Autologous Cord Blood Infusions Are Safe and Feasible in Young Children with Autism Spectrum Disorder: Results of a Single-Center Phase I Open-Label Trial

Geraldine Dawson, Jessica M Sun, Katherine S Davlantis, Michael Murias, Lauren Franz, Jesse Troy, Ryan Simmons, Maura Sabatos-DeVito, Rebecca Durham, Joanne Kurtzberg, Geraldine Dawson, Jessica M Sun, Katherine S Davlantis, Michael Murias, Lauren Franz, Jesse Troy, Ryan Simmons, Maura Sabatos-DeVito, Rebecca Durham, Joanne Kurtzberg

Abstract

Despite advances in early diagnosis and behavioral therapies, more effective treatments for children with autism spectrum disorder (ASD) are needed. We hypothesized that umbilical cord blood-derived cell therapies may have potential in alleviating ASD symptoms by modulating inflammatory processes in the brain. Accordingly, we conducted a phase I, open-label trial to assess the safety and feasibility of a single intravenous infusion of autologous umbilical cord blood, as well as sensitivity to change in several ASD assessment tools, to determine suitable endpoints for future trials. Twenty-five children, median age 4.6 years (range 2.26-5.97), with a confirmed diagnosis of ASD and a qualified banked autologous umbilical cord blood unit, were enrolled. Children were evaluated with a battery of behavioral and functional tests immediately prior to cord blood infusion (baseline) and 6 and 12 months later. Assessment of adverse events across the 12-month period indicated that the treatment was safe and well tolerated. Significant improvements in children's behavior were observed on parent-report measures of social communication skills and autism symptoms, clinician ratings of overall autism symptom severity and degree of improvement, standardized measures of expressive vocabulary, and objective eye-tracking measures of children's attention to social stimuli, indicating that these measures may be useful endpoints in future studies. Behavioral improvements were observed during the first 6 months after infusion and were greater in children with higher baseline nonverbal intelligence quotients. These data will serve as the basis for future studies to determine the efficacy of umbilical cord blood infusions in children with ASD. Stem Cells Translational Medicine 2017;6:1332-1339.

Keywords: Autism spectrum disorder; Autologous umbilical cord blood; Cell therapy.

© 2017 The Authors Stem Cells Translational Medicine published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.

Figures

Figure 1
Figure 1
Frequency of adverse events. Number of patients reporting an event is listed in parentheses.
Figure 2
Figure 2
Vineland Adaptive Behavior Scales‐II (VABS‐II) Socialization Standard Score. (A): Distribution of VABS‐II Socialization Standard Score in all participants over time. (B): Distribution of VABS‐II Socialization Score stratified by nonverbal intelligence quotient.
Figure 3
Figure 3
Global Impression Scale (GCI). (A): CGI‐Severity over time. (B): CGI‐Improvement over baseline as assessed at 6 and 12 months.

References

    1. Baio J. Prevalence of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 sites, United States, 2010. MMWR Surveill Summ 2014;63:1–21.
    1. Buescher AS, Cidav Z, Knapp M et al. Costs of autism spectrum disorders in the United Kingdom and the United States. JAMA Pediatr 2014;168:721–728.
    1. Dawson G, Rogers S, Munson J et al. Randomized, controlled trial of an intervention for toddlers with autism: The early start denver model. Pediatrics 2010;125:e17–e23.
    1. de la Torre‐Ubieta L, Won H, Stein JL et al. Advancing the understanding of autism disease mechanisms through genetics. Nat Med 2016;22:345–361.
    1. Mandy W, Lai MC. Annual Research Review: The role of the environment in the developmental psychopathology of autism spectrum condition. J Child Psychol Psychiatry 2016;57:271–292.
    1. Sahin M, Sur M. Genes, circuits, and precision therapies for autism and related neurodevelopmental disorders. Science 2015;350
    1. Gao R, Penzes P. Common mechanisms of excitatory and inhibitory imbalance in schizophrenia and autism spectrum disorders. Curr Mol Med 2015;15:146–167.
    1. Volk L, Chiu SL, Sharma K et al. Glutamate synapses in human cognitive disorders. Annu Rev Neurosci 2015;38:127–149.
    1. Wolff JJ, Gu H, Gerig G et al. Differences in white matter fiber tract development present from 6 to 24 months in infants with autism. Am J Psychiatry 2012;169:589–600.
    1. Young AMH, Chakrabarti B, Roberts D et al. From molecules to neural morphology: Understanding neuroinflammation in autism spectrum condition. Mol Autism 2016;7:1–8.
    1. Voineagu I, Wang X, Johnston P et al. Transcriptomic analysis of autistic brain reveals convergent molecular pathology. Nature 2011;474:380–384.
    1. Braunschweig D, Krakowiak P, Duncanson P et al. Autism‐specific maternal autoantibodies recognize critical proteins in developing brain. Transl Psychiatry 2013;3:e277.
    1. Vargas DL, Nascimbene C, Krishnan C et al. Neuroglial activation and neuroinflammation in the brain of patients with autism. Ann Neurol 2005;57:67–81.
    1. Morgan JT, Chana G, Pardo CA et al. Microglial activation and increased microglial density observed in the dorsolateral prefrontal cortex in autism. Biol Psychiatry 2010;68:368–376.
    1. Suzuki K, Sugihara G, Ouchi Y et al. Microglial activation in young adults with autism spectrum disorder. JAMA Psychiatry 2013;70:49–58.
    1. Bachstetter AD, Pabon MM, Cole MJ et al. Peripheral injection of human umbilical cord blood stimulates neurogenesis in the aged rat brain. BMC Neurosci 2008;9:22.
    1. Shahaduzzaman M, Golden JE, Green S et al. A single administration of human umbilical cord blood T cells produces long‐lasting effects in the aging hippocampus. Age (Dordr) 2013;35:2071–2087.
    1. Sun J, Allison J, McLaughlin C et al. Differences in quality between privately and publicly banked umbilical cord blood units: A pilot study of autologous cord blood infusion in children with acquired neurologic disorders. Transfusion 2010;50:1980–1987.
    1. Cotten CM, Murtha AP, Goldberg RN et al. Feasibility of autologous cord blood cells for infants with hypoxic‐ischemic encephalopathy. J Pediatr 2014;164:973–979.e1.
    1. Sun JM, Grant GA, McLaughlin C et al. Repeated autologous umbilical cord blood infusions are feasible and had no acute safety issues in young babies with congenital hydrocephalus. Pediatr Res 2015;78:712–716.
    1. Diagnostic and Statistical Manual of Mental Disorders: DSM‐5. Washington, D.C: American Psychiatric Association, 2013.
    1. Lord C, Rutter M, DiLavore P et al. Autism Diagnostic Observation Schedule (ADOS‐2). 2nd ed. Torrance, CA: Western Psychological Services, 2012.
    1. Rutter M, Le Couteur A, Lord C et al. Autism Diagnostic Interview‐Revised (ADI‐R). Torrance, CA: Western Psychological Services, 2005.
    1. Roid GH. Stanford‐Binet Intelligence Scales for Early Childhood (Early SB5). Fifth ed. Itasca, IL: Riverside Publishing, 2003.
    1. Mullen E. Mullen Scales of Early Learning. AGS ed. Bloomington, MN: NCS Pearson Inc, 1995.
    1. Shoulars K, Noldner P, Troy JD et al. Development and validation of a rapid, aldehyde dehydrogenase bright‐based cord blood potency assay. Blood 2016;127:2346–2354.
    1. Rubinstein P, Dobrila L, Rosenfield RE et al. Processing and cryopreservation of placental/umbilical cord blood for unrelated bone marrow reconstitution. Proc Natl Acad Sci USA 1995;92:10119–10122.
    1. Sparrow S, Cicchetti D, Balla D. Vineland Adaptive Behavior Scales (Vineland II): Parent/Caregiver Rating Form. 2nd ed Minneapolis, MN: NCS Pearson Inc, 2005.
    1. Balboni G, Tasso A, Muratori F et al. The vineland‐II in preschool children with autism spectrum disorders: An item content category analysis. J Autism Dev Disord 2016;46:42–52.
    1. Perry A, Flanagan HE, Dunn Geier J et al. Brief report: The vineland adaptive behavior scales in young children with autism spectrum disorders at different cognitive Levels. J Autism Dev Disord 2009;39:1066–1078.
    1. Yang S, Paynter JM, Gilmore L. Vineland adaptive behavior scales: II profile of young children with autism spectrum disorder. J Autism Dev Disord 2016;46:64–73.
    1. Sparrow S, Cicchetti DV, Balla DA. Vineland Adaptive Behavior Scales: Survey Forms Manual. 2nd ed Minneapolis, MN: NCS Pearson Inc, 2005.
    1. Cohen IL, Sudhalter V. PDDBI Parent Rating Form. Lutz, FL: Psychological Assessment Resources Inc; 2005.
    1. Cohen IL, Sudhalter V. PDD Behavior Inventory Professional Manual. Lutz, FL: Psychological Assessment Resources Inc; 2005.
    1. Martin NA, Brownell R. Expressive One‐Word Picture Vocabulary Test (EOWPVT‐4). 4th ed. Novato, CA: Academic Therapy Publications Inc, 2011.
    1. Tobii. Tobii TX300. Danderyd, Sweden: Tobii Technology, 2014.
    1. Chawarska K, Macari S, Shic F. Context modulates attention to social scenes in toddlers with autism. J Child Psychol Psychiatry 2012;53:903–913.
    1. Kantzer AK, Fernell E, Westerlund J et al. Young children who screen positive for autism: Stability, change and “comorbidity” over two years. Res Dev Disabil 2016.
    1. Guideline on the Clinical Development of Medicinal Products for the Treatment of Autism Spectrum Disorder (ASD) ‐ Draft. 2016. Available at . Last accessed November 14, 2016.

Source: PubMed

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