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Debbaut E, Steyaert J, El Bakkali M. Autism spectrum disorder profiles in RASopathies: A systematic review. Mol Genet Genomic Med 2024; 12:e2428. [PMID: 38581124 PMCID: PMC10997847 DOI: 10.1002/mgg3.2428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 03/10/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND RASopathies are associated with an increased risk of autism spectrum disorder (ASD). For neurofibromatosis type 1 (NF1) there is ample evidence for this increased risk, while for other RASopathies this association has been studied less. No specific ASD profile has been delineated so far for RASopathies or a specific RASopathy individually. METHODS We conducted a systematic review to investigate whether a specific RASopathy is associated with a specific ASD profile, or if RASopathies altogether have a distinct ASD profile compared to idiopathic ASD (iASD). We searched PubMed, Web of Science, and Open Grey for data about ASD features in RASopathies and potential modifiers. RESULTS We included 41 articles on ASD features in NF1, Noonan syndrome (NS), Costello syndrome (CS), and cardio-facio-cutaneous syndrome (CFC). Individuals with NF1, NS, CS, and CFC on average have higher ASD symptomatology than healthy controls and unaffected siblings, though less than people with iASD. There is insufficient evidence for a distinct ASD phenotype in RASopathies compared to iASD or when RASopathies are compared with each other. We identified several potentially modifying factors of ASD symptoms in RASopathies. CONCLUSIONS Our systematic review found no convincing evidence for a specific ASD profile in RASopathies compared to iASD, or in a specific RASopathy compared to other RASopathies. However, we identified important limitations in the research literature which may also account for this result. These limitations are discussed and recommendations for future research are formulated.
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Affiliation(s)
- Edward Debbaut
- Center for Developmental Psychiatry, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Leuven Autism Research (LAuRes)KU LeuvenLeuvenBelgium
| | - Jean Steyaert
- Center for Developmental Psychiatry, Department of NeurosciencesKU LeuvenLeuvenBelgium
- Leuven Autism Research (LAuRes)KU LeuvenLeuvenBelgium
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Moerkerke M, Daniels N, Tibermont L, Tang T, Evenepoel M, Van der Donck S, Debbaut E, Prinsen J, Chubar V, Claes S, Vanaudenaerde B, Willems L, Steyaert J, Boets B, Alaerts K. Chronic oxytocin administration stimulates the oxytocinergic system in children with autism. Nat Commun 2024; 15:58. [PMID: 38167302 PMCID: PMC10762037 DOI: 10.1038/s41467-023-44334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Clinical efficacy of intranasal administration of oxytocin is increasingly explored in autism spectrum disorder, but to date, the biological effects of chronic administration regimes on endogenous oxytocinergic function are largely unknown. Here exploratory biological assessments from a completed randomized, placebo-controlled trial showed that children with autism (n = 79, 16 females) receiving intranasal oxytocin for four weeks (12 IU, twice daily) displayed significantly higher salivary oxytocin levels 24 hours after the last oxytocin nasal spray administration, but no longer at a four-week follow up session. Regarding salivary oxytocin receptor gene (OXTR) epigenetics (DNA-methylation), oxytocin-induced reductions in OXTR DNA-methylation were observed, suggesting a facilitation of oxytocin receptor expression in the oxytocin compared to the placebo group. Notably, heightened oxytocin levels post-treatment were significantly associated with reduced OXTR DNA-methylation and improved feelings of secure attachment. These findings indicate that four weeks of chronic oxytocin administration stimulated the endogenous oxytocinergic system in children with autism.
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Affiliation(s)
- Matthijs Moerkerke
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Nicky Daniels
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Laura Tibermont
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Tiffany Tang
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Margaux Evenepoel
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Stephanie Van der Donck
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Edward Debbaut
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Jellina Prinsen
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Stephan Claes
- University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Bart Vanaudenaerde
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Illness and Metabolism, KU Leuven, Leuven, Belgium
| | - Lynn Willems
- Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Illness and Metabolism, KU Leuven, Leuven, Belgium
| | - Jean Steyaert
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Bart Boets
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Kaat Alaerts
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
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Moerkerke M, Daniels N, Van der Donck S, Tibermont L, Tang T, Debbaut E, Bamps A, Prinsen J, Steyaert J, Alaerts K, Boets B. Can repeated intranasal oxytocin administration affect reduced neural sensitivity towards expressive faces in autism? A randomized controlled trial. J Child Psychol Psychiatry 2023; 64:1583-1595. [PMID: 37278339 DOI: 10.1111/jcpp.13850] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by difficulties in social communication and interaction. Crucial for efficient social interaction is the ability to quickly and accurately extract information from a person's face. Frequency-tagging electroencephalography (EEG) is a novel tool to quantify face-processing sensitivity in a robust and implicit manner. In terms of intervention approaches, intranasal administration of oxytocin (OT) is increasingly considered as a potential pharmacological approach for improving socio-communicative difficulties in ASD, through enhancing social salience and/or reducing (social) stress and anxiety. METHODS In this randomized, double-blind, placebo-controlled, mechanistic pharmaco-neuroimaging clinical trial, we implemented frequency-tagging EEG to conduct an exploratory investigation into the impact of repeated OT administration (4 weeks, 12 IU, twice daily) on neural sensitivity towards happy and fearful facial expressions in children with ASD (8-12 years old; OT: n = 29; placebo: n = 32). Neural effects were assessed at baseline, post-nasal spray (24 hr after the last nasal spray) and at a follow-up session, 4 weeks after the OT administration period. At baseline, neural assessments of children with ASD were compared with those of an age- and gender-matched cohort of neurotypical (NT) children (n = 39). RESULTS Children with ASD demonstrated reduced neural sensitivity towards expressive faces, as compared to NT children. Upon nasal spray administration, children with ASD displayed a significant increase in neural sensitivity at the post- and follow-up sessions, but only in the placebo group, likely reflecting an implicit learning effect. Strikingly, in the OT group, neural sensitivity remained unaffected from the baseline to the post-session, likely reflecting a dampening of an otherwise typically occurring implicit learning effect. CONCLUSIONS First, we validated the robustness of the frequency-tagging EEG approach to assess reduced neural sensitivity towards expressive faces in children with ASD. Furthermore, in contrast to social salience effects observed after single-dose administrations, repeated OT administration dampened typically occurring learning effects in neural sensitivity. In line with OT's social anxiolytic account, these observations possibly reflect a predominant (social) stress regulatory effect towards emotionally evocative faces after repeated OT administration.
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Affiliation(s)
- Matthijs Moerkerke
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Nicky Daniels
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Stephanie Van der Donck
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Laura Tibermont
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Tiffany Tang
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Edward Debbaut
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Annelies Bamps
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Jellina Prinsen
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jean Steyaert
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Kaat Alaerts
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Research Group for Neurorehabilitation, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Bart Boets
- Center for Developmental Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
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Daniels N, Moerkerke M, Steyaert J, Bamps A, Debbaut E, Prinsen J, Tang T, Van der Donck S, Boets B, Alaerts K. Effects of multiple-dose intranasal oxytocin administration on social responsiveness in children with autism: a randomized, placebo-controlled trial. Mol Autism 2023; 14:16. [PMID: 37081454 PMCID: PMC10117268 DOI: 10.1186/s13229-023-00546-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Intranasal administration of oxytocin is increasingly explored as a new approach to facilitate social development and reduce disability associated with a diagnosis of autism spectrum disorder (ASD). The efficacy of multiple-dose oxytocin administration in children with ASD is, however, not well established. METHODS A double-blind, randomized, placebo-controlled trial with parallel design explored the effects of a 4-week intranasal oxytocin administration (12 IU, twice daily) on parent-rated social responsiveness (Social Responsiveness Scale: SRS-2) in pre-pubertal school-aged children (aged 8-12 years, 61 boys, 16 girls). Secondary outcomes included a questionnaire-based assessment of repetitive behaviors, anxiety, and attachment. Effects of oxytocin were assessed immediately after the administration period and at a follow-up, 4 weeks after the last administration. The double-blind phase was followed by a 4-week single-blind phase during which all participants received intranasal oxytocin. RESULTS In the double-blind phase, both the oxytocin and placebo group displayed significant pre-to-post-improvements in social responsiveness and secondary questionnaires, but improvements were not specific to the intranasal oxytocin. Notably, in the single-blind phase, participants who were first allocated to intranasal placebo and later changed to intranasal oxytocin displayed a significant improvement in social responsiveness, over and above the placebo-induced improvements noted in the first phase. Participants receiving oxytocin in the first phase also showed a significant further improvement upon receiving a second course of oxytocin, but only at the 4-week follow-up. Further, exploratory moderator analyses indicated that children who received psychosocial trainings (3 or more sessions per month) along with oxytocin administration displayed a more pronounced improvement in social responsiveness. LIMITATIONS Future studies using larger cohorts and more explicitly controlled concurrent psychosocial trainings are warranted to further explore the preliminary moderator effects, also including understudied populations within the autism spectrum, such as children with co-occurring intellectual disabilities. CONCLUSIONS Four weeks of oxytocin administration did not induce treatment-specific improvements in social responsiveness in school-aged children with ASD. Future studies are warranted to further explore the clinical efficacy of oxytocin administration paired with targeted psychosocial trainings that stimulate socio-communicative behaviors. Trial registration The trial was registered with the European Clinical Trial Registry (EudraCT 2018-000769-35) on June 7th, 2018 ( https://www.clinicaltrialsregister.eu/ctr-search/trial/2018-000769-35/BE ).
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Affiliation(s)
- Nicky Daniels
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Box 1501, 3001, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Matthijs Moerkerke
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Jean Steyaert
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Child Psychiatry, UPC KU Leuven, Leuven, Belgium
| | - Annelies Bamps
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Department of Child Psychiatry, UPC KU Leuven, Leuven, Belgium
| | - Edward Debbaut
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Department of Child Psychiatry, UPC KU Leuven, Leuven, Belgium
| | - Jellina Prinsen
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Box 1501, 3001, Leuven, Belgium
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
| | - Tiffany Tang
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Stephanie Van der Donck
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Bart Boets
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Kaat Alaerts
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, Box 1501, 3001, Leuven, Belgium.
- Leuven Autism Research (LAuRes), KU Leuven, Leuven, Belgium.
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Knops N, Herman J, van Dyck M, Ramazani Y, Debbaut E, van Damme-Lombaerts R, Levtchenko E, van den Heuvel LP, Fieuws S, Kuypers D. Tacrolimus dose requirements in paediatric renal allograft recipients are characterized by a biphasic course determined by age and bone maturation. Br J Clin Pharmacol 2016; 83:863-874. [PMID: 27966227 DOI: 10.1111/bcp.13174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/10/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022] Open
Abstract
AIMS Despite longstanding recognition of significant age-dependent differences in drug disposition during childhood, the exact course and the underlying mechanisms are not known. Our aim was to determine the course and determinants of individual relative dose requirements, during long-term follow-up in children on tacrolimus. METHODS This was a cohort study in a tertiary hospital with standardized annual pharmacokinetic (PK) follow-up (AUC0-12hr ) in recipients of a renal allograft (≤19 years), between 1998 and 2015. In addition, the presence of relevant pharmacogenetic variants was determined. The evolution of dose-corrected exposure was evaluated using mixed models. RESULTS A total of 184 PK visits by 43 children were included in the study (median age: 14.6). AUC0-12h corrected for dose per kg demonstrated a biphasic course: annual increase 4.4% (CI: 0.3-8.7%) until ±14 years of age, followed by 13.4% increase (CI 8.7-18.3%). Moreover, exposure corrected for dose per m2 proved stable until 14 years (+0.8% annually; CI: -3.0 to +4.8%), followed by a steep increase ≥14 years (+11%; CI: 7.0-16.0%). Analysis according to bone maturation instead of age demonstrated a similar course with a distinct divergence at TW2: 800 (P = 0.01). Genetic variation in CYP3A4, CYP3A5, and CYP3A7 was associated with altered dose requirements, independent of age. CONCLUSIONS Children exhibit a biphasic course in tacrolimus disposition characterized by a high and stable drug clearance until a specific phase in pubertal development (TW2: 800 at age: ±14 years), followed by an important decline in relative dose requirements thereafter. Pharmacogenetic variation demonstrated an age/puberty independent effect. We suggest a critical reappraisal of current paediatric dosing algorithms for tacrolimus and drugs with a similar disposition.
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Affiliation(s)
- Noël Knops
- Dept. of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.,Laboratory for Pediatrics, Dept. of Development & Regeneration, KU Leuven, O&N3, bus 817, Leuven, Belgium
| | - Jean Herman
- Dept. of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Maria van Dyck
- Dept. of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Yasaman Ramazani
- Laboratory for Pediatrics, Dept. of Development & Regeneration, KU Leuven, O&N3, bus 817, Leuven, Belgium
| | - Edward Debbaut
- Dept. of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Rita van Damme-Lombaerts
- Dept. of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
| | - Elena Levtchenko
- Dept. of Pediatric Nephrology and Solid Organ Transplantation, University Hospitals Leuven, Herestraat 49, Leuven, Belgium.,Laboratory for Pediatrics, Dept. of Development & Regeneration, KU Leuven, O&N3, bus 817, Leuven, Belgium
| | - Lambertus P van den Heuvel
- Laboratory for Pediatrics, Dept. of Development & Regeneration, KU Leuven, O&N3, bus 817, Leuven, Belgium
| | - Steffen Fieuws
- Interuniversity Institute for Biostatistics and statistical Bioinformatics, University of Leuven, Belgium, Kapucijnenvoer 35, Leuven, Belgium
| | - Dirk Kuypers
- Dept. of Nephrology and Renal Transplantation, University Hospitals Leuven, Herestraat 49, Leuven, Belgium
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