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PMID: 26443675 Published · ppublish English Journal Article Review Systematic Review

Pharmacological Modulation of GABA Function in Autism Spectrum Disorders: A Systematic Review of Human Studies.

Journal of autism and developmental disorders ·Vol. 46 ·No. 3 ·2016-03-00 ·Pages 825-39

Brondino N, Fusar-Poli L, Panisi C, Damiani S, Barale F, Politi P

Abstract

Autism spectrum disorders are an emerging health problem worldwide, but little is known about their pathogenesis. It has been hypothesized that autism may result from an imbalance between excitatory glutamatergic and inhibitory GABAergic pathways. Commonly used medications such as valproate, acamprosate, and arbaclofen may act on the GABAergic system and be a potential treatment for people with ASD. The present systematic review aimed at evaluating the state-of-the-art of clinical trials of GABA modulators in autism. To date there is insufficient evidence to suggest the use of these drugs in autistic subjects, even if data are promising. Of note, short-term use of all the reviewed medications appears to be safe. Future well designed trials are needed to elucidate these preliminary findings.

Keywords
Autism spectrum disorder Clinical trials GABA Systematic review
MeSH Terms
Autism Spectrum Disorder/drug therapy,metabolism GABA Modulators/pharmacology,therapeutic use Humans gamma-Aminobutyric Acid/metabolism
Chemicals
GABA Modulators gamma-Aminobutyric Acid
Authors & Affiliations
6 authors, click to expand affiliations / ORCID
Brondino Natascia
Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy. [email protected].
Fusar-Poli Laura
Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.
Panisi Cristina
Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.
Damiani Stefano
Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.
Barale Francesco
Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.
Politi Pierluigi
Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.
References (86)
86 references, click to expand
  1. Brief report: Pilot single-blind placebo lead-in study of acamprosate in youth with autistic disorder.
    J Autism Dev Disord. 2014 Apr;44(4):981-7 PMID: 24052275
  2. The diuretic bumetanide decreases autistic behaviour in five infants treated during 3 months with no side effects.
    Acta Paediatr. 2010 Dec;99(12):1885-8 PMID: 20608900
  3. Improving emotional face perception in autism with diuretic bumetanide: a proof-of-concept behavioral and functional brain imaging pilot study.
    Autism. 2015 Feb;19(2):149-57 PMID: 24343334
  4. Loss of GABAergic neurons in the hippocampus and cerebral cortex of Engrailed-2 null mutant mice: implications for autism spectrum disorders.
    Exp Neurol. 2013 Sep;247:496-505 PMID: 23360806
  5. Neuroprotective agent riluzole potentiates postsynaptic GABA(A) receptor function.
    Neuropharmacology. 2002 Feb;42(2):199-209 PMID: 11804616
  6. Pervasive developmental disorders in preschool children: confirmation of high prevalence.
    Am J Psychiatry. 2005 Jun;162(6):1133-41 PMID: 15930062
  7. The brain GABA-benzodiazepine receptor alpha-5 subtype in autism spectrum disorder: a pilot [(11)C]Ro15-4513 positron emission tomography study.
    Neuropharmacology. 2013 May;68:195-201 PMID: 22546616
  8. The level of GAD67 protein is highly sensitive to small increases in intraneuronal gamma-aminobutyric acid levels.
    J Neurochem. 1994 Apr;62(4):1375-81 PMID: 8133268
  9. New insights into the role of the GABA(A)-benzodiazepine receptor in psychiatric disorder.
    Br J Psychiatry. 2001 Nov;179:390-6 PMID: 11689393
  10. Expression of GABA(B) receptors is altered in brains of subjects with autism.
    Cerebellum. 2009 Mar;8(1):64-9 PMID: 19002745
  11. Association of GABRB3 polymorphisms with autism spectrum disorders in Korean trios.
    Neuropsychobiology. 2006;54(3):160-5 PMID: 17230033
  12. Impact of acamprosate on behavior and brain-derived neurotrophic factor: an open-label study in youth with fragile X syndrome.
    Psychopharmacology (Berl). 2013 Jul;228(1):75-84 PMID: 23436129
  13. Evaluation of the GABAergic nervous system in autistic brain: (123)I-iomazenil SPECT study.
    Brain Dev. 2012 Sep;34(8):648-54 PMID: 22099869
  14. Effect of flumazenil on GABAA receptors in isolated rat hippocampal neurons.
    Neurochem Res. 2002 Dec;27(12):1605-12 PMID: 12515312
  15. Association between a GABRB3 polymorphism and autism.
    Mol Psychiatry. 2002;7(3):311-6 PMID: 11920158
  16. Reversal of disease-related pathologies in the fragile X mouse model by selective activation of GABAB receptors with arbaclofen.
    Sci Transl Med. 2012 Sep 19;4(152):152ra128 PMID: 22993295
  17. Divalproex sodium vs. placebo in the treatment of repetitive behaviours in autism spectrum disorder.
    Int J Neuropsychopharmacol. 2006 Apr;9(2):209-13 PMID: 16316486
  18. Flumazenil. A reappraisal of its pharmacological properties and therapeutic efficacy as a benzodiazepine antagonist.
    Drugs. 1991 Dec;42(6):1061-89 PMID: 1724638
  19. Decreased GABAA receptors and benzodiazepine binding sites in the anterior cingulate cortex in autism.
    Autism Res. 2009 Aug;2(4):205-19 PMID: 19650112
  20. Suppressed GABAergic inhibition as a common factor in suspected etiologies of autism.
    J Autism Dev Disord. 2001 Apr;31(2):247-8 PMID: 11450824
  21. Autism-associated neuroligin-3 mutations commonly disrupt tonic endocannabinoid signaling.
    Neuron. 2013 May 8;78(3):498-509 PMID: 23583622
  22. Basic pharmacology of valproate: a review after 35 years of clinical use for the treatment of epilepsy.
    CNS Drugs. 2002;16(10):669-94 PMID: 12269861
  23. Minicolumnar abnormalities in autism.
    Acta Neuropathol. 2006 Sep;112(3):287-303 PMID: 16819561
  24. Downregulation of GABAA receptor protein subunits α6, β2, δ, ε, γ2, θ, and ρ2 in superior frontal cortex of subjects with autism.
    J Autism Dev Disord. 2014 Aug;44(8):1833-45 PMID: 24668190
  25. Glutamic acid decarboxylase 65 and 67 kDa proteins are reduced in autistic parietal and cerebellar cortices.
    Biol Psychiatry. 2002 Oct 15;52(8):805-10 PMID: 12372652
  26. [3H]-flunitrazepam-labeled benzodiazepine binding sites in the hippocampal formation in autism: a multiple concentration autoradiographic study.
    J Autism Dev Disord. 2007 May;37(5):911-20 PMID: 17019626
  27. Decreased GAD65 mRNA levels in select subpopulations of neurons in the cerebellar dentate nuclei in autism: an in situ hybridization study.
    Autism Res. 2009 Feb;2(1):50-9 PMID: 19358307
  28. The pharmacology and function of central GABAB receptors.
    Int Rev Neurobiol. 1994;36:97-223 PMID: 7822122
  29. Identification of significant association and gene-gene interaction of GABA receptor subunit genes in autism.
    Am J Hum Genet. 2005 Sep;77(3):377-88 PMID: 16080114
  30. Arbaclofen placarbil, a novel R-baclofen prodrug: improved absorption, distribution, metabolism, and elimination properties compared with R-baclofen.
    J Pharmacol Exp Ther. 2009 Sep;330(3):911-21 PMID: 19502531
  31. Subunit composition, distribution and function of GABA(A) receptor subtypes.
    Curr Top Med Chem. 2002 Aug;2(8):795-816 PMID: 12171572
  32. A double-blind, placebo-controlled study of valproate for aggression in youth with pervasive developmental disorders.
    J Child Adolesc Psychopharmacol. 2005 Aug;15(4):682-92 PMID: 16190799
  33. Correlation Between Hepatocyte Growth Factor (HGF) and Gamma-Aminobutyric Acid (GABA) Plasma Levels in Autistic Children.
    Biomark Insights. 2013 Jun 12;8:69-75 PMID: 23825437
  34. Decreased GAD67 mRNA levels in cerebellar Purkinje cells in autism: pathophysiological implications.
    Acta Neuropathol. 2007 May;113(5):559-68 PMID: 17235515
  35. A randomised controlled trial of bumetanide in the treatment of autism in children.
    Transl Psychiatry. 2012 Dec 11;2:e202 PMID: 23233021
  36. Decreased left perisylvian GABA concentration in children with autism and unaffected siblings.
    Neuroimage. 2014 Feb 1;86:28-34 PMID: 23370056
  37. En2 knockout mice display neurobehavioral and neurochemical alterations relevant to autism spectrum disorder.
    Brain Res. 2006 Oct 20;1116(1):166-76 PMID: 16935268
  38. Neurons in the fusiform gyrus are fewer and smaller in autism.
    Brain. 2008 Apr;131(Pt 4):987-99 PMID: 18332073
  39. Serotonin and amino acid content in platelets of autistic children.
    Acta Psychiatr Scand. 1993 May;87(5):312-6 PMID: 8517170
  40. Risk and correlates of autism spectrum disorder in children with epilepsy: a community-based study.
    J Child Neurol. 2011 May;26(5):540-7 PMID: 21421903
  41. Advances in autism genetics: on the threshold of a new neurobiology.
    Nat Rev Genet. 2008 May;9(5):341-55 PMID: 18414403
  42. Autism.
    Lancet. 2009 Nov 7;374(9701):1627-38 PMID: 19819542
  43. GABA system dysfunction in autism and related disorders: from synapse to symptoms.
    Neurosci Biobehav Rev. 2012 Oct;36(9):2044-55 PMID: 22841562
  44. Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010.
    MMWR Surveill Summ. 2014 Mar 28;63(2):1-21 PMID: 24670961
  45. Effect of inhibitors of GABA aminotransferase on the metabolism of GABA in brain tissue and synaptosomal fractions.
    J Neurochem. 1981 Apr;36(4):1521-7 PMID: 7264649
  46. Effects of anticonvulsant drugs on the cerebral enzymes metabolizing GABA.
    Epilepsia. 1975 Nov;16(4):649-55 PMID: 9890792
  47. GABAergic/glutamatergic imbalance relative to excessive neuroinflammation in autism spectrum disorders.
    J Neuroinflammation. 2014 Nov 19;11:189 PMID: 25407263
  48. Relationship between chronic lead toxicity and plasma neurotransmitters in autistic patients from Saudi Arabia.
    Clin Biochem. 2011 Sep;44(13):1116-20 PMID: 21763301
  49. Impairment of cortical GABAergic synaptic transmission in an environmental rat model of autism.
    Int J Neuropsychopharmacol. 2013 Jul;16(6):1309-18 PMID: 23228615
  50. Carnosine modulates zinc and copper effects on amino acid receptors and synaptic transmission.
    Neuroreport. 1998 Oct 26;9(15):3503-7 PMID: 9855307
  51. Elevated plasma gamma-aminobutyric acid (GABA) levels in autistic youngsters: stimulus for a GABA hypothesis of autism.
    Med Sci Monit. 2002 Aug;8(8):PR1-6 PMID: 12165753
  52. Association of social and cognitive impairment and biomarkers in autism spectrum disorders.
    J Neuroinflammation. 2014 Jan 08;11:4 PMID: 24400970
  53. mRNA and protein levels for GABAAalpha4, alpha5, beta1 and GABABR1 receptors are altered in brains from subjects with autism.
    J Autism Dev Disord. 2010 Jun;40(6):743-50 PMID: 20066485
  54. Two human glutamate decarboxylases, 65-kDa GAD and 67-kDa GAD, are each encoded by a single gene.
    Proc Natl Acad Sci U S A. 1992 Mar 15;89(6):2115-9 PMID: 1549570
  55. Pilot study of the behavioral effects of flumazenil in two children with autism.
    J Autism Dev Disord. 2000 Dec;30(6):619-20 PMID: 11261474
  56. GABA(A) receptor downregulation in brains of subjects with autism.
    J Autism Dev Disord. 2009 Feb;39(2):223-30 PMID: 18821008
  57. Neuroanatomic observations of the brain in autism: a review and future directions.
    Int J Dev Neurosci. 2005 Apr-May;23(2-3):183-7 PMID: 15749244
  58. Riluzole enhances glutamate uptake in rat astrocyte cultures.
    Cell Mol Neurobiol. 2004 Feb;24(1):123-8 PMID: 15049516
  59. GABAergic signaling as therapeutic target for autism spectrum disorders.
    Front Pediatr. 2014 Jul 08;2:70 PMID: 25072038
  60. 15q11-13 GABAA receptor genes are normally biallelically expressed in brain yet are subject to epigenetic dysregulation in autism-spectrum disorders.
    Hum Mol Genet. 2007 Mar 15;16(6):691-703 PMID: 17339270
  61. Divalproex sodium vs placebo for the treatment of irritability in children and adolescents with autism spectrum disorders.
    Neuropsychopharmacology. 2010 Mar;35(4):990-8 PMID: 20010551
  62. Three probands with autistic disorder and isodicentric chromosome 15.
    Am J Med Genet. 2000 Jun 12;96(3):365-72 PMID: 10898916
  63. Bumetanide reduces seizure frequency in patients with temporal lobe epilepsy.
    Epilepsia. 2013 Jan;54(1):e9-12 PMID: 23061490
  64. STX209 (arbaclofen) for autism spectrum disorders: an 8-week open-label study.
    J Autism Dev Disord. 2014 Apr;44(4):958-64 PMID: 24272415
  65. Non-invasive evaluation of the GABAergic/glutamatergic system in autistic patients observed by MEGA-editing proton MR spectroscopy using a clinical 3 tesla instrument.
    J Autism Dev Disord. 2011 Apr;41(4):447-54 PMID: 20652388
  66. Effects of STX209 (arbaclofen) on neurobehavioral function in children and adults with fragile X syndrome: a randomized, controlled, phase 2 trial.
    Sci Transl Med. 2012 Sep 19;4(152):152ra127 PMID: 22993294
  67. Brief report: acamprosate in fragile X syndrome.
    J Autism Dev Disord. 2010 Nov;40(11):1412-6 PMID: 20213249
  68. The clinical pharmacology of acamprosate.
    Br J Clin Pharmacol. 2014 Feb;77(2):315-23 PMID: 23278595
  69. The neuroprotective agent riluzole inhibits release of glutamate and aspartate from slices of hippocampal area CA1.
    Eur J Pharmacol. 1993 Dec 21;250(3):473-6 PMID: 8112408
  70. Developmental regulation of GABAergic signalling in the hippocampus of neuroligin 3 R451C knock-in mice: an animal model of Autism.
    Front Cell Neurosci. 2013 Jun 04;7:85 PMID: 23761734
  71. Gabrb3 gene deficient mice exhibit impaired social and exploratory behaviors, deficits in non-selective attention and hypoplasia of cerebellar vermal lobules: a potential model of autism spectrum disorder.
    Behav Brain Res. 2008 Mar 5;187(2):207-20 PMID: 17983671
  72. Parvalbumin-, calbindin-, and calretinin-immunoreactive hippocampal interneuron density in autism.
    Acta Neurol Scand. 2010 Feb;121(2):99-108 PMID: 19719810
  73. Epilepsy in autism.
    Lancet Neurol. 2002 Oct;1(6):352-8 PMID: 12849396
  74. Lower Purkinje cell counts in the cerebella of four autistic subjects: initial findings of the UCLA-NSAC Autopsy Research Report.
    Am J Psychiatry. 1986 Jul;143(7):862-6 PMID: 3717426
  75. Human gamma-aminobutyric acid type B receptors are differentially expressed and regulate inwardly rectifying K+ channels.
    Proc Natl Acad Sci U S A. 1998 Dec 8;95(25):14991-6 PMID: 9844003
  76. Density and distribution of hippocampal neurotransmitter receptors in autism: an autoradiographic study.
    J Autism Dev Disord. 2001 Dec;31(6):537-43 PMID: 11814263
  77. Mechanism of nitrogen metabolism-related parameters and enzyme activities in the pathophysiology of autism.
    J Neurodev Disord. 2012 Feb 13;4(1):4 PMID: 22958401
  78. Neurochemical and molecular pharmacological aspects of the GABA(B) receptor.
    Neurochem Res. 2000 Oct;25(9-10):1233-9 PMID: 11059797
  79. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations.
    Pediatrics. 2006 Jul;118(1):e139-50 PMID: 16818529
  80. Riluzole as an adjunctive therapy to risperidone for the treatment of irritability in children with autistic disorder: a double-blind, placebo-controlled, randomized trial.
    Paediatr Drugs. 2013 Dec;15(6):505-14 PMID: 23821414
  81. Neuroactive steroids reduce neuronal excitability by selectively enhancing tonic inhibition mediated by delta subunit-containing GABAA receptors.
    Proc Natl Acad Sci U S A. 2003 Nov 25;100(24):14439-44 PMID: 14623958
  82. An open-label naturalistic pilot study of acamprosate in youth with autistic disorder.
    J Child Adolesc Psychopharmacol. 2011 Dec;21(6):565-9 PMID: 22136091
  83. Double-blind, placebo-controlled study of L-carnosine supplementation in children with autistic spectrum disorders.
    J Child Neurol. 2002 Nov;17(11):833-7 PMID: 12585724
  84. Absence of seizures despite high prevalence of epileptiform EEG abnormalities in children with autism monitored in a tertiary care center.
    Epilepsia. 2006 Feb;47(2):394-8 PMID: 16499766
  85. A neuroligin-3 mutation implicated in autism increases inhibitory synaptic transmission in mice.
    Science. 2007 Oct 5;318(5847):71-6 PMID: 17823315
  86. Neuroanatomy of autism.
    Trends Neurosci. 2008 Mar;31(3):137-45 PMID: 18258309
Article Info
Journal
Journal of autism and developmental disorders
Abbr.
J Autism Dev Disord
ISSN
1573-3432
Published
2016-03-00
Pages
825-39
Language
English
Region
United States
NLM ID
7904301
Subset
IM
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