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it is the smallest in Europe

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it is the smallest in Europe

Only one other case has existed in the world so far. In Europe, it is the first time that such a young child, only three years and eight months old, has had his microbiota transplanted to treat GvHD, a serious complication that arose after the bone marrow transplant he underwent to recover from myeloid leukemia. . The double transplant, performed at the Irccs Policlinico Sant’Orsola in Bologna, was successful and the little one has now recovered and has been discharged. «The clinical improvement is exciting», comments the general director of Sant’Orsola Chiara Gibertoni.

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The smallest in Europe to undergo a double transplant

«This is a unique case given the age of the patient – he explains – Microbiota transplantation is currently authorized only in adults for a clinical indication. In this case, however, thanks to the support of the National Center and the Regional Transplant Center we took the opportunity to experiment with this method in a completely exceptional, but authorized way.” The child arrived at the hospital in the Emilian capital from Bosnia, thanks to the support of the Ageop Ricerca association. The transplant of hematopoietic stem cells donated by the mother was first performed, but after about four months intestinal GvHD appeared, a feared complication of “host rejection” disease, due to which he was hospitalized for two months and subjected to various lines of immunosuppressive therapy, even with an experimental drug, but without response. «The child had a very aggressive pathology with a strong decline in clinical conditions – explains Professor Riccardo Masetti, of the Pediatric Oncology of Sant’Orsola – for some time we have been studying the beneficial effects of the composition of the microbiota in children before the transplant, now we wanted to put them in place for this difficult post-transplant case. It was a huge therapeutic success, beyond our expectations.”

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The intestinal microbiota

The intestinal microbiota is the set of bacteria that inhabit the intestine; transplanting it consists of transferring a stool preparation taken from a donor into a patient’s intestine to re-establish a healthy composition. In the case of the little one, the healthy transplanted microbiota (donated by a 42-year-old) was able to “educate” the immune system to no longer recognize stem cells as hosts to attack, so as to allow them to continue their beneficial activity. The recruitment of donors is very selective: on average 10% are eligible. Today in Italy microbiota transplantation is authorized only for Clostridium difficile infection; to apply it to a pediatric case and to GvHD pathology, a particular authorization process was necessary.

The prospects

Now promising prospects are opening up: «As a researcher, it is a great success of scientific research, as a doctor a great opportunity for these young patients to have a new therapy, as a man and father I feel like saying that for the families experiencing this drama it is it opens up an unexpected therapeutic perspective”, reiterates Professor Giovanni Barbara, director of Gastroenterology and head of the Microbiota Transplant Center of the Irccs Sant’Orsola in Bologna. «The microbiota is central in many pathologies, not only of the intestine, but also of distant organs, such as the brain – continues Barbara – There is already talk of modulation of the microbiota in diseases such as Parkinson’s and Alzheimer’s, or even in autistic pathology. There are connections between the microbiota and the cardiovascular system, between the microbiota and the lungs.” Meanwhile, the IRCCS was the winner of a research call for the study of microbiota transplantation in liver transplant patients.

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