Emerging biomarkers in autism spectrum disorder: a systematic review

Abstract

Autism spectrum disorder (ASD) affects approximately 2% of children in the United States (US) yet its etiology is unclear and effective treatments are lacking. Therapeutic interventions are most effective if started early in life, yet diagnosis often remains delayed, partly because the diagnosis of ASD is based on identifying abnormal behaviors that may not emerge until the disorder is well established. Biomarkers that identify children at risk during the pre-symptomatic period, assist with early diagnosis, confirm behavioral observations, stratify patients into subgroups, and predict therapeutic response would be a great advance. Here we underwent a systematic review of the literature on ASD to identify promising biomarkers and rated the biomarkers in regards to a Level of Evidence and Grade of Recommendation using the Oxford Centre for Evidence-Based Medicine scale. Biomarkers identified by our review included physiological biomarkers that identify neuroimmune and metabolic abnormalities, neurological biomarkers including abnormalities in brain structure, function and neurophysiology, subtle behavioral biomarkers including atypical development of visual attention, genetic biomarkers and gastrointestinal biomarkers. Biomarkers of ASD may be found prior to birth and after diagnosis and some may predict response to specific treatments. Many promising biomarkers have been developed for ASD. However, many biomarkers are preliminary and need to be validated and their role in the diagnosis and treatment of ASD needs to be defined. It is likely that biomarkers will need to be combined to be effective to identify ASD early and guide treatment.

Keywords: Autism spectrum disorder (ASD); biomarkers; epigenetic; eye movement; folate; genetic; methylation; mitochondria; neuroimmune; neurophysiology; redox.

Figure 1

Promising biomarkers for ASD. *, available studies provide quantitative estimates for biomarker. Ab, antibody; EEG, electroencephalograph; ETC, electron transport chain; fMRI, functional magnetic resonance imaging; FRAA, folate receptor alpha autoantibody; IL, interleukin; MEG, magnetoencephalography; MRI, magnetic resonance imaging; RFC, reduce folate carrier; RNA, ribonucleic acid; SNPs, single nucleotide polymorphisms.