News Release

'Goldilocks' neonatal immune response may protect against autism

Mid-range level of immune protein associated with lowest risk

Peer-Reviewed Publication


Philadelphia, November 10, 2020 - The causes of autism spectrum disorder (ASD) - including genetic and environmental factors - are not entirely understood. Many studies have already shown that serious maternal infection during pregnancy is associated with increased risk for offspring in both people and animals. New research however, shows that the lowest risk for ASD is associated with mid-levels of an immune marker measured at birth - whereas too much or not enough were linked to increased risk.

The report from researchers at the Karolinska Institute in Sweden appears in Biological Psychiatry, published by Elsevier. The study hinges on the idea that the developing brain may be particularly vulnerable to disturbances in immune signaling and exposure to inflammation.

"We studied a set of molecules called acute phase proteins that are part of the innate immune system, which is our first line of defense against infections and is always monitoring the body for signs of invasion," said lead author Renee Gardner, PhD. "These molecules are circulating in our bloodstream all the time, but they can rise rapidly after exposure to infection."

The researchers examined the proteins from blood samples, taken at birth, of nearly 1,000 children with ASD and over 1,000 healthy controls from the Stockholm Youth Cohort, a Swedish health registry. Babies born with high levels of a classical marker of inflammation, called C-reactive protein (CRP), were at highest risk for ASD.

The thinking based on previous studies was simply that too much inflammation is bad for the developing brain. Surprisingly, however the lowest risk was associated with levels of CRP in the mid-range. "This means that too much inflammation may indeed be a bad thing for the developing brain, but so might too little, Dr. Gardner explained.

"Among newborn babies whose mothers had been hospitalized for an infection during pregnancy, those who were able to make a little more of these acute phase proteins tended to have a lower risk of autism. So it seems as if a greater ability to respond to the immediate environment might translate to a lower risk of autism," she added.

In a second part of the study, the researchers compared the immune protein levels at birth between children with ASD and their siblings without ASD. The unaffected siblings had higher levels of the immune markers than those with ASD. "This is interesting because siblings share about half their DNA, and the environment inside the womb and during the first few days of life are likely similar between siblings," Dr. Gardner said.

Another interesting finding relates to the risk for ASD posed by maternal anemia, or iron deficiency. Among babies whose mothers were anemic, those with the highest levels of the iron-binding protein ferritin in their blood - a proxy for iron levels - were protected from autism. That finding hints at the importance of iron status for the developing brain and may explain the anemia-linked risk of neurodevelopmental disorders.

"The association between markers of activation of the immune system at birth and the subsequent risk for autism could be important," said Biological Psychiatry editor John Krystal, MD. "We have been seeking avenues for prevention for ASD, such as mechanisms that could be targeted by medications before the onset of symptoms. However, we must be cautious as we do not yet know whether immune activation is a contributor or a marker of the risk for autism."


Notes for editors

The article is "Neonatal levels of acute phase proteins and risk of autism spectrum disorders," by Renee Gardner, Brian Lee, Martin Brynge, Hugo Sjöqvist, Christina Dalman, Håkan Karlsson ( It appears as an Article in Press in Biological Psychiatry, published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; please contact Rhiannon Bugno at or +1 254 522 9700. Journalists wishing to interview the authors may contact Renee Gardner at or +46 70 355 57 56, or contact the Karolinska Institute Press Office at or +46 8 524 860 77.

The authors' affiliations and disclosures of financial and conflicts of interests are available in the article.

John H. Krystal, MD, is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.

About Biological Psychiatry

Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.

The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.

Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 7th out of 155 Psychiatry titles and 12th out of 271 Neurosciences titles in the Journal Citations Reports® published by Clarivate Analytics. The 2019 Impact Factor score for Biological Psychiatry is 12.095.

About Elsevier

Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we're committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell , more than 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

Media contact

Rhiannon Bugno, Editorial Office
Biological Psychiatry
+1 254 522 9700

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