1 00:00:00,000 --> 00:00:03,840 My guest today is Dr. Kristen Lyall. 2 00:00:03,840 --> 00:00:10,960 Dr. Kristen Lyall is an associate professor in the Modifiable Risk Factors Program at 3 00:00:10,960 --> 00:00:16,960 the A.J. Drexel Autism Institute at Drexel University. 4 00:00:16,960 --> 00:00:23,980 She earned her doctorate in epidemiology from the Harvard School of Public Health, followed 5 00:00:23,980 --> 00:00:30,120 by postdoctoral training at the UC Davis Mind Institute. 6 00:00:30,120 --> 00:00:36,020 Subsequently, she served as a research scientist in the Environmental Health Investigations 7 00:00:36,020 --> 00:00:42,120 Branch of the California Department of Public Health. 8 00:00:42,120 --> 00:00:49,920 Her research is dedicated to exploring the modifiable factors that influence autism development. 9 00:00:49,920 --> 00:00:58,320 Dr. Lyall's work focuses on understanding how parental factors, prenatal exposure to 10 00:00:58,320 --> 00:01:05,980 environmental chemicals and maternal dietary elements interact and correlate with autism 11 00:01:05,980 --> 00:01:10,500 and other neurodevelopmental outcomes. 12 00:01:10,500 --> 00:01:17,700 She also employs continuous quantitative measures to explore traits related to neurodevelopmental 13 00:01:17,700 --> 00:01:18,700 diagnosis. 14 00:01:18,700 --> 00:01:23,980 Offering a nuanced view of the autism phenotype. 15 00:01:23,980 --> 00:01:31,260 Dr. Lyall plays a pivotal role in leading and participating in large-scale collaborative 16 00:01:31,260 --> 00:01:34,180 epidemiological studies. 17 00:01:34,180 --> 00:01:41,900 These studies aim to uncover insights into autism and various child health outcomes, leveraging 18 00:01:41,900 --> 00:01:49,180 her expertise to shape the field's understanding and approach to these conditions. 19 00:01:49,180 --> 00:01:55,980 With specialties in psychiatric, reproductive, and nutritional epidemiology, her research 20 00:01:55,980 --> 00:02:05,500 delves into broad spectrum of risk factors for autism, including exposure to air pollution, 21 00:02:05,500 --> 00:02:14,700 maternal prenatal, hormone, and protein levels, gestational diabetes, infertility treatments, 22 00:02:14,700 --> 00:02:20,700 and maternal, autoimmune, or other medical conditions. 23 00:02:20,700 --> 00:02:25,700 And now, my conversation with Dr. Kristen Lyall. 24 00:02:25,700 --> 00:02:33,460 Dr. Lyall, I would just love to understand about your medical journey or your education 25 00:02:33,460 --> 00:02:37,660 journey, and could you take me through that and just touch on the different stops you 26 00:02:37,660 --> 00:02:39,260 had and different interests? 27 00:02:39,260 --> 00:02:40,260 Sure. 28 00:02:40,260 --> 00:02:47,500 Well, first, I'll also start off by saying thank you for inviting me to your podcast. 29 00:02:47,500 --> 00:02:57,500 So yeah, I did my undergraduate degree at Middlebury College up in Vermont, and new going 30 00:02:57,500 --> 00:03:04,940 in, I was interested in science and really started out as a biology major. 31 00:03:04,940 --> 00:03:13,940 I was very interested in human genetics and kind of patterns of genetics, I guess, but 32 00:03:13,940 --> 00:03:16,900 wasn't someone that necessarily wanted to be in the lab. 33 00:03:16,900 --> 00:03:22,940 And then in the latter years of my undergraduate, I got really interested in psychology. 34 00:03:22,940 --> 00:03:31,460 And I also started working as a part-time job, as a behavioral aid for a family who had 35 00:03:31,460 --> 00:03:34,860 a child with autism. 36 00:03:34,860 --> 00:03:41,060 And that was really my introduction to autism and getting to know that family, and also 37 00:03:41,060 --> 00:03:45,020 the counselor who worked with that family. 38 00:03:45,020 --> 00:03:53,060 And then after school, I worked for several years as a research assistant at Massive Chuset's 39 00:03:53,060 --> 00:03:59,620 General Hospital in a very research active group with great people. 40 00:03:59,620 --> 00:04:05,020 And I think that's kind of a theme across my career is just getting to work with wonderful 41 00:04:05,020 --> 00:04:07,500 people. 42 00:04:07,500 --> 00:04:18,140 And again, got the opportunity to learn more about autism and to directly work with families. 43 00:04:18,140 --> 00:04:25,820 And I was administering various different assessments and tests. 44 00:04:25,820 --> 00:04:28,300 And so that was really interesting. 45 00:04:28,300 --> 00:04:32,940 And it also was my first introduction to epidemiology. 46 00:04:32,940 --> 00:04:40,060 So I had never even, I don't know that I'd heard the word epidemiology until my experience 47 00:04:40,060 --> 00:04:45,300 in that research group where one of the investigators was an epidemiologist. 48 00:04:45,300 --> 00:04:51,900 And the more that I learned about that field, the more it really kind of spoke to me and 49 00:04:51,900 --> 00:04:57,500 seemed like it could be a fit for my interests and kind of bringing together the different 50 00:04:57,500 --> 00:05:03,460 substantive areas that I was interested in, but applying the methods and the research 51 00:05:03,460 --> 00:05:06,740 design and the statistics. 52 00:05:06,740 --> 00:05:14,900 And so that was when I applied to a couple of epidemiology programs to get a doctorate 53 00:05:14,900 --> 00:05:20,540 or PhD and ended up going to Harvard School of Public Health. 54 00:05:20,540 --> 00:05:24,020 And there I got really interested in. 55 00:05:24,020 --> 00:05:27,580 So I was in the psychiatric epidemiology track. 56 00:05:27,580 --> 00:05:32,860 I also got interested in there are all these other subfields of epidemiology. 57 00:05:32,860 --> 00:05:35,900 It's not just infectious diseases. 58 00:05:35,900 --> 00:05:40,180 It's not just cancer epidemiology. 59 00:05:40,180 --> 00:05:45,220 And it's really kind of using those methods to study a whole range of different things 60 00:05:45,220 --> 00:05:49,580 from a kind of population perspective. 61 00:05:49,580 --> 00:05:54,700 And so I got interested in nutrition as well there. 62 00:05:54,700 --> 00:06:04,420 And then following my time in graduate school, I did a postdoc at UC Davis Mine Institute. 63 00:06:04,420 --> 00:06:07,740 And by that time, I had done quite a bit of work. 64 00:06:07,740 --> 00:06:10,980 My dissertation was focused on autism. 65 00:06:10,980 --> 00:06:16,020 Again, working with really great mentors, I was given the opportunity to help kind of 66 00:06:16,020 --> 00:06:19,100 lead a study while in graduate school. 67 00:06:19,100 --> 00:06:29,140 And so had learned so much about autism, done a lot of research kind of as a student. 68 00:06:29,140 --> 00:06:34,460 But the MIND Institute was a really wonderful postdoc experience because it had a much kind 69 00:06:34,460 --> 00:06:41,860 of broader training across areas that I didn't really previously have training in. 70 00:06:41,860 --> 00:06:49,980 So things like immunology, neurology, neuroimaging, all these other aspects, and then also the 71 00:06:49,980 --> 00:06:56,300 clinical exposure because I wasn't trained in kind of clinical assessments. 72 00:06:56,300 --> 00:07:04,500 I'd done some different measures, but hadn't been trained in diagnosing autism. 73 00:07:04,500 --> 00:07:09,180 And so there was really that kind of well-rounded training. 74 00:07:09,180 --> 00:07:20,100 And then from there, actually went to work as an epidemiologist at the California Department 75 00:07:20,100 --> 00:07:28,420 of Public Health, again, working with great people in an environmental group. 76 00:07:28,420 --> 00:07:34,540 And then after about a year there, I switched to my current role, which is at the A.J. 77 00:07:34,540 --> 00:07:38,460 Drexel Autism Institute of Drexel University. 78 00:07:38,460 --> 00:07:42,940 And I'm currently an associate professor. 79 00:07:42,940 --> 00:07:47,460 And I've been at Drexel for about eight years now. 80 00:07:47,460 --> 00:07:48,460 Yeah. 81 00:07:48,460 --> 00:07:52,100 What took you to Drexel? 82 00:07:52,100 --> 00:07:58,260 Well, it was wonderful living in California, I will say that. 83 00:07:58,260 --> 00:08:01,580 But most of my family is on the East Coast. 84 00:08:01,580 --> 00:08:08,020 And then I was also, so there was the family and the personal component, but there were 85 00:08:08,020 --> 00:08:11,060 really great people at the Autism Institute at Drexel. 86 00:08:11,060 --> 00:08:16,660 And I was really excited about the opportunity to work with them. 87 00:08:16,660 --> 00:08:24,620 And I think also I've kind of always been drawn to the academic environment where you're 88 00:08:24,620 --> 00:08:29,580 doing the research, but you also get to work with students and mentor students. 89 00:08:29,580 --> 00:08:35,620 And so those were some big reasons, but it definitely wasn't easy to leave California. 90 00:08:35,620 --> 00:08:38,340 Yeah. 91 00:08:38,340 --> 00:08:45,980 Tell me about the role of an epidemiologist with autism, because it doesn't, one, I just 92 00:08:45,980 --> 00:08:50,740 should say that I love this because it adds a little bit of diversity into the research, 93 00:08:50,740 --> 00:08:55,940 which I think anytime that happens in science is a huge bonus. 94 00:08:55,940 --> 00:09:00,660 But it's not something that you often hear about or see. 95 00:09:00,660 --> 00:09:01,660 Yeah. 96 00:09:01,660 --> 00:09:07,420 So there are different kind of aspects to epidemiology. 97 00:09:07,420 --> 00:09:14,940 So one, that I would say plays a big role in autism is kind of the descriptive epidemiology 98 00:09:14,940 --> 00:09:16,100 side. 99 00:09:16,100 --> 00:09:19,860 And that might sound kind of very basic. 100 00:09:19,860 --> 00:09:26,820 We're basically counting numbers, how many people have a given condition. 101 00:09:26,820 --> 00:09:34,180 And for autism, a huge factor, of course, is that the prevalence has increased so much 102 00:09:34,180 --> 00:09:35,900 over the past several decades. 103 00:09:35,900 --> 00:09:44,740 So when I began in the early 2000s, autism was still considered a very rare condition. 104 00:09:44,740 --> 00:09:51,580 The prevalence had been increasing since about the early 1990s, but was really on a 105 00:09:51,580 --> 00:09:56,380 very sharp upward trajectory that has continued. 106 00:09:56,380 --> 00:10:00,300 And epidemiology is the reason why we have those numbers. 107 00:10:00,300 --> 00:10:08,700 It's the methods that go into the counting and obtaining accurate estimates of autism. 108 00:10:08,700 --> 00:10:14,900 And so those surveillance efforts are kind of one side of the autism epidemiology piece. 109 00:10:14,900 --> 00:10:20,940 And of course, when we know that the prevalence has been increasing so much, that can also 110 00:10:20,940 --> 00:10:28,220 help to stimulate research into kind of what I would consider the other side of epidemiology 111 00:10:28,220 --> 00:10:36,980 or another portion of it is trying to figure out why a given outcome or condition is occurring. 112 00:10:36,980 --> 00:10:42,460 Are there people who are more susceptible to given conditions or what are the risk factors 113 00:10:42,460 --> 00:10:46,340 or contributing causes to a given condition? 114 00:10:46,340 --> 00:10:53,780 And so that's the other kind of portion of where epidemiology comes in is trying to understand 115 00:10:53,780 --> 00:11:01,140 causes of a condition, where and why and how it's occurring. 116 00:11:01,140 --> 00:11:06,820 And the last thing I would say is that, and as you mentioned, science is really better 117 00:11:06,820 --> 00:11:09,580 when we bring people together from different fields. 118 00:11:09,580 --> 00:11:16,300 And so while I'm an epidemiologist and I work with a lot of other epidemiologists, I've 119 00:11:16,300 --> 00:11:19,660 always working also with people from other fields too. 120 00:11:19,660 --> 00:11:27,180 And I think that's what keeps the work moving forward and helps make sure that, okay, I'm 121 00:11:27,180 --> 00:11:29,220 not an expert in immunology. 122 00:11:29,220 --> 00:11:32,580 I've had a little bit of training on it, but I'm going to work with this person over here 123 00:11:32,580 --> 00:11:38,020 that is an expert so that we can help try and learn more. 124 00:11:38,020 --> 00:11:40,580 Yeah, that's wonderful. 125 00:11:40,580 --> 00:11:42,620 In science, we have that silo. 126 00:11:42,620 --> 00:11:49,740 We often hear about the silo, which is a good thing because for that specific subject, we're 127 00:11:49,740 --> 00:11:52,460 increasing our knowledge and data set about that. 128 00:11:52,460 --> 00:11:59,100 But something especially as so broad as autism, it's good to have expanded edges outward and 129 00:11:59,100 --> 00:12:00,780 upward, I think. 130 00:12:00,780 --> 00:12:02,780 Yeah, for sure. 131 00:12:02,780 --> 00:12:09,500 We always try and work in interdisciplinary teams so that we're not looking at things 132 00:12:09,500 --> 00:12:11,660 from only one perspective. 133 00:12:11,660 --> 00:12:12,660 Yeah. 134 00:12:12,660 --> 00:12:18,620 Tell me about modifiable risk factors. 135 00:12:18,620 --> 00:12:19,620 Sure. 136 00:12:19,620 --> 00:12:27,740 So, you know, I mentioned having an early interest in human genetics. 137 00:12:27,740 --> 00:12:34,940 And so we know, of course, autism is something with a very high genetic contribution to it. 138 00:12:34,940 --> 00:12:38,060 There's a high heritability to autism. 139 00:12:38,060 --> 00:12:46,100 But we also know that that heritability and genetic background is very complex. 140 00:12:46,100 --> 00:12:54,780 And I spent some time working in some laboratories and doing some lab work. 141 00:12:54,780 --> 00:13:03,140 I think learning more about nutrition and environmental chemicals and sort of all these 142 00:13:03,140 --> 00:13:09,860 things in the environment that we're exposed to, I get really interested in, okay, what 143 00:13:09,860 --> 00:13:16,500 are the pieces of this puzzle that we have some control over or that can be modified 144 00:13:16,500 --> 00:13:25,860 or that, you know, shift different aspects of, you know, how outcomes present or co-occurrence 145 00:13:25,860 --> 00:13:28,860 of outcomes. 146 00:13:28,860 --> 00:13:36,660 And so I think it's, to some extent, it's that idea of being able to change and modify 147 00:13:36,660 --> 00:13:37,660 things. 148 00:13:37,660 --> 00:13:43,860 So, when we talk about modifiable risk factors, I think more on the environmental side, things 149 00:13:43,860 --> 00:13:45,940 that we have control over to change. 150 00:13:45,940 --> 00:13:51,940 It doesn't always mean that there are easy changes, you know, when we look at various 151 00:13:51,940 --> 00:13:59,660 environmental toxicants, oftentimes those require policy and regulation to change. 152 00:13:59,660 --> 00:14:07,740 So we're not always talking easy modification, but that's kind of one component there to 153 00:14:07,740 --> 00:14:13,740 thinking about factors that are possible to change. 154 00:14:13,740 --> 00:14:22,980 And then I'm also growing increasingly interested in kind of interactions across different factors. 155 00:14:22,980 --> 00:14:30,860 So, you know, are there dietary components that mitigate the effects of some of these 156 00:14:30,860 --> 00:14:33,700 environmental chemicals that we're exposed to? 157 00:14:33,700 --> 00:14:37,980 And there is some growing evidence that that's occurring. 158 00:14:37,980 --> 00:14:43,980 So, you know, maybe we can't really control our air pollution levels, but we can take 159 00:14:43,980 --> 00:14:49,340 a prenatal vitamin that might help mitigate some of the effects of some of those air pollutants. 160 00:14:49,340 --> 00:14:50,340 Okay. 161 00:14:50,340 --> 00:14:53,700 That's something that I'm curious about. 162 00:14:53,700 --> 00:15:01,660 If whatever it is that we have in our biology that is used to kind of fight off of these 163 00:15:01,660 --> 00:15:03,580 environmental risk factors. 164 00:15:03,580 --> 00:15:13,060 Is it that we're declining in our ability to fight off disease or these risk factors? 165 00:15:13,060 --> 00:15:16,260 Or are they these risk factors just increasing? 166 00:15:16,260 --> 00:15:23,780 In other words, I guess, is it we're lacking what we used to before the 1930s? 167 00:15:23,780 --> 00:15:28,300 Or is it just an overwhelming amounts of the environmental risk factors? 168 00:15:28,300 --> 00:15:32,860 I don't know the answer to that, but it is very fascinating to me. 169 00:15:32,860 --> 00:15:33,860 Yeah, it is. 170 00:15:33,860 --> 00:15:36,820 I mean, it's a good question. 171 00:15:36,820 --> 00:15:44,740 I don't know the answer necessarily, but I do know, you know, there were exposed to 172 00:15:44,740 --> 00:15:52,980 tens of thousands of chemicals in the environment, many of which are not very well regulated. 173 00:15:52,980 --> 00:16:00,220 And oftentimes when we do find evidence that a given chemical or class of chemicals does 174 00:16:00,220 --> 00:16:08,300 have adverse effects on health, you know, not just neurodevelopmental outcomes, but 175 00:16:08,300 --> 00:16:16,580 kind of broadly hormone disruption and all these other different impacts on health. 176 00:16:16,580 --> 00:16:22,140 Oftentimes those chemicals are replaced with other chemicals, even if that one class or 177 00:16:22,140 --> 00:16:24,300 chemical is banned. 178 00:16:24,300 --> 00:16:29,020 And so this is a situation that's called regrettable substitutions. 179 00:16:29,020 --> 00:16:39,180 So it's a little bit of an ongoing challenge in trying to make sure that, you know, all 180 00:16:39,180 --> 00:16:44,540 the different things that we are exposed to in our environment are actually safe for health 181 00:16:44,540 --> 00:16:45,540 and regulated. 182 00:16:45,540 --> 00:16:46,540 Yeah. 183 00:16:46,540 --> 00:16:53,220 But for sure, you know, the number of things that we've been exposed to in our environment 184 00:16:53,220 --> 00:17:00,980 with increasing industrialization, use of plastics has certainly increased exposures 185 00:17:00,980 --> 00:17:04,220 that have the potential to adversely impact health. 186 00:17:04,220 --> 00:17:05,220 Yeah. 187 00:17:05,220 --> 00:17:09,580 That's exactly what I was wondering or think about is the industrialization because it 188 00:17:09,580 --> 00:17:11,540 fits the timelines. 189 00:17:11,540 --> 00:17:15,060 And I mean, everything about it just makes sense. 190 00:17:15,060 --> 00:17:18,380 But I don't have data on it. 191 00:17:18,380 --> 00:17:23,180 But there are some things that you mentioned that I've already listed out for some questions. 192 00:17:23,180 --> 00:17:29,260 And I would, one of them, the most pressing one is since you mentioned diet, but maybe 193 00:17:29,260 --> 00:17:34,820 other prenatal vitamins and such, are there certain diets that can mitigate the risk of 194 00:17:34,820 --> 00:17:36,820 autism? 195 00:17:36,820 --> 00:17:42,900 I guess what I'm trying to say is or ask is, is there like an approach or preparation 196 00:17:42,900 --> 00:17:49,580 that families can take to kind of reduce the risk going into pregnancy? 197 00:17:49,580 --> 00:17:50,580 Yeah. 198 00:17:50,580 --> 00:17:52,220 So that's a really good question. 199 00:17:52,220 --> 00:17:58,660 I think my first response is to remember how complex autism is. 200 00:17:58,660 --> 00:18:05,780 And so I always get a little bit worried when we focus on one risk factor in trying to pitch 201 00:18:05,780 --> 00:18:15,660 it as something that is going to be the one factor that is going to be going to reduce 202 00:18:15,660 --> 00:18:19,540 risk for a given individual. 203 00:18:19,540 --> 00:18:28,540 But that said, there are over a dozen studies, at least now, that have found an inverse association 204 00:18:28,540 --> 00:18:35,260 between taking a prenatal folic acid supplement, a prenatal vitamin that is rich in folic 205 00:18:35,260 --> 00:18:41,380 acid, especially in that early part of pregnancy. 206 00:18:41,380 --> 00:18:46,860 There are a number of studies that have examined other dietary factors. 207 00:18:46,860 --> 00:18:49,820 And you mentioned a specific diet, right? 208 00:18:49,820 --> 00:18:53,900 And so that brings to my mind what we call dietary patterns. 209 00:18:53,900 --> 00:19:01,660 So these are routine ways of eating across a whole series of foods and nutrients. 210 00:19:01,660 --> 00:19:05,500 And so there have been a handful of studies that have looked at these kind of broader 211 00:19:05,500 --> 00:19:10,660 patterns of eating during pregnancy. 212 00:19:10,660 --> 00:19:16,500 And we haven't really found very strong associations there. 213 00:19:16,500 --> 00:19:21,060 We've done a couple of studies where we've looked at specific foods and in particular 214 00:19:21,060 --> 00:19:23,220 fish intake. 215 00:19:23,220 --> 00:19:31,340 Now fish are interesting because they're the primary source of polyunsaturated fatty acids. 216 00:19:31,340 --> 00:19:38,220 And there's a particular PUFA or polyunsaturated fatty acid that is of real interest for brain 217 00:19:38,220 --> 00:19:41,300 development and that's DHA. 218 00:19:41,300 --> 00:19:45,500 It's the most abundant fatty acid, omega-3 fatty acid in the brain. 219 00:19:45,500 --> 00:19:51,100 And it's really important in all of these ongoing neurodevelopmental processes that are occurring 220 00:19:51,100 --> 00:19:55,980 while the baby is growing inside the womb. 221 00:19:55,980 --> 00:20:01,820 And so we found in a couple studies that the more fish you eat or that eating fish at all 222 00:20:01,820 --> 00:20:09,460 in pregnancy has been associated with a reduced risk or likelihood of having a child with 223 00:20:09,460 --> 00:20:10,460 autism. 224 00:20:10,460 --> 00:20:13,540 That's not to say that's the only factor that's important. 225 00:20:13,540 --> 00:20:19,140 But it could be one contributing cause in some cases. 226 00:20:19,140 --> 00:20:23,980 So fish in pregnancy and reducing odds. 227 00:20:23,980 --> 00:20:32,540 And that may be because that fish is a good source of these brain healthy facts. 228 00:20:32,540 --> 00:20:36,860 The other thing, I guess I should take a step back and mention because I've been talking 229 00:20:36,860 --> 00:20:41,540 about mom diet or prenatal diet during pregnancy. 230 00:20:41,540 --> 00:20:47,340 And the reason why I've been talking more about the prenatal or pregnancy period is 231 00:20:47,340 --> 00:20:54,540 because we know one that's a really critical sensitive time period of the baby's development. 232 00:20:54,540 --> 00:21:01,980 It's also when the brain structures and early neurodevelopment is being set up. 233 00:21:01,980 --> 00:21:12,460 And then lastly, when we look to our experts in other fields, we've seen evidence that 234 00:21:12,460 --> 00:21:19,700 that's when some of the pathways to develop autism really begin early in gestation or 235 00:21:19,700 --> 00:21:21,380 during gestation. 236 00:21:21,380 --> 00:21:28,980 And that's not to say that autism can be diagnosed prenatally or at birth. 237 00:21:28,980 --> 00:21:34,620 But it's to say that some of the differences that we see in the brain are beginning during 238 00:21:34,620 --> 00:21:36,740 pregnancy. 239 00:21:36,740 --> 00:21:45,180 And so when we think about likelihood of developing autism, we're all often studying prenatal 240 00:21:45,180 --> 00:21:46,180 factors. 241 00:21:46,180 --> 00:21:51,060 And that's not at all to suggest that what happens after pregnancy doesn't matter for 242 00:21:51,060 --> 00:21:52,060 child development. 243 00:21:52,060 --> 00:21:54,380 It very much does. 244 00:21:54,380 --> 00:22:01,180 There's a ton of great research to show that early interventions really make huge impacts 245 00:22:01,180 --> 00:22:04,500 on children and their outcomes. 246 00:22:04,500 --> 00:22:09,740 But often when we're talking about risk factors or factors that are involved in etiology, 247 00:22:09,740 --> 00:22:14,100 we tend to be focusing on the very early periods of gestation. 248 00:22:14,100 --> 00:22:15,100 Okay. 249 00:22:15,100 --> 00:22:22,780 It's a very, it's a big region of interest, especially for my curiosity is that that time 250 00:22:22,780 --> 00:22:26,380 frame that you just described there. 251 00:22:26,380 --> 00:22:27,380 Yeah. 252 00:22:27,380 --> 00:22:36,500 Tell me a little bit about and correct me, as I say this about some of those, I don't 253 00:22:36,500 --> 00:22:43,460 want to call them biomarkers, but I'm going to have to about how you kind of quantify 254 00:22:43,460 --> 00:22:50,220 these and kind of establish the risk about each one. 255 00:22:50,220 --> 00:22:51,220 Sure. 256 00:22:51,220 --> 00:22:59,860 So I'll follow through with kind of the fish example as one exposure of interest. 257 00:22:59,860 --> 00:23:08,060 And so when we're doing these studies, there's lots of different ways that you can try and 258 00:23:08,060 --> 00:23:12,780 you know, say, is this exposure associated with autism? 259 00:23:12,780 --> 00:23:19,780 So we could collect a sample of families who have a child with autism and then try and 260 00:23:19,780 --> 00:23:24,980 collect a sample of comparison families who have a child who does not have a diagnosis 261 00:23:24,980 --> 00:23:29,900 of autism and then say, what did you eat during pregnancy? 262 00:23:29,900 --> 00:23:33,140 And that was, you know, five years ago. 263 00:23:33,140 --> 00:23:35,380 And then we could compare. 264 00:23:35,380 --> 00:23:38,940 That's called the case control study. 265 00:23:38,940 --> 00:23:44,620 And there's some concerns with, you know, one remembering back, well, what did I eat 266 00:23:44,620 --> 00:23:45,860 during pregnancy? 267 00:23:45,860 --> 00:23:50,820 Or what were the different things that I was exposed to? 268 00:23:50,820 --> 00:23:56,260 That's not to say that that study design isn't useful for some questions. 269 00:23:56,260 --> 00:23:58,460 But that's a concern with that. 270 00:23:58,460 --> 00:24:07,340 So another type of study design is enrolling women when they're pregnant and asking them 271 00:24:07,340 --> 00:24:09,660 about, okay, what are you eating in pregnancy? 272 00:24:09,660 --> 00:24:11,740 What products are you using? 273 00:24:11,740 --> 00:24:14,140 And collecting biospecimens from them. 274 00:24:14,140 --> 00:24:15,940 So can you give us a urine sample? 275 00:24:15,940 --> 00:24:18,340 Can you give us a blood sample? 276 00:24:18,340 --> 00:24:22,660 And then waiting over time to see how their child develops. 277 00:24:22,660 --> 00:24:25,620 And that's called a cohort study. 278 00:24:25,620 --> 00:24:32,620 And so that they introduced a couple of different study designs, but also to kind of note that 279 00:24:32,620 --> 00:24:37,500 there are, in addition to different ways we can collect information from people and group 280 00:24:37,500 --> 00:24:43,620 people, there are different ways that we can get information about exposure histories. 281 00:24:43,620 --> 00:24:51,300 And so when we collect urine samples or blood samples, we can measure all sorts of things 282 00:24:51,300 --> 00:24:55,780 in these biospecimens or samples that are provided. 283 00:24:55,780 --> 00:25:01,540 And so again, to get back to fish so we can collect those, those questionnaires asking 284 00:25:01,540 --> 00:25:08,580 about dietary intake, we can also measure those fats that I mentioned, the omega-3 fatty 285 00:25:08,580 --> 00:25:11,700 acids in people's blood. 286 00:25:11,700 --> 00:25:17,340 And that is another way that we can say, oh, well, this person has really high DHA levels 287 00:25:17,340 --> 00:25:18,820 in their blood. 288 00:25:18,820 --> 00:25:23,820 How does that relate to these outcomes of the child? 289 00:25:23,820 --> 00:25:32,100 And it's a nice, subjective way to compare to the reported data and get an actual biological 290 00:25:32,100 --> 00:25:40,500 assessment that is associated or not with the outcome that we're studying of interest. 291 00:25:40,500 --> 00:25:47,100 And so we've done some studies where we've measured these different fats in samples collected 292 00:25:47,100 --> 00:25:56,420 from moms and also from newborn heel sticks and measured these fats in the blood spots 293 00:25:56,420 --> 00:26:04,980 that are collected routinely from babies for neonatal screening processes and tried to see 294 00:26:04,980 --> 00:26:11,340 are these different levels of these fatty acids associated with autism. 295 00:26:11,340 --> 00:26:18,060 And like for most things with neurodevelopment, the answer is a little complicated. 296 00:26:18,060 --> 00:26:25,660 We haven't seen very clear patterns of associations, but we did find some evidence that, well, 297 00:26:25,660 --> 00:26:33,100 maybe there are certain levels that are associated, maybe very low levels are associated with 298 00:26:33,100 --> 00:26:40,380 a certain subtype of autism with co-occurring intellectual disability, but that's a sort 299 00:26:40,380 --> 00:26:44,820 of preliminary finding that needs a follow up. 300 00:26:44,820 --> 00:26:51,420 But those biomarkers can be really useful in different research studies that we're doing 301 00:26:51,420 --> 00:26:55,780 to try and get that objective measure of exposure. 302 00:26:55,780 --> 00:26:56,780 Okay. 303 00:26:56,780 --> 00:27:00,820 It's like whenever I hear you describe that. 304 00:27:00,820 --> 00:27:07,740 It's like putting, I don't want to say percentages, but I'm going to have to, I think, just because 305 00:27:07,740 --> 00:27:13,780 my inability to really explain what I'm thinking, but like certain percentages of risk associated 306 00:27:13,780 --> 00:27:19,900 with this item or in a combination of these items, is that accurate? 307 00:27:19,900 --> 00:27:20,900 Yes. 308 00:27:20,900 --> 00:27:21,900 Yeah. 309 00:27:21,900 --> 00:27:25,300 And actually, I would say that's a pretty good summary. 310 00:27:25,300 --> 00:27:34,540 So we have different ways of trying to assign risk associated with a given factor that we're 311 00:27:34,540 --> 00:27:35,540 studying. 312 00:27:35,540 --> 00:27:40,220 So one way we can think about it is attributable risk. 313 00:27:40,220 --> 00:27:48,020 So what are the, if we've removed this risk factor from the population, what would be 314 00:27:48,020 --> 00:27:53,060 the corresponding reduction in cases associated with that? 315 00:27:53,060 --> 00:27:59,380 And there are a lot of assumptions that go along with making those, determining those 316 00:27:59,380 --> 00:28:00,380 statistics. 317 00:28:00,380 --> 00:28:09,900 But essentially, yes, you're trying to determine, okay, like how much of the case load is this 318 00:28:09,900 --> 00:28:13,180 one factor contributing? 319 00:28:13,180 --> 00:28:19,700 Is this factor contributing to the rise in autism prevalence? 320 00:28:19,700 --> 00:28:23,940 And so those are different things that we try and tease out. 321 00:28:23,940 --> 00:28:30,180 And when we're doing these estimates and trying to look for associations between one factor, 322 00:28:30,180 --> 00:28:33,620 so I mentioned, we know it's never just one factor, right? 323 00:28:33,620 --> 00:28:35,340 Autism is so complex. 324 00:28:35,340 --> 00:28:43,940 And in addition to having multiple causes or risk factors within any one individual, it's 325 00:28:43,940 --> 00:28:52,260 also highly likely that we have different kind of sets of factors, so different combinations 326 00:28:52,260 --> 00:28:58,380 of factors going in to different cases. 327 00:28:58,380 --> 00:29:05,940 But when we're looking at any one individual factor at a time, we also try and say, okay, 328 00:29:05,940 --> 00:29:13,420 well, what else do I need to account for when I'm looking at this association and this outcome? 329 00:29:13,420 --> 00:29:22,700 Even if it's like a so-called weak association, if you have multiple weak associations, it 330 00:29:22,700 --> 00:29:30,140 kind of like builds up and strengthens the ability to maybe have actionable steps into 331 00:29:30,140 --> 00:29:31,740 reducing the risk. 332 00:29:31,740 --> 00:29:32,740 Yeah. 333 00:29:32,740 --> 00:29:41,140 So what you mentioned is kind of thinking about the multiple hits or combinations of 334 00:29:41,140 --> 00:29:42,140 risk factors. 335 00:29:42,140 --> 00:29:51,420 So we can think about, are there two risk factors that act on the same pathway that then increase 336 00:29:51,420 --> 00:29:53,780 susceptibility to this outcome? 337 00:29:53,780 --> 00:30:01,660 Or is there one factor that exacerbates the effect of another factor? 338 00:30:01,660 --> 00:30:03,180 I like to think about factor. 339 00:30:03,180 --> 00:30:09,900 What are other factors that mitigate the effects of risk factors? 340 00:30:09,900 --> 00:30:21,020 And so we're trying, more people now that we have more large-scale studies and databases 341 00:30:21,020 --> 00:30:27,740 with autism information, I think we're kind of in the era now where we're going to see 342 00:30:27,740 --> 00:30:33,220 more consideration of combinations of risk factors. 343 00:30:33,220 --> 00:30:40,460 In the past, we've been kind of limited by smaller sample sizes often, not always, but 344 00:30:40,460 --> 00:30:46,220 it can be hard to look at combinations of risk factors together when you have a small 345 00:30:46,220 --> 00:30:50,540 sample because then it gets to statistical power. 346 00:30:50,540 --> 00:30:55,580 And do you have enough people in each category to be able to do what you were talking about? 347 00:30:55,580 --> 00:31:02,020 Like, what's the percentage increase or decrease associated with this factor? 348 00:31:02,020 --> 00:31:09,300 So that's where a lot of these research efforts that are bringing together participants from 349 00:31:09,300 --> 00:31:14,020 all around the country have been really helpful. 350 00:31:14,020 --> 00:31:19,300 So I'm involved, for example, in one study that's a national consortium. 351 00:31:19,300 --> 00:31:25,780 It's called the Environmental Influences on Child Health Outcomes or ECHO study program. 352 00:31:25,780 --> 00:31:33,540 And it has brought together existing studies across the country and it has pooled data 353 00:31:33,540 --> 00:31:38,260 and is now collecting new data all under the same common measure. 354 00:31:38,260 --> 00:31:45,740 But what that has done has been, it's allowed us to have much larger sample sizes than have 355 00:31:45,740 --> 00:31:52,780 typically been seen in any one study of autism. 356 00:31:52,780 --> 00:31:57,340 It's like you're evolving a biomarker, in my opinion. 357 00:31:57,340 --> 00:32:05,020 We can take a biomarker from a test, lab test, whatever, however the method, but you're 358 00:32:05,020 --> 00:32:15,100 evolving it and a little bit of making it a step farther in for understanding, I think. 359 00:32:15,100 --> 00:32:16,820 And I just love that so much. 360 00:32:16,820 --> 00:32:27,820 And I hope more will get on to this because I think this is a very promising outcomes. 361 00:32:27,820 --> 00:32:29,300 It seems to me. 362 00:32:29,300 --> 00:32:37,900 I was reviewing your paper, I just love this paper, annual reviews of public health where 363 00:32:37,900 --> 00:32:43,460 there's many items listed and parsed out. 364 00:32:43,460 --> 00:32:52,340 Can you tell me a little bit about, maybe I'll start with immune factors or hormone and protein 365 00:32:52,340 --> 00:32:53,340 factors? 366 00:32:53,340 --> 00:32:54,340 Sure. 367 00:32:54,340 --> 00:33:02,060 Well, so I should note that as with all work I do, that paper was definitely a team effort. 368 00:33:02,060 --> 00:33:07,420 And I've mentioned how grateful I am to all the mentors I've had, but also to all the 369 00:33:07,420 --> 00:33:09,820 collaborators that I get to work with. 370 00:33:09,820 --> 00:33:14,860 And these are people who are experts in their own fields. 371 00:33:14,860 --> 00:33:24,420 And so the immune piece of autism and immunology in itself is very interesting. 372 00:33:24,420 --> 00:33:31,420 And so one thing that I've learned a lot along the way is actually during gestation, 373 00:33:31,420 --> 00:33:38,940 the immune system really has a lot of cross talk with neurodevelopment, which is something 374 00:33:38,940 --> 00:33:42,220 that I didn't know before I was a postdoc. 375 00:33:42,220 --> 00:33:49,980 And so there have been a lot of studies that have shown various maternal immune activation 376 00:33:49,980 --> 00:33:50,980 factors. 377 00:33:50,980 --> 00:34:00,820 So autoimmune diseases, fever during pregnancy, infection during pregnancy, and related those 378 00:34:00,820 --> 00:34:07,140 different factors to an increased risk of autism or likelihood of the child developing 379 00:34:07,140 --> 00:34:09,060 autism. 380 00:34:09,060 --> 00:34:16,100 There have also been some studies that have made use of biomarkers and looked at patterns 381 00:34:16,100 --> 00:34:23,460 of cytokines or pro-inflammatory markers and different immune markers and found some 382 00:34:23,460 --> 00:34:25,260 specific associations. 383 00:34:25,260 --> 00:34:33,660 And I've been lucky to get to work with some colleagues in California who've led a population 384 00:34:33,660 --> 00:34:40,180 based case control study that have really focused on a lot of immune markers and autism 385 00:34:40,180 --> 00:34:45,980 and learned a lot about how those relate to autism. 386 00:34:45,980 --> 00:34:50,340 And one interesting finding there is that there did seem to be kind of a general pattern 387 00:34:50,340 --> 00:34:55,540 of associations with some of these immune markers, specifically for autism with co-occurring 388 00:34:55,540 --> 00:34:58,220 intellectual disability. 389 00:34:58,220 --> 00:35:06,300 And I think that's sort of an example of we know how complex and diverse autism is. 390 00:35:06,300 --> 00:35:15,540 We have this one diagnostic label for what really represents a very broad phenotype and 391 00:35:15,540 --> 00:35:20,940 diversity of strengths and challenges. 392 00:35:20,940 --> 00:35:28,420 And I think it is interesting when we can pull apart factors that might put a child 393 00:35:28,420 --> 00:35:38,340 or an individual on a pathway to one kind of subgroup of that broader category because 394 00:35:38,340 --> 00:35:45,820 it helps us learn a little bit more about kind of the underlying biological pathways. 395 00:35:45,820 --> 00:35:51,740 Another thing you mentioned, so hormone influences in autism. 396 00:35:51,740 --> 00:35:55,580 And so there's been a lot of interest in thyroid hormones. 397 00:35:55,580 --> 00:36:00,620 So we know thyroid hormones are so important in neurodevelopment. 398 00:36:00,620 --> 00:36:06,940 All babies are screened and moms during pregnancy for their thyroid hormone levels. 399 00:36:06,940 --> 00:36:13,060 And so there have been a number of studies that have looked at both mom thyroid hormone 400 00:36:13,060 --> 00:36:17,580 levels and there are a couple different ones that are measured during pregnancy as well 401 00:36:17,580 --> 00:36:25,060 as baby in those newborn heel stick and other biospecimens and examined associations with 402 00:36:25,060 --> 00:36:26,940 those. 403 00:36:26,940 --> 00:36:31,660 And the results have been a little bit inconsistent. 404 00:36:31,660 --> 00:36:36,860 So I don't think we have necessarily a clear picture there. 405 00:36:36,860 --> 00:36:44,660 But I have a student who is using some different statistical methodologies and there seem to 406 00:36:44,660 --> 00:36:50,900 be some differences kind of across levels of autism traits. 407 00:36:50,900 --> 00:36:58,180 So it may be important to consider again kind of what are those subgroups or sub phenotypes 408 00:36:58,180 --> 00:36:59,460 within autism. 409 00:36:59,460 --> 00:37:11,180 Do we get a clearer picture of how this biomarker, this exposure might be related to this outcome? 410 00:37:11,180 --> 00:37:14,580 Thyroid is a region of interest. 411 00:37:14,580 --> 00:37:17,860 And you're right, it is across data. 412 00:37:17,860 --> 00:37:18,860 Yeah. 413 00:37:18,860 --> 00:37:26,460 And that's been one reason why there's a lot of interest in a class of chemicals called 414 00:37:26,460 --> 00:37:28,740 endocrine disrupting chemicals. 415 00:37:28,740 --> 00:37:36,220 And these are EDCs because we know that they, as the name implies, disrupt hormone levels. 416 00:37:36,220 --> 00:37:42,060 And so there's been a lot of interest in those chemicals and whether they relate to autism 417 00:37:42,060 --> 00:37:51,700 specifically and also neurodevelopment more broadly and evidence that these are important 418 00:37:51,700 --> 00:37:55,060 chemicals to be considering and regulating. 419 00:37:55,060 --> 00:37:58,060 Yeah. 420 00:37:58,060 --> 00:38:07,700 The tyrosine, synthesizing it from tyrosine is a very fascinating story, I think, because 421 00:38:07,700 --> 00:38:09,420 it's an aromatic amino acid. 422 00:38:09,420 --> 00:38:14,380 It's a very strange or rare special type of amino acid. 423 00:38:14,380 --> 00:38:18,740 And yeah, there's only three of them. 424 00:38:18,740 --> 00:38:22,980 And how they're synthesized is very unique. 425 00:38:22,980 --> 00:38:29,660 And we can see that there's a lot of people that's on thyroid medicine now that have disrupted 426 00:38:29,660 --> 00:38:37,700 thyroid, which is very problematic and goes back to the environmental risk factors that 427 00:38:37,700 --> 00:38:38,700 we're talking about. 428 00:38:38,700 --> 00:38:45,900 It's very much in line with this modern life, I think. 429 00:38:45,900 --> 00:38:50,860 Something I was wanting to talk to you about is you mentioned something as simple as a 430 00:38:50,860 --> 00:39:00,100 fever or something that's really even acute within pregnancy might increase the risk of 431 00:39:00,100 --> 00:39:06,660 this neurodevelopment at this time frame that really disrupts the progression or the process 432 00:39:06,660 --> 00:39:11,100 of the neurodevelopment, being a typical development. 433 00:39:11,100 --> 00:39:19,660 Is something so brief like that known to play a factor in maybe this child will now develop 434 00:39:19,660 --> 00:39:20,660 autism? 435 00:39:20,660 --> 00:39:23,380 Yeah, so it's a great question. 436 00:39:23,380 --> 00:39:25,780 I think there are a couple of different threads in there. 437 00:39:25,780 --> 00:39:30,980 And so one is the piece of critical windows. 438 00:39:30,980 --> 00:39:33,780 When is this specific factor happening? 439 00:39:33,780 --> 00:39:41,380 And can something so acute actually have such a big impact on development? 440 00:39:41,380 --> 00:39:47,620 And so we take, for example, folic acid and neural tube defects. 441 00:39:47,620 --> 00:39:55,820 So if you're really low deficient in folic acid, if that's occurring in what we call 442 00:39:55,820 --> 00:40:03,060 the periconceptional window when the neural tube is forming, then the baby can end up 443 00:40:03,060 --> 00:40:07,980 with these neural tube defects, which are catastrophic. 444 00:40:07,980 --> 00:40:14,420 And so that's the reason why we fortify and we recommend folic acid supplementation in 445 00:40:14,420 --> 00:40:17,060 the early part of pregnancy. 446 00:40:17,060 --> 00:40:19,460 And so that's the critical window aspect. 447 00:40:19,460 --> 00:40:24,380 And so we do have evidence, yes, that certain exposures that timing really matters. 448 00:40:24,380 --> 00:40:25,980 They have a much stronger effect. 449 00:40:25,980 --> 00:40:30,300 And that's because of the neurodevelopmental processes that are happening. 450 00:40:30,300 --> 00:40:37,700 It's lining up the exposure just at the right or wrong window of when these developmental 451 00:40:37,700 --> 00:40:42,340 processes are happening and when they're most susceptible to some sort of environmental 452 00:40:42,340 --> 00:40:43,340 insult. 453 00:40:43,340 --> 00:40:51,780 Now, the other piece can fever once during pregnancy actually cause autism. 454 00:40:51,780 --> 00:40:55,460 And that's kind of a loaded question. 455 00:40:55,460 --> 00:41:01,900 And so I think the other piece that's important to remember there is there's the genetic background. 456 00:41:01,900 --> 00:41:09,180 And so not everyone who gets fever during pregnancy develops a child, their child goes 457 00:41:09,180 --> 00:41:11,620 on to develop autism. 458 00:41:11,620 --> 00:41:16,940 And so we have to remember maybe it's fever combined with something else or maybe it's 459 00:41:16,940 --> 00:41:22,300 fever combined with a genetic background plus three other factors. 460 00:41:22,300 --> 00:41:28,100 And so it's this whole kind of interaction. 461 00:41:28,100 --> 00:41:31,060 And we call them causal pie as an epidemiology. 462 00:41:31,060 --> 00:41:33,740 It's all the different pieces that come together. 463 00:41:33,740 --> 00:41:40,580 But interestingly for both infection and fever, there have been suggestions that when we look 464 00:41:40,580 --> 00:41:45,860 at fever in the, I think it's the third trimester, I might be saying that wrong. 465 00:41:45,860 --> 00:41:49,340 I can't remember it's the first or third. 466 00:41:49,340 --> 00:41:56,100 But there have been stronger signals or evidence for an association and a specific trimester 467 00:41:56,100 --> 00:41:57,100 with those. 468 00:41:57,100 --> 00:42:00,260 So that's kind of another component there. 469 00:42:00,260 --> 00:42:08,260 And then there's also, we have to consider, the mom's health matters too, right? 470 00:42:08,260 --> 00:42:12,660 So mitigating the effects of that fever, it's important to get the fever under control. 471 00:42:12,660 --> 00:42:19,260 So anytime we're looking at a medical condition, of course, you have to consider, you know, 472 00:42:19,260 --> 00:42:21,900 what's the impact on the mom's health too? 473 00:42:21,900 --> 00:42:26,780 And is the mother taking some sort of medication for that condition? 474 00:42:26,780 --> 00:42:36,700 And then we get into questions about, well, is the medication causing any sort of impacts? 475 00:42:36,700 --> 00:42:41,540 And then there's this kind of balancing of risks and benefits. 476 00:42:41,540 --> 00:42:47,940 And I think we're still learning more about, you know, all these different components. 477 00:42:47,940 --> 00:42:53,100 But certainly evidence that when a mother does have a fever, it's important to, you know, 478 00:42:53,100 --> 00:42:54,100 address that. 479 00:42:54,100 --> 00:42:55,100 Wow. 480 00:42:55,100 --> 00:42:57,100 It could be so sensitive. 481 00:42:57,100 --> 00:43:05,660 I had a doctor, a surgeon on from Duke, who's now doing umbilical cord sim cells on autistics. 482 00:43:05,660 --> 00:43:07,460 And he done it on his son. 483 00:43:07,460 --> 00:43:10,940 And his son was almost nonverbal. 484 00:43:10,940 --> 00:43:17,220 And the way he describes it is about two weeks later, two, three weeks later, I mean, now 485 00:43:17,220 --> 00:43:19,940 he's completely, he lives independent. 486 00:43:19,940 --> 00:43:21,580 You know, he has like a girlfriend. 487 00:43:21,580 --> 00:43:23,340 It just like helped him so much. 488 00:43:23,340 --> 00:43:31,580 And I'm thinking as I hear more about this, it's like that umbilical cord is rescuing 489 00:43:31,580 --> 00:43:38,420 whatever insults from the placenta to womb that probably occurred during pregnancy. 490 00:43:38,420 --> 00:43:44,340 I'm not super familiar with that research. 491 00:43:44,340 --> 00:43:47,500 Um, yeah, I mean, it's certainly interesting. 492 00:43:47,500 --> 00:43:52,780 And I know there's a lot of interest in stem cells. 493 00:43:52,780 --> 00:43:58,540 I think for, you know, when we're looking at things in epidemiology studies, we're trying 494 00:43:58,540 --> 00:44:01,860 to get those population level effects. 495 00:44:01,860 --> 00:44:07,580 So, rather than, you know, is this something that has impacted one person? 496 00:44:07,580 --> 00:44:16,100 It's more looking at large groups of people and trying to glean and determine what at 497 00:44:16,100 --> 00:44:20,860 the population level are contributors to this outcome. 498 00:44:20,860 --> 00:44:26,420 Yeah, it's like what we mentioned earlier about maybe this thing is weak, but as you 499 00:44:26,420 --> 00:44:36,020 build up, it kind of just strengthens whatever it is, the topic of interest there. 500 00:44:36,020 --> 00:44:37,420 That's incredible. 501 00:44:37,420 --> 00:44:41,020 Air pollution is something that's heavily researched. 502 00:44:41,020 --> 00:44:50,340 There's been an explosion of air pollution studies over the past decade, one to two decades. 503 00:44:50,340 --> 00:44:57,100 I think the first paper looking at air pollution and autism, I think was 2012. 504 00:44:57,100 --> 00:45:00,660 So not that long ago. 505 00:45:00,660 --> 00:45:06,900 And I think, you know, the reason why there's a lot of interest in air pollution is everyone's 506 00:45:06,900 --> 00:45:08,220 exposed to it, right? 507 00:45:08,220 --> 00:45:17,340 So even if the effects are small, you know, or the only impacts for certain individuals, 508 00:45:17,340 --> 00:45:25,980 whatever the case may be, it is this ubiquitous factor that is really everywhere. 509 00:45:25,980 --> 00:45:35,780 And we know that there are certain pollutants in the air that do have impacts on development, 510 00:45:35,780 --> 00:45:43,740 neurodevelopment, all kinds of outcomes, asthma and airways, overall health. 511 00:45:43,740 --> 00:45:50,300 So it's certainly an exposure that people have been paying a lot of attention to. 512 00:45:50,300 --> 00:45:58,460 And I believe there's some emerging and ongoing animal studies that have demonstrated some 513 00:45:58,460 --> 00:46:06,580 biologic pathways that actually help to support the association, things like oxidative stress, 514 00:46:06,580 --> 00:46:07,580 inflammation. 515 00:46:07,580 --> 00:46:08,580 Oxidative stress. 516 00:46:08,580 --> 00:46:09,580 Yeah. 517 00:46:09,580 --> 00:46:14,460 Oxidative stress is definitely a question. 518 00:46:14,460 --> 00:46:18,340 And that's related, of course, also to input. 519 00:46:18,340 --> 00:46:21,940 Those are two kind of interlinked pathways. 520 00:46:21,940 --> 00:46:30,020 And so we did a study actually trying to measure biomarkers of oxidative stress and mothers. 521 00:46:30,020 --> 00:46:34,380 And this was in a relatively small study. 522 00:46:34,380 --> 00:46:42,700 But some colleagues of mine developed this study where families who already had a child 523 00:46:42,700 --> 00:46:50,020 with autism were contacted and asked if they were going to be getting pregnant again. 524 00:46:50,020 --> 00:46:55,620 And so then those families were followed through their next pregnancy to allow for that kind 525 00:46:55,620 --> 00:47:03,460 of cohort model and prospective follow-up from pregnancy through early development. 526 00:47:03,460 --> 00:47:10,300 And just wonderful participation in these studies that really help drive the research. 527 00:47:10,300 --> 00:47:15,100 And the mothers provided biological specimens. 528 00:47:15,100 --> 00:47:20,220 And we've been able to measure all sorts of different things in these samples. 529 00:47:20,220 --> 00:47:28,180 And so we measured isoprostanes and other markers of kind of generalized oxidative stress 530 00:47:28,180 --> 00:47:35,700 to try and see are these biomarkers during pregnancy that are indicators of increased 531 00:47:35,700 --> 00:47:36,900 oxidative stress? 532 00:47:36,900 --> 00:47:42,700 Are they related to later outcomes of autism? 533 00:47:42,700 --> 00:47:54,100 And again, didn't see very strong associations, but some potential kind of signals for different 534 00:47:54,100 --> 00:47:55,180 patterns. 535 00:47:55,180 --> 00:48:01,860 So something that I think could be expanded upon in larger studies and trying to tease 536 00:48:01,860 --> 00:48:10,700 apart, do we see different associations with different subgroups? 537 00:48:10,700 --> 00:48:14,260 What is something recently that you're most excited about? 538 00:48:14,260 --> 00:48:17,180 Well, I'm really excited. 539 00:48:17,180 --> 00:48:21,020 I mentioned the ECHO program, that large consortium. 540 00:48:21,020 --> 00:48:26,980 I'm really excited about getting to participate in that network. 541 00:48:26,980 --> 00:48:34,260 One because it allows for things that we haven't always been able to do yet in autism research 542 00:48:34,260 --> 00:48:40,700 with the larger numbers, at least for the type of work that I do, focus on nutrition 543 00:48:40,700 --> 00:48:43,100 and environmental chemicals. 544 00:48:43,100 --> 00:48:48,820 And then I'm really excited about looking at interactions and thinking about not just 545 00:48:48,820 --> 00:48:56,300 one factor at a time, but can we get a little bit more of a holistic picture about how all 546 00:48:56,300 --> 00:48:59,300 these puzzle pieces fit together? 547 00:48:59,300 --> 00:49:04,540 Not just one at a time, but what's the effect of this one and this one? 548 00:49:04,540 --> 00:49:11,180 Especially if we have some kind of pathway that we think they're both acting on or one 549 00:49:11,180 --> 00:49:17,660 is going to resolve the impacts of this factor on another pathway. 550 00:49:17,660 --> 00:49:25,500 And so we have a study now that is looking at does prenatal diet modify the effects of 551 00:49:25,500 --> 00:49:27,660 air pollution exposure on autism? 552 00:49:27,660 --> 00:49:32,380 And that's a study funded by NIEHS. 553 00:49:32,380 --> 00:49:36,940 And so we're delving into those results now. 554 00:49:36,940 --> 00:49:44,180 But I'm really interested in kind of expanding that line of work and then also trying to 555 00:49:44,180 --> 00:49:48,220 learn more about all the good and bad things in diet. 556 00:49:48,220 --> 00:49:54,260 So we've got these beneficial nutrients, but we also have highly packaged and processed 557 00:49:54,260 --> 00:49:58,420 foods that it can be a source of chemical exposures. 558 00:49:58,420 --> 00:50:05,220 What can we learn about their intake in children and how that's impacting child health? 559 00:50:05,220 --> 00:50:11,700 So I've focused mainly on prenatal diet, but what about the child diet side and how does 560 00:50:11,700 --> 00:50:12,700 that modify? 561 00:50:12,700 --> 00:50:20,300 We know that children with autism and individuals with autism can often have food sensitivities 562 00:50:20,300 --> 00:50:23,900 and highly restricted diets. 563 00:50:23,900 --> 00:50:28,500 And that presents all sorts of challenges in its own right. 564 00:50:28,500 --> 00:50:34,420 I think any parent can tell you that it can be hard to get their kid to eat vegetables 565 00:50:34,420 --> 00:50:36,420 and to eat a healthy diet. 566 00:50:36,420 --> 00:50:43,980 I think when you're working within the realm of autism, that whole kind of landscape changes 567 00:50:43,980 --> 00:50:44,980 even further. 568 00:50:44,980 --> 00:50:53,300 And so what can we do to help support the lives of these families and individuals in 569 00:50:53,300 --> 00:50:57,980 a way that improves supports and outcomes? 570 00:50:57,980 --> 00:51:04,820 And so I'm excited to learn more about kind of the ongoing child pieces and how that may 571 00:51:04,820 --> 00:51:12,820 kind of modify different outcomes within autism. 572 00:51:12,820 --> 00:51:20,260 And we've also kind of been expanding in different ways to think about learning more about kind 573 00:51:20,260 --> 00:51:30,260 of the health and well-being of the family unit and supporting mom health. 574 00:51:30,260 --> 00:51:37,820 When you've been in autism research for a long time, you really get a lot of great interaction 575 00:51:37,820 --> 00:51:44,420 with families and really are grateful for the research participation and for hearing 576 00:51:44,420 --> 00:51:46,980 back from families. 577 00:51:46,980 --> 00:51:52,340 And so I think it's important to think about ways that we can give back and help support 578 00:51:52,340 --> 00:51:53,340 as well. 579 00:51:53,340 --> 00:51:54,340 So Pam? 580 00:51:54,340 --> 00:52:02,220 Autism is a very pressing topic for many people and for good reason. 581 00:52:02,220 --> 00:52:09,900 Yeah, I'm glad that people are like that and participating. 582 00:52:09,900 --> 00:52:11,220 It's just so pressing. 583 00:52:11,220 --> 00:52:15,580 The rates are pressing. 584 00:52:15,580 --> 00:52:21,420 But the food sensitivity, it's like there's so many autism and XYZ conditions always. 585 00:52:21,420 --> 00:52:27,980 There's so many comorbids and GI problems is one that's really high and like the food 586 00:52:27,980 --> 00:52:31,860 sensitivity and so forth. 587 00:52:31,860 --> 00:52:40,620 It's like finding out how to fix this is incredible. 588 00:52:40,620 --> 00:52:44,940 And I'm so looking forward to the data that you just described. 589 00:52:44,940 --> 00:52:52,540 Is there a place that we can look for your research and this data in the future? 590 00:52:52,540 --> 00:52:53,540 That's a great question. 591 00:52:53,540 --> 00:52:57,860 Yeah, so again, I'm going to shout out the ECHO Network again. 592 00:52:57,860 --> 00:53:01,100 I think they do a really nice job of providing research. 593 00:53:01,100 --> 00:53:02,260 This is not just my work. 594 00:53:02,260 --> 00:53:06,780 There's a whole list of wonderful collaborators. 595 00:53:06,780 --> 00:53:14,900 But there's a large focus on, okay, let's not make science so hard to access and understand. 596 00:53:14,900 --> 00:53:15,900 Right? 597 00:53:15,900 --> 00:53:23,380 And so there's a whole page that summarizes research study across everything that ECHO 598 00:53:23,380 --> 00:53:25,180 is looking at. 599 00:53:25,180 --> 00:53:28,500 And so that's a site that I would direct people to. 600 00:53:28,500 --> 00:53:31,020 It's echochildren.org. 601 00:53:31,020 --> 00:53:37,580 And it provides one-liner summaries of research summary studies that have been recently published 602 00:53:37,580 --> 00:53:41,020 as well as longer summaries. 603 00:53:41,020 --> 00:53:43,220 And so that's one place. 604 00:53:43,220 --> 00:53:54,460 The more maybe scientific or technical side of things PubMed is searching on there, but 605 00:53:54,460 --> 00:54:02,820 those are often kind of more directed at the researcher side or scientist side audience. 606 00:54:02,820 --> 00:54:08,140 And although I will say some journals do a really nice job of making sure that there's 607 00:54:08,140 --> 00:54:15,580 a lay summary that we're not just directing results and findings to one audience only, 608 00:54:15,580 --> 00:54:21,460 but really trying to make sure that they're accessible and reachable and understandable 609 00:54:21,460 --> 00:54:24,420 to anyone who wants to access that information. 610 00:54:24,420 --> 00:54:25,420 Yeah. 611 00:54:25,420 --> 00:54:29,020 I mean, individual studies. 612 00:54:29,020 --> 00:54:36,140 So I mentioned that one cohort, the early study has its own website. 613 00:54:36,140 --> 00:54:42,780 And I'm sure I'm forgetting other different resources to find these things, but those 614 00:54:42,780 --> 00:54:45,740 are kind of some of the major ones. 615 00:54:45,740 --> 00:54:52,980 And the NIH also lists summaries, which also includes lay summaries of different projects 616 00:54:52,980 --> 00:54:53,980 that they're funding. 617 00:54:53,980 --> 00:54:59,860 And that can be another resource to find out about what are some ongoing projects that 618 00:54:59,860 --> 00:55:03,820 are going on in autism addressing these topics as well as others. 619 00:55:03,820 --> 00:55:09,820 Yeah, I just appreciate your actionable tools that you're providing for families. 620 00:55:09,820 --> 00:55:11,460 I think it's very incredible. 621 00:55:11,460 --> 00:55:17,620 And a lot more work to do, that's for sure. 622 00:55:17,620 --> 00:55:24,940 And yeah, hoping that we can provide some information that can be useful to people. 623 00:55:24,940 --> 00:55:25,940 Yeah. 624 00:55:25,940 --> 00:55:36,260 I'm hoping for the day that we can have this preparation, like preparing, going into pregnancy, 625 00:55:36,260 --> 00:55:43,780 and it will just do great wonders to the risk or the rates, I should say. 626 00:55:43,780 --> 00:55:45,180 I can't thank you enough. 627 00:55:45,180 --> 00:55:51,140 I'm very excited about your role, the epidemiology aspect of this. 628 00:55:51,140 --> 00:55:53,980 And I think this is just incredible information. 629 00:55:53,980 --> 00:56:00,340 Well, thank you so much, and I'm always happy to answer questions and again, really appreciate 630 00:56:00,340 --> 00:56:05,300 the invitation to come and spend time with you and talk about my work a little bit. 631 00:56:05,300 --> 00:56:07,860 Yeah, it's very valuable information. 632 00:56:07,860 --> 00:56:15,060 So I'll put some links in the show notes and promote it on social media, the little social 633 00:56:15,060 --> 00:56:16,060 media that I'm on. 634 00:56:16,060 --> 00:56:19,340 But yeah, I just want to get your message out. 635 00:56:19,340 --> 00:56:20,340 Great. 636 00:56:20,340 --> 00:56:21,340 Well, thank you so much. 637 00:56:21,340 --> 00:56:22,940 It's been so nice to get to talk to you. 638 00:56:22,940 --> 00:56:28,060 Yeah, I appreciate you interacting with me. 639 00:56:28,060 --> 00:56:32,780 If you're listening to the podcast or listening to the episode, please feel free to leave 640 00:56:32,780 --> 00:56:35,580 a review or ratings. 641 00:56:35,580 --> 00:56:42,940 In podcasting, review and ratings are crucial, and I very much appreciate your feedback. 642 00:56:42,940 --> 00:56:52,420 You can contact me on X at RPS, 47586, or click on the hop link so you can have links 643 00:56:52,420 --> 00:56:56,780 to all the show platforms and contact information. 644 00:56:56,780 --> 00:57:05,500 You can email me info.fromthespectrum at gmail.com. 645 00:57:05,500 --> 00:57:23,260 And thank you for listening to From the Spectrum podcast.