroom sleeping environment might impact on some important issues accompanying at least some autism.

Just in case you hadn't come across the concept of a cleanroom, the concept is that a space is provided where various systems are put in place to control environmental pollutants such as dust, microbes and various chemical emissions. More readily associated with the construction of microchips, satellites or the preparation of various pharmaceutics, I was unable to find any previous studies on the use of cleanrooms 'for autism' so the Faber study seems to represent a bit of a first...

The study is open-access but here are a few details:

• Ten children diagnosed with an autism spectrum disorder (ASD) with "prior evidence of heavy metal and chemical toxicity and immune dysregulation seen through low plasma zinc/serum copper ratios and abnormal T and B cell subsets, respectively" were included for study.
• Then: "each child and a parent spent two consecutive weeks sleeping in the cleanroom 
• between May and October 2010." The cleanroom in question was based at The Children's Institute and consisted of HEPA filters, cleanroom bedding, a UV water purification system and was "furnished with ash furniture sealed with water soluble polyurethane." Cleanroom status was confirmed via particle counting.
• Behaviour, blood and hair were collected and tested pre- and post-cleanroom attendance. Blood and hair were analysed for various compounds including nutrients and externally-derived chemicals. Glutathione levels (total, reduced and oxidised) were also assayed for using everyone's favourite analytical method: mass spectrometry.
• Results: children's results were analysed on the basis of their grouping into a younger age cohort (5 and under) and an older age cohort (6 and older). Bearing in mind the small participant numbers: "The overall pattern of results indicates greater improvements in immune dysregulation and behavior in the younger children, age 5 and under." But: "The older children displayed a worsening in behavioral rating scale performance, which may have been caused by the mobilization of toxins from their tissues."
• Among the various results presented, glutathione status seemed to change for at least some of the children over the course of cleanroom residence which the authors interpreted as possibly indicating: "a reduction of oxidative stress." 
• The idea that some children actually presented with increased levels of certain toxicants following their cleanroom experience is an interesting one. "Out of the ten participants, eight decreased mean serum benzene, six increased mean serum toluene and five increased serum xylene." Further: "One possible explanation for these results is that, throughout the study, VOCs were mobilized from tissues into the serum at varying rates."
• The authors conclude: "The performance of a controlled study of 24 hour per day cleanroom exposure for children with autism appears to be an appropriate next step, given the physiologic changes from the limited exposure to a cleanroom environment noted in this study."

Whilst I did find this to be an interesting study, there are a couple of caveats to mention. This was a straight forward open trial of cleanrooms for autism so 'preliminary' is an important word to use in relation to the results. I note also that whilst the trial was registered with ClinicalTrials.org (see here) it seems to have been done pretty retrospectively ("First received: July 16, 2014").

"The child and parent arrived at TCI and spent approximately ten hours each evening in the cleanroom while wearing silk or cotton clothes." What this means is that during the day, when most people are moving around various environments (including the great outdoors) participants were not contained in that sterile environment. There could have been a myriad of different variables to account for the results during this 'free time' including the idea that parents themselves may have altered their child's routines as a function of being part of the study. I say this not to somehow sabotage the results, merely to say that in a study looking at 'detoxification' in relation to autism, one can't discount other factors coming into play.

Insofar as the idea that 'a controlled study of 24 hour per day cleanroom exposure' might be indicated, I think we might have to take a small step back before this is considered. With the limited exposure I've had to cleanrooms during my career I can safely say that I would not take lightly to spending even one day/night in a cleanroom environment. Not least because of the limited living space that would be available as a result of cost considerations but also how the study is potentially talking about housing young children with autism in such an environment and what that might mean for them and an important disruption to their home/school routine among others. That being said I do like one idea discussed by the authors that: "Younger children may have felt an extra closeness to their parents during the study, leading to positive behavioral change." Yes, it's a shocker: children generally love being next to their parents.

Music from Ian Dury & The Blockheads.

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[1] Faber S. et al. A cleanroom sleeping environment’s impact on markers of oxidative stress, immune dysregulation, and behavior in children with autism spectrum disorders. BMC Complementary and Alternative Medicine 2015, 15:71

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Faber, S., Zinn, G., Boggess, A., Fahrenholz, T., Kern, J., & Kingston, H. (2015). A cleanroom sleeping environment’s impact on markers of oxidative stress, immune dysregulation, and behavior in children with autism spectrum disorders BMC Complementary and Alternative Medicine, 15 (1) DOI: 10.1186/s12906-015-0564-0