Research

Heal the body,

help the brain
Parents have long reported gut problems in
children with autism. But a new treatment,
Microbiota Transfer Therapy (MTT), is
reporting remarkable results in reducing
gut and debilitating autism symptoms.
Dr Ben Marlow discusses the approach with
one of its pioneers, Professor James Adams

My five-year-old son Freddie has
a diagnosis of ‘severe autism’. He
has terrible gut issues that have left
him in serious pain (he has an
incredibly high pain threshold, so
this pain must be awful). He has
sleepless nights, early-morning
Dr Ben Marlow is a waking and screaming, and awful
consultant loose, sticky stools that are
paediatrician
(neurodisability)
incredibly offensive.
Stool tests have revealed very
working for the NHS
in Essex. He is also
father to Freddie, who
restricted gut flora, predominated
by raised clostridial species. Using
antibiotics and additional
has autism supplements, we have managed to
improve his pain and many
gastrointestinal symptoms, but we
are always looking for help in this
area. I have seen many children
with autism in my NHS clinic
(especially on the severe end of the
spectrum) with similar gut issues;
unfortunately, there has almost
become an acceptance that this is
‘part of autism’, so the problem is
not being properly addressed.
Gut-brain axis
A dysregulated gut-brain axis (the
biochemical communication
system between the gut and the
brain) has been implicated in a
number of neurodevelopmental
disorders1. These include ASD2,
Parkinson’s, Alzheimer’s and, more
recently, fibromyalgia. Growing
I have seen
many children
with autism in my NHS
clinic with gut issues;
unfortunately, there
has almost become an
acceptance that this is
‘part of autism’”
evidence from research has shown
that children with ASD have distinct
gut microbiomes that can’t be
explained merely by them having a
Gut action: restricted diet. My question is: are
an illustration the distinct gut microbiomes a
of the human primary cause of autism, or a
digestive secondary problem that propagates
system, with a the ongoing symptoms?
close-up view It makes sense either way to
of intestinal better understand an individual’s
bacteria microbiome, eradicate the problem
bacteria and introduce beneficial
ones. The hypothesis would be that
the deranged gut-brain axis will
function better. One of the
researchers who is innovating and
paving the way in this area is
Professor James Adams, who
directs the autism/Asperger’s
research programme at Arizona
State University.
Professor Adams’ work
Professor Adams’ background is in
engineering, but after one of his
three children was diagnosed with
ASD in 1994 he dedicated his
research to the field of autism. He
has published remarkable work
that explores not only the
microbiome, but also nutritional
and dietary interventions3. His
collaborator on microbiome
evaluations is Professor Rosa
Krajmalnik-Brown who, like
Professor Adams, is based at
Arizona State University.
I had the pleasure of speaking
to Professor Adams via videolink
about a two-year follow-up study to
his initial Microbiota Transfer
Therapy (MTT) trial. MTT is a
special type of faecal transplant,
and the two-year follow-up shows
remarkable improvements in gut
health and autism symptoms long
after treatment.
Prof Adams interview
Q Please tell us about the
MTT trial
A The trial involved 18 children
(aged 7-16) with a diagnosis
of ASD (83 per cent defined as
severe). They were given pre-
treatment with Vancomycin for two
weeks and a bowel cleanse,
followed by eight weeks of MTT.

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We support over 720 autistic people across the UK
Q What did the initial
results show? A Reduced microbiome diversity
is linked to factors such as

and have 37 specialist autism services that are either A An 80 per cent reduction in GI
[gastrointestinal] symptoms,
based on the ‘Gastrointestinal
accredited or working towards accreditation with the Rating Scale’ (GSRS), a 25 per cent
National Autistic Society. reduction in core ASD symptoms
scored through CARS [Childhood
lower fibre intake (mother), and
C-sections leading to less
exposure to microbes from the
vaginal and GI tracts. Antibiotic
use in pregnancy and the first few
months of infancy, and children

Our support for autistic people is designed around your

needs and interests. We also involve you in choosing your
7,800+ Autism Rating Scale], and an
improvement in social skills, with
reduction in hyperactivity, irritability
being breast-fed for a shorter time
also add to it.
The lack of diversity results in
Voyage
Care sta and stereotypy. The average impaired metabolism and epithelial
support workers, giving you confidence you have well- now com ff have developmental age improved by cell function, leading to increased
trained staff who understand you and your autism. pleted o
our spe ne of 1.4 years. intestinal permeability. Pathogens

We can support you in many ways, including everyday

cialist a
training
courses
utism
.
living at home, going out and finding education or
employment. Whatever you’re doing, we here to provide
great quality care and support.
Pioneers: The study was ‘open label’, so both
Professor researchers and participants knew
Adams and they were receiving the treatment.
colleague
Professor Rosa Q What was in the
microbiota you used?
Krajmalnik-
Brown A It’s a highly purified product
(99 per cent bacteria), freeze-
dried for storage. It reflects a large
diversity of commensal [normal]
microbes from a healthy donor. It is
then made into a liquid (scent and
taste free) and given orally with
stomach acid suppressants. Six
This is Michael - we have
supported him to finish
children were given the treatment
rectally (non-sedated). This Initially
was three times a day for two days
another year at college! and then daily for eight weeks.
Other infections, such as
Clostridium difficile, have been
shown to only require one to two
doses, but for some reason
children with ASD require daily
treatment for many weeks.
Q Were these
improvements
maintained at two years?
A In the follow-up at two years
there was a 59 per cent
reduction in GI symptoms compared
to baseline; and a low gradual
improvement in core ASD features,
with a 47 per cent reduction in core
autism symptoms compared to
baseline. At the start of the study,
83 per cent of participants were
deemed ‘severe,’ yet after two years
At the start of
the study, 83 per
cent of participants
were deemed ‘severe,’
yet after two years
only 17 per cent had
that label”
only 17 per cent had that label. The
Vineland Adaptive Behaviour Scale
(VABS) also showed a developmental
improvement of 2.5 years.
Q Incredible! Was this
change reflected in
increased gut diversity?
are more able to enter the body
through the gut, triggering the
immune system.
Q When can Freddie
and other children in
the UK have access to
this treatment?
A We are trying to set up a
Phase 2 trial involving 50
children aged 5-17 that will be
randomised, double-blind and
placebo controlled.
The study has been approved
by the FDA and funding is being
sought, but this will not be
available to UK children even if
they are flown to the US.
However, depending on the
results, the plan will be to extend
this to Phase 3 multisite, which
potentially can be open to children
in the UK. Funding is an issue, as it
costs £1 million for a study
involving 50 children.
Q That is frustrating,
what about MTT in the
UK or Europe?
A MTT from donors should be
regulated and properly
screened. There has been a recent
case of one serious illness and one
adult fatality, where both patients
were immunosuppressed and
received donor stool with MDR

REFERENCES
A These behaviours were
mirrored with increased gut
diversity. There was a 200-times
(multidrug resistant bacteria).
Also, in autism the duration of
MTT has to be for much longer
1
Rogers, GB et al: ‘From gut dysbiosis to altered brain increase in Prevotella [bacteria that than in other conditions – in this
function and mental illness: mechanisms and produce butyrate, which provides study it was eight weeks, but
pathways.’ Molecular Psychiatry 21, 738–748,  energy to gut epithelial cells], and a we’re still not sure about the
https://doi.org/10.1038/mp.2016.50 (2016). four-times increase in correct duration.

Get in touch
2
Sharon, G, Sampson, TR, Geschwind, DH & Mazmanian, Bifidobacterium [highly beneficial However, there are many other
SK: ‘The central nervous system and the gut digestive bacteria]. nutritional and dietary supports that
microbiome.’ Cell 167, 915–932, 
https://doi.org/10.1016/j.cell.2016.10.027 (2016).
3
Adams et al, 2018: ‘Comprehensive nutritional and dietary
Q Why is a reduced
microbiome diversity
seen in ASD, and how
I would recommend from my
recently published paper in
Nutrients3. The supports are now
0800 035 3776 Intervention for autism spectrum disorder – a randomised, does this contribute to described for parents as the
controlled 12-month trial.’ Nutrients 10 (3) 369. GI symptoms and core ‘ANRC Protocol’, and are available
referrals@voyagecare.com https://www.ncbi.nlm.nih.gov/pubmed/29562612 ASD features? at www.autismNRC.org

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