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Ditters IAM, Huidekoper HH, Kruijshaar ME, Rizopoulos D, Hahn A, Mongini TE, Labarthe F, Tardieu M, Chabrol B, Brassier A, Parini R, Parenti G, van der Beek NAME, van der Ploeg AT, van den Hout JMP, Mengel E, Hennermann J, Smitka M, Muschol N, Marquardt T, Marquardt M, Thiels C, Spada M, Pagliardini V, Menni F, della Casa R, Deodato F, Gasperini S, Burlina A, Donati A, Pichard S, Feillet F, Huet F, Mention K, Eyer D, Kuster A, Espil Taris C, Lefranc J, Barth M, Bruel H, Chevret L, Pitelet G, Pitelet C, Rivier F, Dobbelaere D. Effect of alglucosidase alfa dosage on survival and walking ability in patients with classic infantile Pompe disease: a multicentre observational cohort study from the European Pompe Consortium. The Lancet Child & Adolescent Health 2022; 6:28-37. [DOI: 10.1016/s2352-4642(21)00308-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022]
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Spada M, Pagliardini V, Ricci F, Biamino E, Mongini T, Porta F. Early higher dosage of alglucosidase alpha in classic Pompe disease. J Pediatr Endocrinol Metab 2018; 31:1343-1347. [PMID: 30433875 DOI: 10.1515/jpem-2018-0336] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 07/30/2018] [Accepted: 10/29/2018] [Indexed: 01/08/2023]
Abstract
Background With conventional enzyme replacement therapy (ERT), the clinical prognosis of classic Pompe disease is often unsatisfactory. About half the patients treated with ERT at the recommended dosage (20 mg/kg every other week) require ventilatory support within the first years of life. The heterogeneous response to ERT has been related to different factors, including cross-reactive immunologic material (CRIM) status and age at ERT initiation. Early treatment with a standard dosage of ERT improves clinical outcome and avoids mechanical ventilation in CRIM-positive patients detected at newborn screening, not preventing persistent hyperCKemia and muscle weakness. Later treatment with higher dosages of ERT was shown to provide similar benefits in CRIM-positive patients. Here, we report the clinical and biochemical outcomes of six patients with classic Pompe disease treated with different dosages of alglucosidase alpha at different ages. Methods A standard dosage of ERT was employed in five patients, sharing a poor prognosis after transient clinical improvements, even in the case of early treatment (four died at 22.2±11.9 months and one survived but required tracheostomy and gastrostomy). Early higher dosage of alglucosidase alpha (40 mg/kg/week from 14 days) was administered to one CRIM-positive patient with fetal persistent bradycardia. Results Early higher dosage of alclucosidase alpha not only achieved normal neuromotor development but also the full correction of biochemical markers of muscle damage until 3 years of age, an unmet target with the standard dosage. Speech delay was not prevented by this approach. Conclusions We suggest that early treatment with a higher dosage of ERT may further improve clinical prognosis in classic Pompe disease.
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Affiliation(s)
- Marco Spada
- Department of Pediatrics, University of Torino, Torino, Italy
| | | | - Federica Ricci
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Elisa Biamino
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Tiziana Mongini
- Department of Neuroscience, University of Torino, Torino, Italy
| | - Francesco Porta
- Department of Pediatrics, University of Torino, Torino, Italy
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Ricci F, Brusa C, Rossi F, Rolle E, Placentino V, Berardinelli A, Pagliardini V, Porta F, Spada M, Mongini T. Functional assessment tools in children with Pompe disease: A pilot comparative study to identify suitable outcome measures for the standard of care. Eur J Paediatr Neurol 2018; 22:1103-1109. [PMID: 30166092 DOI: 10.1016/j.ejpn.2018.08.001] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/05/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pompe disease (PD) is a rare condition caused by mutations in gene encoding for the enzyme alpha-glucosidase, resulting in an abnormal intracellular accumulation of glycogen. The disease clinical spectrum ranges from severe infantile forms to adult-onset forms with minor limitations. Since 2000 enzyme replacement therapy (ERT) is available and disease natural history has changed, with prolonged survival and evidence of myopathic features. METHODS In this study, we monitored disease progression up to three years in eight young patients with PD. Based on the literature data and the long term personal experience, we selected validated functional scales for neuromuscular disorders and compared the results to identify a simple and reliable protocol for the follow-up of children with PD. Moreover, we evaluated cognitive functions using developmental/cognitive tests. RESULTS Based on study results, we suggest that motor functions in children with PD could be better assessed by Chop Intend, MFM20 (Motor Function Measure Scale for Neuromuscular Diseases 20) and NSAA (North Star Ambulatory Assessment), according to age and functional level. Evaluation should be completed with ROM (Range Of Motion) measurement, MRC (Medical Research Council) evaluation and 6MWT (6 Minute Walk test) when possible. CONCLUSIONS The proposed protocol seems to be reliable and should be done every six months, because of the progressive natural history of the disease, the rapid changes typical of developmental age and the need to document ERT effects. About cognitive functions, additional tests to classical intelligence scales (WISC, WPPSI) should be useful to better describe specific neuropsychological profile.
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Affiliation(s)
- Federica Ricci
- Department of Pediatrics, Division of Child Neurology and Psychiatry, Turin University Hospital, Piazza Polonia 94, 10126, Turin, Italy.
| | - Chiara Brusa
- Department of Pediatrics, Division of Child Neurology and Psychiatry, Turin University Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Francesca Rossi
- Department of Pediatrics, Division of Child Neurology and Psychiatry, Turin University Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Enrica Rolle
- Department of Pediatrics, Division of Child Neurology and Psychiatry, Turin University Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Valeria Placentino
- Department of Pediatrics, Division of Child Neurology and Psychiatry, Turin University Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Angela Berardinelli
- Division of Childhood and Adolescence Neurology, IRCCS Mondino, via Mondino 2, 27100, Pavia, Italy
| | - Veronica Pagliardini
- Department of Pediatrics, Division of Metabolic Diseases, Turin University Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Francesco Porta
- Department of Pediatrics, Division of Metabolic Diseases, Turin University Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Marco Spada
- Department of Pediatrics, Division of Metabolic Diseases, Turin University Hospital, Piazza Polonia 94, 10126, Turin, Italy
| | - Tiziana Mongini
- Department of Neuroscience, Division of Neurology and Neuromuscular Diseases, Turin University Hospital, Corso Bramante 88/90, 10126, Turin, Italy
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Porta F, Peruzzi L, Bonaudo R, Pieretti S, Busso M, Cocchi E, Conio A, Pagliardini V, Spada M. Differential response to renal replacement therapy in neonatal‐onset inborn errors of metabolism. Nephrology (Carlton) 2018; 23:957-961. [DOI: 10.1111/nep.13409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Francesco Porta
- Departments of PediatricsDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
| | - Licia Peruzzi
- Departments of NephrologyDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
| | - Roberto Bonaudo
- Departments of NephrologyDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
| | - Silvia Pieretti
- Departments of PediatricsDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
| | - Marta Busso
- Departments of PediatricsDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
| | - Enrico Cocchi
- Departments of PediatricsDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
| | - Alessandra Conio
- Departments of Anesthesia and Intensive CareDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
| | - Veronica Pagliardini
- Departments of PediatricsDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
| | - Marco Spada
- Departments of PediatricsDialysis and Transplantation Unit, Città della Salute e della Scienza, Regina Margherita Children's Hospital Torino Italy
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Parini R, De Lorenzo P, Dardis A, Burlina A, Cassio A, Cavarzere P, Concolino D, Della Casa R, Deodato F, Donati MA, Fiumara A, Gasperini S, Menni F, Pagliardini V, Sacchini M, Spada M, Taurisano R, Valsecchi MG, Di Rocco M, Bembi B. Long term clinical history of an Italian cohort of infantile onset Pompe disease treated with enzyme replacement therapy. Orphanet J Rare Dis 2018; 13:32. [PMID: 29422078 PMCID: PMC5806382 DOI: 10.1186/s13023-018-0771-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 10/30/2017] [Accepted: 01/25/2018] [Indexed: 01/12/2023] Open
Abstract
Background Enzyme replacement therapy (ERT) has deeply modified the clinical history of Infantile Onset Pompe Disease (IOPD). However, its long-term effectiveness is still not completely defined. Available data shows a close relationship between clinical outcome and patients’ cross-reactive immunological status (CRIM), being CRIM-negative status a negative prognostic factor. At the same time limited data are available on the long-term treatment in CRIM-positive infants. Methods A retrospective multicentre observational study was designed to analyse the long-term effectiveness of ERT in IOPD. Thirteen Italian centres spread throughout the country were involved and a cohort of 28 patients (15 females, 13 males, born in the period: February 2002–January 2013) was enrolled. IOPD diagnosis was based on clinical symptoms, enzymatic and molecular analysis. All patients received ERT within the first year of life. Clinical, laboratory, and functional data (motor, cardiac and respiratory) were collected and followed for a median period of 71 months (5 years 11 months). Results Median age at onset, diagnosis and start of ERT were 2, 3 and 4 months, respectively. CRIM status was available for 24/28 patients: 17/24 (71%) were CRIM-positive. Nineteen patients (67%) survived > 2 years: 4 were CRIM-negative, 14 CRIM-positive and one unknown. Six patients (5 CRIM-positive and one unknown) never needed ventilation support (21,4%) and seven (6 CRIM-positive and one unknown: 25%) developed independent ambulation although one subsequently lost this function. Brain imaging study was performed in 6 patients and showed peri-ventricular white matter abnormalities in all of them. Clinical follow-up confirmed the better prognosis for CRIM-positive patients, though a slow, progressive worsening of motor and/or respiratory functions was detected in 8 patients. Conclusions These data are the result of the longest independent retrospective study on ERT in IOPD reported so far outside clinical trials. The data obtained confirmed the better outcome of the CRIM-positive patients but at the same time, showed the inability of the current therapeutic approach to reverse or stabilize the disease progression. The results also evidenced the involvement of central nervous system in Pompe disease. To better understand the disease clinical history and to improve treatment efficacy larger multicentre studies are needed as well as the development of new therapeutic approaches.
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Affiliation(s)
- Rossella Parini
- Pediatric Rare Diseases Unit, Department of Pediatrics, MBBM Foundation, ATS Monza e Brianza, Via Pergolesi 33, 20900, Monza, Italy.
| | - Paola De Lorenzo
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Andrea Dardis
- Centre for Rare Diseases, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Alberto Burlina
- Department for Women and Children's Health, U.O.C. Inborn Metabolic Diseases, University Hospital, Padova, Italy
| | | | - Paolo Cavarzere
- Department of Pediatrics, University Magna Graecia, Catanzaro, Italy
| | - Daniela Concolino
- Department of Pediatrics, University Magna Graecia, Catanzaro, Italy
| | - Roberto Della Casa
- Department of Translational Sciences, Pediatrics, University Federico II, Naples, Italy
| | - Federica Deodato
- Division of Metabolism Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Alice Donati
- Department of Pediatrics, Meyer Children's Hospital, Metabolic and Muscular Unit, University of Firenze, Florence, Italy
| | - Agata Fiumara
- Department of Clinical and Experimental Medicine, Metabolic Diseases, Pediatric Clinic, University of Catania, Catania, Italy
| | - Serena Gasperini
- Pediatric Rare Diseases Unit, Department of Pediatrics, MBBM Foundation, ATS Monza e Brianza, Via Pergolesi 33, 20900, Monza, Italy
| | - Francesca Menni
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, University of Milano, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | | | - Michele Sacchini
- Department of Pediatrics, Meyer Children's Hospital, Metabolic and Muscular Unit, University of Firenze, Florence, Italy
| | - Marco Spada
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Roberta Taurisano
- Division of Metabolism Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Grazia Valsecchi
- Centre of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maja Di Rocco
- Rare Diseases Unit, Pediatric Hospital Istituto Giannina Gaslini, Genoa, Italy
| | - Bruno Bembi
- Centre for Rare Diseases, University Hospital Santa Maria della Misericordia, Udine, Italy
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Abstract
We report a case of acute hemorrhagic edema of infancy (AHEI) occurred in an 11-month-old male infant after upper respiratory tract infection. The onset was dramatic with petechiae, ecchymosis, and annular, nummular, or targetoid purpuric plaques on the extremities, face, and ears. Acute hemorrhagic edema of infancy is a benign form of leukocytoclastic vasculitis that typically affects children between 4 and 24 months of age. The etiology remains still unknown. The potential triggers of AHEI include preceding bacterial or viral infections, immunizations, and drugs. Although the clinical picture is fearful, in the majority of cases, it involves only cutaneous small vessels. Recognizing this as a distinct clinical entity allows to establish an appropriate prognosis for this rare benign disease in children.This report could be a helpful reminder, especially for emergency physicians, to discriminate AHEI from other more severe diseases, such as meningococcal sepsis.
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Porta F, Pagliardini V, Celestino I, Pavanello E, Pagliardini S, Guardamagna O, Ponzone A, Spada M. Neonatal screening for biotinidase deficiency: A 30-year single center experience. Mol Genet Metab Rep 2017; 13:80-82. [PMID: 28971021 PMCID: PMC5608602 DOI: 10.1016/j.ymgmr.2017.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/26/2017] [Accepted: 08/26/2017] [Indexed: 11/16/2022] Open
Abstract
We reviewed the outcome of newborn screening for biotinidase deficiency performed at our department since 1987. Among 1,097,894 newborns screened, 461 were recalled, and 18 were identified as affected by complete or partial biotinidase deficiency (incidence 1:61,000, false positive rate 0.04%). The common missense mutation Q456H was found in 80% of patients with profound biotinidase deficiency. Of them, one patient harbored the novel mutation M399I in compound heterozygosity (M399I/Q456H). The complex allele A171T/D444H in cis was found in two patients with profound biotinidase deficiency (in homozygosity and in compound heterozygosity with the R211H mutation, respectively) and in one patient with partial biotinidase deficiency (in compound heterozygosity with the protective allele D444H in trans). All detected patients were treated and followed up at our Center until present. Biotin therapy (10-20 mg/day) allowed the full prevention of clinical symptoms in all patients with no adverse effects. These excellent outcomes confirm that newborn screening for biotinidase deficiency is a very effective secondary prevention program.
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Affiliation(s)
| | | | | | | | | | | | | | - Marco Spada
- Department of Pediatrics, University of Torino, Italy
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Spada M, Kasper D, Pagliardini V, Biamino E, Giachero S, Porta F. Metabolic progression to clinical phenotype in classic Fabry disease. Ital J Pediatr 2017; 43:1. [PMID: 28049500 PMCID: PMC5209809 DOI: 10.1186/s13052-016-0320-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 09/22/2016] [Accepted: 12/14/2016] [Indexed: 11/23/2022] Open
Abstract
Background Fabry disease is an X-linked lysosomal storage disorder due to α-galactosidase A (α-Gal A) deficiency. Clinical onset of Fabry disease is preceded by significant storage of globotriaosylceramide (Gb3) and related glycosphingolipids, but the extent of the metabolic progression before symptoms is unknown. Using a newly recognized effector and marker of Fabry disease, globotriaosylsphingosine (LysoGb3), we aimed to provide a metabolic picture of classic Fabry disease from the neonatal period to childhood. Methods LysoGb3 was assessed at different times in two brothers with classic Fabry disease (genotype c. 370–2 A > G). The firstborn was diagnosed after clinical onset at 11 years of age, whereas the second-born was diagnosed in the neonatal period. LysoGb3 was measured in dried blood spots by high-sensitive electrospray ionization liquid chromatography tandem mass spectrometry. Results Blood LysoGb3 concentrations were consistent with patients’ age and clinical picture, with lower levels in the asymptomatic neonate (19.1 ng/ml) and higher levels in the symptomatic child (94.3 ng/ml). In the second-born, LysoGb3 doubled during the first 5 months of life (37.4 ng/ml), reaching ~40% concentration observed in the symptomatic period. The neonatal LysoGb3 concentration in classic Fabry disease exceeded that observed in normal subjects by over 15 times. Conclusions A substantial increase of LysoGb3 was documented during the first months of life in classic Fabry disease, suggesting an early plateau during the pre-symptomatic period. Such a progressive metabolic trend during the pre-symptomatic period implies the potential definition of a metabolic threshold useful for a preventive therapeutic approach of classic Fabry disease. Additionally, the consistent increase of LysoGb3 in the neonatal period in classic Fabry disease suggests LysoGb3 as a useful marker for improving the specificity of newborn screening for Fabry disease.
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Affiliation(s)
- Marco Spada
- Department of Pediatrics, University of Torino, Piazza Polonia 94, 10126, Torino, Italy
| | | | - Veronica Pagliardini
- Department of Pediatrics, University of Torino, Piazza Polonia 94, 10126, Torino, Italy
| | - Elisa Biamino
- Department of Pediatrics, University of Torino, Piazza Polonia 94, 10126, Torino, Italy
| | - Silvana Giachero
- Department of Pediatrics, University of Torino, Piazza Polonia 94, 10126, Torino, Italy
| | - Francesco Porta
- Department of Pediatrics, University of Torino, Piazza Polonia 94, 10126, Torino, Italy.
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Cadario F, Savastio S, Pagliardini V, Bagnati M, Vidali M, Cerutti F, Rabbone I, Fontana F, Lera R, De Donno V, Valori A, Gruden G, Bona G, Bruno G. Vitamin D levels at birth and risk of type 1 diabetes in childhood: a case-control study. Acta Diabetol 2015; 52:1077-81. [PMID: 26018939 DOI: 10.1007/s00592-015-0772-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 02/14/2015] [Accepted: 05/11/2015] [Indexed: 01/08/2023]
Abstract
AIMS To assess whether vitamin D levels at birth were associated with risk of having type 1 diabetes up to 10 years of age and the potential modifier effect of ethnic group. METHODS The Piedmont Diabetes Registry and the Newborn Screening Regional data were linked to identify cases (n = 67 incident children aged ≤10 years at diabetes onset, 2002-2012) and up to five controls (n = 236) matched for birthday and ethnic group. Cards with neonatal blood spot were used and 25-hydroxyvitamin D(3) assessed with tandem mass spectroscopy. RESULTS In conditional logistic regression, OR for unit increment of log vitamin D was 0.78 (95 % CI 0.56-1.10). Vitamin D was significantly lower in migrant than in Italian control newborn babies (p < 0.0001), and interaction between vitamin D and migrant status was statistically significant (p = 0.04). Compared to migrant newborns babies with vitamin D ≥ 2.14 ng/ml, migrants with lower levels had an OR of 14.02 (1.76-111.70), whereas no association was evident in Italians. CONCLUSIONS Our case-control study within the Piedmont Diabetes Registry showed no association between vitamin D levels at birth and risk of having type 1 diabetes up to 10 years of age, apart from the subgroup of migrant babies, which might have clinical implications if confirmed.
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Affiliation(s)
- Francesco Cadario
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Novara, Italy
| | - Silvia Savastio
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Novara, Italy
| | - Veronica Pagliardini
- Department of Pediatrics, Newborn Screening Regional Center, University of Torino, Turin, Italy
| | - Marco Bagnati
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Matteo Vidali
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
| | - Franco Cerutti
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Novara, Italy
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | | | | | | | | | - Gabriella Gruden
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - Gianni Bona
- Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Novara, Italy
| | - Graziella Bruno
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
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Cadario F, Savastio S, Magnani C, Cena T, Pagliardini V, Bellomo G, Bagnati M, Vidali M, Pozzi E, Pamparana S, Zaffaroni M, Genoni G, Bona G. High Prevalence of Vitamin D Deficiency in Native versus Migrant Mothers and Newborns in the North of Italy: A Call to Act with a Stronger Prevention Program. PLoS One 2015; 10:e0129586. [PMID: 26067469 PMCID: PMC4466139 DOI: 10.1371/journal.pone.0129586] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 05/11/2015] [Indexed: 01/08/2023] Open
Abstract
Background Vitamin D status during pregnancy is related to neonatal vitamin D status. Vitamin D deficiency has been associated with an increased risk of rickets in children and osteomalacia in adults. Aim of this study was to investigate 25OHD levels in maternal serum and in neonatal blood spots in native and migrant populations living in Novara (North Italy, 45°N latitude). Methods and Findings We carried out a cross sectional study from April 1st 2012 to March 30th 2013, in a tertiary Care Center. Maternal blood samples after delivery and newborns' blood spots were analyzed for 25OHD levels in 533 pairs. Maternal country of origin, skin phototype, vitamin D dietary intake and supplementation during pregnancy were recorded. Multivariate regression analysis, showed a link between neonatal and maternal 25OHD levels (R-square:0.664). Severely deficient 25OHD values (<25 nmol/L) were found in 38% of Italian and in 76.2% of migrant’s newborns (p <0.0001), and in 18% of Italian and 48,4% of migrant mothers (p <0.0001) while 25OHD deficiency (≥25 and <50 nmol/L) was shown in 40.1% of Italian and 21.7% of migrant’s newborns (p <0.0001), and in 43.6% of Italian and 41.3% of migrant mothers (p <0.0001). Italian newborns and mothers had higher 25OHD levels (34.4±19.2 and 44.9±21.2nmol/L) than migrants (17.7±13.7 and 29.7±16.5nmol/L; p<0.0001). A linear decrease of 25OHD levels was found with increasing skin pigmentation (phototype I 42.1 ±18.2 vs phototype VI 17.9±10.1 nmol/l; p<0.0001). Vitamin D supplementation resulted in higher 25OHD values both in mothers and in their newborns (p<0.0001). Conclusions Vitamin D insufficiency in pregnancy and in newborns is frequent especially among migrants. A prevention program in Piedmont should urgently be considered and people identified as being at risk should be closely monitored. Vitamin D supplementation should be taken into account when considering a preventative health care policy.
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Affiliation(s)
- Francesco Cadario
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Novara, Italy
- * E-mail:
| | - Silvia Savastio
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Corrado Magnani
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of “Piemonte Orientale Amedeo Avogadro” and CPO-Piemonte, Novara, Italy
| | - Tiziana Cena
- Unit of Medical Statistics and Cancer Epidemiology, Department of Translational Medicine, University of “Piemonte Orientale Amedeo Avogadro” and CPO-Piemonte, Novara, Italy
| | | | - Giorgio Bellomo
- Central Laboratory of Maggiore della Carità Hospital, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Marco Bagnati
- Central Laboratory of Maggiore della Carità Hospital, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Matteo Vidali
- Central Laboratory of Maggiore della Carità Hospital, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Erica Pozzi
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Stella Pamparana
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Mauro Zaffaroni
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Giulia Genoni
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
| | - Gianni Bona
- Division of Pediatrics, Department of Health Sciences, University of “Piemonte Orientale Amedeo Avogadro”, Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Novara, Italy
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Porta F, Pagliardini S, Pagliardini V, Ponzone A, Spada M. Newborn screening for galactosemia: a 30-year single center experience. World J Pediatr 2015; 11:160-4. [PMID: 25754754 DOI: 10.1007/s12519-015-0017-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 05/01/2014] [Accepted: 08/27/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Galactosemia due to complete or near-complete galactose-1-phosphate uridyltransferase (GALT) deficiency was the first disorder added to the pioneering newborn screening panel besides phenylketonuria. In the last 50 years, many criticisms have been focused on the opportunity of its inclusion. Consequently, long-term single center experiences with this issue are generally lacking. METHODS We reviewed the outcome of newborn screening for hypergalactosemia performed at our department since 1982 and the correspondent long-term clinical outcome. RESULTS Among 1 123 909 newborns screened for hypergalactosemia, 33 showed abnormal results confirmed at second tier test. Thirteen patients were affected with classic galactosemia, 8 partial GALT deficiency, 3 severe galactokinase deficiency, 7 transient galactosemia, one congenital porto-systemic shunt, and one glucose transporter 2 deficiency. Acute neonatal liver failure in the late first week of life (5.8±1.1 days) unavoidably complicated the clinical course of classic galactosemia, unless in three second-born siblings treated on the basis of presumptive diagnosis immediately after newborn screening sample collection on day 3. Despite early treatment and long-term steadily normal peripheral blood galactose, 77% of patients with severe GALT deficiency present mild to severe intellectual disabilities. All patients with partial GALT deficiency showed normal intellectual development on a regular diet, as well as patients with galactokinase deficiency under treatment. CONCLUSIONS Availability of screening results within the fifth day after birth would allow the prevention of acute decompensation in classic galactosemia. A systematic diagnostic work-up in all positive newborns is essential to unravel the etiology of hypergalactosemia.
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Affiliation(s)
- Francesco Porta
- Department of Pediatrics, University of Torino, Torino, Italy,
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Affiliation(s)
- Francesco Porta
- Department of Pediatrics; University of Torino; Torino Italy
| | | | - Luca Roasio
- Department of Pediatrics; University of Torino; Torino Italy
| | - Elisa Biamino
- Department of Pediatrics; University of Torino; Torino Italy
| | - Marco Spada
- Department of Pediatrics; University of Torino; Torino Italy
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Pagliardini V, Pagliardini S, Corrado L, Lucenti A, Panigati L, Bersano E, Servo S, Cantello R, D'Alfonso S, Mazzini L. Chitotriosidase and lysosomal enzymes as potential biomarkers of disease progression in amyotrophic lateral sclerosis: a survey clinic-based study. J Neurol Sci 2014; 348:245-50. [PMID: 25563799 DOI: 10.1016/j.jns.2014.12.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [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: 06/04/2014] [Revised: 11/11/2014] [Accepted: 12/10/2014] [Indexed: 12/13/2022]
Abstract
The aim of this study was to determine if blood chitotriosidase (Chit) activity and lysosomal enzyme levels might represent markers of disease activity and progression in amyotrophic lateral sclerosis (ALS). It is a survey clinic-based study performed in a tertiary ALS centre. Blood samples were obtained from 76 patients with ALS in different stages of the disease and from 106 healthy individuals serving as controls. Chit activity and the levels of acid alpha-glucosidase, acid alpha-galattosidase A, beta-glucocerebrosidase, and alpha-l-iduronidase were detected using the dried blood spots (DBS) technique. The CHIT1 genotype for exon 10 duplication and for the p.G102S variant was also determined. Chit activity was significantly higher in ALS patients than in healthy individuals. This difference was independent of the genotypes at CHIT1 functional variants. Chit were significantly higher in 34 rapidly progressing patients as compared to 42 with slowly progressive disease. Acid alpha-glucosidase was higher than normal and significantly correlated with the severity of the disease. Glucocerebrosidase and alpha-l-iduronidase activity were significantly lower in patients than in the controls. Alpha-galactosidase A was higher than normal only in rapidly progressing patients. We have employed a very simple and affordable laboratory test to measure blood Chit and lysosomal enzymes activity which could be easily included in the screening of ALS patients recruited in clinical trials. Remarkably, high levels of chitinase and alpha-galactosidase A could help to distinguish patients with fast progression from those with slow progression of the disease and possibly to follow the effects of treatments on neuroinflammation and autophagy.
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Affiliation(s)
| | - Severo Pagliardini
- Department of Pediatric and Newborn Screening, University of Torino, Italy
| | - Lucia Corrado
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases, A. Avogadro' University, Italy
| | - Ausiliatrice Lucenti
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Laura Panigati
- Department of Pediatric, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Enrica Bersano
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Serena Servo
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Roberto Cantello
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy
| | - Sandra D'Alfonso
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases, A. Avogadro' University, Italy
| | - Letizia Mazzini
- Department of Neurology, A. Avogadro' University, Maggiore della Carità University Hospital, Novara, Italy.
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Spada M, Porta F, Vercelli L, Pagliardini V, Chiadò-Piat L, Boffi P, Pagliardini S, Remiche G, Ronchi D, Comi G, Mongini T. Screening for later-onset Pompe's disease in patients with paucisymptomatic hyperCKemia. Mol Genet Metab 2013; 109:171-3. [PMID: 23566438 DOI: 10.1016/j.ymgme.2013.03.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/04/2013] [Accepted: 03/04/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pompe's disease is an inherited metabolic myopathy caused by acid α-glucosidase deficiency. Early diagnosis optimizes the treatment effectiveness. METHODS One-hundred-thirty-seven consecutive patients with unexplained hyperCKemia underwent the assessment of acid α-glucosidase activity on dried blood spot. Second tier confirmatory testing in positive patients included the assessment of α-glucosidase activity on lymphocytes or muscle tissue and molecular analysis. RESULTS Three patients were diagnosed with later-onset Pompe's disease, revealing 2.2% prevalence in asymptomatic hyperCKemia. Moreover, three patients positive to the screening revealed abnormal biochemical second tier testing, but were heterozygous for the common c.-32-13T>G mutation at molecular level. CONCLUSIONS The selective screening for later-onset Pompe's disease in asymptomatic hyperCKemia allowed the identification of affected patients in a pre-clinical stage. Additionally, the identification of carriers with biochemical alterations related to Pompe's disease extends the spectrum of its manifestations to heterozygous subjects.
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Affiliation(s)
- Marco Spada
- Department of Pediatrics, University of Torino, Italy
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Porta F, Pagliardini V, Barbera C, Calvo P, Pagliardini S, Lualdi S, Filocamo M, Spada M. Neonatal chitotriosidase activity is not predictive for Niemann-Pick disease type A/B: implications for newborn screening for lysosomal storage disorders. Mol Genet Metab 2013; 108:106. [PMID: 23228552 DOI: 10.1016/j.ymgme.2012.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/08/2012] [Indexed: 02/04/2023]
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Spada M, Garelli D, Riggi C, Pagliardini V, Lualdi S, Filocamo M, Porta F. Spontaneous regression of hypertrophic cardiomyopathy in an infant with Pompe's disease. Mol Genet Metab 2012; 107:763. [PMID: 23088900 DOI: 10.1016/j.ymgme.2012.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/02/2012] [Indexed: 10/27/2022]
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Beccari T, Balducci C, Pompa A, Stensland HM, Guaragno M, Pagliardini V, Menghini AR, Persichetti E, Bellucci M. Production of human lysosomal alpha-mannosidase in transgenic tobacco plants. Curr Opin Biotechnol 2011. [DOI: 10.1016/j.copbio.2011.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Porta F, Pagliardini S, Pagliardini V, Dotta A, Mussa A, Spada M. Lysosomal enzyme activities in phenylketonuria. Mol Genet Metab 2011; 102:508. [PMID: 21316999 DOI: 10.1016/j.ymgme.2011.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 01/26/2011] [Indexed: 10/18/2022]
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