The Genetic Basis, Lung Involvement, and Therapeutic Options in Niemann-Pick Disease: A Comprehensive Review

Niemann-Pick Disease (NPD) is a rare autosomal recessive disease belonging to lysosomal storage disorders. Three types of NPD have been described: NPD type A, B, and C. NPD type A and B are caused by mutations in the gene SMPD1 coding for sphingomyelin phosphodiesterase 1, with a consequent lack of acid sphingomyelinase activity. These diseases have been thus classified as acid sphingomyelinase deficiencies (ASMDs). NPD type C is a neurologic disorder due to mutations in the genes NPC1 or NPC2, causing a defect of cholesterol trafficking and esterification. Although all three types of NPD can manifest with pulmonary involvement, lung disease occurs more frequently in NPD type B, typically with interstitial lung disease, recurrent pulmonary infections, and respiratory failure. In this sense, bronchoscopy with broncho-alveolar lavage or biopsy together with high-resolution computed tomography are fundamental diagnostic tools. Although several efforts have been made to find an effective therapy for NPD, to date, only limited therapeutic options are available. Enzyme replacement therapy with Olipudase α is the first and only approved disease-modifying therapy for patients with ASMD. A lung transplant and hematopoietic stem cell transplantation are also described for ASMD in the literature. The only approved disease-modifying therapy in NPD type C is miglustat, a substrate-reduction treatment. The aim of this review was to delineate a state of the art on the genetic basis and lung involvement in NPD, focusing on clinical manifestations, radiologic and histopathologic characteristics of the disease, and available therapeutic options, with a gaze on future therapeutic strategies.

MYNd&CO (Mindfulness, Yoga, Nutrition, development & Coaching, and Osteopathy) randomized controlled trial for a positive psychophysical experience in pregnancy and after birth: a study protocol

BACKGROUND AND AIM

The medicalisation of birth pathway may negatively impact on women's empowerment, enhancing distress even in cases of healthy pregnancies. We have built a program which is comprised of Mindfulness, Yoga, Nutrition, development & Counselling, Coaching, antenatal classes, and Osteopathic treatment (MYNd&CO).

METHODS

This study is a randomized controlled trial involving low-risk pregnant women. They will be randomized to the experimental (MYNd&CO intervention plus standard care) or control group (standard care). The primary (general health and wellbeing, maternal distress) and secondary outcome measures (urinary incontinence, sexual problems, and physical wellbeing) will be assessed via questionnaires at baseline and 6 months after childbirth. The independent-samples t-test and Chi-square will be used to detect changes in the outcomes between intervention and control group.

DISCUSSION

The trial is expected to increase knowledge about the effectiveness of a holistic approach in low-risk pregnant women, in terms of obstetrical and psychophysiological outcomes.