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DOAST- NPK- Chennai- INDIA   1
„DOAST Integrated Therapy‟
    Successful in-vivo technique
  in synergy with Global research.

  Treatment Guided research
            which
Follows the LEADS and focuses on
  safe and effective interventions

            DOAST- NPK- Chennai- INDIA   2
Dr.Bernaud Rimland
               Authored the Neurobiological
                        approach.
                         The First
          POSITIVE TURN IN
          AUTISM RESEARCH

 Four decades of Global Research.
Are we able to deliver peace at home?

         DOAST- NPK- Chennai- INDIA           3
 Autism research exhibits analytical
      threads, but patterns remain
  fragmented lacking a unified concept.
 As on date we lack a coherent view on
 brain function within the framework of
          other organ systems.

              DOAST- NPK- Chennai- INDIA   4
POSITIVE APPROACH of DOAST
  „Instead of studying it through a
       symptom by symptom
 approach, autistic behavior should
be understood better by studying the
 underlying intermediary biological
              processes‟

             DOAST- NPK- Chennai- INDIA   5
Emerging qualitative changes in
    clinical status including loss of
     diagnosis suggest that a more
appropriate description for ASD could
  be a “chronic dynamic reversible
 encephalopathy” rather than “static
encephalopathy” as considered so far.

             DOAST- NPK- Chennai- INDIA   6
“Cognitive, emotional and synaptic
functions of the brain basically rely on
the macromolecular computing system
of RNA protein- and protein to protein
  interactions which appear to be the
         result of fine grained
information, encoded and accumulated
        over evolutionary time”.


              DOAST- NPK- Chennai- INDIA   7
DOAST- NPK- Chennai- INDIA   8
Neuro-Endo-Immune-
  GI Tract Network,
 Autonomic Balance,
&Neurotransmitters.

     DOAST- NPK- Chennai- INDIA   9
Genes,            CNS-ENDO-IMMUNE-GI
  Molecular order,
                                                  Bio feed back &
                             Tract- Network
 Protein expression,                             Autonomic Balance
                              Homeostasis
 Nerurotransmitters
Neuronal connectivity.

                                                       Upstream
                                                       molecular
                                                        unrest

           Altered                Normal
          network              Performance           Downstream
         Homeostasis         Social&Cognitive,
                                 Activities
                                                      Systemic
                                                    Inflammation


    Behavior&Cognitive
       dysfunction.                               Susceptible
                                                    Genetic
      AUTISM                                       landscape


                          DOAST- NPK- Chennai- INDIA                 10
“Decreased connectivity is at the heart of autism‟.
  Fairly close regions of the brains involved in
    motor tasks have difficulty coordinating
                      activity.
 It makes sense that social and communication
   skills are greatly impaired, as they involve
    more complex synchronous coordination
    between more distant areas of the brain.

                   DOAST- NPK- Chennai- INDIA    11
Consequences of inflammatory factors

Breaking boundaries between the body
             and brain,

 Destabilization and loss of synaptic
            connections.

             DOAST- NPK- Chennai- INDIA   12
Our Concept..                                   Upstream
                                                    molecular
                                                     unrest
   Down stream
   inflammation
 Dietary or environmental
          triggers,
                                                Synaptic
     Gut micro biome
  systemic inflammatory                       connectivity
cytokines on a chronic basis                 affected in in
                                               susceptible
                                              individuals.
                       DOAST- NPK- Chennai- INDIA               13
Genes,            CNS-ENDO-IMMUNE-GI
  Molecular order,
                                                            Bio feed back &
                             Tract- Network
 Protein expression,                                       Autonomic Balance
                              Homeostasis
 Nerurotransmitters
Neuronal connectivity.
                                                                 Upstream
                                                                 molecular
                                   Normal                         order
                                Performance
                              Social&Cognitive,
            Restore               Activities
           Network                                               Downstream
          Homeostasis                                             Molecular
                                                                   order
                                          INTEGRATED
                                            THERAPY

    Improved
    Behavior&                                                   Cellular
    Cognition                                                   Stressors
                         Integrated Therapy Hypothesis
                              DOAST- NPK- Chennai- INDIA                       14
Deviate from the „Hard wired‟ concept and
               „untreatable‟ stigma.

 Effectively treating the „downstream inflammatory
pathology‟ could initiate reestablishment of „upstream
  molecular order‟ . Molecular order restored could
    activate the dormant neuronal pools, improve
   connectivity and restore functional integration.


                   DOAST- NPK- Chennai- INDIA        15
DOAST Integrated therapy

 Pioneering concept of therapeutic integration or
  fusion, where scientifically chosen traditional
Indian treatment methods are applied with modern
  medical understanding to treat specific chronic
         ailments, and autism in particular.


                  DOAST- NPK- Chennai- INDIA   16
The Components of Integrated Therapy.

   The Science of Yoga, Ayurveda &
              Siddha &
      Modern medical expertise.




             DOAST- NPK- Chennai- INDIA   17
Reducing Cellular stress
  Toxin elimination
  Rejuvenation and
    Regeneration.

        DOAST- NPK- Chennai- INDIA   18
Prognostic Evaluation
        No reliable bio-marker.
 Observed improvements in behavior
 and cognition domains are the only
  reliable non-invasive indicators of
 restoration of molecular order and
integration of the upstream neuronal
                 pools.

             DOAST- NPK- Chennai- INDIA   19
Patient selection.

• DSM-IV guidelines, (CARS) and M-CHAT are
  the standard assessment tools used.

• Patient pool represents a spectrum of severity
  observed in autistic patients in general.

• Their racial origin is Asian. Age 3- 16 years.

• Cohort of 30 individuals on different follow up
  period on this therapy since 2004.


                   DOAST- NPK- Chennai- INDIA       20
Therapeutic protocol
 The prescribed diet „Sathvik Diet‟ practiced by
  the science Yoga.
 Herbal medications, certified by the Ayurvedic
  [including Siddha] pharmacopia of India are
  administered.
 Yoga technique is a combinatorial approach.
 Oleation therapies with medicated oils.




                  DOAST- NPK- Chennai- INDIA        21
Ethical & safety guidelines followed
 A well informed consent,
 The therapy techniques and medicines are chosen
  by evidence based risk benefit ratio, proven over
  centuries in their clinical application,
 One to one & Group basis application along with
  the parent,
 Documentation on paper and video,
 Pretreatment EEG and periodic monitoring of
  biochemical parameters to assess renal, hepatic
  and hematological functions.

                   DOAST- NPK- Chennai- INDIA         22
Assessment of Clinical benefits
GI Tract,                     Eye contact,
                                Play,
Respiratory,
                               


                               Communication,
Sleep,                         Empathy
Morbidity,                    & Generalization
                               are the behavior domains
Emotions,
                               chosen to assess and
Behavior,                     quantify behavior and
Cognition.                    cognitive improvement.


                DOAST- NPK- Chennai- INDIA           23
Controls
 We follow each patient, from the time of admission and
  through their recovery (or lack of it). Thus each participant
  in the study will serve as his/her own control.

 Improvement is influenced by the age of induction into
  therapy, duration of follow-up and compliance to the details.

   Parental compliance to be proportional to the trust on
  therapy.
  Willful or accidental default in medicine or dietary regime
  'influenced by the above listed „variables', resulted in
  temporary return of symptoms. Such events helped us
  understand the therapeutic role played by components of
  therapy in a better way.
                      DOAST- NPK- Chennai- INDIA             24
VALIDITY
 Consistent replication lends validity,
 Supports the hypothesis that chronic
  inflammation could indeed be the common
  denominator.

                     Future research
We contemplate generating carefully characterized full
   genome expression profiling data to validate our
 biomedical approach and to study the involvement of
the intestinal flora in the inflammation related etiology
                         of autism.

                    DOAST- NPK- Chennai- INDIA          25
The core of our study will be a repeated
   measures examination of the interplay
 between the biology of inflammatory and
 oxidative stress markers on the one hand
and processing, connectivity and reactivity
   abnormalities on the other which may
  conceivably converge on to the autism
                  profile.

               DOAST- NPK- Chennai- INDIA   26
Proposed Study
 Examine the gastrointestinal
 metagenomic analysis of intestinal
 flora,
Non-coding RNA (ncRNA) expression
 profiles on lymphoblasts in a series of
 before and after comparison based
 molecular studies.

               DOAST- NPK- Chennai- INDIA   27
Outcome of the proposal
Generate direct evidence in favor of a causal
relationship between systemic inflammation and
autism,
 Generate diagnostic determinants for definition
of this variant of autism,
Define a link between diagnostics and treatment
by this and any future treatment technique.




                DOAST- NPK- Chennai- INDIA         28
In the least invasive manner, using this
      DOAST treatment modality as a
     physiological probe, we study the
linear, causal relationship between cellular-
  level changes and behavioural problems
 within the high performance environment
        of the human nervous system.


                DOAST- NPK- Chennai- INDIA   29
The identification of relationships between
  the multiple levels, all of which can be
   expected to shift based on both huge
   amounts of clinical experience and a
  growing wealth of published scientific
 data, will be a contribution to identifying
   treatment targets that simultaneously
address multiple features of autism at their
                    root.

                DOAST- NPK- Chennai- INDIA   30
While there are risks associated with any dogma
challenging proposal, the most compelling gains
    of this project is that success in any of the
 multiple facets of this investigation will lead to
 important new knowledge about epigenetic and
     molecular denominator based integrated
  therapeutic approaches for a heterogeneous
neural disorder that has so far not responded
         significantly to mono therapy.



                  DOAST- NPK- Chennai- INDIA      31
DOAST- NPK- Chennai- INDIA   32

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Positive Turn in Autism Research

  • 2. „DOAST Integrated Therapy‟ Successful in-vivo technique in synergy with Global research. Treatment Guided research which Follows the LEADS and focuses on safe and effective interventions DOAST- NPK- Chennai- INDIA 2
  • 3. Dr.Bernaud Rimland Authored the Neurobiological approach. The First POSITIVE TURN IN AUTISM RESEARCH Four decades of Global Research. Are we able to deliver peace at home? DOAST- NPK- Chennai- INDIA 3
  • 4.  Autism research exhibits analytical threads, but patterns remain fragmented lacking a unified concept.  As on date we lack a coherent view on brain function within the framework of other organ systems. DOAST- NPK- Chennai- INDIA 4
  • 5. POSITIVE APPROACH of DOAST „Instead of studying it through a symptom by symptom approach, autistic behavior should be understood better by studying the underlying intermediary biological processes‟ DOAST- NPK- Chennai- INDIA 5
  • 6. Emerging qualitative changes in clinical status including loss of diagnosis suggest that a more appropriate description for ASD could be a “chronic dynamic reversible encephalopathy” rather than “static encephalopathy” as considered so far. DOAST- NPK- Chennai- INDIA 6
  • 7. “Cognitive, emotional and synaptic functions of the brain basically rely on the macromolecular computing system of RNA protein- and protein to protein interactions which appear to be the result of fine grained information, encoded and accumulated over evolutionary time”. DOAST- NPK- Chennai- INDIA 7
  • 9. Neuro-Endo-Immune- GI Tract Network, Autonomic Balance, &Neurotransmitters. DOAST- NPK- Chennai- INDIA 9
  • 10. Genes, CNS-ENDO-IMMUNE-GI Molecular order, Bio feed back & Tract- Network Protein expression, Autonomic Balance Homeostasis Nerurotransmitters Neuronal connectivity. Upstream molecular unrest Altered Normal network Performance Downstream Homeostasis Social&Cognitive, Activities Systemic Inflammation Behavior&Cognitive dysfunction. Susceptible Genetic AUTISM landscape DOAST- NPK- Chennai- INDIA 10
  • 11. “Decreased connectivity is at the heart of autism‟. Fairly close regions of the brains involved in motor tasks have difficulty coordinating activity. It makes sense that social and communication skills are greatly impaired, as they involve more complex synchronous coordination between more distant areas of the brain. DOAST- NPK- Chennai- INDIA 11
  • 12. Consequences of inflammatory factors Breaking boundaries between the body and brain, Destabilization and loss of synaptic connections. DOAST- NPK- Chennai- INDIA 12
  • 13. Our Concept.. Upstream molecular unrest Down stream inflammation Dietary or environmental triggers, Synaptic Gut micro biome systemic inflammatory connectivity cytokines on a chronic basis affected in in susceptible individuals. DOAST- NPK- Chennai- INDIA 13
  • 14. Genes, CNS-ENDO-IMMUNE-GI Molecular order, Bio feed back & Tract- Network Protein expression, Autonomic Balance Homeostasis Nerurotransmitters Neuronal connectivity. Upstream molecular Normal order Performance Social&Cognitive, Restore Activities Network Downstream Homeostasis Molecular order INTEGRATED THERAPY Improved Behavior& Cellular Cognition Stressors Integrated Therapy Hypothesis DOAST- NPK- Chennai- INDIA 14
  • 15. Deviate from the „Hard wired‟ concept and „untreatable‟ stigma. Effectively treating the „downstream inflammatory pathology‟ could initiate reestablishment of „upstream molecular order‟ . Molecular order restored could activate the dormant neuronal pools, improve connectivity and restore functional integration. DOAST- NPK- Chennai- INDIA 15
  • 16. DOAST Integrated therapy Pioneering concept of therapeutic integration or fusion, where scientifically chosen traditional Indian treatment methods are applied with modern medical understanding to treat specific chronic ailments, and autism in particular. DOAST- NPK- Chennai- INDIA 16
  • 17. The Components of Integrated Therapy. The Science of Yoga, Ayurveda & Siddha & Modern medical expertise. DOAST- NPK- Chennai- INDIA 17
  • 18. Reducing Cellular stress Toxin elimination Rejuvenation and Regeneration. DOAST- NPK- Chennai- INDIA 18
  • 19. Prognostic Evaluation No reliable bio-marker. Observed improvements in behavior and cognition domains are the only reliable non-invasive indicators of restoration of molecular order and integration of the upstream neuronal pools. DOAST- NPK- Chennai- INDIA 19
  • 20. Patient selection. • DSM-IV guidelines, (CARS) and M-CHAT are the standard assessment tools used. • Patient pool represents a spectrum of severity observed in autistic patients in general. • Their racial origin is Asian. Age 3- 16 years. • Cohort of 30 individuals on different follow up period on this therapy since 2004. DOAST- NPK- Chennai- INDIA 20
  • 21. Therapeutic protocol  The prescribed diet „Sathvik Diet‟ practiced by the science Yoga.  Herbal medications, certified by the Ayurvedic [including Siddha] pharmacopia of India are administered.  Yoga technique is a combinatorial approach.  Oleation therapies with medicated oils. DOAST- NPK- Chennai- INDIA 21
  • 22. Ethical & safety guidelines followed  A well informed consent,  The therapy techniques and medicines are chosen by evidence based risk benefit ratio, proven over centuries in their clinical application,  One to one & Group basis application along with the parent,  Documentation on paper and video,  Pretreatment EEG and periodic monitoring of biochemical parameters to assess renal, hepatic and hematological functions. DOAST- NPK- Chennai- INDIA 22
  • 23. Assessment of Clinical benefits GI Tract, Eye contact, Play, Respiratory,  Communication, Sleep,  Empathy Morbidity, & Generalization are the behavior domains Emotions, chosen to assess and Behavior, quantify behavior and Cognition. cognitive improvement. DOAST- NPK- Chennai- INDIA 23
  • 24. Controls  We follow each patient, from the time of admission and through their recovery (or lack of it). Thus each participant in the study will serve as his/her own control.  Improvement is influenced by the age of induction into therapy, duration of follow-up and compliance to the details. Parental compliance to be proportional to the trust on therapy. Willful or accidental default in medicine or dietary regime 'influenced by the above listed „variables', resulted in temporary return of symptoms. Such events helped us understand the therapeutic role played by components of therapy in a better way. DOAST- NPK- Chennai- INDIA 24
  • 25. VALIDITY  Consistent replication lends validity,  Supports the hypothesis that chronic inflammation could indeed be the common denominator. Future research We contemplate generating carefully characterized full genome expression profiling data to validate our biomedical approach and to study the involvement of the intestinal flora in the inflammation related etiology of autism. DOAST- NPK- Chennai- INDIA 25
  • 26. The core of our study will be a repeated measures examination of the interplay between the biology of inflammatory and oxidative stress markers on the one hand and processing, connectivity and reactivity abnormalities on the other which may conceivably converge on to the autism profile. DOAST- NPK- Chennai- INDIA 26
  • 27. Proposed Study  Examine the gastrointestinal metagenomic analysis of intestinal flora, Non-coding RNA (ncRNA) expression profiles on lymphoblasts in a series of before and after comparison based molecular studies. DOAST- NPK- Chennai- INDIA 27
  • 28. Outcome of the proposal Generate direct evidence in favor of a causal relationship between systemic inflammation and autism, Generate diagnostic determinants for definition of this variant of autism, Define a link between diagnostics and treatment by this and any future treatment technique. DOAST- NPK- Chennai- INDIA 28
  • 29. In the least invasive manner, using this DOAST treatment modality as a physiological probe, we study the linear, causal relationship between cellular- level changes and behavioural problems within the high performance environment of the human nervous system. DOAST- NPK- Chennai- INDIA 29
  • 30. The identification of relationships between the multiple levels, all of which can be expected to shift based on both huge amounts of clinical experience and a growing wealth of published scientific data, will be a contribution to identifying treatment targets that simultaneously address multiple features of autism at their root. DOAST- NPK- Chennai- INDIA 30
  • 31. While there are risks associated with any dogma challenging proposal, the most compelling gains of this project is that success in any of the multiple facets of this investigation will lead to important new knowledge about epigenetic and molecular denominator based integrated therapeutic approaches for a heterogeneous neural disorder that has so far not responded significantly to mono therapy. DOAST- NPK- Chennai- INDIA 31