Natalia Maximova1, Floriana Zennaro2, Massimo Gregori3, Giulia Boz4, Davide Zanon5, Gabriel Mbalaviele6. 1. Institute for Maternal and Child Health - IRCCS Burlo Garofolo, via dell'Istria 65/1, 34137 Trieste, Italy. Electronic address: natalia.maximova@burlo.trieste.it. 2. Hôpitaux Pédiatriques de Nice, CHU Lenval, 57 Avenue de la Californie, 06200 Nice, France. 3. Institute for Maternal and Child Health - IRCCS Burlo Garofolo, via dell'Istria 65/1, 34137 Trieste, Italy. Electronic address: massimo.gregori@burlo.trieste.it. 4. University of Cagliari, Cittadella Universitaria di Monserrato, S. P. Monserrato Sestu Km 0.700 CA, 09042 Monserrato, Cagliari, Italy. 5. Institute for Maternal and Child Health - IRCCS Burlo Garofolo, via dell'Istria 65/1, 34137 Trieste, Italy. Electronic address: davide.zanon@burlo.trieste.it. 6. Division of Bone and Mineral Diseases, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, CB 8301, St. Louis, MO 63110, USA. Electronic address: gmbalaviele@wustl.edu.
Abstract
OBJECTIVE: Autosomal recessive osteopetrosis (ARO) is a rare congenital disorder of defective bone resorption. The inability of osteoclasts to resorb bone compromises the development of bone marrow cavity, and ultimately, leads to defective hematopoiesis and death within the first decade. The only curative treatment currently available for certain forms of ARO is hematopoietic stem cell transplantation (HSCT). Infants over ten months of age suffering from ARO are defined as patients with advanced disease; HSCT to these patients is associated with high risk of transplant-related mortality (TRM). Because of the extreme variability of ARO clinical phenotypes, the most reliable predictive factor of TRM and graft failure risk is the residual bone marrow space volume. CASE REPORT: We report clinical and radiological outcomes of one patient affected by ARO and treated with HSCT at advance stage of the disease. We describe the anomalies in various tissues, including bone marrow and bones at the moment of the diagnosis and document their gradual disappearance after HSCT until their complete resolution based on magnetic resonance imaging (MRI) observations. We provided radiological images of the cranial vault bone structure modifications, correlating the radiological appearance of the optical canals and nerves and of the cerebellum with the neurological manifestations of the disease. CONCLUSIONS: Our results demonstrate that MRI is a highly sensitive technique that provides excellent images of bone marrow space before and after HSCT without exposing children to ionizing radiation. MRI also permits us to evaluate post-transplant skeletal remodeling and the deriving changes in the hematopoietic and sensory system.
OBJECTIVE:Autosomal recessive osteopetrosis (ARO) is a rare congenital disorder of defective bone resorption. The inability of osteoclasts to resorb bone compromises the development of bone marrow cavity, and ultimately, leads to defective hematopoiesis and death within the first decade. The only curative treatment currently available for certain forms of ARO is hematopoietic stem cell transplantation (HSCT). Infants over ten months of age suffering from ARO are defined as patients with advanced disease; HSCT to these patients is associated with high risk of transplant-related mortality (TRM). Because of the extreme variability of ARO clinical phenotypes, the most reliable predictive factor of TRM and graft failure risk is the residual bone marrow space volume. CASE REPORT: We report clinical and radiological outcomes of one patient affected by ARO and treated with HSCT at advance stage of the disease. We describe the anomalies in various tissues, including bone marrow and bones at the moment of the diagnosis and document their gradual disappearance after HSCT until their complete resolution based on magnetic resonance imaging (MRI) observations. We provided radiological images of the cranial vault bone structure modifications, correlating the radiological appearance of the optical canals and nerves and of the cerebellum with the neurological manifestations of the disease. CONCLUSIONS: Our results demonstrate that MRI is a highly sensitive technique that provides excellent images of bone marrow space before and after HSCT without exposing children to ionizing radiation. MRI also permits us to evaluate post-transplant skeletal remodeling and the deriving changes in the hematopoietic and sensory system.
Authors: Imranul Alam; Rita L Gerard-O'Riley; Dena Acton; Sara L Hardman; Madeline Murphy; Marta B Alvarez; Rachel J Blosser; Anthony Sinn; Edward F Srour; Melissa A Kacena; Michael J Econs Journal: FASEB J Date: 2022-09 Impact factor: 5.834