Objective: To evaluate the potential of Neural Stem Cell (NSC)-based approach to correct the metabolic defect and to ameliorate pathology in Twitcher (Twi) mice, a true model of Globoid Cell Leukodystrophy (GLD).Materials and Methods: Twi mice display severe demyelination and neurodegeneration, with a median survival of 46 days. We derived NSC lines from the subventricular zone of neonatal Twi mice and of wt littermates. Using bidirectional lentiviral vectors (bdLV) encoding for galactocerebrosidase (GALC) and GFP, we achieved high efficiency of transduction (>80%) and supraphysiological GALC levels (2-3 fold the wt levels) in mutant NSC, with no toxicity or functional impairment due to transgene over-expression. Similar supraphysiological GALC levels were obtained following bdLV. GALC transduction of wt NSC. Of importance, gene-corrected cells allowed more efficient metabolic cross-correction of GALC-deficient NSC then wt cells in vitro, due to more efficient enzyme secretion in the extracellular milieau. In order to obtain a stable source of GALC-secreting cells in the brain we transplanted wt or GALC over-expressing NSCs into the telencephalic lateral ventricles of neonatal (post-natal day 2) Twi mice (1x10^6 total cells, bilateral injection). Forty days after transplant we evaluated on NSC-treated mice and on untreated controls: i) NSC engraftment, distribution and fate (by immunocytochemistry); ii) the presence of a functional GALC protein in tissues and cerebrospinal fluid (by western blot and enzymatic assays); iii) intracellular storage (by lectin staining); iv) improvement of pathology (by immunocytochemistry and qPCR ). A group of treated mice was monitored for body weight and motor skills until a fixed human endpoint, in order to assess the impact of NSC therapy in delaying the onset of symptoms and prolonging lifespan.Results: Forty days after transplant we found NSC (identified by GFP expression) widely distributedinto the brain parenchyma, from the olfactory bulb to the hippocampus. Many cells were found lining the ventricles, along the corpus callosum and in the external capsula. Engrafted NSC (1-3% of the total injected cells) either expressed glial cell markers or retained antigenic features of immature neural cells and did not show proliferative activity. Of note, they robustly produced and secreted the GALC protein, as demonstrated by immunohistochemistry and by western blot using anti-GALC antibody. Most important, GALC activity was restored to 50% of wt levels in brain and spinal cord tissues of NSC-transplanted Twi mice, indicating widespread and efficient transport of the bioactive enzyme in CNS tissues (mainly through CSF flow) coupled to active cross-correction. The metabolic correction correlated with amelioration of pathology, clearance of tissue storage and partial rescue of the phenotype. We are currently evaluating the potential therapeutic advantage of GALC-overexpressing NSC as compared to the wt counterpart.Conclusion: These results, together with our preliminary data indicating the feasibility of safe GALC-overexpression in human fetal NSC (a therapeutically relevant cell type), warrant further consideration of NSC gene therapy for the treatment of GLD, likely in combination with other approaches (i.e. bone marrow transplant, currently under evaluation in our laboratory) ensuring enzymatic reconstitution in visceral organs and in the PNS.