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WCAP 
World Community Autism Program


Autism, Pigments and the Immune System

Immune System Regulation of Pain and Stress: evidence for the utilization of chiral substances.
Natural pain killers in the autist.

by Sandra J. Desorgher and Max Desorgher (c.1999 revised 2001)
First published online at Autism99 Online conference



Contents

Introduction "Autism is a movement disorder at the cellular level"
    Circadian Rhythm "The relationship of pigment metabolism to circadian and circannual rhythms"
    Transthyretin and xanthophils (lutein)
    Correlates of pathogenesis in autism   "The connection between movement, pigment and known
 scientific data on autism"

Part One:  Autism and Affective disorders: New findings in neurochemistry
    Galanin "Galanin may thus be involved in the manifold functions hitherto ascribed to ascending 5-hydroxytryptamine neurons"
    Kynurenine "A number of neuroactive compounds, the kynurenines, are metabolites of tryptophan"
    Autism a hypoglutamatergic disorder?
    Tetrahydrobiopterin "Severe tetrahydrobiopterin (BH4) deficiency is a naturally occurring model of cerebral catecholamine and serotonin shortage"
    Galanin & Epilepsy "hippocampal galanin acts as an endogenous anticonvulsant via galanin receptors"
    Autism & Anorexia Nervosa "deregulation of the serotonergic neurotransmitter system as a common underlying mechanism"
    Autism, Trichotillomania & Seasonal Affective Disorder (SAD) "Oils and pigments leaving the body through the hair
 and hair follicles may be responsible for the biological responses which result in trichotillomania"

Part Two: Autism - Evolutionary Perspectives "Syndromes with autism show purine synthesis defects and/or pigmentation defects"
    Brain Structure "The size of the brain stem and cerebellar vermis are anatomically altered in autistic children"
     Pellagra "Altered mental status is common in pellagrins"
    The cytochrome P-450 pathway and its relevance to autism "Lutein is an aldehyde and an immune response to lutein
 could produce a similar interference in P450 lipid peroxidation"
    NMDA and NO
    The pterin factor
    Cathepsins

Part Three: Natural pain killers from our immune system "In the autist the substances released back into the body when the macrophage engulfs and removes the pigment can be epoxides, carboxylase and potentially mu opioids."

References
    Introduction
    Part One & Part Two
    Part Three



*Quoted material presented in brown i.e. medline abstracts


Introduction

 Autism is a movement disorder at the cellular level,
 involving the immunomodulation of pigment metabolism. At
 the cellular level pigments are moved about through a
 complex system which explains the relationship of
 pigmentation and movement (1); “both pigment
 aggregation and maintenance of the CPM (central pigment
 mass) are dynein-dependent processes. (2) “dynein is
 localized in Purkinje cells of cerebellum and axons of
 central and peripheral nervous systems.” (4)

 “Two of the most consistently observed biological findings
 in autism are increased serotonin levels in the blood and
 immunological abnormalities. A positive relationship was
 observed between elevated serotonin levels and the MHC
 types previously associated with autism.” (10)

 The predominant pathogen that I have identified in my
 research as creating a hapten-type immune response is
lutein, I suggest that  it is  being engulfed and removed
from the body by the cytokine reaction, leading to a
cascade of metabolic responses which is dependent
upon the individual’s genetics, diet and environment (13).
To support this  hypothesis, five years of research has
taken place with  diagnosed autists from around the world
implementing an  individualized lutein free diet. The results
of these efforts  are the basis of this paper.

 As the full potential of an immune response to a pigment
 of this nature is elucidated, it becomes clear that the
 co-occurring disorders associated with autism may or may
 not involve the immune response. However, these
 disorders most often do have a connection to the pigment
 metabolism or pigment genetics. (53)

 Included in either the evaluation criteria or research on
 autism have been behavior, movement, handedness, (29)
 speech pathology, eating disorders(32), hearing
 differences (33), visual anomalies (60) as well as the
 alternative diagnoses of Prader-Willi Syndrome (40), Rett’s
 Syndrome and the co-occurring disorders of
 Hypomelanosis of Ito (34, 35, 36), Angelman Syndrome
 (37,38,39), Anorexia (30, 31), Tuberous Sclerosis (41),
 Usher’s type I and type II, trichothiodystrophy (45), light
 chain storage disorder or Scotopic Sensitivity Syndrome,
 abnormal tryptophan metabolism (46), circadian rhythm
 disturbances as in sleep disorders, Circannual rhythm
 disturbances as in Seasonal Affective Disorder (47),
 trichotillomania (47), blindness and retinal abnormalities
 (48,49), ear discharge (52), vitiligo, adenylosuccinate
 lyase deficiency, xerophthalmia, auto-immunity, Raynaud’s
 phenomena, Hartnup’s Disease (50), Phenolketonuria (59),
 Cytochrome P450 (P for pigment) abnormalities as well as
 diseases with some similar clinical as well as laboratory
 findings such as Xeroderma pigmentosum (42).


Circadian rhythm

 The relationship of pigment metabolism to circadian and
 circannual rhythms was first described in our book (13):
 ‘Many parents of autistic children are now familiar with
 the pineal gland for its role in melatonin secretion. Less
 familiar is the pineal gland’s function as a regulatory gland
 to environmental stimuli, metabolism, immunity, adrenal
 glands, behavior and brain chemistry. The pineal gland
 could be the connecting link in current theories, research
 and treatments for autism. A very important feature to
 note about the pineal gland is that the pineal gland is not
 protected by the blood brain barrier.’ I have mentioned
 that ‘carotenoids are not essential to the human diet’ ref
 (AA) however, the pigments perform regulatory actions
 which can include the role of lutein as the serotonin
 regulator. Serotonin and melatonin are both indoleamines.
 ‘John Panskepp Ph.D. in his article “Melatonin The Sleep
 Master”shares with us the role of melatonin to coordinate
 our “SCN Clock”. “This clock-like control center is situated
 in two small clusters of neurons at the base of the brain
 called the suprachiasmatic nuclei (SCN) which, as the
 name implies, are situated directly above the optic
 chiasm, the place where half the nerves from each of our
 eyes cross over to the opposite halves of our brains. The
 many output pathways from the SCN control practically all
 behavioral rhythms that have been studied, from feeding
 to sleep. When both nuclei are destroyed, animals scatter
 their behavior haphazardly throughout the day instead of
 maintaining a well-patterned routine of daily activities.”’
 (55)

 ‘An unrecognized type of receptor in the eye's retina must
 detect light and help set the body's circadian rhythm
 clock.(BB) Two proteins found in the retina may be those
 previously unknown receptors, which help regulate daily
 rhythms of sleep and activity, hormone release, appetite,
 and other functions. A team of researchers report in two
 papers published that mice lacking normal rods and cones,
 types of light-sensitive receptors on the retina, are still
 able to use light to reset their circadian clocks. (CC)
 ‘Researchers led by Dr. Gijsbertus T.J. van der Horst of
 Erasmus University in Rotterdam, the Netherlands, began
 their research by studying two retinal proteins, the
 “cryptochromes”Cry1 and Cry2. These proteins are very
 similar to proteins that regulate the day/night cycle of
 plants. The team theorized that they might also play a
 role in establishing circadian rhythm in animals. Mice
 deficient in both Cry1 and Cry2 displayed a complete loss
 of normal daily rhythm, according to the investigators.’ “In
 mammals the retina contains photoactive molecules
 responsible for both vision and circadian photoresponse
 systems. CRY1 is expressed at high level in the SCN and
 oscillates in this tissue in a circadian manner. These data,
 in conjunction with the established role of CRY2 in
 photoperiodism in plants, lead us to propose that
 mammals have a vitamin A-based photopigment (opsin)
 for vision and a vitamin B2-based pigment (cryptochrome)
 for entrainment of the circadian clock.” (61)


Transthyretin and xanthophils (lutein)

 "Transthyretin (TTR) in plasma is associated with yellow
 compounds. Their properties differ, and in the chicken
 protein a major yellow compound has recently been
 identified as a carotenoid, lutein, also called xanthophyll.
 The human TTR derivative has chromatographic and
 spectral properties identical to a yellow photochemical
 degradation product of biopterin and a spectrum like that
 of the pterin aldehyde.”(62)

 “Histologic, biochemical, and spectral absorption data
 suggest that the yellow color is due to a xanthophyllic
 pigment, lutein, that is distributed in all retinal layers
 internal to the outer nuclear layer, with greatest
 concentration in the outer and inner plexiform layers.
 Clinically absent in newborns, the pigment gradually
 accumulates from dietary sources and appears to serve
 both as an optical filter, by absorbing blue light and
 reducing chromatic aberration, and in a protective
 capacity, preventing actinic damage.” (64)

 “Transthyretin, a protein synthesized and secreted by the
 choroid plexus and liver, binds thyroid hormones in
 extracellular compartments. This binding prevents
 accumulation of thyroid hormones in the lipids of
 membranes, establishing extracellular thyroid hormone
 pools for the distribution of the hormones throughout the
 body and brain”. (66) (69)

 “Localization of retinol binding protein (RBP) and
 transthyretin (TTR) may indicate a role in the transport
 and distribution of retinol and thyroid hormone,
 respectively, from yolk to embryo prior to establishment of
 the circulatory system.” “Protein proportions
 (transthyretin and transferrin) increased until about 3
 years of age and decreased from then on.” “Studies
 on the physical-chemical properties of these hybrid TTRs
 will help to understand the pathogenicity associated with
 TTR.” “A low molar ratio of retinol binding protein to
 transthyretin indicates vitamin A deficiency during
 inflammation.”(71-74)

  “Carotenol esters in human skin may be formed by
 reesterification of xanthophylls (lutein) following
 absorption. Also, very small amounts of esters may
 circulate in the blood and subsequently accumulate in
 tissues such as skin."(75)

 Small blister-type eruptions and mosquito bite like bumps
 on the skin have been reported with picture
 documentation from autistic children beginning the lutein
 free individualized dietary protocol. It is my hypothesis
 that these prurigo type eruptions are simply agglutination
 of carotenol fatty esters being removed naturally through
 the skin. That the elimination of the pathogen, lutein,
 allows for the utilization of these same type fatty esters
 which are entering the digestive system with
 non-pathogen containing carbohydrates thus accounting
 for the alleviation of the blister-type skin eruptions
 reported consistently in those who had experienced this
 occurrence.


Correlates of pathogenesis in autism

 As we consider the results of an immune response which
 identifies a pigment such as lutein as non-self and
 produces a cytokine reaction we can follow the
 possibilities for outcome of this reaction to the area of
 the brain referenced in the autism research., “ loss of
 cerebellar Purkinje and granule cells occurring early in
 brain development and an immature development of the
 limbic system.”(14) To fully identify the possibility of this
 immune system response and state that autism is a
 manifestation of symptoms brought about by this reaction
 the connection between movement, pigment and known
 scientific data on autism must be shown. Therefore the
 relationship between the purkinje neuron cells, dynein and
 pigment must exist. “Immunohistochemical experiments
 have demonstrated that dynein is localized in Purkinje
 cells of cerebellum and axons of central and peripheral
 nervous systems.”(4) This coupled with the data which
 ‘show that dynein is involved in the homogeneous
 distribution of dispersed pigment’ (2) should be adequate
 to justify the potential of the hypothesis. “Microtubules
 serve as a rail on which motor proteins, such as kinesin
 and dynein superfamily proteins, convey their
 cargoes.”(15)

 There must also be shown the relationship between these
 factors, purkinje cells and pigment, and their relationship
 to the immune system. “Polypeptide subunits from these
 microtubule-based motility factors were detected on
 phagosomes.”(16)

 This information must fit within the knowledge database
 thus collected in relationship to autism. “Ahlsen says that
 GFAP is elevated in all cases of autism or autistic-like,
 whether child or adolescent. This was 47 out of 47 cases,
 which to me means 100%. In autism the levels remain at
 sometimes three times the normal level.” (13,17,18) “Aryl
 sulfatase works chemically rather opposite PST, and I had
 wondered last year if maybe a problem in aryl sulfatase
 would lead to not enough sulfate around to power the
 PST enzyme, which is the scenario described by Rosemary
 Waring’s study of PST in autism.”(13,18,19,20)

 It has been indicated that neurofilament antibody is a
 consistent marker for autism. The neuroglial cells are of
 three types: astrocytes and oligodendrocytes (astroglia
 and oligodendroglia), which appear to play a role in myelin
 formation, transport of material to neurons, and
 microcytes (microglia), which phagocytize waste products
 of nerve tissue. Called also glia. (21) So, if the types of
 neuroglial cells associated with myelin formation are not
 effected, as can be indicated by CSF testing, then we are
 left with the neuroglial cells which are associated with
 phagocytosis. One type of phagocyte cell is the
 macrophage. In the brain this is called myelinophage, in
 the liver kupffer cells. The primary function of these cells
 are to break down and remove substances the immune
 system marks as ‘non-self’. In studies dating back to 1952
 (22) carotenes, bilirubin, methemoglobin and the levels of
 these and other pigment wastes in amniotic fluid have
 been used as a marker to determine the fetal
 environment. Elevated bilirubin is a consistent marker in
 infants later diagnosed with neurological impairment.(23)
 Bilirubin is said to remain in the brain once it has reached
 this destination. However, I believe that with the autist,
 the immune trigger is pigment and that the phagocytosis
 is the immune system’s attempt to remove the hapten
 from the brain through the Cerebral Spinal Fluid, thus loss
 of granule cells (14). Research into the phagocytosis of
 the pigment metabolites (pterins, carotenoids) and the
 improvement for many using dietary intervention removing
 the pigments from their diet leading to improvement and
 ‘symptom free’ results (13) has produced some of the
 most dramatic case histories available. (24, 39)

 Additional evidence to support the linking of this data can
 be included from further research on autism and the
 co-occurring disorder tuberous sclerosis (25) “Altered
 patterns of gangliosides in the CNS might reflect
 important correlates of pathogenesis in autism.” (27) This
 information also has the potential to elucidate the
 intriguing connections between the known and suspected
 co-occurring genetic disorders and autism, especially
 genetic disorders associated with pigmentation. (44) (28)


Part One: Affective disorders

 More recent reports identifying autism as “an affective
 disorder treatable with antidepressants such as Prozac
 (fluoxetine)”(1) have failed to include the information
 identifying the co-occurring “abnormalities in CSF
 (cerebral spinal fluid) which have been reported in
 OCD.”(2) “The prolactin response to d-fenfluramine was
 significantly increased in OCD patients compared with
 controls. The disparate results of studies of 5-HT
 (serotonin) neuroendocrine function in OCD make it
 unlikely that disturbances of brain 5-HT function play a
 central role in the pathophysiology of OCD.” (3) “Results
 indicate that galanin exerts an inhibitory effect via an
 increase in K+ (potassium) conductance in
 5-hydroxytryptamine neurons by acting on a postsynaptic
 receptor. In addition, galanin at low, possibly physiological
 concentrations enhances the inhibitory effect of
 5-hydroxytryptamine at the cell soma level. Galanin may
 thus be involved in the manifold functions hitherto
 ascribed to ascending 5-hydroxytryptamine neurons, for
 example in mood regulation.”(4) These factors may finally
 be the evidence needed to elucidate autism as an immune
 system regulated response. (5, 26, 51, 53)

Galanin
  “The effects on 5-HT release in vivo are most likely
 mediated by a galanin receptor in the dorsal raphe. The
 implications of these findings are discussed in relation to
 the role of acetylcholine in cognitive functions in the
 forebrain and the role of the raphe 5-HT neurons in
 affective disorders.” “A recent study has shown
 that ventral hippocampal galanin plays a role in spatial
 learning and that it has an inhibitory effect on basal
 acetylcholine release.” “Inhibition of cholinergic
 transmission by cosecreted GAL may be enhanced under
 certain conditions.” “Galanin-like immunoreactivity and
 galanin receptors are found in dorsal root ganglion (DRG)
 cells and in dorsal horn interneurons, suggesting that this
 neuropeptide may have a role in sensory transmission and
 modulation at the spinal level. Expression of galanin or
 galanin receptors in the DRG and spinal cord are altered,
 sometimes in a dramatic fashion, by peripheral nerve
 injury or inflammation.” “Overall, galanin appears to
 have inhibitory effects in the central nervous system,
 causing in most cases a potassium-mediated
 hyperpolarization accompanied by a decrease in input
 resistance. Other actions include a reduction in
 presynaptic excitatory inputs and an interaction with
 other applied neurotransmitters. These effects are robust
 and long lasting in most cases.”(5-10)

 Some studies already have identified: “The effects of
 fenfluramine (hydrochloride) [an SSRI] on the behaviors of
 autistic children. Videotaped data favored the subjects
 while on placebo. The implications of this research make it
 difficult to recommend fenfluramine as a treatment for
 autism.”(11)

 Emotional states and lack of emotional expression in
 autism may be a protective measure which cannot be
 maintained under conditions of extreme stress, most often
 a response to change in routine or environment. Hormones
 synthesized from cholesterol: glucocorticoids (cortisol
 corticosterone); mineralcorticoids (aldosterone );
 androgens (testosterone, estrogens, and progestins).
 Some symptoms of metabolic problems in the adrenal
 glands are: in the medulla - increased secretion of
 catecholamines, hypertension, excessive sweating,
 blanching or flushing of skin, tachycardia, headache,
 weight loss, personality changes, signs of increased
 metabolism, constipation, postural hypotension; in the
 cortex, when increased secretion of cortical hormones
 occurs, one of a variety of syndromes may occur:
 Cushing’s syndrome (buffalo hump/moon face), muscle
 wasting, osteoporosis, decreased glucose tolerance,
 atherosclerosis, and systolic hypertension.

 Inositol, like choline, also exists in cells as a phosphatide.
 Current research indicates that inositol lipids appear to be
 intimately involved in Ca mediated control of cell functions
 by hormones and other ligands, in cell proliferation, and in
 the attachment of enzymes to the plaza membranes.
 Stearic and arachidonic acid esterified represent the
 major fatty acids in phosphatidylinositol of mammalian
 tissues. And, current research indicates that each form of
 inositol may have distinct, unique biologic activity. A list
 has been summarized by Mitchell in “Modern Nutrition in
 Health and Disease”: Stimuli whose major effects are to
 produce rapid physiologic responses include muscarinic,
 cholinergenic, adrenergenic, serotonin, histamine
 receptors, angiotensin, vasopressin, and those that bring
 about long term stimulation of cell proliferation.

Kynurenine
 “Approximately 40% of the kynurenine in brain is
 synthesized there, the remainder having come from
 plasma. Tryptophan loading also increases kynurenine
 formation in the brain and in the periphery. Because of
 the formation of kynurenine, which competes for cerebral
 transport and cellular uptake of L-tryptophan, and
 because of substrate inhibition on tryptophan
 hydroxylase, excessively high doses of tryptophan may
 actually decrease the production of cerebral serotonin
 and 5-hydroxyindoleacetic acid.”(15)

 Protein intake needs to be carefully considered in autism
 just as it is in the co-occurring disorder of PKU
 (phenylketonuria). It has been my observation that
 following the ‘food guide pyramid’ would provide protein at
 3 to 4 times the RDA (recommended daily allowance)
 which is higher than the RDI (recommended daily intake).

 “It can be concluded, that reduction of D2-receptors is
 due to loss of cholinergic and GABA-ergic cell bodies in
 the striatum or may be a response to iron deficiency. Low
 serotonergic and high kynurenergic activity may be of
 pathogenetic importance.”(16)

 “Recent studies have revealed that, in addition to
 serotonin, a number of neuroactive compounds, the
 kynurenines, are metabolites of tryptophan. Of these,
 perhaps the most important is quinolinic acid, a neurotoxin
 that acts at the N-methyl-D-aspartate (NMDA) receptor
 and whose precursor responsiveness to tryptophan far
 exceeds that of serotonin. In the central nervous system,
 kynurenines, and in particular quinolinic acid, may
 modulate excitatory amino acid transmission, and may act
 as neurotoxic agents implicated in the pathogenesis of
 several neurologic diseases.”(18)

 Lab tests often indicate a need for ubiquinone
 supplementation. However, the additional supplementation
 can lead to additional neurotoxins. I have found that
 removing the lutein and balancing the nutrient intake
 results in superior outcomes and is the primary method for
 reducing natural opioid production.

Autism a 'hypoglutamatergic disorder'?
 “Based on 1) neuroanatomical and neuroimaging studies
 indicating aberrations in brain regions that are rich in
 glutamate neurons and 2) similarities between symptoms
 produced by N-methyl-D-aspartate (NMDA) antagonists in
 healthy subjects and those seen in autism, it is proposed
 in the present paper that infantile autism is a
 hypoglutamatergic disorder.” “Increased glutamatemia
 may be dietary in origin or may arise endogenously for
 several reasons, among others, metabolic derrangements
 in glutamate metabolism perhaps involving vitamin B6,
 defects or blockage of the glutamate receptor at the
 neuronal compartment, or alterations in the function of
 the neurotransmitters transporters. Increments of taurine,
 an inhibitor, is likely compensatory and calcium
 dependent.”(19, 23)

Tetrahydrobiopterin
  “6R-L-erythro-5, 6, 7, 8-Tetrahydrobiopterin (6R-BH4) is
 known as a cofactor for the hydroxylases of
 phenylalanine, tyrosine and tryptophan and also as a
 cofactor for nitric oxide synthase. 6R-BH4 acts on specific
 membrane receptors to directly stimulate the release of
 monamine neurotransmitters such as dopamine and
 serotonin, independently of its cofactor activity. In
 addition, it indirectly stimulates the release of
 non-monoamine neurotransmitters such as acetylcholine
 and glutamate, through activation of monoaminergic
 systems. In this paper, we briefly review recent
 experimental data, which provide new insights into the
 role of 6R-BH4 as a regulator of neuronal function. We
 also discuss the possibility of treatment by 6R-BH4 of
 neuropsychiatric diseases such as Parkinson's disease,
 Alzheimer's disease, depression and infantile autism.”(20)

 “Severe tetrahydrobiopterin (BH4) deficiency is a naturally
 occurring model of cerebral catecholamine and serotonin
 shortage. …Our data indicate immense hyperprolactinemia
 but few other hormonal disturbances in severe BH4
 deficiency.” “Defects in tetrahydrobiopterin and a
 deficiency of aromatic L-amino acid decarboxylase,
 tyrosine hydroxylase or dopamine-beta-hydroxylase are
 candidate inborn errors for neurotransmitter metabolites
 screening. This investigation has to be considered in any
 child with motor retardation and extrapyramidal
 signs.”(20-21)

 What percentage of individuals diagnosed with autism
 have been screened for inborn errors? Subtle
 improvements in behavior and decreased anxiety have
 been reported consistently when folic acid
 supplementation has been included in an autism
 intervention regimen.

 “Antidepressant treatment effects differ according to
 many variables, including the pre-existing state of the
 organism (e.g. depressed, stressed or normal), the
 species, the duration of treatment and the particular brain
 or peripheral circuits investigated. These examples
 illustrate the complexity found in attempts to identify a
 unitary mechanism of antidepressant drug action.” (24)

Galanin & Epilepsy
 “Thyroid hormone is required for basal and
 estrogen-induced expression of anterior pituitary
 galanin.” “We examined the role of hippocampal
 galanin in an animal model of status epilepticus (SE). We
 suggest that hippocampal galanin acts as an endogenous
 anticonvulsant via galanin receptors. SE-induced galanin
 depletion in the hippocampus may contribute to the
 maintenance of seizure activity, whereas the increase of
 galanin concentration and the appearance of
 galanin-immunoreactive neurons may favor the cessation
 of SSSE. The seizure-protecting action of galanin SSSE
 opens new perspectives in the treatment of SE.” (12,13,26)

 “An abnormal circadian pattern of melatonin was found in
 a group of young adults with an extreme autism
 syndrome. Although not out of phase, the serum
 melatonin levels differed from normal in amplitude and
 mesor. There appears to be a tendency for various types
 of neuroendocrinological abnormalities in autistics, and
 melatonin, as well as possibly TSH and perhaps prolactin,
 could serve as biochemical variables of the biological
 parameters of the disease.”(30)

  “Growth hormone (GH)-releasing hormone (GHRH)
 stimulates GH and slow wave sleep” “It is now well
 established that the balance between the neuropeptides
 growth hormone-releasing hormone (GHRH) and
 corticotropin-releasing hormone (CRH) plays a key role in
 normal and pathological sleep regulation. In addition to
 GHRH, galanin, growth hormone-releasing peptide, and
 neuropeptide Y also promote sleep, unlike ACTH(4-9),
 which disturbs sleep.”(31-32)

 “Galanin is an important target for regulation by many
 hormones, and we postulate that as a cotransmitter,
 galanin acts presynaptically to modulate the secretion of
 GnRH and GHRH, possibly by altering their pulsatile release
 patterns, which in turn influences the release of the
 gonadotropins and GH from the pituitary.” (35)

 “Changes occur in the GH secretory pattern under
 discrete, pathological conditions, such as abnormal
 growth and dwarfism, diabetes, and acromegaly, as well
 as during inflammatory processes.”(36)

Autism and anorexia nervosa
 “The development of anorexia nervosa in a
 high-functioning, early adolescent, autistic female is
 described. This case raises the issue of co-occurrence of
 childhood-onset disorders sharing the phenomena of
 obsessions and compulsions. The role of deregulation of
 the serotonergic neurotransmitter system as a common
 underlying mechanism in these disorders is
 suggested.” “Because of the increase in public school
 programs for severely handicapped children, teachers are
 more likely than ever to be confronted with serious
 medical or psychological problems like anorexia nervosa. If
 programs are to meet the needs of these children in the
 future, service and resource models for the public school
 settings must be developed.”(37-38)

 “An example of self-administered gastric tube nutrition in
 a boy aged 15 years with infantile autism is presented.
 The boy would neither eat nor drink in the normal manner
 since the age of eight years and has gradually
 administered tube-feeding himself. This patient does not
 fulfill the international criteria for the diagnosis of anorexia
 nervosa.”(39)

 “Most autistic children showed a large variation of total
 sleep time. Forty per cent of subjects showed 10% or
 more on coefficient of variation of total sleep time. In the
 retiring and rising time, many subjects tended to show
 late retiring and early rising.”(41)

Autism, Trichotillomania and Seasonal Affective
Disorder (SAD)
 “Our data indicate that the optical pathway participates
 in prolactin regulation.” “Intraocular pressure and
 prolactin measures in seasonal affective disorder (SAD).
 The SAD women had significantly lower IOP and PRL
 values than the control subjects at all four time points
 measured starting from 4.00 p.m. The authors discuss the
 implications of the finding of lowered IOP in relation to
 opposing roles of dopamine and serotonin in prolactin
 secretion in SAD.”(43-44)

 Both seasonal affective disorder (SAD) and
 trichotillomania are reported as co-occurring in autism.
 (42) Oils and pigments leaving the body through the hair
 and hair follicles may be responsible for the biological
 responses which result in trichotillomania.(45)(46) (47)
 The hairpulling greatly dimishes with changes in diet and
 supplementation. Additionally, changes in hair color and
 structure are noted. Eyelash hairs with thick hairbulbs and
 dark pigmentation as well as course structure can change
 to depigmented hairs. In one instance the symptoms of
 co-occurring aldosterism were alleviated in an adult
 female autist.


Autism - evolutionary perspectives
 Evolution of the autism disorder most probably is a result
 of our own medical breakthroughs. The development of
 the original vaccine placing a live attenuated virus inside
 a lipid filled chloroplast has forced our immune system to
 re-evaluate the potential for a chloroplast (carotenoid
 containing plant structure) to harbor a pathogen.
 Agricultural changes including the widespread use of
 pesticides contributed further to the immune system’s
 alert to chloroplasts and pathogens. As the developing
 fetal immune system produces it’s first cytokines which
 set out to identify a non-self pathogen it is reasonable
 that pigments/pterins such as lutein and beta-carotene
 are readily available and easily cross the placental barrier.
 This would occur at the time of development just past
 neural tube closure. Although neural tube closure has
 been suggested as a time for the developmental
 alterations leading to a diagnosis of autism this slightly
 earlier time frame would likely also produce a significant
 population with autism and co-occurring spina bifida. This
 correlation does not exist. The immune response to a
 pigment pathogen would likely result in co-occurring
 disorders of purine, pyrimidine, and pigment metabolism.
 This correlation does exist.

 “Syndromes with autism show purine synthesis defects
 (PSDs) and/or pigmentation defects (PDs)” . (48) (49) By
 continuing to diagnose autism solely on the basis of the
 behavioral characteristics we continue to be deprived of
 the information which could become available should
 screening tests such as that provided to determine PKU
 at birth be implemented. This type of diagnostic tool
 would further increase the database of information
 necessary to establish the connection between autism
 and those diseases, disorders and conditions which lead
 to inevitable miscarriage, fetal distress and early infant
 death. “Disorders in purine and pyrimidine metabolism may
 be difficult to recognize because their recent description
 means many are little known. These disorders should be
 suspected, particularly where the history involves siblings,
 in anaemia, susceptibility to infection, or neurological
 deficits including autism, delayed development, epilepsy,
 self-mutilation, muscle weakness and - unusual in children
 and adolescents - gout.”(50) “Autism is caused by very
 lengthy expansions of (CAG)n, (CGG)n and (GAA)n
 repeats, while schizophrenia results from much smaller
 (CAG)n and (CGG)n repeat expansions.”(48)

Brain Structure abnormalities
 “The neuropeptide galanin (GAL) has been shown to be
 located in the pituitary gland and to modulate the
 secretion of several pituitary hormones. In the human
 pituitary, GAL is almost exclusively located within
 corticotrophs. The possibility exists that GAL produced by
 corticotrophs exerts its action principally through a locally
 mediated paracrine or autocrine mechanism without being
 secreted into the bloodstream.” “Galanin gene
 expression may represent a useful marker for
 differentiating the anterior and posterior cerebellar
 lobes.”(51) (52) (53) (54) (55) (56)

 “Autism may be one of the first developmental
 neuropsychiatric disorders for which substantial
 concordance exists among several independent
 microscopic and macroscopic studies as to the location
 and type of neuroanatomic maldevelopment. Onset might
 be as early as the second trimester. Discovery of the
 etiologies underlying cerebellar maldevelopment may be
 the key to uncovering some of the causes of infantile
 autism.” “The rapid maturation of the pro-dynorphin
 system in the substantia nigra is in contrast to the
 development of the pro-dynorphin system in the posterior
 pituitary where adult-like processing patterns are not
 observed until neonatal day 21”. “The brain stem
 and cerebellar vermis lobules VIII to X were found to be
 significantly smaller in autistic children. This suggests that
 the size of the brain stem and cerebellar vermis are
 anatomically altered in autistic children and that growth
 of the brain stem and cerebellar vermis in autistic children
 is different from normal children.”(11, 58-60)

 “Nerve growth factor inhibits sympathetic neurons'
 response to an injury cytokine: …recent evidence
 suggests that galanin plays a role in peripheral nerve
 regeneration.” “…results suggest that autism may
 involve a type of structural brain impairment different from
 MR.” “These results suggested that significant
 anatomical changes took place in the posterior fossa brain
 structures in the prenatal period in autistic children, but
 were not progressive.” “Results suggest that
 brainstem and vermian abnormalities in autism were due to
 an early insult and hypoplasia rather than to a progressive
 degenerative process.” “Fewer than 35 brains have
 been examined pathologically, none with modern
 techniques. The findings thus far suggest subtle prenatal
 neuronal maldevelopment in the cerebellum and certain
 limbic structures. Abnormalities in distributed networks
 involving serotonin and perhaps other neurotransmitters
 require further documentation.”(62-67)

Pellagra
 “The data suggested that ascorbic acid was rapidly (iron
 accelerated) metabolized to monodehydroascorbate, a
 compound that rapidly reacts with tissue (NADPH) to form
 (NADP). This mechanism could reduce tissue levels of
 (NADPH) such that the feed-back control of tryptophan
 pyrrolase enzyme was depressed. The change in control
 level of the pyrrolase enzyme permitted large quantities of
 tryptophan to be converted into the kynurenine pathway
 products, and a smaller quantity for the serotonin
 pathway. This mechanism could contribute to the
 abnormal tryptophan metabolism found in chronic
 pellagrins with dementia.”(70)

 “Serotonin metabolism is pellagra: Altered mental status is
 common in pellagrins.” “Particular features of clinical
 pellagra: The follow-up of an important number of
 patients during the last three decades has shown a
 substantial difference between the clinical description of
 pellagra in the 40's (the triad: dermatitis, diarrhea,
 dementia) and its clinical aspects today: sun-exposed
 teguments revealing erythema and rapidly becoming
 pigmented and parchment like, dried, parched lips, angular
 stomatitis, lead like sclera fine cornea vascularization;
 gastro-intestinal disturbances: constipation, unjustified
 diarrhea, strange migratory abdominal feelings
 accompanied by ubiquitous dysesthesias. Other
 characteristics of this form of disease are: unexpressive
 look, continuously concerned, thoughtful, anxious or
 frowning, labile mind, headaches, insomnia.” (71-72)

 “Metabolic photodermatoses are diseases in which
 photosensitization reactions, often revealing, are due to
 the accumulation in the skin of an endogenous
 chromophore as a result of a congenital (porphyria) or
 acquired (pellagra) enzymatic disorder.” (73)

 “Pellagra was once a major cause of three behaviorally
 different mental disorders - schizophreniform,
 manic-depressive-like, and phobic neurotic
 - plus drying dermatoses, autonomic
 neuropathies, tinnitus, and fatigue. In this preliminary
 study all three of the corresponding present-day mental
 diseases are found to exhibit, statistically, the same
 pellagraform physical disorders but to ameliorate not so
 much with vitamins as with supplements of a newly
 discovered trace omega-3 essential fatty acid (w3-EFA),
 which provides the substrate upon which niacin and other
 B vitamin holoenzymes act uniquely to form the
 prostaglandin 3 series tissue hormones regulating
 neurocircuits en block. Since present-day refining and
 food selection patterns, as well as pure corn diets,
 deplete both the B vitamins and W3-EFA, the existence of
 therapeutically cross-reacting homologous catalyst and
 substrate deficiency forms of pellagra are postulated, the
 first contributing to the B vitamin deficiency epidemics of
 50-100 years ago, the second to the more recent
 endemic ‘Diseases of Western Civilization’ which express in
 certain genetic subgroups as the major mental illnesses of
 today.”(74)

 “About 1900, modern food selection and processing
 caused widespread epidemics of the B vitamin deficiency
 diseases of beriberi and pellagra which, for genetic
 reasons, often expressed as different diseases ranging
 from bowel and heart disease to dermatoses and
 psychoses. But the B vitamins merely help convert
 essential fatty acids (EFA) into the prostaglandin (PG)
 tissue regulators and it now turns out that, through
 hydrogenation, milling and selection of w3-poor southern
 foods, we have also been systematically depleting, by as
 much as 90%, a newly discovered trace Nordic EFA (w3)
 of special importance to primates and sole precursor of
 the PG3(4) series, even as a concurrent fiber deficiency
 increases body demand for EFA. Since substrate EFA is
 processed by many B vitamin catalysts, an EFA deficiency
 will mimic a panhypovitaminosis B, i.e., a mixture of
 substrate beriberi and substrate pellagra resembling
 vitamin beriberi and pellagra but exhibiting as even more
 diverse endemic disease. It is an assumption that our
 dominant diseases are unrelated to each other.” (75)

 “Although one of the first biological treatments of a major
 psychiatric disorder was the dietary treatment of pellagra,
 the use of diet and dietary components in the study of
 psychopathology has not aroused much interest. …data
 indicate that low serotonin levels alone cannot cause
 depression. Folic acid deficiency causes a lowering of
 brain serotonin in rats, and of cerebrospinal fluid
 5-hydroxyindoleacetic acid in humans. There is a high
 incidence of folate deficiency in depression, and there are
 indications in the literature that some depressed patients
 who are folate deficient respond to folate administration.
 Folate deficiency is known to lower levels of
 S-adenosylmethionine, and S-adenosylmethionine is an
 antidepressant that raises brain serotonin levels. These
 data suggest that low levels of serotonin in some
 depressed patients may be a secondary consequence of
 low levels of S-adenosylmethionine.”(76)

 “A 9-year-old girl presented with a red scaly rash
 confined to sun-exposed areas which started at 2 years
 of age and had the appearance of pellagra. Investigation
 of urinary tryptophan metabolites following an oral
 tryptophan load, showed increased excretion of
 kynurenine and kynurenic acid but reduced excretion of
 3-hydroxy-kynurenine, xanthurenic acid and N1-methyl
 nicotinamide. These results indicated a defect in the
 hydroxylation of kynurenine, an important reaction in the
 synthesis of the nicotinamide nucleotide coenzymes, NAD
 and NADP, from tryptophan. The patient went on to
 develop severe colitis and psychological changes. All her
 symptoms responded to treatment with nicotinamide.” (77)

The  Cytochrome P (Pigment)-450 pathway and its relevance to autism
 Ascorbic acid is a requisite in the diet of man. It may act
 as a reducing agent in enzymatic reactions, particularly
 those catalysed by hydroxylases. Vitamin C is a water
 soluble vitamin crucial for the maintenance of connective
 tissue, wound healing and scar formation. Deficiency is
 known as scurvy and symptoms include dry skin, bleeding
 and swollen gums, bone pains, dental cavities and mouth
 sores.

 The effects of scurvy are due to a failure of the
 hydroxylation of proline residues in collagen synthesis and
 the consequent failure of fibroblasts to produce mature
 collagen. Problems with collagen synthesis are not
 associated with autism or the primary conditions
 co-occurring with autism. This absence of problems with
collagen synthesis is likely a result of certain advantages
which may be afforded the autistic population based on
the immune diversity which results after the immune error
(lutein reaction) occurs. Other advantages may include that
autists do not present with the manifestation of specific
conditions or diseases for which they have been identified
as 'at risk' based on current genetic studies. How the pigment
pathways are altered individually and for the population
have resulted in need for identifying supplements which
can improve outcome. Common supplements such as
ascorbic acid and niacin may result in unexpected adverse
reactions for this 'abnormal' population. Closer study should
reveal that supplements designed to address the specific
needs of this population may include NADH, SAMe and
some hormones (VIP, galanin), enzymes and medications
(oral tiaconazole) not yet available.

“At all concentrations of ADP and collagen used the
 autistic children consistently exhibited diminished platelet
 aggregability; the differences, however, did not reach
 statistical significance.”(78)

 “To determine the role of major chromophores of the
 human retinal pigment epithelium (RPE) in photooxidation
 of ascorbate, we monitored spectrophotometrically rates
 of ascorbate depletion, induced by blue light, in
 suspensions of human RPE melanin, melanolipofuscin and
 lipofuscin and in preparation of pigmented and
 nonpigmented bovine RPE cells. The results clearly show
 that melanin is the key retinal pigment responsible for the
 photosensitized oxidation of exogenous ascorbate.
 Because in the absence of oxygen, no measurable
 oxidation of ascorbate is observed, it can be concluded
 that melanin acts as an electron transfer agent. Biological
 implications of this study remain unclear; however, the
 formation of oxygen-reactive species that accompany
 melanin-mediated photooxidation of ascorbate may
 represent a potential risk to the RPE that should be
 minimized by yet unknown cellular mechanisms.” (80)

  “The role of NADPH--cytochrome P450 reductase and
 cytochrome P450 in NADPH- and ADP--Fe3(+)-dependent
 lipid peroxidation was investigated. The results suggest
 that NADPH- and ADP--Fe3(+)-dependent lipid
 peroxidation involves both NADPH--cytochrome P450
 reductase and cytochrome P450.”(81)

 “polyunsaturated fatty acids are initially reduced to form
 alkoxyl radicals, which then undergo intramolecular
 rearrangement to form epoxyalkyl radicals.” (82)

 “The inactivation of cytochrome P450 2B4 by aldehydes in
 a reconstituted enzyme system requires molecular oxygen
 and NADPH and is not prevented by the addition of
 catalase, superoxide dismutase, epoxide hydrolase,
 glutathione, or ascorbic acid. We conclude that
 inactivation of P450 by aldehydes occurs via homolytic
 cleavage of a peroxyhemiacetal intermediate to give an
 alkyl radical that reacts with the heme.” “Using a
 reconstituted system comprised of purified NADPH-P450
 reductase, P450 and isolated microsomal lipid or pure
 L-alpha-phosphatidylcholine diarachidoyl, a mechanism
 has been proposed for the iron-independent microsomal
 lipid peroxidation and its prevention by ascorbic acid.
 Apparently, ascorbic acid prevents initiation of lipid
 peroxidation by interacting with P450 Fe3+.O2.-.” (84)

 “SOD activity has increased in the mammals which is
 accompanied by a decrease in the L-gulonolactone
 oxidase LGO activity. In fact, there has been an inverse
 relationship between LGO and SOD in the progress of
 evolution. SOD activity is markedly high in the guinea pig,
 flying mammal, monkey and man, the species those lack
 LGO. The inverse relationship between LGO and SOD is
 also observed in rats during postnatal development, that
 is when the new born rats are exposed to high
 concentration of atmospheric oxygen. Recent results from
 our laboratory indicate that ascorbic acid is specifically
 needed for protection of microsomal membranes against
 cytochrome P450-mediated lipid peroxidation and protein
 oxidation, where SOD is ineffective. Data presented in this
 paper also indicate an apparent tissue-specific correlation
 among LGO activity, P450 level and O2.- production
 during phylogenetic evolution.”(85)

 Lutein is an aldehyde and an immune response to lutein
 could produce a similar interference in P450 lipid
 peroxidation thus identifying the need for the minimal
 intake of vitamin C in the autist and the abnormal or
 detrimental effects of megadosing with vitamin C.

 "Human cytochrome P (pigment)450's are pro-oxidants in
 iron/ascorbate-initiated microsomal lipid peroxidation.” (86)

 “Excessive cystine and histidine increased serum
 cholesterol and alpha-tocopherol. Excessive cystine and
 methionine increased liver and kidney alpha-tocopherol
 and ascorbic acid. Excessive tyrosine and phenylalanine
 caused a marked increase in serum copper and
 ceruloplasmin activity, whereas excessive cystine,
 methionine, and histidine caused a decrease in the
 ceruloplasmin activity. Excessive histidine increased liver
 cytochrome P-450, whereas excessive tyrosine markedly
 decreased liver cytochrome P-450.”(87)

 Recent investigations into the use of diet as a therapy for
 autism has resulted in high numbers of children with
 autism being placed on restrictive diets. Abnormal levels
 of cystine and histidine are common in their lab profiles
 prior to implementing the lutein free diet.

 “There are extreme contradictions in the question of an
 optimum intake of vitamin C. Ideal RDA should be based
 on studies with increasing vitamin C doses in which the
 efficiency of the ascorbate-dependent systems would be
 correlated with the vitamin C concentration in the target
 tissues. On the basis of correlations of the hepatic
 vitamin C levels in guinea pigs with the rate of cholesterol
 degradation and the activity of microsomal detoxification
 systems, it is suggested that such intake of ascorbic acid
 is optimum that ensures a maximum body pool and
 maximum steady-state levels of vitamin C in the tissues.
 It is probable that in healthy adults, such a dose ranges
 from 100 to 200mg and that in stress conditions, it
 exceeds 200mg per day.”(88)

 “Long-term or high-dosage consumption of vitamin C may
 play a role in calcium oxalate kidney stone formation. …
 Oxalate excretion increased by about 350% during
 ascorbate ingestion before haematuria. Ascorbate
 concentrations also increased dramatically but appeared
 to reach a plateau maximum. Increasing calcium excretion
 was accompanied by decreasing potassium and phosphate
 values. Clinicians need to be alerted to the potential
 dangers of large dose ingestion of vitamin C in some
 individuals.”(92)

 "Ascorbic acid inhibits lipid peroxidation but enhances DNA
 damage in rat liver nuclei incubated with iron ions: In this
 report we studied DNA damage and lipid peroxidation in rat
 liver nuclei incubated with iron ions for up to 2 hrs in order
 to examine whether nuclear DNA damage was dependent
 on membrane lipid peroxidation. The chain-breaking
 antioxidants butylated hydroxytoluene and diphenylamine
 (an alkoxyl radical scavenger) did not inhibit DNA damage.
 Hence, this study demonstrated that ascorbic acid
 enhanced Fe(II)-induced DNA base modification which
 was not dependent on lipid peroxidation in rat liver
 nuclei.”(93)

 It has been my experience with the implementation of
 individualized dietary intervention and autism that
 excesses are equally as deregulating as deficiencies.
 Some individuals do require higher intake and/or
 supplementation of specific nutrients based on lab work
 and testing identifying individual exposures to toxins, such
 as heavy metals. From the case files, a significant
 regression has been observed with an excessive
 consumption of vitamin C. In one instance an 8 year old
 male child reached symptom free status and was
 declassified. Almost 2 years later symptoms returned. The
 only change identified was an increased intake of dietary
 vitamin C. With a return to the RDI levels of vitamin C (up
 to 60 mg supplementation with additional dietary intake of
 50 to 150 mg) his symptoms were once again alleviated.
 (22)

NMDA and NO
 “Cytokines and NO production could play a role in
 regulation of the blood-ocular barrier function and of the
 development of ocular inflammation.”(94)

 “The data from purification, ligand binding, reconstitution
 and immunochemical studies indicate that there is a group
 of small molecular size proteins (30 to 70 kDa) that form
 what appear to be NMDA receptor complexes. Based on
 cell biological studies of the expression and localization of
 one of the subunits of this complex, the
 glutamate-binding subunit, it appears that this putative
 NMDA receptor plays a key role in neuronal sensitivity to
 NMDA and in neuronal survival in early development.
 However, brain neurons quite clearly express another
 family of proteins which have all functional characteristics
 of an NMDA receptor plus a great degree of variability
 that can account for the varieties of NMDA receptors
 found in brain. If brain neurons are indeed expressing two
 very diverse families of proteins that function as
 glutamate/NMDA receptors, this must be an indication
 that either there is a very selective expression of one of
 these forms in specific neurons or neuronal compartments,
 or that one of these forms of the receptor plays an
 important role in unique functions of the cell, such as
 synaptic plasticity or neurodegeneration.” (95)

 “This study determined if hippocampal AMPA and NMDA
 subunit immunoreactivity (IR) in temporal lobe epilepsy
 patients was increased compared with nonseizure
 autopsies. In humans, these findings support the
 hypothesis that glutamate receptor subunits are
 increased in association with chronic temporal lobe
 seizures, which may enhance excitatory neurotransmission
 and seizure susceptibility.”(96)

 “N-methyl-D-aspartate (NMDA)-activated glutamate
 receptor subunits are invariably expressed in neurons,
 although NMDA-activated currents have been recently
 described in Bergmann glia. To date, the NMDA receptor
 subunit 2B (NMDAR2B) was thought not to be expressed
 in adult cerebellum. Our findings suggest that Bergmann
 glial cells contain the molecular machinary to synthesize
 the NMDA receptor 2B subunit. The role of physiological
 NMDA receptors in the interaction between Bergmann glia
 and Purkinje neurons is not yet known.” (97)

 “Our findings suggest a common mechanism for galanin
 and NOS (NADPH-diaphorase activity) expression.”
 “When galanin (10(-8) M) and the cholinergic agonists
 muscarine and nicotine (10(-6) M) were tested on the
 same astrocyte, all three compounds induced a
 hyperpolarization, suggesting a colocalization of functional
 galanin and cholinergic receptors on the glial
 membrane.”(98-99)

 “NMDA induces NO release from primary cell cultures of
 human fetal cerebral cortex: We and others have
 previously reported that N-methyl-D-aspartate (NMDA)
 induces nitric oxide (NO) release from the rat cerebral
 cortex in vivo. It is crucial to determine if this
 phenomenon also exists in human brain tissue. This is the
 first time, to our knowledge, that extracellular NO
 concentration evoked by exogenous NMDA has been
 directly measured from the fetal human cortical
 neurons.”(100)

 The behavior associated with NO production in the autist
 is maniacal laughter. This symptom can be understood as
 the protective mechanism in a metabolism with elevated
 levels of free radicals. (101) (102) (103)

The pterin factor
 The combination of elements which make up the simplest
 pterin and simplest amino acids are nearly the same.
 When we consider the additional carbons and hydrogens
 (isoprenoids, oil residues, PUFA fats) which are part of the
 metabolites of the fruits and vegetables, then the
 complexity of the plant storage system and the response
 of the human immune system to these foods becomes
 more clearly understood. The most understood immune
 system responses are to amino acids. Recently there have
 been carbohydrate receptors identified. (105). The
 carbohydrate receptor is located on the C5a amino acid
 chain cytokine present on cell walls which is an immune
 component which can trigger many immune system
 responses. It may be significant that serine has been
 identified as part of the cytokine amino acid chain. It is
 possible that the similarities between the identified pterin
 [of which there are many i.e. biopterin, neopterin: pterin
 is the simplest] and the structure of the cytokine could
 provoke an immune system glitch (like a computer virus).
 The immune system is needed to identify ‘self’ or ‘not self’
 and ‘not self’ is then removed. By identifying a substance
 which is nearly identical to the amino acids contained in
 the cytokine there could be the consequence that the
 immune system determines “Self is not self”and this could
 lead to an immune compromised host.

 In August of 1996, lutein pigment was finally identified as
 a pterin (pigment) in Stockholm, Sweden. The pterin
 connection has been elucidated through the research into
 PKU, a disorder of tetrahydrobiopterinhydrofolic acid
 metabolism which is listed as one of 5 conditions likely to
 precede an autism diagnosis. Viral exposure and vaccine
 reactions are additional factors associated with or
 possibly leading to an autism diagnosis. High levels of
 cytokines (immune components which identify non-self
 pathogens) leads to an increase in production of
 macrophage cells (the immune components which engulf
 and remove pathogens) which produce antibodies to
 antigens. So an increased reaction to vaccines and
 viruses could be a result of elevated levels of
 macrophages, and identifying the reason for the elevated
 levels of macrophages (cytokine reaction to a hapten)
 and the knowledge that pterins can act as haptens (106)
 leads to a scientific theory with supportable evidence for
 the removal of specific dietary components to determine
 outcome.

 The lutein pigment is a carotenoid pigment widely
 distributed in fruits, vegetables, meat fats and some
 grains. ‘Biopterin is a hapten without antigenicity’ (107)
 The disorders of pterin metabolism most scientifically
 investigated to date are PKU, Senile dementia of the
 Alzheimer’s type, Methylene tetrahydrofolate deficiency,
 Down’s syndrome, Parkinson’s disease, some types of
 depression, aluminum and dialysis dementia.

Cathepsins
 Just as our gastrointestinal system relies on digestive
 enzymes to perform its functions so the immune system
 components utilize their own special digestive enzymes
 called cathepsins. “Cathepsin B: A lysosomal cysteine
 proteinase which hydrolyzes proteins, with a specificity
 resembling that of papain. The enzyme is present in a
 variety of tissues and is important in many physiological
 and pathological processes. In pathology, cathepsin b has
 been found to be involved in demyelination, emphysema,
 rheumatoid arthritis, and neoplastic infiltration.” (108)

 “The existence of anomalies of tryptophan's metabolism is
 certainly shown in many diseases, however the true
 physiopathogenetic meaning of these metabolic
 alterations is not yet specified. Particularly it is not
 definite if these alterations are the cause of diseases,
 which they appear in, or if they are secondary
 alterations.”(109)

 “The serotonin system has been implicated as a factor in
 some cases of autism since the finding in 1961(Himwich et
 al) of elevated serotonin in the blood of patients with
 autism.”(110)

 To date the lack of understanding of the immune systems
 role in regulation of tryptophan has been a major problem.
 The duel role of tryptophan as a pigment containing amino
 acid as well as its role in binding to pigments makes this
 substance a target for immune system regulation in a
 metabolism which has identified a pigment as a pathogen.
 The specific ways in which the immune system
 manipulates the tryptophan leads to variations most
 commonly referred to as autism spectrum disorders.
 Further complications in understanding this interaction
 occurs as a result of the hapten nature of the
 pigment/pterin lutein.

 “Cathepsin G purified from neutrophil granules triggered
 platelet aggregation and serotonin release independent of
 arachidonic acid metabolites and platelet-activating
 factor formation.”(111) Cathepsin G, similar to
 chymotrypsin is one of the cathepsin proteases which
 have been proven to function in HLA class II mediated
 antigen presentation.

 “Because the major neurologic complication is a peripheral
 neuropathy and the causes of this condition are myriad,
 pyridoxine may cause neuropathy only in patients with a
 pre-existing susceptibility to this condition.” (116) We
 have not been given the assessment to identify
 individuals with the pre-existing susceptibility. “When
 evaluating vitamin B-6 requirements or status in humans,
 protein intake must be considered.”(117)

 Favorable reports on B6 supplementation influence
 caregivers to utilize this information. Identifying the
 nutritional status of the individual could result in a more
 positive outcome should supplementation be chosen as a
 form of intervention. It has been my experience that
 supplementation with B6 could be greatly reduced or
 eliminated entirely in individuals diagnosed with autism
 who choose to implement the pigment restricted/balanced
 nutrient intake dietary intervention. Thus far autism
 therapies have primarily consisted of treating symptoms.
 The elucidation of a specific cause as well as the
 interventions that treat that cause, are likely to produce
 superior outcome, whereas attempting to manipulate the
 metabolism without considering the nutritional status of
 the individual and cause of symptoms can lead to
 “diarrhoea, drowsiness, nausea, vomiting and
 agitation”(118) as well as itching, blister type eruptions,
 panic, headache, profuse sweating, stress, refusal to eat
 etc.

 In order to achieve optimal metabolism in the autist the
 regulation of amino acids must involve providing the
 essential fatty acid interaction. (120) (121) “The data
 obtained suggest that kynurenine and serotonin pathways
 of tryptophan metabolism were intensified in vitiligo.”(124)

 “Urinary excretion of indolyl-3-acryloylglycine (chromogen
 of the so-called Kimmig's light band) in 15 normal subjects
 was highly significantly increased in June-September
 ("summer") against the November-April ("winter")
 collection in the same subjects.”(125)

 “Many specific gene products are sequentially made and
 utilized by the melanocyte as it emigrates from its
 embryonic origin, migrates into specific target sites,
 synthesizes melanin(s) within a specialized organelle,
 transfers pigment granules to neighboring cells, and
 responds to various exogenous cues. A mutation in many
 of the respective encoding genes can disrupt this process
 of melanogenesis and can result in hypopigmentary
 disorders. Vitiligo, in contrast, results from the destruction
 and removal of the melanocyte in the epidermis and
 mucous membranes.”(126)

 My case history files contain many instances of
 co-occurring vitiligo with autism and additionally reports
 of familial instances of vitiligo.



Natural pain killers from our immune system

 “Epoxide carboxylase from the bacterium Xanthobacter
 strain Py2 is a multicomponent enzyme system which
 catalyzes the pyridine nucleotide-dependent carboxylation
 of aliphatic epoxides to beta-ketoacids as illustrated by
 the reaction epoxypropane + CO2 + NADPH + NAD+ -->
 acetoacetate + H+ + NADP+ + NADH. The stereoselective
 dehydrogenases of the Xanthobacter epoxide carboxylase
 system were able to substitute for the corresponding
 components of the N. corallina system when using (R) and
 (S)-epoxypropane as substrates, and vice versa. These
 results provide the first demonstration of the involvement
 of stereospecific dehydrogenases in aliphatic epoxide
 metabolism and provide new insights into microbial
 strategies for the utilization of chiral organic
 molecules.”(123) This shows the pyridine utilization of the
 bacterium in the manufacture of chiral organic molecules
 using epoxide carboxylase. In the autist the substances
 released back into the body when the macrophage engulfs
 and removes the pigment can be epoxides, carboxylase
 and potentially mu opioids. Thus the basic understanding
 of how the autist can manufacture opioids such as
 dermorphin and deltorphin. Reducing the naturally
 manufactured pain killers in the autist requires reducing
 the number of immune cells produced in response to the
 incoming pathogen as well as dietary opioids. This requires
 a lutein free diet.

 The peptides generated by the immune macrophage cells
 can be opioid peptides. Changes made to the diets of
 autistic individuals which may reduce specific food derived
 opioids will not eliminate the natural potential of the autist
 to manufacture opioid peptides: “In vitro human
 hemoglobin hydrolysis by cathepsin D was investigated. It
 confirmed that hemoglobin could appear as a precursor of
 some bioactive peptides following proteolytic
 degradation.” “Using this method, a kinetic study of
 hemorphins appearance has been undertaken. In this
 paper, we also evidenced the generation of
 VV-hemorphin-7 from globin by peritoneal
 macrophages.”(1-2)

 Increasing the autists potential to produce natural
 carboxyl proteinase can result in a decrease in the
 production of the immune macrophage generation of
 natural pain killers. This can result in a more normal
 sensitivity to pain stimuli. To accomplish this the autist
 must have adequate digestive enzymes and regulated
 intake of dietary protein as well as the removal of the
 immune pathogen – lutein. (3)

 Immune activation of neuroactive kynurenines directly
 effect the availability of essential nutrients revealed as
 low or deficiency levels of some B-vitamins, particularly
 riboflavin. Dietary regulation of food substances which
 increase the conversion of tryptophan to kynurenine must
 be regulated. And, adequate intake of B-vitamins will
 produce results which are not obtainable with
 supplementing the B-vitamins and no dietary regulation.
 (4) Elevated levels of free radicals from immune activation
 produced by dietary intake of food substances identified
 as pathogens in the autist contribute significantly to the
 production of toxic and neurotoxic substances. (5)

 To accomplish the strategies to augment mitochodrial
 function requires that the dietary pathogens be identified
 and eliminated, the nitrogen containing amino acids be
 regulated and the metabolism functioning at optimal level
 with healed mucosal linings and the recognized essential
 nutrients present and available. When the pigment
 pathogen is eliminated and testing confirms improved
 gastrointestinal functioning resulting from dietary
 intervention and dietary sources of natural enzymes are
 supplied the results are increase in cognitive abilities and
 a reduction or elimination of the behaviors which
 characterize autism:

 “Mitochondria are vulnerable to a wide array of
 endogenous and exogenous factors which appear to be
 linked by excessive nitric oxide production. Strategies to
 augment mitochondrial function, either by decreasing
 production of endogenous toxic metabolites, reducing
 nitric oxide production, or stimulating mitochondrial
 enzyme activity may be beneficial in the treatment of
 autism.”6

 Improvements in cognitive abilities and a decrease in
 behaviors which are measured to identify autism are the
 results of dietary intervention which removes the immune
 triggering pathogen. Superior results can be obtained
 when additional therapies are used in conjunction with
 dietary intervention. Presently under study is the use of
 secretin. Further research which confirms the potential for
 sources of galanin regulation will increase the opportunity
 for including these substances or products in the
 therapeutic regimen. One such product which has this
 potential is Growth Hormone Releaser.

 “Nitric oxide synthase (NOS)-containing neurons are found
 in many loci throughout the central nervous system,
 which include the cerebral cortex, the cerebellum, the
 hippocampus, and the hypothalamus. NO plays a very
 important role in control of neuronal activity in all of these
 areas by diffusing into neurons where it activates soluble
 guanylate cyclase (sGC) leading to generation of cyclic
 guanosine monophosphate (cGMP) and cyclooxygenase 1
 leading to generation of prostaglandins. Both of these
 active agents are involved in mediating the actions of NO,
 the first gaseous transmitter. In the cerebellum, NO is
 extremely important and it is also thought to mediate
 long-term potentiation in the hippocampus.

 Various stresses and corticoids have been shown in
 monkeys and also in rodents to cause neuronal cell death.
 This may be via the stimulation of glutamic acid release,
 which by N-methyl-D-aspartate (NMDA) receptors causes
 release of NO, which can lead to neuronal cell death. In
 the hypothalamus,. NO stimulates corticotropin-releasing
 hormone (CRH), prolactin releasing factor, growth
 hormone-releasing hormone (GHRH), and somatostatin,
 lutenizing hormone-releasing hormone (LHRH), but not
 follicle stimulating hormone-releasing factor (FSHRF)
 release. In situations of increased release of NO in the
 hypothalamus, it could cause neuronal cell death.
 Following bacterial or viral infections, toxic products of
 the ineffective agents, such as bacterial
 lipopolysaccharide (LPS), circulate to the brain, where
 they induce interleukin-1 and iNOS mRNA and synthesis.
 After several hours delay, massive quantities of NO are
 released. Induction of iNOS occurs in the choroid plexus,
 meninges, in circumventricular organs, and in large
 numbers of iNOS neurons in the arcuate and
 paraventricular nuclei. The large amounts of NO released
 by iNOS may well produce death not only of neurons but
 also glial. Repeated bouts of systemic infection even
 without direct neural involvement could result in induction
 of iNOS in the central nervous system and lead to large
 fall out of neurons in hippocampus to impair memory,
 hypothalamus to decrease fever, and neuroendocrine
 response to infection, and could play a role in the
 pathogenesis of degenerative neuronal diseases of aging,
 such as Alzheimers. The largest induction of iNOS occurs
 in the anterior pituitary and pineal glands. The damage to
 the pituitary could also impair responses to stress and
 infection, and the release of NO during infection could be
 responsible for the degenerative changes in the pineal and
 diminished release of melatonin, an antioxident, and
 consequently, an antiaging hormone, that occur with
 age.”7

 Improving the characteristic eating disorders recognized
 to accompany an autism diagnosis can be accomplished
 with dietary intervention and supportive therapies.
 Improving the signals which regulate eating behaviors can
 result in superior outcome. Therapies used in conjunction
 with dietary intervention such as squeeze therapy,
 massage therapy, secretin infusion and GHR 15 may result
 in the improved signaling needed to reduce abnormal
 eating behavior and increase normal eating behavior.
 Sensory integration and behavioral intervention therapies
 can play a contributing role in improving the feeding
 practices of the autist and therefore increasing the
 opportunity for providing a nutrient rich diet.

  “Patients with GH deficiency appear to have impaired
 psychological well being and potentially significant
 neuropsychiatric manifestations, such as lack of
 concentration and memory impairment. However, it
 is unknown whether this impairment in psychological well
 being is associated specifically with GH deficiency or is
 due to another factor associated with hypopituitarism.” 18-19

 “Indoloyl-Acriloyl Glycine (IAG) has many but not all of the
 properties of a peptide. The two major elements of the
 molecule are joined by way of a peptide bond. One of the
 elements (glycine) is an amino-acid whereas the other
 element, the indole part of the molecule, although almost
 certainly derived from the amino-acid tryptophan is not,
 strictly speaking, an amino-acid. The compound is,
 therefore peptide like or “peptoid”in nature. For the
 purposes of our interpretation, we assume that the other
 peaks which appear in our profiles, between 17 and 30
 minutes are similarly peptide (or peptoid) in nature and
 that many of these are derived from the incomplete
 breakdown of food.”21

 Elevated levels of IAG are also found in Hartnup’s and
 SAD. The inconsistency in the diets of the autists and
 sometimes very self-limited or intentionally restricted diets
 might indicate that a source other than dietary is
 responsible for the unusual peptides or peptoids. The
 tryptophan component indole is also a pigment and
 tryptophan metabolism irregularity is a consistent
 biochemical marker for autism.

 Neurotransmitter irregularities in the autist is a strong
 indication that the ACTH/cortisol axis is abnormal and that
 stress and immune function contributes to the altered
 metabolism in the autist. (22)

 Removing the immune triggering pathogen may be
 insufficient to improve GH release or regulation in the
 autist. Additional therapies are being used and reported to
 influence hypothalamic and hypophyseal regulation. Food
 deprivation or the potentially nutrient deficient diets of
 the autist following a restricted or self limited diet has not
 been adequately researched. (35) The manufacture of
 drug-like opioids by the immune system macrophages or
 derived from food contribute to the behavioral
 characteristics which define the disorder of autism.

 “The chimeric peptides C7, M15, M32, and M40, which
 have been reported to antagonize some actions of
 galanin, all produced varying degrees of depression of
 evoked EPSCs.”(40) Stimulating galanin production with
 squeeze therapy or using growth hormone releasing food
 supplements in conjunction with decreasing the levels of
 naturally produced opioids in the autist should be given
 further attention. Dietary intervention is the most
 comprehensive tool available for use in treating autism.


References
 

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 (BB) April 16th issue of Science

 (CC) Imperial College of Science Technology and Medicine
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 50. Additional research has identified markers so
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 of the study groups, including research by Paul Shattock:
 “Some of you are aware that in the last year our listmate,
 Paul Shattock, has been able to identify the "peak" that
 shows up in urinary profiles performed by his lab and by
 Dr. Reichelt's lab in Norway.  In a paper presented in
 Durham this spring, Paul explained that this substance is
 IAG, indolyl-acriloyl glycine. Dr. Reichelt reported finding
 this substance in 96% of 200 children with autism he has
 tested in the last four years.  This peak has been used by
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 52. Out of pure curiousity, what does it mean when they
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 removed at four or five years old, he still has this
 discharge...it's thick and waxy...he has only had two ear
 infections in the last 12 months or so,...the ped. never
 seems concerned.  I always have wondered

 about it though.  Any idea's? Sincerely, Terry J. (from the
 internet)

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 70. Reptilian behavioural patterns in childhood autism;
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 71. Expression of retinol binding protein and transthyretin
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 72. Quantification of cerebrospinal fluid proteins in
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 73. Screening and biochemical characterization of
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 74. A low molar ratio of retinol binding protein to
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 75. Xanthophyll esters in human skin; Wingerath, T., Sies,
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Part I - Affective Disorders  - References

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 4. Galanin-5-hydroxytryptamine interactions:
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 5. Modulation of acetylcholine and serotonin transmission
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 6. Galanin modulates 5-hydroxytryptamine functions.
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 21. Abnormalities of biogenic amines affecting the
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 22. Sara’s Diet study group – a database of 1500 case
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 25. Tonic clonic seizures and tachycardia induced by
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 30. Brief report: circadian melatonin, thyroid-stimulating
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 33. Innervation of histaminergic tuberomammillary neurons
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