Early skeletal outcomes after hematopoietic stem and progenitor cell gene therapy for Hurler syndrome

Mucopolysaccharidosis type I Hurler (MPSIH) is characterized by severe and progressive skeletal dysplasia that is not fully addressed by allogeneic hematopoietic stem cell transplantation (HSCT). Autologous hematopoietic stem progenitor cell-gene therapy (HSPC-GT) provides superior metabolic correction in patients with MPSIH compared with HSCT; however, its ability to affect skeletal manifestations is unknown. Eight patients with MPSIH (mean age at treatment: 1.9 years) received lentiviral-based HSPC-GT in a phase 1/2 clinical trial (NCT03488394). Clinical (growth, measures of kyphosis and genu velgum), functional (motor function, joint range of motion), and radiological [acetabular index (AI), migration percentage (MP) in hip x-rays and MRIs and spine MRI score] parameters of skeletal dysplasia were evaluated at baseline and multiple time points up to 4 years after treatment. Specific skeletal measures were retrospectively compared with an external cohort of HSCT-treated patients. At a median follow-up of 3.78 years after HSPC-GT, all patients treated with HSPC-GT exhibited longitudinal growth within WHO reference ranges and a median height gain greater than that observed in patients treated with HSCT after 3-year follow-up. Patients receiving HSPC-GT experienced complete and earlier normalization of joint mobility compared with patients treated with HSCT. Mean AI and MP showed progressive decreases after HSPC-GT, suggesting a reduction in acetabular dysplasia. Typical spine alterations measured through a spine MRI score stabilized after HSPC-GT. Clinical, functional, and radiological measures suggested an early beneficial effect of HSPC-GT on MPSIH-typical skeletal features. Longer follow-up is needed to draw definitive conclusions on HSPC-GT's impact on MPSIH skeletal dysplasia.

Mononuclear cell reactivity to food allergens in neonates, children and adults

A model of antigen-specific T-cell proliferative responses based on reciprocal patterns of responses to dietary and inhalant allergens has been suggested, the former being frequent in infancy but rare in adults, whereas the latter are preserved and expand between infancy and adulthood. We have evaluated the age-related variations of mononuclear cell reactivity to food allergens. The cord blood mononuclear cells (CBMC) of 30 neonates without family history of atopy and the peripheral blood mononuclear cells (PBMC) of 20 healthy children and of 40 healthy adults were stimulated in vitro with beta-lactoglobulin (BLG) or ovalbumin (OVA) and the cultures were harvested after 7 days. Neonates, children and adults were compared for the percentages of positive responses and for the magnitude of response. Adult subjects showed significantly lower percentages of positive responses and reduced magnitude of response than those observed in neonates and children either in BLG or in OVA cultures. We have not observed a decrease of food allergen mononuclear cell reactivity between neonates and children for the frequency of positive responses. The magnitude of response of neonates was significantly lower than that of children in BLG cultures. Our results seem to confirm the loss of mononuclear cell reactivity to food allergens in adult age. However, other reports show conflicting data. We suggest that a rigorous standardization of the methodological steps of in vitro mononuclear cell stimulation with allergen is necessary.

[Early deterioration of the mother-child relation. "Time with families" as a model for prevention and therapy]

"Time with families" is the model of service presented in this paper. Its approach is rooted in the theory of attachment by J. Bowlby. Starting from the observation of attachment patterns in mothers and children, this Service aims at promoting short-term, cost-effective and highly focused interventions enabling the child to structure secure "Internal Working Models". "Time with families" started in 1988 in the area served by the Health Welfare District 36 in Lombardia, as an integrated socio-sanitary program aimed at preventing problems in the early relations between mother and child. This program is the result of a cooperation between different services, including SIMEE, Family and Pediatric Counselling Services and Social Services. Three are the main components of the program: 1) the "First Days" program, based on health visits made by professionals to support the new mother in taking care of the newborn; 2) the clinic of child neuropsychiatry to evaluate and treat problems in the early relation between mother and child during his first three years of life through two technical approaches: short mother-child psychotherapy and functions' integrated therapy; 3) "Time with families", with a Day Center open for parents and children to ease their reciprocal relationships in this period of life, to start and realize clinical interventions and to offer individual and group counselling to parents. Thanks to this varied offer of services, its flexibility and multidisciplinarity of its approach, "Time with families" can be considered a bridge service between prevention and therapy, able to monitor and follow-up parents' and children's health conditions and to determine their styles of attachment so to intervene in at-risk situations to prevent future complications or long term consequences.

In vitro IgE synthesis in neonates with different family history of atopy

In this study we want to correlate family history of atopy and in vitro synthesis of IgE, IL4 and IFN gamma in 5 neonates with biparental (group A), 5 with uniparental (group B) and 5 with absent family history of atopy (group C). An aliquot of neonatal blood mononuclear cells (NBMC) was incubated in presence of PHA in combination with the phorbol ester acetate (TPA). The supernatants of cultures were harvested after 48-72 hours of incubation and stored at -20 degrees C until testing for lymphokine production by ELISA kits. Only one neonate of group B showed detectable in vitro synthesis of IL4 (45 pg/ml) after PHA + TPA stimulation. All the others failed to produce detectable levels either of IL4 or IFN gamma. Another aliquot of NBMC was cultured in the presence of saturating concentrations of rhIL4 for 48 h. After this pre-incubation step, the non-adherent cells were cultured in the presence of: 1) rhIL4; 2) rhIL4 + anti-IL4 antibody (Ab); 3) rhIL4 + anti-IFN gamma Ab; 4) rhIFN gamma, 5) rhIFN gamma + anti-IFN gamma Ab + rhIL4; 6) PWM + rhIL4; 7) unstimulated culture. The supernatants of these cultures were tested for their IgE content. In general, spontaneous IgE production by NBMC was very low, rhIL4 did not induce a significant increase of IgE synthesis. The other modalities of stimulations did not produce significative changes. We did not observe significative differences among the three groups of neonates. On the basis of our results, we conclude that NBMC aren't able to produce significative amounts of IgE in vitro either spontaneously or after IL4 stimulation. This test and the evaluation of IL4 and IFN gamma in vitro production aren't useful markers of atopy predisposition.