Probiotics and oxytocin nasal spray as neuro-social-behavioral interventions for patients with autism spectrum disorders: a pilot randomized controlled trial protocol

Xue-Jun Kong, Jun Liu, Jing Li, Kenneth Kwong, Madelyn Koh, Piyawat Sukijthamapan, Jason J Guo, Zhenyu Jim Sun, Yiqing Song, Xue-Jun Kong, Jun Liu, Jing Li, Kenneth Kwong, Madelyn Koh, Piyawat Sukijthamapan, Jason J Guo, Zhenyu Jim Sun, Yiqing Song

Abstract

Background: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by impairments in social interaction and communication. Oxytocin (OXT), as a neuropeptide, plays a role in emotional and social behaviors. Lactobacillus reuteri (L. reuteri) supplementation led to an OXT-dependent behavioral improvement in ASD mouse models. Despite some promising results from animal studies, little is known about the efficacy of supplementation with L. reuteri, alone or with exogenous OXT therapy, on social-behavioral functions in ASD patients. This paper presents a protocol for a pilot randomized controlled trial to evaluate the feasibility of conducting a full trial comparing oral supplementation of L. reuteri probiotics and intranasal OXT spray to placebo on the effect of social and behavioral functions in ASD patients. The study will also capture preliminary estimates of the efficacy of the proposed interventions in ASD patients.

Methods: This pilot trial is a two-staged, randomized, double-blind, placebo-controlled, parallel-group study. Throughout the study (0-24 weeks), 60 patients with ASD will be randomly assigned to receive either oral L. reuteri probiotics or placebo. In the second study stage (13-24 weeks), all participants will receive intranasal OXT spray. As primary outcomes, serum OXT levels will be assayed and social behaviors will be assessed via the Autism Behavior Checklist and the Social Responsiveness Scale which are validated questionnaires, an objective emotional facial matching test, and a new video-based eye-tracking test. Secondary outcomes include the GI-severity-index and Bristol Stool Chart to assess GI function and gut microbiome/short-chain fatty acids. All the outcomes will be assessed at baseline and weeks 12 and 24.

Discussion: This pilot study will provide important information on the feasibility of recruitment, blinding and concealment, treatment administration, tolerability and adherence, specimen collection, outcome assessment, potential adverse effects, and the preliminary efficacy on both primary and secondary outcomes. If successful, this pilot study will inform a larger randomized controlled trial fully powered to examine the efficacies of oral L. reuteri probiotics and/or intranasal OXT spray on social-behavioral improvement in ASD patients.

Trial registration: ClinicalTrials.gov, NCT03337035. Registered 8 November 2017.

Keywords: ASD; Autism spectrum disorders; Neuro-social behaviors; OXT; Oxytocin; Probiotics; Randomized controlled trial.

Conflict of interest statement

Competing interestsThe authors declare that they have no competing interests.

© The Author(s). 2020.

Figures

Fig. 1
Fig. 1
Study design. OXT oxytocin, ABC Aberrant Behavior Checklist, SRS social responsiveness scale, GSI gastrointestinal severity index, Gaba gamma-aminobutyric acid, IL interleukin, TGF tumor growth factor, IFN interferon, GFAP glial fibrillary acidic protein, MBP myelin basic protein, TNF tumor necrosis factor, fMRI functional magnetic resonance imaging, L. reuteri Lactobacillus reuteri

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