MS, the gut, and Autism in males and females

 

There is quite a lot in this blog about MS (multiple sclerosis) because it is the classic myelin disorder and so is well researched. Many other neurological conditions, including some autism, also feature impaired myelination. 

One of the very cheap myelin therapies is the old anti-histamine drug Clemastine. I learnt this week that it will be trialed in children with Pitt Hopkins syndrome. It is a very logical choice and some parents have already trialed it. I used it for a few years and did feel there was a benefit. The key is to keep the dose low enough not to cause drowsiness. Very long term use may reduce acetylcholine in the brain, so it is not a forever medicine.

Then I saw some interesting research from Japan showing that it appears that multiple sclerosis starts in the gut.

We already know from interesting US research that you must have had the Epstein-Barr virus (EBV) to be able to develop MS. It also depends on the age at which you caught the virus. The older you were, the bigger the risk of later developing MS. So it is best to get EBV very young, or avoid it entirely by vaccination (expected to be available in 10 years). EBV is also known to increase the risk of certain cancers, so I guess the vaccination will get adopted.

 

The role of the gut

For years, researchers have suspected that the gut plays an important role in neurological conditions. What has been missing is a clear explanation, a step-by-step account of how something happening in the intestine could influence the brain.

A recent study provides exactly that for Multiple Sclerosis.

 

How Intestinal Cells Trigger Multiple Sclerosis

Summary: For years, scientists have suspected that the gut plays a role in Multiple Sclerosis (MS), but the “smoking gun” linking the two has been elusive. A landmark study has finally identified the cellular mechanism: Intestinal Epithelial Cells (IECs)—the cells lining your gut—are acting as “accidental” messengers.

The study found that in patients with MS, these gut cells abnormally express MHC II, a protein that “presents” antigens to the immune system. This interaction mistakenly transforms ordinary immune cells into pathogenic Th17 cells, which then migrate from the gut directly to the central nervous system to attack the brain and spinal cord.

Key Facts

·         The Accidental Messenger: IECs do not normally “talk” to the immune system in this way. In MS, they begin expressing MHC II, which “primes” CD4+ T cells to become aggressive.

·         The Th17 Migration: Using “Kaede” protein tracking (which changes colour under light), researchers proved that these gut-primed Th17 cells physically travel from the intestine to the spinal cord to drive neuroinflammation.

·         Human Connection: The team used single-cell RNA sequencing on human biopsies to confirm that the same inflammatory patterns seen in mouse models are present in the intestines of human MS patients.

·         New Treatment Target: Most current MS therapies target B cells in the blood; this study suggests that treating the gut environment or blocking the antigen-presenting activity of gut cells could stop MS at its source.

 

This new knowledge should shift the focus of treatment away from simply suppressing the immune system after damage has started, toward stopping the problem earlier at its source. Future therapies may aim to block these abnormal gut signals, target specific inflammatory pathways, and use gut-focused treatments such as microbiome modulation and diet. Overall, the goal is to prevent the immune system from being mis-trained in the first place, rather than just managing the consequences later.

  

The actual study:-

Intestinal epithelial MHC class II induces encephalitogenic CD4 T cells and initiates central nervous system autoimmunity

The gut as an immune training ground

The key finding is that cells lining the gut, intestinal epithelial cells, can act as unexpected immune instructors.

In MS, these cells begin expressing MHC class II, a molecule normally used by immune cells to “present” antigens. This abnormal behavior turns the gut lining into a kind of misguided training center.

The result is:

• Activation of Th17 cells
• These cells become highly inflammatory
• They migrate from the gut to the brain and spinal cord
• They drive autoimmune attack on myelin

This is a causal pathway from gut to brain.

 

A shared biological axis

The gut is not just influencing the brain, it is actively programming immune cells that control it.

This gut-immune-brain axis likely operates across multiple conditions, including autism, asthma, and ADHD.

 

Intestinal epithelial cells and autism

Intestinal epithelial cells sit at the center of the gut–immune interface and may also play a role in Autism.

They have three key functions.

 

1. Barrier control

IECs regulate what passes from the gut into the body.

If this barrier is altered, microbial products and metabolites may enter circulation and immune activation may increase

Some studies in autism report increased gut permeability, suggesting altered epithelial function.

 

2. Immune signaling

IECs actively communicate with the immune system. They release cytokines, influence T-cell behavior and potentially affect pathways like Th17 cells

In MS, abnormal IEC signaling directly drives inflammation.

In autism, similar immune pathways are implicated, though less directly established.

 

3. Microbiome interpretation

IECs “read” signals from gut microbes.

·        balanced microbiome produces healthy regulatory signals

·        dysbiosis produces inflammatory signals

 

In autism, microbiome differences are common, meaning IEC signaling may be altered.

 

Autism - same axis, different outcome

In autism, we see:

• altered microbiome
• gut inflammation
• immune activation (including Th17/IL-17 in some cases)

 

The difference is timing and target.

 

Step	MS (Adult)	Autism (Early Life)
Gut signal	IEC activation	Dysbiosis / gut inflammation
Immune response	Pathogenic Th17 cells	Altered immune signaling
Brain effect	Myelin attack	Developmental disruption
Timing	Adulthood	Early childhood

 

Why more females have MS

Multiple Sclerosis is 2–4 times more common in females.

Females have:

• stronger immune responses
• two X chromosomes (more immune genes)
• greater responsiveness to immune signals

When the gut sends the wrong signal, females are more likely to amplify it into autoimmunity.

Hormonal shifts (e.g., pregnancy/postpartum) further support an immune-driven mechanism.

 

Why more males have Autism

Severe autism is 3–4 times more common in males.

Males show:

• higher vulnerability during early brain development
• only one X chromosome (less genetic backup)
• less regulated early-life immune signaling

When the gut–immune system is activated early, males are more likely to cross the threshold into neurodevelopmental disruption.

Females appear more protected via:

• neural resilience
• better early immune regulation
• genetic redundancy

 

The EBV connection: a required trigger

One of the most important recent discoveries is the role of Epstein-Barr Virus infection in MS.

Large longitudinal studies show:

• individuals not infected with EBV almost never develop MS
• after EBV infection, the risk of MS increases dramatically (around 30-fold)

This suggests EBV is a necessary but not sufficient factor.

 

How EBV fits the model

EBV infects and persists in B cells, altering immune behavior. It may:

• create immune cells that recognize both viral proteins and brain proteins (molecular mimicry)
• keep B cells chronically activated
• prime the immune system toward autoimmunity

 

A multi-hit model of MS

The emerging picture is that MS requires multiple aligned factors:

1.     EBV infection
creates autoreactive immune potential

2.     Gut immune dysregulation
generates inflammatory Th17 cells

3.     Environmental modifiers (e.g., low vitamin D)
reduce immune regulation

Together, these drive immune attack on the brain

EBV loads the gun, the gut pulls the trigger, and the immune system fires at the brain.

 

Why MS varies by latitude

MS prevalence increases with distance from the equator.

• Lower rates near the equator
• Higher rates in northern regions

This reflects environmental effects on immune regulation.

 

Vitamin D and sunlight

Reduced sunlight lowers vitamin D, which normally:

• suppresses excessive Th17 cells activity
• promotes immune tolerance

Low vitamin D removes a key brake on autoimmunity.

 

Infection timing

Epstein-Barr Virus infection often occurs later in higher latitude regions, triggering stronger immune responses.

 

Microbiome differences

Geography affects diet and microbial exposure, shaping the gut–immune axis.

 

Hygiene effects

Reduced early microbial exposure may impair immune training.

 

Why some conditions improve with age

A striking observation across medicine is that many children “grow out of” certain conditions.

This includes:

• Mild autism (in some cases)
• Asthma
• Attention Deficit Hyperactivity Disorder

This reflects a shared biological pattern.

 

The dynamic regulation model

Early life is a period of high instability:

• the gut barrier is still developing
• the microbiome is fluctuating
• the immune system is learning tolerance
• the brain is highly sensitive

This creates a system that is:

• more reactive
• more inflammatory
• more vulnerable

 

What Changes Over Time

Three stabilizing processes occur:

1. Gut stabilization

• microbiome becomes more consistent
• fewer abnormal immune triggers

2. Immune regulation improves

• better control of inflammation
• reduced overactivation (including Th17 pathways)

3. Brain maturation

• circuits strengthen
• compensatory pathways develop
• regulation improves

 

The threshold effect

Symptoms can be viewed as crossing a threshold:

• Above threshold → visible condition
• Below threshold → mild or no symptoms

As stability improves:

• inflammation ↓
• regulation ↑

The individual may drop below the clinical threshold (unless they keep lowering the diagnostic threshold, as with autism)

 

Implications for Treatment

Focus on stabilizing the system, not just suppressing symptoms.

Potential approaches:

• improve gut health and microbiome stability
• reduce inappropriate immune activation
• support metabolic resilience
• ensure adequate vitamin D and environmental exposure
• minimize chronic inflammatory triggers

 

For MS:

• targeting EBV and gut immune programming may prevent disease at its source

 

For autism and related conditions:

• early stabilization of the gut–immune axis may improve outcomes

 

Does severe autism improve with age?

Severe autism is not a fixed condition where everything is determined at the start of life. While some children begin with greater challenges than others, what happens over time depends heavily on how skills develop during the long period of childhood and adolescence. These include communication, social interaction, emotional regulation, and daily living abilities. Early progress in these areas can create a positive ripple effect, making future learning easier and more natural.

If certain skills are delayed or missed early on, development may be slower—but this does not mean progress is impossible. The brain remains capable of learning and adapting, even later in life. This means that outcomes are not set in stone, much is up to the parents.

What shapes these outcomes is a combination of factors. Biology plays an important role—things like brain plasticity, energy levels, and overall health can influence how easily a child can learn. Biology can be modified pharmacologically, which is what EpiphanyASD is all about.

Biology is only part of the picture. Therapy, education, and the home environment are equally important. Structured teaching, repetition, encouragement, and meaningful interaction all create opportunities for skills to develop.

Importantly, these factors interact with each other. When a child’s biological state improves, they become more receptive to learning. In turn, effective therapy and support can help build new abilities, which further improves confidence, behavior, and engagement. This creates a positive cycle where progress builds on progress. Nothing changes over night, it is a slow process. Increasing skill acquisition rate by just 10% can lead to a massive difference over a decade.

This is why outcomes in autism are so variable. Two children who start at a similar level can follow very different paths depending on the opportunities they have and how their abilities are supported over time.

There are also important developmental windows, particularly in early childhood, when learning certain skills is easier. However, these windows do not fully close. Progress may become slower later, but it is still very much possible. Many individuals continue to gain skills well into adolescence and adulthood.

In this way, severe autism is better understood as a dynamic developmental process rather than a fixed outcome. The trajectory can be changed, sometimes substantially, depending on how biology, learning, and environment come together over time.

 

A note on EBV

Epstein–Barr virus (EBV), also known as human herpesvirus 4, is a common virus that infects most people and remains in the body for life. It is best known for causing infectious mononucleosis (“glandular fever”), especially when infection occurs in adolescence.

EBV spreads via saliva.

Childhood transmission is very common globally, but as hygiene increases it gets caught at older ages. In western countries kissing during adolescence is a major route.

90-95% of adults carry the EBV, the only question is at what age they were exposed.

Early exposure to EBV is less risky than late exposure. This fits the hygiene hypothesis, which has been covered in this blog and my book.

The hygiene hypothesis proposes that reduced exposure to microbes in early life results in less “training” of the immune system and causes higher risk of immune dysregulation in later life.

Exposure to pets at home will help train a young child’s immune system, but does not expose him/her to EBV, which is exclusively a human virus. 

Pentoxifylline – Clearly an Effective add-on Autism Therapy for some

 

They also had Pentoxifylline for autism back in the 1970s – time for a revival?

 

Pentoxifylline and other more modern PDE inhibitors have been mentioned many times in this blog.

https://epiphanyasd.blogspot.com/search/label/PDE4

https://epiphanyasd.blogspot.com/search/label/Pentoxifylline

Pentoxifylline has been used in autism clinical trials dating back almost 50 years. A casual observer would naturally assume it cannot possibly be effective, or else surely its use would have caught on by now.

Some readers have long been using a PDE inhibitor as part of their child’s autism polytherapy. People have been asking me to let them know my thoughts on Pentoxifylline, the most accessible PDE inhibitor.

I think the key is that we are talking about an add-on, or adjunct, therapy.  We are no longer talking about pentoxifylline therapy vs no therapy, as they were in the 1970s.  Even in those decades-old studies there was a sub group of “super responders”.  Either the percentage of such responders, or the “super-response” itself was just too small to create waves leading to wider adoption.

In my autism world, I had been trying to develop more expressive language using sulforaphane and calcium folinate (leucovorin). A comment from Valentina prompted me to finally start my trial of Pentoxifylline.  It became apparent that the amount of expressive language was increasing, but the major factor was the Pentoxifylline not the calcium folinate (leucovorin).  To avoid GI side effects, I give Pentoxifylline after meals, which means it does sometimes get omitted/forgotten. It emerged that expressive language was clearly correlated to whether Pentoxifylline was taken or forgotten.

Reviewing the old studies, increased use of language does get a mention as an effect of Pentoxifylline.

 

What is the biological effect of Pentoxifylline?

Pentoxifylline is a non-selective PDE inhibitor, which you might think is a bad thing, since it looks like is it just PDE4 that we want to inhibit.

Pentoxifylline is also a non-selective antagonist of adenosine receptors A₁ and A_2A that are located in both the heart and brain.  These two adenosine receptors have important roles in the brain, regulating the release of other neurotransmitters such as dopamine and glutamate.

Pentoxifylline is normally prescribed because of its effects on your blood.  It improves red blood cell deformability, reduces blood viscosity and decreases the potential for platelet aggregation and blood clot formation.  So not a bad potential drug for the effects of severe Covid (which causes "sticky" blood), or indeed the extremely rare negative reaction to Astra Zeneca’s vaccine reported in Norway.  I had my Astra Zeneca Covid shot last week and Monty will be having his. Even young children with severe autism have been vaccinated where we live, at the parents' insistence. It looks like crossing international borders is going to to be much easier with proof of vaccination, so even if you had the virus the vaccine is useful.  Most people we know have had the virus, since where we live public policy was more towards protecting livelihoods than lives.  A lack of obesity and very old people kept the death rate quite low.  Now we seem to have more vaccines than demand for them.

Studies show that Pentoxifylline increases blood flow to the brain.  We know that blood flow to the brain in autism is impaired; the research describes it as unstable rather than just weak.

It sounds like Pentoxifylline is a polytherapy in itself, it has so many effects possibly relevant to autism.

 

Are Ibudilast and Roflumilast/Daxas an alternative to Pentoxifylline?

This question has come up already in the comments section.

We know that Ibudilast and Roflumilast are much more selective for PDE4 than Pentoxifylline.  We know that both Ibudilast and Roflumilast have interesting effects on the brain.

Pentoxifylline has some potentially beneficial effects that are not shared by Ibudilast or Roflumilast.  Pentoxifylline is cheap and proven safe in a series of trials in young children. 

I think that the typical autism dose of Pentoxifylline, 200mg twice a day, likely does not provide the effect on PDE4 provided by the small dose of Roflumilast/Daxas used in trials to improve cognition and sensory gating.

I think you would need to trial the drugs separately and, if they indeed provide a benefit, find the effective combination.  

So far I have trialed the 100 mcg dose of Roflumilast/Daxas on myself to check for GI side effects and see if it affects how thoughts and sensory inputs are processed, as the research suggests it does. I think it does indeed have the cognitive effects, but in me personally the GI effects also appear.  Some readers have told me this 100 mcg dose works for Aspies, and without side effects.

Some readers have tried Ibudilast.

Ling favours Pterostilbene, a natural PDE4 inhibitor. Pterostilbene has many other modes of action, including relating to inflammation, diabetes, aging and even cancer.

  

Conclusion 

Polytherapy is becoming fashionable these days and it is about time too.  Here it is all about MS (Multiple Sclerosis):-

 

UK to test existing drugs as treatment for MS in world-first trial

“Ultimately, MS will be treated with a combination of drugs,” said Gray. “You’ll have immunomodulatory drugs and anti-inflammatory drugs that stop the immune attacks, and they will be combined with treatments that can protect nerves from damage, and treatments that can repair the damaged myelin. That should stop MS.”

 

Each drug, given individually, will not deliver a dramatic result, but in combination the effective can be substantial.

Autism also requires polytherapy.  A few small steps can take you a large stride forwards. 

I did once consider using the analogy of fixing an old car, but I thought people might not like it and also autism develops very early in life not at the end; but Professor Ramaekers used the analogy on me, so I will follow suit.

You may need to fix many things on an old car, to get it back to its former glory.  The more problems you fix, the better the result will be.  You just have to start and keep on going.

In autism, and car restoration, the order in which you fix things does matter.  You probably need to learn this the hard way.

In a near perfect car (Asperger’s) really small issues, like faulty electric windows or squeaky suspension, can be extremely annoying, though the car remains perfectly functional; it gets you from A to B.

Pentoxifylline, by itself, is not going to “cure” anyone’s autism, but for some people it will be another step in that direction.

 

Another old idea has resurfaced - sodium phenylbutyrate (shortened to NaPB).

I think this drug was used for completely the wrong reasons, by a tiny number of people, a decade ago, but now common mouse models of autism are showing that this pan-HDAC inhibitor and ER-stress inhibitor has potent beneficial effects.  It is changing gene expression via an epigenetic mechanism.

If you look on Google, it appears as another quack therapy.

Four autism treatments that worry physicians – LA Times in 2009

Four that worry physicians. The Chicago Tribune examined four treatments in depth. Medical experts said that the therapies have not been proved to help children with autism and that each also carries risks. 

#4 Phenylbutyrate

Kennedy Krieger Institute: “No research conducted into use for autism.” -- Trine Tsouderos and Patricia Callahan

 

https://www.chicagotribune.com/lifestyles/ct-xpm-2009-11-23-chi-autism-science-nov23-story.html

Patricia Kane, who calls herself "the queen of fatty acid therapy," initially sounds like a skeptic of alternative autism treatments. She distances herself from the Defeat Autism Now! approach and says hyperbaric oxygen therapy, IVIG and chelation drugs all can be harmful.

"If you could see what happens to children when they're given some of these crazy interventions that ruin their life, and it's so painful," said Kane, whose office is in New Jersey. "Parents say, 'Patricia Kane will tell us the truth,' and I believe parents deserve the medical truth when it comes to their children."

One of her fans is Kent Heckenlively, a California science teacher who writes for ageofautism.com, self-described as the "daily web newspaper of the autism epidemic." After spending "a couple of hundred thousands" on treatments, from chelation to stem cell therapy, for his daughter with autism, Heckenlively said Kane appealed to him in part because her protocol includes lab tests run by the prestigious Kennedy Krieger Institute.

"I can trust them, I think," Heckenlively said.

Kane, who points to neuroinflammation as a feature of autism, discusses Pardo's study in a chapter she co-wrote on autism treatments for the book "Food and Nutrients in Disease Management."

Kane says many children with autism have a buildup in their brains of a substance called very-long-chain fatty acids. Her "PK Protocol" -- named after her initials -- is aimed at burning them off with a prescription drug, phenylbutyrate, that is normally used to treat extremely rare genetic disorders in which ammonia builds up in the body.

Side effects of phenylbutyrate include vomiting, rectal bleeding, peptic ulcer disease, irregular heartbeat and depression. No clinical trials have evaluated this drug as an autism therapy, and the idea that very-long-chain fatty acids have a role in autism is not proven by science.

Kane is not a medical doctor. When treating children with autism, she says, she works in concert with the child's physician, who supervises treatment.

She said she holds a doctorate in nutrition that was issued by Columbia Pacific University, an unaccredited institution that was shut down after a lengthy court battle with the state of California. An administrative law judge in 1997 found that the school awarded excessive credit for prior experiential learning, failed to employ qualified faculty and didn't meet requirements for issuing degrees.

Kane said Columbia Pacific granted her a doctorate after the school "consolidated my work," which Kane described as "clinical work" and continuing medical education courses for doctors. Her doctorate is valid, she said, because it was issued before the university ran into problems with the state.

Last year she was the subject of a television news investigation about her work with patients with ALS, also known as Lou Gehrig's disease. The disease, which affects motor neurons, is a death sentence.

but now in 2021, things have changed:-

 

Sodium phenylbutyrate reduces repetitive self-grooming behavior and rescues social and cognitive deficits in mouse models of autism

We found that acute and chronic treatment of NaPB remarkably improved, not only core ASD symptoms, including repetitive behaviors and sociability deficit, but also cognitive impairment in the BTBR mice. NaPB substantially induced histone acetylation in the brain of the BTBR mice. Intriguingly, the therapeutic effects of NaPB on autistic-like behaviors, such as repetitive behaviors, impaired sociability, and cognitive deficit also showed in the valproic acid (VPA)–induced mouse model of autism

These findings suggest that NaPB may provide a novel therapeutic approach for the treatment of patients with ASD.

Correcting miss-expressed genes is the holy grail for the treatment of many diseases and in particular for all those parents whose child has a single gene type of autism.  In this blog I also call them DEGs (differentially expressed genes); everyone with autism has some DEGs. There is a lot in this blog about HDAC inhibitors, these can modify gene expression via the epigenome.  HDAC inhitors therefore can potentially fix DEGs.  NaPB was approved 25 years ago by the FDA to treat urea cycle disorders and is used in children over 20 kg.  It is not cheap and as usual it is much more expensive in the United States, at a high dose it is crazily expensive like cancer drugs, many of which are also HDAC inhibitors.  NaPB is another bulk chemical they put in tablets and multiply that cost by whatever they feel like. There is a reaction against this trend in some countries, for example using cheap generic Potassium Bromide for Dravet syndrome, instead of the overly expensive tablets. 

NaPB is used off-label to treat ALS/motor neuron disease.

 

More Research to support a Trial of Clemastine in Autism and particularly in Pitt Hopkins

                                                

Clemastine is an old antihistamine drug that we saw in earlier posts can stimulate oligodendrocytes to work harder and produce more myelin.

Myelin is needed to learn new skills and to control your body. It only starts to form in the third trimester, as the brain begins to grow rapidly. Myelination continues after birth but the rate appears to be controlled by social/emotional exposure.  The more isolated the baby is, the less myelin is produced.

                          

https://kids.frontiersin.org/article/10.3389/frym.2018.00020

Interruption of the myelination process is known to cause long term problems.

Loss of myelin and lack of remyelination underlies Multiple Sclerosis.

It appears that loss of myelin may underlie cognitive loss in regressive autism, childhood disintegrative disorder and adult hypoxia.  First the myelin layer is lost and, depending on the underlying dysfunction, the neuron may die.  If it is just a case of lost myelin this can potentially be repaired.

Girls with Rett syndrome regress and lose previously acquired skills at about 18 months.  Is the loss of skills also a manifestation of a loss of myelin?  If so, can this loss of skills be controlled to minimize its effect?

In a previous post we have looked at the repurposing of Clemastine to improve remyelination.  At high doses this is an emerging therapy for Multiple Sclerosis (MS).  MS is a progressive disease where myelin is repeatedly lost.  Myelin is not permanent and constantly needs to be “remyelinated”.

As Ling has noted, the Pitt Hopkins syndrome researchers have published their results looking at mouse models of both Pitt Hopkins and broader autism and they have found that the same oligodendrocyte genes are indeed dysregulated in all these cases.

We already knew that myelin in idiopathic autism is thinner than it should be, which was why I was originally looking at ways to enhance myelination.

The new research gives further support for remyelination as a target for improving learning, cognitive function and motor skills in autism.  The new data shows that this likely particularly applies to those with Pitt Hopkins syndrome.  This syndrome is caused by a lack of Transcription Factor 4 (TCF4) when one of the two copies of its gene is not functional.  A more modest lack of TC4 is likely to be much more common that Pitt Hopkins itself.

Defects of myelination are common pathophysiology in autism spectrum disorder

Autism Spectrum Disorder (ASD) is genetically heterogeneous in nature with convergent symptomatology, suggesting dysregulation of common molecular pathways. We analyzed transcriptional changes in the brains of five independent mouse models of Pitt-Hopkins Syndrome (PTHS), a syndromic ASD caused by autosomal dominant mutation in TCF4, and identified considerable overlap in differentially expressed genes (DEGs). Gene and cell-type enrichment analyses of these DEGs highlighted oligodendrocyte dysregulation and we confirmed the myelin-associated transcriptional signature in two additional mouse models of syndromic ASD (Pten^m3m4/m3m4, Mecp2^tm1.1Bird). We subsequently validated oligodendrocyte deficits in our Tcf4 mouse model which showed inefficient oligodendrocyte maturation in both an isolated oligodendrocyte in vitro cell culture system and ex vivo at day 24 (P24) and day 42 (P42). Furthermore, we used transmission electron microscopy (TEM) to visualize myelination in the corpus callosum (CC) of Tcf4^+/tr and Tcf4^+/+ littermates, observing a significant decrease in the proportion of myelinated axons in the CC of Tcf4^+/tr mice compared to Tcf4^+/+ littermates. Similar to our ex vivo IHC results, we observed a significant reduction in the number of CNP-positive oligodendrocytes in primary cultures derived from Tcf4^+/tr mice compared to Tcf4^+/+ littermates. When comparing compound action potentials (CAP) using electrophysiology, we show the ratio of N1/N2 is significantly reduced in the Tcf4^+/tr mice compared to Tcf4^+/+ littermates, indicative of a greater proportion of CAP traveling down unmyelinated axons. Moreover, we integrated syndromic PTHS mouse model DEGs with human ASD genes (SFARI) and human idiopathic ASD postmortem brain RNA-seq, and found significant enrichment of overlapping DEGs and common biological pathways associated with myelination. Remarkably, we show that DEGs from syndromic ASD mouse models can be used to identify human idiopathic ASD cases from controls. These results from seven independent mouse models of ASD are validated in human brain, implicating disruptions in oligodendrocyte biology as shared mechanisms in ASD pathology.

Here is more on the same paper:-

Loss of insulation on neurons may contribute to autism

Genes involved in the formation of myelin, a fatty substance that sheathes neurons, are altered in brain tissue from autistic people and in several mouse models. The mice also have unusually few myelinated nerve fibers.

Researchers presented the unpublished findings yesterday at the 2019 Society for Neuroscience annual meeting in Chicago, Illinois.

“In general, across the whole spectrum, there’s a defect in myelination,” says Brady Maher, lead investigator at the Lieber Institute for Brain Development in Baltimore, Maryland.

Myelination is the process by which neuronal fibers are coated in myelin. Myelin is made by brain cells called oligodendrocytes, and it enables fast neuronal signaling.

Maher and his colleagues saw hints that myelination is disrupted in Pitt-Hopkins syndrome, an autism-related condition caused by mutations in a gene called TCF4. Children with this rare syndrome are slow to learn to walk, and most are minimally verbal; some have autism.

The researchers analyzed gene expression patterns in five mouse models of this syndrome, each with a different mutation in TCF4. They found that in all of the mice, genes involved in myelination are among those with altered expression.

The researchers then compared gene expression patterns of the mutant mice with those of two other autism mouse models: mice with mutations in MECP2 or PTEN. All three mouse models show alterations in the expression of a shared set of 34 genes, most of which are involved in myelination.

The same genes show atypical expression in two independent gene-expression datasets from autistic people, the researchers found.

Maher says his team is investigating why the TCF4 mutant mice have too few oligodendrocytes. They are also testing whether drugs that enhance myelination reverse the mice’s problems.

Clemastine in Autism

Several readers of this blog have reported a positive effect from Clemastine, you can find their comments in earlier posts.

Monty, aged 16 with ASD, has been using it for many months and it will be added to my Polypill at the next update.

In the US Clemastine is no longer available in the OTC form.  It is available as a generic with a prescription

https://www.tevagenerics.com/product/clemastine-fumarate-tablets-usp

In the rest of the world it is called Tavegil, or Tavegyl and being a common hay fever drug is usually OTC (no prescription).

In the Baltic states 20 tablets cost Eur 5 (USD 5.50). In the United Kingdom 60 tablets costs GBP 10 (USD 13).  You may have to ask the pharmacy to order it for you, it is not widely stocked, or order it online.

A 1 mg tablet of Clemastine contains 1.34 mg of Clemastine hydrogen fumarate.  This can be confusing because one product is marked 1mg and the identical tablet is elsewhere marked 1.34mg.

The US product by Teva is Clemastine 2mg containing 2.7 mg of Clemastine hydrogen fumarate

The experimental dose in Multiple Sclerosis is so high it causes drowsiness.  Clemastine affects histamine H1 receptors in the brain and so makes you sleepy.

My “autism dose” is less than the hay fever dose and is 1mg Clemastine (containing 1.34 mg of Clemastine hydrogen fumarate) taken in the evening.

Some readers are giving a morning dose and an evening dose, as you would for hay fever.  I would expect this to have a greater effect on oligodendrocytes, but will come at the cost of a degree of drowsiness, which may or may not be important.

I think people should be given clemastine immediately after a regression into autism and also anyone suffering as result of hypoxia. We saw the MRI of a man treated with clemastine after hypoxia in an earlier post and we saw the myelin damage and its repair.

Given 18 months of age is the typical age for the first regression in autism, perhaps pediatricians should take note? Perhaps the Johns Hopkins doctors should try using it on their patients with mitochondrial disorders?

I would also think those with what was called CDD (childhood disintegrative disorder) would be likely beneficiaries.

Comments so far suggest that clemastine benefits some people more than others, but this is exactly what you would expect.  In the case of the man with hypoxia, clemastine really was a silver bullet, it was given very promptly and loss of myelin was his only problem.  Most people with severe autism have more problems than just patchy myelin.

Treatment Window

In some single gene autism there does appear to be a treatment window and this has been confirmed in animal models. One example is the very expensive use of the drug Rapamycin in TSC (tuberous sclerosis complex).

Multiple Critical Periods for Rapamycin Treatment to Correct Structural Defects in Tsc-1-Suppressed Brain


Many interventions however do seem to be beneficial regardless of age.

This can be summed up as “it's never too late, but the sooner you start the better the result will be”.

Will a toddler with Pitt Hopkins learn to walk much earlier if taking Clemastine?  The logic is there to support this.

Will a girl with Rett Syndrome regress less far if taking Clemastine, during the regression?

Conclusion

Most parents naturally hesitate to give drugs to treat children with autism. They do not hesitate to give numerous drugs to their elderly relatives, who are the ones who are most likely to get side effects and have much less time to benefit from them.

Some drugs are much safer than others and the irony is that the drugs commonly used to treat autism by psychiatrists are the ones with known problems.

It appears that many very safe existing drugs can be used to treat features of autism.

Do you wait a decade, or likely more, to see if a safe old hay fever drug might improve cognition and/or motor skills in your case of autism or Pitt Hopkins? Or just buy these hay fever pills and see for yourself?

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