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De Martino L, Russo C, Bifano D, Quaglietta L, Spennato P, Cinalli G. Pineocytoma in a child with Pallister-Killian syndrome: a case report and review of the literature. Childs Nerv Syst 2024:10.1007/s00381-024-06426-4. [PMID: 38689102 DOI: 10.1007/s00381-024-06426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024]
Abstract
Pallister-Killian syndrome (PKS; OMIM #601803) is a rare genetic disorder typically characterized by developmental delay, seizures, sparse temporal hair, and facial dysmorphisms. PKS is most frequently caused by mosaic supernumerary isochromosome 12p. Here, we report a 27-month-old girl with a prenatal diagnosis of PKS and a histopathological diagnosis of pineocytoma.
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Affiliation(s)
- Lucia De Martino
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Carmela Russo
- Neuroradiology Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Delfina Bifano
- Patology Unit, Department of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pietro Spennato
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
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Bibbò F, Asadzadeh F, Boccia A, Sorice C, Bianco O, Saccà CD, Majello B, Donofrio V, Bifano D, De Martino L, Quaglietta L, Cristofano A, Covelli EM, Cinalli G, Ferrucci V, De Antonellis P, Zollo M. Targeting Group 3 Medulloblastoma by the Anti-PRUNE-1 and Anti-LSD1/KDM1A Epigenetic Molecules. Int J Mol Sci 2024; 25:3917. [PMID: 38612726 PMCID: PMC11011515 DOI: 10.3390/ijms25073917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
Medulloblastoma (MB) is a highly malignant childhood brain tumor. Group 3 MB (Gr3 MB) is considered to have the most metastatic potential, and tailored therapies for Gr3 MB are currently lacking. Gr3 MB is driven by PRUNE-1 amplification or overexpression. In this paper, we found that PRUNE-1 was transcriptionally regulated by lysine demethylase LSD1/KDM1A. This study aimed to investigate the therapeutic potential of inhibiting both PRUNE-1 and LSD1/KDM1A with the selective inhibitors AA7.1 and SP-2577, respectively. We found that the pharmacological inhibition had a substantial efficacy on targeting the metastatic axis driven by PRUNE-1 (PRUNE-1-OTX2-TGFβ-PTEN) in Gr3 MB. Using RNA seq transcriptomic feature data in Gr3 MB primary cells, we provide evidence that the combination of AA7.1 and SP-2577 positively affects neuronal commitment, confirmed by glial fibrillary acidic protein (GFAP)-positive differentiation and the inhibition of the cytotoxic components of the tumor microenvironment and the epithelial-mesenchymal transition (EMT) by the down-regulation of N-Cadherin protein expression. We also identified an impairing action on the mitochondrial metabolism and, consequently, oxidative phosphorylation, thus depriving tumors cells of an important source of energy. Furthermore, by overlapping the genomic mutational signatures through WES sequence analyses with RNA seq transcriptomic feature data, we propose in this paper that the combination of these two small molecules can be used in a second-line treatment in advanced therapeutics against Gr3 MB. Our study demonstrates that the usage of PRUNE-1 and LSD1/KDM1A inhibitors in combination represents a novel therapeutic approach for these highly aggressive metastatic MB tumors.
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Affiliation(s)
- Francesca Bibbò
- Department of Molecular Medicine and Medical Biotechnological DMMBM, University Federico II of Naples, 80131 Naples, Italy; (F.B.); (V.F.); (P.D.A.)
- CEINGE Biotecnologie Avanzate “Franco Salvatore”, 80131 Naples, Italy; (F.A.); (A.B.); (C.S.); (O.B.)
| | - Fatemeh Asadzadeh
- CEINGE Biotecnologie Avanzate “Franco Salvatore”, 80131 Naples, Italy; (F.A.); (A.B.); (C.S.); (O.B.)
- SEMM European School of Molecular Medicine, 20139 Milan, Italy
| | - Angelo Boccia
- CEINGE Biotecnologie Avanzate “Franco Salvatore”, 80131 Naples, Italy; (F.A.); (A.B.); (C.S.); (O.B.)
| | - Carmen Sorice
- CEINGE Biotecnologie Avanzate “Franco Salvatore”, 80131 Naples, Italy; (F.A.); (A.B.); (C.S.); (O.B.)
| | - Orazio Bianco
- CEINGE Biotecnologie Avanzate “Franco Salvatore”, 80131 Naples, Italy; (F.A.); (A.B.); (C.S.); (O.B.)
| | - Carmen Daniela Saccà
- Department of Biology, University Federico II of Naples, 80138 Naples, Italy; (C.D.S.); (B.M.)
| | - Barbara Majello
- Department of Biology, University Federico II of Naples, 80138 Naples, Italy; (C.D.S.); (B.M.)
| | - Vittoria Donofrio
- Department of Pathology, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy; (V.D.); (D.B.)
| | - Delfina Bifano
- Department of Pathology, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy; (V.D.); (D.B.)
| | - Lucia De Martino
- Pediatric Neuro-Oncology, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy; (L.D.M.); (L.Q.)
| | - Lucia Quaglietta
- Pediatric Neuro-Oncology, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy; (L.D.M.); (L.Q.)
| | - Adriana Cristofano
- Pediatric Neuroradiology, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy; (A.C.); (E.M.C.)
| | - Eugenio Maria Covelli
- Pediatric Neuroradiology, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy; (A.C.); (E.M.C.)
| | - Giuseppe Cinalli
- Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital, AORN, 80129 Naples, Italy;
| | - Veronica Ferrucci
- Department of Molecular Medicine and Medical Biotechnological DMMBM, University Federico II of Naples, 80131 Naples, Italy; (F.B.); (V.F.); (P.D.A.)
- CEINGE Biotecnologie Avanzate “Franco Salvatore”, 80131 Naples, Italy; (F.A.); (A.B.); (C.S.); (O.B.)
| | - Pasqualino De Antonellis
- Department of Molecular Medicine and Medical Biotechnological DMMBM, University Federico II of Naples, 80131 Naples, Italy; (F.B.); (V.F.); (P.D.A.)
- CEINGE Biotecnologie Avanzate “Franco Salvatore”, 80131 Naples, Italy; (F.A.); (A.B.); (C.S.); (O.B.)
| | - Massimo Zollo
- Department of Molecular Medicine and Medical Biotechnological DMMBM, University Federico II of Naples, 80131 Naples, Italy; (F.B.); (V.F.); (P.D.A.)
- CEINGE Biotecnologie Avanzate “Franco Salvatore”, 80131 Naples, Italy; (F.A.); (A.B.); (C.S.); (O.B.)
- DAI Medicina di Laboratorio e Trasfusionale, ‘AOU Federico II Policlinico’, 80131 Naples, Italy
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De Martino L, Picariello S, Russo C, Errico ME, Spennato P, Papa MR, Normanno N, Scimone G, Colafati GS, Cacchione A, Mastronuzzi A, Massimino M, Cinalli G, Quaglietta L. Extra-neural metastases in pediatric diffuse midline gliomas, H3 K27-altered: presentation of two cases and literature review. Front Mol Neurosci 2023; 16:1152430. [PMID: 37547920 PMCID: PMC10398382 DOI: 10.3389/fnmol.2023.1152430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Pediatric diffuse midline gliomas (DMG), H3 K27- altered, are the most aggressive pediatric central nervous system (CNS) malignancies. Disease outcome is dismal with a median survival of less than one year. Extra-neural metastases are an unusual occurrence in DMG and have been rarely described. Methods and results Here, we report on two pediatric patients affected by DMG with extra-neural dissemination. Their clinical, imaging, and molecular characteristics are reported here. An 11-year-old male 5 months after the diagnosis of diffuse intrinsic pontine glioma (DIPG) developed metastatic osseous lesions confirmed with computed tomography (CT) guided biopsy of the left iliac bone. The patient died one month after the evidence of metastatic progression. Another 11-year-old female was diagnosed with a cerebellar H3K27- altered DMG. After six months, she developed diffuse sclerotic osseous lesions. A CT-guided biopsy of the right iliac bone was non-diagnostic. She further developed multifocal chest and abdominal lymphadenopathy and pleural effusions. Droplet digital polymerase chain reaction (ddPCR) on pleural effusion revealed the presence of H3.3A mutation (c.83A>T, p.K28M). The patient died 24 months after the diagnosis of DMG and 3 months after the evidence of metastatic pleural effusion. Discussion Extra-neural metastasis of DMG is a rare event and no standard therapy exists. An accurate and early diagnosis is necessary in order to develop a personalized plan of treatment. Further research is needed to gain further insights into the molecular pathology of DMG, H3K27- altered and improve the quality of life and the final outcome of patients with this deadly disease.
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Affiliation(s)
- Lucia De Martino
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Stefania Picariello
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Carmela Russo
- Neuroradiology Unit, Department of Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Elena Errico
- Patology Unit, Department of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pietro Spennato
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Rosaria Papa
- Department of Paediatric Haematology/Oncology, Cell Therapy, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Nicola Normanno
- Cell Biology and Biotherapy Unit, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Giuseppe Scimone
- Radiotherapy Unit, AOU San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giovanna Stefania Colafati
- Oncological Neuroradiology Unit, Department of Imaging, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonella Cacchione
- Neurooncology Unit, Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Angela Mastronuzzi
- Neurooncology Unit, Department of Paediatric Haematology/Oncology, Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maura Massimino
- Pediatric Oncology, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milan, Italy
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
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Spinelli C, Ghionzoli M, Sahli LI, Guglielmo C, Frascella S, Romano S, Ferrari C, Gennari F, Conzo G, Morganti R, De Napoli L, Quaglietta L, De Martino L, Picariello S, Grandone A, Luongo C, Gambale A, Patrizio A, Fallahi P, Antonelli A, Ferrari SM. DICER1 Syndrome: A Multicenter Surgical Experience and Systematic Review. Cancers (Basel) 2023; 15:3681. [PMID: 37509342 PMCID: PMC10377723 DOI: 10.3390/cancers15143681] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/13/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
DICER1 syndrome is a rare genetic disorder that predisposes patients to the development of malignant and non-malignant diseases. Presently, DICER1 syndrome diagnosis still occurs late, usually following surgical operations, affecting patients' outcomes, especially for further neoplasms, which are entailed in this syndrome. For this reason, herein we present a multicenter report of DICER1 syndrome, with the prospective aim of enhancing post-surgical surveillance. A cohort of seven patients was collected among the surgical registries of Pediatric Surgery at the University of Pisa with the General and Oncologic Surgery of Federico II, University of Naples, and the Pediatric Surgery, Regina Margherita Hospital, University of Turin. In each case, the following data were analyzed: sex, age at diagnosis, age at first surgery, clinical features, familial, genetic investigations, and follow-up. A comprehensive literature review of DICER1 cases, including case reports and multicenter studies published from 1996 to June 2022, was performed. Eventually, the retrieved data from the literature were compared with the data emerging from our cohort of patients.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Marco Ghionzoli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Linda Idrissi Sahli
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Carla Guglielmo
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Silvia Frascella
- Division of Pediatric Surgery, Department of Surgical Pathology, University of Pisa, 56126 Pisa, Italy
| | - Silvia Romano
- Departmental Section of Medical Genetics, S. Chiara Hospital, 56126 Pisa, Italy
| | - Carlo Ferrari
- Division of Pediatric Surgery, Regina Margherita Hospital, 10126 Turin, Italy
| | - Fabrizio Gennari
- Division of Pediatric Surgery, Regina Margherita Hospital, 10126 Turin, Italy
| | - Giovanni Conzo
- Division of General and Oncologic Surgery-Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Via Pansini 1, 80131 Naples, Italy
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56124 Pisa, Italy
| | - Luigi De Napoli
- Division of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and of the Critic Area, University of Pisa, 56126 Pisa, Italy
| | - Lucia Quaglietta
- Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children's Hospital, 80123 Naples, Italy
| | - Lucia De Martino
- Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children's Hospital, 80123 Naples, Italy
| | - Stefania Picariello
- Neuro-Oncology Unit, Department of Paediatric Oncology, Santobono-Pausilipon Children's Hospital, 80123 Naples, Italy
| | - Anna Grandone
- Department of Woman, Child of General and Specialized Surgery, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Caterina Luongo
- Department of Woman, Child of General and Specialized Surgery, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Antonella Gambale
- CEINGE Advanced Biotechnology, 80131 Naples, Italy
- Integrated Care Department of Laboratory Medicine, Unit of Medical Genetics, Federico II Hospital, 80131 Naples, Italy
| | - Armando Patrizio
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy
| | - Poupak Fallahi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Alessandro Antonelli
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
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Spennato P, Onorini N, Vitulli F, Imperato A, De Martino L, Ruggiero C, Cinalli G. Endoscopic ultrasonic resection of calcified tumor of the third ventricle. Neurosurg Focus Video 2023; 8:V6. [PMID: 37089748 PMCID: PMC10114909 DOI: 10.3171/2023.1.focvid22143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 01/17/2023] [Indexed: 04/25/2023]
Abstract
In this video, the authors present ultrasonic resection of calcified tumor of the third ventricle in a 12-year-old boy. He presented to the emergency department with a 1-week history of headache, drowsiness, and bilateral papilledema. Despite extensive calcification visible on a CT scan, a minimally invasive pure endoscopic approach was chosen. The use of an ultrasonic aspirator allows fast and safe removal of the tumor. The histological diagnosis was a low-grade glioneuronal tumor. In conclusion, the endoscopic ultrasonic aspirator is a useful tool to resect tumors in the ventricular system. The presence of calcifications within the tumor does not contraindicate an endoscopic approach. The video can be found here: https://stream.cadmore.media/r10.3171/2023.1.FOCVID22143.
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Affiliation(s)
- Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital AORN, Naples
| | - Nicola Onorini
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital AORN, Naples
| | - Francesca Vitulli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital AORN, Naples
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odonotostomatological Sciences, Università degli Studi di Napoli "Federico II," Naples; and
| | - Alessia Imperato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital AORN, Naples
| | - Lucia De Martino
- Department of Pediatric Neurooncology, Santobono-Pausilipon Children’s Hospital AORN, Naples, Italy
| | - Claudio Ruggiero
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital AORN, Naples
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children’s Hospital AORN, Naples
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6
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Spennato P, De Martino L, Russo C, Errico ME, Imperato A, Mazio F, Miccoli G, Quaglietta L, Abate M, Covelli E, Donofrio V, Cinalli G. Tumors of Choroid Plexus and Other Ventricular Tumors. Adv Exp Med Biol 2023; 1405:175-223. [PMID: 37452939 DOI: 10.1007/978-3-031-23705-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Tumors arising inside the ventricular system are rare but represent a difficult diagnostic and therapeutic challenge. They usually are diagnosed when reaching a big volume and tend to affect young children. There is a wide broad of differential diagnoses with significant variability in anatomical aspects and tumor type. Differential diagnosis in tumor type includes choroid plexus tumors (papillomas and carcinomas), ependymomas, subependymomas, subependymal giant cell astrocytomas (SEGAs), central neurocytomas, meningiomas, and metastases. Choroid plexus tumors, ependymomas of the posterior fossa, and SEGAs are more likely to appear in childhood, whereas subependymomas, central neurocytomas, intraventricular meningiomas, and metastases are more frequent in adults. This chapter is predominantly focused on choroid plexus tumors and radiological and histological differential diagnosis. Treatment is discussed in the light of the modern acquisition in genetics and epigenetics of brain tumors.
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Affiliation(s)
- Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy.
| | - Lucia De Martino
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Carmela Russo
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Maria Elena Errico
- Department of Pathology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Alessia Imperato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Federica Mazio
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Giovanni Miccoli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Massimo Abate
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Eugenio Covelli
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Vittoria Donofrio
- Department of Pathology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
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Improda N, Rosanio F, De Martino L, Picariello S, Mozzillo E, Franzese A, Quaglietta L, Quaglietta L. Precocious Pseudo-Puberty in a 7-Year-Old Girl Due to Malignant Mixed Ovarian Germ Cell Tumor. Turk Arch Pediatr 2023; 58:115-116. [PMID: 35950740 PMCID: PMC9885806 DOI: 10.5152/turkarchpediatr.2022.22140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Nicola Improda
- Department of Translational and Medical Sciences, Section of Pediatrics, University Federico II, Naples, Italy,Department of Pediatric Emergency, Santobono-Pausilipon Children's Hospital, Naples, Italy,Corresponding author:Nicola Improda✉
| | - Francesco Rosanio
- Department of Translational and Medical Sciences, Section of Pediatrics, University Federico II, Naples, Italy
| | - Lucia De Martino
- Department of Pediatric Oncology, Neurooncology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Stefania Picariello
- Department of Pediatric Oncology, Neurooncology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Enza Mozzillo
- Department of Translational and Medical Sciences, Section of Pediatrics, University Federico II, Naples, Italy
| | - Adriana Franzese
- Department of Translational and Medical Sciences, Section of Pediatrics, University Federico II, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Neurooncology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
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8
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Zollo M, Asadzadeh F, Ferrucci V, De Antonellis P, Bibbò F, Siciliano R, Sorice C, Criscuolo G, Filiz DK, Tecik M, Amente S, Saccà CD, Gorini F, Pedone E, Diana D, Pirone L, Fattorusso R, Navas L, Donofrio V, Errico ME, Spennato P, De Martino L, Quaglietta L, Tirone F, Cinalli G. DDDR-32. A NEW IMMUNOMODULATORY FUNCTION OF PYRIDO-PYRIMIDINE DERIVATIVES TO IMPAIR METASTATIC GROUP 3 MEDULLOBLASTOMA IN VIVO. Neuro Oncol 2022. [PMCID: PMC9660321 DOI: 10.1093/neuonc/noac209.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Medulloblastoma (MB) is an embryonal tumor of the cerebellum constituting ~ 20% of pediatric brain tumors. To date, four MB molecular groups (further stratified in twelve subtypes) have been described. Among them, Groups 3 and Group 4 MB have the poorest prognosis due to their high metastatic potential. Recently, we have reported a metastatic axis driven by Prune1 overexpression in MB Group3 characterized by canonical TGF-β signaling enhancement and epithelial-mesenchymal transition. Here, we have developed a new not toxic pyrido-pyrimidine derivative with the ability to impair Prune-1-driven-axis, thus ameliorating the survival rate of a murine model of metastatic MB Group3 characterized by overexpression of human Prune1 gene in the cerebellum (under the control of MATH1 promoter). Of importance, this small molecule also is showing immunomodulatory functions thus inhibiting the conversion of tumor-infiltrating T lymphocytes (TILs) to immunosuppressive regulatory T cells (Tregs) in vivo via impairing the secretion of inflammatory cytokines from MB cells. Furthermore, this molecule can also act synergistically with the currently used modified-intensity chemotherapy (e.g. in PNET5 use of Vincristine) or potential in the combination with epigenetics drugs (e.g., LSD1/KDM1A inhibitors). Altogether these results are of importance for future targeted therapies of high-risk metastatic MB. Acknowledgments: We thank for funding support: the Italian Association for Cancer Research (AIRC) Grant IG no. 22129 (M.Z.) and Lazio Innova Grant n. 85-2017-14785 (FT; MZ)
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Affiliation(s)
- Massimo Zollo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy. , Naples , Italy
| | - Fatemeh Asadzadeh
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy. , Naples , Italy
| | - Veronica Ferrucci
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy. , Naples , Italy
| | - Pasqualino De Antonellis
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy. , Naples , Italy
| | - Francesca Bibbò
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy. , Naples , Italy
| | | | - Carmen Sorice
- CEINGE Biotecnologie Avanzate, Naples, Italy. , Naples , Italy
| | - Giuseppina Criscuolo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy. , Naples , Italy
| | | | - Melisa Tecik
- CEINGE Biotecnologie Avanzate, Naples, Italy. , Naples , Italy
| | - Stefano Amente
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy. , Naples , Italy
| | - Carmen Daniela Saccà
- Department of Biology, University of Naples 'Federico II', Naples, Italy , Naples , Italy
| | - Francesca Gorini
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy. , Naples , Italy
| | - Emilia Pedone
- Dipartimento di Farmacia, Università degli Studi di Napoli Federico II, Naples, Italy , Naples , Italy
| | - Donatella Diana
- Dipartimento di Farmacia, Università degli Studi di Napoli Federico II, Naples, Italy , Naples , Italy
| | - Luciano Pirone
- Dipartimento di Farmacia, Università degli Studi di Napoli Federico II, Naples, Italy , Naples , Italy
| | - Roberto Fattorusso
- Dipartimento di Farmacia, Università degli Studi di Napoli Federico II, Naples, Italy , Naples , Italy
| | - Luigi Navas
- Department of Veterinary Medicine and Animal Productions, Universita` degli Studi di Napoli Federico II, Naples, Italy , Naples , Italy
| | - Vittoria Donofrio
- Surgical Pathology, Ospedale Santobono-Pausilipon, Naples, Italy , Naples , Italy
| | - Maria Elena Errico
- Surgical Pathology, Ospedale Santobono-Pausilipon, Naples, Italy , Naples , Italy
| | - Pietro Spennato
- Paediatric Neurosurgery, Neuro-oncologia, AORN Santobono-Pausilipon, Naples, Italy , Naples , Italy
| | - Lucia De Martino
- Paediatric Neurosurgery, Neuro-oncologia, AORN Santobono-Pausilipon, Naples, Italy , Naples , Italy
| | - Lucia Quaglietta
- Paediatric Neurosurgery, Neuro-oncologia, AORN Santobono-Pausilipon, Naples, Italy , Naples , Italy
| | - Felice Tirone
- Biochemistry and Cell Biology (IBBC) National Research Council, Monterotondo - Rome Italy , Rome , Italy
| | - Giuseppe Cinalli
- Paediatric Neurosurgery, Neuro-oncologia, AORN Santobono-Pausilipon, Naples, Italy , Naples , Italy
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9
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Massimino M, Biassoni V, Mastronuzzi A, Schiavello E, Barretta F, Quaglietta L, Milanaccio C, Pecori E, Cacchione A, Boschetti L, Ruscio VD, Chiesa S, Scimone G, Barra S, De Martino L, Ramaglia A, Picariello S, Verrico A, Alessandro O, Vennarini S, Podda M, Gattuso G, Cinalli G, Antonelli M, Modena P, De Cecco L, Buttarelli FR, Gandola L. DIPG-04. Feasibility and early results of phase 2 open label randomized study of radiotherapy(RT), concomitant nimotuzumab and vinorelbine and re-irradiation at relapse, versus multiple elective radiotherapy courses with concomitant vinorelbine and nimotuzumab for newly diagnosed childhood and adolescence Diffuse intrinsic Pontine Glioma (DIPG). Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac079.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: The purposes of this trial were to evaluate the feasibility, response, PFS/OS of a randomized study comparing two different RT schedules for DIPG while administering the same systemic treatment. METHODS: Patients: 2-21 years-old with a not-pretreated radiologically verified DIPG (MRI blindly reviewed at diagnosis and every 12 weeks thereafter) and symptoms duration below 6 months. Biopsy was required if suggested by atypical imaging. Vinorelbine 20 mg/m2+nimotuzumab 150 mg/m2 were administered weekly for 12 weeks; thereafter every other week until tumor progression or for up to 2 years. Standard(ST) arm included focal RT at total dose of 54Gy (1.8Gy/day); for local progression re-irradiation was proposed at 19.8Gy, in case of dissemination craniospinal irradiation(CSI) at 36Gy was adopted. Experimental(SP) arm included three elective courses of RT at defined timepoints at 36Gy, 19.8Gy and 19.8Gy with possible reirradiation for relapse at 9 Gy. Incidences of local(L) and distant(D) progression were assessed in a competing risk setting. RESULTS: Aggregated preliminary results are given for 4 Italian centers. 54 pts were screened and 51 included, 27 in ST, 28 males, median age 7 years (range 3-17). Median time of observation was 17.9 months. Twelve patients needed a shunt, 10 during treatment; 20 were biopsied, in 18 cases according local protocols. 19/20 tumors had H3.3 K27 mutation. 41 relapsed, 28 locally, 13 with a component of dissemination. 36 died, one for tracheotomy bleeding. SP irradiation was feasible and never produced significant radionecrosis. Median EFS/OS were 7.3/12.9 months, respectively; EFS/OS at 1 year were 19.0%/57.3%, not differing between patients with local vs. disseminated relapses. Patients submitted to biopsies had more dissemination (P=0.04) and less local progression (P=0.077). CONCLUSIONS: Treatment was feasible and OS confirmed previous results obtained in a single center. Randomization results will be later reported.
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Affiliation(s)
- Maura Massimino
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | | | | | | | | | | | - Emilia Pecori
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Luna Boschetti
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Silvia Chiesa
- , Fondazione Policlinico Universitario Agostino Gemelli IRCCS , Roma , Italy
| | - Giuseppe Scimone
- Ospedale San Giovanni di Dio e Ruggi D’Aragona , Salerno , Italy
| | | | | | | | | | | | | | | | - Marta Podda
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | | | | | | | - Loris De Cecco
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
| | | | - Lorenza Gandola
- Fondazione IRCCS Istituto Nazionale dei Tumori , Milano , Italy
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10
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De Martino L, Tresserras-Giné G, Quaglietta L, Spennato P, Errico M, Bifano D, Cinalli G. Giant intracranial infantile myofibromatosis of the skull base: report of two cases. Childs Nerv Syst 2022; 38:837-841. [PMID: 34244845 DOI: 10.1007/s00381-021-05271-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Infantile myofibromatosis is a rare and nonmalignant pediatric tumor of myofibroblastic origin that may occur in solitary or multifocal forms. Soft tissue of the head and neck, trunk, and extremities, skeleton, and viscera are usually involved. Intracranial involvement is reported to be extremely rare, and its clinical picture has been poorly characterized. We present two cases of giant infantile myofibromatosis of the skull base with intracranial involvement. The first case with prenatal diagnosis involved extensively the extradural space of the occipital region and was previously treated by chemotherapy for a previous diagnosis of hemangioperycitoma. Tumor was removed at the age of 5 months and no recurrence was observed during the 3-year follow-up. The second case in a 2-year-old baby involved the anterior cranial base, the nasal cavity, the right orbit, and presented massive involvement of the anterior cranial fossa. Surgery allowed complete removal and a recurrence-free period of 7 years after surgery. Treatment options for these unusual cases are presented and details of histological diagnosis are discussed.
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Affiliation(s)
- Lucia De Martino
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Gloria Tresserras-Giné
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy.,Department of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy.,Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy.,Department of Neurosurgery, Hospital Universitari Dexeus, Barcelona, Spain
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Mariaelena Errico
- Department of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Delfina Bifano
- Department of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy. .,Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Via Mario Fiore n. 6, 80129, Naples, Italy.
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11
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Onorini N, Spennato P, Orlando V, Savoia F, Calì C, Russo C, De Martino L, de Santi MS, Mirone G, Ruggiero C, Quaglietta L, Cinalli G. The Clinical and Prognostic Impact of the Choice of Surgical Approach to Fourth Ventricular Tumors in a Single-Center, Single-Surgeon Cohort of 92 Consecutive Pediatric Patients. Front Oncol 2022; 12:821738. [PMID: 35280797 PMCID: PMC8912940 DOI: 10.3389/fonc.2022.821738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective A single-institution cohort of 92 consecutive pediatric patients harboring tumors involving the fourth ventricle, surgically treated via the telovelar or transvermian approach, was retrospectively reviewed in order to analyze the impact of surgical route on surgery-related outcomes and cumulative survival. Methods Clinical, radiological, surgical, and pathology details were retrospectively analyzed. We selected n = 6 surgery-related clinical and radiological outcomes: transient and permanent neurological deficits, duration of assisted ventilation, postoperative new onset medical events, postoperative cerebellar mutism, and extent of resection. We built univariate and multivariate logistic models to analyze the significance of relationships between the surgical routes and the outcomes. Cumulative survival (CS) was estimated by the cohort approach. Results There were 53 girls and 39 boys (mean age, 83 months). Telovelar approach was performed in 51 cases and transvermian approach in 41 cases. Early postoperative MRI studies showed complete removal in 57 cases (62%) and measurable residual tumor in 35 cases (38%). The average tumor residual volume was 1,316 cm3 (range, 0.016-4.231 cm3; median value, 0.9875 cm3). Residual disease was more often detected on immediate postop MRI after telovelar approach, but the difference was not significant. Cerebellar mutism was observed in 10 cases (11%). No significant difference in the onset of cerebellar mutism was detected between telovelar and transvermian approach. The choice of surgical approach did not significantly modify any other postoperative outcome and 1-/3-year CS of high-grade surgically treated tumors. Conclusions With the limitation of a single-center, single-surgeon retrospective series, our findings offer significant data to reconsider the real impact of the choice of the surgical route to the fourth ventricle on the incidence of cerebellar mutism and surgery-related morbidity. This seems to be in line with some recent reports in the literature. Surgical approach to the fourth ventricle should be individualized according to the location of the tumor, degree of vermian infiltration, and lateral and upward extension. Telovelar and transvermian approaches should not be considered alternative but complementary. Pediatric neurosurgeons should fully master both approaches and choose the one that they consider the best for the patient based on a thorough and careful evaluation of pre-operative imaging.
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Affiliation(s)
- Nicola Onorini
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Pietro Spennato
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Valentina Orlando
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.,Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Fabio Savoia
- Evaluative Epidemiology-Childhood Cancer Registry of Campania, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Camilla Calì
- Evaluative Epidemiology-Childhood Cancer Registry of Campania, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Carmela Russo
- Department of Pediatric Neurosciences, Pediatric Neuroradiology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia De Martino
- Department of Pediatric Neurosciences, Pediatric Neuro-Oncology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Maria Serena de Santi
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Mirone
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Claudio Ruggiero
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Neurosciences, Pediatric Neuro-Oncology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosciences, Pediatric Neurosurgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
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12
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De Martino L, Picariello S, Triarico S, Improda N, Spennato P, Capozza MA, Grandone A, Santoro C, Cioffi D, Attinà G, Cinalli G, Ruggiero A, Quaglietta L. Diencephalic Syndrome Due to Optic Pathway Gliomas in Pediatric Patients: An Italian Multicenter Study. Diagnostics (Basel) 2022; 12:diagnostics12030664. [PMID: 35328218 PMCID: PMC8947184 DOI: 10.3390/diagnostics12030664] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/19/2022] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
Diencephalic syndrome (DS) is a rare pediatric condition associated with optic pathway gliomas (OPGs). Since they are slow-growing tumors, their diagnosis might be delayed, with consequences on long-term outcomes. We present a multicenter case series of nine children with DS associated with OPG, with the aim of providing relevant details about mortality and long-term sequelae. We retrospectively identified nine children (6 M) with DS (median age 14 months, range 3–26 months). Four patients had NF1-related OPGs. Children with NF1 were significantly older than sporadic cases (median (range) age in months: 21.2 (14–26) versus 10 (3–17); p = 0.015). Seven tumors were histologically confirmed as low-grade astrocytomas. All patients received upfront chemotherapy and nutritional support. Although no patient died, all of them experienced tumor progression within 5.67 years since diagnosis and were treated with several lines of chemotherapy and/or surgery. Long-term sequelae included visual, pituitary and neurological dysfunction. Despite an excellent overall survival, PFS rates are poor in OPGs with DS. These patients invariably present visual, neurological or endocrine sequelae. Therefore, functional outcomes and quality-of-life measures should be considered in prospective trials involving patients with OPGs, aiming to identify “high-risk” patients and to better individualize treatment.
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Affiliation(s)
- Lucia De Martino
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (L.D.M.); (S.P.)
| | - Stefania Picariello
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (L.D.M.); (S.P.)
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, via L. De Crecchio n° 2, 80138 Naples, Italy; (A.G.); (C.S.)
| | - Silvia Triarico
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy; (S.T.); (G.A.); (A.R.)
| | - Nicola Improda
- Emergency Unit, Department of Emergency, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy;
- Section of Pediatrics, Department of Translational and Medical Sciences, University Federico II, via S. Pansini n° 5, 80138 Naples, Italy
| | - Pietro Spennato
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (P.S.); (G.C.)
| | - Michele Antonio Capozza
- Pediatric Oncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, via Posillipo n° 226, 80123 Naples, Italy;
| | - Anna Grandone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, via L. De Crecchio n° 2, 80138 Naples, Italy; (A.G.); (C.S.)
| | - Claudia Santoro
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, via L. De Crecchio n° 2, 80138 Naples, Italy; (A.G.); (C.S.)
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, via L. De Crecchio n° 2, 80138 Naples, Italy
| | - Daniela Cioffi
- Pediatric Endocrinology Unit, Department of Pediatrics, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy;
| | - Giorgio Attinà
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy; (S.T.); (G.A.); (A.R.)
| | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (P.S.); (G.C.)
| | - Antonio Ruggiero
- Pediatric Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy; (S.T.); (G.A.); (A.R.)
| | - Lucia Quaglietta
- Neurooncology Unit, Department of Pediatric Oncology, Santobono-Pausilipon Children’s Hospital, via M. Fiore n° 6, 80129 Naples, Italy; (L.D.M.); (S.P.)
- Correspondence:
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13
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Gambale A, Russo R, Andolfo I, Quaglietta L, De Rosa G, Contestabile V, De Martino L, Genesio R, Pignataro P, Giglio S, Capasso M, Parasole R, Pasini B, Iolascon A. Germline mutations and new copy number variants among 40 pediatric cancer patients suspected for genetic predisposition. Clin Genet 2019; 96:359-365. [DOI: 10.1111/cge.13600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Antonella Gambale
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Immacolata Andolfo
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Lucia Quaglietta
- Azienda Ospedaliera di Rilievo Nazionale Santobono PausiliponS.C. Pediatria Oncologia, Dip. di Oncoematologia Pediatrica Napoli Italy
| | - Gianluca De Rosa
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Valentina Contestabile
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
| | - Lucia De Martino
- Azienda Ospedaliera di Rilievo Nazionale Santobono PausiliponS.C. Pediatria Oncologia, Dip. di Oncoematologia Pediatrica Napoli Italy
| | - Rita Genesio
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
| | - Piero Pignataro
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
| | - Sabrina Giglio
- Biomedical Experimental and Clinical Sciences "Mario Serio"University of Florence Florence Italy
- SOD Genetica MedicaAzienda Ospedaliero‐Universitaria Meyer Florence Italy
| | - Mario Capasso
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
- IRCCS SDN Naples Italy
| | - Rosanna Parasole
- Azienda Ospedaliera di Rilievo Nazionale Santobono PausiliponS.C. Pediatria Oncologia, Dip. di Oncoematologia Pediatrica Napoli Italy
| | - Barbara Pasini
- Dipartimento di Scienze MedicheUniversità degli Studi di Torino Torino Italy
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie MedicheUniversità degli Studi di Napoli Federico II Naples Italy
- CEINGE Biotecnologie Avanzate Naples Italy
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14
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De Martino L, Spennato P, Vetrella S, Capasso M, Porfito C, Ruotolo S, Abate ME, Cinalli G, Quaglietta L. Symptomatic malignant spinal cord compression in children: a single-center experience. Ital J Pediatr 2019; 45:80. [PMID: 31300063 PMCID: PMC6626347 DOI: 10.1186/s13052-019-0671-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/20/2019] [Indexed: 11/20/2022] Open
Abstract
Background Malignant spinal cord compression (MSCC) is associated withpoor prognosis and may lead to permanent paralysis, sensory loss, and sphincter dysfunction. Very limited data are available on incidence and etiology of MSCC in pediatric population. We aimed to examine etiology, clinical presentation and treatment of pediatric patient with MSCC admitted to the Santobono-Pausilipon Children’s Hospital, Naples, Italy. Methods Forty-four children under 18 yearsadmitedsince 2007 and assessed for MSCC clinical presentations, evaluation, and treatment.were retrospectively collected from our institutional pediatric oncology and neurosurgery database. Results The median age at time of MSCC diagnosis was 52 months, with a peak in young (≤3 years) patients. The leading cause of MSCC was extramedullary tumors (63.6%), in particular neuroblastoma (27.2%) followed by Ewing sarcomas (15.9%). Cord compression was the presenting feature of a new malignancy in 33 (75%) patients, and a consequence of metastatic disease progression or relapse in the remaining 11 (25%) patients. Motor deficit was the initial symptoms of spinal compression in all patients, while pain was present in about 60% of patients, followed by sphincteric deficit (43.2%). The primary tumor site was located in the neck in 3 (6.8%) patients, thorax in 16 (36.4%), cervico-thoracic region in 3 (6.8%), thoraco-lumbar region in 8 (18.2%), abdomen in 5 (11.4%), lumbar-sacral region in 7 (15.9%) and thoracic-lumbar-sacral region in 1 (2.3%). The median length of the interval between symptom onset and tumor diagnosis varied widely from 0 to 360 days in the entire population, however this interval was significantly shorter in patients with known neoplasia in comparisonto patients with new diagnosis (at relapse 7 days [interquartile range 3–10] vs at diagnosis 23 days [7–60]). Pre and post-operative spine magnetic resonance imagingwas performed in all cases, and most(95%) patients underwent neurosurgical treatment as first treatment. Severe motor deficit was associated with younger age and severe motor deficit at diagnosis was associated withworst motor outcomes at discharge from neurosurgery. Patients with progression or relapsed disease showed a worst prognosis, while the majority of patients (70.5%) were alive at 5 years after diagnosis. Conclusions The natural history of MSCC in children is associated to permanent paralysis, sensory loss, and sphincter dysfunction, thus prompt diagnosis and correct management are needed to minimize morbidity. Treatment strategies differed widely among cancer types and study groups in the absence of optimal evidence-based treatment guidelines. When the diagnosis is uncertain, surgery provides an opportunity to biopsy the lesion in addition to treating the mass.
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Affiliation(s)
- Lucia De Martino
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy.
| | - Piero Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Simona Vetrella
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Maria Capasso
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Carolina Porfito
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Serena Ruotolo
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Massimo Eraldo Abate
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
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15
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Tridente A, De Martino L, De Luca D. Porcine vs bovine surfactant therapy for preterm neonates with RDS: systematic review with biological plausibility and pragmatic meta-analysis of respiratory outcomes. Respir Res 2019; 20:28. [PMID: 30728009 PMCID: PMC6366095 DOI: 10.1186/s12931-019-0979-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/06/2019] [Indexed: 01/16/2023] Open
Abstract
Background Bovine surfactants are known to be clinically equivalent but it is unclear if porcine or bovine surfactants at their licensed dose should be preferred to treat respiratory distress syndrome in preterm neonates. Methods We performed a comprehensive review of biochemical and pharmacological features of surfactants to understand the biological plausibility of any clinical effect. We then performed a pragmatic meta-analysis comparing internationally marketed porcine and bovine surfactants for mortality and respiratory outcomes. Search for randomised controlled trials with no language/year restrictions and excluding “grey” literature, unpublished or non-peer reviewed reports was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the most recent methodological recommendations. Results Sixteen articles were included in the review and 14 in the meta-analysis (1491 neonates). 200 mg/kg poractant-α (a porcine surfactant) was associated with lower BPD/mortality (OR 0.632[95%CI:0.494, 0.809];p < 0.001),BPD (OR 0.688[95%CI:0.512, 0.925];p = 0.013), retreatment (OR 0.313[95%CI:0.187, 0.522];p < 0.0001), airleaks (OR 0.505[95%CI:0.308, 0.827];p = 0.006) and lung haemorrhage (OR 0.624[95%CI:0.388, 1];p = 0.051). Gestational age is associated with effect size for BPD (coefficient: 0.308 [95%CI:0.063, 0.554];p = 0.014) and surfactant retreatment (coefficient: -0.311 [95%CI:-0.595, − 0.028];p = 0.031). Conclusion 200 mg/kg poractant-α is associated with better respiratory outcomes compared to bovine surfactants at their licensed dose. The effect of poractant-α on BPD and surfactant retreatment is greater at lowest and highest gestational ages, respectively. Trial registration PROSPERO n.42017075251. Electronic supplementary material The online version of this article (10.1186/s12931-019-0979-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ascanio Tridente
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK.,Critical Care Unit, Whiston Hospital, St Helens and Knowsley Teaching Hospitals, Merseyside, UK
| | - Lucia De Martino
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A. Béclère", South Paris University Hospitals, Assistance Publique-Hôpitaux de Paris (APHP) , Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Medical Center "A. Béclère", South Paris University Hospitals, Assistance Publique-Hôpitaux de Paris (APHP) , Paris, France. .,Physiopathology and Therapeutic Innovation Unit, INSERM U999, South Paris-Saclay University, Paris, France.
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De Martino L, Errico ME, Ruotolo S, Cascone D, Chiaravalli S, Collini P, Ferrari A, Muto P, Cinalli G, Quaglietta L. Pediatric lung adenocarcinoma presenting with brain metastasis: a case report. J Med Case Rep 2018; 12:243. [PMID: 30172261 PMCID: PMC6119591 DOI: 10.1186/s13256-018-1781-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosis and treatment of primary lung adenocarcinoma in children remains challenging given its rarity. Here we highlight the clinical history, pathological evaluation, genomic findings, and management of a very young patient with metastatic lung adenocarcinoma. CASE PRESENTATION A 10-year-old white girl presented with brain metastases due to primary pulmonary adenocarcinoma. Next generation sequencing analysis with "Comprehensive Cancer Panel" highlighted the presence of multiple non-targetable mutations in the FLT4, UBR5, ATM, TAF1, and GUCY1A2 genes. She was treated aggressively with chemotherapy, surgery, and radiation therapy for local and distant recurrence. Eventually, therapy with nivolumab was started compassionately, and she died 23 months after diagnosis. CONCLUSIONS Extremely rare cancers in children such as lung adenocarcinoma need accurate and specific diagnosis in order to develop an optimal plan of treatment. It is also necessary to underline that "children are not little adults," thus implying that an adult-type cancer in the pediatric population might have a different etiopathogenesis. Diagnostic confirmation and primary treatment of such rare conditions should be centralized in reference centers, collaborative networks, or both, with multidisciplinary approaches and very specific expertise.
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Affiliation(s)
- Lucia De Martino
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy.
| | - Maria Elena Errico
- Department of Pathology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Serena Ruotolo
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
| | - Daniele Cascone
- Department of Neuroscience, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Stefano Chiaravalli
- Department of Pediatric Oncology, Fond. IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Soft Tissue and Bone Pathology, Histopathology and Pediatric Pathology Unit, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Andrea Ferrari
- Department of Pediatric Oncology, Fond. IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paolo Muto
- Radiation Oncology Unit, National Tumor Institute of Naples, Foundation G. Pascale, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Children's Hospital, Posillipo Street, 226, 80122, Naples, Italy
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De Martino L, Yousef N, Ben-Ammar R, Raimondi F, Shankar-Aguilera S, De Luca D. Lung Ultrasound Score Predicts Surfactant Need in Extremely Preterm Neonates. Pediatrics 2018; 142:peds.2018-0463. [PMID: 30108142 DOI: 10.1542/peds.2018-0463] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are several lung ultrasound scores (LUS) for evaluating lung aeration in critically ill adults with restrictive lung disorders. A modified LUS adapted for neonates correlates well with oxygenation and is able to be used to predict the need for surfactant in preterm neonates with respiratory distress syndrome (RDS). However, no data are available for extremely preterm neonates for whom timely surfactant administration is especially important. We hypothesized that LUS might be reliable in extremely preterm neonates with RDS who are treated with continuous positive airway pressure. We aimed to determine the diagnostic accuracy of LUS in predicting the need for surfactant treatment and re-treatment in this population. METHODS We performed a prospective cohort diagnostic accuracy study between 2015 and 2016 in a tertiary-care academic center. Inborn neonates at ≤30 weeks' gestation with RDS treated with continuous positive airway pressure were eligible. Surfactant was given on the basis of oxygen requirement thresholds derived from European guidelines, and a LUS was not used to guide surfactant treatment. We calculated the LUS after admission and analyzed its diagnostic accuracy to predict surfactant treatment and re-treatment. RESULTS We enrolled 133 infants; 68 (51%) received 1 dose of surfactant and 19 (14%) received 2 surfactant doses. A LUS is significantly correlated with oxygenation index (ρ = 0.6; P < .0001) even after adjustment for gestational age (P < .0001). A LUS can be used to accurately predict the need for the first surfactant dose (area under the curve = 0.94; 95% confidence interval: 0.90-0.98; P < .0001) and also the need for surfactant redosing (area under the curve = 0.803; 95% confidence interval: 0.72-0.89; P < .0001). The global accuracy for the prediction of surfactant treatment and re-treatment is 89% and 72%, respectively. CONCLUSIONS LUS may be used to predict the need for surfactant replacement in extremely preterm neonates with RDS.
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Affiliation(s)
- Lucia De Martino
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Centre, South Paris University Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France.,Section of Pediatrics, Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; and
| | - Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Centre, South Paris University Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Rafik Ben-Ammar
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Centre, South Paris University Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Francesco Raimondi
- Section of Pediatrics, Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy; and
| | - Shivani Shankar-Aguilera
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Centre, South Paris University Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, A. Béclère Medical Centre, South Paris University Hospitals, Assistance Publique Hôpitaux de Paris, Paris, France; .,Physiopathology and Therapeutic Innovation, Université Paris-Saclay, Paris, France
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18
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Ferrucci V, de Antonellis P, Pennino FP, Asadzadeh F, Siciliano R, Virgilio A, Galeone A, De Martino L, Quaglietta L, Errico ME, Donofrio V, Picard D, Remke M, Chesler L, Swartling F, Weiss W, Taylor M, Cinalli G, Zollo M. MBRS-52. TARGETING PRUNE-1 IN A GEMM OF METASTATIC MEDULLOBLASTOMA: A POTENTIAL ROUTE OF INHIBITION FOR NEW FUTURE THERAPIES. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Veronica Ferrucci
- European School of Molecular Medicine (SEMM), Milan, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Pasqualino de Antonellis
- CEINGE Biotecnologie Avanzate, Naples, Italy., Naples, Italy
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Francesco Paolo Pennino
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy., Naples, Italy
| | | | | | - Antonella Virgilio
- Dipartimento di Farmacia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Aldo Galeone
- Dipartimento di Farmacia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Lucia De Martino
- Paediatric Neurosurgery, Ospedale Santobono-Pausilipon, Naples, Italy
| | - Lucia Quaglietta
- Paediatric Neurosurgery, Ospedale Santobono-Pausilipon, Naples, Italy
| | | | | | - Daniel Picard
- German Cancer Consortium (DKTK), Department of Paediatric Oncology, Haematology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marc Remke
- German Cancer Consortium (DKTK), Department of Paediatric Oncology, Haematology, and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Louis Chesler
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Fredrik Swartling
- Science for Life Laboratory, Rudbeck Laboratory, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - William Weiss
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Michael Taylor
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Arthur and Sonia Labatt Brain Tumour Research Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Giuseppe Cinalli
- Paediatric Neurosurgery, Ospedale Santobono-Pausilipon, Naples, Italy
| | - Massimo Zollo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Naples, Italy
- CEINGE Biotecnologie Avanzate, Naples, Italy., Naples, Italy
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Esposito A, Capalbo D, De Martino L, Rezzuto M, Di Mase R, Pignata C, Salerno M. Long-term effects of growth hormone (GH) replacement therapy on hematopoiesis in a large cohort of children with GH deficiency. Endocrine 2016; 53:192-8. [PMID: 26511947 DOI: 10.1007/s12020-015-0781-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
The aim of our prospective case-control study was to evaluate long-term effects of GH replacement therapy on erythrocytes parameters, leukocytes, and platelets numbers in a large cohort of children with isolated GH deficiency (GHD). Hemoglobin (Hb) concentration, hematocrit (Hct), mean corpuscular volume, mean corpuscular hemoglobin, red cell distribution width, number of erythrocytes, leukocytes, neutrophils, lymphocytes, monocytes and platelets, ferritin, and C-reactive protein were evaluated in 85 children with isolated GHD (10.20 ± 3.50 years) before and annually during the first 5 years of GH replacement therapy and in 85 healthy children age and sex comparable to patients during 5 years of follow-up. Compared with controls, GHD children at study entry showed lower Hb (-1.18 ± 0.87 vs. -0.40 ± 0.90 SDS, p < 0.0001), red cells number (-0.24 ± 0.81 vs. 0.25 ± 1.14 SDS, p < 0.0001), and Hct (-1.18 ± 0.86 vs. -0.68 ± 0.99 SDS, p < 0.0001). Twelve GHD patients (14 %) showed a normocytic anemia. GH therapy was associated with a significant increase in Hb, Hct, and red cells number which became all comparable to controls within the first 2 years of treatment. Moreover, hemoglobin levels normalized in all anemic GHD patients after 5 years of therapy. No difference between patients and controls was found in leukocytes and platelets numbers neither at baseline nor during the study. GHD in childhood is associated with an impairment of erythropoiesis which causes a normocytic anemia in a considerable percentage of patients. GH replacement therapy exerts a beneficial effect leading to a significant increase of erythrocytes parameters and recovery from anemia. Neither GHD nor GH replacement treatment exerts effects on leukocytes or platelets numbers.
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Affiliation(s)
- Andrea Esposito
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Donatella Capalbo
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Lucia De Martino
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Martina Rezzuto
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Raffaella Di Mase
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Claudio Pignata
- Pediatric Immunology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy
| | - Mariacarolina Salerno
- Pediatric Endocrinology Unit, Department of Translational Medical Sciences, University of Naples "Federico II", via Sergio Pansini 5, 80131, Naples, Italy.
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20
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De Martino L, Capalbo D, Improda N, Lorello P, Ungaro C, Di Mase R, Cirillo E, Pignata C, Salerno M. Novel Findings into AIRE Genetics and Functioning: Clinical Implications. Front Pediatr 2016; 4:86. [PMID: 27597936 PMCID: PMC4992815 DOI: 10.3389/fped.2016.00086] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/02/2016] [Indexed: 01/22/2023] Open
Abstract
Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED), formerly known as autoimmune polyendocrine syndrome type 1, is a paradigm of a monogenic autoimmune disease caused by mutations of a gene, named autoimmune regulator (AIRE). AIRE acts as a transcription regulator that promotes immunological central tolerance by inducing the ectopic thymic expression of many tissue-specific antigens. Although the syndrome is a monogenic disease, it is characterized by a wide variability of the clinical expression with no significant correlation between genotype and phenotype. Indeed, many aspects regarding the exact role of AIRE and APECED pathogenesis still remain unraveled. In the last decades, several studies in APECED and in its mouse experimental counterpart have revealed new insights on how immune system learns self-tolerance. Moreover, novel interesting findings have extended our understanding of AIRE's function and regulation thus improving our knowledge on the pathogenesis of APECED. In this review, we will summarize recent novelties on molecular mechanisms underlying the development of APECED and their clinical implications.
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Affiliation(s)
- Lucia De Martino
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | | | - Nicola Improda
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Paola Lorello
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Carla Ungaro
- Department of Pediatrics, Federico II University , Naples , Italy
| | | | - Emilia Cirillo
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Claudio Pignata
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
| | - Mariacarolina Salerno
- Pediatric Section, Department of Translational Medical Sciences, Federico II University , Naples , Italy
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21
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Abstract
Diarrhoea in infants and young children is defined as >200g/day of stools, and occurs when there is an imbalance between intestinal fluids absorption and secretion. This may be caused by either a decreased absorption (osmotic diarrhoea) or an increased secretion (secretory diarrhoea). Chronic diarrhoea defines intestinal loss of water and electrolytes with increased stool frequency, reduced consistency and larger volume over more than 14days. This disorder in children shows a wide range of aetiologies depending on the age. The knowledge of common and rare aetiologies is important to optimize the diagnostic approach. A stepwise approach, starting with a comprehensive history, physical examination, inspection and collection of stool samples, helps to devise appropriate diagnostic and therapeutic management. In this article we discuss the pathophysiology, aetiology and possible approach to chronic diarrhoea in infancy.
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Affiliation(s)
- Vincenza Pezzella
- Department of Translational Medicine, Pediatric Section, University of Naples "Federico II", Via S. Pansini, 5, 80131 Naples, Italy.
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22
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De Martino L, Capalbo D, Improda N, D'Elia F, Di Mase R, D'Assante R, D'Acunzo I, Pignata C, Salerno M. APECED: A Paradigm of Complex Interactions between Genetic Background and Susceptibility Factors. Front Immunol 2013; 4:331. [PMID: 24167503 PMCID: PMC3805967 DOI: 10.3389/fimmu.2013.00331] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 09/30/2013] [Indexed: 01/08/2023] Open
Abstract
Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a rare autosomal recessive disease, caused by mutations of a single gene named Autoimmune regulator gene (AIRE) which results in a failure of T-cell tolerance. Central tolerance takes place within the thymus and represents the mechanism by which potentially auto-reactive T-cells are eliminated through the negative selection process. The expression of tissue-specific antigens (TSAs) by medullary thymic epithelial cells (mTECs) in the thymus is a key process in the central tolerance and is driven by the protein encoded by AIRE gene, the transcription factor autoimmune regulator (AIRE). A failure in this process caused by AIRE mutations is thought to be responsible of the systemic autoimmune reactions of APECED. APECED is characterized by several autoimmune endocrine and non-endocrine manifestations and the phenotype is often complex. Although APECED is the paradigm of a monogenic autoimmune disorder, it is characterized by a wide variability of the clinical expression even between siblings with the same genotype, thus implying that additional mechanisms, other than the failure of Aire function, are involved in the pathogenesis of the disease. Unraveling open issues of the molecular basis of APECED, will help improve diagnosis, management, and therapeutical strategies of this complex disease.
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Affiliation(s)
- Lucia De Martino
- Pediatric Section, Department of Translational Medical Sciences, "Federico II" University , Naples , Italy
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23
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Wasniewska M, Corrias A, Aversa T, Valenzise M, Mussa A, De Martino L, Lombardo F, De Luca F, Salerno M. Comparative evaluation of therapy with L-thyroxine versus no treatment in children with idiopathic and mild subclinical hypothyroidism. Horm Res Paediatr 2013; 77:376-81. [PMID: 22699818 DOI: 10.1159/000339156] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 04/24/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The question of whether children with subclinical hypothyroidism (SH) should be treated or not is controversial due to the lack of studies on outcomes of SH children treated with L-thyroxine (L-T(4)) versus those receiving no therapy. OBJECTIVES (a) To evaluate thyroid tests under L-T(4) and after therapy withdrawal in 69 SH children (group A) and (b) to compare our results with those recorded in 92 untreated children (group B). DESIGN Group A children were treated for 24 months and TSH and FT(4) levels 3 months after therapy withdrawal were compared with those measured in group B at the end of follow-up in order to investigate treatment effects. RESULTS The prevalence of children who had normalized TSH at the end of follow-up was higher in group A, but the prevalence of those who had normalized or maintained unchanged TSH was similar in the two groups, as was the prevalence of children who exhibited a TSH increase >10 mU/l. In group A, TSH values at 27 months were associated with baseline values. CONCLUSIONS (a) Two-year treatment in SH children is unable to modify posttherapy outcome of hyperthyrotropinemia; (b) therapy is unable to prevent the risk of further TSH increase after treatment withdrawal, and (c) posttherapy TSH outcome is conditioned by baseline TSH.
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Capalbo D, Giardino G, Martino LD, Palamaro L, Romano R, Gallo V, Cirillo E, Salerno M, Pignata C. Genetic basis of altered central tolerance and autoimmune diseases: a lesson from AIRE mutations. Int Rev Immunol 2012; 31:344-62. [PMID: 23083345 DOI: 10.3109/08830185.2012.697230] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The thymus is a specialized organ that provides an inductive environment for the development of T cells from multipotent hematopoietic progenitors. Self-nonself discrimination plays a key role in inducing a productive immunity and in preventing autoimmune reactions. Tolerance represents a state of immunologic nonresponsiveness in the presence of a particular antigen. The immune system becomes tolerant to self-antigens through the two main processes, central and peripheral tolerance. Central tolerance takes place within the thymus and represents the mechanism by which T cells binding with high avidity self-antigens, which are potentially autoreactive, are eliminated through so-called negative selection. This process is mostly mediated by medullary thymic epithelia cells (mTECs) and medullary dendritic cells (DCs). A remarkable event in the process is the expression of tissue-specific antigens (TSA) by mTECs driven by the transcription factor autoimmune regulator (AIRE). Mutations in this gene result in autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED), a rare autosomal recessive disease (OMIM 240300). Thus far, this syndrome is the paradigm of a genetically determined failure of central tolerance and autoimmunty. Patients with APECED have a variable pattern of autoimmune reactions, involving different endocrine and nonendocrine organs. However, although APECED is a monogenic disorder, it is characterized by a wide variability of the clinical expression, thus implying a further role for disease-modifying genes and environmental factors in the pathogenesis. Studies on this polyreactive autoimmune syndrome contributed enormously to unraveling several issues of the molecular basis of autoimmunity. This review focuses on the developmental, functional, and molecular events governing central tolerance and on the clinical implication of its failure.
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Capalbo D, De Martino L, Giardino G, Di Mase R, Di Donato I, Parenti G, Vajro P, Pignata C, Salerno M. Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy: insights into genotype-phenotype correlation. Int J Endocrinol 2012; 2012:353250. [PMID: 23133448 PMCID: PMC3485503 DOI: 10.1155/2012/353250] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/17/2012] [Accepted: 09/17/2012] [Indexed: 12/21/2022] Open
Abstract
Autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED) is a rare autosomal recessive disease, caused by mutations of a single gene named autoimmune regulator gene (AIRE) which results in a failure of T cell tolerance within the thymus. Chronic mucocutaneous candidiasis, chronic hypoparathyroidism, and Addison's disease are the hallmarks of the syndrome. APECED is also characterized by several autoimmune endocrine and nonendocrine manifestations, and the phenotype is often complex. Moreover, even though APECED is a monogenic disease, its clinical picture is generally dominated by a wide heterogeneity both in the severity and in the number of components even among siblings with the same AIRE genotype. The variability of its clinical expression implies that diagnosis can be challenging, and a considerable delay often occurs between the appearance of symptoms and the diagnosis. Since a prompt diagnosis is essential to prevent severe complications, clinicians should be aware of all symptoms and signs of suspicion. The aim of this paper is to give an overview on the clinical presentation and diagnostic criteria of APECED and to focus on current knowledge on genotype-phenotype correlation.
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Affiliation(s)
- Donatella Capalbo
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Lucia De Martino
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Giuliana Giardino
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaella Di Mase
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Iolanda Di Donato
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Giancarlo Parenti
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Pietro Vajro
- Department of Pediatrics, University of Salerno, 84081 Salerno, Italy
| | - Claudio Pignata
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
| | - Mariacarolina Salerno
- Department of Pediatrics, University of Naples Federico II, 80131 Naples, Italy
- *Mariacarolina Salerno:
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