Hematopoietic stem cell transplantation in children with chronic granulomatous disease: the Spanish experience

Introduction

Hematopoietic stem cell transplantation (HCT) can cure chronic granulomatous disease (CGD). However, transplant-associated morbidity or mortality may occur, and it is still controversial which patients benefit from this procedure. The aim of this retrospective study was to evaluate the outcome of pediatric patients who received HCT in one of the Spanish pediatric transplant units.

Results

Thirty children with a median age of 6.9 years (range 0.6-12.7) were evaluated: 8 patients received a transplant from a sibling donor (MSD), 21 received a transplant from an unrelated donor (UD), and 1 received a haploidentical transplant. The majority of the patients received reduced-intensity conditioning regimens based on either busulfan plus fludarabine or treosulfan. Relevant post-HCT complications were as follows: i) graft failure (GF), with a global incidence of 28.26% (CI: 15.15-48.88), 11.1% in patients with MSD (1.64-56.70) and 37.08% in unrelated donors (19.33-63.17); and ii) chronic graft-versus-host disease (GVHD), with an incidence of 20.5% (8.9-43.2), 11.1% in patients with MSD (1.64-56.70) and 26.7% in unrelated donors (10.42-58.44). Post-HCT infections were usually manageable, but two episodes of pulmonary aspergillosis were diagnosed in the context of graft rejection. The 2-year OS was 77.3% (55.92-89.23). There were no statistically significant differences among donor types.

Discussion

HCT in patients with CGD is a complex procedure with significant morbidity and mortality, especially in patients who receive grafts from unrelated donors. These factors need to be considered in the decision-making process and when discussing conditioning and GVHD prophylaxis.

Extensive Axonal and Glial Fiber Growth from Fetal Porcine Cortical Xenografts in the Adult Rat Cortex

Axonal growth from cortically placed fetal neural transplants to subcortical targets in adult hosts has been difficult to demonstrate and is assumed to be minimal; however, experiments using xenogeneic neural grafts of either human or porcine fetal tissues into the adult rat striatum, mesencephalon, and spinal cord have demonstrated the capability for long-distance axonal growth. This study reports similar results for porcine cortical xenografts placed in the adult rat cerebral cortex and compares these findings with results from cortical allografts. Adult rats that previously received unilateral cortical lesions by an oblique intracortical stereotaxic injection of quinolinic acid, were implanted with suspensions of either E14 rat or E38 xenogeneic porcine fetal cortical cells. Xenografted rats were immunosuppressed by cyclosporin A. The corpus callosum was intact in all cases and grafts were confined to the overlying cortex. After a 31-34 wk posttransplant survival period, acetylcholinesterase (AChE) staining and tyrosine hydroxylase (TH) immunocytochemistry revealed that both allo- and xenografts received host afferents. Retrograde tracer injections into the ipsilateral striatum and cerebral peduncle in allografted animals failed to show any axonal growth to either subcortical target. Using a porcine-specific axonal marker in xenografted animals, we found graft axons in white matter tracts (corpus callosum, internal capsule, cingulum bundle, and medial forebrain bundle) and within the caudate-putamen and both the ipsilateral and contralateral cerebral cortex. Graft axons were not found in the thalamus, midbrain, or spinal cord. In addition, using an antibody to porcine glial fibers, we observed more extensive graft glial fiber growth into the same host fiber tracts, as far caudally as the cerebral peduncle, but not into gray matter targets outside the cortex. These results demonstrate that porcine cortical xenograft axons and glia can extend from lesioned cerebral cortex to cortical and subcortical targets in the adult rat brain. These findings are relevant for prospects of repairing cortical damage and obtaining functional recovery.

Total Absorption Spectroscopy Study of (92)Rb Decay: A Major Contributor to Reactor Antineutrino Spectrum Shape

The antineutrino spectra measured in recent experiments at reactors are inconsistent with calculations based on the conversion of integral beta spectra recorded at the ILL reactor. (92)Rb makes the dominant contribution to the reactor antineutrino spectrum in the 5-8 MeV range but its decay properties are in question. We have studied (92)Rb decay with total absorption spectroscopy. Previously unobserved beta feeding was seen in the 4.5-5.5 region and the GS to GS feeding was found to be 87.5(25)%. The impact on the reactor antineutrino spectra calculated with the summation method is shown and discussed.

Enhanced γ-Ray Emission from Neutron Unbound States Populated in β Decay

Total absorption spectroscopy is used to investigate the β-decay intensity to states above the neutron separation energy followed by γ-ray emission in (87,88)Br and (94)Rb. Accurate results are obtained thanks to a careful control of systematic errors. An unexpectedly large γ intensity is observed in all three cases extending well beyond the excitation energy region where neutron penetration is hindered by low neutron energy. The γ branching as a function of excitation energy is compared to Hauser-Feshbach model calculations. For (87)Br and (88)Br the γ branching reaches 57% and 20%, respectively, and could be explained as a nuclear structure effect. Some of the states populated in the daughter can only decay through the emission of a large orbital angular momentum neutron with a strongly reduced barrier penetrability. In the case of neutron-rich (94)Rb the observed 4.5% branching is much larger than the calculations performed with standard nuclear statistical model parameters, even after proper correction for fluctuation effects on individual transition widths. The difference can be reconciled by introducing an enhancement of 1 order of magnitude in the photon strength to neutron strength ratio. An increase in the photon strength function of such magnitude for very neutron-rich nuclei, if it proves to be correct, leads to a similar increase in the (n,γ) cross section that would have an impact on r process abundance calculations.

The characterization of a murine model of mucopolysaccharidosis II (Hunter syndrome)

Mucopolysaccharidosis II (MPS II, Hunter syndrome in humans) is an X-linked inherited lysosomal storage disease caused by a deficiency in the lysosomal enzyme iduronate-2-sulfatase (I2S). I2S catalyses a step in the catabolism of glycosaminoglycans (GAGs) dermatan sulfate and heparan sulfate, and when it is deficient or absent GAGs accumulate in tissues and organs. Male knockout mice (IdS-KO), which lack the gene coding for I2S, exhibit many of the characteristics seen in the human disease. Compared to wild-type control mice, urine GAG excretion was elevated at 4 weeks of age and remained high throughout the lifespan, and tissue GAG levels were elevated as early as 7 weeks of age. Liver, spleen and other organs were significantly larger in the IdS-KO mice than in the wild-type. Radiographic examination revealed sclerosis and enlargement of the skull at 4 weeks of age and appendicular bone enlargement at 10-13 weeks of age. Micro CT scans showed severe periosteal bone formation at the lateral aspect of the distal tibia and calcification of the calcaneus tendon. This model was used in the development of idursulfase for treatment of MPS II and may continue to be useful in the evaluation of treatment strategies of this chronic and progressive disorder.

A comparison of methods to determine amino acid digestibility of feed ingredients for chickens

Two experiments were conducted to compare standardized ileal amino acid (AA) digestibility in 7- and 21-d-old chicks and true AA digestibility as determined by the precision-fed cecectomized rooster assay for several ingredients used in poultry feeds. Diets were formulated to contain soybean meal, cottonseed meal, poultry by-product meal, and fish meal in experiment 1 and corn, wheat, soybean meal, poultry by-product meal, feather meal, and fish meal in experiment 2 as the sole sources of protein. Celite, used as an indigestible marker, was added at 1.5% of the diet. The test diets were fed ad libitum to broiler chicks from 0 to 7 d of age in experiment 1 and from 4 to 7 and 17 to 21 d of age in experiment 2. Ileal digesta samples were collected after euthanizing the birds at 7 d of age in experiment 1 and at 7 and 21 d of age in experiment 2. Additionally, cecectomized, Single-Comb White Leghorn roosters were used for crop intubation of the test diets for determination of true AA digestibility. In experiment 1, AA digestibility of all ingredients tested was significantly lower at 7 d of age than when determined by the rooster assay. In experiment 2, no differences were detected between AA digestibility at 7 or 21 d of age in the chick assay for the majority of the indispensable AA. However, the AA digestibility coefficients obtained by the chick assay at 7 d and, in some cases, at 21 d of age, were significantly lower than those obtained by the rooster assay. In conclusion, there were differences in the AA digestibility coefficients obtained through the chick and the rooster assays. Such discrepancies could be associated with an age effect or the methodological differences between both methods.

Variations in the digestible lysine requirement of broiler chickens due to sex, performance parameters, rearing environment, and processing yield characteristics

Four experiments were conducted to evaluate variations in the digestible lysine (DLYS) requirement estimates of broilers due to rearing environment, sex, or growth performance during the starter period (7 to 21 d) and due to sex, growth, and carcass yield characteristics during the grower period (21 to 38 d). In the first 3 experiments, chicks were allocated to either battery or floor pens. The fourth experiment was conducted during the grower period with birds reared in floor pens only. All the studies used a lysine-deficient corn-soybean meal-corn gluten meal basal diet formulated to be isonitrogenous and isocaloric. Treatments consisted of 5 graded levels of DLYS varying from 0.70 to 1.21% in the first 3 experiments and from 0.73 to 1.13% in the fourth experiment. The DLYS requirement was estimated by broken-line methodology based on body weight gain (BWG) and gain:feed ratio (G:F) for the starter period, and the same variables plus breast meat yield for the grower period. During the starter period, the average DLYS requirement of males based on BWG was slightly higher than that of females reared in battery (0.96 vs. 0.94%) or floor pens (0.98 vs. 0.93%). However, based on G:F, the average DLYS requirement of females was slightly higher than that of males reared in both battery (0.99 vs. 0.96%) and floor pens (1.01 vs. 0.99). The DLYS requirement based on G:F was higher than that based on BWG only for females in both rearing environments. Rearing environment did not affect the DLYS requirement of broilers during the starter period. In the grower period, the DLYS requirement of males was higher than that of females based on BWG (0.97 vs. 0.93%), but for G:F it was similar for both sexes (0.96%). The DLYS requirement for females based on G:F was higher than that based on BWG. The DLYS requirement for maximum breast meat yield of males (0.98%) or females (0.90%) was similar to the estimate for maximal growth performance.

Joint vibration analysis in patients with articular inflammation

The study of articular sounds using a computerized system (SonoPAK) in patients with temporomandibular disorders (TMD) of inflammatory origin revealed an increase of vibratory energy when compared to asymptomatic individuals. The following conclusions were reached: 1. The amount of vibratory energy registered in these patients ranged from 8.50 to 57.61 Hz. The major vibrations occurred in the middle of the mandibular opening cycle; 2. The mean vibratory energy measured at less than 300 Hz was between 5.70 and 48.64 Hz and at higher than 300 Hz was between 3.70 and 8.99 Hz; 3. The peak amplitude in the patients with inflammation ranged from 0.35 to 3.96 Pascal and the peak of frequency from 83.20 to 120.20 Hz.

Joint vibrations analysis in asymptomatic volunteers and symptomatic patients

The joint sound is a common sign in TMD. The diagnosis is important to establish the treatment of pathological alterations which occur in the TMJ. In this study, two groups were selected: 1. Asymptomatic volunteers; and 2. Symptomatic patients who were diagnosed in a clinical examination. After the initial examination, they were submitted to evaluation using electrovibratography (SonoPAK II, BioResearch Assoc., Inc., Milwaukee, Wisconsin). The analysis of results indicated that the averages of the vibratory energy in the symptomatic group presented higher values in all stages of the mandibular movement when compared to the averages of vibratory energy registered in the asymptomatic group.

Extensive axonal and glial fiber growth from fetal porcine cortical xenografts in the adult rat cortex

Axonal growth from cortically placed fetal neural transplants to subcortical targets in adult hosts has been difficult to demonstrate and is assumed to be minimal; however, experiments using xenogeneic neural grafts of either human or porcine fetal tissues into the adult rat striatum, mesencephalon, and spinal cord have demonstrated the capability for long-distance axonal growth. This study reports similar results for porcine cortical xenografts placed in the adult rat cerebral cortex and compares these findings with results from cortical allografts. Adult rats that previously received unilateral cortical lesions by an oblique intracortical stereotaxic injection of quinolinic acid, were implanted with suspensions of either E14 rat or E38 xenogeneic porcine fetal cortical cells. Xenografted rats were immunosuppressed by cyclosporin A. The corpus callosum was intact in all cases and grafts were confined to the overlying cortex. After a 31-34 wk posttransplant survival period, acetylcholinesterase (AChE) staining and tyrosine hydroxylase (TH) immunocytochemistry revealed that both allo- and xenografts received host afferents. Retrograde tracer injections into the ipsilateral striatum and cerebral peduncle in allografted animals failed to show any axonal growth to either subcortical target. Using a porcine-specific axonal marker in xenografted animals, we found graft axons in white matter tracts (corpus callosum, internal capsule, cingulum bundle, and medial forebrain bundle) and within the caudate-putamen and both the ipsilateral and contralateral cerebral cortex. Graft axons were not found in the thalamus, midbrain, or spinal cord. In addition, using an antibody to porcine glial fibers, we observed more extensive graft glial fiber growth into the same host fiber tracts, as far caudally as the cerebral peduncle, but not into gray matter targets outside the cortex. These results demonstrate that porcine cortical xenograft axons and glia can extend from lesioned cerebral cortex to cortical and subcortical targets in the adult rat brain. These findings are relevant for prospects of repairing cortical damage and obtaining functional recovery.

Gasdynamic focusing in an underexpanded jet

Gasdynamic focusing is demonstrated to concentrate a sample stream along the flow axis in an underexpanded supersonic jet. The focusing is characterized, using the technique of laser-induced fluorescence, for an I(2) seeded He expansion at pressure ratios between 2 and 6. The spatial fluorescence profile is monitored via array detection as a function of the sample and sheath volume flow rates and pressures. For source pressures between 10 and 100 Torr, the results obtained can be qualitatively understood using the model of hydrodynamic focusing. The observed deviations from this model are discussed in terms of gaseous diffusion and jet expansion.

Insulin binding and glucose transport activity in cardiomyocytes of a diabetic rat

We studied insulin binding and glucose transport in isolated adult cardiomyocytes from rats with 2-wk streptozotocin-induced diabetes. At 37 degrees C, cells from diabetic rats bound less 125I-insulin and exhibited lower rates of 3-O-methylglucose transport than cells from control rats. In contrast, the amount of 125I-insulin bound to myocytes at 4 degrees C was the same in both groups. Preincubation of cells from both groups with 10-10,000 ng/ml insulin significantly increased their basal rates of glucose transport by approximately 40%. However, the augmented rates in diabetics were still approximately 36% lower than the corresponding insulin-stimulated rates in the controls. When the glucose transport data were expressed as percent maximal insulin effect and plotted as a function of the amount of insulin bound, the curves obtained from both diabetic and nondiabetic controls were superimposable. These data demonstrate that 1) heart cells from diabetic rats bind less insulin than from control rats under conditions in which they exhibit impaired glucose transport rates, 2) there is no apparent difference in total receptor number between the two groups, but internalization of intact insulin appears to be diminished in diabetes, 3) coupling exists between insulin binding and glucose transport in both groups, and 4) these impaired processes are completely reversed by insulin treatment in vivo but not in vitro.

Thyrotropin-releasing hormone (TRH) increases morbidity and mortality in the gerbil stroke model

The gerbil model for stroke, using permanent unilateral carotid artery occlusion and restriction of the contralateral artery, was used to assess exogenous thyrotropin-releasing hormone (TRH, 10 mg/kg, i.p.) effect on cerebral ischemia. TRH immediately post-occlusion, compared to saline controls, significantly increased mortality (P = 0.025). This was supported by worsening reflected in the stroke index and time to death. Thyrotropin (0.1 IU, i.p.) in the same model was without effect. These surprising results were unexpected due to the beneficial response to the pharmacologically related naloxone.

Effect of angiotensin-converting enzyme inhibitor (SQ 20881) on the plasma concentration of angiotensin I, angiotensin II, and arginine vasopressin in the dog during hemorrhagic shock

The effect of an angiotensin-converting enzyme inhibitor on the circulating levels of angiotensin I, angiotensin II, and arginine vasopressin was studied in dogs subjected to hypotensive hemorrhagic shock. In dogs subjected to hemorrhage but not given the inhibitor, angiotensin II rose 20-fold (from 69 to 1,343 pg/ml of plasma), whereas in dogs subjected to hemorrhage but pretreated with the inhibitor, angiotensin II rose only 2-fold (from 92 to 171 pg/ml of plasma). In the pretreated dogs angiotensin I rose 30-fold (from 108 to 3,232 pg/ml of plasma). There was no statistically significant difference between the vasopressin levels found in the untreated dogs and the levels found in dogs given the inhibitor (1,016 and 1,095 pg/ml of plasma). Of the 15 dogs in the untreated group, five died before retransfusion was completed (four of cardiac failure and one of cardiac arrhythmia); none of the 10 dogs in the inhibitor-treated group died. These observations suggest that the very high levels of angiotensin II observed following severe hemorrhage do not contribute significantly to the increased secretion of vasopressin and that the inhibitor protects against death, possibly by suppressing the very high blood levels of angiotensin II observed following this type of experimental hemorrhagic shock.