Autism and Immunology

7/28/2019 Autism and Immunology

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Autism And Immunology

Tony Hermawan


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Pendahuluan

Autisme adalah salah satu bentuk penyakit yanng

tergolong dalam gangguan pervasif.

Berasal dari autos diri sendiri

menunjukkan gejala hidup dalam dunia sendiri

Autisme adalah gangguan perkembangan pervasif

pada anak yang ditandai dengan adanya

gangguan dan keterlambatan dalam bidangkognitif, bahasa, perilaku, komunikasi dan

interaksi sosial.


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Autism is a complex, developmental disability

that is evident within the first 3 years of life.

It is a behaviorally defined syndrome that is

recognized by difficulties in communication,

social interaction and perceptual organization

(pattern of behavior) .

Symptoms vary in degree of severity, from

mild to severe impairments.


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Etiologi

Evironmental factor :

congenital rubella infection

anticonvulsants and antiemetics takenduring pregnancy,

perinatal hypoxia

postnatal infections such as encephalitis Genetic ?


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Sistim Neuromunologi

Kelainan sistim imun pada autisme

dihubungkan dengan adanya antibodi reaktif

pada SSP yang mengakibatkan terjadinya

kerusakan jaringan neuron

Paparan sistim imun pada periode kritikal

perkembangan sist imun menyebabkan

terjadinya autisme


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Sistem imun dan sistem Saraf

Keduanya merupakan suatu sistem yang

bekerja menyampaikan sinyal melalui

pelepasan mediator kimiawi seperti

neuropeptida, neurothropin dan sitokinin.

Banyak peptida yang sama berperan dalam

kedua sistim tersebut.


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Traditional view of Autism

Autism is a group of behaviors caused by

some defective gene or genes which cause

structural changes in the brain.

We cant fix brain abnormalities that you are

born with, so other than behavioral therapies,

there isnt anything that will improve the

childs level of functioning.


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Immune and Nervous systems

Communicate with chemical messages

Interact with each other


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The Ideal Immune System

Recognize all foreign organisms.

Bacteria, viruses, parasites (fungi,worms)

Efficiently and rapidly destroy invaders.

Prevent a second infection with the samemicrobe (have a memory).

Never cause damage to self.


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Cytokines

the Language of the Immune System

Chemical messages that are the main communication

system between cells of the immune system

(and other systems

especially the nervous system).


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Can be divided several ways:

Th1 (adaptive/memory, cell mediated): IL-2, IFN-

Th2 (adaptive/memory, antibodies):IL-4, IL-5, IL-13, IL-

10,TGF-

Innate: TNF-, IL-1, IL-6, IL-12

Pro-inflammatory: TNF-, IL-1, IL-6

Anti-inflammatory: TGF-, IL-10 Regulatory: IL-10, IL-12,TGF-

Cytokines

the Language of the Immune System


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Immunopathology in autism

Dysregulation of immunityin autistic children leads to all fourproblems:

Deficiency / dysfunction

Hypersensitivity / allergy

Autoimmunity

Inflammation


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Immune Abnormalities in Autism

Abnormal immune systems have been found in about 20-70% ofpatients with autism in a wide variety of studies, depending onwhich part of the immune system is examined.

Studies are generally small with not-well-characterized children orare limited to a single subgroup so it is hard to draw firmconclusions.

Nearly every study finds that some children have poor T regulatoryfunction

Many studies find that ASD children have low-normal

immunoglobulins (IgG, IgM, IgA) and/or low T cell numbers and/orlow-normal functioning and/or low and poorly functional NaturalKiller cells ; a subset of children have true immunodeficiency.

Some children have low serum IgA, predisposing them torespiratory and GI infections.


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Blood (serum) findings in ASD

Some children have allergy (atopy)with high levels ofIgE.

Traditional IgE allergies can be

measured either by blood testing(RAST) or by skin prick testing.

It is well documented that in neuro-

typical children, untreated allergiescause poor memory andconcentration as well as poor sleep.


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Blood (serum) findings in ASD

A child on the autism spectrum with

recurrent infections deserves an immune

evaluation for immunodeficiency

A child on the autism spectrum with eczema,

chronic nasal symptoms, asthma, significant

GI symptoms, or recurrent respiratory

infections deserves an allergyevaluation forIgE inhalant and food allergies.


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There is a tendency towards a positive familyhistory of autoimmunity in familiesRheumatoid Arthritis, Thyroiditis - with an ASD

child, and a genetic tendency towardsautoimmune disorders as well.

Many, many types ofautoantibodies (againstself tissues) have been found in ASDchildren but the significance of the manytypes of anti-brain antibodies is not clear.


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GI Tract - Mucosal findings

Gut inflammation insome children

Abnormal lymphocyteprofiles: lots of

T cells present wherenone should be.

Abnormal cytokineprofiles: pro-inflammatory withlots of TNF- and toolittle regulatory IL-10


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Immune Reactions to Food

Immune cells from autistic children with GI symptomsshowed strong pro-inflammatory response and areduced ability to switch off the immune responsecompared to normal children.

Immune reactivity to milk and wheat common with or

without GI symptoms. Soy and corn next mostcommon.

Still no test or good predictors (although a fewchildren did have IgE antibodies which can bemeasured) - elimination and challenge best.

Yeast (Candida albicans) overgrowthalso found in thestools of some children


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Autism spectrum disorders and allergy: observation from a pediatric allergy/immunology clinic

Harumi Jyonouchi

Pediatrics, University of Medicine and Dentistry of New Jersey (UMDNJ)


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prenatal viral infections might damage the

immature immune system and induce viral

tolerance (Stubbs & Crawford, 1977)

decreased production of immunoglobulins or

B and T-cell dysfunction (Warren et al.,1986)

Immunity, neuroglia and

neuroinflammation in autism (vargas et al)


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Immunity, neuroglia and

neuroinflammation in autism (vargas et al)


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Autism and Immunology