Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada.
Autism Res. 2021 Sep;14(9):1820-1836. doi: 10.1002/aur.2560. Epub 2021 Jun 26.
The emerging role of a microbiota-gut-brain axis in autism spectrum disorder (ASD) suggests that modulating gut microbial composition may offer a tractable approach to addressing the lifelong challenges of ASD. The aim of this systematic review was to provide an overview and critically evaluate the current evidence on the efficacy and safety of probiotic, prebiotic, synbiotic, and fecal microbiota transplantation therapies for core and co-occurring behavioral symptoms in individuals with ASD. Comprehensive searches of MEDLINE, EMBASE, Scopus, Web of Science Core Collection, Cochrane Library, and Google Scholar were performed from inception to March 5, 2020, and two update searches were completed on October 25, 2020, and April 22, 2021, respectively. A total of 4306 publications were identified, of which 14 articles met the inclusion criteria. Data were extracted independently by two reviewers using a preconstructed form. Results of probiotic studies do not confirm the supposed beneficial effect of probiotics on ASD, whereas prebiotics and synbiotic combinations appear to be efficacious in selective behavioral symptoms. Evidence of the efficacy of fecal microbiota transplantation in ASD is still scarce but supports further research. Overall, the current evidence base to suggest beneficial effects of these modalities in ASD is limited and inconclusive. More clinical trials are currently looking at the use of microbial-based therapies in ASD. With a robust double-blind randomized controlled protocol to investigate the efficacy, these trials should provide significant and definitive results. LAY SUMMARY: There is a link between altered gut bacteria and autism spectrum disorder. Some people believe that modulating bacterial composition in the gut may help reduce autism symptoms, but evidence from human studies suggesting beneficial effects of probiotic, prebiotic, and combination thereof as well as fecal transplants in autism spectrum disorder is limited and inconclusive. Current data should not encourage use of these modalities. Further clinical studies are needed.
肠道微生物群-肠道-大脑轴在自闭症谱系障碍（ASD）中的作用日益凸显，这表明调节肠道微生物组成可能为解决 ASD 的终身挑战提供一种可行的方法。本系统综述的目的是提供一个概述，并批判性地评估目前关于益生菌、益生元、合生菌和粪便微生物群移植疗法治疗 ASD 核心和共发行为症状的疗效和安全性的证据。从开始到 2020 年 3 月 5 日，全面检索了 MEDLINE、EMBASE、Scopus、Web of Science 核心合集、Cochrane 图书馆和 Google Scholar，并分别于 2020 年 10 月 25 日和 2021 年 4 月 22 日进行了两次更新检索。共确定了 4306 篇出版物，其中 14 篇文章符合纳入标准。两名审查员使用预先构建的表格独立提取数据。益生菌研究的结果并不能证实益生菌对 ASD 的预期有益作用，而益生元和合生菌组合似乎对选择性行为症状有效。粪便微生物群移植在 ASD 中的疗效证据仍然很少，但支持进一步研究。总的来说，目前的证据基础表明这些方式在 ASD 中的有益作用是有限的和不确定的。目前，更多的临床试验正在研究微生物为基础的疗法在 ASD 中的应用。这些试验采用稳健的双盲随机对照方案来研究疗效，应该会提供重要和明确的结果。
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