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Autism and Secretin

John Wills Lloyd

University of Virginia
Curry School of Education

Updated: 13-June-2001;
Previous substantive update: 28-Sep-98 12:21:41 EDT
Additional links added 18-October-98 and 28-October-98
Last update: Tuesday, 21-Jan-2014 14:02:09 EST

See a post on EBD Blog, Secretin Still Does Not Help, about a recent review of research on secretin by Krishnaswami, McPheeters, Veenstra-VanderWeele (2011) that appeared in Pediatrics.
Secretin is a neurotransmitter (a chemical messenger) in the neuropeptide group. It is one of the hormones that controls digestion (gastrin and cholecystokinin [CCK] are the others). It is a polypeptide composed of 27 amino acids and is secreted by cells in the digestive system when the stomach empties. Secretin stimulates

  1. the pancreas to emit digestive fluids that are rich in bicarbonate which neutralizes the acidity of the intestines,
  2. the stomach to produce pepsin (an enzyme that aids digestion of protein), and
  3. the liver to produce bile.

Secretin receptors are coded on human chromosome 2. The US National Institute of Health maintains the Online Mendelian Inheritance in Man (sic!) database that includes an entry on secretin. NIH also has UniGene data base and the IL Weizman Center's GeneCard database has entries about relevant genes, including Hs.767, Hs.2681, and especially Hs.2199.

Single injections of synthetic secretin are sometimes used in conducting tests of the digestive system, for example in cases where excessive secretion of gastric juices causes ulcers or when evaluating patients for pancreatic cancer. It is given intraveneously during upper gastrointestinal endoscopy or other tests (see secretin stimulation test). L. Donalson has a series of slides about the gastrointestinal tract, one of which shows where secretin fits into the work of the digestive system.

Biological labs providing biologically active products offer secretin synthesized from humans, porcine (swines), and rats. These companies supply peptides for research uses, not for individual consumers. Note: It's a bad idea to administer drugs, including secretin, without proper medical knowledge and monitoring.

Secretin has been found to have various behavioral effects. For example, it depressed the effects of single doses of morphine in mice and increased the delay before the animals jumped to avoid an aversive stimulus (Babarczy, Szabo, & Telegdy, 1995). When injected, it decreased approaches to novel items, movement in an open environment, and respiration in rats (Charlton, 1983). To be sure, though, the report that is likely to generate the most interest among those interested in the effects of secretin on autism stated

Within 5 weeks of the secretin infusion, a significant amelioration of the children's gastrointestinal symptoms was observed, as was a dramatic improvement in their behavior, manifested by improved eye contact, alertness, and expansion of expressive language. (Horvath, Stefanatos, Sokolski, Wachtel, Nabors & Tildon, 1998)

Preliminary clinical trials began in 1997-98. Reports about the results of those trials are sketchy. S. Baker had slides about his trials at http://www.sbakermd.com/database/slides/, but that site was not active as of 13 June 2001.

As of the summer of 2001, I searched the medical and psychological literature for other studies about secretin as a therapy for autism. I found three controlled studies (Chez et al., 2000; Dunn-Geier et al, 2000; Sandler et al, 1999), none of which reported benefits for children given secretin. Despite Rimland's (2000) criticism of some of the research, reviewers (Hunsinger, Nguyen, Zebraski, & Raffa, 2000; Posey & McDougle, 2000) have agreed that there is insufficient evidence to support secretin's use as a therapy for autism. Posey and McDougle (2000) state the results bluntly: "Recent controlled trials of secretin have not shown efficacy compared to placebo."

The Cochrane Collaboration provided a review of the evidence it could locate through March of 2005. The conclusions are straightforward: "There is no evidence that single or multiple dose intravenous secretin is effective and as such it should not currently be recommended or administered as a treatment for autism."

The surge of interest in secretin as a therapuetic agent has led some to express concern about the rapid adoption of unproven therapies in special education and disabilities. R. Nickel of the American Academy for Cerebral Palsy and Developmental Medicine discussed secretin as an illustration in discussing how people should approach alternative therapies. L. H. Diller described this concern well on his page reviewing the Sandler et al. (1999) study. People too often abandon interventions for which we have good evidence about effectiveness of some other therapies in special education and disabilities (see our pages on effective methods and procedures) in favor of what appear to be easy and highly helpful therapies for which we have no good evidence.


Resources about using secretin-like substances to treat autism have appeared in many places, particularly the popular press. Most of the interest in this followed the observations by Victoria and Gary Beck about their son Parker's improvement after taking secretin. People should be cautious about seeking immediate treatment, as the data are discouraging and the use of secretin to treat autism is still "off label" (i.e., not a recommended medical practice). Here are a few links related to this topic.


References

Babarczy, E., Szabo, G., & Telegdy, G. (1995). Effects of secretin on acute and chronic effects of morphine. Pharmacology, Biochemistry & Behavior, 51, 469-472.

Beck, V., & Beck, G. (1998). Unlocking the potential of secretin. San Diego: Autism Research Institute.

Chez, M. G., Buchanan, C. P., Bagan, B. T., Hammer, M. S., McCarthy, K. S., Ovrutskaya, I., Nowinski, C. V., & Cohen, Z. S. (2000). Secretin and autism: A two-part clinical investigation. Journal of Autism & Developmental Disorders, 30(2), 87-94.

Charlton, C. G. (1983). Secretin modulation of behavioral and physiological functions in the rat. Peptides, 4(5), 739-742.

Dunn-Geier, J., Ho, H. H., Auersperg, E., Doyle, D., Eaves, L., Matsuba, C., Orrbine, E., Pham, B., & Whiting, S. (2000). Effect of secretin on children with autism: A randomized controlled trial. Developmental Medicine & Child Neurology, 42, 796-802.

Horvath, K., Stefanatos, G., Sokolski, K. N., Wachtel, R., Nabors L., & Tildon, J. T. (1998). Improved social and language skills after secretin administration in patients with autistic spectrum disorders. Journal of the Association for Academic Minority Physicians, 9, 9-15.

Hunsinger, D. M., Nguyen, T., Zebraski, S. E., & Raffa, R. B. (2000). Is there a basis for novel pharmacotherapy of autism? Life Sciences, 67, 1667-1682.

Posey, D. J., & McDougle, C. J. (2000). The pharmacotherapy of target symptoms associated with autistic disorder and other pervasive developmental disorders. Harvard Review of Psychiatry. 8(2), 45-63.

Rimland, B. (2000). Comments on "Secretin and autism: A two-part clinical investigation" by M. G. Chez et al. Journal of Autism & Developmental Disorders, 30(2), 95.

Sandler, A. D., Sutton, K. A., DeWeese, J., Girardi, M. A., Sheppard, V., & Bodfish, J. W. (1999). Lack of benefit of a single dose of synthetic human secretin in the treatment of autism and pervasive developmental disorder. New England Journal of Medicine, 341, 1801-1806.


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