Our Researcher in Focus for January is Dr Michael Carter. Michael is a National Children’s Research Centre funded Clinical Research Fellow based in the Infant Centre at University College Cork, working under the supervision of Prof. Deirdre Murray and Dr Louise Gibson. Michael is working on the PiRAMiD study: PRedicting early onset Autism through Maternal Immune Activation and proteomic Discovery.
Autism Spectrum Condition refers to a broad range of neurodevelopmental conditions that affects social interaction and communication. As Michael explains “Autism spectrum disorder (ASC) is an increasingly prevalent lifelong disorder of childhood development. Research suggests changes of ASC can begin even before a child has been born and signs and symptoms of the condition become more obvious as the child gets older. Problems encountered by people affected by ASC include, difficulties with changes in routine, behaviours such as fixations, difficulties both expressing and understanding language, and approximately one third of people affected have a learning disability. In the Western World, quoted prevalence of ASC is between 1% and 2.5% depending on your geographical area. Richer areas with better access to services and diagnostic testing tend to have higher rates compared to more resource poor settings”.
The early diagnosis of ASC is extremely important as earlier interventions can improve developmental outcomes for children. “The problem we are trying to address is one of timing. Typically, children with ASC do not receive a diagnosis until they are aged 4-5 years or older. This is problematic, as it has been shown repeatedly that early intervention in the first 2 years of life, leads to better outcomes in children affected by ASC. If we can identify children with ASC at an earlier age, then they can receive early intervention therapies, and we can expect improved outcomes” said Michael.
The exact causes of ASC are poorly understood but have been linked to both genetic and environmental factors. Michael is particularly interested in how maternal inflammation during pregnancy owing to factors such as viral infection may play a role in the development of ASC. Michael explains “This maternal immune activation means that mothers have an abnormal triggering of their immune system that may have an impact on the developing foetus. We have identified some of these immune triggers such as influenza and rubella, but many others remain unclear”.
Michael is investigating whether increased levels of markers of inflammation during pregnancy may be an indicator of the development of ASC during childhood. To do this, he is utilising samples collected through the Cork BASELINE Birth Cohort Study. BASELINE was an NCRC funded prospective birth cohort study that followed the growth and development of over 2000 children from early pregnancy. Longitudinal monitoring of this large cohort of children allowed the study investigators (including Michael’s supervisor Prof. Deirdre Murray) to assess the incidence and determinants of a number of childhood conditions including eczema and food allergies.
Using the BASELINE study samples, initial studies have led to some interesting findings. “We have found a profile of inflammation in the blood samples of pregnant mothers which was associated with an elevated risk of Autism in their children. This was even stronger for those children with early autism, which presented within the first 2 years of life. This is an exciting finding, with the potential to change how we manage ASC” said Michael.
Building on these early findings, Michael’s research on the PiRAMiD study is to improve our understanding of inflammation in mothers of children with ASC and to assess the ability of markers of inflammation to predict ASC”. To do this, Michael is validating the BASELINE study results by examining maternal inflammation activation in a separate birth cohort from New Zealand. If the similar results are seen in the BASELINE and New Zealand cohorts, he intends to examine the screening potential of the identified inflammatory markers in a newly recruited prospective cohort of children with ASC and stored serum samples from their mothers. Together, these studies will further define if biomarkers of inflammation can be used to identify children at risk of ASC. Michael states “Infants at risk of ASC could be identified so that targeted early screening and focused intervention could be performed in the first years of life. This would improve the ability of these children to interact with their parents and others, improving their quality of life and outcome”.
In addition to his clinical work and research, Michael is also an advocate for improving how healthcare professionals communicate with children. Through TiNY Health, Michael and Gail Condon create award winning books and animations for children and their parents that address changes, worries and milestones such as COVID-19 and vaccination. You can find more about TiNY Health at http://tiny-health.com and http://writingfortiny.com.
More information on Michael’s research can be found through the following link:
ResearchGate: https://www.researchgate.net/profile/Michael_Carter51