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- Gene-environment interactions in Autism Spectrum Disorder (ASD)Publication . Santos, João Xavier; Vicente, Astrid Moura; Nunes, AnaAutism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by deficits in social communication and interaction and repetitive and restricted behaviors. While heritability estimates support a role for gene-environment interactions in ASD etiology, there is a paucity of strategies that integrate both components. The objective of this work was to identify gene-environment interactions involved in ASD risk. Through a systematic literature review we identified neurotoxic xenobiotics previously implicated in ASD, including air pollutants and endocrine disruptors. Using a school-based screening strategy we provide an updated prevalence estimate for 7-9 years old children from Centro Region of Portugal, of 0.5% (95% CI: 0.3-0.7). Leveraging public air quality monitoring data we estimated early-life exposure to criteria air pollutants in 217 ASD-subjects, and show that exposure to particulate matter during critical neurodevelopmental windows is associated with a higher clinical severity of ASD. In silico inspection of large genetic datasets (N=6224) showed that ASD-subjects carry predicted-damaging variants in a panel of 77 genes involved in the regulation of detoxification and physiological barriers (blood-brain barrier and placenta) permeability (XenoReg genes). Database query indicates that these genes interact with ASD implicated xenobiotics. Through biochemical analyses of neonatal dried blood spots and the piloting of an early-life exposures assessment questionnaire we retrospectively collected environmental data for 70 ASD-children. The integration of environmental and sequencing data revealed a group of 13 patients for whom gene-environment interactions likely contributed to disease etiology. We present evidence that genetically-susceptible subjects might be at higher risk of ASD due to an increased vulnerability to early-life exposures. Possible underlying neuropathological mechanisms, including neuroinflammation, oxidative stress, endocrine disruption and epigenetics, warrant experimental validation. This work reinforces the need for clinical stratification and for monitoring early-life exposures, providing knowledge that, prospectively, may be translated to personalized medicine strategies applied in clinical practice.