Researchers at MassGeneral Hospital for Children (MGHfC) have been selected to receive a grant of $1.5 million from the European Commission as part of an international consortium to study the role of the gut microbiome in autism spectrum disorders (ASD). GEMMA, which stands for Genome, Environment, Microbiome and Metabolome in Autism, plans to enroll 600 infants at risk of developing ASD at centers in Italy, Ireland and the U.S.

“We are in the midst of an epidemic of ASD, which parallels an increase in other chronic inflammatory disorders,” says Alessio Fasano, MD, director of the Mucosal Immunology and Biology Research Center (MIBRC) and chief of the Division of Pediatric Gastroenterology and Nutrition at MGHfC. “But the rate of growth is much steeper for ASD, with an increase from one in 500 children in the mid-1970s to a staggering one in 59 in 2018.”

According to a study from the London School of Economics, ASDs carry larger societal costs than cancer, heart disease and stroke combined. Fasano suspects that environmental factors might be helping to fuel this epidemic. “We want to follow infants at risk of ASD from birth, so we can follow, step by step, their progress toward ASD,” he says.

Collecting stool, tissue and blood samples from children over a 5-year period – along with environmental data – scientists will study the interaction of the gut microbiome and its related mechanisms with the intestinal barrier and immune response. The goal of GEMMA is to identify biomarkers – measurable changes in the gut microbiome – that could predict development of ASD in genetically predisposed infants.

Allan Walker, MD, founder of the MIBRC and honorary pediatrician at MGHfC, is Conrad Taff Professor of Nutrition at Harvard Medical School and an expert on probiotics, infant nutrition and the infant microbiome. He is lead principal investigator for the complex project that includes 16 organizations from the U.S., Finland, France, Italy, the Netherlands and the United Kingdom. The consortium, which also involves researchers from Johns Hopkins University, will employ experts in genomics, the microbiome, metabolomics, epidemiology, animal research models, clinical study design, biostatistics and artificial intelligence to build mathematical models to predict who will develop ASD.

“We have learned that gut microorganisms play a vital role in the development of the individual not only during infancy but even before birth,” says Walker. “If we can learn how the interactions of the intestinal micriobiota might drive some of the changes that lead to ASD, we can develop personalized, preventive measures for this devastating condition.”

GEMMA participants include scientists from the European Biomedical Research Institute of Salerno, Nutricia Research, Medinok, Bio-Modeling Systems, Euformatics, Theoreo SRL, National University of Ireland Galway, Azienda Sanitaria Locale Salerno, Consiglio Nazionale delle Ricerche, Institut National de la Recherche Agronomique, the French National Institute of Health and Medical Research, Utrecht University, Tampere University, Imperial College London, John Hopkins University and Massachusetts General Hospital for Children. Total funding for the GEMMA project is $16.6 million. GEMMA is one of three projects selected for funding by the European Commission as part of its Horizon 2020 Programme.

Founded in 1811, the Massachusetts General Hospital is the oldest and largest teaching hospital of Harvard Medical School. The 1,011-bed medical center each year admits more than 50,000 inpatients, handles more than 1.5 million visits to its extensive outpatient programs at the main campus and four health centers, and records nearly 109,000 emergency visits. The surgical staff perform more than 42,000 operations annually, and the MGH Vincent Obstetrics Service delivers nearly 3,900 babies a year. The largest nongovernment employer in the city of Boston, the MGH has more than 25,600 employees, including more than 5,000 registered nurses.  MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $900 million.  MGH and Brigham and Women's Hospital are founding members of Partners HealthCare System, a Boston-based integrated health care delivery system.  In 2003, MGH became the first hospital in the state to be awarded Magnet designation by the American Nurses Credentialing Center.  In August 2018, the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."