U.S. patent application number 15/641035 was filed with the patent office on 2018-01-04 for method of diagnosis and treating gastrointestinal and neurological diseases associated with species of genus clostridium.
This patent application is currently assigned to The United States of America as represented by the Department of Veterans Affairs. The applicant listed for this patent is The Department of Veterans Affairs. Invention is credited to Paula Carlson, Sydney M. Finegold.
Application Number | 20180002741 15/641035 |
Document ID | / |
Family ID | 60806168 |
Filed Date | 2018-01-04 |
United States Patent
Application |
20180002741 |
Kind Code |
A1 |
Finegold; Sydney M. ; et
al. |
January 4, 2018 |
METHOD OF DIAGNOSIS AND TREATING GASTROINTESTINAL AND NEUROLOGICAL
DISEASES ASSOCIATED WITH SPECIES OF GENUS CLOSTRIDIUM
Abstract
The invention includes a method of diagnosis and treating autism
associated with an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject. In one
embodiment, the method comprises administering to the subject (e.g.
a subject having an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens in the gut) one or more agents to reduce or
eliminate beta2-toxin-gene positive Clostridium perfringens in the
subject so as to relieve one or more symptoms of autism.
Inventors: |
Finegold; Sydney M.; (Los
Angeles, CA) ; Carlson; Paula; (Los Angeles,
CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
The Department of Veterans Affairs |
Washington |
DC |
US |
|
|
Assignee: |
The United States of America as
represented by the Department of Veterans Affairs
|
Family ID: |
60806168 |
Appl. No.: |
15/641035 |
Filed: |
July 3, 2017 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
62357549 |
Jul 1, 2016 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
C12Q 1/689 20130101;
C12Q 2600/106 20130101; C12Q 2600/118 20130101; C12Q 1/6883
20130101; C12Q 2600/158 20130101 |
International
Class: |
C12Q 1/68 20060101
C12Q001/68 |
Goverment Interests
[0003] This invention was made with support from the Autism
Research Institute. The government has certain rights in the
invention.
Claims
1. A method of treating autism associated with an overgrowth of
beta2-toxin-gene-positive Clostridium perfringens in the gut of an
autistic subject comprising administering to the subject having an
overgrowth of Clostridium perfringens positive for beta2-toxin gene
one or more agents to reduce or eliminate beta2-toxin-gene positive
Clostridium perfringens in the subject so as to relieve one or more
symptoms of autism; thereby, treating autism associated with an
overgrowth of beta2-toxin-gene-positive Clostridium perfringens in
the autistic subject.
2. The method of claim 1, wherein the overgrowth of
beta2-toxin-gene-positive Clostridium perfringens is an
overrepresentation or excess of beta2-toxin-gene-positive
Clostridium perfringens vegetative cells, spores or a combination
thereof, in the gut of the autistic subject.
3. The method of claim 2, wherein the overgrowth of
beta2-toxin-gene-positive Clostridium perfringens is detected as an
overrepresentation or excess of Clostridium perfringens vegetative
cells, Clostridium perfringens spores or combination thereof, in
the feces of an autistic subject compared to a control subject or
population of control subjects.
4. The method of claim 1, wherein the control subject or population
of control subjects has about 1.5.times.10.sup.3 colony forming
units of beta2-toxin-gene-positive Clostridium perfringens per gram
dry weight of fecal specimen.
5. (canceled)
6. (canceled)
7. The method of claim 1, wherein the overgrowth of
beta2-toxin-gene-positive Clostridium perfringens in the gut of an
autistic subject is positively correlated with an overgrowth of
Clostridium perfringens.
8. The method of claim 7, wherein the overgrowth of Clostridium
perfringens results in at least a 3-fold increase in Clostridium
perfringens colony forming units in the autistic subject over a
control subject or a population of control subjects.
9.-17. (canceled)
18. The method of claim 1, wherein the beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject
additionally comprises a Clostridium perfringens alpha-toxin
gene.
19. The method of claim 1, wherein the beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject is free
of a Clostridium perfringens alpha-toxin gene.
20.-32. (canceled)
33. The method of claim 1, wherein the beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject produces
a Clostridium perfringens beta2-toxin and alpha-toxin but is free
of a Clostridium perfringens beta-toxin, Clostridium perfringens
epsilon-toxin and Clostridium perfringens iota-toxin.
34. The method of claim 1, wherein the beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject produces
a Clostridium perfringens beta2-toxin but is free of a Clostridium
perfringens alpha-toxin, Clostridium perfringens beta-toxin,
Clostridium perfringens epsilon-toxin and Clostridium perfringens
iota-toxin.
35. (canceled)
36. (canceled)
37. The method of claim 1, wherein the one or more agent(s) is an
antimicrobial, a bacteriophage, a probiotic, a probiotic group, a
prebiotic or a vaccine which would lead to production of an
anti-toxin against a toxin produced by the
beta2-toxin-gene-positive Clostridium perfringens in the gut of the
autistic subject, or a combination thereof.
38. The method of claim 1, wherein the agent to reduce or eliminate
beta2-toxin-gene-positive Clostridium perfringens is selected from
the group consisting of ABT-773, ampicillin, sulbactam, amphomycin,
azithromycin, bacitracin, carboxmycin, cephlosporins,
clarithromycin, erythromycin, furazolidone, nitrofuran, fusidic
acid, sodium fusidate, gramicidin, a penem, imipenem, josamycin,
linezolid, oxazolidinone, a macrolide, metronidazole,
nitroimidazole, mikamycin, minocycline, novobiocin, oleandomycin,
triacetyloleandomycin, ostreogrycin, piperacillin, tazobactam,
pristinamycin, ramoplanin, ristocetin, rosamicin, rosaramicin,
spectinomycin, spiramycin, streptogramin, synergistin, teicoplanin,
telithromycin, ticarcillin, clavulanic acid, tyrocidin,
tyrothricin, vancomycin, vernamycin, and virginiamycin.
39. The method of claim 37, wherein the antimicrobial is selected
from the group consisting of ABT-773, ampicillin, sulbactam,
amphomycin, azithromycin, bacitracin, carboxmycin, cephlosporins,
clarithromycin, erythromycin, furazolidone, nitrofuran, fusidic
acid, sodium fusidate, gramicidin, a penem, imipenem, josamycin,
linezolid, oxazolidinone, a macrolide, metronidazole,
nitroimidazole, mikamycin, minocycline, novobiocin, oleandomycin,
triacetyloleandomycin, ostreogrycin, piperacillin, tazobactam,
pristinamycin, ramoplanin, ristocetin, rosamicin, rosaramicin,
spectinomycin, spiramycin, streptogramin, synergistin, teicoplanin,
telithromycin, ticarcillin, clavulanic acid, tyrocidin,
tyrothricin, vancomycin, vernamycin, and virginiamycin.
40. The method of claim 37, wherein the probiotic or the probiotic
group is selected from the group consisting of Bacteroides
thetaiotaomicron, Bacteroides vulgatus, Bacteroides distasonis,
Bacteroides fragilis, Bifidobacterium adolescentis group,
Eubacterium aerofaciens, Clostridium ramosum, Escherichia coli,
Streptococcus faecalis group, Lactobacillus spp., L. acidophilus,
gram-negative anaerobes, enterococci, Bacteroides sp.,
Parabacteroides, Prevotella, Porphyromonas, gram-positive anaerobic
cocci, Clostridium sp., Enterobacteriaceae, E. coli, L. bulgaricus,
S. thermophilus, Collinsella genus, Bifidobacterium genus,
Bifidobacterium longum, Bifidobacterium angulatum, Dialister
invisus, Clostridium leptum, Firmicutes, Actinobacteria,
Faecalibacterium, Ruminococcus, Eubacterium, Alistipes, Roseburia,
Anaerofilum, Streptococcus, Turicibacter, Parabacteroides, Dorea,
Veillonella, Akkermansia, Sporobacter, Ethanoligenens,
Papillibacter, Holdemania, Weissella, Dialister, Pseudoramibacter,
Streptococcus, Anaerovorax, Lactococcus, Leuconostoc,
Ethanoligenens, Helcococcus, Alkaliphilus, Clostridium bolteae,
Clostridium methylpentosum, Eubacterium ruminantium,
Phascolarctobacterium faecium, Alistipes species, Bifidobacterium
species, Lactobacillus species, and Bacteroides caccae.
41.-45. (canceled)
46. The method of claim 37, wherein the toxin is Clostridium
perfringens beta2-toxin.
47. (canceled)
48. A method of treating autism associated with an overgrowth of
beta2-toxin-gene-positive Clostridium perfringens in the gut of an
autistic subject comprising: a) determining existence of an
overgrowth of Clostridium perfringens positive for beta2-toxin gene
in a sample from the subject; and (b) administering to the subject
one or more agents to reduce or eliminate beta2-toxin-gene positive
Clostridium perfringens in the subject so as to relieve one or more
symptoms of autism; thereby, treating autism associated with an
overgrowth of beta2-toxin-gene-positive Clostridium perfringens in
the autistic subject.
49.-56. (canceled)
57. A method of identifying an autistic subject whose autism may be
alleviated by a course of treatment directed against an overgrowth
of Clostridium perfringens so as to reduce or eliminate the
overgrowth comprising (a) determining existence of said overgrowth
in the autistic subject, thereby, identifying the autistic subject
whose autism may be alleviated by a course of treatment directed
against the overgrowth of Clostridium perfringens.
58.-65. (canceled)
66. A method for monitoring the course of autism in an autistic
subject by identifying the subject by the method of claim 57 or 58
and quantitatively determining a level of overgrowth of Clostridium
perfringens, overgrowth of beta2-toxin-gene-positive Clostridium
perfringens, activity of Clostridium perfringens beta2-toxin from a
biological sample from the subject at one time point and comparing
a value so determined with the value determined from a second
sample from the subject, such samples being taken at different
points in time, a difference in the values determined being
indicative of the course of the autistic condition.
67. (canceled)
68. (canceled)
69. The method of claim 66, wherein a decrease in the overgrowth of
Clostridium perfringens, overgrowth of beta2-toxin-gene-positive
Clostridium perfringens, activity of Clostridium perfringens
beta2-toxin is indicative or predictive of reducing severity or
duration of one or more symptoms associated with autism.
70. The method of claim 66, wherein an increase in the overgrowth
of Clostridium perfringens, overgrowth of beta2-toxin-gene-positive
Clostridium perfringens, activity of Clostridium perfringens
beta2-toxin is indicative or predictive of increasing severity or
duration of one or more symptoms associated with autism.
71. (canceled)
Description
[0001] This patent application claims the benefit of U.S. Ser. No.
62/357,549, filed Jul. 1, 2016, the contents of which is herein
incorporated by reference in its entirety into the present patent
application.
[0002] Throughout this application various publications are
referenced. The disclosures of these publications in their
entireties are hereby incorporated by reference into this
application in order to more fully describe the state of the art to
which this invention pertains.
BACKGROUND OF THE INVENTION
[0004] It was known that intestinal clostridia contribute to the
clinical picture of autism (U.S. Pat. No. 9,168,275). For example,
our microbiological studies revealed a higher incidence and higher
counts of clostridia in autism subjects' fecal samples compared to
control samples and there is a significantly reduced overall
bacterial diversity in the feces of the autistic group children
(1-4).
[0005] Now we have discovered that autistic children may harbor an
overgrowth of beta2-toxin-gene-positive Clostridium perfringens in
their intestinal microflora and that such toxin-producing organisms
are an important target to alleviate autism and its symptoms. This
discovery provides additional methods for diagnosis and treating
autistic children positive for toxin-producing Clostridium
perfringens in their gut.
SUMMARY OF THE INVENTION
[0006] The invention includes a method of treating autism
associated with an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject. In one
embodiment, the method comprises administering to the subject
having an overgrowth of Clostridium perfringens positive for
beta2-toxin gene one or more agents to reduce or eliminate
beta2-toxin-gene positive Clostridium perfringens in the subject so
as to relieve one or more symptoms of autism; thereby, treating
autism associated with an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens in the autistic subject. In another
embodiment, the method comprises administering to the subject (e.g.
a subject having an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens in the gut) one or more agents to reduce or
eliminate beta2-toxin-gene positive Clostridium perfringens in the
subject so as to relieve one or more symptoms of autism.
[0007] In another embodiment, the method comprises a) determining
an overgrowth of Clostridium perfringens positive for beta2-toxin
gene in a sample from the subject; and (b) administering to the
subject, who has been determined to have the overgrowth of
Clostridium perfringens positive for beta2-toxin gene in (a), one
or more agents to reduce or eliminate beta2-toxin-gene positive
Clostridium perfringens in the subject so as to relieve one or more
symptoms of autism.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] FIG. 1 indicates an outline of an analysis of stool
specimens from autistic children and control children.
[0009] FIG. 2 is a diagram illustrating correlation between C.
perfringens CFU/g and the CFU/g of beta2-toxin-producing C.
perfringens presented in log 10 scale.
[0010] FIG. 3 is a PCR analysis of toxin genes of Clostridium
perfringens.
DETAILED DESCRIPTION OF THE INVENTION
[0011] The invention includes methods of treating autism associated
with an overgrowth of beta2-toxin-gene-positive Clostridium
perfringens in the gut of an autistic subject. In one embodiment,
the method comprises administering to the subject (e.g., a subject
having an overgrowth of beta2-toxin-gene-positive Clostridium
perfringens in the gut) one or more agents to reduce or eliminate
beta2-toxin-gene positive Clostridium perfringens in the subject so
as to relieve one or more symptoms of autism. Examples of symptoms
of autism include, but are not limited to, social deficits,
language impairment, and repetitive behaviors. Additional examples
include associated neurological issues such as sleep deficits, mood
swings, anxiety, hyperactivity, immune dysfunction, and seizures.
Autism associated with an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens includes early onset autism, late onset
autism, and regressive autism. In one embodiment, autism associated
with an overgrowth of beta2-toxin-gene-positive Clostridium
perfringens is regressive autism.
[0012] In one embodiment, feces, fecal specimen or stool may be
used to determine an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens strain, Clostridium perfringens species or
Clostridium genus in the gut of a subject. In one embodiment, the
sample from a subject is a fecal specimen or stool. For example, an
overgrowth of beta2-toxin-gene-positive Clostridium perfringens in
the gut includes a range of about 10.sup.3-10.sup.4 CFU per gram
dry weight of fecal specimen from a subject. Overgrowth of
beta2-toxin-gene-positive Clostridium perfringens includes other
ranges described herein.
[0013] In another embodiment of the invention, the method comprises
administering to the subject (e.g., a subject having an overgrowth
of beta2-toxin-gene-positive Clostridium perfringens in the gut)
one or more agents to reduce or eliminate beta2-toxin-gene positive
Clostridium perfringens in the subject so as to relieve one or more
symptoms of autism; thereby treating autism associated with an
overgrowth of beta2-toxin-gene-positive Clostridium perfringens in
the autistic subject.
[0014] In another embodiment, the method comprises a) determining
an overgrowth of Clostridium perfringens positive for beta2-toxin
gene in a sample from the subject; and (b) administering to the
subject, who has been determined to have the overgrowth of
Clostridium perfringens positive for beta2-toxin gene in (a), one
or more agents to reduce or eliminate beta2-toxin-gene positive
Clostridium perfringens in the subject so as to relieve one or more
symptoms of autism. For example, wherein the sample may be a fecal
sample.
[0015] In one embodiment of the invention, the overgrowth of
beta2-toxin-gene-positive Clostridium perfringens is an
overrepresentation or excess of beta2-toxin-gene-positive
Clostridium perfringens vegetative cells, spores or a combination
thereof, in the gut of the autistic subject compared to
non-autistic subject or population of non-autistic subjects. In one
embodiment, overrepresentation of beta2-toxin-gene-positive
Clostridium perfringens vegetative cells, spores or a combination
thereof, may be with respect to total Clostridium or total
Clostridium perfringens. The percent beta2-toxin-gene-positive
Clostridium perfringens vegetative cells, spores or a combination
thereof, as a fraction of total Clostridium count or total
Clostridium perfringens count is higher in the autistic subject
compared to non-autistic subject or population of non-autistic
subjects.
[0016] In one embodiment, the percent beta2-toxin-gene-positive
Clostridium perfringens vegetative cells, spores or a combination
thereof, of total Clostridium in the autistic subject is about
3-fold higher than non-autistic subject or population of
non-autistic subjects. In one embodiment, the percent
beta2-toxin-gene-positive Clostridium perfringens vegetative cells,
spores or a combination thereof, of total Clostridium in the
autistic subject is more than 3-fold higher than non-autistic
subject or population of non-autistic subjects. In one embodiment,
the percent beta2-toxin-gene-positive Clostridium perfringens
vegetative cells, spores or a combination thereof, of total
Clostridium perfringens in the autistic subject is more than 3-fold
higher than non-autistic subject or population of non-autistic
subjects. In one embodiment, the percent beta2-toxin-gene-positive
Clostridium perfringens vegetative cells, spores or a combination
thereof, of total Clostridium perfringens in the autistic subject
is 10-fold higher than non-autistic subject or population of
non-autistic subjects. In one embodiment, the percent
beta2-toxin-gene-positive Clostridium perfringens vegetative cells,
spores or a combination thereof, of total Clostridium perfringens
in the autistic subject is 20-fold higher than non-autistic subject
or population of non-autistic subjects. In one embodiment, the
percent beta2-toxin-gene-positive Clostridium perfringens
vegetative cells, spores or a combination thereof, of total
Clostridium perfringens in the autistic subject is about 22-fold
higher than non-autistic subject or population of non-autistic
subjects.
[0017] In one embodiment, the amount of beta2-toxin-gene-positive
Clostridium perfringens vegetative cells, spores or a combination
thereof, exceeds mean counts of beta2-toxin-gene-positive
Clostridium perfringens of a non-autistic subject or population of
non-autistic subjects. In one embodiment, the amount of
beta2-toxin-gene-positive Clostridium perfringens of the autistic
subject exceeds 1.48.times.10.sup.3 colony forming unit (CFU) per
gram dry weight of fecal specimen, the mean counts of
beta2-toxin-gene-positive Clostridium perfringens of a non-autistic
subject or population of non-autistic subjects. In one embodiment,
the amount of beta2-toxin-gene-positive Clostridium perfringens of
the autistic subject is more than 1.48.times.10.sup.3 colony
forming unit (CFU) per gram dry weight of fecal specimen. In one
embodiment, the amount of beta2-toxin-gene-positive Clostridium
perfringens of the autistic subject exceeds the amount of a
non-autistic subject or population of non-autistic subjects by more
than 3-fold. In one embodiment, the amount of
beta2-toxin-gene-positive Clostridium perfringens of the autistic
subject exceeds the amount of a non-autistic subject or population
of non-autistic subjects by more than 10-fold. In one embodiment,
the amount of beta2-toxin-gene-positive Clostridium perfringens of
the autistic subject exceeds the amount of a non-autistic subject
or population of non-autistic subjects by more than 20-fold. In one
embodiment, the amount of beta2-toxin-gene-positive Clostridium
perfringens of the autistic subject exceeds the amount of a
non-autistic subject or population of non-autistic subjects by more
than 30-fold. In one embodiment, the amount of
beta2-toxin-gene-positive Clostridium perfringens of the autistic
subject exceeds the amount of a non-autistic subject or population
of non-autistic subjects by more than 40-fold. In one embodiment,
the amount of beta2-toxin-gene-positive Clostridium perfringens of
the autistic subject exceeds the amount of a non-autistic subject
or population of non-autistic subjects by about 44-fold. In one
embodiment, the amount of beta2-toxin-gene-positive Clostridium
perfringens of the autistic subject is more than 4.5.times.10.sup.3
colony forming unit (CFU) per gram dry weight of fecal specimen. In
one embodiment, the amount of beta2-toxin-gene-positive Clostridium
perfringens of the autistic subject is more than 1.5.times.10.sup.4
colony forming unit (CFU) per gram dry weight of fecal specimen. In
one embodiment, the amount of beta2-toxin-gene-positive Clostridium
perfringens of the autistic subject is more than 3.0.times.10.sup.4
colony forming unit (CFU) per gram dry weight of fecal specimen. In
one embodiment, the amount of beta2-toxin-gene-positive Clostridium
perfringens of the autistic subject is more than 4.5.times.10.sup.4
colony forming unit (CFU) per gram dry weight of fecal specimen. In
one embodiment, the amount of beta2-toxin-gene-positive Clostridium
perfringens of the autistic subject is more than 6.0.times.10.sup.4
colony forming unit (CFU) per gram dry weight of fecal specimen. In
one embodiment, the amount of beta2-toxin-gene-positive Clostridium
perfringens of the autistic subject is about 6.55.times.10.sup.4
colony forming unit (CFU) per gram dry weight of fecal
specimen.
[0018] In another embodiment, the overgrowth of
beta2-toxin-gene-positive Clostridium perfringens is detected as an
overrepresentation or excess of Clostridium perfringens vegetative
cells, Clostridium perfringens spores or combination thereof, in
the feces of an autistic subject compared to a control subject or
population of control subjects. For example, the control subject or
population of control subjects may have about 1.5.times.10.sup.3
colony forming units of beta2-toxin-gene-positive Clostridium
perfringens per gram dry weight of fecal specimen. In another
example, the autistic subject has more than about
1.9.times.10.sup.3 colony forming units of
beta2-toxin-gene-positive Clostridium perfringens per gram dry
weight of fecal specimen. In yet a further embodiment, the autistic
subject may have more than about 6.times.10.sup.4 colony forming
units of beta2-toxin-gene-positive Clostridium perfringens per gram
dry weight of fecal specimen.
[0019] In one embodiment, overrepresentation of Clostridium
perfringens vegetative cells, Clostridium perfringens spores or
combination thereof, is the presence of greater percent Clostridium
perfringens vegetative cells, Clostridium perfringens spores or
combination thereof, wherein the percent is determined from the
amount of Clostridium perfringens vegetative cells, Clostridium
perfringens spores or combination thereof, in a fecal specimen and
dividing by the amount of total Clostridium within the same
specimen. An overrepresentation of Clostridium perfringens
vegetative cells, Clostridium perfringens spores or combination
thereof, for an autistic subject means that the percent Clostridium
perfringens vegetative cells, Clostridium perfringens spores or
combination thereof is greater for the autistic subject than in the
case of a control subject or a population of control subjects.
[0020] In one embodiment, an excess of Clostridium perfringens
vegetative cells, Clostridium perfringens spores or combination
thereof, in the feces of an autistic subject means that the number
of Clostridium perfringens vegetative cells, Clostridium
perfringens spores or combination thereof, is greater in the case
of in the feces of an autistic subject compared to a control
subject or population of control subjects.
[0021] In one embodiment, the control subject or population of
control subjects may be non-autistic subject or population of
non-autistic subjects. In one embodiment, the non-autistic subject
or population of non-autistic subjects do not have GI symptoms or
neurologic disease.
[0022] In one embodiment, the autistic subject has GI
abnormalities. In one embodiment, the subject may have a different
neurologic disease other than autism.
[0023] In one embodiment, the autistic subject, control subject or
population of control subjects is a child or are children. In one
embodiment, the child or children are 3 years of age or younger. In
another embodiment, the child or children are less than 12 years of
age. In another embodiment, the child or children are less than 14
years of age. In a further embodiment, the child or children are
less than 16 years of age. In yet a further embodiment, the child
or children are more than 2 years of age. In one embodiment, the
child or children are 2-9 years of age. In one embodiment, the
child or children is human.
[0024] In one embodiment of the invention, the overgrowth of
beta2-toxin-gene-positive Clostridium perfringens in the gut of an
autistic subject may be positively correlated with an overgrowth of
Clostridium perfringens. For example, the overgrowth of Clostridium
perfringens may result in at least a 3-fold increase in Clostridium
perfringens colony forming units in the autistic subject over a
control subject or a population of control subjects. In another
example, the overgrowth of Clostridium perfringens may result in at
least a 10-fold increase in Clostridium perfringens colony forming
units in the autistic subject over a control subject or a
population of control subjects.
[0025] In yet a further example, the control subject or the
population of control subjects may have about 1.7.times.10.sup.4
colony forming units of Clostridium perfringens per gram dry weight
of fecal specimen. In another example, the autistic subject may
have more than about 5.times.10.sup.4 colony forming units of
Clostridium perfringens per gram dry weight of fecal specimen. In
an additional example, the autistic subject may have more than
about 1.7.times.10.sup.5 colony forming units of Clostridium
perfringens per gram dry weight of fecal specimen. In an additional
example, the autistic subject may have about 2.1.times.10.sup.5
colony forming units of Clostridium perfringens per gram dry weight
of fecal specimen.
[0026] For a value described as being "about" refers to any value
within the range of values encompassed by .+-.10%.
[0027] In one embodiment of the invention, the beta2-toxin alters
normal cellular process of a host cell afflicted with said toxin, a
neighboring cell, or a group of cells participating in
communication between the gut and the brain of the subject or a
combination thereof. For example, the group of cells may include
neurons or nerve cells participating in communication between the
gut and the brain of the autistic subject. For example, alteration
of normal cellular process may include a genomic effect, a
non-genomic effect, a cytotoxic effect or a combination thereof. In
an embodiment of the invention, the genomic effect may include a
change in gene expression. In yet a further embodiment, the
non-genomic effect may include a change in signal transduction,
action potential, neurotransmitter release, cell membrane fluidity,
cell membrane porosity, cell membrane integrity or a combination
thereof. For example, the cytotoxic effect may result in necrosis
or apoptosis. In one example, the host cell or the neighboring cell
is a cell of the gastrointestinal tract, a neuron innervating the
gastrointestinal tract or a combination thereof.
[0028] An example of a beta2-toxin-gene-positive Clostridium
perfringens includes, but is not limited to, a Clostridium
perfringens beta2-toxin gene, cpb2. In one embodiment, the
Clostridium perfringens beta2-toxin gene, cpb2, comprises a nucleic
acid sequence as given in any of GenBank Accession Nos.: KF155292,
GU581185, GU581184, GU581183, GU581182, GU581181, GU581180,
GU581179, GU581177, GU581176, HQ853338, HQ853337, HQ853336,
HQ853335, HQ853334, HQ853333, HQ853332, HQ853331, HQ853330,
HQ853329, AY609177, AY609176, AY609175, AY609174, AY609172,
AY609171, AY609170, AY609169, AY609168, AY609167, AY609166,
AY609165, AY609163, AY609162, AY609161, GU581178, EU260099,
AY730636, AY730635, AY730634, AY730633, AY730632, AY730631,
AY730630, EF076030, EF076029, EF076028, AY297455, KJ874348,
AY609183, AY609182, AY609181, AY609180, AY609179, AY609178,
AY609173, AY609164, AY884041, AY884040, AY884039, AY884038,
AY884037, AY884036, AY884035, DQ525205 and L77965.
[0029] In one embodiment of the invention, the presence of the
Clostridium perfringens beta2-toxin gene, cpb2, may be detected
with a primer pair direct to sense and anti-sense strands of
Clostridium perfringens cpb2 gene, having a nucleic acid sequence
as given in any of GenBank Accession Nos.: KF155292, GU581185,
GU581184, GU581183, GU581182, GU581181, GU581180, GU581179,
GU581177, GU581176, HQ853338, HQ853337, HQ853336, HQ853335,
HQ853334, HQ853333, HQ853332, HQ853331, HQ853330, HQ853329,
AY609177, AY609176, AY609175, AY609174, AY609172, AY609171,
AY609170, AY609169, AY609168, AY609167, AY609166, AY609165,
AY609163, AY609162, AY609161, GU581178, EU260099, AY730636,
AY730635, AY730634, AY730633, AY730632, AY730631, AY730630,
EF076030, EF076029, EF076028, AY297455, KJ874348, AY609183,
AY609182, AY609181, AY609180, AY609179, AY609178, AY609173,
AY609164, AY884041, AY884040, AY884039, AY884038, AY884037,
AY884036, AY884035, DQ525205 and L77965. In a particular
embodiment, the pair of primers is AGATTTTAAATATGATCCTAACC and
CAATACCCTTCACCAAATACTC. In another example, the pair of primers
produces a polymerase chain product of 548 bp.
[0030] In another embodiment of the invention, the Clostridium
perfringens beta-toxin gene, cpb, comprises a nucleic acid sequence
as given in any of GenBank Accession Nos.: KP064410, KP064409,
KP064408, KP064407, KP064406, KP064405, KP064404, GU054492,
HQ424445, X83275 and KP768395.
[0031] In yet another embodiment, the beta2-toxin-gene-positive
Clostridium perfringens found in the gut of the subject includes a
Clostridium perfringens alpha-toxin gene. In another embodiment,
the beta2-toxin-gene-positive Clostridium perfringens found in the
gut of the subject does not include a Clostridium perfringens
alpha-toxin gene, a Clostridium perfringens beta-toxin gene, a
Clostridium perfringens epsilon-toxin gene, a Clostridium
perfringens iota-toxin gene or a combination thereof. In yet a
further embodiment, the beta2-toxin-gene-positive Clostridium
perfringens in the gut of an autistic subject comprises a
Clostridium perfringens alpha-toxin gene but is free of a
Clostridium perfringens beta-toxin gene, epsilon-toxin gene and
iota-toxin gene. In an additional embodiment, the
beta2-toxin-gene-positive Clostridium perfringens in the gut of an
autistic subject is free of a Clostridium perfringens alpha-toxin
gene, beta-toxin gene, epsilon-toxin gene and iota-toxin gene.
[0032] Additionally, in one embodiment of the invention, the
beta2-toxin-gene-positive Clostridium perfringens produces
Clostridium perfringens beta2-toxin. In one example, the
beta2-toxin-gene-positive Clostridium perfringens additionally
comprises Clostridium perfringens alpha-toxin gene and produces
Clostridium perfringens beta2-toxin. In another example, the
beta2-toxin-gene-positive Clostridium perfringens produces
Clostridium perfringens alpha-toxin. In yet a further example, the
beta2-toxin-gene-positive Clostridium perfringens produces a toxin
that is free of Clostridium perfringens alpha-toxin. Additionally,
in another example, the beta2-toxin-gene-positive Clostridium
perfringens is free of Clostridium perfringens alpha-toxin, free of
a Clostridium perfringens beta-toxin, free of a Clostridium
perfringens epsilon-toxin, free of a Clostridium perfringens
iota-toxin or a combination thereof. In an additional example,
beta2-toxin-gene-positive Clostridium perfringens in the gut of an
autistic subject produces a Clostridium perfringens beta2-toxin and
alpha-toxin but is free of a Clostridium perfringens beta-toxin,
Clostridium perfringens epsilon-toxin and Clostridium perfringens
iota-toxin. In a further example, the beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject produces
a Clostridium perfringens beta2-toxin but is free of a Clostridium
perfringens alpha-toxin, Clostridium perfringens beta-toxin,
Clostridium perfringens epsilon-toxin and Clostridium perfringens
iota-toxin. In another example, the beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject is free
of a Clostridium perfringens beta2-toxin, Clostridium per
alpha-toxin, Clostridium perfringens beta-toxin, Clostridium
perfringens epsilon-toxin and Clostridium perfringens iota-toxin.
In a further example, the beta2-toxin-gene-positive Clostridium
perfringens in the gut of an autistic subject produces a toxin
other than a Clostridium perfringens beta-toxin, Clostridium
perfringens epsilon-toxin and Clostridium perfringens
iota-toxin.
[0033] In accordance with the practice of the invention, in the
composition of the invention, one or more agent(s) includes any of
an antimicrobial, a bacteriophage, a probiotic, a probiotic group,
a prebiotic or a vaccine which would lead to production of an
anti-toxin against a toxin produced by the
beta2-toxin-gene-positive Clostridium perfringens in the gut of the
autistic subject. For example, the agent may be a polypeptide, a
nucleic acid or a small molecule which inhibits the transcription
of Clostridium perfringens beta2-toxin gene, destabilizes a
beta2-toxin RNA, inhibits the translation of Clostridium
perfringens beta2-toxin mRNA transcript, or decreases the half-life
of a Clostridium perfringens beta2-toxin protein.
[0034] Suitable examples of agents to reduce or eliminate
beta2-toxin-gene-positive Clostridium perfringens include, but are
not limited to, ABT-773, ampicillin, sulbactam, amphomycin,
azithromycin, bacitracin, carboxmycin, cephlosporins,
clarithromycin, erythromycin, furazolidone, nitrofuran, fusidic
acid, sodium fusidate, gramicidin, a penem, imipenem, josamycin,
linezolid, oxazolidinone, a macrolide, metronidazole,
nitroimidazole, mikamycin, minocycline, novobiocin, oleandomycin,
triacetyloleandomycin, ostreogrycin, piperacillin, tazobactam,
pristinamycin, ramoplanin, ristocetin, rosamicin, rosaramicin,
spectinomycin, spiramycin, streptogramin, synergistin, teicoplanin,
telithromycin, ticarcillin, clavulanic acid, tyrocidin,
tyrothricin, vancomycin, vernamycin, and virginiamycin. Such an
agent to reduce or eliminate beta2-toxin-gene-positive Clostridium
perfringens may be administered singly or in a combination with
other agents, concurrently or sequentially, and by any suitable
route.
[0035] Suitable examples of antimicrobial agents include, but are
not limited to, ABT-773, ampicillin, sulbactam, amphomycin,
azithromycin, bacitracin, carboxmycin, cephlosporins,
clarithromycin, erythromycin, furazolidone, nitrofuran, fusidic
acid, sodium fusidate, gramicidin, a penem, imipenem, josamycin,
linezolid, oxazolidinone, a macrolide, metronidazole,
nitroimidazole, mikamycin, minocycline, novobiocin, oleandomycin,
triacetyloleandomycin, ostreogrycin, piperacillin, tazobactam,
pristinamycin, ramoplanin, ristocetin, rosamicin, rosaramicin,
spectinomycin, spiramycin, streptogramin, synergistin, teicoplanin,
telithromycin, ticarcillin, clavulanic acid, tyrocidin,
tyrothricin, vancomycin, vernamycin, and virginiamycin. Such an
antimicrobial agent may be administered singly or in a combination
with other agents, concurrently or sequentially, and by any
suitable route.
[0036] Suitable examples of a probiotic or the probiotic agent
include, but are not limited to, Bacteroides thetaiotaomicron,
Bacteroides vulgatus, Bacteroides distasonis, Bacteroides fragilis,
Bifidobacterium adolescentis group, Eubacterium aerofaciens,
Clostridium ramosum, Escherichia coli, Streptococcus faecalis
group, Lactobacillus spp., L. acidophilus, gram-negative anaerobes,
enterococci, Bacteroides sp., Parabacteroides, Prevotella,
Porphyromonas, gram-positive anaerobic cocci, Clostridium sp.,
Enterobacteriaceae, E. coli, L. bulgaricus, S. thermophilus,
Collinsella genus, Bifidobacterium genus, Bifidobacterium longum,
Bifidobacterium angulatum, Dialister invisus, Clostridium leptum,
Firmicutes, Actinobacteria, Faecalibacterium, Ruminococcus,
Eubacterium, Alistipes, Roseburia, Anaerofilum, Streptococcus,
Turicibacter, Parabacteroides, Dorea, Veillonella, Akkermansia,
Sporobacter, Ethanoligenens, Papillibacter, Holdemania, Weissella,
Dialister, Pseudoramibacter, Streptococcus, Anaerovorax,
Lactococcus, Leuconostoc, Ethanoligenens, Helcococcus,
Alkaliphilus, Clostridium bolteae, Clostridium methylpentosum,
Eubacterium ruminantium, Phascolarctobacterium faecium, Alistipes
species, Bifidobacterium species, Lactobacillus species, and
Bacteroides caccae. Such a probiotic or the probiotic agent may be
administered singly or in a combination with other agents,
concurrently or sequentially, and by any suitable route.
[0037] Examples of a prebiotic include, but are not limited to,
trans-galactooligosaccharide, inulin, Larch arabinogalactan,
resistant starch, pectin, beta-glucans, xylooligosaccharides, and a
combination thereof. In one embodiment, the prebiotic promotes the
growth of gut-colonizing bacteria that compete with the
beta2-toxin-gene-positive Clostridium perfringens or inhibits the
growth of the beta2-toxin-gene-positive Clostridium perfringens. In
one embodiment, the Clostridium sp. is free of
beta2-toxin-gene-positive Clostridium perfringens of. In one
embodiment, the prebiotic promotes the growth of Bifidobacterium
species, Lactobacillus species, Akkermansia, or a combination
thereof. A discussion of prebiotics may be found in the following
references which are incorporated in their entirety: Gibson G R and
Roberfroid M G (1995) J Nutr. 125 (6): 1401-1412; Roberfroid M B
(2007) J Nutr. 137 (3 Suppl 2): 830S-7S; Kelly G S (1999)
Alternative Medicine Review 4 (2): 96-103; Zaman et al. (2015)
Critical Reviews in Biotechnology: 1-7; Gomez et al. (2014) Journal
of Agricultural and Food Chemistry 62 (40): 9769-9782; Arena et al.
(2014) International Journal of Molecular Sciences 15 (2):
3025-3039; and Jain et al. (2015) Indian Journal of Experimental
Biology 53 (3): 131-142.
[0038] An example of an anti-toxin agent includes, but is not
limited to, an antibody against a toxin.
[0039] In one embodiment, the antibody is an antibody against
Clostridium perfringens beta2-toxin, a fragment of Clostridium
perfringens beta2-toxin, Clostridium perfringens alpha-toxin, a
fragment of Clostridium perfringens alpha-toxin or a combination
thereof. Antibodies Clostridium perfringens beta2-toxin are
commercially available and well known (J. Zeng et al. Journal of
Immunology Research, volume 2016, Article ID 570868; Novus
Biologicals). Antibodies Clostridium perfringens alpha-toxin are
commercially available and well known (H. Saito, et al., FEMS
Microbiology Letters (1989), 59:173-176; US Biological).
[0040] In another embodiment, the antibody is an antibody against a
toxin from a beta2-toxin-gene-positive Clostridium perfringens
wherein the toxin is not Clostridium per beta2-toxin or its
fragment, Clostridium perfringens alpha-toxin or its fragment,
Clostridium perfringens beta-toxin or its fragment, Clostridium
perfringens epsilon-toxin or its fragment, or Clostridium
perfringens iota-toxin or its fragment.
[0041] For example, the antibody may be a neutralizing antibody or
an inhibitory antibody.
[0042] In one embodiment, the antibody is a polyclonal antibody, a
monoclonal antibody, an antigen-binding fragment of an antibody or
a bispecific antibody.
[0043] In a further embodiment, the antigen-binding fragment of an
antibody comprises a Fab antibody fragment, a F(ab')2 antibody
fragment, a Fv antibody fragment or a single chain variable
fragment (scFv).
[0044] Suitable examples of toxins include, but are not limited to,
Clostridium perfringens beta2-toxin and Clostridium perfringens
alpha-toxin.
[0045] In one embodiment, the vaccine comprises Clostridium
perfringens beta2-toxin, a fragment of Clostridium perfringens
beta2-toxin, Clostridium perfringens alpha-toxin, a fragment of
Clostridium perfringens alpha-toxin or a combination thereof.
[0046] In another embodiment, the vaccine is free of Clostridium
perfringens beta-toxin, a fragment of Clostridium perfringens
beta-toxin, Clostridium perfringens epsilon-toxin, a fragment of
Clostridium perfringens epsilon-toxin, Clostridium perfringens
iota-toxin, a fragment of Clostridium per iota-toxin or a
combination thereof.
[0047] In another embodiment, the vaccine comprises a toxin or a
fragment thereof produced by the beta2-toxin-gene-positive
Clostridium perfringens wherein the toxin is not Clostridium
perfringens beta2-toxin or its fragment, Clostridium perfringens
alpha-toxin or its fragment, Clostridium perfringens beta-toxin or
its fragment, Clostridium perfringens epsilon-toxin or its
fragment, or Clostridium perfringens iota-toxin or its
fragment.
[0048] A suitable example of a vaccine is one that leads to the
production of an antibody against Clostridium perfringens
beta2-toxin or Clostridium perfringens alpha-toxin or a combination
thereof. For example, the antibody may be free of an antibody
against Clostridium perfringens beta-toxin, Clostridium perfringens
epsilon-toxin or Clostridium perfringens iota-toxin or a
combination thereof. In a separate embodiment, the vaccine leads to
the production of an antibody against a toxin produced by the
beta2-toxin-gene-positive Clostridium perfringens wherein the toxin
is not Clostridium perfringens beta2-toxin, Clostridium perfringens
alpha-toxin, Clostridium perfringens beta-toxin, Clostridium
perfringens epsilon-toxin or Clostridium perfringens
iota-toxin.
[0049] Suitable examples of agents that reduce or eliminate
beta2-toxin-gene-positive Clostridium perfringens include, but are
not limited to, an antibody, a lectin, a protease, or a protein,
peptide, carbohydrate or small molecule that interacts with
beta2-toxin of Clostridium perfringens. In one embodiment, the
antibody is an anti-beta2-toxin antibody. In another embodiment,
the antibody inhibits activity, decreases stability or alters
localization of beta2-toxin of Clostridium perfringens.
Additionally, examples of a protein, peptide, carbohydrate or small
molecule that interact with beta2-toxin are those that inhibit
formation of a functional toxin, prevent post-translational
modification, prevent protein assembly, prevent formation of a
potential pore-forming complex, prevent association with chaperone
protein, accessory protein or receptor, promote degradation of said
toxin, mis-localize said beta2-toxin, inhibit expression of said
beta2-toxin or stabilize beta2-toxin with a natural inhibitor to
Clostridium perfringens beta2-toxin so as to maintain an inactive
state of the Clostridium perfringens beta2-toxin. Merely by way of
example, the natural inhibitor may be an inhibitor to Clostridium
perfringens beta2-toxin present in fecal material or sample. In
another example, the protein, peptide, carbohydrate or small
molecule are those that prevent normal folding or assembly of the
beta2-toxin, prevent insertion of the beta2-toxin into a cell
membrane, prevent interaction with other toxin subunits and prevent
its function as a pore-forming toxin.
[0050] In one embodiment, an agent that reduces or eliminates
beta2-toxin-gene-positive Clostridium perfringens may be a
bacteriophage. The bacteriophage may be virulent for Clostridium
perfringens. In one embodiment, examples of bacteriophages virulent
for Clostridium perfringens include, but are not limited to,
bacteriophages from the Siphoviridae family and Podoviridae family.
Suitable members of the Siphoviridae family virulent for
Clostridium perfringens and may be used in a bacteriophage or phage
therapy to reduce or eliminate beta2-toxin-gene-positive
Clostridium perfringens or beta-toxin-gene-related
toxin-gene-positive Clostridium perfringens include .PHI.CP39O and
.PHI.CP26F (Seal et al., Arch. Virol. 2011; 156:25-35 [PubMed:
20963614]). Suitable members of the Podoviridae family virulent for
Clostridium perfringens and may be used in a bacteriophage or phage
therapy to reduce or eliminate beta2-toxin-gene-positive
Clostridium perfringens include .PHI.CPV1 (Volozhantsev et al.,
Virus Res. 2011; 155:433-439 [PubMed: 21144870]), .PHI.CP24R
(Morales et al., Arch. Virol. 2012; 157:769-772 [PubMed:
22218967]), .PHI.CPV4, .PHI.ZP2, and .PHI.CP7R (Volozhantsev et
al., PLoS ONE. 2012; 7:e38283 [PubMed: 22666499]. Use of
bacteriophages virulent for Clostridium perfringens and its gene
products to control animal and human diseases without having
deleterious effects on beneficial probiotic bacteria are discussed
in Seal el al., Poult Sci. 2013; 92(2): 526-533, whose reference is
incorporated in its entirety. An agent to reduce or eliminate
beta2-toxin-gene-positive Clostridium perfringens may be
administered singly or in a combination with other agents,
concurrently or sequentially, and by any suitable route.
[0051] The invention further provides methods of identifying an
autistic subject whose autism may be alleviated by a course of
treatment directed against an overgrowth of beta2-toxin-positive
Clostridium perfringens so as to reduce or eliminate the
overgrowth. In one embodiment, the method comprises (a) determining
existence of said overgrowth in the autistic subject, thereby
identifying the autistic subject whose autism may be alleviated by
a course of treatment directed against the overgrowth of
beta2-toxin-positive Clostridium perfringens.
[0052] In another embodiment, the overgrowth of Clostridium
perfringens comprises an overgrowth of beta2-toxin-positive
Clostridium perfringens.
[0053] In another further embodiment, the overgrowth of Clostridium
perfringens is an overgrowth of beta2-toxin-positive Clostridium
perfringens.
[0054] In one embodiment, the step of determining the existence of
said overgrowth in the autistic subject comprises (a) detecting
presence of beta2-toxin-positive Clostridium perfringens in a
sample from the subject; (b) quantifying the amount of
beta2-toxin-positive Clostridium perfringens in the sample; (c)
comparing the value in (b) with a value for the amount of
beta2-toxin-positive Clostridium perfringens in non-autistic
subject or subjects; and (d) finding that the value of (b) is
greater than the value from non-autistic subject or subjects. In
one embodiment, the value of (b) being greater than the value from
non-autistic subject or subjects is a statistically significant
difference. The Clostridium perfringens may include a vegetative
cell, spore or combination thereof.
[0055] In another embodiment of the invention, the method comprises
(a) determining existence of said overgrowth in the autistic
subject, thereby identifying the autistic subject whose autism may
be alleviated by a course of treatment directed against the
overgrowth of beta2-toxin-producing Clostridium perfringens.
Further, in one embodiment, the step of determining existence of
said overgrowth in the autistic subject comprises (a) detecting
presence of beta2-toxin-positive Clostridium perfringens in a
sample from the subject; (b) quantifying the activity of
Clostridium perfringens beta2-toxin in a sample from the subject;
(c) comparing the value in (b) with a value for the activity of
Clostridium perfringens beta2-toxin in a sample or samples from
non-autistic subject or subjects; and (d) finding that the value of
(b) is greater than the value of sample or samples from
non-autistic subject or subjects.
[0056] In yet a further embodiment, the method comprises the step
of determining the presence of said beta2-toxin in the autistic
subject, thereby, identifying the autistic subject whose autism may
be alleviated by a course of treatment directed against beta2-toxin
of Clostridium perfringens. The method further comprises (b)
quantifying activity of beta2-toxin; (c) comparing a value obtained
in (b) against a threshold value; and (d) finding greater activity
of beta2-toxin in the autistic subject. In one embodiment, the
Clostridium perfringens comprises a vegetative cell. In an
embodiment of the invention, the fecal material of the autistic
subject is used to determine said overgrowth. In yet another
embodiment, the fecal material of the autistic subject is used to
determine presence of beta2-toxin of Clostridium perfringens. In an
additional embodiment, the presence of beta2-toxin of Clostridium
perfringens is determined by detecting the presence of nucleic acid
encoding beta2-toxin of Clostridium perfringens or presence of
polypeptide for beta2-toxin of Clostridium perfringens. In an
additional embodiment, the presence of beta2-toxin of Clostridium
perfringens is determined by determining the activity of
beta2-toxin of Clostridium perfringens.
[0057] The invention further provides methods of screening autistic
subjects whose autism may be alleviated by a course of treatment
directed against beta2-toxin of Clostridium perfringens by
identifying the subject by any of the methods of the invention.
[0058] The invention additionally provides methods for monitoring
the course of autism in an autistic subject by identifying the
subject by any of the methods of the invention and quantitatively
determining a level of overgrowth of Clostridium perfringens,
overgrowth of beta2-toxin-gene-positive Clostridium perfringens,
activity of Clostridium perfringens beta2-toxin from a biological
sample from the subject at one time point and comparing a value so
determined with the value determined from in a second sample from
the subject, such samples being taken at different points in time,
a difference in the values determined being indicative of the
course of the autistic condition.
[0059] In one embodiment, a decrease in the overgrowth of
Clostridium perfringens, overgrowth of beta2-toxin-gene-positive
Clostridium perfringens, activity of Clostridium perfringens
beta2-toxin is indicative or predictive of reducing severity or
duration of one or more symptoms associated with austism.
[0060] In another embodiment, an increase in the overgrowth of
Clostridium perfringens, overgrowth of beta2-toxin-gene-positive
Clostridium perfringens, activity of Clostridium perfringens
beta2-toxin is indicative or predictive of reducing severity or
duration of one or more symptoms associated with austism.
[0061] In another embodiment, one or more symptoms associated with
autism is any of early onset autism, late stage autism or
regressive autism.
[0062] In a further embodiment, a method of treating autism
associated with an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens in the gut of an autistic subject
comprising: a) determining existence of an overgrowth of
Clostridium perfringens positive for beta2-toxin gene in a sample
from the subject; and (b) administering to the subject one or more
agents to reduce or eliminate beta2-toxin-gene positive Clostridium
perfringens in the subject so as to relieve one or more symptoms of
autism; thereby, treating autism associated with an overgrowth of
beta2-toxin-gene-positive Clostridium perfringens in the autistic
subject. In one embodiment, an antimicrobial used to treat autism
associated with an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens so as to reduce or eliminate
beta2-toxin-gene-positive Clostridium perfringens should have
certain characteristics for optimal benefit and minimal side
effects. Certain antimicrobials have characteristics appropriate to
treat even very young children, and such drugs are useful to treat
disorders having the gut-brain involvement. Preferably, an
antimicrobial selected as a therapy will have one or more of the
following properties: [0063] 1) Good in vitro activity against
beta2-toxin-gene-positive Clostridium perfringens; [0064] 2)
Relatively poor activity against most other organisms normally
found in the gut flora; [0065] 3) Safe doses capable of achieving a
concentration in the colon or elsewhere in the GI tract where the
offending organism proliferates exceeding the minimal inhibitory
concentration or minimal bactericidal concentration of the drug by
at least four or five-fold concentrations; [0066] 4) Preferably
absorbed very little or not at all when given orally (to minimize
systemic effects); [0067] 5) Bactericidal activity preferred
(rather than purely inhibitory activity); [0068] 6) Not
cross-resistant with vancomycin or other drugs that are important
for treatment of systemic infections; [0069] 7) Resistance does not
develop readily (i.e., the drug does not readily engender
resistance in bacteria); [0070] 8) Palatable in liquid form when
taken orally (for administration to children), or readily
formulated into other oral doses (to enhance patient compliance);
[0071] 9) Well tolerated orally over extended period of time
(preferably at least 3-4 months); [0072] 10) Little or no toxicity,
either systemically or in the bowel; [0073] 11) Preferably
effective when given only once or twice daily; and [0074] 12)
Preferably moderate in price.
[0075] Drugs that have one or more of the above characteristics may
have utility for antimicrobial therapy in treating neurological
disorders with gut flora etiology, such as those associated with an
overgrowth of beta2-toxin-gene-positive Clostridium
perfringens.
[0076] Appropriate doses of the antimicrobials (as given above) are
within the range given for many other conditions for which the
antimicrobials are prescribed. Dosage information can be found, for
example, in the Physicians' Desk Reference, 54.sup.th edition,
Medical Economics Company, Montvale, N.J. (2000 or subsequent
editions). In certain instances, the doses may be elevated to the
extent necessary to maintain a bactericidal or bacteriostatic
concentration throughout the gastrointestinal tract. The
antimicrobials are preferably formulated for oral administration,
such as in liquid form, tablet, capsule, granules, chewable, etc.
Tablets or capsules may be enterically coated to minimize gastric
absorption of the drug when the pH of the stomach is high or
emptying is slow due to certain drugs or diseases, the stomach can
be colonized with many bacteria.
[0077] The antimicrobials can be administered as known in the art.
It is desirable to select a route of administration that is most
effective for the therapy, examples thereof being oral
administration or parenteral administration such as intravenous
administration with subsequent excretion into the bowel.
[0078] A preferred compound for treating Clostridium overgrowth in
the gut is ramoplanin, also known as A-16686 (see, e.g., U.S. Pat.
Nos. 4,303,646; 4,328,316; 4,427,656; 5,539,087; and 5,925,550; and
Parenti et al.; Drugs Exp Clin Res 16(9):451-5 (1990); all herein
incorporated by reference). This antibiotic is not cross-resistant
with vancomycin, it engenders very little to no resistance in
bacteria, is not detectably absorbed systemically in humans (making
it exceptionally safe, even for young children), can be made
palatable in a liquid form, achieves high concentrations in the
large intestine, has very good activity against clostridia, can be
given twice a day, and is primarily active against gram positive
organisms at the dosage levels administered. Ramoplanin is
preferable to drugs such as vancomycin and metronidazole, which
have previously been used, because, for example, vancomycin, while
achieving a high concentration in the intestines throughout, is
effective against Bacteroides, a beneficial genus of gut flora, as
well as clostridial species. In a special formulation it is also a
potent antibiotic against, e.g., systemic methicillin-resistant
Staphylococcus infections, and widespread use for other purposes
risks inducing vancomycin-resistant Staphylococcus or other
species. Metronidazole, on the other hand, is not an ideal
candidate because of its ready systemic absorption, which can lead
to neurotoxic side effects when given in high enough concentrations
to remain effective in the gut, and the fact that it is quite
bitter and thus difficult to formulate as a liquid for oral
use.
[0079] When using antimicrobial in treating autism associated with
an overgrowth of beta2-toxin-gene-positive Clostridium perfringens,
it is desirable to minimize the extent of normal bacterial flora
disruption of the gut during antimicrobial treatment. As such, it
is highly desirable to tailor an antimicrobial therapy as
specifically as possible against beta2-toxin-gene-positive
Clostridium perfringens.
[0080] When using a probiotic or probiotic agent to treat autism
associated with an overgrowth of beta2-toxin-gene-positive
Clostridium perfringens, dosage (colony forming units (cfu) of each
bacterium) is preferably at least the number found in the mean
count/gram, and is supplied to the patient daily or twice daily for
a number of days until it is determined that the bacteria have
become established. The formulation can be provided as active cells
or spores. It can be provided in an enterically coated form (e.g.,
for active cells) to protect sensitive cells from the gastric
environment. A preferred therapy involves temporary elimination or
suppression of the patient's flora (primarily or entirely with the
use of antimicrobial agents, preferably directed specifically
against beta2-toxin-gene-positive Clostridium perfringens) and
introduction of a new, non-pathogenic flora that consists of a
number of bacteria normally found in the bowel that convey
colonization resistance (to prevent regrowth or re-implantation of
the offending bacteria). Therapies are preferably patterned after
those described in the poultry literature, for example, Wooley et
al., Avian Dis. 43(2):245-50, (1999); Hume et al., J. Food Prot.
61(6):673-6 (1998); Cornier et al., J. Food Prot. 61(7):796-801
(1998); Hume et al., Avian Dis. 40(2):391-7 (1996); Cornier et al.,
Poult Sci. 74(7):1093-101 (1995); and Cornier et al., Poult Sci.
74(6):916-24 (1995), all herein incorporated by reference.
[0081] Alternatively, bacteriophage specific for the bacterium
producing the toxin can be introduced to the patient's
gastrointestinal tract to reduce or kill the toxin-producing
bacteria, and probiotic therapy mixtures can be concurrently or
subsequently administered. An example of a successful protocol
involving this strategy with Clostridium difficile can be found in
Ramesh et al., Anaerobe 5:69-78 (1999), herein incorporated by
reference. Bacteriophage may be susceptible to gastric acidity and
such acidity should be neutralized prior to phage administration,
or else the bacteriophage can be administered in an enterically
coated tablet or capsule.
[0082] Probiotic therapy can be used in conjunction with
antimicrobials used to treat infections in otherwise normal
patients (i.e., before the onset of aneurological disorder) in
order to prevent or reduce the risk of the occurrence of a
neurological disorder. Alternatively, it can be used in conjunction
with antimicrobials being used to reduce, eliminate or inhibit the
beta2-toxin-gene-positive Clostridium perfringens species overgrown
in a patient's gastrointestinal tract, and to promote the
re-emergence of normal gut flora. In one embodiment, probiotic
therapy may take the form of a fecal therapy using fecal material
obtained from a normal subject without autism or GI abnormality and
this fecal material is administered to an autistic subject with an
overgrowth of beta2-toxin-gene-positive Clostridium perfringens
alone or in combination with an antimicrobial, a different
probiotic, a different probiotic group, a prebiotic, a
bacteriophage or a vaccine.
[0083] The following Examples are intended to be illustrative
rather than encompassing.
EXAMPLES
Example 1
[0084] We studied stool specimens from 33 autistic children aged
2-9 years with GI abnormalities and 13 control children without
autism and without GI symptoms (FIG. 1). We performed quantitative
comparison of overall Clostridium species, C. perfringens strains
from the fecal microflora of autistic and control children by
conventional, selective anaerobic culture methods. We performed PCR
analysis for main C. perfringens toxins.
Materials and Methods
[0085] Clostridium Culture.
[0086] This study used previously processed and homogenized stool
specimens stored frozen at -80.degree. C. Aliquots of the
homogenized specimens were diluted 1:10 in pre-reduced
thioglycollate broth (Anaerobe Systems, Morgan Hill, Calif.). For
the selective isolation of Clostridium, these diluted aliquots of
the stool specimens were processed two ways, utilizing ethanol and
heat treatments, to select spores. For ethanol treatment, a 1 ml
aliquot was incubated with 100% ethanol for 10 minutes. For heat
treatment, the rest of the thioglycollate tube was incubated at
80.degree. C. for 10 min. Subsequently, 10-fold serial dilutions
were plated (100 .mu.l/plate) onto Brucella and CDC agar plates
(Anaerobe Systems) from both preparations. The plates were
incubated under anaerobic conditions at 37.degree. C. for 72 h
before initial inspection and re-incubated up to 7 days (8).
Anaerobic conditions consisted of a gas mixture of 5% CO.sub.2, 5%
H.sub.2, and 90% N.sub.2; the residual oxygen was removed by
palladium catalysts. Clostridium colonies were counted and the
counts were adjusted to dry weight of stool. Similarly,
characteristic C. perfringens colony types were counted and the
counts were adjusted to dry weight of stool. Single C. perfringens
colonies were selected, described and subcultured on Brucella agar
and incubated for 48 h., as described above. Additionally, as a
back-up enrichment culture, the heat-treated thioglycollate tubes
were incubated at 37.degree. C. for 72 h and then let stand at room
temperature for one week before subculturing.
[0087] Reference Strains.
[0088] C. perfringens reference strains ATCC 3626 and ATCC 14809
were obtained from the American Type Culture Collection (ATCC). The
strains were grown 48 h on Brucella agar and processed as described
below.
[0089] DNA Extraction.
[0090] For PCR analysis of C. perfringens, several single colonies
obtained after 48 h cultivation on Brucella agar were inoculated
into 250 .mu.l nuclease-free water and boiled for 20 min to lyse
the cells. After centrifugation at 13000 g for 5 min at room
temperature, the supernatant fluid was removed and used in the PCR
reaction.
[0091] Toxin PCR.
[0092] PCR assay to detect the genes for C. perfringens a-toxin
(cpa), b-toxin (cpb), b2-toxin (cpb2), i-toxin (iA), and
enterotoxin (cpe) was performed using primer pairs as shown in
Table 1. The C. perfringens strains were typed utilizing methods as
previously described (9, 10) with the exception that instead of
multiplex PCR, single PCR's were performed with each primer pair.
The PCR conditions were as follows: DNA was denatured for 2 min at
95.degree. C. and amplified for 35 cycles (1 min at 94.degree. C.,
1 min at 55.degree. C., 1 min at 72.degree. C. for denaturation,
annealing and extension phases, respectively), followed by an
additional period of extension for 10 min at 72.degree. C. PCR
products were separated by electrophoresis in a 2% (w/v) agarose
gel stained with ethidium bromide. Amplified bands were visualized
and photographed under UV illumination.
[0093] Verification of PCR Products.
[0094] Verification of the PCR products was done by DNA sequencing
of purified PCR product. The PCR products were excised from an
agarose gel and purified using the QIAquick gel extraction kit
(Qiagen, Valencia, Calif.). The purified PCR products were
sequenced directly with a Biotech Diagnostic Big Dye sequencing kit
(Biotech Diagnostics, CA) on an ABI 3130 Avant sequencer (Applied
Biosystems, Foster City, Calif.). The sequencing data were analyzed
by comparison of the consensus sequences with GenBank sequences by
using Ribosomal Database Project (RDP-II) (Michigan State
University, East Lansing) (11), and Basic Local Alignment Search
Tool (BLAST) (12). Analyses of the sequences were performed by
comparing with the sequences of the type strains retrieved from
GenBank by using the program Clustal W (13).
Results
[0095] We performed quantitative, selective anaerobic culture from
stool specimens of 33 autistic children and 13 control children (7)
(Table 2). Overall, the mean colony-forming unit (CFU) Clostridium
cell count obtained from stool samples of the autistic children was
9.2.times.10.sup.7 cfu/g dry weight, and 4.73.times.10.sup.7 cfu/g
dry weight from normal control children. 30/33 and 10/13 autism and
control samples, respectively, yielded C. perfringens. The mean
colony forming unit (CFU) C. perfringens cell count obtained from
stool samples of the autistic children was 2.12.times.10.sup.5
cfu/g dry weight, and 1.7.times.10.sup.4 cfu/g dry weight from
normal control children. Altogether, we isolated 111 different C.
perfringens strains (based on colony morphology) from the autism
samples and 23 from the control samples. The PCR analysis (8) for
clostridial toxins of these C. perfringens isolates (FIG. 3)
revealed that autism samples had statistically significantly
(p=0.014) higher incidence of C. perfringens beta2-toxin (Table 2).
The mean CFU of beta2-toxin-producing C. perfringens cell count
obtained from stool samples of the autistic children was
6.55.times.10.sup.4 cfu/g dry weight, and 1.48.times.10.sup.3 cfu/g
dry weight from normal control children. C. perfringens CFU/g and
the CFU/g of beta2-toxin-producing C. perfringens were moderately,
positively correlated (Spearman corr==0.7125) (FIG. 2).
DISCUSSION
[0096] C. perfringens beta2-toxin was first studied and described
in 1997 by Popoff's group (5). Initially it was found in enteric
disease in animals (piglets, horses) and in food. Subsequently, it
was found in other animals and in soil, and finally in humans. C.
perfringens isolates carrying beta2-toxin have been described in
human gastrointestinal diseases, including food poisoning,
antibiotic-associated diarrhea (AAD) and sporadic diarrhea (SD).
Altogether, 24% (7/29) isolates from humans with food poisoning
were shown to produce beta2-toxin; whereas, 76% (34/46) isolates
from humans suffering with either AAD or SD were beta2-toxin
positive (15). Thirty-four of these AAD- and SD-isolates produced
beta2-toxin in vitro, whereas only one food poisoning isolate
produced the toxin in vitro. From the one healthy person tested, a
beta2-toxin-harboring C. perfringens was also isolated and was
capable of producing the beta2-toxin in vitro (15). Another study
characterizing C. perfringens isolates of SD patients demonstrated
the presence of beta2-toxin in 87% (12/14) isolates; ten of these
isolates produced the beta2-toxin in vitro (16). In a study of
fecal samples of 43 healthy North Americans, 13 (30%) people had
beta2-toxin-harboring C. perfringens (17).
[0097] Our findings suggest that the involvement of beta2-toxin in
autism is remarkable, with 79% of the 33 autism patients showing
its presence in feces, compared to 38% of the 13 control subjects.
Our results are similar to reports where subjects with AAD and SD
were shown to harbor 76-87% of beta2-toxin producing C. perfringens
(15, 16), and normal healthy subjects 30% (17).
[0098] We have not seen this high incidence with any of the other
bacteria that we have described as having involvement in
autism.
TABLE-US-00001 TABLE 1 Primers for PCR detection of Clostridium
perfringens toxin genes cpa, cpb, cpb2, etx, iA and cpe Forward
primer Reverse primer Size Ref. cpa GCTAATGTTACTGCCGTTGA
CCTCTGATACATCGTGTAAG 324 9 cpb GCGAATATGCTGAATCATCTA
GCAGGAACATTAGTATATCTTC 196 9 cpb2 AGATTTTAAATATGATCCTAACC
CAATACCCTTCACCAAATACTC 548 10 cpe GGAGATGGTTGGATATTAGG
GGACCAGCAGTTGTAGATA 233 9 cpetx TGGGAACTTCGATACAAGCA
AACTGCACTATAATTTCCTTTTC 655 9 C cpia ACTACTCTCAGACAAGACAG
CTTTCCTTCTATTACTATACG 446 9
TABLE-US-00002 TABLE 2 Clostridium perfringens mean counts (CFU/g)
and toxin typing of isolates from fecal specimens of autistic and
control children CFU/g Specimens Beta2- Number of positive
specimens C. perfringens Toxin-positive Beta2- Total isolated
Clostridium C. perfringens C. perfringens Toxin CPE Alpha Beta
Epsilon Iota Autism 33 30 9.20E+07 2.12E+05 6.55E+04 26/33 3/33 30
0 0 0 (79%) (9%) Control 13 10 4.73E+07 1.70E+04 1.48E+03 5/13 1/13
10 0 0 0 (38%) (8%) p-value 0.17{circumflex over ( )}
0.031{circumflex over ( )} 0.0028{circumflex over ( )} 0.014*
0.015{circumflex over ( )}{circumflex over ( )} {circumflex over (
)}t-test; {circumflex over ( )}{circumflex over ( )}Wilcoxon t-test
*2-tail Fisher exact test
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