There are two closely related hormones, vasopressin and oxytocin, that have been extensively researched in autism.
With oxytocin you can modify social-bonding
behavior. You can increase oxytocin in the brain either via a nasal spray
containing oxytocin, or you can add a specific bacterium to your gut that
triggers a signal to the brain to produce more of its own oxytocin. The latter is my preferred method, because
you can produce a mild long-lasting effect throughout the day.
Oxytocin has a very short life and it
does not cross the blood brain barrier.
There is even a new study in the works
that will compare these two methods of treating autism.
Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by impairments in social interaction and communication. Oxytocin (OXT), as a neuropeptide, plays a role in emotional and social behaviors. Lactobacillus reuteri (L. reuteri) supplementation led to an OXT-dependent behavioral improvement in ASD mouse models. Despite some promising results from animal studies, little is known about the efficacy of supplementation with L. reuteri, alone or with exogenous OXT therapy, on social-behavioral functions in ASD patients. This paper presents a protocol for a pilot randomized controlled trial to evaluate the feasibility of conducting a full trial comparing oral supplementation of L. reuteri probiotics and intranasal OXT spray to placebo on the effect of social and behavioral functions in ASD patients. The study will also capture preliminary estimates of the efficacy of the proposed interventions in ASD patients.
Methods
This pilot trial is a
two-staged, randomized, double-blind, placebo-controlled, parallel-group study.
Throughout the study (0–24 weeks), 60 patients with ASD will be randomly
assigned to receive either oral L. reuteri probiotics or placebo. In the second
study stage (13–24 weeks), all participants will receive intranasal OXT spray.
As primary outcomes, serum OXT levels will be assayed and social behaviors will
be assessed via the Autism Behavior Checklist and the Social Responsiveness
Scale which are validated questionnaires, an objective emotional facial
matching test, and a new video-based eye-tracking test. Secondary outcomes
include the GI-severity-index and Bristol Stool Chart to assess GI function and
gut microbiome/short-chain fatty acids. All the outcomes will be assessed at
baseline and weeks 12 and 24.
Discussion
This pilot study will provide important information on the feasibility of recruitment, blinding and concealment, treatment administration, tolerability and adherence, specimen collection, outcome assessment, potential adverse effects, and the preliminary efficacy on both primary and secondary outcomes. If successful, this pilot study will inform a larger randomized controlled trial fully powered to examine the efficacies of oral L. reuteri probiotics and/or intranasal OXT spray on social-behavioral improvement in ASD patients.
My conclusion was to add two drops of L.Reuteri DSM 17938 (Biogaia Protectis) into the liquid part of my son's Polypill therapy. That way there are no extra pills to swallow and in theory the bottle should last 50 days, so I am not forever looking to buy more. If you want a bigger effect, just add more drops. The producer suggests a daily dose of 5 drops for babies, to promote GI health - the original intended purpose.
When it comes to Vasopressin it looks like you cannot avoid a nasal inhaler, unless you want to try transcutaneous electrical acupoint stimulation (TEAS). There is a debate as to whether Vasopressin and its analogs (man-made modified versions) can cross the blood brain barrier and to what extent.
There are 4 previous posts that looked at Vasopressin.
https://epiphanyasd.blogspot.com/search/label/Vasopressin
The Vasopressin showing good results
in the trials at Stanford is the injectable pharmaceutical version of the hormone made into a
nasal spray. This kind of spray could be
made easily at a compounding pharmacy.
It turns
out that a synthetic analog of vasopressin, called desmopressin, has been
widely used for over 40 years to treat nocturnal enuresis (night-time
bed-wetting) among other more serious conditions.
Desmopressin in
Autism
“Nocturnal enuresis is common in
individuals with but to our knowledge, there are no reports that desmopressin
enhances social functioning in ASD (or in any other clinical population). This
may be because desmopressin is typically administered at bedtime (so prosocial
effects would be less evident) and orally (oral desmopressin does not cross the
blood-brain barrier). The most likely explanation, however, is that
desmopressin acts selectively on AVPR2, rather than on AVPR1A”
From:
Desmopressin N=1 example
I was recently contacted by the father
of a young boy with autism who has been prescribed Desmopressin nasal spray by his neurologist.
The father noted major positive
behavioral changes from the first dose.
This is of course great news.
Desmopressin is a widely available
drug, seen as safe, and that is why it is prescribed to children.
In the US the nasal spray version is
no longer widely used for children and they use the oral version.
In some countries it is used for
people with MS (Multiple Sclerosis) with nocturnal enuresis.
Desmopressin Shortage
Before
readers get too excited, Ferring Pharmaceuticals, the big producer of
Desmopressin nasal sprays did voluntarily withdraw its brands (Minirin, DDAVP Nasal Spray, Desmopressin
Acetate Nasal Spray) from the market in August 2020 due to a
quality problem.
There is now a shortage and so what
was an easy to obtain drug, may be more difficult to get. There is a Pfizer version called Presinex.
From the above paper on vasopressin for autism:-
Vasopressin benefits
“In conclusion, the present pilot study determined that 4-week intranasal AVP treatment compared to placebo enhanced social communication abilities, diminished anxiety symptoms, and reduced repetitive behaviors in children with ASD. On nearly all behavioral measures, participants with the highest pre-treatment blood AVP concentrations benefitted the most from AVP treatment, suggesting that pre-treatment blood AVP concentrations may be useful for setting dosing guidelines for this medication. Last, intranasal AVP treatment was well tolerated with minimal side effects in this pediatric study population. These preliminary findings suggest that intranasal AVP treatment has potential to enhance social abilities in an ASD patient population characterized by currently intractable social impairments”
Transcutaneous electrical acupoint stimulation (TEAS) to raise vasopressin
“there is evidence that nonpharmacological interventions may facilitate endogenous AVP release, for example, electroacupuncture stimulation increases brain AVP concentrations in rats. Transcutaneous electrical acupoint stimulation (TEAS) therapy improves social functioning and anxiety symptoms in children with ASD, particularly in those with the largest post-treatment increase in blood AVP concentrations. The authors of this prior report theorized that increased AVP signaling may be the mechanism by which the prosocial and anxiolytic benefits of TEAS treatment were achieved”
Vasopressin with
Bumetanide - take great care
A while back, one reader did ask me
about taking intranasal Vasopressin with Bumetanide. His doctor in California thought this might not be wise since the two drugs have opposing effects.
·
Bumetanide (a
diuretic) makes you pee more.
·
Vasopressin (the
anti-diuretic hormone) makes you pee less.
The real problem is the risk of low
sodium, hyponatremia. This is always a
risk with vasopressin and the risk might well increase if you took Bumetanide. The risk is going to be dose dependent.
If you take Vasopressin and then drink
large amounts of water this will disturb the volume of fluids in your body and
in particular it will lower the level of sodium. This may lead to seizures and ultimately
worse.
Bumetanide does disturb the level of
electrolytes, but nearly all the change usually occurs in Potassium, this is
why you need to add back potassium via diet and add a supplement. Sodium is not normally a problem, but always
check all electrolytes when taking a blood draw.
If someone adds vasopressin to their
existing bumetanide therapy, the doctor should definitely monitor the level of
sodium.
In most people’s diet, sodium is one
thing you are likely to have too much of and it is very easy to add a bit more
sodium if the blood test suggests it is necessary. In extreme cases of low sodium you need to use a special re-hydration drink, or an intravenous saline solution. Monty has a relative who keeps going to hospital for the latter.
The diuretic action of Bumetanide is a
side effect of the "autism effect" and so if you can reduce the diuresis of bumetanide that would be
good thing. Researchers are trying to
find a better-bumetanide and their goal is to have no diuresis.
If combining vasopressin with
Bumetanide is accompanied by both reduced diuresis and a matching reduction in
fluid intake, this might actually work well.
Clearly, extra care needs to be taken and what might be perfectly safe
in one person may not be safe in another person.
Conclusion
I do
have to give a big thank-you to our reader who shared his experience with
Desmopressin and to the neurologist for suggesting it.
Desmopressin
looks like one of those autism therapies that needs only a very short trial to
determine whether it is beneficial. This
is a big advantage.
You
would hope the Stanford vasopressin researchers make a short trial of
Desmopressin, just to compare the effect.
They probably will not.
All
you have to decide is whether it is going to be the left nostril, or the right
nostril. With intranasal insulin there
was a problem with irritation inside the nose, so alternating left and right
sides might be best. You hold your
breath and then squirt the spray; the objective is not to breath the spray into
your lungs. An easy mistake to make.