Autism Spectrum Disorders and the Gut Microbiota

Fattorusso, Antonella; Di Genova, Lorenza; Dell’Isola, Giovanni; Mencaroni, Elisabetta; Esposito, Susanna

doi:10.3390/nu11030521

Cited by 484Gut microbiota and healthAutism Spectrum Disorder ResearchProbiotics and Fermented Foods

Autism Spectrum Disorders and the Gut Microbiota

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Fattorusso, Antonella, Di Genova, Lorenza, Dell’Isola, Giovanni, Mencaroni, Elisabetta, Esposito, Susanna·2019·Nutrients

DOI 10.3390/nu11030521PMC PMC6471505

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Abstract

In recent years, there has been an emerging interest in the possible role of the gut microbiota as a co-factor in the development of autism spectrum disorders (ASDs), as many studies have highlighted the bidirectional communication between the gut and brain (the so-called “gut-brain axis”). Accumulating evidence has shown a link between alterations in the composition of the gut microbiota and both gastrointestinal and neurobehavioural symptoms in children with ASD. The aim of this narrative review was to analyse the current knowledge about dysbiosis and gastrointestinal (GI) disorders in ASD and assess the current evidence for the role of probiotics and other non-pharmacological approaches in the treatment of children with ASD. Analysis of the literature showed that gut dysbiosis in ASD has been widely demonstrated; however, there is no single distinctive profile of the composition of the microbiota in people with ASD. Gut dysbiosis could contribute to the low-grade systemic inflammatory state reported in patients with GI comorbidities. The administration of probiotics (mostly a mixture of Bifidobacteria, Streptococci and Lactobacilli) is the most promising treatment for neurobehavioural symptoms and bowel dysfunction, but clinical trials are still limited and heterogeneous. Well-designed, randomized, placebo-controlled clinical trials are required to validate the effectiveness of probiotics in the treatment of ASD and to identify the appropriate strains, dose, and timing of treatment.

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Over 100 genes and genomic regions have been implicated in ASD, with 350-400 genes potentially contributing to increased susceptibility.
“To date, over 100 genes and genomic regions have been implicated in ASD, with a broader range (350–400 genes) potentially contributing to increased susceptibility [8].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
Dysbiosis has been implicated in the gastrointestinal and neuropsychiatric symptoms of ASD, potentially through mechanisms involving immune dysregulation, increased intestinal permeability, and disrupted gut-brain communication.
“Dysbiosis, characterized by alterations in the gut microbiota composition, has been implicated in the gastrointestinal and neuropsychiatric symptoms of ASD, potentially through mechanisms involving immune dysregulation, increased intestinal permeability, and disrupted gut–brain communication [8].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
An elevated abundance of Ruminococcaceae, Enterobacteriaceae, Pasteurellaceae, and Lachnospiraceae families has been observed in the digestive tract of individuals with ASD.
“Moreover, an elevated abundance of Ruminococcaceae, Enterobacteriaceae, Pasteurellaceae, and Lachnospiraceae families has been observed in the digestive tract of individuals with ASD [8,50,52,96,97,98,101,105,110,111].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
Studies suggest a potential increase in the prevalence of Lactobacillus in the fecal samples of patients diagnosed with ASD.
“Additionally, studies suggest a potential increase in the prevalence of Lactobacillus in the fecal samples of patients diagnosed with ASD [8,18,50,96,97,98,102,103,106,109,110,111].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
Fattorusso et al. indicated the potential for an increased abundance of Caloramator and Sarcina in ASD cases.
“In addition, the research by Fattorusso et al. indicated the potential for an increased abundance of Caloramator and Sarcina in ASD cases [8].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]

Studies have shown a significant increase in the prevalence of Clostridium bacteria in ASD patients compared to the general population.
“Studies has shown a significant increase in the prevalence of Clostridium bacteria in ASD patients compared to the general population [8,50,52,96,97,98,99,100,101,102,103,104,105,106,107,108,109].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
The presence of Staphylococcus, Coprococcus, Lactococcus, and Flavonifractor may be detected in lower quantities in ASD.
“In addition, the presence of Staphylococcus, Coprococcus, Lactococcus, and Flavonifractor may be detected in lower quantities [8,52,107,111,114,115].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
The prevalence of certain bacterial families, including Coriobacteriaceae, Actinomycetaceae, and Bifidobacteriaceae, has been observed to decline in individuals with ASD compared to the general population.
“Studies indicate that the prevalence of certain bacterial families, including Coriobacteriaceae, Actinomycetaceae, and Bifidobacteriaceae, has been observed to decline in individuals with ASD compared to those in the general population [8,101].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
A reduction in the number of bacteria from the Veillonella and Streptococcus genera was observed in patients with ASD.
“Additionally, there was a corresponding reduction in the number of bacteria from the Veillonella and Streptococcus genera, which are classified within these families [8,18,52,101,107,112,114,115].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
A notable decrease in the prevalence of bacteria from the Veillonellaceae and Streptococcaceae families was observed in patients with ASD.
“A notable decrease in the prevalence of bacteria from the Veillonellaceae and Streptococcaceae families was observed in patients with ASD.”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
Dysbiosis in the gut microbiota not only contributes to gastrointestinal symptoms but also plays a significant role in shaping behavioral and neuropsychological outcomes in individuals with ASD.
“Research indicates that dysbiosis in the gut microbiota not only contributes to gastrointestinal symptoms but also plays a significant role in shaping behavioral and neuropsychological outcomes in individuals with ASD [8,52,89].”
From The Gut–Brain–Microbiota Connection and Its Role in Autism Spectrum Disorders (2025) · cites this paper as [8]
Probiotic administration is a promising intervention for behavioral symptoms and GI dysfunction, but clinical studies are still limited and inconclusive.
“The administration of probiotics, especially in the context of the “gut–brain-axis”, is a promising intervention for behavioral symptoms, at the same time for GI dysfunction, but clinical studies are still limited and inconclusive [38].”
From Gastrointestinal Symptoms and Feeding Problems and Their Associations with Dietary Interventions, Food Supplement Use, and Behavioral Characteristics in a Sample of Children and Adolescents with Autism Spectrum Disorders (2020) · cites this paper as [38]
A lower level of tryptophan may influence the synthesis of serotonin in the brain, playing a role in mood and cognitive impairment characterizing ASD children.
“Indeed, a lower level of tryptophan may influence the synthesis of serotonin in the brain, playing a role on the mood and cognitive impairment which characterize ASD children [202].”
From Autism, Gastrointestinal Symptoms and Modulation of Gut Microbiota by Nutritional Interventions (2019) · cites this paper as [202]

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The microbiome is essential for normal gut intrinsic primary afferent neuron excitability in the mouse
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Enteric short-chain fatty acids: microbial messengers of metabolism, mitochondria, and mind: implications in autism spectrum disorders
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Parasite-Microbiota Interactions With the Vertebrate Gut: Synthesis Through an Ecological Lens
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Gut to brain interaction in Autism Spectrum Disorders: a randomized controlled trial on the role of probiotics on clinical, biochemical and neurophysiological parameters
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Amelioration of experimental autoimmune encephalomyelitis by probiotic mixture is mediated by a shift in T helper cell immune response
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“In addition, GF and CF diets only reduce levels of two toxins, gluteomorphins and caseomorphins but cannot heal the mucosa or restore gut microbiota composition [150].”
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Microbiology of regressive autism
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Human-derived probiotic Lactobacillus reuteri strains differentially reduce intestinal inflammation
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Pathways underlying the gut-to-brain connection in autism spectrum disorders as future targets for disease management
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Small intestinal enteropathy with epithelial IgG and complement deposition in children with regressive autism
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The enteric bacterial metabolite propionic acid alters brain and plasma phospholipid molecular species: Further development of a rodent model of autism spectrum disorders
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Desulfovibrio species are potentially important in regressive autism
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Exploring gut microbes in human health and disease: Pushing the envelope
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The level of arabinitol in autistic children after probiotic therapy
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Urinary p-cresol in autism spectrum disorder
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Alteration of Plasma Glutamate and Glutamine Levels in Children with High-Functioning Autism
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Gut Protozoa: Friends or Foes of the Human Gut Microbiota?
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Antidepressant-like effects of sodium butyrate and its possible mechanisms of action in mice exposed to chronic unpredictable mild stress
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Intestinal Dysbiosis and Yeast Isolation in Stool of Subjects with Autism Spectrum Disorders
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Clostridium butyricum pretreatment attenuates cerebral ischemia/reperfusion injury in mice via anti-oxidation and anti-apoptosis
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Effectiveness of the gluten-free, casein-free diet for children diagnosed with autism spectrum disorder: Based on parental report
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Ketogenic Diet Improves Core Symptoms of Autism in BTBR Mice
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Gut Microbiota in Health, Diverticular Disease, Irritable Bowel Syndrome, and Inflammatory Bowel Diseases: Time for Microbial Marker of Gastrointestinal Disorders
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Urinary p-cresol is elevated in small children with severe autism spectrum disorder
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Intracerebroventricular injections of the enteric bacterial metabolic product propionic acid impair cognition and sensorimotor ability in the Long–Evans rat: Further development of a rodent model of autism
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Can probiotics benefit children with autism spectrum disorders?
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Familial Recurrence of Autism Spectrum Disorder: Evaluating Genetic and Environmental Contributions
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Targeting gut microbiome: a novel and potential therapy for autism
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Evidence of the Gluten-Free and Casein-Free Diet in Autism Spectrum Disorders: A Systematic Review
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Chronic treatment with valproic acid or sodium butyrate attenuates novel object recognition deficits and hippocampal dendritic spine loss in a mouse model of autism
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Authors: Fattorusso, A., Di Genova, L., Dell’Isola, G., Mencaroni, E., & Esposito, S.
Affiliations: University of Perugia (IT)
Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, 06132 Perugia, Italy
Corresponding author: Esposito, Susanna
ORCID: Dell’Isola, Giovanni
Esposito, Susanna
Venue: Nutrients
Publisher: MDPI AG
Published: 2019-02-28
Volume: 11
Issue: 3
Pages: 521
ISSN: 2072-6643 (ISSN-L)
DOI: 10.3390/nu11030521
PMC: PMC6471505
OpenAlex: W2916032641
Cited by: 484
References: 184
Citations by year: 2026: 45 · 2025: 87 · 2024: 69 · 2023: 82 · 2022: 67 · 2021: 85 · 2020: 35 · 2019: 13 · 2018: 1
FWCI: 4.40
Type: journal article
Language: en
Open access: gold
dx.doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Nutrients (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Life Sciences › Agricultural and Biological Sciences › Food Science › Probiotics and Fermented Foods
Keywords: autism spectrum disorder, gut microbiota, gut dysbiosis, gut-brain axis, gastrointestinal diseases, probiotics, bowel dysfunction, systemic inflammation, Bifidobacterium, lactobacilli, Streptococcus, children
MeSH terms: Autism Spectrum Disorder, Gastrointestinal Microbiome, Humans, Dysbiosis

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Autism Spectrum Disorders and the Gut Microbiota

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