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Objectives Fabry disease (FD) is an X-linked lysosomal storage disorder, resulting from a deficiency of the enzyme α-galactosidase A, responsible for breaking down glycolipids such as globotriaosylceramide and its deacylated derivative, globotriaosylsphingosine (LysoGb3). Here, we compare the levels of LysoGb3 in dried blood spots (DBS) and plasma in patients with classic and late-onset phenotypes. Methods LysoGb3 measurements were performed in 104 FD patients, 39 males and 65 females. Venous blood was collected. A portion was spotted onto filter paper and another portion separated to obtain plasma. The LysoGb3 concentrations in DBS and plasma were determined by highly sensitive electrospray ionization liquid chromatography tandem mass spectrometry. Agreement between different matrices was assessed using linear regression and Bland Altman analysis. Results The method on DBS was validated by evaluating its precision, accuracy, matrix effect, recovery, and stability. The analytical performances were verified by comparison of a total of 104 paired DBS and plasma samples from as many FD patients (representing 46 GLA variants). There was a strong correlation between plasma and the corresponding DBS LysoGb3 concentrations, with few exceptions. Discrepancies were observed in anemic patients with typically low hematocrit levels compared to the normal range. Conclusions The method proved to be efficient for the rapid analysis of LysoGb3. DBS provides a convenient, sensitive, and reproducible method for measuring LysoGb3 levels for diagnosis, initial phenotypic assignment, and therapeutic monitoring in patients with FD.

While propranolol pharmacokinetics has been extensively studied in adults, this study reports the first evaluation of propranolol pharmacokinetics in term and preterm neonates.Propranolol concentrations were measured in four term and 32 preterm newborns treated with oral propranolol at the dose of 0.5 or 0.25 mg/kg every 6 h by serial dried blood spots.The levels of propranolol, although with high inter-individual variability, were proportional with the administered dose. Pharmacokinetic parameters evaluated at the steady state in newborns treated with 0.5 mg/kg/6 h showed values of maximal (71.7 ± 29.8 ng/mL), minimal (42.2 ± 20.8 ng/mL) and average concentration (60.8 ± 25.0 ng/mL), time of maximal concentration (2.6 ± 0.9 h) and area under the time-concentration curve (364.7 ± 150.2 ng/mL/h) similar to those observed in adults. In both dosing groups, elimination half-life was significantly longer (14.9 ± 4.3 and 15.9 ± 6.1 h), and apparent total body clearance (27.2 ± 13.9 and 31.3 ± 13.3 mL/kg/min) lower than those reported in adults, suggesting a slower metabolism in newborns. No differences were observed between newborns with different gestational age or different sex.Neonates treated with propranolol-exhibited drug concentrations proportional with the dose, with significant long half-life.

Background: Insulin-resistant hyperglycaemia may occasionally complicate the clinical course of organic acidaemias. Study Design: Clinical observation. Results: Two term infants, one suffering from acute early-onset methylmalonic acidaemia, the other suffering from acute early-onset propionic acidaemia, presented acutely with dehydration, ketoacidosis, and hyperammonaemia. Urinary organic acid, plasma amino acids, and blood and plasma acylcarnitine analysis allowed the diagnosis of methylmalonic and propionic acidaemias. The detection of the novel c.481G>A (p.Gly161Arg) and the known c.655A>T (p.Asn219Tyr) MUT gene mutations identified the first patient as affected by methylmalonic acidaemia mut type. The high increase of propionylcarnitine after carnitine administration in both patients suggested a greatly elevated metabolic intoxication. Both newborns showed insulin-resistant hyperglycaemia. Patient 1 died, but patient 2, after a strong reduction of glucose administration, survived. To our knowledge, this is the only patient with this complication who survived. Conclusion: Insulin-resistant hyperglycaemia complicating neonatal onset of methylmalonic and propionic acidaemias is probably a marker of a serious disease. One patient with this complication survived after a strong reduction of glucose administration. Even if this is probably only a partial intervention, we hypothesize that in this situation a reduction of glucose administration can reduce almost the risk of persistent hyperglycaemia. Further studies are required to confirm our hypothesis.

In an expanded newborn screening program for inborn errors of metabolism by LC-MS/MS in Tuscany, six newborns out of 169,000 showed decreased blood citrulline levels. In one of them, molecular analysis of the OTC gene identified the known p.Trp265Leu mutation, which is correlated with late-onset ornithine transcarbamylase deficiency (OTCD). Hypocitrullinemia is not a reliable marker for OTCD newborn screening, especially for late-onset forms that may exhibit normal citrulline levels. However, when hypocitrullinemia is detected in a newborn in whom intestinal dysfunction and prematurity have been excluded, OTCD should be investigated first because of the OTCD incidence (1:14,000) and the small size of the OTC gene coding sequence.

INTRODUCTION: Morphological anomalies of the extracranial internal carotid artery (ICA) cause symptomatic cerebrovascular insufficiency in 4-16% of the cases. The aim of the present study is to evaluate macroscopic and microscopic features of a group of extracranial ICA anomalies, specifically kinking, coiling, and tortuosity, eventually affecting the surgical approach. MATERIALS AND METHODS: From January 2003 to December 2005, 10 out of 169 (6%) revascularized patients (pts) were operated upon because of an ICA anomaly. They were all but two symptomatics. Seven pts were treated by ICA transection and end-to-side reimplantation of the ICA at the level of the carotid bulb; three pts were treated by ICA resection and end-to-end anastomosis. In all the cases a segment of ICA was resected; in three cases one more segment was also obtained from a common carotid artery (CCA) and these specimens were histologically examined. Patients were followed-up through a 3-year period. RESULTS: No pts died and none suffered of neurologic events. Duplex scan and arteriographic postoperative control showed the correct surgical reconstruction. Matching preoperative clinical findings with presence or absence of significant atherosclerotic stenotic lesion, we found out a positive cerebral CT in one pt (20%) in both groups; fluent neurological deficit was preeminent in pts with pure ICA anomalies (40% vs. 0%) (P = 0.2); pts with pure ICA anomalies were significantly younger than 65 years old (80% vs. 0%) (P = 0.03) and males were more involved by pure ICA anomalies (60% vs. 40%) (P = 0.1). The histological examination of ICA specimens showed a reduction of elastic fibers and muscular cells with a compensative increase of connective fibers. CONCLUSIONS: At our knowledge this is the first study focused on ICA anomalies like kinking, coiling, and tortuosity, comparing histologic features of CCA and ICA specimens coming from the same affected carotid axis. Our results, although preliminary, show elastic and muscular tissue substituted by loose connective tissue, configuring a metaplasia of tunica media limited to the ICA. Our hypothesis is that extracranial ICA, being a segment of transition between an elastic vessel (CCA) and a muscular vessel (intracranial ICA), is particularly subject to metaplastic transformation, analogously to other transition zones in human body. Our purpose is now to confirm by ultrastructural and molecular biology techniques, in a wider series, the presence of this metaplasia, since this could condition also the revascularization techniques.

Genetic and biochemical prenatal diagnosis was performed at 11 weeks of gestation in a family with a proband affected by mut methylmalonic aciduria (MMA) and homozygotes for the MUT gene c.643G>A (p.Gly215Ser) mutation. Both chorionic villus and amniotic fluid samples were used. The presence of high levels of methylmalonic acid and propionylcarnitine determined by gas chromatography/mass spectrometry and LC/MS/MS analysis, respectively, and the identification of the p.Gly215Ser at a homozygous level in foetal DNA allowed a certain, rapid and early diagnosis. To our knowledge, this is the first mut MMA prenatal diagnosis carried out by genetic and biochemical approach.

An HPLC-ESI-MS method in a positive mode is proposed to qualitatively analyse the saponin fractions from dietary supplements ofTribulus terrestris L. This method allows for theseparation of structural isomers, as highlighted for some terrestrosines. The MS fragmentation pattern resulted diagnostic to collect structural information and the characteristic loss of water from some furostanolic saponins was highlighted for the first time. Due to the wide number of glycosidic furostanolic and spirostanolic saponins extracted from tribulus, a complete reference “molecular weight map” was created. Finally, a seml-quantitative evaluation of the total saponin content was carried cut by HPLC-MS using protodioscin as external standard.

Objectives: Autologous saphenous vein (ASV) for arterial reconstruction, in vascular limb injuries is the graft material of choice. Denatured saphenous vein homograft (DSVH), thanks to its characteristics of readily available autologous biological prosthesis, has been proposed as alternative. We report our prospective experience with DSVH employed for arterial reconstruction in civilian limb vascular injuries. Materials: From January 1994 to June 1996, DSVH was implanted in 16 male patients (pts.) treated for arterial civilian injuries of eight upper limbs and eight lower limbs. Methods: In 14 cases it was performed as an interposition graft and in two cases a bypass. We performed a 30-month follow-up and a 20-month mean follow-up. Results: Four patients had graft thrombosis at the first postoperative week and were submitted to the replacement of the graft with reappearance of distal arterial pulse; one of them had graft failure at the fifth postoperative week and because the necrosis due to extensive soft tissue damage, he was submitted to limb amputation. After 30-months' follow-up we obtained 75% primary patency rate and 93% secondary patency rate. Conclusions: In the absence of suitable ASV, DSVH appears to be an interesting alternative for arterial repair in limbs in civilian vascular injuries.

Aminoacylase 1 (ACY1) deficiency is a rare inborn error of metabolism of which less than 20 observations have been described. Patients exhibit urinary excretion of specific N-acetyl amino acids and manifest a heterogeneous clinical spectrum including intellectual disability, motor delay, seizures, moderate to severe mental retardation, absent speech, growth delay, muscular hypotonia and autistic features. Here, we report the case of ACY1 enzyme deficiency in a 6-year-old girl presenting severe intellectual disability, motor retardation, absence of spontaneous locomotor activity and severe speech delay. Urinary excretion of N-acetylated amino acids was present. Mutational analysis of ACY1 gene identified the new homozygous c.1001_1001+5del6 mutation, which alters the mRNA transcription leading to exon 13 skipping and inclusion of a premature stop codon (p.Lys308Glufs*7). A quantitative fluorescent multiplex-polymerase chain reaction (QFM-PCR) assay has been set up and confirmed homozygosity of the mutation in the patient's DNA. Biochemical analysis showed absence of ACY1 enzyme activity in the patient's fibroblasts. The structure of the mutated protein has been defined by homology modeling (HM). Our data endorse the hypothesis of a link between this inborn error of metabolism and the neurological manifestations observed in patients with ACY1 deficiency.

Background Escherichia coli asparaginase is an enzyme that depletes serum levels of asparagine. It is used to treat acute lymphoblastic leukaemia and related forms of non-Hodgkin’s lymphoma. Polyethylene glycosylated–asparaginase (pegaspargase), obtained by covalently attaching polyethylene glycol to the native enzyme, has been shown to sustain similar reductions in serum asparagine concentrations compared with the native enzyme. In addition, pegaspargase has a decreased immunogenicity and a prolonged half-life. The summary of product characteristics (Oncaspar) indicates that the intravascular infusion should be given over a period of 1–2 h but nothing is known on the long term stability and activity of the enzyme after dilution. Purpose Evaluation of the biological activity of pegaspargase diluted to 16 UI/mL in NaCl 0.9% and stored up to 48 h at 4°C and at room temperature. A study of drug degradation was also carried out. Material and methods Samples of pegaspargase solution diluted in NaCl 0.9% were stored refrigerated at 4°C and at room temperature and protected from light. The biological activity of the two solutions was determined by measuring hydrolysis of L-asparagine, and the ammonia released by the enzyme was quantified with Nessler’s reagent. The absence of degradation products or aggregates in the two solutions was verified using size exclusion fast protein liquid chromatography (SEC-FPLC) under the following condition: Superdex 200 10/300 column; Tris buffer pH=8.6; 0.5 mL/min flow rate; 280 nm UV detection; 100 µL injection volume. Results In the samples stored both at 4°C and at room temperature, enzymatic activity was preserved over a period of 48 h. No degradation or aggregation was observed in these samples over the same period. Conclusion The variation in enzymatic activity of the diluted pegaspargase solutions compared with the fresh solution was less than 5% after 48 h, with no significant differences between storage at 4°C or at room temperature. Preservation of the enzymatic activity and the stability of the solutions evaluated will allow us to store pegaspargase for up to 48 h with costs savings and an improvement in patient compliance. A microbiological study is in progress to validate the aseptic manufacturing process in order to guarantee the sterility of the stored solutions. No conflict of interest.

Ferri L, Guido C, la Marca G, Malvagia S, Cavicchi C, Fiumara A, Barone R, Parini R, Antuzzi D, Feliciani C, Zampetti A, Manna R, Giglio S, Della Valle CM, Wu X, Valenzano KJ, Benjamin ER, Donati MA, Guerrini R, Genuardi M, Morrone A. Fabry disease: polymorphic haplotypes and a novel missense mutation in the GLA gene. Fabry disease (FD) is an X-linked lysosomal storage disorder with a heterogeneous spectrum of clinical manifestations that are caused by the deficiency of α-galactosidase A (α-Gal-A) activity. Although useful for diagnosis in males, enzyme activity is not a reliable biochemical marker in heterozygous females due to random X-chromosome inactivation, thus rendering DNA sequencing of the α-Gal-A gene, alpha-galactosidase gene (GLA), the most reliable test for the confirmation of diagnosis in females. The spectrum of GLA mutations is highly heterogeneous. Many polymorphic GLA variants have been described, but it is unclear if haplotypes formed by combinations of such variants correlate with FD, thus complicating molecular diagnosis in females with normal α-Gal-A activity. We tested 67 female probands with clinical manifestations that may be associated with FD and 110 control males with normal α-Gal-A activity. Five different combinations of GLA polymorphic variants were identified in 14 of the 67 females, whereas clearcut pathogenetic alterations, p.Met51Ile and p.Met290Leu, were identified in two cases. The latter has not been reported so far, and both mutant forms were found to be responsive to the pharmacological chaperone deoxygalactonojirimycin (DGJ; migalastat hydrochloride). Analysis of the male control population, as well as male relatives of a suspected FD female proband, permitted the identification of seven different GLA gene haplotypes in strong linkage disequilibrium. The identification of haplotypes in control males provides evidence against their involvement in the development of FD phenotypic manifestations.

We report on our 6-year experience of expanded newborn screening by tandem mass spectrometry in Tuscany (Italy), the first Italian Region to screen all newborns for more than 40 inborn errors of metabolism: organization, diseases observed and updates on methods to reduce false-positive and false-negative tests are described. Blood collection is recommended between 48 and 72 h of life. Blood spots are sent daily by courier to laboratory. When a positive result occurs, two subsequent procedures are followed: for disorders with possible acute metabolic decompensation, the baby is immediately recalled and clinical examinations and confirmatory tests are performed; for the other disorders, the nursery provides for a second blood spot. If the test is positive, clinical examinations and confirmatory tests are performed. In both cases, if confirmatory tests are positive, a treatment and a follow-up programme are started. Up to now, spots from 160 000 infants have been analysed and 80 affected patients have been identified (disorders of amino acids, organic acids and fatty acids metabolism). We describe adjustments to cut-off values, the introduction of a second-tier test for propionic acidaemia and for methylmalonic aciduria, the inclusion of succinylacetone in the panel of metabolites, and protocols for premature infants and for newborns on parenteral nutrition or transfused. These changes resulted in a reduction in recalls from 1.37% to 0.32% and consequently of working time and parental stress. Avoiding false-negatives by using more specific markers and minimizing the false-positive rate with second-tier testing is important for a successful newborn screening programme.

Malonic aciduria is a rare autosomal recessive disorder caused by deficiency of malonyl-CoA decarboxylase, encoded by the MLYCD gene. We report on a patient with clinical presentation in the neonatal period. Metabolic investigations led to a diagnosis of malonyl-CoA decarboxylase deficiency, confirmed by decreased activity in cultured fibroblasts. High doses of carnitine and a diet low in lipids led to a reduction in malonic acid excretion, and to an improvement in his clinical conditions, but at the age of 4 months he died suddenly and unexpectedly. No autopsy was performed. Molecular analysis of the MLYCD gene performed on the proband's RNA and genomic DNA identified a previously undescribed mutation (c.772-775delACTG) which was homozygous. This mutation was present in his mother but not in his father; paternity was confirmed by microsatellite analysis. A hypothesis of maternal uniparental disomy (UPD) was investigated using fourteen microsatellite markers on chromosome 16, and the results confirmed maternal UPD. Maternal isodisomy of the 16q24 region led to homozygosity for the MLYCD mutant allele, causing the patient's disease. These findings are relevant for genetic counselling of couples with a previously affected child, since the recurrence risk in future pregnancies is dramatically reduced by the finding of UPD. In addition, since the patient had none of the clinical manifestations previously associated with maternal UPD 16, this case provides no support for the existence of maternally imprinted genes on chromosome 16 with a major effect on phenotype. © 2007 The Authors Journal compilation

Background Vernal Keratoconjunctivitis (VKC) is an allergic conjunctivitis, often not easily diagnosed and properly treated. The disease is very debilitating for patients, may be complicated by corneal lesions and can evolve to keratoconus. Purpose The exponential increase in VKC patients led us to start a close collaboration between pharmacists and allergists, ophthalmologists, and chemists. The goal was to address and solve problems caused by the lack of adequate knowledge of VKC, in order to find a diagnostic-therapeutic course, improve patient compliance and provide high-quality products as an alternative to conventional treatments. Material and methods After discussions with allergists and ophthalmologists, pharmacists formulated 3 different kinds of eye drops as treatment: ciclosporin 1% and tacrolimus 0.1%, both in methylcellulose 0.15%, and ciclosporin 2% in sunflower oil. The stability of such formulations was demonstrated by using liquid chromatography coupled to a triple quadrupole mass spectrometer. The pharmacist now prepares a weekly supply of eye drops, after allergists pass on the number of children who will undergo eye examinations. Then, the pharmacist proceeds, after allergist confirmation, to arrange for eye drops to be sent directly to patients’ homes in the whole country. Results The LC/MS/MS and sterility analysis results allowed the pharmacist to declare that formulations in methylcellulose 0.15% and in sunflower oil were safe for up to 45 days. Such formulations were chosen considering also patient compliance. Indeed, one of the results of the team collaboration has been the development of the formulation in sunflower oil, which can be stored at room temperature; thus leading to huge advantages in terms of patient compliance. Conclusion The preparation of a galenical formulation of such quality has contributed to the efficacy of the treatment. Moreover, the sharing of information between medical doctors, pharmacists and nurses has led to personalised assistance that is highly responsive to health needs. Reference Leonardi A. Prog Retin Eye Res 2002;21(3):319–39 No conflict of interest.

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive disorder characterized by severe gastrointestinal dysmotility, cachexia, ptosis, ophthalmoparesis, peripheral neuropathy and leukoencephalopathy. The disease is due to a thymidine phosphorylase defect. This enzyme catalyses the phosphorolysis of thymidine to thymine and deoxyribose 1-phosphate. For this reason, increased levels of thymidine in plasma and urine are found in MNGIE patients. Haemodialysis can reduce circulating plasma thymidine levels and can be beneficial in some MNGIE patients. We developed a fast analytical method based on HPLC-ESI-MS/MS capable of identifying pyrimidine nucleotides (thymine, cytosine, uracil) and nucleosides (thymidine, citidine, uridine) in plasma and urine after direct dilution of the samples without pre-treatment. In the patient studied, we observed a significant reduction of plasmatic and urinary thymidine levels during and after dialysis. However, we noted a progressive reduction of the initial thymidine level after some dialytic trials. This method will be useful not only for thymidine level follow-up during dialysis in MNGIE patients but also for the improvement of the diagnosis or diagnostic suspect in other pyrimidine defects such as dihydropyrimidine dehydrogenase deficiency, dihydropyrimidinase deficiency and ureidopropionase deficiency.

Genetic and biochemical prenatal diagnosis was performed at 11 weeks of gestation in a family with a proband affected by mut methylmalonic aciduria (MMA) and homozygotes for the MUT gene c.643GA (p.Gly215Ser) mutation. Both chorionic villus and amniotic fluid samples were used. The presence of high levels of methylmalonic acid and propionylcarnitine determined by gas chromatography/mass spectrometry and LC/MS/MS analysis, respectively, and the identification of the p.Gly215Ser at a homozygous level in foetal DNA allowed a certain, rapid and early diagnosis. To our knowledge, this is the first mut MMA prenatal diagnosis carried out by genetic and biochemical approach.

The introduction of new technologies such as tandem mass spectrometry (MS/MS) has lead to a major revolution in newborn screening for metabolic diseases: from “a test for a disease” (i.e. Guthrie test) to “a test for many diseases”. On a single drop of blood it is now possible to analyze and quantify various metabolites, not only acylcarnitines and amino acids, but also adenosine and 2′-deoxyadenosine (for the detection of ADA-SCID) and lysosomal enzymes. Therefore a great potential can be seen in near future for the diagnosis of diseases for which there may be a specific and effective therapy.

A prerequisite for the efficacy of chemotherapy is that it reaches the tumor mass at a therapeutic concentration. In brain tumors this phenomenon is hampered by the presence of the blood brain barrier (BBB) which limits the spread of chemotherapeutic agents within the brain. It is lately emerged as this Multi Drug Resistance (MDR) phenomenon is explained through the cooperation of P-glycoprotein (P-gp, ABCB1) and breast cancer resistance protein (BCRP, ABCG2), two “gatekeeper" transporters that work in tandem on the BBB and are also present on the plasma membrane of certain brain tumors. Recently, we have attempted to improve the therapeutic efficacy of pharmacological treatment in malignant brain tumors by safe and temporary BBB permeabilization. We have demonstrated that morphine and, to a lower level, ondansetron and dexamethasone allow an accumulation of doxorubicin within the rat brain by LC-MS/MS mass spectrometry. All these drugs are substrates of P-gp and BCRP efflux pumps. The aim of the current proposal is to expand our preliminary observation, to understand the mechanism of action of BBB “permeabilization” induced by morphine or other drugs, and to exploit this method for the “treatment” of brain tumour in an animal model. i) Quantifying the level drugs that do not usually cross the BBB (mitoxantrone or melphalan) after morphine pre-treatment in a preclinical model. Verifying the cytotoxic effect of morphine plus doxorubicin (and other chemotherapeutic agents) treatment by using MTT and TUNEL analysis in glioblastoma cell lines ii) Quantifying the level of drugs that do not usually cross the BBB after morphine pre-treatment in an artificial BBB through a monolayer of MDCKII cells over-expressing the human P-gp or BCRP. iii) Investigating the regulatory role of certain microRNA in MDR mechanism by RT-PCR and western blot analysis of P-gp, BCRP, miR-21, miR-27a and miR-451. Our data suggest that blocking efflux transporters by pretreatment with morphine, ondansetron or desamethasone is able to allow doxorubicin penetration inside the brain. This is not associated with acute cardiac or renal toxicity. These preliminary results will enable us to novel therapeutic approaches to refractory or recurrent brain tumors in which molecules usually stopped by the BBB may have a therapeutic impact.

Aim of the present comparative clinical study was to demonstrate the efficacy of the topical application of mesoglycan, a profibrinolytic agent, for healing of leg ulcers in patients with chronic venous insufficiency.Forty patients, observed in our outpatients department, with venous leg ulcers have been randomized in two groups of twenty subjects, each treated with topical application of mesoglycan (1 or 2 vials/day) or vegetal stimulins and followed for two months, with controls after 15, 30 and 60 days.At the end of the observation period, ulcer healing rate was 95% in the mesoglycan group, while a lower healing rate was obtained in the stimulins group (80%).The present study confirms previous clinical experiences with mesoglycan and suggests its application in the topical treatment of venous ulcers.

Background: Children and adolescents with overt type 1 diabetes (T1D) have been found to show an altered carnitine profile. This pattern has not previously been analyzed in neonates before onset of the disease. Materials and methods: Fifty children who developed T1D during the first 6 years of life, born and living in the Tuscany and Umbria Regions of Italy, were identified and 200 controls were recruited into the study. All newborns were subjected to extended neonatal screening by mass spectrometry at 48–72 h of life. Four controls for each of the 50 index cases were taken randomly and blinded in the same analytical batch. The panel used for neonatal screening consists of 13 amino acids, free carnitine, 33 acyl-carnitines and 21 ratios. All Guthrie cards are analyzed within 2 days of collection. Results: Total and free carnitine were found to be significantly lower in neonates who later developed T1D compared with controls. Moreover, the concentrations of the acyl-carnitines – acetyl-L-carnitine (C2), proprionylcarnitine (C3), 3-hydroxyisovalerylcarnitine (C5OH), miristoylcarnitine (C4), palmitoylcarnitine (C16) and stearoylcarnitine (C18) – were also significantly low in the cases vs controls. Furthermore, total amino-acid concentrations, expressed as the algebraic sum of all amino acids tested, showed a trend toward lower levels in cases vs controls. Conclusions: We found that carnitine and amino-acid deficit may be evident before the clinical appearance of T1D, possibly from birth. The evaluation of these metabolites in the neonatal period of children human leukocyte antigen genetically at ‘risk’ to develop T1D, could represent an additional tool for the prediction of T1D and could also offer the possibility to design new strategies for the primary prevention of the disease from birth.

Background Women with autoimmune diseases can often lead a normal life and give birth to healthy children; however disease activity and drugs administered during pregnancy can potentially have an effect on their offspring. Bone health is influenced by many factors, some of them starting at birth or even during prenatal life. Heparin is known to cause bone loss, and data on its transplacental passage are scanty. Objectives To evaluate bone status with phalangeal ultrasound and parameters of bone metabolism in children born from a cohort of mothers with autoimmune diseases and treated with agents known to reduce bone mass. Methods We have enrolled 40 children born from mothers with autoimmune diseases who were treated during pregnancy with low molecular weight heparin (LMVH) and/or prednisone. History and physical examination (including body mass index), laboratory tests including bone alkaline phosphatase, osteocalcin, ICTP telopeptide, vitamin D levels, and phalangeal ultrasonography (DBM Sonic Italy), were performed in all cases. Demographic, clinical, and laboratory data were entered into a customized database, and results were analyzed with SPSS software. In some children whose mothers were treated with LMWH, we retrieved dried blood spots taken after 48 hours of life for newborn screening purposes and we analyzed the possible presence of heparin with a new liquid chromatography tandem mass spectrometry method. Results We enrolled 26 girls and 14 boys (mean age 5y10mo, range 9mo-11y), born from 30 mothers with SLE or connective tissue diseases. These women had been continuously treated during pregnancy with daily LMWH (n=10), prednisone (n=15), or both (n=15). Fetal distress was recorded in 4 cases, prematurity in 14, neonatal complications in 7. Median birth weight was 2935 g, range 520-3790. Growth and development were within normal limits for age in all cases, clinical examination did not show major abnormalities, and laboratory tests were normal for age. Despite previous supplementation in 37/40, vitamin D serum levels were decreased ( s : 0.41, p s : -0.32, p 2 =0.18, p vs 68.2 ng/ml ± 2.8, p Conclusions Children born from mothers with autoimmune diseases are at risk to develop reduced bone mass, however this effect seems to decrease with growing age. The administration of LMWH and of prednisone seem to be safe with regard to children’s bone health. Disclosure of Interest None Declared

The aim of this work was to contribute to the phytochemical characterization ofCichorium intybus L. var.silvestre, chicory. Semi-preparative HPLC analysis was applied to an extract of fresh wild chicory leaves to separate and collect the main polyphenolic compounds. HPLC-diode-array detection (DAD), HPLC-MS, and NMR were used for the complete chemical characterization of all the compounds isolated. The molecules characterized were monocaffeoyl tartaric acid, chicoric acid, monocaffeolyp-hydroxycinnamoyl tartaric acid, caffeoyl feruloyl tartaric acid, chlorogenic acid, quercetin-3-O-glucuronide, luteolin-7-O-glucuronide, and quercetin-3-O-glucoside. The chromatographic behaviour of the main components of the extract of the leaves has been compared on three different stationary phases-LiChrosorb RP18, Luna C18, and Luna Phenyl-Hexyl.

Il panel ha registrato la presentazione di sedici studi o ricerche che hanno affrontato direttamente o indirettamente alcuni aspetti significativi della intelligenza, della comprensione e della partecipazione nei contesti di apprendimento-insegnamento (Lucisano & De Luca, 2015). Uno dei contesti ricorrenti nelle indagini è quello universitario, che è esaminato con riferimento particolare: alla introduzione nella didattica di dispositivi (pod- cast - Tore, Tino e Fedeli, Università di Padova); alla sperimenta- zione di modelli innovativi (IMPROVe Model - Miranda, Uni- versità di Salerno, Di Palma, Università di Napoli “Parthenope”) e predisposizione di interventi che possono qualificare la didat- tica e sviluppare il pensiero critico (Imperio), la comprensione e la partecipazione attiva degli studenti; alla formazione dei do- centi universitari con utilizzo della videoanalisi e l’osservazione di strategie di Informal Formative Assessment (Rosa, Università di Bologna); alla progettazione di percorsi di English medium in- struction ed engament degli studenti, che prevedono l’utilizzo della Peer Observation con un approccio trasformativo (Mortari, Silva e Bevilacqua, Università di Verona); alla organizzazione delle attività di tirocinio (Giuliani, Università Roma Tre) e alla conduzione dei corsi di specializzazione per il sostegno (Malusà, Università di Trento; Pintus, Università di Parma); alla formazio- ne dei docenti di scuola primaria.

The California bay laurel or Umbellularia californica (Hook. & Arn.) Nutt., is known as the 'headache tree' because the inhalation of its vapours can cause severe headache crises. However, the underlying mechanism of the headache precipitating properties of Umbellularia californica is unknown. The monoterpene ketone umbellulone, the major volatile constituent of the leaves of Umbellularia californica, has irritating properties, and is a reactive molecule that rapidly binds thiols. Thus, we hypothesized that umbellulone stimulates the transient receptor potential ankyrin 1 channel in a subset of peptidergic, nocioceptive neurons, activating the trigeminovascular system via this mechanism. Umbellulone, from µM to sub-mM concentrations, selectively stimulated transient receptor potential ankyrin 1-expressing HEK293 cells and rat trigeminal ganglion neurons, but not untransfected cells or neurons in the presence of the selective transient receptor potential ankyrin 1 antagonist, HC-030031. Umbellulone evoked a calcium-dependent release of calcitonin gene-related peptide from rodent trigeminal nerve terminals in the dura mater. In wild-type mice, umbellulone elicited excitation of trigeminal neurons and released calcitonin gene-related peptide from sensory nerve terminals. These two responses were absent in transient receptor potential ankyrin 1 deficient mice. Umbellulone caused nocioceptive behaviour after stimulation of trigeminal nerve terminals in wild-type, but not transient receptor potential ankyrin 1 deficient mice. Intranasal application or intravenous injection of umbellulone increased rat meningeal blood flow in a dose-dependent manner; a response selectively inhibited by systemic administration of transient receptor potential ankyrin 1 or calcitonin gene-related peptide receptor antagonists. These data indicate that umbellulone activates, through a transient receptor potential ankyrin 1-dependent mechanism, the trigeminovascular system, thereby causing nocioceptive responses and calcitonin gene-related peptide release. Pharmacokinetics of umbellulone, given by either intravenous or intranasal administration, suggest that transient receptor potential ankyrin 1 stimulation, which eventually results in meningeal vasodilatation, may be produced via two different pathways, depending on the dose. Transient receptor potential ankyrin 1 activation may either be caused directly by umbellulone, which diffuses from the nasal mucosa to perivascular nerve terminals in meningeal vessels, or by stimulation of trigeminal endings within the nasal mucosa and activation of reflex pathways. Transient receptor potential ankyrin 1 activation represents a plausible mechanism for Umbellularia californica-induced headache. Present data also strengthen the hypothesis that a series of agents, including chlorine, cigarette smoke, formaldehyde and others that are known to be headache triggers and recently identified as transient receptor potential ankyrin 1 agonists, utilize the activation of this channel on trigeminal nerves to produce head pain.

Orotic acid (OA), a marker of hereditary orotic aciduria, is usually used for the differential diagnosis of some hyperammonemic inherited defects of urea cycle and of basic amino acid transporters. This study was aimed to establish age related reference intervals of OA in urine, and for the first time in plasma, and dried blood spot (DBS) from 229 apparently healthy subjects aged from three days to 40 years. The quantification of OA was performed by a previously implemented method, using a stable isotope dilution with 1,3-[(15)N(2)]-orotic acid and hydrophilic interaction liquid chromatography-tandem mass spectrometry (HILIC-MS/MS). The method has proved to be sensitive and accurate for a quantitative analysis of OA also in DBS and plasma. According to previous studies, urinary OA levels (mmol/mol of creatinine) decrease significantly with age. The upper limits (as 99th %ile) were of 3.44 and 1.30 in groups aged from three days to 1 year (group 1) and from 1 year to 12 years (group 2), respectively; in teenagers (from 13 to 19 years; group 3) and adults (from 20 to 40 years; group 4) urinary levels became more stable and the upper limits were of 0.64 and 1.21, respectively. Furthermore, OA levels in DBS (μM) also resulted significantly higher in subjects of group 1 (upper limit of 0.89) than in subjects of groups 2, 3 and 4 (upper limits of 0.24, 0.21, and 0.29, respectively). OA levels in plasma (μM) were significantly lower in subjects of group 3 (upper limit of 0.30) than in subjects of groups 1, 2, and 4 (upper limits of 0.59, 0.48, and 0.77, respectively). This method was also employed for OA quantification in plasma and DBS of 17 newborns affected by urea cycle defects, resulting sensitive and specific enough to screen these disorders.