What do Cochrane systematic reviews say about interventions for autism spectrum disorders?

CONTEXT AND OBJECTIVE:: Autism spectrum disorders (ASDs) include autistic disorder, Asperger's disorder and pervasive developmental disorder. The manifestations of ASDs can have an important impact on learning and social functioning that may persist during adulthood. The aim here was to summarize the evidence from Cochrane systematic reviews on interventions for ASDs. DESIGN AND SETTING:: Review of systematic reviews, conducted within the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS:: We included and summarized the results from Cochrane systematic reviews on interventions for ASDs. RESULTS:: Seventeen reviews were included. These found weak evidence of benefits from acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups, Theory of Mind cognitive model, aripiprazole, risperidone, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI); this last only for adults. No benefits were found for sound therapies, chelating agents, hyperbaric oxygen therapy, omega-3, secretin, vitamin B6/magnesium and SSRI for children. CONCLUSION:: Acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups and the Theory of Mind cognitive model seem to have benefits for patients with autism spectrum disorders (very low to low-quality evidence). Aripiprazole, risperidone, tricyclic antidepressants and SSRI (this last only for adults) also showed some benefits, although associated with higher risk of adverse events. Experimental studies to confirm a link between probable therapies and the disease, and then high-quality long-term clinical trials, are needed.

What do Cochrane systematic reviews say about interventions for autism spectrum disorders? / O que as revisões sistemáticas Cochrane falam sobre intervenções para os transtornos do espectro autista?

ABSTRACT CONTEXT AND OBJECTIVE: Autism spectrum disorders (ASDs) include autistic disorder, Asperger’s disorder and pervasive developmental disorder. The manifestations of ASDs can have an important impact on learning and social functioning that may persist during adulthood. The aim here was to summarize the evidence from Cochrane systematic reviews on interventions for ASDs. DESIGN AND SETTING: Review of systematic reviews, conducted within the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: We included and summarized the results from Cochrane systematic reviews on interventions for ASDs. RESULTS: Seventeen reviews were included. These found weak evidence of benefits from acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups, Theory of Mind cognitive model, aripiprazole, risperidone, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI); this last only for adults. No benefits were found for sound therapies, chelating agents, hyperbaric oxygen therapy, omega-3, secretin, vitamin B6/magnesium and SSRI for children. CONCLUSION: Acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups and the Theory of Mind cognitive model seem to have benefits for patients with autism spectrum disorders (very low to low-quality evidence). Aripiprazole, risperidone, tricyclic antidepressants and SSRI (this last only for adults) also showed some benefits, although associated with higher risk of adverse events. Experimental studies to confirm a link between probable therapies and the disease, and then high-quality long-term clinical trials, are needed.

RESUMO CONTEXTO E OBJETIVO: Os transtornos do espectro autista (TEA) incluem autismo, doença de Asperger e transtorno global do desenvolvimento. As manifestações dos TEA podem ter importante impacto na aprendizagem e funcionamento social, que pode persistir durante a fase adulta. O objetivo foi resumir as evidências de revisões sistemáticas Cochrane sobre intervenções para TEA. TIPO DE ESTUDO E LOCAL: Revisão de revisões sistemáticas conduzida na Disciplina de Medicina Baseada em Evidências da Escola Paulista de Medicina, Universidade Federal de São Paulo. MÉTODOS: Nós incluímos e resumimos os resultados de revisões sistemáticas Cochrane sobre intervenções para TEA. RESULTADOS: Foram incluídas 17 revisões que encontraram evidências fracas de benefícios da acupuntura, dietas isentas de glúten e caseína, intervenção comportamental intensiva precoce, musicoterapia, intervenção precoce mediada pelos pais, grupos de habilidades sociais, modelo cognitivo de Teoria da Mente, aripiprazol, risperidona, antidepressivos tricíclicos, inibidores seletivos da recaptação da serotonina (ISRS); o último apenas para adultos. Nenhum benefício foi encontrado com terapias sonoras, agentes quelantes, oxigenoterapia hiperbárica, ômega-3, secretina, vitamina B6/magnésio e ISRS para crianças. CONCLUSÃO: Acupuntura, dietas sem glúten e caseína, intervenção comportamental intensiva precoce, musicoterapia, intervenção precoce mediada pelos pais, grupos de habilidades sociais e modelo cognitivo de Teoria da Mente parecem ter benefícios para pacientes com TEA (evidência de qualidade muito baixa a baixa). Aripiprazol, risperidona, antidepressivos tricíclicos e ISRS (o último apenas para adultos) também apresentam algum benefício, embora estejam associados a maior risco de eventos adversos. Estudos experimentais confirmando a relação entre prováveis terapias e a doença, e então ensaios clínicos de alta qualidade e de longo seguimento, são necessários.

Characterization, specificity and sensibility of produced anti-Rhamdia quelen vitellogenin in Brazilian fish species.

Endocrine-disrupting chemicals (EDCs) are widespread used and can interfere on hormone regulation with adverse consequences for both biota and human. Vitellogenin (vtg) is a yolk precursor protein synthesized by the liver in response to estrogen. In order to characterize the vtg of tropical fish Rhamdia quelen and establish a molecular biomarker, adult male individuals were exposed to 17-ß-estradiol (E2) for vtg induction and anti-R. quelen vtg polyclonal antibodies production. Vitellogenic female fish were used as positive control group. E2-induced vtg was characterized as a glycolipophosphoprotein of high molecular mass with peptide mass fingerprint very similar in E2-exposed male and vitellogenic female fish. A polyclonal serum containing anti-R. quelen vtg antibodies was produced and showed high specificity and sensibility to detect the vtg of three fish species: R. quelen, Piaractus mesopotamicus and Prochilodus lineatus. Wildlife and laboratory studies reported that EDCs released into the environment may alter the levels of plasma vtg in male fish, making this protein a valuable biomarker of xenoestrogens exposure. Then, we propose the use of anti-R. quelen vtg as a tool for biomonitoring studies and water quality assessment in Brazil and South American countries where the three fish species occur.

Brown spider (Loxosceles intermedia) venom triggers endothelial cells death by anoikis.

Brown spider (Loxosceles sp.) venom affects the endothelium of vessels and triggers disruptive activity in the subendothelial matrix. The vascular disorders observed after venom exposure include leukocyte and platelet activation, disseminated intravascular coagulation, an increase in vessel permeability and hemorrhage into the dermis. In this study, we report additional evidence regarding the mechanism of endothelial cell cytotoxicity induced by Loxosceles intermedia venom. Exposure to venom led to endothelial cell detachment in a time-dependent manner. Loss of cell anchorage and cell-cell adhesion following venom exposure was accompanied by changes in the distribution of the α5ß1 integrin and VE-cadherin. An ultrastructural analysis of cells treated with venom revealed morphological alterations characteristic of apoptosis. Moreover, after venom exposure, the ratio between Bax and Bcl-2 proteins was disturbed in favor of Bax. In addition, late apoptosis was only observed in cells detached by the action of venom. Accordingly, there was no increase in apoptosis when cells were exposed to L. intermedia venom in suspension, suggesting that the loss of cell anchorage provides the signal to initiate apoptosis. Thus, L. intermedia venom likely triggers endothelial cell death indirectly through an apoptotic mechanism known as anoikis.