The purpose of this study is to assess the effects of a 6-months supplementation with probiotic Vivomixx® on inflammatory and gastrointestinal (GI) biomarkers, gastrointestinal disturbances, behavioral and developmental profiles, and neurophysiological features in preschoolers with Autism Spectrum Disorders (ASD) with or without GI symptoms.
Autism Spectrum Disorders (ASD) are most likely multifactorial diseases in which the combination of genetic and environmental factors might have a role in the expression of the phenotype. A high incidence of gastrointestinal (GI) symptoms is reported in ASD. GI disturbances and altered gut microflora could make a child with a genetic predisposition for ASD more prone to express the ASD phenotype or increase the severity of his behavioral symptoms. The exploitation of strategies which can reduce the gut production and absorption of toxins or restore normal gut microbiota, such as probiotics may represent a non-pharmacological option in the treatment of GI disturbances in ASD. The aim of this study is to determine effects of probiotics supplementation with Vivomixx® in ASD children on specific GI symptoms, ASD core deficits, cognitive and language development, on inflammatory and gastrointestinal (GI) biomarkers and on Quantitative Electroencephalographic measures (QEEG). Vivomixx® is a probiotic mixture of 8 probiotic strains (Bifidobacterium breve, Bifidobacterium longum, Bifidobacterium infantis, Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus paracasei, Lactobacillus bulgaricus and Streptococcus thermophilus). An additional aim of the study is to determine the environmental exposure to phthalates (chemical pollutant) in ASD children, and the possible effects of probiotic supplementation on their urinary concentrations. A group of 100 unselected preschoolers with ASD will be classified as belonging to the Gastro Intestinal (GI) group or to the Not Gastro Intestinal (NGI) group on the basis of the presence of significant GI symptoms at GI severity Index. Subjects belonging to the two groups (GI and NGI) will be blind randomized 1:1 to regular diet with probiotic Vivomixx® or with placebo for 6 months. All the participants will be assessed at the baseline, after three months and after six months from the baseline in order to evaluate the possible changes in GI symptoms, in ASD symptomatology, in other affective and behavioral comorbid symptoms, in plasmatic, urinary and fecal biomarkers related to abnormal intestinal function and in the electrophysiological patterns. The effects of treatments with probiotics on children with ASD need to be confirmed by rigorous controlled trials. Aiming to examine the impact of this treatment not only on clinical but also on neurophysiological patterns this trial sets out to provide new insights into the gut-brain connection in autism. Moreover, this study's results could add new data on the relationship between the presence of phthalates, clinical features and neurophysiological patterns in ASD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
85
Two packets (900 billions bacteria) per os (P.O.) daily x 1 month and one packet (450 billions bacteria) P.O. daily x 5 months
Two packets (4,4 grams of maltose and silicon dioxide x 2) P.O. daily x 1 month and one packet (4,4 grams of maltose and silicon dioxide) P.O. daily x 5 months
IRCCS Stella Maris Foundation
Calambrone, Pisa, Italy
Changes in severity level of ASD symptomatology
Delta of scores at Autism Diagnostic Observation Schedule-2
Time frame: 6 months
Changes in GI symptomatology
Delta of scores at GI Severity Index
Time frame: 3 months and 6 months
Changes in Electroencephalogram (EEG) power
Registration with a 128-channels digital EEG: power will be assessed within each frequency band
Time frame: 6 months
Changes in EEG coherence
Registration with a 128-channels digital EEG: coherence will be assessed within each frequency band
Time frame: 6 months
Changes in EEG asymmetry
Registration with a 128-channels digital EEG: asymmetry will be assessed within each frequency band
Time frame: 6 months
Changes in levels of serum Lipopolysaccharide
Delta of values of serum Lipopolysaccharide
Time frame: 6 months
Changes in levels of serum Leptin
Delta of values of serum Leptin
Time frame: 6 months
Changes in levels of serum Resistin
Delta of values of serum Resistin
Time frame: 6 months
Changes in levels of serum Tumor Necrosis Factor - alfa
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Delta of values of serum Tumor Necrosis Factor - alfa
Time frame: 6 months
Changes in levels of serum Interleukin-6 (IL-6)
Delta of values of serum Interleukin-6 (IL-6)
Time frame: 6 months
Changes in levels of serum Plasminogen Activator Inhibitor-1 (PAI-1)
Delta of values of serum Plasminogen Activator Inhibitor-1 (PAI-1)
Time frame: 6 months
Changes in levels of fecal calprotectin
Delta of values of fecal calprotectin
Time frame: 3 months and 6 months
Changes in global ASD symptomatology assessed by Childhood Autism Rating Scale
Delta of scores at Childhood Autism Rating Scale
Time frame: 6 months
Changes in ASD symptomatology: repetitive behaviors
Delta of scores at Repetitive Behavior Scale
Time frame: 3 months and 6 months
Changes in ASD symptomatology: sensory profiles
Delta of scores at Sensory Profile
Time frame: 3 months and 6 months
Changes in global ASD symptomatology assessed by Social Communication Questionnaire
Delta of scores at Social Communication Questionnaire
Time frame: 3 months and 6 months
Changes in Developmental Quotient
Delta of score at Griffiths Mental Developmental Scale
Time frame: 6 months
Changes in Adaptive Functioning
Delta of scores at Vineland Adaptive Behavior Scale-II
Time frame: 6 months
Changes in Behavioral Profiles
Delta of scores at Child Behavior Checklist 1.5-5
Time frame: 3 months and 6 months
Changes in Parental Stress
Delta of scores at Parenting Stress Index
Time frame: 3 months and 6 months