“When it comes to treatments for ASD, we know that one size does not fit all,” she says from her office in Los Angeles. “Some kids with GI problems may respond to treatment and some may not. But there will be incredible value added if we can scientifically identify a subset of kids who can be treated this way.
“And once we start to understand what’s going on in their guts, it may shed light on the underlying biology of the syndrome and lead us to what’s going on in the brain and nervous system.”
The research of Fasano and his colleagues is complicated because ASD is just that – a spectrum disorder – hard to pin down because it is not a single, defined medical condition. Its causes are thought to be myriad, which is why Fasano says that “we have to walk the same route that each of these children took to arrive at ASD as their final destination. By doing so, we aim to help these same kids turn around and walk back, like following bread crumbs.”
This work is a natural extension of Fasano’s ground-breaking research into celiac disease, because he suspects that no matter the cause, leaky gut syndrome will inevitably lead to diverse health problems because all sorts of bad things get through to the rest of the body.
“I believe in serendipity,” Fasano says. “Word spread that I was working on leaky gut syndrome and Autism Speaks invited me to talk about how impaired barriers may function in autism,” he says.
“I thought, ‘Wouldn’t that be interesting?’ I don’t see many kids with autism, but in some of the kids brought to us with gluten sensitivity and behavioral issues, I can definitely see a difference. They become more verbal. Some are almost indistinguishable from kids without such issues.”
“The key,” he continues, “is to figure out who has gluten sensitivity and a leaky gut and not just randomly treat all ASD patients,” he says. That’s why he and other medical researchers need to identify better biomarkers for gluten sensitivity, as has been done for celiac disease.
Fasano’s first challenge is to identify a specific combination of “bad bacteria” that causes the leaky gut, which in turn leads to inflammation and, finally, to ASD. If such a combination exists, next he wants to track the bacteria’s pathways to identify metabolites that can be used as biomarkers, or red flags, in the development of the disorder. Finally, with pathways mapped and red flags marked, he wants to try to repair the intestinal barrier by manipulating the bacteria.
The goal of the research is twofold: to identify kids at risk of developing ASD in the first place and, for those who already have it, to reverse it as much as possible.
“The gut is not like Las Vegas. What happens in the gut does not stay in the gut,” he says. “Just like in celiac disease, some of these immune cells will migrate to other areas of the body, including the brain.” And the few autopsy reports he has seen of children with ASD indicate that they had inflammation in their brains.
“How did it happen?” he asks. “How can we prevent it? That’s what we want to understand.”