Effectiveness of a 5 weeks telerehabilitation programme with virtual reality glasses in boys with Duchenne and Becker during the COVID-19: A clinical trial.

BACKGROUND: Duchenne and Becker muscular dystrophy (from now "DMD" and "BMD" respectively) are the neuromuscular diseases with the most significant involvement in children. It affects dystrophin production, reducing the patient's mobility and quality of life. New technologies have become part of physical therapy in DMD and BMD. During the COVID-19 pandemic, telerehabilitation through virtual reality-based games could help these children to keep their abilities. OBJECTIVE: The purpose of this study is to know if the use of the virtual platform in a multimodal intervention program achieves changes in the results obtained in the six-minute walk test in children affected by DMD and BMD. To estimate the difference in mobility in patients with DMD and BMD, as measured with the six-minute walking test (6MWT), between 10 conventional and telerehabilitation treatment sessions. As secondary objectives, measuring other specific motor scales was proposed to see whether these had changed after receiving the 10 defined sessions. METHODS: Descriptive, open, quasi-experimental study with prospective A-B (control-intervention) design. Sample size of twelve participants who fulfilled the control criteria followed the program for five weeks, up to 10 telerehabilitation sessions. During the sessions, the participants used virtual reality glasses to train for the treatment goals. All sessions were in person, and participants were assessed before and after the intervention. Analysis was performed using R (R Core Team (2022) according to the different functional assessments performed for each test. RESULTS: The participants showed a 19.55 m increase in the 6MWT scale. The motor function was also kept stable according to other scales used to assess it. North Start result were kept stable in both treatments (P value = .199). Furthermore, Time up and go test was shorter in 0.1 seconds in telerehabilitation time and Motor Function Measure in all of the 3 dimensions shown no significant differences with a P value = .084. Finally, Infant effort (EPInfant) shown that during the training the fatigue increased in the middle and decreased by the end but the perception throughout the sessions, was lower even though the exercise intensity increased. CONCLUSIONS: There is no difference between a conventional and telerehabilitation treatment, so the telerehabilitation tool could be used without harming this type of children, facilitating their access to therapies and stimulating learning to maintain their functional capacity. Telerehabilitation may helpful maintain motor function in children with DMD and BMD. The learning effect helped to reduce the feeling of fatigue in children during the program. CLINICALTRIAL: This trial has the approval of the Andalucía Ethics Committee with PEIBA code 0107-N-20. The results of the research will be disseminated by the investigators to peer-reviewed journals. Trial registration no. NCT03879304.

Active colitis exacerbates immune response to internalized food antigens in mice.

BACKGROUND: Previous studies have indicated that colitis increases intestinal permeability to food antigens. This condition also generates an immunoreactive milieu in the gut, which may exacerbate or counteract allergy reactions. This, along with the fact that both colitis and allergy are being codiagnosed more frequently, means the scientific interest on the immune relation between these pathologies is increasing. We evaluated the immune response to an internalized food antigen that was initiated during a concomitant active intestinal inflammatory response. METHODS: An ovalbumin (OVA)-induced immune response was analyzed in healthy mice and in mice suffering from colitis induced by the administration of dinitrofluorobenzene/dinitrosulfonic acid (DNFB/DNS) at the moment of OVA challenge. The OVA-induced clinical score and allergy response both in plasma and in splenocyte cultures from these animals were compared. RESULTS: Although no differences were observed in the allergy clinical score, the concomitant active colitis led to an increase in the immune response to OVA antigen, as shown by increased spleen size and OVA-induced splenocyte proliferation, exacerbated expression of total and OVA-specific IgG1 levels, increased colonic IL-4 expression and OVA-induced IL-4 and IL-5 cytokine expression in spleen cells. CONCLUSIONS: Our results indicate that animals with active colitis undergo an exacerbated immune response to an internalized antigen. This finding could be relevant for the allergy management of patients presenting simultaneously with chronic colitis.

A shorter and more specific oral sensitization-based experimental model of food allergy in mice.

Cow's milk protein allergy (CMPA) is one of the most prevalent human food-borne allergies, particularly in children. Experimental animal models have become critical tools with which to perform research on new therapeutic approaches and on the molecular mechanisms involved. However, oral food allergen sensitization in mice requires several weeks and is usually associated with unspecific immune responses. To overcome these inconveniences, we have developed a new food allergy model that takes only two weeks while retaining the main characters of allergic response to food antigens. The new model is characterized by oral sensitization of weaned Balb/c mice with 5 doses of purified cow's milk protein (CMP) plus cholera toxin (CT) for only two weeks and posterior challenge with an intraperitoneal administration of the allergen at the end of the sensitization period. In parallel, we studied a conventional protocol that lasts for seven weeks, and also the non-specific effects exerted by CT in both protocols. The shorter protocol achieves a similar clinical score as the original food allergy model without macroscopically affecting gut morphology or physiology. Moreover, the shorter protocol caused an increased IL-4 production and a more selective antigen-specific IgG1 response. Finally, the extended CT administration during the sensitization period of the conventional protocol is responsible for the exacerbated immune response observed in that model. Therefore, the new model presented here allows a reduction not only in experimental time but also in the number of animals required per experiment while maintaining the features of conventional allergy models. We propose that the new protocol reported will contribute to advancing allergy research.