SearchingEquilibrium

Blogging against disablism

2007-05-01T13:54:00.000-03:00

Hi
As many parents, I did not know about disability until my son was diagnosed with autism. However, these years have been a learning experience about autism and about how to learn to be the best mother my autistic son deserves.
In this journey, I consider that there are many aspects to analyze.

For me, autism in my son has many levels. He has a different genetics than the norm In this sense, this different genetics is an integral part of him. He has also many many medical problems related to the interaction of this different genetics (and genetic expression, transcription, proteomics, metabolism and biochemistry) with the environment. In this sense, and I do not know how much, autism is partially something he has. And in this sense, it is not a different way of being for me.

However, even if I do not know exactly how much is the relative contribution of each, he learns differently, he perceives the world different and he has special needs (medical, emotional, educational and sociological) that requires accommodation, acceptation and understanding.

Today, is Blogging Against Disablism Day, in which many people
“write about disability and rail against the discrimination that disabled people continue to face...from discrimination in education and employment, through health care, parenting, family life and relationships, as well as the interaction of disablism with other forms of prejudice”.

In my personal experience, one very painful aspect to face was the health care that my son needed and it was extremely difficult to find, for now. Each age will bring its own challenges. Employment is very related to adult life, but all the other aspects will affect each area of my son´s life. And for me, the main aspects to consider have been prejudice, ignorance and preconcepts, because they affect every area of my son´s life and they lead to discrimination.

Only with
-a different view to autism from the scientific/medical area to all aspects from testing to treatment of concomitant medical problems to ASD diagnosis
-a different view from the educational aspect, with another information and training of special and non-special teachers and authorities in educational system
-a different interest from the sociological/political area
-a different understanding from the overall importance of family life and relationships without preconcepts about what autistics can/can not or do/do not feel /think/learn or share
-a higher importance given to parents concerned about their autistic children health,
-a different consideration about what autistic adults think/feel about their condition at all levels and what they have to say about all the medical/scientific/political/educational/sociological/emotional aspects
-and a different effort to have a common place of understanding of all involved prone to do it,to hear and to learn (doctors in practice, researchers, politics, parents, autistics of all ages)
a real sociological change will be possible.

To this goal, it is of paramount importance IMO the understanding that the dignity should be respected in every human being-autistic or not.The possibility of the experience of life in society as a fruitful and grateful experience-even under own rules in terms of accomodation and special needs-should be guaranteed, being part of a family /community with the acceptation and understanding of the differences in cognition/neurology as part of the human variation, considering different needs at all levels, and based on love that each human being deserves because his/her existence.

I want to think (and hope) that this kind of Future is possible… and from my humble place I will do my best to help to construct it.

Brain derived neurotrophic factor-BDNF-and Autism- II-Impact of xenobiotics

2007-04-05T09:29:00.000-03:00

Now, we know some about the roles and importance of BDNF.
Time to some questions
What gene/ receptor activated produces BDNF?
What sequence of reactions produces BDNF?
What affects BDNF production?

This is from IMFAR 2007

“SELECTIVE INDUCTION OF BRAIN-DERIVED NEUROTROPHIC FACTOR (BDNF) SECRETION BY ASTROCYTES CHALLENGED WITH A TOLL-LIKE RECEPTOR (TLR) 9 AGONIST: POSSIBLE LINK BETWEEN PERINATAL INFECTION AND ELEVATED BDNF LEVELS IN AUTISM
List of Authors
D. S. Spinner, E. J. Marchi, D. J. Kerr, E. Babcock, G. LaFauci, G. S. Merz, R. J. Kascsak, W. T. Brown
Background: Elevation of the neurotrophic factor BDNF in serum and glial cell activation in the brain are both common features of autism. Viral infection during the perinatal period such as rubella in humans, or influenza and Borna disease in rodents are also associated with autism or autism-like neurodevelopmental abnormalities. Since viral and other infections trigger innate immune responses by activating members of the Toll-like receptor (TLR) family (TLR1-13), we investigated whether TLR ligation increases secretion of autism-associated neurotrophic factors by glial cells.

Objectives: To determine whether activation of TLR signaling in microglia and astrocytes influences the secretion of neurotrophic factors.

Methods: Microglia and astrocytes in culture were exposed to agonists for TLR2 (bacterial lipopeptide pam3CSK4), TLR3 (poly(I:C) double-stranded RNA), TLR4 (lipopolysaccharide), or TLR9 (unmethylated CpG DNA) at 10 ug/ml for 48 hrs. Levels of BDNF in culture medium were quantified by a Luminex-based immunoassay.

Results: BDNF secretion in astrocytes was substantially increased upon exposure to the TLR9 agonist CpG DNA, but not following exposure to agonists for TLR2, 3, or 4. In microglia, however, BDNF remained undetectable under all experimental conditions. Both astrocytes and microglia were found to express all TLRs tested (TLR2, 3, 4, and 9).
Conclusions: Activation of TLR9 signaling in astrocytes specifically upregulates BDNF secretion. These findings provide links bridging infection, gliosis, and biochemical features of autism, and thus have significant implications regarding a role for innate immune activation in the etiology of autism.”

Therefore I want to introduce TLR-9. TLR are Toll-like Receptors.
TLR-9

There are TLR on the cell surfaces and TLR on the membranes that are used to degrade patogens.
You will find this description
“TLR-9* binds unmethylated cytosine-guanine dinucleotide sequences (CpG DNA) found in bacterial and viral genomes”
The point is that the cytosine-guanine dinucleotide sequence is NOT present in mammals, therefore this is a “radar” to detect non- self sequences .

TLR
In all, thousands of genes are activated by TLR signaling, and collectively, the TLRs constitutes one of the most powerful and important gateways for gene modulation.

Exp Dermatol. 2006 May;15(5):331-41.
Immune response modifiers--mode of action.Schiller M, Metze D, Luger TA, Grabbe S, Gunzer M.
The innate immune system governs the interconnecting pathways of microbial recognition, inflammation, microbial clearance, and cell death. A family of evolutionarily conserved receptors, known as the Toll-like receptors (TLRs), is crucial in early host defense against invading pathogens. Upon TLR stimulation, nuclear factor-kappaB activation and the interferon (IFN)-regulatory factor 3 pathway initiate production of pro-inflammatory cytokines, such as interleukin-1 and tumor necrosis factor-alpha, and production of type I IFNs (IFN-alpha and IFN-beta), respectively. The innate immunity thereby offers diverse targets for highly selective therapeutics, such as small molecular synthetic compounds that modify innate immune responses. The notion that activation of the innate immune system is a prerequisite for the induction of acquired immunity raised interest in these immune response modifiers as potential therapeutics for viral infections and various tumors…The induction of predominately T helper (Th)1-type cytokine profiles by TLR agonists such as imiquimod might have further benefits by shifting the dominant Th2-type response in atopic diseases such as asthma and atopic dermatitis to a more potent Th1 response.

TLR-9 is related to GI issues
Homeostatic effects of TLR9 signaling in experimental colitis

The Pathway of TLR-9 and other TLR

Int Rev Immunol. 2006 May-Aug;25(3-4):155-81.
TLR9 in health and disease.Vollmer J.
Coley Pharmaceutical, GmbH, Langenfeld, Germany.

Toll-like receptor 9 (TLR9) is specialized for the recognition of pathogenic nucleic acids. TLR9 is expressed in intracellular compartments where it responds specifically to pathogen DNA. Several factors contribute to the ability of TLR9 to discriminate between self and foreign DNA. Regulatory mechanisms of the innate and adaptive immune system exist that balance the immune responses mediated by TLR9. Short synthetic CpG oligodeoxynucleotides -the ones I mentioned above-are used to induce controlled and directed TLR9-dependent stimulation and are effective immune modulators in preclinical and clinical studies. This review will summarize the interplay between TLR9-dependent opposing stimulatory and regulatory effects in innate and adaptive immunity.
Therefore TLR-9 is important not only because of the substrates that bind to it, but also because of the consecuences of the binding (such as BDNF elevation)

Now, let´s go to present some published clues on the impact on BDNF and neurotrophic factors in general of the environment

BDNF

*Regulates glycinergic and Gabaergic synaptogenesis in developing spinal neurons
Link
*Triggers Calcium peaks in developìng dendrites and Calcium signalling with other neurotrophic factors
Link-1

*Modulates the function of the Serotonin transporter function
Link
Elevated platelet serotonin (5-HT) in 20%-25% of cases and efficacy of selective 5-HT reuptake inhibitors (SSRIs) in treating anxiety, depression, and repetitive behaviors points to the 5-HT transporter (5-HTT; SERT) as a strong candidate gene.
mounting evidence for genetic linkage of autism to the chromosome 17q11.2 region that harbors the SERT locus (SLC6A4) supports a genetic effect at or near this gene. We confirm recent reports of sex-biased genetic effects in 17q by showing highly significant linkage driven by families with only affected males. Association with common alleles fails to explain observed linkage; therefore, we hypothesized that preferential transmission of multiple alleles does explain it

Am J Hum Genet. 2005 Aug;77(2):265-79.
Allelic heterogeneity at the serotonin transporter locus (SLC6A4) confers susceptibility to autism and rigid-compulsive behaviors.Sutcliffe JS, Delahanty RJ, Prasad HC, McCauley JL, Han Q, Jiang L, Li C, Folstein SE, Blakely RD.

What if there is a combination of SLC6A4 polymorphism plus high BDNF?

*Affects the disease progression of MeCp2 mutant mice
Link

*Up regulates the alpha7 nicotinic acethylcholine receptor levels in hippocampal neurons
Link
In neurons the alpha-7 nicotinic receptor activates PI3 kinase, activating the anti-apoptotic kinase AKT.

*Is higher in fullterm than in preterm non-autistic children
Link
Not only neonatal BDNF levels, but also levels during the first week of life are important. In Preterm neonates day 4 the levels was much lower that in Preterm day 1. It would be interesting to see how BDNF changes during development in autistics.

*It is related to thymocytes activatioin
Link
a complex network involving the neurotrophin BDNF and its specific receptors may have a role in sustaining thymocyte precursor survival and supporting the thymocyte differentiation process. All together, our results suggest that the thymus may be the site of integration of different neuroimmune networks that are potentially involved in the regulation of thymocyte survival and/or differentiation

* It is related to transient receptor potencial C
Link
*It is expressed in several parts of the (rat) developing brain
Link
*It is less efficiently processed than NGF
Link
*It is very much involved in synaptic plasticity
Link
Our data provide striking evidence for a rapid inhibitory effect of p75(NTR) on NMDA-R currents that antagonizes TrkB-mediated NMDA-R potentiation. These opposing mechanisms might be present in a large proportion of forebrain synapses and may contribute importantly to synaptic plasticity.
Impact of diet
*BDNF Modulates the outcome of a fat saturated diet on synaptic plasticity and cognition
Link
*BDNF´s receptors are localized to enteric ganglion cells and glia (TrkB). TrkA also share same localization ( but not TrkC).
Link

In postnatal intestine, BDNF immunoreactivity was primarily localized to enteric ganglion cells, with NT-3 localized to enteric plexuses, intermuscular basal lamina, and along or between circular and longitudinal smooth muscle cells. CONCLUSIONS: These data indicate that neurotrophic influences may be involved in ENS development and survival, with potential importance in functional differentiation disorders of the intestinal ENS.

*BDNF expression is related to diet

Link

*Two months on the HFS diet were sufficient to reduce hippocampal level of BDNF and spatial learning performance
Link

Allergies
*BDNF is upregulated during allergic inflammation. Within the inflammed tissue neurons, structural cells and invading immune cells are sources and targets of neurotrophins.
Link
*BDNF is altered in asthma
Link
Furthermore, immune cells themselves can produce neurotrophins under certain conditions, and the levels of neurotrophins, as well as neurotrophic activities, are strongly upregulated in allergic conditions.

The role of neurotrophins in bronchial asthma: contribution of the pan-neurotrophin receptor p75
Nerve growth factor: an important molecule in allergic inflammation and tissue remodelling
*BDNF levels can be a marker of atopic dermatitis
Link
*BDNF selectively enhances specific allergen IgE production
Link

Xenobiotic impact through oxidative stress

*In the cellular answer to oxidative stress ( mediated by H2O2) sustained activation of all three MAPK subfamilies: extracellular signal-regulated protein kinase (ERK), c-Jun N-terminal kinase/stress-activated protein kinase (JNK/SAPK) and p38 was found, inducing apoptosis. NF-kappaB is related to both the ERK and JNK/SAPK signalling. Being simple, oxidative stress affects/induces cell death.
Necrosis is different from apoptosis.Apoptosis may occur in a single cell surrounded by viable cells;necrosis involves a group of cells simultaneously.

*Apoptosis can be related to caspases activation
Link
*This MAPK can activate a lot of reactions
Link
Free radical scavengers N-acetyl-L-cysteine (NAC), or glutathione (GSH), inhibited ERK2 activation and, to a much lesser extent, JNK1 activation by BHA/tBHQ, implicating the role of oxidative stress.
Several ribosome-directed toxicants have the capacity to damage 28S ribosomal RNA and/or interfere with its functioning, thus compromising protein synthesis. This can lead to what has been called "ribotoxic stress," a response that stimulates MAP kinase signaling
Link

Toxic Elements
*BDNF modulates PKC activation. PKC can be affected by heavy metals
Link
*Mercury in different forms abolish activation of different kinase pathways
Link-1
Link-2
Link-3
Or causes necrosis in certain cell lines as thimerosal
Link-4

Control levels of fragmented DNA were similar in both the presence and absence of NGF. With and without NGF, thimerosal caused elevated levels of fragmented DNA appearing at 0.01 microM (apoptosis) to decrease at concentrations >1 microM (necrosis). These data demonstrate that thimerosal could alter NGF-induced signaling in neurotrophin-treated cells at concentrations lower than those responsible for cell death.

*Lead affects diferent kinase pathways
Link-1
These results indicate that the phosphorylation of hippocampal ERK1/2 and p38(MAPK) is stimulated by lead in a period of rapid brain development, an effect that may underlie, at least in part, the neurotoxicty elicited by this metal.
Link-2
Link-3
Link-4

*Aluminium induces apoptosis
Link-1
Our study demonstrates that aluminum can induce the apoptosis of cortical neurons and SAPK/JNK signal transduction pathway may play an important role in the apoptosis
Link-2

Essential elements
*Zn defficiency induces cell death activates Trk signalink pathway

Link-1
Link-2
Link-3
and BDNF expression
Link-4

Recent work has shown that zinc is involved in the developmental regulation of neurotrophins and N-methyl-D-aspartate (NMDA) receptors, controlling use of glutamate as a neurotransmitter in the central nervous system (CNS). This is particularly important in the hippocampus, a region of the brain involved in learning and memory, and is an intriguing link to the role of zinc in neuropsychological development.

Nutr Rev. 2006 Sep;64(9):428-32.
Regulation of the NMDA receptor: implications for neuropsychological development.Levenson CW.

*Iron and amyloid beta peptide neurotoxicity are related to proapoptotic signaling
Link-1
Please remember than in a subgroup of autistics high levels of amyloid beta peptide have been found in a recent manuscript.
Link-2
Link-3

*Calcium channels are of paramount importance here.

It is supposed that this is kind of a feedback.NMDA receptor stimulation induces the influx of extracelular Ca+2 that may evoke the release of BDNF and the activation of TRkB. TrkA is the receptor of NGF and TrkB is the receptor of BDNF. Interferon gamma (IFN-gamma) increased NFG expression, down regulated BDNF expression The chronic blocking of NMDA receptors has a secondary effect the inhibition of BDNF synthesis in the hippocampus and may impair neuronal development. Brain specific phosphorylation of ME CP2 regulates BDNF transcription, dendritic growth and spine maturity.

Link-1

Both genetic, developmental and degenerative aberrations are to be encompassed within such an approach, as well as all deviations from the necessary components of behaviour that are generally understood to incorporate "normal" functioning. In the present treatise, both conditions of hyperactivity/hypoactivity, akinesia and bradykinesia together with a constellation of other symptoms and syndromes are considered in conjunction with the neuropharmacological and brain morphological alterations that may or may not accompany them, e.g. following neonatal denervation. As a case in point, the neuroanatomical and neurochemical points of interaction in Attention Deficit and Hyperactivity disorder (ADHD) are examined with reference to both the perinatal metallic and organic environment and genetic backgrounds. The role of apoptosis, as opposed to necrosis, in cell death during brain development necessitates careful considerations of the current explosion of evidence for brain nerve growth factors, neurotrophins and cytokines, and the processes regulating their appearance, release and fate. Some of these processes may possess putative inherited characteristics, like alpha-synuclein, others may to greater or lesser extents be endogenous or semi-endogenous (in food), like the tetrahydroisoquinolines, others exogenous until inhaled or injested through environmental accident, like heavy metals, e.g. mercury. Another central concept of neurodevelopment is cellular plasticity, thereby underlining the essential involvement of glutamate systems and N-methyl-D-aspartate receptor configurations…

* Recent studies confirm the importance of Zinc
Link

Calcium homeostasis in the Central Nervous System – implications for brain development and autism

About other environmental stressors:
1-Formaldehyde and neurotrophins
Toxicology. 2004 Apr 1;197(1):1-13
Differential immunogenic and neurogenic inflammatory responses in an allergic mouse model exposed to low levels of formaldehyde.
Fujimaki H, Kurokawa Y, Kunugita N, Kikuchi M, Sato F, Arashidani K.
...These results provide the first experimental evidence that low levels of long-term formaldehyde inhalation can induce differential immunogenic and neurogenic responses in allergic mice...
2- Sci Total Environ. 2001 Apr 10;270(1-3):113-21. Induction of the imbalance of helper T-cell functions in mice exposed to diesel exhaust. Fujimaki H, Ushio H, Nohara K, Ui N.
Administration of diesel exhaust particles (DEP) increases antigen-specific IgE production and IgE-secreting cells, and induces Th2-type cytokine profiles in the airway in mice and humans. To determine the early effects of diesel exhaust (DE) inhalation on the cytokine production profile, BALB/c mice were exposed to 0 (controls) and 1.0 mg/m3 DE inhalation for 4 weeks. Intraperitoneal sensitization with ovalbumin (OVA) was conducted immediately before DE inhalation. Mice were treated with anti-CD4 or anti-CD8 mAb 1 day before and after the sensitization. On day 21, these mice were boosted with OVA and blood; bronchoalveolar lavage (BAL) fluid, and spleens were collected on day 28. In BAL fluid, both TNFalpha and IL-10 production in DE-exposed and control mice remained basically the same. IL-6 production in the anti-CD4 treatment group of DE-exposed mice, however, significantly increased compared with that of the controls. In vitro antigen-stimulated interleukin-4 (IL-4) and -10 (IL-10) production in spleen cells of exposed mice were not affected by low-dose DE inhalation. In vitro interferon (IFN)-gamma production in the anti-CD4 treated group of exposed mice decreased markedly. Although anti-OVA IgE production in the plasma of sham-treated mice exposed to DE was the same level as for controls, anti-CD4 mAb treatment in DE-exposed mice significantly reduced IgE production compared to controls. In anti-OVA IgG1 production, anti-CD4 or anti-CD8 mAb treatment in DE-exposed groups also significantly reduced. Anti-OVA IgG2a production was reduced by treatment with anti-CD4 mAb, but increased by anti-CD8 mAb treatment in DE-exposed mice. Low dose DE inhalation is thus shown to adversely affect the cytokine and antibody production in mice by altering CD4+ and CD8+ T-cell functions.
3-The effect of chlorpyrifos and chlorpyrifos-oxon on brain cholinesterase, muscarinic receptor binding, and neurotrophin levels in rats following early postnatal exposure
4-Developmental neurotoxicity of industrial chemicals
A few industrial chemicals (eg, lead, methylmercury, polychlorinated biphenyls [PCBs], arsenic, and toluene) are recognised causes of neurodevelopmental disorders and subclinical brain dysfunction. Exposure to these chemicals during early fetal development can cause brain injury at doses much lower than those affecting adult brain function. Recognition of these risks has led to evidence-based programmes of prevention, such as elimination of lead additives in petrol. Although these prevention campaigns are highly successful, most were initiated only after substantial delays. Another 200 chemicals are known to cause clinical neurotoxic effects in adults…
The toxic effects of such chemicals in the developing human brain are not known and they are not regulated to protect children. The two main impediments to prevention of neurodevelopmental deficits of chemical origin are the great gaps in testing chemicals for developmental neurotoxicity and the high level of proof required for regulation. New, precautionary approaches that recognise the unique vulnerability of the developing brain are needed for testing and control of chemicals.

Therefore imbalances in toxic/essential elements affects strongly BDNF expression, levels and receptors number and function. Even more, the kinase cascade that BDNF begins can be strongly affected by xenobiotics and oxidative stress- including ribotoxic stress.

Continuará...

Brain derived neurotrophic factor-BDNF- and Autism-I

2007-03-25T13:05:00.000-03:00

BDNF or brain derived neurotrophic factor was the second neurotrophic to be characterized. The other two are nerve growth factor or NGF and neurotrophin 3 (NT-3). The Gene for BDNF is located in the chromosome 11p13 (an interesting location I must say, thinking in autism and keeping in mind recent findings). There is a fourth one called neurotrophin-4/5 ( NT 4/5).
A very graphic and simple presentation of the function (please see figure in color)
Neurotrophic factors

BDNF binds at least two receptors on the cells
1-TRkB (pronounced TRACK B). This is a receptor tyrosine kinase. Kinase is a kind of enzyme that transfers phosphate groups (PO4 with 3 negative charges) from ATP (Adenosin TriPhosphate) to substrates. This is named phosphorylation. The tyrosine kinase (TK) adds phosphate to a tyrosine of an enzyme.

And here a simple explanation of what is the function and how the process is in terms of how TK begins a cascade of signals
Link
You can find here
Link
some images on neurotrophins- and this is the only reason I posted-nothing to do with promotion of nothing, but the demonstration of the status of the science in terms of testing
2- LN GFR or low affinity nerve growth factor receptor, also known as p75-NTR, whose role is less clear. It seems a sink for neurofactors. This factor can signal a cell to die by apoptosis. The p75NTR belongs to the tumor necrosis factor (TNF) receptor family and was the first identified neurotrophin receptor

Low levels of BDNF have been linked to depression, OCD, Alzheimer, Rett, Huntigton and dementia. BDNF modulates excitatory and inhibitory synaptic transmission by inhibition of GABA (gama amino butyric acid)-A receptors.

Here you can find more information on neurotrophic factors- if you want.
Review
You can find in figure 2 that NGF activates TrkA receptor, BDNF activates TrkB receptors such as NT4/5 and NT-3 activates TrkC, all the Trk are tyrosine kinase receptors.

The Trk-independent pathway of p75NTR increases intracellular ceramide levels and further activates Nuclear Factor k B (NFkB) transcription factor and Jun N- terminal K kinase.

BDNF is a neurotrophin, such as Nerve growth factor or NGF, neurotrophin 3- NT3 and neurotrophin 4/-NT4/5. There are also neuropoietins, Insulin-like Growth Factors 1 and 2, transforming growth factors, fibroblast growth factors and finally other factors.
There is a theory, the Target Field theory. In this theory the axons of neurons growth towards the higher concentration of tropic factors in the target tissue. Neurons that succeed are maintained; if they do not succeed they die. In is interesting that they act like dimmers and they all share six cysteine residues (an aminoacid with SH bond).
From here thereafter, I will link a certain study, will transcribe some interesting conclusion from the authors in italics and I will add my own ideas about in normal.

Studies on knockout mice on neurotrophin have been unsuccessful because it is considered that probably a system of compensation is acting in the CNS in the development, a back up system that allows the differentiation of the neurotrophins to compensate for the loss of some. Even more , the knockout mice lacks the gene; probably this situation is totally different to a decrease/increase of the amount of a neurotrophin ( or its receptor) in cells.
As you know, neurexin/neuroligin have been very much mentioned about autism lately.
From Columbia Health Sciences
Link
Here there is an explanation of what the neuroligin/neuroxin couple do in terms of concerted mechanism of synaptogenesis.

Development and Regulation of Dendritic Spine Synapses
Link
Let´s go to focus on neurotrophin and neuroligin/neurexin. Please go to the figure 1. The “Connections” between the dendritic spine and the presynaptic terminal are N cadherin with B catenin in blue; neuroligin and neurexin in light brown and ephrin with EphR.

From here, not only neurotrophin but also neuroligin/neurexin are extremely important to generate dendritic spine synapses. It seems that neuroligin/neurexin are active mainly in the first step of synapse formation

What is the role of a neurotrophic factor?
Here
Link
In figure 1 you can find a map of the cascade of reactions that the BDNF tyrosine kinase domain produces.
Basically the tyrosin kinase receptor or TrkB- through the BDNF- activates
A-the phospholipase C pathway (PLC), that produces Ca and diacylglicerol and affects the protein kinase C (PKC) and CAM (Ca+2/calmodulindependent protein kinase) kinases
B-the phosphatidylinositol 3-OH (PI-3-K)- PI-3-K activates AKT ( a serine/threonine kinase or Protein Kinase B) and p-70 s6 that act on Caspaces and Bad proteins (proapoptotic therefore these are signals to the cell to die). The PI3K dependent AKT activation could be regulated through the PTEN (remember the last news about a role in autism), which work as the opposite of PI3K. AKT regulates the cellular survival by binding and regulating several receptors, such as nuclear factor kB or NFkB.
About PTEN, the link has been considered to neurodegenerative disease, not autism per se.
c-The RAS (a protein G that switches in activated and deactivated forms RAS GDP and RAS GTP; the diference is from di (D) to tri (T) Phosphate) activation the change is related to one group phosphate more added. RAS activates a number of pathways but an especially important one seems to be, the mitogen-activated protein (MAP) kinases, which themselves transmit signals downstream to other protein kinases and gene regulatory proteins. MAP is a Serine/threonine-specific protein kinase that respond to extracellular stimuli (mitogens). MAP regulates mitosis differentiation and apoptosis of cells.
To date, four distinct groups of MAPKs have been characterized in mammals:
I-extracellular signal-regulated kinases (ERKs). The ERKs (also known as classical MAP kinases) signaling pathway is preferentially activated in response to growth factors and a tumor promoter, and regulates cell proliferation and cell differentiation.
II-Jun N-terminal kinases (JNKs), also known as stress-activated protein kinases (SAPKs).
III-p38 isoforms. Both JNK and p38 signaling pathways are responsive to stress stimuli, such as cytokines, ultraviolet irradiation, heat shock, and osmotic shock, and are involved in cell differentiation and apoptosis.
IV-ERK5. ERK5, which has been found recently, is activated both by growth factors and by stress stimuli, and it participates in cell proliferation.
Yes, it is extremely difficult. To have a picture of how difficult, I have found these very illustrative:
1- MAPK
Link
2-Apoptosis
link
3-Protein Kinases
Link
4-Protein Kinase C-PKC
link
5-NFkB
link
Localize AKT
6-Protein Kinase B or AKT
link
Please localize the PTEN, to the left.
I am very enthusiastic on all this but I have also a headache if I try to understand everything. I have found useful to use these graphs to follow the explanation of the manuscripts, that are per se very complicated.Indeed. Please do not look for the commercial aspect- the pathways have been posted by a company of testing-, I considered the pathways clear- and colourful. I think is a good picture of the complexity we are talking about, don´t you think?
About BDNF roles
1-Exposure to stress and corticoesterone has been shown to decrease the expression of BDNF in rats and lead to eventual atrophy of hippocampus
2-Glutamate, voluntary exercise, caloric restriction, intellectual stimulation increase expression of BDNF.
3-Targeted disruption of the BDNF gene pertubs brain and sensory neuron development, but not motor neuron development.
Each kind of neurotrophin could be linked to an specific disease or susceptibility.
Neurotrophin can also play a role in immune modulation.
4- Brain-Derived Neurotrophic Factor Stimulates Energy Metabolism in Developing Cortical Neurons
link
Some comments particularly interesting
“The increased Na+-dependent amino acid uptake by BDNF is followed by an enhancement of overall protein synthesis associated with the differentiation of cortical neurons. Together, these data demonstrate the ability of BDNF to stimulate glucose utilization in response to an enhanced energy demand resulting from increases in amino acid uptake and protein synthesis associated with the promotion of neuronal differentiation by BDNF. Results revealed that BDNF increases glucose utilization and the expression of the neuronal glucose transporter GLUT3.
Thus BDNF knock-out mice exhibit substantially reduced numbers of cranial and spinal sensory neurons as well as marked decreases in the expression of neuropeptide Y (NPY) and calcium-binding proteins in specific brain regions, including cerebral cortex and hippocampus. It is also well established that BDNF increases peptidergic differentiation of GABA-containing neurons as it stimulates the expression of specific neuropeptides such as somatostatin, substance P, NPY, and cholecystokinin both in vitro and in vivo In the CNS BDNF promotes structural changes in axonal and dendritic arborisation.Thus BDNF increases the length and complexity of dendrites of cortical pyramidal neurons.
Our in vitro observations provide evidence that BDNF plays a determinant role as a stimulator of glucose utilization and GLUT3 expression in response to the increased energy demand resulting from the enhanced amino acid uptake and protein synthesis associated with the promotion of neuronal development by this neurotrophic factor”

And I thought in Ian´s post (from A shade of Grey) on increased demands of nutrients and minicolumns posts ; if there is a higher brain growth the first 2 years of life when I read this. Also in the transport system of aminoacids, carboxylic acids and glucose through the BBB in children.

5- BDNF part of a serie of genes involved in ASD?
It is important to remember that c- MET gene polymorphisms has been reported in families with MORE than one child with autism. cMET is also a receptor tyrosine kinase.
I only want to mention
Link
How c-met ( in magenta) is related to our PI3K ( in red) activated by BDNF. cMET affects PI3K and AKT.
How can we think that only one or two genes can affect the overall function of for example this pathway? How someone on the earth can present something for sure with the level of complexity that this has is something out of my understanding (what about interactions between genes?)
I want to focus on BDNF and autism
About role and function of BDNF
Link
The main conclusions from this manuscript
a-There are several theories about the neuronal release of neurotrophins.. They seem contradictory depending of the kind of neuron used (cortical or from the hippocampus)
b-NT-3 and BDNF- but not NGF-modulate the efficiency of synaptic transmission.
c-Neurotrophins induce the presynaptic release of glutamate(excitatory), GABA (inhibitory), and acethylcholine.
d-There are clues about the direct interaction of BDNF/TRkB with synapsin, a protein required for the release of vesicles.
e-Neurotrophins mediates the activation of ion channels (Na+, Ca+2) and interact with NMDA-N methyl D aspartate- receptors.
f-Neurotrophins participate in neuronal plasticity.BDNF is directly involved in hippocampal Long Term Potentiation or LPT ( involved in learning and memory).
g-The interplay between slow and fast events must be considered. The key question is how spatial and temporal availability of acutely secreted neurotrophins contribute to multiple pathways that regulate neuronal function in the CNS:

How Visual Stimulation Turns Up Bdnf Genes to Shape the Brain
"This suggests that sensory experience regulates different genes in your brain depending on your age and past experience. Thus, nurture, our experience of the world via our senses, acts through nature, sets of genes, to alter brain circuits."
Link
The sensory integration and how the sensorial information is analyzed impact the neurotrophins and modulates their activity.

BDNF and Huntigton´s disease
Link
Huntingtin protein is the transcription factor that allows the expression of BDNF.In Huntigton´s BDNF is very low.

In Autism
Genetic analyses of the brain-derived neurotrophic factor (BDNF) gene in autism.
Link
“BDNF expression in the drug-naive autistic group was found to be significantly higher than in the control group. We suggest that BDNF has a possible role in the pathogenesis of autism through its neurotrophic effects on the serotonergic system”
It is clear that autism is well different than Huntigton´s disease from the BDNF point of view. BDNF is overexpressed in autism, not underexpressed. BDNF is higher in autism.

Brain-derived neurotrophic factor and autoantibodies to neural antigens in sera of children with autistic spectrum disorders, Landau-Kleffner syndrome, and epilepsy.
Link
“BDNF levels and IgG/IgM autoantibodies to BDNF, ECs, MBP, and histones were measured in children with autism, childhood disintegrative disorder (CDD), pervasive developmental delay-not otherwise specified (PDD-nos), acquired epilepsy, Landau-Kleffner syndrome (LKS); healthy children (HC), and children with non-neurological illnesses (NNI).
Children with developmental disorders and epilepsy have higher autoantibodes (AAs) to several neural antigens compared to controls. The presence of both BDNF AAs and elevated BDNF levels in some children with autism and CDD suggests a previously unrecognized interaction between the immune system and BDNF.”

Impaired cerebellar development and function in mice lacking CAPS2, a protein involved in neurotrophin release.
Link
CAPS2 mediated BDNF release may be involved in synaptic plasticity even in the fully developed cerebellar circuit, because BDNF is regulatory of Purkinje cells synapses. CAPS2 is specifically associated with the cerebellar postnatal development during which tens of millions of neurons undergo vigorous differentiation events.
From Link

Therefore we have autoantibodies to BDNF, high levels of BDNF in autism and the reported impact of BDNF in cerebellar postnatal development, mainly Purkinje cells synapsis.

High levels of Alzheimer beta-amyloid precursor protein (APP) in children with severely autistic behavior and aggression.
“Although no neuropathologic substrate underlying autism has been found, the findings of brain overgrowth via neuroimaging studies and increased levels of brain-derived neurotrophic factor (BDNF) in neuropathologic and blood studies favor an anabolic state”
There are beta amyloid precursor protein and BDNF high levels in autism.

Reduced serum levels of brain-derived neurotrophic factor in adult male patients with autism.
Link

Now, it seems that at birth BDNF is overexpressed and in adult autistic male is lower than controls.
Two questions
a-Is this a common finding in non-autistic with development or this is an isolated case?
b-Why/how/when BDNF changes with age?

Neurotrophic factors in the pathogenesis of Rett syndrome.
Link
“Impairment in dendritic development in Rett syndrome could be the consequence of cholinergic deficiency and of neurotrophic factor/glutamate imbalance. Cholinergic gene expression might be influenced by the Rett syndrome gene directly or via the neurotrophic factor system.”

The implicancies of impact in cholinergic, glutamate systems are clear from this report.

Neuropeptides and neurotrophins in neonatal blood of children with autism or mental retardation
Link
"Neonatal concentrations of VIP (vasoactive intestinal peptide), CGRP (calcitonin gene-related peptide) , BDNF, and NT4/5 (neurotrophin 4/5) were higher (ANOVA, all p values < 0.0001 by Scheffe test for pairwise differences) in children in the autistic spectrum and in those with mental retardation without autism than in control children"

Localization of neurotrophins and their high-affinity receptors during human enteric nervous system development.
Link
From infancy through adulthood, TrkA and TrkB immunoreactivities were localized to both enteric ganglion cells and glia, whereas TrkC was localized exclusively to enteric ganglion cells. In postnatal intestine, BDNF immunoreactivity was primarily localized to enteric ganglion cells, with NT-3 localized to enteric plexuses, intermuscular basal lamina, and along or between circular and longitudinal smooth muscle cells. CONCLUSIONS: These data indicate that neurotrophic influences may be involved in ENS development and survival, with potential importance in functional differentiation disorders of the intestinal ENS.

Nutr Rev. 2006 Sep;64(9):428-32. Links
Regulation of the NMDA receptor: implications for neuropsychological development.Levenson CW.

Recent work has shown that zinc is involved in the developmental regulation of neurotrophins and N-methyl-D-aspartate (NMDA) receptors, controlling use of glutamate as a neurotransmitter in the central nervous system (CNS). This is particularly important in the hippocampus, a region of the brain involved in learning and memory, and is an intriguing link to the role of zinc in neuropsychological development.
It is supposed that this is kind of a feedback.
NMDA receptor stimulation induces the influx of extracelular Ca+2 that may evoke the release of BDNF and the activation of TRkB. TrkA is the receptor of NGF and TrkB is the receptor of BDNF. Interferon gamma increased NFG expression, down regulate BDNF expression The chronic blocking of NMDA receptors has a secondary effect the inhibition of BDNF synthesis in the hippocampus and may impair neuronal development. Brain specific phosphorylation of MECP2 regulates BDNF transcription, dendritic growth and spine maturity

Critical Periods of Vulnerability for the Developing Nervous System: Evidence from Humans and Animal Models
Link
In addition, a number of environmental chemicals and pharmaceutical agents alter the expression and/or signal transduction of these trophic molecules, including ethanol (146-152), methyl mercury (153,154), aluminum (155), and cholinesterase inhibitors (138,139,156). Although neurotrophic factors are perturbed in experimental animals after exposure to environmental agents, the involvement of these factors in developmental disorders has only recently been suggested in humans (157).

Dietary restriction (DR) increases the lifespan of rodents and increases their resistance to several different age-related diseases including cancer and diabetes. Beneficial effects of DR on brain plasticity and neuronal vulnerability to injury have recently been reported, but the underlying mechanisms are unknown. We report that levels of brain-derived neurotrophic factor (BDNF) are significantly increased in the hippocampus, cerebral cortex, and striatum of rats maintained on a DR regimen compared to animals fed ad libitum (AL). Seizure-induced damage to hippocampal neurons was significantly reduced in rats maintained on DR, and this beneficial effect was attenuated by intraventricular administration of a BDNF-blocking antibody. These findings provide the first evidence that diet can effect expression of a neurotrophic factor, demonstrate that BDNF signaling plays a central role in the neuroprotective effect of DR, and proffer DR as an approach for reducing neuronal damage in neurodegenerative disorders.
Link

Well. The effect/nature/role of BDNF and its importance from here is clear. Now, how can the environment modulate this neurotrophin and the signals of TrkB? There are a lot of reported clues about. I will let the analysis of them for a forthcoming post.

From Dr Julie Grether Epidemiology of Autism: Current Controversies and Research Directions “We don’t yet know if BDNF and other identified neurotrophins and neuropeptides actually contribute to the pathogenesis of autism or may only represent markers of the disorder. Available evidence regarding their role in early brain development and abnormal levels present in newborns, if confirmed, strongly suggest, however, that these proteins may have etiologic significance”.

The other side of BDNF
a-Neurotrophin-mediated potentiation of neuronal injury.
Link
a more specific manuscript
Link

The p75 receptor is related to the Janus K Pathway and these are signals to the cells to die. It seems that VIP (vasoactive intestinal peptide) can prevent partially neuronal death. It seems that, depending on conditions, BDNF can be toxic to cortical grey matter. An enzyme NADPH oxidase seems to be involved,

b-The role of NADPH oxidase, neuronal nitric oxide synthase and poly(ADP ribose) polymerase in oxidative neuronal death induced in cortical cultures by brain-derived neurotrophic factor and neurotrophin-4/5.
Link
Three distinct mechanisms generate oxygen free radicals in neurons and contribute to cell death during anoxia and reoxygenation.
Link

“We found that three distinct mechanisms contribute to neuronal injury by generating ROS and oxidative stress, each operating at a different stage of ischemia and reperfusion. In response to hypoxia, mitochondria generate an initial burst of ROS, which is curtailed once mitochondria depolarize or prevented by previous depolarization with uncoupler. A second phase of ROS generation that followed after a delay was blocked by the xanthine oxidase (XO) inhibitor oxypurinol. This phase correlated with a rise in [Mg2+]c, suggesting XO activation by accumulating products of ATP consumption. A third phase of ROS generation appeared at reoxygenation. This was blocked by NADPH oxidase inhibitors and was absent in cells from gp91(phox-/-) knock-out mice. It was Ca2+ dependent, suggesting activation by increased [Ca2+]c during anoxia, itself partly attributable to glutamate release. Inhibition of either the NADPH oxidase or XO was significantly neuroprotective. Thus, oxidative stress contributes to cell death over and above the injury attributable to energy deprivation”

Potentiated necrosis of cultured cortical neurons by neurotrophins
Link
c-
Characterization of the toxic mechanism triggered by Alzheimer's amyloid-beta peptides via p75 neurotrophin receptor in neuronal hybrid cells.
Link
Remember please the high levels of beta amyloid protein found in some autistics.

Considering these reports, BDNF can activate the p75 receptor and include the activation of NADPH oxidase, pro stress oxidative.

What is the balance between the pro-oxidative stress vs the protective effect when BDNF levels are high, such as in autism?

Gene-Gene interactions, polygenia and epigenetics

Experimental gene interaction studies with SERT mutant mice as models for human polygenic and epistatic traits and disorders.
Link

“When diseases or disorders or traits are due to genetic factors, there are several mechanisms by which they can inherited. Such conditions can essentially be divided into single gene disorders and polygenic disorders. Single gene disorders include hemophilia, cystic fibrosis, neurofibromatosis and Huntington disease. In single gene disorders a rare mutation results in the complete disruption of the function of a gene. Some of the greatest advances in genetics during the past 100 years have come from the elucidation of the genes for virtually every single gene disorder. Their DNA has been cloned, sequenced and the gene localized to a specific chromosomal region.

Polygenic disorders, by contrast, are due to the interactive or epistatic effects of many different genes on different chromosomes, each gene contributing to only a small part of the picture (variance). These genes interact with environmental factors. Except for a few rare families [12], all behavioral disorders such as manic-depressive disorder, schizophrenia, major depression, panic disorder, autism and ADHD [3] are likely to be polygenic. While we do not yet know the total number of genes involved, it is likely to range from 50 to several hundred. In contrast to the gene defects for single gene disorders (mutations), the defects for polygenic disorders are much less severe, otherwise they would be single gene disorders. Thus, we call them gene variants instead of gene mutations, and individuals have to inherit a number of them if they are to cause a clinical effect [13]. A second distinction is that mutations that severely affect gene function are very rare. Since they are often present in less than 1 in 100,000 individuals the diseases they cause are also very rare. In fact, all single gene disorders combined affect less than 1.5% of the population. By contrast, the gene variants involved in polygenic disorders are common and polygenic disorders themselves are common. This "common gene, common disorder" theory of polygenic disorders has gained wide acceptance. An alternative theory, of "rare gene, common disorder," postulates a large number of rare mutations of different genes [14].In association studies of a wide range of behavioral disorders, even when the association is significant the percent of the variance attributable to that gene is usually in the 0.5 to 3% range and averages less than 1.5%. This suggests that even if genes only account for 72 to 95% of the total variance, 50 or more different genes would be involved […]. This does not mean that every affected individual has inherited 50 or more of these variants. It is likely that only a subset of the total potential set of gene variants is required in a given individual. Because of this, polygenic disorders show a great deal of genetic heterogeneity […]. That is, different individuals with ADHD are likely to have inherited somewhat different sets of genes. However, each affected ADHD individual must have inherited enough gene variants to pass a liability threshold, allowing them to develop ADHD.
From Link

Now, more and more I think on autism as a polygenic disorder.

The Genetics of Autism
Link

Some of the genes that have been reported to be linked or associated to autism are:
1-Chromatin remodelling and gene expression:MeCp2 (importance in Rett syndrome); FMRP (important in fragile X mental retardation),EN2, HOXA2 and WNT (the last three transcription factors dysregulated).
2-Actin cytoskeleton dynamics- look please for the MET pathway and you will find the actin to the left.TSC1/TSC2 (important in tuberous sclerosis) ; NF1 ( important in neurofibromatosis);cAMPGEF. These produce inactivation of GTPase (inactivation of an enzyme).
3-Synaptic scaffolding proteins: Schank Dendrite induction, binding partner of neuroligin
4-Receptors and transporters.GRIN2A (A NMDA receptor subunit), GriK2 (kainite receptor subunit), GABAr (GABA receptor), SLOSA4 (serotonine trasnporter¡), SLC 25 A (aspartate-glutamate); OXTR (oxytocin receptor) and AVPR1 (vasopressin receptor). 5 HTT is the serotonin transporter.
5-Second messenger problems:PRKCB1 (protein kinase C); CaCNA (Ca+2 Channel), NBEA (PKA(Protein Kinase A) anchor protein.
6-Cell adhesión molecules NLGN-3; NLGN-4 (NLGN seems important in autism) ; NrCAM
7-Secreted proteins: RELN, LAMB (laminin).

If you can get the manuscript
Searching for way outs of the autism maze:…” from Persico and Burgeroun from Trends in Neuroscience please go to the figure 1 and you will have a graph in colors about the proteins that can be altered in autism related to synapsis.
BDNF would be related to second messenger problems and cell adhesion molecules because of the signals that these receptors produce.

Some clues of correlations
1-Wang H, Chan SA, Ogier M, Hellard D, Wang Q, Smith C, Katz DM. Related Articles,Dysregulation of brain-derived neurotrophic factor expression and neurosecretory function in Mecp2 null mice.J Neurosci. 2006 Oct 18;26(42):10911-5.
2- Neurobiol Dis. 2002 Oct;11(1):221-9.BDNF regulates the expression of fragile X mental retardation protein mRNA in the hippocampus.Castren M, Lampinen KE, Miettinen R, Koponen E, Sipola I, Bakker CE, Oostra BA, Castren E.
3-BDNF induced the phosphorylation of tuberin / There are results that are consistent with a model wherein neurofibromin acts as a negative regulator of neurotrophin-mediated signaling for survival of embryonic peripheral neurons.
4-Caldeira MV, Melo CV, Pereira DB, Carvalho R, Correia SS, Backos DS, Carvalho AL, Esteban JA, Duarte CB.BDNF regulates the expression and the synaptic delivery of AMPA receptor subunits in hippocampal neurons.J Biol Chem. 2007 Mar 2;
5-Chen Q, He S, Hu XL, Yu J, Zhou Y, Zheng J, Zhang S, Zhang C, Duan WH, Xiong ZQ.Differential roles of NR2A- and NR2B-containing NMDA receptors in activity-dependent brain-derived neurotrophic factor gene regulation and limbic epileptogenesis.J Neurosci. 2007 Jan 17;27(3):542-52.
6-Carrasco MA, Castro P, Sepulveda FJ, Tapia JC, Gatica K, Davis MI, Aguayo LG.
Regulation of glycinergic and GABAergic synaptogenesis by brain-derived neurotrophic factor in developing spinal neurons.Neuroscience. 2007 Mar 16;145(2):484-94. Epub 2007 Feb 15.
7-Neurotrophins modulate neuron-glia interactions at a vertebrate synapse.
Link

“Our results indicate that acute application of both NT-3 and BDNF, but not NGF, increased PSC (perisynaptic Schwann cells) Ca2+ responses. BDNF increased PSC responsiveness through potentiation of ATP (adenosine triphosphate) responses while NT-3 modulated muscarinic acetylcholine receptor signalling.”

8-Taniguchi N, Shinoda Y, Takei N, Nawa H, Ogura A, Tominaga-Yoshino K. Possible involvement of BDNF release in long-lasting synapse formation induced by repetitive PKA activation. Neurosci Lett. 2006 Oct 2;406(1-2):38-42. 2006 Aug 9.

With this very partial picture, it seems to me that the picture is extremely complex to discard nothing. With such a number of interactions, retrograde signals and feeback, multiple changes depending on the development. What if BDNF roles are very much wide and complete and interelated with other systems ( immune system, gastrointestinal system)?

What do you think?
María Luján-Argentina

Some comments in Gastrointestinal issues in ASD

2007-03-11T09:56:00.000-03:00

You know, I have prepared a long – and I say LONG- post about published science in gastrointestinal issues in autism as concomitant medical problem (CMP), including all the topics on my previous post. But somehow, I was not convinced about. I feel I was lacking the key questions to answer, trying to present a very much wide picture- and therefore what I wanted to say would be diluted with much information not so important.
Therefore I focused on the questions I presented in my previous post.

The no written sentence in all cases is: “We need more high quality, high level research done by high level and commited scientists to confirm anecdotical evidence and previous clues in autism“. If you are interested, I can send the expanded version- much longer with all the proper citations in which I based these analysis (Or please let a comment therefore I include the link). Thanks

No cause/cures implications. For now, they are CMP that SHOULD be screened, tested, diagnosed and treated SUCH as in the case of non-autistics, IMHO. For me, another aspect of the advocate for my son I am, and yes he had several of the gut conditions I mention-now properly screened, tested, diagnosed and treated.
In bold, remarks and (partial) conclussions- or better opinions about potential conclussions-, in normal the manuscript´s findings and in italics my comments.

1-In general, autistic children/teens/adults have gastrointestinal issues more than non-autistic children/teen/adults?
One of the most recent published manuscripts form the Dr Horvath group (2002) reported for 36 children with ASD symptoms like chronic diarrhea, abdominal discomfort and distension. The histological examination revealed grade I or II reflux esophagitis in 69.4 % (25/36), chronic gastritis in near 40 %(15/36) and chronic duodenitis in near 66.6 % (24/36). Twenty two of the 25 children with reflux (88%) had night awakenings, signs of abdominal disconfort and pushing on the abdomen. None of the patients had H. Pylori.
Low intestinal carbohydrate digestive enzyme activity was reported in 21 children of 36 (58.3 %), even when no abnormality was found in pancreatic function. 27 of 36 children had an increased pancreatico billiar fluid output after intravenous secretin administration. 21 of 36 children had diarrhea (near 60 %). Low lactase was found in 14 patients. One kind of cells, the Paneth cells, showed similar results to studies done to Chron´s patients.
Kushak R and Buie T reported lactase deficiency in 58-65 %, isomaltase/palatinase deficiency in 30 to 40 % in ASD. Children with intestinal inflamation are 77 % deficient in lactase and 64 % in isomaltase.
Same author studied the possibility of GER (Gastroesophageal reflux) with GI complaints and aggression or self-injurious behavior GER was identified in 5 of 5 patients tested by wireless pH testing. Esophagitis was seen in 3 of 6 patients biopsied.
* pH testing data are reported in a scale called de Meester score. Normal is less than 14.72. Autistic Children showed from 19.7 to 75.1.
* Author concludes that aggressive or self injury behavior may be a manifestation of pain from GERD
And in adults the problem is generally underdiagnosed
Link

Data show quite distinct patterns of O-glycosylation within the glycocalix in children with autism, not simply due to inflammation.This may contribute to alterations in the colonic mucosal flora. As clinical improvement has been reported in autistic children when enteric dysbiosis is treated, these changes warrant further study if confirmed in larger series.
*The glycocalix is the polysaccharide-containing material (that is a covering of polymers of monosugars) lying outside the cells of the gut.
*Glycosylation is a process by which the glycocalix is modified by other sugars ( involving other enzymes for example). Abnormalities associated with disease states are major contributors to diversity in glycan expression
* It seems that not only inflammation, but altered glycosilation pathways of glycocalix can be found in gut in ASD.

…findings demonstrate a focal CD8-dominated gastritis in autistic children, with novel features. The lesion is distinct from the recently recognized focal gastritis of Crohn's disease, which is not CD8-dominated. As in the small intestine, there is epithelial deposition of IgG.

*CD8 is a glycoprotein- that is a protein with a sugar attached- When the cytotoxic T-Cells have a CD8 attached they are called CD8+Tcells. A cytotoxic T cell is a cell that can kill cells infected by viruses or other pathogens after activation.
*The epitelial deposition of IgG is suggestive of gut autoimmunity following Torrente et al.
*There are 7 medical conditions that can be related to milk/gluten/food allergies, not only Celiac disease, mediated by IgE or not. Food allergy is not the same as food intolerance.
*Suspected hypoacidity and gastroesophageal reflux can be present, specially if asthma is present
*There are acid and non-acid reflux and can be gastroesophageal or duodenogastric .

The development of non-IgE-mediated food allergies is associated with relatively subtle immunological abnormalities, including maturational delay in IgA, IgG subclass, CD8, and NK cell responses (Simon Murch Comment)- this is the topic of another post.

*Pancreatic deficiency affects more lipid digestion than protein digestion.
*There are published clues of carbohydrate, lipids and protein degradation problems in ASD (lack of enzymes, several organs of the digestive system malfunction).
*There are published clues of inflammation/immune activation in gut in ASD (Paul Ashwood recent work). These inflammation conditions includes: ileal lymphoid nodular hyperplasia-LNH- (and related), ileitis, colitis and colonic LNH, upper and lower gastrointestinal tract inflammation
*In almost all patients with heartburn, there is identifiable esophageal mucosal pathology, though only about 40% have endoscopically detectable erosions. The remaining 60% of patients with heartburn but no erosions have nonerosive GERD.
*Gastritis can be of different kinds. Although gastropathies may be mediated by inflammatory mechanisms, mucosal infiltration by polymorphonuclear or mononuclear cells is not necessary. The modern classification of gastritis incorporates etiology and morphologic and topographic mucosal changes
*Duodenitis is basically inflammation and irritation of the wall of the first part of the small intestine.
It is true that it has been published that the percentage of autistic children with GI issues was EXACTLY (9%) the same than non-autistic children with GI issues (BMJ. 2002 Aug 24;325(7361):419-21.
Relation of childhood gastrointestinal disorders to autism: nested case-control study using data from the UK General Practice Research Database.Black C, Kaye JA, Jick H. )BUT the authors considered ONLY 2 first years of age. My celiac son was diagnosed at 3y 2 months and he never had diarrhea or GI issues during his 2 first years of life. Horvath manuscript presents data on children with 5.7 + or – 2 years.

* It seems that near 10-20 % of the general population has IBS.
Considering all the gastrointestinal problems, children with autism- (age range 0-8 years) has 38 to 60 % maximum diarrhea and near 36 % constipation problems.

A recent manuscript on the issue confirm a high percentage
Biol Psychiatry. 2007 Feb 15;61(4):492-497. Epub 2007 Jan 3.
Relationship of Dietary Intake to Gastrointestinal Symptoms in Children with Autistic Spectrum Disorders.Levy SE, Souders MC, Ittenbach RF, Giarelli E, Mulberg AE, Pinto-Martin JA.
“Reported frequency of GI abnormalities, including abnormal stool consistency (e.g., bulky or loose), was increased (54%)”
These data say that autistic children have near 3 times more GI issues than non- autistic children- for now (20 vs 60 %).

2-Autistic children/teens/adults with gastrointestinal problems have the same symptoms and severity of non-ASD children with the same medical problem-considering other factors such as stress ALSO?
This work compares autistic individuals and non-autistic individuals with different Gastrointestinal issues
Disaccharidase activities in 308 autistic (AI) and 206 non-autistic individuals (NAI) with different GIP (gastrointestinal problems).
The frequency of GIP among AI and NAI was: diarrhea, 38 vs 18 %; abdominal pain, 36 vs 59 %; food sensitivity, 14 vs 11%; constipation, 4 vs. 0.5%; GER (reflux), 3 vs. 11%; FTT (failure to thrive), 2 vs. 6%; diarrhea with abdominal pain, 6 vs 5%; diarrhea with food sensitivity, 6 vs 3%; and abdominal pain with food sensitivity, 4 vs 3%. AI with diarrhea (n = 206) demonstrated significantly lower maltase (P < 0.05) activity than NAI with diarrhea. Frequency of lactase deficiency in AI with FTT (n = 5) was significantly higher (80% vs 25%; P < 0.05) than in NAI with FTT and frequency of palatinase deficiency in AI with diarrhea was significantly higher than in NAI (28% vs 11%; P < 0.05) with the same GIP. AI and NAI with other GIP had similar frequency of disaccharidase deficiencies.
This study presents results on constipation
Although constipation occurs in 2% to 5% of healthy children, its clinical diagnosis is often difficult in children with behavioral disorders. Despite this, moderate or severe constipation was more frequent in the autistic group than in the control subjects (36% vs 10%). 54.4% of autistic children had moderate/severe loading or acquired megarectum compared with 24.1% of control subjects. Milk was the strongest predictor of constipation in the autistic group, whereas stool frequency, gluten consumption, soiling, and abdominal pain were not predictive of constipation (Dr Heuschkel / Dr Afzal publication).

*Diarrhea was present in 38 vs 18%; Lactase deficiency in Autistics with failure to thrive was VERY much higher 80% vs 25 % and palatinase deficiency 28 vs 11 %.
*It seems from these results that milk intolerance ( through lactose, casein intolerance) was related with constipation and enzyme deficiencies –lactase, maltase and palatinase- with diarrhea
The prevalence of IBS in North America is 10-15 % equally divided among IBS with constipation, IBS with diarrhea and IBS alternating between diarrhea and constipation (that is near 3.33 to 5 % of the general population for each). There are 9 population studies and the prevalence varied between 3 to 20 % but most estimates were concentrated between 10 and 15 %. However, these studies´s quality and quantity are limited.

Patients with IBS symptoms have been studied by different tests. In general Colitis IBD, Colorectal cancer, celiac disease, gastrointestinal infection, thyroid malfunction and lactose malabsorption are found. The main difference bewteen the general population and IBS patients is celiac disease (4.67 % vs 0.25 – 0.5 %), being the others in the same range. IBS patients exhibit visceral hypersensivity. Finally behavioral therapy seems to be more effective than placebo at relieving individual IBS symptoms, however no trial has provided unequivocal evidence that psychological treatment is efficacious in IBS.
Then,let´s go to see celiac disease as a form of gluten intolerance. A modern view would focus on gluten intolerance, a very much wider spectrum of problems with gluten
Increasing numbers of atypical or asymptomatic cases of celiac disease are being diagnosed. Celiac disease and cow's milk protein allergy are key examples of chronic enteropathy.

The dietary approach to allergy has evolved to include active stimulation of the immature immune system in order to support the establishment of tolerance.

Nestle Nutr Workshop Ser Pediatr Program. 2007;(59):115-31. Links
Chronic enteropathy and feeding.Salvatore S, Hauser B, Vandenplas Y.
Curr Opin Gastroenterol. 2007 Mar;23(2):142-8.
Advances in celiac disease.Craig D, Robins G, Howdle PD.
Academic Medical Unit, Leeds Institute of Molecular Medicine, Leeds, UK.

Although celiac disease is predicted by screening studies to affect approximately 1% of the population of the United States and is seen both in children and in adults, 10%-15% or fewer of these individuals have been diagnosed and treated.

J Clin Invest. 2007 Jan;117(1):41-9. Links
Celiac disease: pathogenesis of a model immunogenetic disease.
Kagnoff MF.
Celiac disease: pathogenesis of a model immunogenetic disease
And Gluten sensitivity as a neurological illness Hadjivassiliou M, Grunewald RA, Davies-Jones G in Journal of Neurology Neurosurgery and Psychiatry 2002;72:560-563
Where the authors say
“Gluten sensitivity can be primarily and at times exclusively a neurological disease. The absence of an enteropathy should not preclude patients from treatment with a gluten-free diet… Antigliadin antibodies are also found in the CSF… This inflammation was primarily seen in the white matter of the cerebellum. There was also marked but patchy Purkinje cell loss. We have also found antibodies against Purkinje cells in patients with gluten ataxia. Our research suggests that IgG antigliadin antibodies cross react with epitopes on Purkinje cells from human cerebellum… Characterisation of the anti-Purkinje cell antibodies by immunoblotting may provide a useful marker for the diagnosis of gluten ataxia in a manner analogous to the use of antiendomysium antibodies as a marker for coeliac disease or the anti-Yo antibody in paraneoplastic cerebellar degeneration.”
Other authors include conclusions like this
“Celiac disease should be considered in patients with idiopathic neuropathy even when gastrointestinal symptoms are absent”.(Muscle Nerve. 2007 Jan 16; Celiac disease presenting with motor neuropathy: Effect of gluten free-diet.Rigamonti A, Magi S, Venturini E, Morandi L, Ciano C, Lauria G).
Well, now, let´s go to see gut flora differences and other published clues about
* Presence of Clostridia hystoliticum was one of the main findings in FS of autistic chidlren
*Children with autism had 9 species of Clostridium not found in controls, whereas controls yielded only 3 species not found in children with autism.
*Analysis of the real-time PCR data indicated that the cell count differences between autistic and control children for C. bolteae and the following Clostridium groups were statistically significant: mean counts of C. bolteae and clusters I and XI in autistic children were 46-fold (P = 0.01), 9.0-fold (P = 0.014), and 3.5-fold (P = 0.004) greater than those in control children, respectively,
*There is a profile of composition of the intestinal flora that changes with age and development in non-autistic children:
*Healthy children can have chlostridia infections present but they are solved with development –after the year of age-and controlled with the maturation of the immune system. It seems that this change in the immune system has no place in some autistic children, that maintain unhealthy levels of abnormal bacteria in gut and who are affected differently by them.
* Positive presence of fungus of Candida strain in stool in some autistic children is related- many times- to IgA deficiency. Only immunedepressed people present this kind of fungal infections out of control
* Other bacterial infections (Giardasis Escherichia coli ,Blastocytis hominis, staphylococcus aureus amebiasis, parasites) are present under testing-anecdotal evidence [Blastocystis hominis and bowel diseases.]
In vitro growth control of selected pathogens by Lactobacillus acidophilus- and Lactobacillus casei-fermented milk
Bacterial infections of the gut (excluding enteric fever)
Luminal host-defense mechanisms against invasive amebiasis
The bacterial weaponry: lessons from Shigella

This is a free chapter of an immunology book-from the web. It explains very graphically what happens with gut pathogen infections and mucosa gut integrity- with other explanations about adaptive immunity.

Chapter 10

Apparently, very specific kinds of food allergies or intolerances- different things- (non- necessarily IgE mediated or presented as celiac disease as such in the case of gluten), inflammatory gastrointestinal conditions- of several kinds-,alterations of gut flora and overgrowth of certain fungal/bacterian infections would be present in some subgroups of autistic children- generally in combination. This kind of situation in combination are found only in immunedepressed people and in some IBS complicated patients (or transplanted).

3-How does the treatment of GI issues changes the IQ and child´s adaptative behavior with certain recorded changes in biochemistry-metabolism? Anecdotical and published evidence.
There are plenty of anecdotes about the GFCF diet- without clinical correlates. Also, there are plenty of anecdotes with important changes in behaviors upon the treatment of GI issues that provoke disconfort, pain, malabsorption and nutritional imbalances. There are also anecdotes of no effect of a diet GFCF ALONE, especially if there is not concomitant search for potential concomitant medical problems to –if present- gastrointestinal issues ( from reflux to nutritional imbalances). And There are also anecdotes of no effect of the GFCF diet, even with a lot of treatments concomitant to these diagnosis. In some other cases, disaccharidases can be imbalanced and the SCDiet has shown to produce some help. Otherwise, when oxalates are high the oxalate-free diet also has provided some help. And in other cases ketogenic diet has produced positive effects. There is probably no field as changing and challenging as the individual detections of GI issues and the concomitant tretament of TROUGH dietary changes.
Because the problems are presented in combination (Gut flora alterations, presence of abnormal bacteria, food intolerances and nutritional imbalances-related to immune alterations, lack of several enzymes, high level of certain compounds related to malabsorption or biochemical alterations) the research of the treatment should be integral, considering all the aspects TOGETHER. I know that this is a nightmare for controls, but it is the problem many parents must face- and very few researchers consider as such (recent work of Elder et al is a demonstration of my point). The needed incorporation of ambiguety and individuality is not easy from the scientific point of view. However, in my anecdotical experience, it has been important to consider.
Why the GFCF diet is going to produce some change if a child has not a food intolerance to gluten and/or casein? You need testing for this- and there are many test available in current labs.
Why the GFCF diet is going to be tested WITHOUT gut support in the form of probiotics and fungal/bacterian/other testing, diagnosis and treatment? In my anecdotical experience, diet is a tiny part of the overall problem- although it helps.
Why the GFCF diet is going to have some kind of effect in celiac, lactose defficient, enzyme defficient children if the enzymes are not tested, the lactose defficiency is not tested, the nutritional imbalances are not balanced (vitamins, essential elements, minerals, fatty acids- recently present in the news- probably related to lipase defficiencies) and the OTHER gut problems are not treated?
Why almost no researchers take all this into consideration, rendering useless in many cases their findings?
An autistic or non-autistic child with celiac disease, milk intolerance, fungal /bacterian infections in gut, enzyme and nutritional defficiencies, Why avoidance of ONLY gluten and casein si going to show improvement if there are many other problems ALSO that remain undetected/untreated?

O no! again I begun in the basement (gastrointestinal problems) and ended in the living room (the immune system). Well there is an excellent recently published paper- beyond the one on the MET signaling in autism- relating the gut with the immune system that I think it will be interesting to analyze together with the NK, CD8, IgG and IgA…Next time :)

Research in Autism and Questions

2007-02-08T18:35:00.001-03:00

One of my personal fields of interest includes the published research on concomitant medical problems to a diagnosis of ASD. I know that this kind of aspects are open a controversy, but before the beginning I want to clarify some points

a-The fact that concomitant medical problems in ASD are not part of the DSMIV implies what? It implies for me that so much is not known about ASD that these concomitant medical problems-able to be clinically detected- may/may not be related to some individual behavior used to diagnose ASD but they are not considered today as part of the diagnosis tool. What IF the behavioral autistic characteristics used to diagnose under the DSMIV are (or not) a manifestation of an untreated medical condition-detectable clinically but undetected today because the knowledge is not enough to know about the importance of? Therefore How can we be sure about the relation –or not-of medical conditions undetected to the autistic behaviors before the detection/treatment of these medical conditions?

b-The treatment of the properly detected/correctly diagnosed concomitant medical problem is the treatment of this ONLY, not a treatment for autism in advance. The cause of the concomitant medical problem (if it is able to be properly assigned) is not a CAUSE of autism in advance.

Hypothesis /theories/explanations should consider this important distinction. Until we know more about genetics/epigenetics- and impact of concomitant medical conditions in autism in a confirmatory way- this should be the discussion limits beyond personal beliefs about, IMHO.

c-There can be different aspects to consider for each field I will analyze (including placebo effect, natural maturity, stressing individual situations, etc).

I will focus for now in serious published literature on medical conditions able to be detected by certain biochemical testing in ASD.I have been thinking for a while about the presentation/comment of selected published literature on aspects not analyzed generally about:

1-Gastrointestinal issues-Fungus,Bacteria,Parasites, other in gut-Organic and physiological dysfunction

2-Immunological findings-Hypo and hyperresponsive-Immunological dysfunction

3-Endocrinological findings-Endocrine System-Hypothalamus, Pituitary Gland ,Thyroid Gland ,Parathyroid Glands ,Adrenal Glands Pineal Body,Reproductive Glands, Pancreas

4-Metabolic findings

The methionine cycle-The folate cycle-The Biopterin cycle-Purines and pirimidines- Urea cycle- Mitocondrial issues-Fatty acids beta oxidation-

Specific genetic metabolic problems-How many? What?

5-Brain research-

Neurotransmitters-Metabolism of neurotransmitters Serotonine, Dopamine Noradrenaline-Adrenaline

Neurocognition

Language development

Nurturing and brain development

6-The controversy about heavy metals and Al

a-Transport system

b-Excretion system

7-The axis gut-immune system-brain. Recent research in the topic

8-Importance of combination of concomitant medical conditions in the health status, behaviour, cognition, language and education in ASD. How much? What areas?

What I propose to do is to analyze certain important papers- important IMO - and to present personal questions of my interest (as the mom of an autistic child) as discussion proposal.

What I propose is to AVOID in the discussion words like CAUSE/S and CURE/S of autism…and I promise to be the most short I can.

What I propose is to focus in 2 questions:

1-In general, autistic children/teens/adults have (certain medical problem here) more than non-autistic children/teen/adults?

2-Autistic children/teens/adults with (certain medical problem here) have the same symptoms and severity of non-ASD children with the same medical problem-considering other factors such as stress ALSO?

I will begin soon, not necessarily in order.

Thank you in advance.I have had some trouble with the initial post (Blogger) but I hope now all is OK.

A New Year

2006-12-28T08:45:00.000-03:00

Hi to all

For us, these are special times. Time of balance. Time of looking inside. Time of reflexion. Christmas time. Time for family, and – as Wade (Rankin) presented so well- time of transformation.

And in this Christmas time I realized how much I have to be grateful of, looking behind in my life. And also how much the world must change about how to give disabled people another space of participation and growing up, accommodation and respect, true empathy and consideration of human and civil rights. This is a experience we, parents of autistic people, share internationally.

Therefore I want to say thank you to every person that has been in touch with me in the blogosphere (or by e-mail) during this year, exchanging ideas. Thank you for your time and for sharing your thoughts with me.
To Ian and Wade, thank you very much for honor me with your friendship.
To Jonathan, thank you for your time, your kindness and the possibility of an excellent exchange- and very fruitful- of ideas.
To all the people who is reading this, I wish you a Happy New Year. I hope we can grow up in the serious science bringing us more clues, more understanding of autism to provide life quality to our autistic children/teens/adults.

Even if it is only a desire expression, I consider important another goal. I hope we can construct bridges for understanding between autistic people of all ages, parents of autistic people, doctors and researchers in autism, of empathy and true discussion, based on science and signed by respect- mutual- but focused on the autistic people needs of all ages in all levels (educational, medical, emotional and social), with the wisdom to discuss properly about what/who is serious and helpful and what/who is not. I hope we can give more understanding to our societies of what autism is.

To all the autistic adults, thank you very much for all you teached- and teach- me about what and how is to be autistic during this year.

Beyond any other consideration, recent times have been very powerful to me in terms of what true advocacy for my child is. And I am very touched by what I have read many times and by what many people blogged and posted and I have learned a lot this year, even when we are not in agreement many times. Being a mom of an autistic child involves for me a continuous evolution mental, spiritual and emotional.

My now not so little sweet autistic child is growing up. Even when times were – and are- sometimes difficult, I have a nucleus of joy and hope because he exists that is beyond everything because he is my son. I hope parents can see the soul and the abilities in their autistic children with the heart beyond the disabilities visible to the eyes.

In this Christmas time and waiting for the begining of 2007, I am grateful for my family. I am grateful for my husband. I am grateful for all the roads of communication, love and understanding we (my son with my husband, my daughter and me) have, and he (with his peers) has constructed with the help of us, his teachers and his schools. I am grateful for all the shared moments with my children. And I am grateful for Life. And I hope that my son and we- his family- learn together to face the challenges for coming the Next year.

Amen.

Respect Meme:5 Simple Questions

2006-10-22T20:01:00.000-03:00

First, I want to acknowledge Jonathan his offer of doing this post. When Jonathan contacted me about this respect meme, I considered it very important because I think that
the way respect is perceived and expected is different from the different positions in the autism debate.For me, it is important to know about.

His answers can be found here

Jonathan Post on Respect Meme.

Yes, the questions from Jonathan are simple but for the answers I must say that I have thought a lot , looking at my own experiences.

1 What is respect for others?

For me, in autism world there are several positions: of the parents of autistic children, of the autistic adults/teens and of the researchers in autism. There are as many different positions in parents as parents of autistic children are. There are many different views of autism in the group of autistic adults/teens. There are other groups of parents that also are researchers in autism field or therapists, and autistic adults that also can be researchers in different areas.

Definition of respect will change then for one or others, depending of who you ask, IMHO, and what is respect for one group is not for another.

Respect for others is:
Besides A) and B ) of Jonathan

A) The avoidance of questioning of motive and the avoidance of personal attacks.

B) Trying to attack the most charitable interpretation of another’s argument as possible.
These are general, but in particular

C) Considering that each parent wants the best for his/her children not because of selfishness. For me as a parent not only the what and the how but also the whys-beyond genetics- and what else than ASD diagnosis are important. But again, each parent has her/his opinion about. Some parents consider ASD a disease (or a syndrome); many others do not.

D) Considering that each autistic adult/teen has –if he/she wants to share- a lot of important things to say IMHO -that must be heard about what and how is being autistic-neurologically, emotionally, medically, sensorially, sociologically, politically, scientifically. I consider that in this point autistic adults/teens must be asked about their opinion on respect, because I only can give a (my) perception of their opinion.

E) Considering that doctors in practice and research deserve consideration for their ideas and work in autism field, because many of them are interested on the whys and what else than ASD diagnosis in ASD is/are present. Their language is very related to autism as a disease-because science tries to maintain objectivity beyond the emotional issues- although taking into account the ethical ones.

Respect for a parent- at least for me- implies the consideration of my emotional status and the importance of my children in my life and also of my decissions about my children´s health as the best I could do for the individual presentation of concomitant medical conditions in him, beyond and besides the ASD diagnosis. Respect for a researcher does not imply emotion , but careful analysis of facts and ideas/hypothesis without the dismiss in advance or the label of unscientific in advance-not the emotional considerations about- Scientists consider ussually autism as a disease to treat as many others and are very involved in numbers and epidemiology and clinical data. Respect for an autistic adult has implied different things in my perception.

So it is what is respect and what is the perception of what is respect for each group, from the others-if interested.

With so different points of views the differences and the struggles and the misunderstandings for me are understable. BTW, Empathy ALWAYS matter and for me it is the root of a true understanding.

2 What are things that appear to respect issues, but are not?

It is certain that the argument (and the ethics and empathy that show ) is/are important but also mocking an argument, even if it can seem valid for a researcher

1-it is very hurting for a parent that has based on it his /her approach of the management of autism in his/her child

2-it is unfair for a scientist to be presented an argument from the emotion and not from the science- quality of the hypothesis, procedures and data. Criticisms can be done without questioning ethics or motives.

3-Sometimes, I have been surprised about how an argument can be understood different from an autistic adult, from his/her perspective and mockering depends on the context and understanding of, even if the original intention was not this.

Beyond the intentions, all can be misunderstood because the interpretations of the same written thing vary-beyond what is evident in language- because of personal concepts about ASD.

3 Is this relevant to the autism discussion and why?

Yes, it is. In a world of perceptions productive discussions depends on how we feel other people are considering us , are trying to understand us- or not- and how we manage the misunderstanding and –in the supposed case- the aggraviation ( or supposed/perceived aggraviation). In the autism discussion, susceptibility is the norm.

4. What can we do to help resolve these issues?

Beyond trying to separate the person of the argument, I do think that how the argument is presented, with what generalization/extrapolation- or not- and the tone/the “read between lines” make the difference between a discussion/debate and a personal war. The understanding of the different positions (even the unconscious differences and interests) is in general absent. The consideration of different positions as valid- not the personal one- is lacking or if you do your effort sometimes is not perceived as such. Many times it seems that the position is” It doesn´t match my thinking: therefore it is wrong”

Such as it is, it has no solution. If a parent thinking in a cure for autism talks with another parent thinking in autism as a way of being and both consider that the personal one is the absolute truth for all and the care about what is respect for each one is absent in the interaction-such as it happens ussually, it has not solution. If a parent thinking in a cure for autism talks with an autistic adult advocating for his rights, it has no solution if both consider that the personal position is the absolute truth for all levels (human rights, metabolism, biochemistry, physiology) and the care about what is respect for each one is absent in the interaction-such as it happens ussually-because the individual experience is not considered. If a researcher looking in biochemical/epigenetics in autism- and finding abnormal tests in ASD- talks with an autistic adult/parent thinking in autism as a way of being and the care (or the knowledge) about what is respect for each one is absent in the interaction-such as it happens ussually , it has no solution.

BTW, asking for clarification before the declaration of the hostilities would be an attempt to decrease the degree of misunderstanding. However, until a real interest in agreement-even partial- is going to develop when possible and depending on individuals I do not think that the situation is going to change easily.

5. How well do you think this will be accomplished?

Perception depends on the emotional status. Even if we want to separate, if we feel our children- or our relationship with them or our decisions about them- are freely criticised without knowledge of who we are or questioning our motives we will react in consequence. How we react in consequence probably makes a difference – or not. In my personal experience, it matters also the different understanding of some particular situation in the interaction with autistic adults or other parents thinking different. In the case of scientists, many times the personal beliefs in terms of potential consequences of research are discussed and they have no true relation with the research basis or goal or the scientists intentions.
I think it will be difficult to achieve a different situation. It depends on many individual perception/positions modifications to produce a true change because

“se necesitan dos para bailar un tango” this is
“you need two to dance a tango”

…and the same for a discussion with personal attacks instead of a progressive/productive debate.

I am very interested on all the opinions about this. Thank you in advance

Introduction

2006-10-17T09:43:00.000-03:00

Why Am I Blogging Now?

Well, beyond my concerns about english as my second language, I begin today my own blog. I apologize in advance for the mistakes in the written language you can find.
I have been mainly since 12 months ago learning about the debate on autism in Internet. My interest in autism in general begun near 3.5 years ago, when my son showed symptoms (at that time with 2 years). At 3 y 2 months he was diagnosed with atypical autism with prognosis of total autism. This is going to be long ( no, really?!) because I begun to write it near 6 months ago.

I feel that the polarization is very high today and in a world of black and white the greys are missed or not considered in the heat of very emotional/ angry discussion.
I wanted to know why people think the way they think, from the proponents/ defensors of the link and of the non-link vaccines-thimerosal /autism, and/or in general an environmental contribution to autism beyond genetics. I have learned a lot about autism, about people- and about me and about debate-, from many people from both sides of the discussion. I wanted also to know the opinion of autistic adults and why of the differences in their opinions in general and in particular. I wanted to know about their feelings and their thinking and to understand. Today, I have more clues about.

I must say that personally, I would not choose for my son transdermal treatments (because of efficiency-where is the proof that i.e DMPS reaches blood through skin?), intravenous treatments (because of personal safety´s concerns about my son), HBOT- because of lack of data regarding safety/efficiency. I would never consider some test/treatment aggressive or potentially dangerous under my personal/familiar analysis (lumbar punction, megadoses of vitamin A, Lupron for example or marijuana, sprays and so on). However, because of the clinical results in my son several aspects of the biomedical approach has been extremely helpful- what to search-once they were analyzed in a team of parents-us-/doctors in my country and out of my country that I found after a lot of personal concern. In the same way, I respect every parent of an autistic child, trying to do their best for their children, even when our family would never choose this or that.

Sometimes I think that the web is a wonderful place but also avoid us from the visual experience of the other, the face to face. I wonder how can many of the things that have been said, be said looking at the eyes of other parents/people. Well, I imagine always that from the other extreme of the line there is a parent/researcher/other that is a human being, just like me, just as vulnerable and strong like me, just with defects and virtues like me. It is sad that many more times than I remember I have not received the same courtesy from those thinking different, you know “ the owners of the truth”, whatever the side of this fence.

About acceptation and love, posting and blogging.

One of the most important aspects that I have considered important is how, once and again, a false dicotomy is presented as true in blogs advocating for neurodiversity. If you are doing biomedical, FOR SURE, you do not accept autism and you want a CURE and this is wrong because you are not respecting your son/daughter and his/her genetics, neurology and individual way of neurocognition. If you are prone to the ideas of neurodiversity, for sure you accept autism per se, you do not want a CURE and, for many this is right because you accept your son/daughter such as it is, because autism is a way of being. Because these ideas are related to human rights and consideration and respect of the human beings the autistic people are, they are seen as right. They are right in the phylosophical point of view for me, but not necessarily they are true in the biological nature or the neuro biochemical/metabolic/ epigenetic/structural/physiological root or they are opposite to do biomedical in my personal view. Philosophy/Ethics versus Biochemistry is not the dicotomy. ALL are important, for me- and in ethics it all depends on the details and motivations and of the heart of the actions/intentions. The dicotomy and the problem is more real and tangible and have multiple faces: required by clinical analysis vs recommended by personal theories (without clinical test or with bad ones); properly tested or not; correctly concomitant medical problem diagnosis (or not) efficient vs non efficient treatment, safe vs unsafe (in the short and long range) –respectul/non-respectful treatment of the autistic person confort or body or mind. If you do not know what to search you will never find something. If you do not find something, you will never treat anything concomitant to the ASD diagnosis. If you do not explore all the available information about treatments how can you rationally decide?

The advocacy is much more to give yourself the permission to say anything to anyone of anyway. And BTW, we-parents of ASD children – are all advocates, someway and the above applies also to ME and I have also had extreme care about my words. Because the effect is the contrary, even if the intentions are loable or important because there is no objectivity behind, even if the defense of human rights are involved.And there are a lot of advocates that unfortunately have this style. And many of the problems they talk about are real and urgent and important to consider and I agree with them in theory sometimes but I disagree with them in the style/tone or in the practice/conclussions and with the free aggresion to people thinking different (or the mockery, the sarcastic/hurting tone or the ridiculization). Whatever my experiences with them, I respect their passion and their commitment. I respect their feelings but many times the perception of the reality-beyond the science- is not the reality- and you can not stablish as if it is-especially when the tree is seen in the other´s eye and the secoya in the own is not noticed/mentioned in the name of advocacy. I respect them even if they do not respect me ( or I feel so). Their choice. However, for many of us the unfair treatment is the rule, only because we think different. And this is a point to show because if someone is advocating for autistics, my son is autistic and I want the best possible advocacy around the world. The advocacy is learned also and I have learned a lot of autistic advocates but also I can appreciate the problems and the shadows in the approach. The shift in paradigm requires from the most vocal advocates a position without criticisms as much as possible because the extreme position is seen then as paradigmatic of a group. We need the best advocacy possible, beyond the criticism as much as possible because the message is otherwise almost lost in the anger and the important is not seen many times and the paradigm is changed by another one that, because of misunderstanding, can be even worse in the perception and as wrong as the previous one.

Having the enough self-confidence to try the understanding of these positions, I will not have easy conclussions about. What about those who do not have the high-level scientific education available and the mental/emotional balance to measure the situation? Why, BTW, so much balance must be required to exchange opinions about a so emotional issue? And where is the empathy?In autism it matters what is said how is said and when is said and I would include, based on what, to who (and this is crucial)- and also where and in what context and with what balance. Not easy to talk about , I must say.

I am, proudly, doing biomedical in an individualized way with my son. I accept him with all my heart and I have never thought in a CURE but in life´s quality in his own terms. I see him as a different human being with all the respect and the consideration that every human being on the earth deserves because we are all diverse, we are all different, with different abilities. I am not poisoned in my view and I am not the spokeperson of nobody but me and him- with the support of my husband. And we have found a lot of clues about the metabolic /biochemical nature of autism symptomalogy. When we treated many of the medical conditions, many of the autistic symptomatology disappeared-surprisingly for us. And we have found so many medical conditions to treat-clinically, using local labs- that it was in the beginning very overwhelming, but not now. And, also I am so tired to be considered a spokeperson or obsessive with vaccines or mocked/ridiculized about my thinking- such as from neurodiversity are openly tired to be called “pharma shills” and “payed by pharma”-, even when nobody gave me
1- a conclusive evidence beyond doubts about that I am wrong with my approach WITH MY SON
and almost nobody gave me
2-the time to read and analyze my thinking/research/overall ideas (that probably it would be long :))
that I have reached the point of convincement of some things:

-There are many parents/adults completely completely convinced that they are right, that their ideas are the truth that simply they do not hear and are not interested about what someone thinking different has to say, even if high level science is explained. Well, perhaps you feel that I am in the other side of the same road (:)). I see my theories /ideas and acknowledge and recognize the holes but I do not understand why the other picture is presented without a puncture ( and I see holes like balls).I assure you that I am more than prone to “sit around a table to hear” but this does not imply to accept that all has been done and that published epi is the truth, to accept any known insult or to explain ad-infinitum that for me autism is not Hg poisoning; that I am not antivaccines or to accept distorted opinions about my son´s view or my relation with him and no, I feel not guilty with my genes.

Have the opinion you want about me, but please do not touch my son or my relation with him because this is the wrongest thing to do in the world.
It is offensive, is aggraviant and cruel and it is inacceptable.

I consider that there is a fundamental difference of attitude: many people think they found the truth whatever the side; I am in the searching for and learning as much as possible.

-I am convinced also that there are many parents completely left alone by the mainstreamed medicine with an autistic child with an enourmous physical suffering, that they are captivated by many not so serious ideas. This is very worrisome but for me, we can warn about the issue, but NEVER to attack parents. But also, many parents have a very rational and serious approach with a child with enormous physical suffering, fighting for serious doctors and safety and efficiency and being extremely informed. BTW, it is hurting to ME to read the description of autistic in the worst ways possible. It is not serious, it is unfair and it is aggraviating, at least for me as the mom of an autistic child, such as it offensive the generalization of very extreme murdering thoughts as common for all parents with children with ASD. The parents who murdered their autistic children committed the worst or the treasons and this is unforgiveable and ununderstable.
-I am convinced that whatever I say, whatever I show, whatever the polite I can be or the demonstration of civility I can give will not change the close mind of many and the extreme position of many more - ir the misunderstanding of me. Simply there is no interest in the evaluation of the possibilities different that the ones they consider as logic under a personal definition of logic and under a personal definition of serious science based on personal beliefs.
You know. Its a wonderful world. If I explain enough, I am perseverant and I am ununderstable. If I feel /am mocked-because at all I can feel tired also AFTER A YEAR of telling the same- and I complain, I am told that I do not accept criticism of science and NOBODY see offense ( even when my ethics/scientific background is attacked directly or tangentially). After near 12 months, to ridiculize appealing to generalizations is simply offensive- as happened recently-, especially because if you offer other perspective -obviously to confirm-you are "vague" and "theoretical".
The aggresions are nor vague neither theoretical; they are very real, from BOTH sides of the debate.
My arguments have been dismissed out of hand by some. Well, when I offered to explain it was too long, too difficult or whatever or I had no answer. Then?? Therefore , always “the truth”-based on known partial published data only- is in the side of the you who are in this position this way. Wonderful world, indeed. But nobody assures that this is THE TRUTH. And my philosophy of what is science and how develops and grows in knowledge is much wide that this. Unfortunately, we never reach this point of discussion because of lack of interest. Again, your choices.
OK;therefore how do you debate in “terra incognita”?
First you hypothesize and after you discuss with available published serious science (when you want, where you want) but with the hyperboles and " the whole vademecum" or "the whole Periodic Table" and the “see your zillion possibilities” arguments I am tired. Especially because when I have offered to explain and to backup with science of different fields (biochemistry, neurobiology, metabolic and so on) I have been dismissed- too long, too difficult, too whatever-AGAIN. And when I have offered to explain why I think the way I do- in my son, that is an important part of my personal position- I remember only 2 people thinking different that accepted and hear enough deep to really know about me and my approach with my son (thank you Jonathan and DoC). Where are we then? In the beginning.

With the degree of knowledge that today there is in autism ALL are imprecise-more or less- and vague because nobody proved anything FOR SURE. But when "they" mention the vaguety- supported with partial epi evidence-“Epidemiology in autism is in its infance“- is proven, when I propose another thing to analyze by 100th time, I am vague. I suppose that always it depends on the eyes who are looking for, the mental attitude/preconcepts you can have/or not and your ideas about the status of science and the personal philosophy of science. The basis of a process of understanding-when possible and depending on individuals-is the interest in the others´s true feelings and motivations and not the mental constructions about the other´s feelings and motivations- many times affected by own perceptions of the world that are very affected by personal experiences/beliefs- previous or not. Therefore the interest in effort and negotiation - socially speaking- obviously not only from society in general for accomodation but for true understanding from autistic adults or ND parents/researchers to non-autistic adult (parents or not) is what I see absent in general, whatever your position as non-ND. And it is unfair that ALL the work must be for us- in the understanding arena and please do not tell me (whatever the side) "the other side started it".

-I am convinced that there are much much more to do that acceptance of ASD and to love beyond everything your child. For me the productive, committed and scientific attitude of consideration of his health to do the development of the best autistic he can be possible, with all the tools I can find and all the serious approaches I need to honor his soul, his mind and his biochemistry is ALSO my approach.
-I am convinced that whatever I can post under my style, it is worth in the webworld if I respect the right to someone else to think different. And I do, especially in blogs of people thinking different- and advocates of autistic people. But I have the right to be respected- and I have been offended/mistreated/misconsidered/accused of antivaccines/accused of non-scientific (and recently of being a spokeperson and many other awful things by association)/ignored so many times after a year and worsening that it is my time to say ENOUGH (it is my right, too).

Dignity is not prerogative of a group. I m not as some people tried to depict me. I have over and over tried to understand and to maintain the discussion civil. I am not recognized myself in all the things that are told about me as for sure. It would be different if I felt i were being characterized accurately and then attacked for something I had done; but instead I feel like a wall on which people are projecting personal views deriving from other times and places that have little to do with anything I have ever said or done or proposed in style/tone/conclussions or treatment of autistic people- including the view of my own son. I am tired of the disqualification because of being Guilty by association, of the Appeal to tradition and to common practice,the appeal to popularity, of the biased sample, the hasty generalization, the spotlight, the appeal to consequences of a belief, of the appeal to belief and of personal attacks in form of ridiculization-over and over-twisting my words many times.And this socavates the sense of what true advocacy is, IMHO.

This is why (in a list of reasons) I am beginning my blog. Because the time of posting in general in blogs where I am not confortable has reached an end. Always the meessage is against someone/a group not pro-understanding to promote a true change. And perhaps, but only perhaps because always depends on the heart of the reader, this way I can be understood better.Because simply the same things are over and over said to me as proven facts- and in different contexts are over and over said, some of them with some reason or simply reason-but locked with out of date/incomplete science-and all science in ASD is incomplete today- some of them not (talking in general)- and my participation has brought no difference, in tone/style or conclussion in many blogs but I feel very well about my past participation . After 1 year, it has been very educative on human nature in its diversity-myself included- but nothing has changed therefore I feel that my collaboration has been almost null to change a very ugly situation. Time to think about, for me. Time to move on.Time to stop.

-I am convinced that my son is not hopeless, that there are a lot to research and to know in ASD. Meanwhile the tone would have to be different when talking of theories/clues as proven facts, whatever the topic- and many people talk forgeting this, everyday. Nobody has the right to use my son´s autism for profit but nobody has the right to speak in my name, and for now, I SPEAKS for him, nobody else.
-There are many blogs from neurodiversity where I feel not welcome, even when I am answered- and I agree that this is a world of perceptions, perhaps it is not the intention or it is the way that autistic adults present their ideas. I have the sensation of the bee in the kitchen: it is supported, but it would be so nice if it goes out or if it shuts up the noise! There are also some others (not more than 2/3) when I feel I am appreciated by the owners of the blog, even if I think different (even very). Thank you Mum is thinking and Kevin and DoC.
Finally, after the finding of these special blogs for me, from Wade (Rankin), Ian (Parker), Kyra and Kristina (Chew) and Amanda (ballastexistanz)- and from very productive exchanges of ideas with Jonathan (Semetko) and with DoC- I have to say thank you for all you teached (and teaches) me about autism and about debate (and about science, emotions, phsycology, life, experiences and productive attitude in the Autismland we all share). I have been said that I am perseverant. However, for me is not perseverance. It is the most rationale approach I can do with the clinical results in my son in autism in particular and my own research and analysis for autism in general.

-I am convinced that with many (if not all the ones I know) of the parents advocating for neurodiversity we share the same strong feelings of love and acceptation – surely-for our children. But the care of an autistic human being is much more than support and love and acceptance, as my son´s biochemistry/clinical analysis- yes, very properly done- have teached me painfully.Many of them- and other autistic adults- are so sure about their ideas as the truth that they have opened an abyss between “them” and anyone thinking different and closed all the doors around, considering that if you are doing biomedical, you are in denial,wrong, obssesed,unethical and unscientific- even when they have no scientific/ other kind proof of this-“because”- as it was my case- you have found several illness in your son and you want to treat them the best you can AND surprisingly the autistic symptomatology partially disappeared and you researched to understand why. And the sad aspect is that I felt very close to ND ideas until the ortodoxia was assumed, defended and stablished as a fact FOR SURE- with any exchange marked by the distrust/preconcepts in ND about biomedical parents/people in general that are not me, with a thinking, position, style, conclussions and overall approach to autism that is not mine and considering me a spokeperson of people I have never talked in the name of. However, I will always support the idea of acceptance of differences and embracing of our autistic children. My son deserves this from me and much more.And my son and ME deserves more of the advocates of autism because My voice is also important to be heard-because for now I am his voice, even if I am far far away from USA/UK/Canada. Whatever the point, there would not be a true advocacy movement without the parents of autistic children. We are not the enemy, but we are seeing/attacked over and over and over as such if we do not embrace- COMPLETELY AND WITHOUT changes-nor a comma- the ND ideas and /or identified with extremes many of us have NOTHING in common. Sorry but for my son ND ideas were not enough to assure his well-being and physical health, simply.

“Never the truth is sad, what it doesn´t have is solution”
Nunca es triste la verdad, lo que no tiene es remedio Joan Manuel Serrat

The point is we are not going to change the truth, whatever our opinions about. And neither our actions.Therefore, Why another space of discussion seems impossible today?

In this sense I also have reached the point to say that it is very important to know what is important to fight for and what is not and WHERE . The known “wisdom to know what I can not change” that I have applied to much more than only one field in my life.OK. Therefore, have a nice life and think what you want for those of you that are not interested on what I have to say or what I think/study.I can not change your ideas about me- never tried to convince you of nothing-or your “locked in”. After a whole year of trying to understand, I do think it is time to have a decision.

But I wonder, beyond my participation or not:
How does this situation help autistic people (children, teens and adults)?
How does this situation will change the way mainstreamed medicine (and society) preconcepts about autism (Autism=Hell, Autism=Cancer, therapy=ABA only)?
How does this situation will allow a space of real discussion of what is junk and what is not, what is useful and what is not and what treatments (under biomedical and mainstreamed) are really effective and safe?.
How productive exchange of opinions and science analysis can take place if all we have in the majority of the blogs is distrust, rants and more rants, and close mind in some cases, and this is related to close the heart to others position and this is repeated once and again if you read archives from 4 / 5 /10 /30 months ago, talking in GENERAL for one time?
How vaccines and thimerosal and environmental xenobiotics would be analyzed seriously with the enormous charge of distrust involved? IF there is a real contribution as an insult, not a cause, Who in the mainstreamed circle of scientists studying genetics related to autism is going to begin to study the issue in collaboration with those who propone a contribution?

When an integrative view of what autism is, considering genetics epigenetics gene expression and environmental potential contributions will arise, from the concerted effort of different groups studying the issue for autistics of all ages and analyzing all the possibilities from the non-link and the link in COMBINATION plus the neurocognitive, sociological, emotional and pshycological aspects –including advocacy-in and for autistic children/teens/adults?
How affects this to MY autistic son? I am (very) concerned about.
Therefore it is my time to complain about the situation and how both extreme sides are collaborating to it.

I wonder when actual learning (real learning and productive exchange of opinions between people thinking different) is taking place in the web, about autism? Only think about it. Today, it is the echo or the war and you find true debate only in very selected places.

I have read that autism does NOT need a cure, especially by autistic adults. However, I do think that there is no ignorance in the need- and the duty and the right as a parent- to ameliorate the physical suffering in your child that is accompanying autism many times and can be properly tested/diagnosed/treated. For me it is not productive the acceptation of the physical suffering in autism as part of the autistic personality and a “detective” work- scientifically based- is needed many times to detect the root of this physical suffering- first hand experience. When you treat properly tested and diagnosed medical conditions concomitant to autism you are not treating the autism-that BTW nobody has known to define me-you are treating medical conditions that are hindering the best of your autistic child to flourish-who asked me about what I found?-probably for me consequences of the interaction of autistic genetics, different for each autistic person, and the envirome. The difference is important because it is based in the root of acceptance and in a personal empathic view of what autism is in general and in particular in my son.

However, I never close doors to nobody, especially in this (my) place.Please left the anger outside and let´s to talk from a different place of mutual respect and respect for other´s ideas. I do think that a different discussion space if possible ( or not, it depends not only on me) ,only if an open heart/mind to ALL the possibilities in the science of autism are considered- and in the agreement about what is non-serious for the majority- with empathy to be the rule and where we can move on ahead with the understanding that many parents doing biomedical have the same acceptance and love to our children that the parent advocating for neurodiversity. I am one of them. What we differ in -many of us- is in the elections of treatments because of our clinical search/findings (even if they are anecdotic for science or unpublished)-beyond and also with the educational/Speech therapy-Occupational therapy ones- not in the love/acceptance of our autistic children.
Even more, there is no agreement with a lot of things in the biomedical field of tests/treatments. In the same way parents can send a strong message depending on whom they select to treat their children- considering CV and conduct and credibility and credentials and serious approach and consideration of the autistic child safety and well-being, the parents and the scientific procedure- in no way to say you are doing biomedical is an endorsement of the whole ideas about how to search/what to test- and where and how-/ what to do next. These are personal and familiar decisions and there are as many as parents.
-I am convinced that the judge of my whole attitude and ideas and approach and love and acceptance of WHO HE IS, but not of WHAT HE HAS AS MEDICAL CONDITIONS AS INEVITABLE AND DEFINITORY OF HIM will be the most important – and the only important finally: MY SON. And yes, the treatment of all these medical conditions has made him less autistic in symptomatology, but obviously did not change his autistic genetics- and will never do- therefore his essence has been/ is / will be always there. I have all the parallel changes in his autistic symptomatology with the clinical studies documented. Because of the privacy, because this is personal, because it is anecdotic and because it was based on my (our) familiar decissions about treatments -different for every child-I will not talk publicly about.

For me,to defend a moderate position (inclusive and considering all the aspects) is my own way to honor my son´s life in one more field, as I try to do it every day in every field of his life with my attitude about the autistic human being he is. Consideration to other people is an attitude I hope I can teach him (and them- I have another child-) with my example, verbal or written. However, this does not exclude the needed self- respect and advocacy for his/her own voice (and the mine also now) to be heard and respected and this is why I presented all my ideas above. As a wise friend told me:” The real test of moral conduct is how one acts in the face of provocation. Someone else's bad behaviour towards me gives me the right to respond and to defend myself, but it does not give me carte blanche to respond in kind” and I agree wholeheartdly (thank you Ian).

When my son was diagnosed, he could not say “I love you mom”. He almost said nothing.I promised me that this, even heartbreaking, was not important. I knew he demonstrated his love in his way. I promised me that the important thing was that I told /tell him every day, every minute with my (our) attitudes that he was/is loved, whatever the challenge. How many times I told him “I love you sweety” was important.
Now, after 3 years, we have our special times every day, many times a day.
Me: I love.,..
Son: you so much mom (smiling and touching my hair)
And like these, many many more special times daily with his father, his peers, his sister, his special teachers his (mainstreamed) teacher, his grandma, his grandpa, tomy (our dog) that were impossible for the doctors who diagnosed him and can be reduced to one word:Happiness.
I suppose that many people ask themselves who is the tall woman walking in the street in the afternoons smiling continuously these days:…ME.

“Because it is not the same to Live than to Honour Life”
“Porque no es lo mismo que vivir, honrar la vida”
Eladia Blazquez-Argentinian singer and songs author

What I am saying is that I ALSO honor my son´s life, such as ND parents do.
And life for me is to honor in my son, my family and friends and in every person in contact with me,even if this person thinks totally different than me, even if this person is aggressive/offensive, even if I can not understand why- or it is difficult. The better I could/can do was/is to leave the words of each one to talk by themselves, to avoid the further interaction after repeated efforts of explanation and understanding- and failing- and I have done/do this. This is my personal definition of dignity, for me and for my son.

This is Searching Equilibrium, a journey and a discovering and for me an opportunity to learn. There is a debate with no rules out there. Well, let´s go to consider rules of fair consideration, at least please HERE to make learning possible (if each of us allow it).

María Luján
To my family in the Family´s Day
Honoring Life and Searching Equilibrium