Friday, 28 November 2014

Is DJ-1 expression negatively associated with severity of Autism? If so, Sodium Benzoate (Cinnamon) may well be beneficial

I do not expect this to be one of my popular posts, but it might deserve to be.

There will be lots of science, but it ends up with a safe potential intervention that can be tried at home.  The good news is that it is inexpensive, tasty and there is already a pretty solid experimental basis for the intervention.

Look in your extended family for relatives with diabetes, COPD (Chronic Obstructive Pulmonary Disease) and Parkinson’s Disease.  This might be useful indicator.

The conclusion is to put some cinnamon in your tea or coffee.

Parkinson’s Disease

Two people recently mentioned Parkinson’s disease to me.

Oxidative stress contributes to the cascade leading to dopamine cell degeneration in Parkinson's disease. This oxidative stress is linked to other components of the degenerative process, such as mitochondrial dysfunction, excitotoxicity, nitric oxide toxicity and inflammation.


One example of motor symptoms in Parkinson’s can be the inability to walk unaided across a room.  When a series of parallel lines are placed on the floor, the person is then able to cross the room, unaided.  This story was told to me when I explained how Monty, aged 11 with ASD, would sometimes get “stuck” and be unable to leave a room or walk downstairs.  Treatment with Atorvastatin, in Monty, makes these symptoms go away.

It seems that Statins have also been shown to lower the incidence of Parkinson’s.

Statins Protective Against Parkinson's: More Evidence

Further evidence that statin use is associated with a reduction in risk for Parkinson's disease has come from a population study from Taiwan.
The study, published online in Neurology on July 24, was conducted by a team led by Yen-Chieh Lee, MD, Cathay General Hospital, Taipei, Taiwan.
In a large population of statin users, they found a lower risk for Parkinson's in those who continued taking lipophilic statins compared with those who discontinued statins upon having reached their cholesterol goal.
Authors of an accompanying editorial conclude, "For those who have to be on statins, it is a comforting thought that there is a potential added advantage of having a lower risk of PD [Parkinson's disease], and possibly other neurologic disorders as well."

Objective: To evaluate the effect of discontinuing statin therapy on incidence of Parkinson disease (PD) in statin users.
Methods: Participants who were free of PD and initiated statin therapy were recruited between 2001 and 2008. We examined the association between discontinuing use of statins with different lipophilicity and the incidence of PD using the Cox regression model with time-varying statin use.
Results: Among the 43,810 statin initiators, the incidence rate for PD was 1.68 and 3.52 per 1,000,000 person-days for lipophilic and hydrophilic statins, respectively. Continuation of lipophilic statins was associated with a decreased risk of PD (hazard ratio [HR] 0.42 [95% confidence interval 0.27–0.64]) as compared with statin discontinuation, which was not modified by comorbidities or medications. There was no association between hydrophilic statins and occurrence of PD. Among lipophilic statins, a significant association was observed for simvastatin (HR 0.23 [0.07–0.73]) and atorvastatin (HR 0.33 [0.17–0.65]), especially in female users (HR 0.11 [0.02–0.80] for simvastatin; HR 0.24 [0.09–0.64] for atorvastatin). As for atorvastatin users, the beneficial effect was seen in the elderly subgroup (HR 0.42 [0.21–0.87]). However, long-term use of statins, either lipophilic or hydrophilic, was not significantly associated with PD in a dose/duration-response relation.
Conclusions: Continuation of lipophilic statin therapy was associated with a decreased incidence of PD as compared to discontinuation in statin users, especially in subgroups of women and elderly. Long-term follow-up study is needed to clarify the potential beneficial role of lipophilic statins in PD.

Comorbidities, Coincidence and Connections

I am no medical expert, but I am good at noticing connections.

I have already decided that there are some interesting conditions that in some way are connected to autism.  These include:-

·        Diabetes
·        Cancer
·        COPD (Chronic obstructive pulmonary disease)

The connection between Parkinson’s disease and autism are:-

·        Oxidative stress
·        Mitochondrial dysfunction
·        Cognitive and behavioral problems (in late stage Parkinson’s)
·        Motor problems (in early stage and onwards in Parkinson’s and mainly in early stage in Autism)

The motor problems in autism are rarely talked about, but in ABA training programs for young children, teaching fine and gross motor skills plays a major role.  In such children, skills that are automatic in typical children can be totally missing.  You then have to teach very basic skills like controlling a crayon, kicking a ball, catching a ball or stacking wooden blocks.

Later on, motor skills seem to become “normal”.  I am amazed to see how Monty, aged 11 with ASD, can now play the piano with all fingers of both hands racing across the ivory.  A few years ago motor skills were clearly impaired. 

This comes back to autism being a dynamic encephalopathy.  An interesting research finding, I noticed recently, was that while oxidative stress appears life-long in autism, mitochondrial dysfunction appears not to be.  In the samples taken from older people with ASD, mitochondria appeared normal, whereas in young people it was typically abnormal.

It is generally accepted that in most people, autistic symptoms seem to moderate with age.  Either they are getting better at managing themselves, or the dysfunctions themselves are moderating with age.

Parkinson’s is a degenerative disease; in autism only childhood disintegrative disorder seems to be degenerative.

COPD & Parkinson’s

There is a proven connection between COPD (Chronic obstructive pulmonary disease) and Parkinson’s, it is a gene/protein called DJ-1 in COPD, also known as Parkinson disease (autosomal recessive, early onset) 7 or PARK7.

In both conditions DJ-1/PARK7 dysfunction causes a cascade of further events that result in the body losing much of its anti-oxidative defenses.

The protein DJ-1 should act to stabilize NRf2, which is released when there is oxidative stress.  Nrf2 should then activate a large number of anti-oxidant genes that then results in a reaction to the oxidative attack.

The problem is that when DJ-1 is insufficient, Nrf2 never gets as far as activating those anti-oxidant genes and so nothing halts the oxidative attack.

The less DJ-1 expression in a person, the worse their COPD (severe asthma) would be.

As is usually the case in human biology, DJ-1 has numerous other functions.

Note that not only does DJ-1 affect Nrf2, it also is a key negative regulator of PTEN that may be a useful prognostic marker for cancer.

In my earlier post on PTEN and statins we saw that:

Statins up-regulate a known key dysfunctional autism gene, and protein, called PTEN.  I mentioned PTEN in a previous post, since one chemical (Indole-3-carbinol (I3C)) released by eating broccoli also up-regulates PTEN.

From my perspective, upregulating PTEN in autism seems to be helpful.

Parkin, DJ-1, and PINK1 dysfunction in Parkinson’s and Autism

It appears that you need three genetic dysfunctions to develop Parkinson’s disease: parkin, DJ-1, and PINK1. Remarkably very similar dysfunctions seem to exist in autism as well.

As we see in COPD, the DJ-1 dysfunction aggravates the oxidative stress problems.

Note that PINK1, known by its full name, is PTEN-induced putative kinase 1.

The following paper shows how statins affect mitochondria, the role of the Parkinson’s genes and how statins help to clear away the dysfunctional mitochondria that can lead to heart disease.  One can assume that the protective effect of statins against Parkinson’s, must relate to a similar “spring cleaning” of dysfunctional mitochondria, but this time in the brain.

Cells treated with simvastatin also displayed slight mitochondrial depolarization as compared to controls. Induction of autophagy was accompanied by decreases in the pro-growth and proliferation pathways mediated by Akt and mTOR, as well as increases in PTEN. PTEN is linked to mitochondrial quality control via the PTEN-induced putative kinase 1 (PINK1), which recruits the E3 ubiquitin ligase Parkin to mitochondrial membranes in response to depolarization. Parkin, in turn, primes the mitochondria for degradation. Reductions in mitochondria were accompanied by decreasing reactive oxygen species (ROS), which are known to cause oxidative injury and stress. By both depolarizing mitochondria and increasing expression of key autophagic proteins, simvastatin fosters a cellular environment that encourages mitochondrial autophagy (mitophagy), which has been linked to cardioprotection. We therefore propose that these mechanisms underlie the cardioprotective effects of statins that are independent of serum cholesterol levels.

For those wondering what is Mitochondrial Autophagy, read this:-

Mitochondrial Autophagy


Efficient and functional mitochondrial networks are essential for myocardial contraction and cardiomyocyte survival. Mitochondrial autophagy (mitophagy) refers to selective sequestration of mitochondria by autophagosomes, which subsequently deliver them to lysosomes for destruction. This process is essential for myocardial homeostasis and adaptation to stress. Elimination of damaged mitochondria protects against cell death, as well as stimulates mitochondrial biogenesis. Mitophagy is a tightly controlled and highly selective process. It is modulated by mitochondrial fission and fusion proteins, BCL-2 family proteins, and the PINK1/Parkin pathway. Recent studies have provided evidence that miRNAs can regulate mitophagy by controlling the expression of essential proteins involved in the process. Disruption of autophagy leads to rapid accumulation of dysfunctional mitochondria, and diseases associated with impaired autophagy produce severe cardiomyopathies. Thus, autophagy and mitophagy pathways hold promise as new therapeutic targets for clinical cardiac care.


How loss of function of the parkin protein leads to dopaminergic cell death in this disease is unclear. The prevailing hypothesis is that parkin helps degrade one or more proteins toxic to dopaminergic neurons.

PARK2 has now been linked to autism:-

Researchers first fingered PARK2, or parkinson protein 2, in 1998 in five people with Parkinson's disease. The protein has since been shown to help degrade neurons that accumulate in the brains of individuals with the disorder.
PARK2 is an ubiquitin ligase E3, which targets proteins for degradation in the cell. Another protein in the same family, UBE3A, is associated with both autism and Angelman syndrome.
PARK2 is also believed to function in the mitochondria. Several studies have linked mitochondrial dysfunction to autism, suggesting a basis for PARK2's association with the disorder.

This debilitating neurological disorder is caused by mutation of the E3 ubiquitin ligase (Ube3A), a gene whose mutation has also recently been associated with autism spectrum disorders (ASD). However, the function of Ube3A in mediating cognitive impairment in individuals with AS and ASDs, as well as its substrates, have been unknown.
Invention: The Greenberg laboratory first demonstrated that neural activity induces Ube3A transcription, and that a decrease in Ube3A expression decreases the plasma membrane expression of, and synaptic transmission through AMPA glutamate receptors (AMPARs). To better understand the role of Ube3A in AS and ASD, the Greenberg lab identified key neural substrates of Ube3A, Arc and Ephexin5, and the mechanisms for their regulation of synaptic transmission. Their findings suggest mechanisms by which Ube3A contributes to cognitive dysfunction in AS and ASD.
Arc: The Greenberg lab demonstrated that disruption of Ube3A activity leads to an increase of Arc and decrease in AMPAR expression at synapses. Drugs that promote AMPAR expression at synapses, such as metabotropic glutamate receptor subtype 5 (mGluR5) antagonists or compounds that inhibit the expression or function or Arc, may reverse symptoms associated with AS and ASD.
Fragile X is a human disorder in which a similar decrease in AMPAR expression at synapses has been demonstrated. This decrease has further been shown to be a result of excessive mGluR5 signaling, resulting in increased Arc translation and excessive AMPAR internalization. Selective mGluR5 antagonists are now entering clinical trials for the treatment of Fragile X, indicating that this type of therapeutic strategy has potential  

Now to understand what goes wrong in Parkinson's

Parkinson’s disease is the second most prevalent neurodegenerative disorder. Clinically, this disease is characterized by bradykinesia, resting tremors, and rigidity due to loss of dopaminergic neurons within the substania nigra section of the ventral midbrain. In the normal state, release of the neurotransmitter dopamine in the presynaptic neuron results in signaling in the postsynaptic neuron through D1- and D2-type dopamine receptors. D1 receptors signal through G proteins to activate adenylate cyclase, causing cAMP formation and activation of PKA. D2-type receptors block this signaling by inhibiting adenylate cyclase. Parkinson’s disease can occur through both genetic mutation (familial) and exposure to environmental and neurotoxins (sporadic). Recessively inherited loss-of-function mutations in parkin, DJ-1, and PINK1 cause mitochondrial dysfunction and accumulation of reactive oxidative species (ROS), whereas dominantly inherited missense mutations in α-synuclein and LRRK2 may affect protein degradation pathways, leading to protein aggregation and accumulation of Lewy bodies. Mitochondrial dysfunction and protein aggregation in dopaminergic neurons may be responsible for their premature degeneration. Another common feature of the mutations in α-synuclein, parkin, DJ-1, PINK1, and LRRK2 is the impairment in dopamine release and dopaminergic neurotransmission, which may be an early pathogenic precursor prior to death of dopaminergic neurons. Exposure to environmental and neurotoxins can also cause mitochondrial functional impairment and release of ROS, leading to a number of cellular responses including apoptosis and disruption of protein degradation pathways. There is also an inflammatory component to this disease, resulting from activation of microglia that causes the release of inflammatory cytokines and cell stress. This microglia activation causes apoptosis via the JNK pathway and by blocking the Akt signaling pathway via REDD1. 
DJ-1 and Autism

We know that oxidative stress is life-long in many people with autism.  We know that anti-oxidants like NAC (N-acteyl cysteine) and ALA (alpha lipoic acid) improve autism.  It is suggested that ALA in particular may stabilize mitochondrial disease.

ALA also has an interesting effect on glial (dys)function and I am wondering if NAC has the same effect.

Alpha-lipoic acid effects on brainglial functions accompanying double-stranded RNA antiviral and inflammatory signaling.

Viral products in the brain cause glial cell dysfunction, and are a putative etiologic factor in neuropsychiatric disorders, notably schizophrenia, bipolar disorder, Parkinson's, and autism spectrum. Alpha-lipoic acid (LA) has been proposed as a possible therapeutic neuroprotectant.

One of the reasons there is some much oxidative stress in autism may be that those anti-oxidant genes were never activated.  That would happen if DJ-1 expression was low.

The less DJ-1, the more oxidative stress.  This in turn would do many things:-

·        damage the mitochondria
·        damage the DNA
·        upset the homeostasis of the endocrine (hormone) system 
·        disrupt the developing brain (Purkinje cell loss etc)

The end result is a big mess, but amazingly not a degenerative one.

A quick recap on oxidative stress

How to up regulate DJ-1

Thanks to all the research into Parkinson’s, an interesting therapy is available to upregulate DJ-1.  A food additive, Sodium Benzoate, known as E211 or even NaC7H5O2 has been shown to be effective (in mice).

Rather than taking E211 you can eat cinnamon and let your body metabolize it into Sodium Benzoate.  As long as you take the Ceylon type of Cinnamon and not one of the cheaper ones, even very high consumption seems to be risk free.

In the cheaper cinnamon, called Cassia, or Chinese, high levels of a substance called coumarin can be found.  This can be harmful to the kidneys and liver and there are legal limits on this type of cinnamon.


DJ-1 (PARK7) is a neuroprotective protein that protects cells from oxidative stress. Accordingly, loss-of-function DJ-1 mutations have been linked with a familial form of early onset Parkinson disease. Mechanisms by which DJ-1 level could be enriched in the CNS are poorly understood. Recently we have discovered anti-inflammatory activity of sodium benzoate (NaB), a metabolite of cinnamon and a widely-used food additive. Here we delineate that NaB is also capable of increasing the level of DJ-1 in primary mouse and human astrocytes and human neurons highlighting another novel neuroprotective effect of this compound. Reversal of DJ-1-inducing effect of NaB by mevalonate, farnesyl phosphate, but not cholesterol and ubiquinone, suggests that depletion of intermediates, but not end products, of the mevalonate pathway is involved in the induction of DJ-1 by NaB. Accordingly, either an inhibitor of p21ras farnesyl protein transferase (FPTI) or a dominant-negative mutant of p21ras alone was also able to increase the expression of DJ-1 in astrocytes suggesting an involvement of p21ras in DJ-1 expression. However, an inhibitor of geranyl transferase (GGTI) and a dominant-negative mutant of p21rac had no effect on the expression of DJ-1, indicating the specificity of the effect. Similarly lipopolysaccharide (LPS), an activator of small G proteins, also inhibited the expression of DJ-1, and NaB and FPTI, but not GGTI, abrogated LPS-mediated inhibition. Together, these results suggest that NaB upregulates DJ-1 via modulation of mevalonate metabolites and that p21ras, but not p21rac, is involved in the regulation of DJ-1

Cinnamon is well known for its antioxidant potential.  In other research other compounds within it are seen as the active ones.

Here is a very interesting trial showing the effect of cinnamon on lowering cholesterol and blood glucose levels.

This Indian study looked at the effect of 3g a day of cinnamon taken with tea.  Below are the results from the control group, without type II diabetes.

The results are remarkable.  Good cholesterol (HDL) goes up, bad cholesterol (LDL) goes down, tryglicerides go down.  Glucose levels go down.  All the antioxidant indicators go up.

In table 2 in the full report you can see that the effect on people with diabetes was even better.




I think it is fair to say that cinnamon has some very interesting effects in human health, but they are not yet fully understood.

It looks like people with Parkinson’s, COPD, diabetes or high cholesterol could well benefit, for one reason or another.

What is interesting to note is that in some countries the age old herbal remedy for COPD is cinnamon.

I think most people likely would benefit to some extent from cinnamon.  The effective dose is very small, 2 to 4 grams, depending on the study.  

As to the effect in autism, there is only one way to find out.

Wednesday, 26 November 2014

What does Cancer Risk and Autism tell us?

Today’s post is a short one.

As you look deeper into how the body functions you come across many, only recently understood, pathways.  In reality these are still “works in progress”, but some will eventually lead to a better understanding of diseases like cancer, diabetes, Parkinson’s, Alzheimer’s and, eventually, many types of autism.

Within this blog we have seen how many common diseases share some underpinnings with autism.  As a result these diseases appear more commonly in people with autism, and so they get called comorbidities.

Some comorbidities get talked about quite a lot, things like epilepsy and MR/intellectual impairment.

For me the really interesting ones and the ones that might actual lead you to some therapeutic implication.  In this respect, allergies (food and airborne) have proved to be the most useful.

Not far behind are heart disease, diabetes and cancer.

In Paul Whiteley’s blog he recently highlighted a study showing how heart disease was increased in autism.  This has been noted before and I believe leads back to calcium channels, known to be dysfunctional in autism.  One particular channel is called Cav1.2 and it is widely expressed in the brain and the heart.  In earlier posts I have covered this channelopathy from the point of view of autism.  Not surprisingly, if you have Cav1.2 dysfunction in the brain, it might very well occur elsewhere.

There are little genetic errors called Single Nucleotide Polymorphisms, or SNPs.  In the CACNA1C gene there are 12,932 known SNPs.  Some of the most common ones are associated with autism, bipolar and schizophrenia.

You can look up this gene, or any other one, and see for yourself.

If you read the gene description above, the idea that heart disease is comorbid with autism is no surprise. 

The lower red arrow points at hypokalemic periodic paralysis.  This has appeared many times on this blog, along with Hypokalemic Sensory Overload.  I discovered long ago that there is a potassium ion channel dysfunction in autism; it appears to be behind the odd sensory overload experienced by many with autism and also in some people with ADHD.  What is interesting is that this dysfunction co-occurs with CACNA1C dysfunctions.

Cancer and Autism

The science behind cancer is complex and so as not to research it in vain, it is useful to know that there is solid evidence linking autism and cancer.

The following study of 8,438 people with autism, compared their incidence of cancer with the incidence in the general population

To understand the jargon first read this excerpt from a fact sheet on cancer statistics:

The expected number is calculated by multiplying each age-specific cancer incidence rate of the reference population by each age-specific population of the community in question and then adding up the results. If the observed number of cancer cases equals the expected number, the SIR is 1. If more cases are observed than expected, the SIR is greater than 1. If fewer cases are observed than expected, the SIR is less than 1.


60 observed cases / 30 expected cases: the SIR is 60/30 = 2.0

Since 2.0 is 100% greater than 1.0, the SIR indicates an excess of 100%.
45 observed cases / 30 expected cases: the SIR is 45/30 = 1.5

Since 1.5 is 50% greater than 1.0, the SIR indicates an excess of 50%.

30 observed cases / 30 expected cases: the SIR is 30/30 = 1.0

A SIR of 1 would indicate no increase or decrease.

Here is the autism study:-

To investigate whether individuals with autism have an increased risk for cancer relative to the general population.
Study design
We enrolled patients with autistic disorder from the Taiwan National Health Insurance database in years 1997-2011. A total of 8438 patients diagnosed with autism were retrieved from the Registry for Catastrophic Illness Patients database. The diagnosis of cancers was also based on the certificate of catastrophic illness, which requires histological confirmation. The risk of cancer among the autism cohort was determined with a standardized incidence ratio (SIR).
During the observation period, cancer occurred in 20 individuals with autism, which was significantly higher than a total number of expected cancers with a SIR estimate of 1.94 (95% CI 1.18-2.99). The number of cancer in males was greater than the expected number with a SIR of 1.95 (1.11-3.16), but no excess risk was found for females with a SIR of 1.91 (0.52-4.88). Cancer developed more than expected in individuals age 15-19 years with the SIR of 3.58 (1.44-7.38), but did not differ in other age range groups. The number of cancers of genitourinary system was significantly in excess of the expected number (SIR 4.15; 95% CI 1.13-10.65), and increased risk was found in ovarian cancer with SIR of 9.21 (1.12-33.29).
Our study demonstrated that patients with autistic disorder have an increased risk of cancer.

So, overall, the risk of all cancers is about twice as high if you have autism.  

Certain cancers are particularly high risk and understanding why this is the case might lead to a better understanding of the “pathways” leading to some types of autism. Due to the rarity of some cancers, like ovarian, one might need to validate the result; note the (1.12-33.29) range for ovarian cancer.

Rather than worry about this risk, we should use these observations to understand and treat autism.

Just as we can counter the elevated risk of heart disease we can do the same for cancer.

Clearly the cancer pathways that will soon be appearing in this blog are relevant to autism.  But in the meantime anyone can reduce their cancer risk by ensuring a high level of antioxidants in their body.  People at higher risk are those with low levels of antioxidants, which include almost all older people and people of all ages with autism.

A vast wealth of information already exists showing the chemo-protective effect of antioxidants.  Cancer clearly generally results from multiple hits, and you may be unlucky to have a single gene that “ups” your risk.  By upping your antioxidant intake you can slash one risk, in this multiple step process.

It does not seem to matter which potent antioxidant you take, but you do need enough of it.  They are all slightly different and most likely a mix of several will yield the best result.

My current favourites are:-

·        NAC (N-acetyl cysteine)
·        ALA (Alpha lipoic acid) - Nrf2 activator
·        Sulforaphane – Nrf2 activator
·        Cocoa Flavanols
·        Lycopene (cooked tomato)

These should reduce both the risk of cancer risk and heart disease.
Other antioxidants mentioned in this blog include:-

·        L-Carnosine
·        Silibinin – Nrf2 activator
·        Selenium

One should be aware that avoiding cancer and treating an existing cancer are different tasks.  Once a cancer has developed, some antioxidants can interfere with the body’s own response mechanism.

My focus is preventative “medicine”.

We saw in an earlier post how children at risk of developing asthma could be identified by their atopic dermatitis.  By treating these children with a cheap mast cell stabilizer called Ketotifen, a trial showed how it was possible to avoid the onset of asthma.

I suspect that the same thing might be possible with epilepsy.  We saw in an earlier post that the first epileptic attack make a (epigenetic?) change, and thereafter there is a greatly increased risk of future seizures.

Other interesting preventative interventions, include statins to avoid Parkinson’s disease and Verapamil to avoid the onset of Type II diabetes.

I did explain all this to the European Medicines Agency some months ago, the idea of treating the comorbidities of autism BEFORE they occur.  Perhaps an idea before its time?