- Email: [email protected]
Serum in the past or at present
Available online at www.sciencedirect.com
ScienceDirect Journal of the Chinese Medical Association 80 (2017) 269e270 www.jcma-online.com
Letter to the Editor
Serum in the past or at present To the Editor, We read with interest the recently published article entitled “Maternal antineuronal antibodies and risk of childhood autism spectrum disorders: A case-control study.”1 Dr Ali and colleagues1 conducted a case-control study to evaluate the serum levels of antineuronal antibodies in women who had children with diagnosed and confirmed autism.1 The authors aimed to explore the role of maternal immune response on the development of childhood autism. The authors found that the presence of certain types of anineuronal antibodies (anti-Yo antibodies and antiamphiphysin antibodies) might contribute significantly to the risk of development of autism in their children.1 This article was quite interesting; however, we questioned the conclusion the authors reached, and we were not convinced by the title “Maternal antineuronal antibodies and risk of childhood autism spectrum disorders.” In fact, it would appear that the methods used by the authors were questionable as well. To begin, the authors should explain the following issues: What was the mean or median age of these children with autism? Are they 4 or 5 years of age? Did the authors enroll women who had already delivered a baby who was later diagnosed with autism in the following period? If the answer was yes, this would suggest that these sera were obtained “now.” Moreover, this would indicate that these autistic children were diagnosed at or about 4 and 5 years after delivery. The sera in Ali et al’s study were not obtained at the time when these women were pregnant. Therefore, the data from their study cannot be totally representative of the real situation of the pregnancies of these women. It was very inappropriate for these authors to draw their conclusion that these antineuronal antibodies contributed significantly to the risk of children’s autism. Additionally, a similar critique is raised about the title of this article. Modification of both the article title and the conclusion these authors could be a superior choice. The “maternal” phase should be used with caution, however, if the data were not obtained from pregnant women. Nonetheless, our comment does not intend to undermine the otherwise excellent works of the authors. In fact, to assess the relationship between “maternal” antineuronal antibodies and childhood autism, the prospective
Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.
study or a retrospective cohort study might be considerably better.2,3 If the case-control study was used, it may require an extensive serum biobank,4 which had already collected these sera of the studied populations (both cases and controls) and should be formed. Finally, our suggestion is that women with some antineuronal antibodies might have a higher risk of autistic children, although the time interval was uncertain. This finding would benefit from further investigation and confirmation. Acknowledgments This article was supported by grants from the Ministry of Science and Technology, Executive Yuan (MOST 103-2314-B010 -043 -MY3), and Taipei Veterans General Hospital (V105C-096; V106C-129; V106D23-001-MY2-1; and V106A012). We also appreciate the Clinical Research Core Laboratory and the Medical Science & Technology Building of Taipei Veterans General Hospital for providing experimental space and facilities. References 1. Ali NH, Khalaf SK, Al-Asadi JS, Abed AH. Maternal antineuronal antibodies and risk of childhood autism spectrum disorders: a case-control study. J Chin Med Assoc 2017;79:661e4. 2. Brown AS, Sourander A, Hinkka-Yli-Salom€aki S, McKeague IW, Sundvall J, Surcel HM. Elevated maternal C-reactive protein and autism in a national birth cohort. Mol Psychiatry 2014;19:259e64. 3. Muto H, Yamamoto R, Ishii K, Kakubari R, Takaoka S, Mabuchi A, et al. Risk assessment of hypertensive disorders in pregnancy with maternal characteristics in early gestation: a single-center cohort study. Taiwan J Obstet Gynecol 2016;55:341e5. 4. Braun JM, Kalkbrenner AE, Just AC, Yolton K, Calafat AM, Sj€odin A, et al. Gestational exposure to endocrine-disrupting chemicals and reciprocal social, repetitive, and stereotypic behaviors in 4- and 5-year-old children: the HOME study. Environ Health Perspect 2014;122:513e20.
Kuan-Chin Wang Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC Wen-Ling Lee Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
http://dx.doi.org/10.1016/j.jcma.2016.12.002 1726-4901/Copyright © 2017, the Chinese Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
270
Letter to the Editor / Journal of the Chinese Medical Association 80 (2017) 269e270
Peng-Hui Wang* Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC *Corresponding author. Dr. Peng-Hui Wang, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail addresses: [email protected], [email protected], [email protected] (P.-H. Wang).
ScienceDirect Journal of the Chinese Medical Association 80 (2017) 269e270 www.jcma-online.com
Letter to the Editor
Serum in the past or at present To the Editor, We read with interest the recently published article entitled “Maternal antineuronal antibodies and risk of childhood autism spectrum disorders: A case-control study.”1 Dr Ali and colleagues1 conducted a case-control study to evaluate the serum levels of antineuronal antibodies in women who had children with diagnosed and confirmed autism.1 The authors aimed to explore the role of maternal immune response on the development of childhood autism. The authors found that the presence of certain types of anineuronal antibodies (anti-Yo antibodies and antiamphiphysin antibodies) might contribute significantly to the risk of development of autism in their children.1 This article was quite interesting; however, we questioned the conclusion the authors reached, and we were not convinced by the title “Maternal antineuronal antibodies and risk of childhood autism spectrum disorders.” In fact, it would appear that the methods used by the authors were questionable as well. To begin, the authors should explain the following issues: What was the mean or median age of these children with autism? Are they 4 or 5 years of age? Did the authors enroll women who had already delivered a baby who was later diagnosed with autism in the following period? If the answer was yes, this would suggest that these sera were obtained “now.” Moreover, this would indicate that these autistic children were diagnosed at or about 4 and 5 years after delivery. The sera in Ali et al’s study were not obtained at the time when these women were pregnant. Therefore, the data from their study cannot be totally representative of the real situation of the pregnancies of these women. It was very inappropriate for these authors to draw their conclusion that these antineuronal antibodies contributed significantly to the risk of children’s autism. Additionally, a similar critique is raised about the title of this article. Modification of both the article title and the conclusion these authors could be a superior choice. The “maternal” phase should be used with caution, however, if the data were not obtained from pregnant women. Nonetheless, our comment does not intend to undermine the otherwise excellent works of the authors. In fact, to assess the relationship between “maternal” antineuronal antibodies and childhood autism, the prospective
Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.
study or a retrospective cohort study might be considerably better.2,3 If the case-control study was used, it may require an extensive serum biobank,4 which had already collected these sera of the studied populations (both cases and controls) and should be formed. Finally, our suggestion is that women with some antineuronal antibodies might have a higher risk of autistic children, although the time interval was uncertain. This finding would benefit from further investigation and confirmation. Acknowledgments This article was supported by grants from the Ministry of Science and Technology, Executive Yuan (MOST 103-2314-B010 -043 -MY3), and Taipei Veterans General Hospital (V105C-096; V106C-129; V106D23-001-MY2-1; and V106A012). We also appreciate the Clinical Research Core Laboratory and the Medical Science & Technology Building of Taipei Veterans General Hospital for providing experimental space and facilities. References 1. Ali NH, Khalaf SK, Al-Asadi JS, Abed AH. Maternal antineuronal antibodies and risk of childhood autism spectrum disorders: a case-control study. J Chin Med Assoc 2017;79:661e4. 2. Brown AS, Sourander A, Hinkka-Yli-Salom€aki S, McKeague IW, Sundvall J, Surcel HM. Elevated maternal C-reactive protein and autism in a national birth cohort. Mol Psychiatry 2014;19:259e64. 3. Muto H, Yamamoto R, Ishii K, Kakubari R, Takaoka S, Mabuchi A, et al. Risk assessment of hypertensive disorders in pregnancy with maternal characteristics in early gestation: a single-center cohort study. Taiwan J Obstet Gynecol 2016;55:341e5. 4. Braun JM, Kalkbrenner AE, Just AC, Yolton K, Calafat AM, Sj€odin A, et al. Gestational exposure to endocrine-disrupting chemicals and reciprocal social, repetitive, and stereotypic behaviors in 4- and 5-year-old children: the HOME study. Environ Health Perspect 2014;122:513e20.
Kuan-Chin Wang Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC Wen-Ling Lee Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan, ROC Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, ROC
http://dx.doi.org/10.1016/j.jcma.2016.12.002 1726-4901/Copyright © 2017, the Chinese Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
270
Letter to the Editor / Journal of the Chinese Medical Association 80 (2017) 269e270
Peng-Hui Wang* Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
Department of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC *Corresponding author. Dr. Peng-Hui Wang, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail addresses: [email protected], [email protected], [email protected] (P.-H. Wang).