Autism Reality

Immunologist Responds to Wagnitz Mercury-Autism Link Argument

The Capital Times (Madison, Wisconsin) carried an opinion piece recently by Michael Wagnitz, a chemist with years of experience in trace analysis, who argued that the brains of some deceased autistic persons showed evidence of neuroinflammation which he attributed to mercury poisoning from the vaccine preservative thimerosal. On that basis Mr. Wagnitz argued that thimerosal poisoning is a cause of autism. The Capital Times has now published a passionate response to the Wagnitz argument by Cheryl A. Robinson, R.N., M.S., immunization program manager, public health, Madison and Dane county.

http://www.madison.com/tct/opinion/letters/index.php?ntid=121460&ntpid=2

Ms. Robinson takes particular aim at Wagnitz’s dismissal of epidemiological evidence refuting a thimerosal-autism link:

The real disservice to your readers was Michael Wagnitz’s dismissal of a vast body of epidemiological evidence. These studies compared large groups of children who received thimerosal-containing vaccine to large numbers of children who did not get these vaccines. The occurrence of autism in each group was the same. While no one believes that mercury is healthy for children or adults, there is simply no evidence demonstrating that thimerosal in vaccine causes or is linked to autism.

Developmental problems are most often noticed when children reach the age of 1 or 2 years – a time when children also receive a large number of immunizations. I understand how easy it is for families to link the two events.“

Ms. Robinson also notes that vaccines in the US are now thimerosal free, with the exception of influenza vaccine for which a thimerosal free version can be requested. She accuses Wagnitz of the kind of alarmism which drives some parents to avoid immunization an unwise decision which poses a genuine threat to public health.

Personally I have not been a subscriber to the mercury-autism link theory and do not think parents should avoid immunizing their children but I thought Mr. Wagnitz argument about neuro-inflammation interesting. Further scientific study and evidence may yet reveal some connection. We certainly should not stop looking at the best available evidence even if it contradicts our own views. I find discussions such as are taking place in the opinion pages of the Madison Capital Times helpful in understanding these issues and the developing state of scientific knowledge surrounding them.

March 4, 2007 Posted by | autism disorder, Capital Times, Madison, mercury, neuroinflammation, Robinson, thimerosal, vaccines, Wagnitz | Leave a comment

Too Soon to Write Off a Possible Mercury (Thimerosal) Autism Link ?

I have personally never been a believer in possible alleged mercury (thimerosal) autism link. Primarily because I accept the overwhelming consensus in the world scientific community that there is no link. Second, because I don’t believe in the conspiracy angle of those who postulate a mercury autism link. Third, for personal reasons, my son displayed unusual behavior, which we have documented in a large photograph collection, since birth. None the less I think that Michael Wagnitz has made a very interesting argument for the mercury vaccine connection. Mr. Wagnitz is a chemist with 20 years experience working trace metal analysis who argues that recent findings of clinical studies examining brain tissue, blood, urine and human cells make a strong case for thimerosal as the agent causing the neuroinflammation which has been found in the brains of deceased autistic persons. The following article in the Madison Wisconsin Capital Times is worth a read. It will be interesting to read critiques of Mr. Wagnitz’ theory but for now at least maybe it is worth waiting for more study before writing off the mercury-autism link.

Michael Wagnitz: Research supports mercury-autism link

By Michael Wagnitz

It was reported repeatedly in 2006 that the link between mercury-containing vaccines and autism has been disproven. Yet if one looks at the most recent research coming from some of our major universities, one may draw the opposite conclusion.

What we have learned in the last couple of years is that the underlying medical condition of autism is neuroinflammatory disease. In a study conducted at John Hopkins University, brain tissue from deceased autistic patients was examined. The tissue showed an active neuroinflammatory process and marked activation of microglia cells. Neuroinflammatory disease is synonymous with an activation of microglia cells.

A study done at the University of Washington showed that baby primates exposed to injected thimerosal (50 percent mercury), at a rate equal to the 1990s childhood vaccine schedule, retained twice as much inorganic mercury in their brains as primates exposed to equal amounts of ingested methylmercury. We know from autometallographic determination that inorganic mercury present in the brain, following the dealkylation of organic mercury, is the toxic agent responsible for changes in the microglial population and leads to neuroinflammation.

Recently it was shown that in more than 250 examined patients, atypical urinary porphyrins were almost three times higher in autistic patients than controls. Porphyrins are precursors to heme, the oxygen-carrying component of blood. Mercury inhibits the conversion of porphyrins to heme. When the patients were treated to remove mercury, urinary porphyrins returned to normal levels.

In a study done at the University of Arkansas, autistic children were found to have significantly lower levels of the antioxidant glutathione. Glutathione is the major antioxidant needed for the elimination of mercury at the cellular level. This may explain why some children are more severely affected by thimerosal in vaccines than others.

While all the government-conducted epidemiological (statistical) studies show no link between thimerosal and autism, the clinical studies examining brain tissue, blood, urine and human cells show a completely different picture.

Michael Wagnitz is a Madison resident with more than 20 years of experience as a chemist working with trace metal analysis.

Published: February 27, 2007

http://www.madison.com/tct/opinion/column/index.php?ntid=120748&ntpid=1

February 27, 2007 Posted by | autism disorder, John Hopkins University, mercury, neuroinflammation, thimerosal, Wagnitz | 1 Comment

Combating Autism Act Spurs Autism Research

The following article from the Psychiatric Times gives a good, digestible, overview of some of the autism studies currently being conducted even as the Combating Autism Act spurs more research.


New Act by Congress Gives Boost to Autism Research
By Arline Kaplan

February 2007, Vol. XXIV, No. 2

The passage and signing in December of the Combating Autism Act (S. 843), which authorizes $945 million over 5 years for research, screening, intervention, and education on autism spectrum disorders (ASD) and developmental disabilities, has been hailed by the advocacy group Cure Autism Now (CAN) as a “federal declaration of war on the epidemic of autism,” a disorder that affects 1 in 166 children. 1 Yet, some battles are already under way at NIMH’s Intramural Research Program, with patient recruitment proceeding for 3 major autism studies.

In a press statement, Jonathan Shestack, father of an autistic child and cofounder of CAN, a large private funding organization for autism research, said S. 843 (now Public Law 109-416) “creates a congressionally mandated road map for a federal assault on autism, including requirements for strategic planning, budget transparency, congressional oversight, and a substantial role for parents of children with autism in the federal decision-making process.”

Key provisions of the law, subject to the availability of appropriations, call for the following:

* Expanded research on ASD, including basic and clinical research in such fields as pathology, developmental neurobiology, genetics, pharmacology, nutrition, immunology, neurobehavioral development, and toxicology.
* The CDC to increase and update its efforts to monitor autism incidence and prevalence around the country and to support the establishment of regional Centers of Excellence in the epidemiology of ASDs and other developmental disabilities.
* Development of a curriculum for continuing education to assist in recognizing the need for valid and reliable screening tools and in using those tools.
* Early screening of individuals at higher risk for ASD and other developmental disabilities.
* Congressional oversight of the Autism Centers of Excellence.
* Expansion and reauthorization of the Interagency Autism Coordinating Committee, composed of relevant government officials, experts, families of those with ASD, and at least one individual who has ASD.

Autism trials

The NIMH studies on the NIH campus in Bethesda, Md, are the first products of a new, integrated focus on autism. One study, “Clinical and Immunological Investigations of Sub-types of Autism,” seeks to learn more about autism and its subtypes. “It is actually two studies in one,” said Susan Swedo, MD, chief of NIMH’s Pediatrics and Developmental Neuropsychiatry Branch.

The first is a study of regressive versus nonregressive autism to determine whether there is an immune or other systemic trigger of children’s neurologic regression, she said. It involves 50 children with idiopathic autism and regression, 50 children with idiopathic autism and no history of regression, 25 children with Rett syndrome, and 50 healthy children. The age range of all 4 groups is between 12 months and 48 months at first visit.

The second component to the study, Swedo said, is part of the Autism Phenome Project, a pilot investigation being conducted in collaboration with David Amaral, PhD, Beneto Foundation Professor and director of research at the M.I.N.D. Institute at the University of California, Davis. Between the 2 sites, the pilot phase of the phenome study involves 50 to 100 children with autism, 50 children with developmental delays, and 50 to 100 children without disorders. The purpose is to identify clinically meaningful subtypes of autism, which could lead to better understanding of the etiology and pathophysiology of the disorder.

Increasingly, researchers are considering that autism may be multiple disorders. The regressive subtype is well characterized, Swedo said, although there is some debate about how common it is. The reports vary from indicating that as few as 10% to as many as 40% of children with autism have a pattern of regression.

With regressive autism, Swedo explained, you have a history of the child developing typically until age 12 to 18 months with appropriate development of language and social skills and then the child loses words and social skills and begins to look indistinguishable from children who have had autistic symptoms from birth or early on.“Some investigators have found that the regressive subtype actually has a worse prognosis,” she said.

To explain the regression, Swedo said that the research team’s working hypothesis is that there are environmental triggers or perhaps genetic aberrations that are expressed at this particular point in the child’s development. One possibility based on Swedo’s work with obsessive-compulsive disorder and the pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections subgroup is that regressive autism develops following a viral or bacterial infection that triggers an autoimmune response and neuropsychiatric symptoms.

The phenome study includes questions related to a child’s exposure to environmental toxins and household products; neuroimaging (structural MRI); and biomarkers; as well as very careful behavioral, neurologic (eg, via electroencephalograms administered while the child sleeps in the hospital overnight), and physical assessments. “The children will be monitored every 6 months to a year until they are age 5, and then intermittently after that time” to examine the validity of their diagnosis and how their symptom course evolves over time, Swedo added.

Minocycline study

In another small-scale intramural study, Treatment of Childhood Regressive Autism With Minocycline: An Anti-Inflammatory Agent Active Within the CNS, NIMH researchers are examining the use of the antibiotic minocycline (Dynacin, Minocin, Myrac) in children aged 3 to 12 years with regressive autism.

“We are using minocycline, a tetracycline derivative, not for its effectiveness as an antibiotic but rather for its ability to modulate the immune system,” Swedo said. “It has fairly specific effects on NF-kappa B and therefore inhibits the initiation of the cascade that leads to inflammation. Published data from the Johns Hopkins group [2,3] demonstrate that brains of individuals with autism have evidence of chronic neuroinflammation. We hope that by stopping that process, the children will be able to recover some of their skills. We are conducting an open-label trial in 10 children and are accepting referrals. If the results are encouraging, we will do a placebo-controlled trial in a larger cohort of subjects.”

Asked about other pharmacologic approaches being investigated at NIMH, Swedo responded, “We have a few in [the] pipeline, but it is premature to talk about them. Eric Hollander, MD, has been doing some work with oxytocin, reported at the American College of Neuropsychopharmacology’s annual meeting.”

Hollander, chairman of psychiatry at the Mt Sinai School of Medicine in New York and director of the Seaver and New York Autism Center of Exellence, and Jennifer Bartz, PhD, found that pitocin (synthetic oxytocin), administered intravenously or nasally, may have significant positive effects in adults with autism. Oxytocin, a hormone that is best known for activity during birth and lactation, is also a brain neurotransmitter involved in social recognition and bonding.

Chelation therapy

The third NIMH study, “Mercury Chelation to Treat Autism,” seeks to address whether chelation therapy can be helpful for autism. The chelation study is a placebo-controlled trial that involves use of meso-2,3-dimercaptosuccinic acid (DMSA, succimer), an orally adminstered chelating agent that binds to all metals including mercury and lead but also to some beneficial metals, such as zinc and iron, according to Swedo. DMSA is commonly used to treat autism, with some surveys estimating that 1 in 12 children with autism has undergone chelation, although it has never been tested in a controlled study and there is no proof that it helps children with the disorder. Support for its use is based on single-case reports of benefits of chelation with DMSA.

Children aged 4 to 10 years in whom autism, Asperger disorder, or pervasive child developmental disorders have been diagnosed; who weigh at least 33 lb; who have detectable, but not toxic, levels of mercury or lead in the blood; and who have not previously received chelation therapy may be eligible for this study.

“The chelation study is based on the hypothesis that mercury toxicity is responsible for at least some cases of autism,” Swedo said. She explained that extensive controversy surrounds the issue of mercury toxicity in autism. The Institute of Medicine (IOM) conducted a comprehensive study of the question of whether thimerosal, an ethylmercury-based compound used previously in the United States as a vaccine preservative for routine childhood immunizations, contributed to the apparent increase in the prevalence of ASDs. 4 The IOM panel concluded that there was no evidence for an association, but the report has been dismissed by some parents who report “toxic mercury levels” among their affected children and who have observed benefits of open-label DMSA administration.

To answer the question in a controlled fashion, the NIMH will enroll about 120 children in the chelation study, with half randomized to placebo and half to DMSA. The trial will last for 6 months, and researchers are enrolling participants now. “We would love to receive referrals,” Swedo said, adding that psychiatrists can find out more by going to http://www.clinicaltrials.gov or by contacting Lorraine Lougee, LCSW, research coordinator. Lougee’s e-mail address is LougeeL@intra.nimh.nih.gov.

Incidence and prevalence

Because of recurrent questions about whether autism is increasing, Swedo was asked about incidence and prevalence. “We have absolutely no data on incidence,” she said. “We can say the disorder appears to be more prevalent now than it has been reported in the past. However, there was a major change in diagnostic criteria and case-finding methods, so it is unclear [whether] it represents a true change in rates of affected individuals. . . . The CDC is conducting several studies currently to address that question.”

There is increasing agreement on what true autism is, using the Autism Diagnostic Observational Schedule, a semistructured observational scale developed to assess social interaction, communication, and play in persons suspected of having autism, and the Autism Diagnostic Interview, Swedo said.

“Those 2 give you nice, reliable cutoffs where you can say a child has autism, is on the autism spectrum, or is developing typically. Including children on the autism spectrum will increase apparent prevalence rates,” Swedo said. “The figure of 1 in 166 children having autism was recently confirmed in a CDC study that reviewed school records and confirmed the diagnosis from medical records. But the study included all children with an ASD as having ‘autism’—this included not only severely affected individuals with full-blown autism but also those with a pervasive developmental disorder not otherwise specified and those with Asperger disorder, a condition [that] is not as impairing.”

“In order to determine the true prevalence of autism and to know whether there is an ‘epidemic’ as some have asserted,” Swedo continued, “we need to have better data about the current prevalence of autism and related disorders and then compare those data with comparable data from previous studies. The CDC is conducting surveillance studies at a number of US sites, and the NIH is sponsoring longitudinal investigations here and abroad to address those questions.”

References

1. Centers for Disease Control and Prevention. How common are autism spectrum disorders (ASD)? Available at: http://www.cdc.gov/ncbddd/autism/asd_common.htm. Accessed January 5, 2007.
2. Pardo CA, Vargas DL, Zimmerman AW. Immunity, neuroglia and neuroinflammation in autism. Int Rev Psychiatry. 2005;17:485-495.
3. Vargas DL, Nascimbene C, Krishnan C, et al. Neuroglial activation and neuroinflammation in the brain of patients with autism [published correction appears in Ann Neurol. 2005;57:304]. Ann Neurol. 2005;57:67-81.
4. Board on Health Promotion and Disease Prevention, Institute of Medicine. Immunization Safety Review: Vaccines and Autism (2004). Available at: http://www.nap.edu/books/030909237X/html/1.html. Accessed January 5, 2007.

http://www.psychiatrictimes.com/showArticle.jhtml?articleId=197002523&pgno=1

February 27, 2007 Posted by | Asperger Disorder, autism disorder, chelation, Combating Autism Act, diagnosis, mercury, minocycline, neuroinflammation, oxytocin, PDD-NOS, prevalence, Psychiatric Times, thimerosal | Leave a comment