Format

Send to

Choose Destination
Psychopharmacology (Berl). 2019 Oct;236(10):3045-3061. doi: 10.1007/s00213-019-05280-6. Epub 2019 May 28.

Beyond the brain: A multi-system inflammatory subtype of autism spectrum disorder.

Author information

1
Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
2
Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
3
Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA.
4
Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
5
Department of Neurology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
6
Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. cmcdougle@mgh.harvard.edu.
7
Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. cmcdougle@mgh.harvard.edu.
8
Lurie Center for Autism, 1 Maguire Road, Lexington, MA, 02421, USA. cmcdougle@mgh.harvard.edu.

Abstract

An immune-mediated subtype of autism spectrum disorder (ASD) has long been hypothesized. This article reviews evidence from family history studies of autoimmunity, immunogenetics, maternal immune activation, neuroinflammation, and systemic inflammation, which suggests immune dysfunction in ASD. Individuals with ASD have higher rates of co-morbid medical illness than the general population. Major medical co-morbidities associated with ASD are discussed by body system. Mechanisms by which FDA-approved and emerging treatments for ASD act upon the immune system are then reviewed. We conclude by proposing the hypothesis of an immune-mediated subtype of ASD which is characterized by systemic, multi-organ inflammation or immune dysregulation with shared mechanisms that drive both the behavioral and physical illnesses associated with ASD. Although gaps in evidence supporting this hypothesis remain, benefits of this conceptualization include framing future research questions that will help define a clinically meaningful subset of patients and focusing clinical interactions on early detection and treatment of high-risk medical illnesses as well as interfering behavioral signs and symptoms across the lifespan.

KEYWORDS:

Autism; Autoimmunity; Immune dysfunction; Inflammation; Medical co-morbidities; Spectrum disorder

PMID:
31139876
DOI:
10.1007/s00213-019-05280-6

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center