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1.
Methods Mol Biol ; 2804: 77-89, 2024.
Article in English | MEDLINE | ID: mdl-38753141

ABSTRACT

Extracellular vesicles (EVs) are secreted by cells and found in biological fluids such as blood, with concentration correlated with oncogenic signals, making them attractive biomarkers for liquid biopsy. The current gold-standard method for EVs isolation requires an ultracentrifugation (UC) step among others. The cost and complexity of this technique are forbiddingly high for many researchers, as well as for routine use in biological laboratories and hospitals. This chapter reports on a simple microfluidic method for EVs isolation, based on a microfluidic size sorting technique named Deterministic Lateral Displacement (DLD). With the design of micrometric DLD array, we demonstrated the potential of our DLD devices for the isolation of nano-biological objects such as EVs, with main population size distribution consistent with UC technique.


Subject(s)
Extracellular Vesicles , Lab-On-A-Chip Devices , Extracellular Vesicles/metabolism , Extracellular Vesicles/chemistry , Humans , Microfluidic Analytical Techniques/instrumentation , Microfluidic Analytical Techniques/methods , Cell Culture Techniques/methods , Ultracentrifugation/methods
3.
Colorectal Dis ; 26(5): 1038-1046, 2024 May.
Article in English | MEDLINE | ID: mdl-38499516

ABSTRACT

AIM: Anal fistula is one of the most common anal diseases, affecting between 1 and 3 per 10 000 people per year. Symptoms have a potentially severe effect on a patient's quality of life. Surgery is the mainstay of treatment, aiming to cure the fistula and preserve anal sphincter function. Rectal advancement flap (RAF) is currently the gold standard treatment but has recurrence rates varying between 20% and 50% and might lead to disturbance of continence. The aim of the trial described in this work is to discover if the minimally invasive fistula tract laser closure (FiLaC™) technique could achieve higher healing rates and a better functional outcome than RAF. METHOD: We will perform a randomized prospective multicentre noninferiority study of the treatment of high trans-sphincteric perianal fistulas, comparing FiLaC™ with RAF in terms of fistula healing, recurrence rate, functional outcome and quality of life. Primary and secondary fistula healing will be evaluated at 26 and 52 weeks' follow-up. Quality of life will be evaluated using the SF-36 questionnaire, the Faecal Incontinence Quality of Life Scale questionnaire and the Vaizey score at 3, 6, 12 and 26 weeks postoperatively. CONCLUSION: High trans-sphincteric fistulas have a potentially severe effect on a patient's quality of life. Classical treatment with RAF is a time-consuming invasive procedure. The LATFIA trial aims to compare FiLaC™ with the gold standard treatment with RAF. In case of noninferiority, FiLaC™ treatment could be standardized as a first line treatment for high trans-sphincteric fistulas. Better conservation of the patient's anal sphincter function could possibly be obtained. Likewise, we will report on the postoperative quality of life when applying these two techniques.


Subject(s)
Anal Canal , Laser Therapy , Quality of Life , Rectal Fistula , Surgical Flaps , Humans , Rectal Fistula/surgery , Prospective Studies , Laser Therapy/methods , Anal Canal/surgery , Treatment Outcome , Female , Male , Recurrence , Adult , Middle Aged , Equivalence Trials as Topic , Wound Healing , Fecal Incontinence/etiology , Fecal Incontinence/surgery , Rectum/surgery
4.
Front Plant Sci ; 14: 1240485, 2023.
Article in English | MEDLINE | ID: mdl-38023872

ABSTRACT

The Landscape Reconstruction Algorithm (LRA) is regarded as the soundest approach for quantifying taxon-specific plant cover from pollen data. The reliability of relative pollen productivity (RPP) estimates is fundamental in the accuracy of quantitative vegetation reconstruction using the LRA approach. Inconsistent RPP estimates produced by different studies can cast doubt on the reliability and applicability of quantitative vegetation reconstruction. Therefore, it is crucial that the RPP estimates are evaluated before being applied for quantitative vegetation reconstruction. We have tested two alternative approaches, namely, a leave-one-out cross-validation (LOO) method and a splitting-by-subregion strategy, using surface pollen assemblages and the REVEALS model-the first step in the LRA-to evaluate the reliability of RPPs estimates of 10 target taxa obtained in the cultural landscape of Shandong. We compared the REVEALS estimates (RVs) with observations of regional vegetation abundance (OBVs) and pollen proportions (PPs). The RVs of all taxa are generally closer to OBVs than PPs, and the degree of similarity depends strongly on the abundance of individual taxa in plant and pollen; taxa dominant in the region show the highest similarity between RVs and OBVs, such as Artemisia, Poaceae, and Humulus. The RVs of all herb taxa except Humulus and Asteraceae SF Cichorioideae are slightly overrepresented, and the RVs of all tree taxa are underrepresented except for Castanea. The comparison of RVs with OBVs collected from different spatial extents shows that the RVs of all herb taxa are more similar to OBVs collected from shorter distances (100 km and 75 km for the entire region and the subregion, respectively), whereas the RVs of all tree taxa are more similar to OBVs collected from longer distances (150 km and 100 km for the entire region and the subregion, respectively). Furthermore, our findings highlight the importance to test different sizes of area for vegetation surveys for evaluation of the RVs given that the appropriate size of vegetation survey may vary between low pollen producers (mainly herbs) and high pollen producers (mainly trees). We consider that the LOO strategy is the best approach in this case study for evaluating the RPP estimates from surface moss polsters. The evaluation confirms the reliability of the obtained RPP estimates for their potential application in quantitative reconstruction of vegetation abundance in temperate China.

5.
Indian J Surg Oncol ; 14(Suppl 1): 131-143, 2023 Jun.
Article in English | MEDLINE | ID: mdl-37359914

ABSTRACT

Extrapelvic endometriosis is a rare presentation of endometriosis with atypical clinical symptoms. It can mimic peritoneal surface malignancy, as well as some abdominal infectious diseases. A 29-year-old Moroccan woman presented with abdominal pain, progressive abdominal distention, and an intermittent inflammatory syndrome. Imaging revealed multiple, progressively growing abdominal cysts. She had elevated tumor markers CA125 and CA19.9. Despite thorough investigation, several differential diagnoses persisted for a long time. Definitive pathological diagnosis could only be established after debulking surgery. Literature review on malignant and benign conditions causing multicystic abdominal distention is provided. When definitive diagnosis is not established, but suspicion for peritoneal malignancy remains, a debulking procedure can be undertaken. Organ preservation can be pursued whenever benign disease is still considered. In case of malignancy, short-term (curative) debulking procedure with or without hyperthermic intraperitoneal chemotherapy (HIPEC) can be proposed.

8.
Neurobiol Dis ; 181: 106116, 2023 06 01.
Article in English | MEDLINE | ID: mdl-37054900

ABSTRACT

Tauopathy is a typical feature of Alzheimer's disease of major importance because it strongly correlates with the severity of cognitive deficits experienced by patients. During the pathology, it follows a characteristic spatiotemporal course which takes its origin in the transentorhinal cortex, and then gradually invades the entire forebrain. To study the mechanisms of tauopathy, and test new therapeutic strategies, it is necessary to set-up relevant and versatile in vivo models allowing to recapitulate tauopathy. With this in mind, we have developed a model of tauopathy by overexpression of the human wild-type Tau protein in retinal ganglion cells in mice (RGCs). This overexpression led to the presence of hyperphosphorylated forms of the protein in the transduced cells as well as to their progressive degeneration. The application of this model to mice deficient in TREM2 (Triggering Receptor Expressed on Myeloid cells-2, an important genetic risk factor for AD) as well as to 15-month-old mice showed that microglia actively participate in the degeneration of RGCs. Surprisingly, although we were able to detect the transgenic Tau protein up to the terminal arborization of RGCs at the level of the superior colliculi, spreading of the transgenic Tau protein to post-synaptic neurons was detected only in aged animals. This suggests that there may be neuron-intrinsic- or microenvironment mediators facilitating this spreading that appear with aging.


Subject(s)
Alzheimer Disease , Tauopathies , Animals , Humans , Mice , Alzheimer Disease/metabolism , Disease Models, Animal , Membrane Glycoproteins/metabolism , Mice, Transgenic , Microglia/metabolism , Receptors, Immunologic/metabolism , Retinal Ganglion Cells/metabolism , tau Proteins/genetics , tau Proteins/metabolism , Tauopathies/pathology , Visual Pathways/metabolism
9.
Brain ; 146(1): 149-166, 2023 01 05.
Article in English | MEDLINE | ID: mdl-35298632

ABSTRACT

Huntington's disease is a fatal neurodegenerative disease characterized by striatal neurodegeneration, aggregation of mutant Huntingtin and the presence of reactive astrocytes. Astrocytes are important partners for neurons and engage in a specific reactive response in Huntington's disease that involves morphological, molecular and functional changes. How reactive astrocytes contribute to Huntington's disease is still an open question, especially because their reactive state is poorly reproduced in experimental mouse models. Here, we show that the JAK2-STAT3 pathway, a central cascade controlling astrocyte reactive response, is activated in the putamen of Huntington's disease patients. Selective activation of this cascade in astrocytes through viral gene transfer reduces the number and size of mutant Huntingtin aggregates in neurons and improves neuronal defects in two complementary mouse models of Huntington's disease. It also reduces striatal atrophy and increases glutamate levels, two central clinical outcomes measured by non-invasive magnetic resonance imaging. Moreover, astrocyte-specific transcriptomic analysis shows that activation of the JAK2-STAT3 pathway in astrocytes coordinates a transcriptional program that increases their intrinsic proteolytic capacity, through the lysosomal and ubiquitin-proteasome degradation systems. This pathway also enhances their production and exosomal release of the co-chaperone DNAJB1, which contributes to mutant Huntingtin clearance in neurons. Together, our results show that the JAK2-STAT3 pathway controls a beneficial proteostasis response in reactive astrocytes in Huntington's disease, which involves bi-directional signalling with neurons to reduce mutant Huntingtin aggregation, eventually improving disease outcomes.


Subject(s)
Huntington Disease , Neurodegenerative Diseases , Animals , Mice , Huntington Disease/genetics , Astrocytes/metabolism , Proteostasis , Neurodegenerative Diseases/pathology , Neurons/metabolism , Huntingtin Protein/genetics , Huntingtin Protein/metabolism
11.
Environ Geochem Health ; 44(4): 1229-1244, 2022 Apr.
Article in English | MEDLINE | ID: mdl-34993733

ABSTRACT

Metal(loid) soil pollution causes environmental and health issues, and thus those sites need to be remediated. This can be done through phytostabilization, in combination with biochar amendment. The objectives were to investigate the potential of Salix viminalis L. associated with Trifolium repens L. for the phytostabilization of biochar-amended contaminated soils by assessing (1) the tolerance of both plants to metal(loid)s, through the biomass production, (2) the concentrations of metal(loid)s in plant parts and (3) the concentrations of metal(loid)s in soil pore water and percolation waters. Results showed that plant growth affected soil pore water Physico-chemical properties and metal(loid) mobility. When comparing the mono- and poly-cultures, although pH was higher with the polyculture than the monoculture, the decrease in Pb mobility did not differ. Moreover, the leachate analysis showed that As concentration in the soil particles leached from the soil was higher in the polyculture condition, while Pb concentration was the highest in the willow vegetated condition. Finally, willow dry weight was not affected by the presence of clover, while clover dry weight was lower when it was grown with willow. In conclusion, the results showed that the willow and clover polyculture was not better than the monoculture of these two species for the phytomanagement of a former mine site amended with biochar.


Subject(s)
Salix , Soil Pollutants , Trifolium , Biodegradation, Environmental , Charcoal/chemistry , Coculture Techniques , Lead/analysis , Soil/chemistry , Soil Pollutants/analysis
12.
Cancers (Basel) ; 13(23)2021 Dec 06.
Article in English | MEDLINE | ID: mdl-34885257

ABSTRACT

Monitoring of minimal residual disease (MRD) by flow cytometry (FCM) is a powerful prognostic tool for predicting outcomes in acute lymphoblastic leukemia (ALL). To apply FCM-MRD in large, collaborative trials, dedicated laboratory staff must be educated to concordantly high levels of expertise and their performance quality should be continuously monitored. We sought to install a unique and comprehensive training and quality control (QC) program involving a large number of reference laboratories within the international Berlin-Frankfurt-Münster (I-BFM) consortium, in order to complement the standardization of the methodology with an educational component and persistent quality control measures. Our QC and quality assurance (QA) program is based on four major cornerstones: (i) a twinning maturation program, (ii) obligatory participation in external QA programs (spiked sample send around, United Kingdom National External Quality Assessment Service (UK NEQAS)), (iii) regular participation in list-mode-data (LMD) file ring trials (FCM data file send arounds), and (iv) surveys of independent data derived from trial results. We demonstrate that the training of laboratories using experienced twinning partners, along with continuous educational feedback significantly improves the performance of laboratories in detecting and quantifying MRD in pediatric ALL patients. Overall, our extensive education and quality control program improved inter-laboratory concordance rates of FCM-MRD assessments and ultimately led to a very high conformity of risk estimates in independent patient cohorts.

13.
Int J Mol Sci ; 22(13)2021 Jun 23.
Article in English | MEDLINE | ID: mdl-34201785

ABSTRACT

Alpha-synuclein (α-syn) and leucine-rich repeat kinase 2 (LRRK2) play crucial roles in Parkinson's disease (PD). They may functionally interact to induce the degeneration of dopaminergic (DA) neurons via mechanisms that are not yet fully understood. We previously showed that the C-terminal portion of LRRK2 (ΔLRRK2) with the G2019S mutation (ΔLRRK2G2019S) was sufficient to induce neurodegeneration of DA neurons in vivo, suggesting that mutated LRRK2 induces neurotoxicity through mechanisms that are (i) independent of the N-terminal domains and (ii) "cell-autonomous". Here, we explored whether ΔLRRK2G2019S could modify α-syn toxicity through these two mechanisms. We used a co-transduction approach in rats with AAV vectors encoding ΔLRRK2G2019S or its "dead" kinase form, ΔLRRK2DK, and human α-syn with the A53T mutation (AAV-α-synA53T). Behavioral and histological evaluations were performed at 6- and 15-weeks post-injection. Results showed that neither form of ΔLRRK2 alone induced the degeneration of neurons at these post-injection time points. By contrast, injection of AAV-α-synA53T alone resulted in motor signs and degeneration of DA neurons. Co-injection of AAV-α-synA53T with AAV-ΔLRRK2G2019S induced DA neuron degeneration that was significantly higher than that induced by AAV-α-synA53T alone or with AAV-ΔLRRK2DK. Thus, mutated α-syn neurotoxicity can be enhanced by the C-terminal domain of LRRK2G2019 alone, through cell-autonomous mechanisms.


Subject(s)
Disease Models, Animal , Dopaminergic Neurons/pathology , Leucine-Rich Repeat Serine-Threonine Protein Kinase-2/metabolism , Mutant Proteins/metabolism , Mutation , alpha-Synuclein/metabolism , Animals , Dopaminergic Neurons/metabolism , Humans , Leucine-Rich Repeat Serine-Threonine Protein Kinase-2/genetics , Mutant Proteins/genetics , Protein Domains , Rats , alpha-Synuclein/genetics
14.
Neurobiol Dis ; 155: 105398, 2021 07.
Article in English | MEDLINE | ID: mdl-34019997

ABSTRACT

The role played by microglia has taken the center of the stage in the etiology of Alzheimer's disease (AD). Several genome-wide association studies carried out on large cohorts of patients have indeed revealed a large number of genetic susceptibility factors corresponding to genes involved in neuroinflammation and expressed specifically by microglia in the brain. Among these genes TREM2, a cell surface receptor expressed by microglia, arouses strong interest because its R47H variant confers a risk of developing AD comparable to the ε4 allele of the APOE gene. Since this discovery, a growing number of studies have therefore examined the role played by TREM2 in the evolution of amyloid plaques and neurofibrillary tangles, the two brain lesions characteristic of AD. Many studies report conflicting results, reflecting the complex nature of microglial activation in AD. Here, we investigated the impact of TREM2 deficiency in the THY-Tau22 transgenic line, a well-characterized model of tauopathy. Our study reports an increase in the severity of tauopathy lesions in mice deficient in TREM2 occurring at an advanced stage of the pathology. This exacerbation of pathology was associated with a reduction in microglial activation indicated by typical morphological features and altered expression of specific markers. However, it was not accompanied by any further changes in memory performance. Our longitudinal study confirms that a defect in microglial TREM2 signaling leads to an increase in neuronal tauopathy occurring only at late stages of the disease.


Subject(s)
Disease Models, Animal , Membrane Glycoproteins/deficiency , Microglia/metabolism , Receptors, Immunologic/deficiency , Tauopathies/metabolism , Thy-1 Antigens/genetics , tau Proteins/genetics , Animals , Female , Humans , Longitudinal Studies , Male , Maze Learning/physiology , Membrane Glycoproteins/genetics , Mice , Mice, Inbred C57BL , Mice, Transgenic , Microglia/pathology , Receptors, Immunologic/genetics , Tauopathies/genetics , Tauopathies/pathology
15.
Brain ; 144(4): 1167-1182, 2021 05 07.
Article in English | MEDLINE | ID: mdl-33842937

ABSTRACT

Deposits of different abnormal forms of tau in neurons and astrocytes represent key anatomo-pathological features of tauopathies. Although tau protein is highly enriched in neurons and poorly expressed by astrocytes, the origin of astrocytic tau is still elusive. Here, we used innovative gene transfer tools to model tauopathies in adult mouse brains and to investigate the origin of astrocytic tau. We showed in our adeno-associated virus (AAV)-based models and in Thy-Tau22 transgenic mice that astrocytic tau pathology can emerge secondarily to neuronal pathology. By designing an in vivo reporter system, we further demonstrated bidirectional exchanges of tau species between neurons and astrocytes. We then determined the consequences of tau accumulation in astrocytes on their survival in models displaying various status of tau aggregation. Using stereological counting of astrocytes, we report that, as for neurons, soluble tau species are highly toxic to some subpopulations of astrocytes in the hippocampus, whereas the accumulation of tau aggregates does not affect their survival. Thus, astrocytes are not mere bystanders of neuronal pathology. Our results strongly suggest that tau pathology in astrocytes may significantly contribute to clinical symptoms.


Subject(s)
Astrocytes/pathology , Hippocampus/pathology , Tauopathies/pathology , tau Proteins/toxicity , Animals , Humans , Male , Mice , Neurons/pathology , Protein Aggregates , Protein Isoforms/genetics , Protein Isoforms/metabolism , Protein Isoforms/toxicity , Tauopathies/metabolism , tau Proteins/genetics , tau Proteins/metabolism
16.
PLoS One ; 16(4): e0246662, 2021.
Article in English | MEDLINE | ID: mdl-33852578

ABSTRACT

In the 12,000 years preceding the Industrial Revolution, human activities led to significant changes in land cover, plant and animal distributions, surface hydrology, and biochemical cycles. Earth system models suggest that this anthropogenic land cover change influenced regional and global climate. However, the representation of past land use in earth system models is currently oversimplified. As a result, there are large uncertainties in the current understanding of the past and current state of the earth system. In order to improve representation of the variety and scale of impacts that past land use had on the earth system, a global effort is underway to aggregate and synthesize archaeological and historical evidence of land use systems. Here we present a simple, hierarchical classification of land use systems designed to be used with archaeological and historical data at a global scale and a schema of codes that identify land use practices common to a range of systems, both implemented in a geospatial database. The classification scheme and database resulted from an extensive process of consultation with researchers worldwide. Our scheme is designed to deliver consistent, empirically robust data for the improvement of land use models, while simultaneously allowing for a comparative, detailed mapping of land use relevant to the needs of historical scholars. To illustrate the benefits of the classification scheme and methods for mapping historical land use, we apply it to Mesopotamia and Arabia at 6 kya (c. 4000 BCE). The scheme will be used to describe land use by the Past Global Changes (PAGES) LandCover6k working group, an international project comprised of archaeologists, historians, geographers, paleoecologists, and modelers. Beyond this, the scheme has a wide utility for creating a common language between research and policy communities, linking archaeologists with climate modelers, biodiversity conservation workers and initiatives.


Subject(s)
Archaeology , Natural Resources , Arabia , Biodiversity , Climate , Conservation of Natural Resources , Data Management , Earth, Planet , Ecosystem , History, Ancient , Humans , Mesopotamia
17.
Metabolites ; 11(5)2021 Apr 22.
Article in English | MEDLINE | ID: mdl-33922384

ABSTRACT

The cerebral metabolic rate of oxygen consumption (CMRO2) is a key metric to investigate the mechanisms involved in neurodegeneration in animal models and evaluate potential new therapies. CMRO2 can be measured by direct 17O magnetic resonance imaging (17O-MRI) of H217O signal changes during inhalation of 17O-labeled oxygen gas. In this study, we built a simple gas distribution system and used 3D zero echo time (ZTE-)MRI at 11.7 T to measure CMRO2 in the APPswe/PS1dE9 mouse model of amyloidosis. We found that CMRO2 was significantly lower in the APPswe/PS1dE9 brain than in wild-type at 12-14 months. We also estimated cerebral blood flow (CBF) from the post-inhalation washout curve and found no difference between groups. These results suggest that the lower CMRO2 observed in APPswe/PS1dE9 is likely due to metabolism impairment rather than to reduced blood flow. Analysis of the 17O-MRI data using different quantification models (linear and 3-phase model) showed that the choice of the model does not affect group comparison results. However, the simplified linear model significantly underestimated the absolute CMRO2 values compared to a 3-phase model. This may become of importance when combining several metabolic fluxes measurements to study neuro-metabolic coupling.

18.
Environ Geochem Health ; 43(4): 1457-1475, 2021 Apr.
Article in English | MEDLINE | ID: mdl-31673918

ABSTRACT

Metal(loid) contamination of soil, resulting from the mining activities, is a major issue worldwide, due to its negative effects on the environment and health. Therefore, these contaminated soils need to be remediated. One realistic method is the assisted phytostabilization, which aims at establishing a vegetation cover on the soil that will reduce metal(loid) bioavailability and spreading through the prevention of wind erosion and water leaching. In addition, amendments are applied to improve soil conditions and ameliorate plant growth. In this goal, biochar and compost showed good results in terms of amelioration of soil fertility and reduction in lead bioavailability. However, they usually have a negative effect on arsenic. On the contrary, iron sulfate showed capacity to reduce arsenic mobility through interaction with its iron hydroxides. Finally, the choice of the appropriate plant species is crucial for the success of assisted phytostabilization. One good option is to use endemic species, adapted to the metal(loid) stress, with a fast growth and large shoot and root systems. The aims of this study were to (1) evaluate the effects of applying biochar, compost and iron sulfate, alone or combined, to a former mine soil on the soil properties and Agrostis capillaris growth, and (2) assess the difference between two Agrostis capillaris ecotypes, an endemic metallicolous ecotype and a non-metallicolous ecotype. Results of the mesocosm experiment showed that amendment application improved soil properties, i.e., reduced soil acidity, increased nutrient availability and lower metal(loid) stress, the best being the combination biochar-compost-iron sulfate. These ameliorations allowed a better plant growth. Finally, the metallicolous ecotype performed better in terms of growth than the non-metallicolous one and could thus be used in an assisted phytostabilization process on the former mine site.


Subject(s)
Agrostis/drug effects , Charcoal , Lead/pharmacokinetics , Soil Pollutants/pharmacokinetics , Soil/chemistry , Agrostis/physiology , Arsenic/analysis , Arsenic/pharmacokinetics , Biodegradation, Environmental , Composting , Ecotype , Ferrous Compounds/chemistry , France , Lead/analysis , Mining , Soil Pollutants/analysis
19.
BMC Ophthalmol ; 20(1): 239, 2020 Jun 18.
Article in English | MEDLINE | ID: mdl-32552699

ABSTRACT

BACKGROUND: Intraocular medulloepithelioma is commonly treated with primary enucleation. Conservative treatment options include brachytherapy, local resection and/or cryotherapy in selected cases. We report for the first time the use of targeted chemotherapy to treat a ciliary body medulloepithelioma with aqueous and vitreous seeding. CASE PRESENTATION: A 17-month-old boy with a diagnosis of ciliary body medulloepithelioma with concomitant seeding and neovascular glaucoma in the right eye was seen for a second opinion after parental refusal of enucleation. Examination under anesthesia showed multiple free-floating cysts in the pupillary area associated with iris neovascularization and a subluxated and notched lens. Ultrasound biomicroscopy revealed a partially cystic mass adjacent to the ciliary body between the 5 and 9 o'clock meridians as well as multiple nodules in the posterior chamber invading the anterior vitreous inferiorly. Fluorescein angiography demonstrated peripheral retinal ischemia. Left eye was unremarkable. Diagnosis of intraocular medulloepithelioma with no extraocular invasion was confirmed and conservative treatment initiated with combined intracameral and intravitreal melphalan injections given according to the previously described safety-enhanced technique. Ciliary tumor and seeding totally regressed after a total of 3 combined intracameral (total dose 8.1 µg) and intravitreal (total dose 70 µg) melphalan injections given every 7-10 days. Ischemic retina was treated with cryoablation as necessary. Three years later, ab interno trabeculotomy followed by 360° gonioscopy-assisted transluminal trabeculotomy 6 months later was performed for uncontrolled intraocular pressure despite antihypertensive drugs combined to cyclophotocoagulation and 7 intravitreal anti-VEGF injections for recurrent iris neovascularization. Cataract was removed at the same operative time. The child has remained disease- and metastasis-free at a 5-year follow-up since the last melphalan injection (25-month follow-up after the combined lensectomy-trabeculotomy) with a controlled intraocular pressure under topical quadritherapy and a best corrected Snellen visual acuity of 0.08. CONCLUSIONS: We report for the first time complete regression of a non-infiltrating ciliary body medulloepithelioma with seeding achieved with only a small number of intracameral and intravitreal melphalan injections. Concomitant secondary neovascular glaucoma and cataract needed appropriate management to allow long-term eye and vision preservation.


Subject(s)
Melphalan/administration & dosage , Neuroectodermal Tumors, Primitive/drug therapy , Retinal Neoplasms/drug therapy , Visual Acuity , Antineoplastic Agents, Alkylating/administration & dosage , Ciliary Body , Humans , Infant , Injections, Intraocular , Intraocular Pressure , Male , Microscopy, Acoustic , Neuroectodermal Tumors, Primitive/diagnosis , Retinal Neoplasms/diagnosis
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