Towards Precision Treatments for Autism Spectrum Disorder(s)

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1 Towards Precision Treatments for Autism Spectrum Disorder(s) Dr. Kevin Pelphrey Autism & Neurodevelopmental Disorders Institute S L I D E 0

2 Disclosures of Potential Conflicts Source Research Funding Advisor/ Consultant Employee Speakers Bureau Books, Intellectual Property In-kind Services (travel) Stock or Equity NIMH x NICHD x NINDS x Carbonell Family x Autism Speaks x Autism Science Foundation x Simons Foundation x John Merck Scholars x Johnson & Johnson x Lynnhaven Oyster Company x S L I D E 1

3 Translational Research at the Virginia Science & Technology Campus Ashburn, Virginia Soft Opening, March 15 th 2018 S L I D E 2

4 Problem: Lack of predictive biomarkers perpetuates the status quo of imprecise treatments, wasted time and resources, failures to optimize progress for our children and their families. S L I D E 3

5 Biomarkers should be: 1) grounded in an understanding of basic mechanisms; 2) sensitive, reliable measures of targeted atypical processes; 3) useful at the individual level; 4) predictive of response and informative of mechanism(s); 5) useful as levers to improve treatment response; 6) practical for implementation S L I D E 4

6 1) Mechanisms of understanding others actions & intentions Pelphrey et al. (2003) Journal of Neuroscience S L I D E 5

7 2) Sensitive, reliable measures of targeted atypical processes S L I D E 6

8 Social vs. Non-Social Motion Coherent Biological (BIO) Scrambled Biological (SCRAM) Kaiser et al. (2010) Proceedings of the National Academy of Sciences S L I D E 7

9 Social vs. Non-Social Motion R R R State: ASD < TD & ASD < US Trait: US < TD & ASD < TD Compensatory: US > TD & US > ASD Kaiser et al. (2010) Proceedings of the National Academy of Sciences S L I D E 8

10 3) Informative at the level of the individual child? Malin Björnsdotter, PhD Discovery Replication? Björnsdotter et al. JAMA: Psychiatry, 2016 S L I D E 9

11 A R B Girls E 4 Disc Rep All TD ASD R C 1Sensitivity 0 All Boys z=-13 AUC = 0.77 x=43 Disc (n = 30) Rep (n = 51) All (n = 81) Specificity D 1Sensitivity 0 1 Sensitivity 0 Matched boys AUC = 0.83 AUC = 0.42 Disc (n = 8) Rep (n = 23) All (n = 31) Rep (n = 41) Specificity Brain response (beta) Brain response (beta) F r = p =.451 Disc Rep All r = p =.011 p =.875 TD ASD r = p = Social Responsiveness Scale Score Björnsdotter et al., JAMA: Psychiatry, 2016 S L I D E 10

12 NIH Autism Center of Excellence: Girls' (Women's) Neurogenetics Network S L I D E 11

13 C. ASD (n = 46) Allison Jack, PhD Displayed in neurological convention (right hemisphere displayed on right). D. ASD (n = 48) z = Cluster-corrected p < z S L I D E 12

14 Archana Venkataraman, PhD TD ASD S L I D E 13

15 Girls Network to Construct mapping Boys Network to Construct mapping S L I D E 14

16 4) Predictive of treatment response & informative of mechanism S L I D E 15

17 Change in Behavior: Social Responsiveness Scale (SRS) Yang et al. (2016) Translational Psychiatry S L I D E 16

18 Cluster 1 Cluster 2 Neuro-prediction of treatment response R y = -50 mm y = -52 mm Cluster 3 Cluster 4 y = 18 mm y =-4 mm weights Increase in severity Yang et al. (2016) Translational Psychiatry Actual change in severity Decrease in severity r =.85, p <.0001 Predicted change in severity S L I D E 17

19 5) Levers to improve treatment response? Art by Charlotte Pretzsch S L I D E 18

20 Intranasal Oxytocin Oxytocin Placebo x = 0 y = 5 x = -58 z = 0 Gordon et al. (2013) Proceedings of the National Academy of Sciences S L I D E 19

21 6) Very nice, but is it practical? but So maybe? S L I D E 20

22 Linking genes, brain, & behavior in the longitudinal study of infants social brain development S L I D E 21

23 S L I D E 22

Results: fnirs (LR and HR 3-Month-Old Infants) LEFT RIGHT Low Risk Low Risk 0.14 0.14 0.09 0.04-0.

24 Results: fnirs (LR and HR 3-Month-Old Infants) LEFT RIGHT Low Risk Low Risk BIOLOGICAL SCRAMBLED BIOLOGICAL SCRAMBLED Hemoglobin change (micromolar) Hemoglobin change (micromolar) Time (in tenths of seconds) Time (in tenths of seconds) High Risk High Risk BIOLOGICAL SCRAMBLED BIOLOGICAL SCRAMBLED Hemoglobin change (micromolar) Hemoglobin change (micromolar) Time (in tenths of seconds) Time (in tenths of seconds) S L I D E 23

25 Universal Screening? Ashley Darcy-Mahoney, PhD, NNP, FAAN 3,600 births per year representing all ethnicities, classes, backgrounds a population-based sample S L I D E 24

26 Acknowledgments Funding for this work was provided by: The Carbonell Family NIMH NICHD NINDS Simons Foundation NSF The Dietz Family Esme Usdan & Family The Dwek Family Autism Speaks Hilibrand Foundation John Merck Scholars Fund Autism Science Foundation Office of the Vice President for Research, GW Children s Research Institute, CNHS Women s Health Research at Yale Binational Science Foundation We thank the participants & their families for participating in our work. We thank our colleagues who make this work so much fun. kevinpelphrey@gwu.edu S L I D E 25

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