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The aims of our study were to evaluate health-related quality of life (HRQoL) in children affected by inflammatory bowel disease (IBD) during the first wave of Coronavirus disease 2019 (COVID-19) pandemic and after 12 months. This was a single-center, prospective, observational study conducted between April 2020 and April 2021. Children from 10 to 18 years with a confirmed diagnosis of IBD were enrolled during the first COVID-19–related national quarantine. The following information was collected at the baseline and after 12 months: IBD subtype, location and phenotype, disease activity, current and previous therapies. Patients were asked to complete the PROMIS Anxietyand IMPACT IIIquestionnaires. One hundred and eighteen patients were enrolled, of whom 54 (46%) were affected by Crohn disease (CD) and 64 (54%) with ulcerative colitis (UC; median age: 15.5 years, range 10.3–18; M/F: 68/50). Median HRQoL was significantly decreased after 12 months compared with the beginning of COVID-19–related quarantine (T1: 76.7 vs T2: 72.8; P< 0.001). At 12 months, a higher number of children were reported to be in active disease when compared with the enrollment [T2: 22/108 (20.4%) vs T1: 12/118 (10%); P= 0.02]. Multivariate analysis showed a significant influence on HRQoL of quarantine period (P< 0.001), female sex (P= 0.016), biologic therapy (P= 0.011), and active disease (P< 0.001). A deterioration of HRQoL after 12 months from COVID-19–related quarantine was observed. Additionally, the higher number of children with active disease at 12 months compared with enrollment may suggest detrimental consequences of the reduced disease control, contributing to decreased HRQoL.

Existing studies usually do not measure the free vitamin D in pediatric patients with inflammatory bowel disease (IBD) and not consider the effect of inflammation on vitamin D levels. The aim of our study was to evaluate the concentrations of vitamin D–binding protein (VDBP), total and free 25-hydroxyvitamin-D (25(OH)D), and to correlate these values with the disease activity markers. Newly diagnosed children with IBD and a group of healthy controls (HCs) were enrolled. VDBP and total and free 25(OH)D levels were measured by enzyme-linked immunosorbent assay and compared using the Student ttest. In each patient with IBD, the activity scores of disease and the main inflammation markers were correlated to total and free 25(OH)D levels. C-reactive protein was also measured in the control group, and it was related to VDBP by a linear regression test for all the groups. Fifty-one consecutive children were enrolled: IBD = 33, HC = 18. Levels of total 25(OH)D were higher in HC than in patients with IBD (P= 0.01). The free/total 25(OH)D ratio was, however, higher in patients with IBD compared to HC (P< 0.001). Finally, levels of VDBP were lower in patients with IBD than in HC (P= 0.001). A significant direct correlation was found between the free/total 25(OH)D ratio and the activity index of disease (r2: 0.17; P= 0.01). Moreover, in patients with IBD and controls we found a significant indirect correlation between VDBP and C-reactive protein (r2: 0.12; P= 0.01). Inflammation inversely correlates to VDBP concentrations and patients with IBD, despite their deficiency in total 25(OH)D, have normal or even higher levels of free 25(OH)D.

The primary role of environment on inflammatory bowel disease (IBD) onset has been recently stressed. We aimed to investigate the effect of environmental factors in an IBD pediatric cohort. A total of 467 subjects (264 IBD and 203 controls) were enrolled. All patients underwent a questionnaire including 5 different groups of environmental risk factors: family history of IBD and autoimmune diseases, perinatal period, home amenities and domestic hygiene, childhood diseases and vaccinations, and diet. In a multivariate model, mother's degree (odds ratio [OR]: 5.5; 2.5–11.6), duration of breast feeding >3rd month (OR: 4.3; 1.6–10.5), father's employment (OR: 3.7; 1.2–8.7), gluten introduction <6th month (OR: 2.8; 1.5–5), number of siblings <2 (OR: 2.8; 1.5–5.3), and family history of autoimmune diseases (OR: 2.7; 1.4–5.3) were significant risk factors for Crohn disease. Low adherence to Mediterranean diet (OR: 2.3; 1.2–4.5), gluten introduction <6th month (OR: 2.8; 1.6–4.9), and number of siblings <2 (OR: 2; 1.1–3.6) were significant risk factors for ulcerative colitis. Owning pets (OR: 0.3; 0.1–0.7) and bed sharing (OR: 0.2; 0.1–0.6) were protective factors for Crohn disease, whereas owning pets (OR: 0.4; 0.2–0.8) and family parasitosis (OR: 0.07; 0.01–0.4) were protective factors for ulcerative colitis. Our study confirms that environmental factors are closely linked to IBD onset and may partly explain IBD rise in developed countries.

Cancer radiotherapy (RT) may induce what is referred to as the “abscopal effect,” a regression of non-irradiated metastatic lesions distant from the primary tumor site directly subject to irradiation. This clinical response is rare, but has been surmised to be an immune-mediated phenomenon, suggesting that immunotherapy and RT could potentially synergize. Here, we report the outcome of patients with advanced melanoma treated with the immune checkpoint blockade monoclonal antibody antagonist, ipilimumab followed by RT. Patients were selected for enrollment at the National Cancer Institute “Fondazione G.Pascale” through the expanded access program in Italy. Those who experienced disease progression after ipilimumab thus received subsequent RT and were selected for analysis. Among 21 patients, 13 patients (62%) received RT to treat metastases in the brain and 8 received RT directed at extracranial sites. An abscopal response was observed in 11 patients (52%), 9 of whom had partial responses (43%) and 2 had stable disease (10%). The median time from RT to an abscopal response was 1 month (range 1–4). Median overall survival (OS) for all 21 patients was 13 months (range 6–26). Median OS for patients with abscopal responses was extended to 22.4 months (range 2.5–50.3) vs. 8.3 months (range 7.6–9.0) without. A local response to RT was detected in 13 patients (62%) and, of these, 11 patients (85%) had an abscopal response and abscopal effects were only observed among patients exhibiting a local response. These results suggest RT after ipilimumab may lead to abscopal responses in some patients with advanced melanoma correlating with prolonged OS. Our data also suggest that local responses to RT may be predictive of abscopal responses. Further research in larger randomized trials is needed to validate these results.