Mollajani R, Joghataei M T, Tehrani-doost M. Bumetanide Therapeutic Effect in Children and Adolescents With Autism Spectrum Disorder: A Review Study. BCN 2019; 10 (5) :433-442
URL:
http://bcn.iums.ac.ir/article-1-1286-en.html
1- Cognitive Neuroscience Institute for Cognitive Science Studies, Tehran, Iran.
2- Department of Anatomy and Neuroscience, Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
3- Research Center for Cognitive and Behavioral Sciences, Tehran university of Medial Sciences, Tehran, Iran.
Abstract:
Introduction: Autism Spectrum Disorder (ASD) is characterized by several impairments in communications and social interactions, as well as restricted interests or stereotyped behaviors. Interventions applied for this disorder are based on multi-modal approaches, including pharmacotherapy. No definitive cure or medication has been introduced so far; therefore, researchers still investigate potential drugs for treating ASD. One of the new medications introduced for this purpose is bumetanide. The present article aimed to review the efficacy of this drug on the core symptoms of ASD and its potential side effects.
Methods: We searched all papers reported on pharmacokinetics, pharmacodynamics, efficacy, and adverse effects of bumetanide on animal models and humans with ASD. The papers were extracted from the main databases of PubMed, Web of Science, and Scopus.
Results: The findings revealed that cortical neurons have high chloride ion (Cl−)i and excitatory actions of gamma-aminobutyric acid in the valproic acid animal model with ASD and mice with fragile X syndrome. Bumetanide, which has been introduced as a diuretic, is also a high-affinity-specific Na+-K+-Cl− cotransporter (NKCC1) antagonist that can reduce Cl− level. The results also indicate that bumetanide can attenuate behavioral features of autism in both animal and human models. Moreover, the studies showed that such medication could activate fusiform face area in individuals with ASD while viewing emotional faces. Also, recent findings suggest that a dose of 1 mg/d of this drug, taken twice daily, might be the best compromise between safety and efficacy.
Conclusion: Recent studies provided some evidence that bumetanide can be a novel pharmacological agent in treating core symptoms of ASD. Future studies are required to confirm the efficacy of this medication in individuals with ASD.
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• An imbalance in excitatory/inhibitory functions in the early development of the brain can be an etiological factor in developing autism spectrum disorder.
• In the early development of the brain, GABA acts as an excitatory agent, which leads to the accumulation of the chloride ions inside the cell.
• Bumetanide, a loop diuretic, is an antagonist to the NKCC1 receptor and can reduce the intracellular chloride ion and shift GABA from excitation to inhibition state.
• Several studies have shown that bumetanide can reduce the symptoms of the autism spectrum disorder and can be considered a new treatment for this disorder.
Plain Language Summary
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in fulfilling social relationships with others, along with repetitive behaviors and interests. The prevalence rate of ASD has increased in recent years. The main treatments used for this disorder have been non-pharmacological. However, a few approved medications such as risperidone and aripiprazole could reduce some non-core symptoms of ASD, but no use for improving social interactions in these patients. Recently, bumetanide has been introduced as a new medication to improve the core symptoms of ASD. Bumetanide has been already utilized as a diuretic for several years. Some studies have also reported the efficacy of this medication in improving symptoms of children with ASD, such as social relationships. The present article reviewed the studies reporting efficacy and adverse effects of bumetanide in patients with ASD.
Type of Study:
Review |
Subject:
Clinical Neuroscience Received: 2018/07/16 | Accepted: 2018/10/17 | Published: 2019/09/1