Epigenetics at Birth Links Microbiome to Neurodevelopment, Potentially ASD and ADHD

The results of a study headed by researchers at Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, indicate that the gut microbiome and epigenetics are intertwined, and that both contribute to neurodevelopment.

The researchers showed that epigenetic changes present at birth can impact how an infant’s gut microbiome develops during their first year. They also identified specific epigenetic changes and gut microbes that were associated with signs of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) when the children were three years old.

“Certain bacteria seem to offer protection, which is exciting because it suggests there could be ways to support a child’s development through diet or probiotics in the future,” said research lead and gastroenterologist Francis Ka Leung Chan, MD. Chan is co-senior author of the team’s published paper in Cell Press Blue, titled “Epigenome-microbiome interplay in early life associates with infants’ neurodevelopmental outcomes,” in which they stated, “We showed that epigenetic alterations at birth were associated with early-life microbiome development and that they determine the risks of neurodevelopmental consequences in children.”

The first years of life are critical for brain development and immune system maturation. Though previous studies have shown that both early epigenetic changes and gut microbiome development can impact health in later life, little is known about how these two systems interact. “Recent data suggest that epigenetic programming of gene expression profiles is sensitive to the early-life environment and can impact health outcomes in children,” the authors wrote. “One environmental cue known to trigger host epigenetic modifications is the genes of bacteria, fungi, and viruses inside the human body, collectively known as the microbiome.”

Co-senior author and public health researcher Hein Min Tun, PhD, of The Chinese University of Hong Kong, commented, “We wanted to see how the epigenome and microbiome interact in early life and if their interaction could influence a child’s risk of developing neurodevelopmental conditions like ASD and ADHD.” The authors added, “New understanding of host-microbe-epigenome interactions and mechanisms of epigenetic changes in early life can be leveraged for the prevention, early detection, and novel interventions of common childhood diseases.”

For their study the researchers characterized DNA methylation patterns from the umbilical cord blood of 571 infants. They paired this information with gut microbiome data collected from 969 infants at two, six, and 12 months of age, and from their parents during the third trimester of pregnancy. When the children reached 36 months of age, the researchers used a behavioral questionnaire to assess their neurodevelopment and investigate links between the microbiome, epigenome, and early signs of ASD and ADHD.

“This, to our knowledge, represents the first longitudinal study with multiple sample types to depict the intimate interplay between perinatal exposures, epigenetic hallmarks, and gut microbiome development and neurodevelopmental outcomes within the first three years of life,” the authors stated.

They found that an infant’s epigenome at birth was associated with birth mode, length of gestation, having older siblings, and maternal allergies, but it was not affected by their parents’ gut microbiomes. Microbiome development, on the other hand, was associated with birth mode, antibiotics, having older siblings, and breastfeeding. Infants who were born by Caesarean section (CS) showed different patterns of DNA methylation for several genes involved in immune responses and brain development. “Some of the changes in methylations of immune- and nervous-system-related genes, associated with CS delivery, are linked to neurodevelopmental outcomes,” they noted.

Their reported findings, the team suggested, “… resonate with studies linking CS to increased risks of immune-mediated and neurodevelopmental disorders, providing mechanistic plausibility through epigenomic and microbial dysbiosis.” The team also showed that an infant’s epigenome at birth impacted how their microbiome developed during their first year. Specifically, infants developed less diverse gut microbiomes at 12 months of age when they showed higher rates of DNA methylation in immune genes involved in recognizing pathogens. “We found that methylation rates in the major histocompatibility complex (MHC) region of infants at birth were linked to differences in the diversity of the infant gut microbiome at 12 months,” they commented.

The behavioral survey revealed that signs of ASD and ADHD in three-year-olds were associated with specific epigenetic patterns and the presence of certain gut microbes. “Importantly, we reported that epigenetic modifications were associated with an increased susceptibility to neurodevelopmental conditions in children, and these effects were in part mediated by microbial colonization.”

However, other microbial species seemed to mitigate these effects: infants with epigenetic patterns associated with ASD or ADHD were less likely to show signs of the disorders if they acquired Lachnospira pectinoschiza and Parabacteroides distasonis, respectively, during their first year. “We discovered a kind of conversation happening: a baby’s epigenetic setting at birth can influence their risk for neurodevelopmental disorders, but the presence of certain ‘good’ bacteria in their gut can step in and modify the risk,” Tun reported. “The foundations for brain health are laid very early, even before birth. However, we don’t want people to think this means a child’s developmental path is fixed at birth. These are complex conditions with many causes, and we’ve only uncovered a small piece of a very large puzzle.”

The researchers are continuing to follow the children who participated in the study to see how these early-life factors relate to their health as they grow. They note that laboratory experiments are needed to confirm the associations between gut microbes and neurodevelopment. In their discussion, the team wrote, “In conclusion, our findings revealed dual alterations to the neonatal epigenome and gut microbiome by perinatal factors and highlight the role of the ‘holo-epigenome’—the integrated host epigenome and microbiome—as a key mediator of neuro-immune outcomes. Interventions targeting microbial restoration or epigenetic modulation during critical developmental windows may mitigate risks of neurodevelopmental disorders.”

First author and gastroenterologist Siew Chien Ng, MD, PhD, added, “The ultimate goal is to develop safe, non-intrusive early interventions such as specific probiotics or live biotherapeutics, that could help nurture a healthy gut microbiome and potentially reduce the risk of neurodevelopmental challenges.”

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How blindness shapes personality: a neuro-ecological account

IntroductionThe established link between personality and psychological well-being underscores the need to understand how major life changes, such as vision loss, reshape an individual’s disposition. While previous research has produced inconsistent findings, the roles of concurrent environmental factors and underlying neural mechanisms have remained largely unexplored.MethodsThis study employed an integrated neuro-ecological framework to investigate how blindness influences personality. We recruited 46 blind participants and 41 sighted controls, who completed comprehensive assessments including the NEO-Five-Factor Inventory, social and lifestyle questionnaires, and multimodal neuroimaging, including structural magnetic resonance imaging (MRI), diffusion MRI, and resting-state functional MRI.ResultsBlind participants showed higher agreeableness, extraversion, and conscientiousness, while reduced neuroticism compared to sighted controls, and these personality trait differences were attenuated after accounting for trait anxiety. These differences were partially mediated by increased perceived social support from friends. Furthermore, mobile phone usage habits showed an interaction with blindness on personality traits. Neuroimaging identified both shared and vision-specific neural correlates of personality. For instance, blindness-related changes in white matter integrity of the anterior thalamic radiation and forceps minor mediated the reduction in neuroticism. Moderated mediation models further revealed that the strength of these neural pathways was regulated by environmental factors, such as social support and mobile phone self-control.DiscussionCollectively, these results indicate that personality patterns in blindness are a dynamic process involving the interplay of neural plasticity and environmental modulation, rather than a direct consequence of sensory loss alone.

The efficacy and safety of transcranial direct current stimulation in patients with ADHD: a systematic review and meta-analysis

ObjectiveThis meta-analysis evaluated the efficacy and safety of transcranial direct current stimulation (tDCS) for treating Attention-Deficit/Hyperactivity Disorder (ADHD).MethodsFollowing PRISMA guidelines, we analyzed 28 randomized controlled trials (RCTs) involving 1,864 participants. Outcomes encompassed core ADHD symptoms, hot and cold executive functions (EFs)—including inhibitory control, working memory, and cognitive flexibility—as well as safety profiles based on adverse events. A multilevel meta-analysis was performed using a random-effects model. Subgroup analyses and meta-regressions were conducted to explore potential moderating factors.ResultsCompared to sham stimulation, tDCS did not significantly improve core ADHD symptoms (standardized mean difference (SMD) = –0.29, 95% CI [–0.59, 0.01], p= 0.05). Similarly, no significant overall effects were observed for cold EFs: inhibitory control (Hedges’ g(g)= –0.11, 95% CI [–0.26, 0.05], p=0.19), working memory (g= 0.13, 95% CI [–0.06, 0.32], p= 0.26), or cognitive flexibility (SMD = –0.42, 95% CI [–1.13, 0.29], p= 0.24). The effect on hot EFs was also non-significant (g = 0.27, 95% CI [–0.14, 0.70], p = 0.19). Exploratory analyses indicated that anode placement at Fp2 was associated with improvement in both inhibitory control (g= –0.52, 95% CI [–0.93, –0.11], p=0.01) and working memory (g = 0.72, 95% CI [0.22, 1.22], p = 0.004), although the overall test for interaction was not significant for inhibitory control (p= 0.19). The most common adverse reactions were mild and transient local skin symptoms, such as itching and redness (RR = 1.42, p=0.04).ConclusiontDCS was well-tolerated but did not demonstrate significant overall efficacy for core ADHD symptoms or executive functions. Anodal stimulation at Fp2 showed potential selective benefits warranting further investigation. tDCS is not currently recommended as a standalone treatment for ADHD. Future research should optimize stimulation protocols and explore combined interventions with behavioral or cognitive therapies.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO, identifier CRD42024612055.

Effect of transcranial magnetic stimulation on prognosis in patients with postherpetic neuralgia and comorbid depression undergoing interventional neuromodulation therapy: protocol for a randomized double-blind placebo-controlled trial

BackgroundPostherpetic neuralgia (PHN) is often accompanied by depression, creating a vicious cycle that exacerbates symptoms and contributes to suboptimal treatment outcomes, even with interventional therapies. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated potential in alleviating both pain and mood disturbances. However, its efficacy in enhancing prognosis when used alongside interventional neuromodulation therapy for PHN accompanied by depression remains inadequately explored and requires further investigation.ObjectiveThis study aims to generate preliminary evidence on the efficacy and safety of rTMS in enhancing prognosis and alleviating pain in patients with PHN and mild to moderate depression undergoing interventional neuromodulation therapy.MethodsThis study is a single-center, randomized, double-blind, placebo-controlled trial involving 174 adult patients with PHN. Participants will be randomly assigned, stratified by interventional neuromodulation therapy, to either the rTMS group (n=87) or the control group (n=87). Both groups will undergo either 10 Hz rTMS or sham stimulation for five consecutive days. The primary outcome is the incidence of poor prognosis at 3 months post-discharge. Secondary outcomes include the incidence of poor prognosis at 6 months post-discharge; Visual Analog Scale (VAS) sleep scores; short-form McGill Pain Questionnaire (SF-MPQ) scores; Self-Rating Depression Scale (SDS) scores; patient satisfaction; Pain Disability Index (PDI) scores; Multidimensional Fatigue Inventory-20 (MFI-20) scores; pregabalin oral doses; and the need for tramadol or antidepressants. Safety outcomes will include assessments of headache, pain at the stimulation site, neck pain, insomnia, muscle soreness, dizziness, nausea, tinnitus, irritability, tachycardia (heart rate > 100 bpm), and epilepsy. Data will be analyzed using a modified intention-to-treat approach.DiscussionThis study aims to provide preliminary evidence on the efficacy and safety of 10 Hz rTMS in improving prognosis and alleviating pain in PHN patients with mild to moderate depression undergoing interventional pain management.Trial registrationhttps://www.chictr.org.cn/bin/project/edit?pid=261070, identifier ChiCTR2500096978.

Nonlinear relationships between fatigue, fear of COVID-19, and PTSD among mental health professionals: the findings of a multi-site survey in China

BackgroundMental health professionals (MHPs) are susceptible to fatigue, particularly during public health crises like the COVID-19 pandemic. This study examined nonlinear relationships between fatigue, post-traumatic stress disorder (PTSD), and fear of COVID-19 (FOC) among MHPs.MethodsA multi-site survey was conducted from January to February 2023. Fatigue was assessed using the Fatigue Visual Analogue Scale (VAS), PTSD with the Post-Traumatic Stress Disorder Checklist for Civilians (PCL-C), and FOC with the Fear of COVID-19 Scale (FCV-19S). Data were analyzed using logistic regression and restricted cubic splines to explore non-linear associations.ResultsOf the 9,858 COVID-recovered MHPs, the prevalence of significant PTSD symptoms (PCL-17 ≥ 50) was 6.85% (95% CI: 6.35% – 7.35%), while significant fear of COVID-19 (FOC ≥ 16) was observed in 61.28% (95% CI: 60.32% – 62.24%). Higher fatigue levels were significantly associated with increased odds for exacerbated PTSD symptomatology (OR = 1.75, 95% CI: 1.65 – 1.86, p < 0.001) and FOC severity (OR = 1.19, 95% CI: 1.16 – 1.21, p < 0.001). Restricted cubic splines analysis revealed nonlinear relationships. Specifically, as fatigue rose towards an inflection point of 5.00, its association with PTSD symptoms strengthened, while its association with FOC showed a decelerating growth.ConclusionThis study underscored fatigue as a factor significantly associated with COVID-recovered MHPs, particularly regarding the presence of PTSD and FOC. However, due to the cross-sectional study design, the direction of causality between fatigue, PTSD, and FOC could not be determined. Regular monitoring and targeted interventions are crucial for managing fatigue during public health crises. Healthcare organizations should provide appropriate work-rest schedules and supportive policies during such periods.

From work-related trauma to suicidal ideation: a serial mediation model of posttraumatic stress and depression in rescue workers

ObjectivesRescue workers face frequent occupational trauma, increasing their risk for posttraumatic stress symptoms (PTSS), depression, and suicidal ideation. However, pathways linking trauma to suicidality remain poorly understood. This study investigated these mechanisms by testing a serial mediation model.MethodsFrom a larger survey of Swiss rescue workers, participants reporting suicidal ideation (n = 44) were matched by age, sex, and profession with a control group without suicidal ideation (n = 44). Symptomatology was assessed using validated questionnaires such as the Posttraumatic Stress Scale-10 (PTSS-10) for posttraumatic stress and the Brief Symptom Inventory (BSI) for depressive symptoms. Structural Equation Modeling (SEM) was employed to test a serial two-mediator model: Trauma Exposure – PTSS – Depressive Symptoms – Suicidal Ideation.ResultsParticipants with suicidal ideation had significantly higher levels of trauma, PTSS, and depressive symptoms. SEM confirmed an excellent model fit (χ² = 1.925, CFI = 1.000, RMSEA <.001) and a full mediation effect: trauma exposure was associated with PTSS, which in turn related to depressive symptoms, which were subsequently linked to suicidal ideation. The specific serial indirect pathway was significant (B = 0.143, p = .011), while the direct path from trauma to suicidal ideation was non-significant. The model explained 69.4% of the variance in suicidal ideation.ConclusionThe findings suggest a developmental pathway in which trauma exposure is associated with suicidal ideation through the sequential roles of PTSS and depressive symptoms. Consequently, suicide prevention for rescue workers should prioritize the management of post-traumatic and depressive symptoms to potentially disrupt this symptomatic progression.

Therapeutic Potential of GLP-1 Receptor Agonists for Smoking Cessation

Glucagon-like peptide-1 (GLP-1) therapies are under investigation for a growing number of neuropsychiatric conditions, including substance use disorders. Cigarette smoking accounts for the largest proportion of substance use-related morbidity and mortality, in part reflecting increased risk for cardiometabolic disease among people who smoke. Given modest quit rates with approved smoking cessation therapies, medications with novel mechanisms of action are needed to expand the available monotherapy and combination treatment options.

How sports betting apps hook users

For most of the last 80 years, sports betting was limited to Las Vegas. But after a 2018 Supreme Court decision loosened regulations on professional sports wagers, it became possible to place bets on games 24/7 — with nothing more than a smartphone and a bank account. 

In 2013, just five years prior to the landmark SCOTUS case, gambling was classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in a new category called “Substance-Related and Addictive Disorders.” This grouped gambling with alcohol use disorder and other addictions. Gambling is also known to have the highest suicide rate of any addiction.

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Peer Mentor Training and Supervision for a Digital Adolescent Depression Treatment in South Africa and Uganda: Mixed Methods Evaluation

Background: Blended digital mental health interventions combining technology with human support are more effective than stand-alone treatments. However, limited research has examined how to train and supervise personnel delivering human support components. The Kuamsha app, a gamified digital intervention for adolescent depression based on behavioral activation, was designed to be paired with low-intensity telephone-based peer support. A structured training and supervision program for peer supporters was codeveloped through workshops with mental health professionals and youth with lived experience of mental health challenges in South Africa and Uganda. To the best of our knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in low- and middle-income countries. Objective: This study assessed the feasibility, acceptability, and fidelity of a training and supervision program for peer supporters delivering a digital mental health intervention in South Africa and Uganda. Methods: We conducted a mixed methods evaluation of the peer mentor program. Quantitative metrics assessed the feasibility of recruitment, retention, and attendance among peer mentors (n=13, South Africa; n=4, Uganda), as well as training acceptability. Fidelity, adherence, and competence were scored at the session level and converted to percentages of the maximum possible score. Linear mixed-effects regression models with a random intercept for provider and site estimated adjusted marginal means (95% CI). In-depth interviews and focus group discussions explored program acceptability and implementation factors. Results: The peer mentor training and supervision program was feasible and acceptable in both settings, with high recruitment (South Africa: n=13/19, 68%; Uganda: 4/4, 100%), retention (South Africa: 9/13, 69%; Uganda: 4/4, 100%), and training attendance rates (89%‐92% in South Africa and 100% in Uganda), alongside qualitative reports of high satisfaction. All peer mentors met a minimum posttraining competency threshold (≥50%), with median competency scores of 70.7% (IQR 45.8%‐78.2%) in South Africa and 75.4% (IQR 73.8%‐77.3%) in Uganda. Independent ratings of recorded calls indicated high overall fidelity in South Africa (84.7%, 95% CI 80.3%‐89.0%) and Uganda (87.7%, 95% CI 83.4%‐92.1%). Adherence was higher in Uganda than South Africa (adjusted mean difference [AMD] 13.30 percentage points, 95% CI 8.99‐17.61; <.001), as was competence (AMD 4.88 percentage points, 95% CI 1.23‐8.53; =.009). The AMD in overall fidelity (3.06 percentage points, 95% CI −0.98 to 7.10) was not statistically significant (=.14). The qualitative findings emphasized the value of ongoing supervision and capacity development, interactive training approaches, and blended delivery models. Conclusions: Locally adapted training and supervision models can strengthen peer mentor capabilities to support digital interventions. Adequate supervisory capacity and incentive structures are critical to sustain engagement, retention, and fidelity. In settings with frequent network disruptions, periodic in-person contact between peer mentors and supervisors may enhance fidelity. Future research should examine how peer mentor fidelity influences user engagement and mental health outcomes. Trial Registration: Pan African Clinical Trials Registry PACTR202206574814636; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23792 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-065977