1
|
Leenaars CHC, Stafleu FR, Häger C, Nieraad H, Bleich A. A systematic review of animal and human data comparing the nasal potential difference test between cystic fibrosis and control. Sci Rep 2024; 14:9664. [PMID: 38671057 PMCID: PMC11053161 DOI: 10.1038/s41598-024-60389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
The nasal potential difference test (nPD) is an electrophysiological measurement which is altered in patients and animal models with cystic fibrosis (CF). Because protocols and outcomes vary substantially between laboratories, there are concerns over its validity and precision. We performed a systematic literature review (SR) of the nPD to answer the following review questions: A. Is the nasal potential difference similarly affected in CF patients and animal models?", and B. "Is the nPD in human patients and animal models of CF similarly affected by various changes in the experimental set-up?". The review protocol was preregistered on PROSPERO (CRD42021236047). We searched PubMed and Embase with comprehensive search strings. Two independent reviewers screened all references for inclusion and extracted all data. Included were studies about CF which described in vivo nPD measurements in separate CF and control groups. Risk of bias was assessed, and three meta-analyses were performed. We included 130 references describing nPD values for CF and control subjects, which confirmed substantial variation in the experimental design and nPD outcome between groups. The meta-analyses showed a clear difference in baseline nPD values between CF and control subjects, both in animals and in humans. However, baseline nPD values were, on average, lower in animal than in human studies. Reporting of experimental details was poor for both animal and human studies, and urgently needs to improve to ensure reproducibility of experiments within and between species.
Collapse
Affiliation(s)
| | - Frans R Stafleu
- Department of Animals in Science and Society-Human-Animal Relationship, Utrecht University, Utrecht, The Netherlands
| | - Christine Häger
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - Hendrik Nieraad
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, Hannover, Germany
| |
Collapse
|
2
|
Leenaars C, Häger C, Stafleu F, Nieraad H, Bleich A. A Systematic Review of the Effect of Cystic Fibrosis Treatments on the Nasal Potential Difference Test in Animals and Humans. Diagnostics (Basel) 2023; 13:3098. [PMID: 37835841 PMCID: PMC10572895 DOI: 10.3390/diagnostics13193098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
To address unmet treatment needs in cystic fibrosis (CF), preclinical and clinical studies are warranted. Because it directly reflects the function of the Cystic Fibrosis Transmembrane conductance Regulator (CFTR), the nasal potential difference test (nPD) can not only be used as a reliable diagnostic test for CF but also to assess efficacy of experimental treatments. We performed a full comprehensive systematic review of the effect of CF treatments on the nPD compared to control conditions tested in separate groups of animal and human subjects. Our review followed a preregistered protocol. We included 34 references: 20 describing mouse studies, 12 describing human studies, and 2 describing both. We provide a comprehensive list of these studies, which assessed the effects of antibiotics, bone marrow transplant, CFTR protein, CFTR RNA, directly and indirectly CFTR-targeting drugs, non-viral and viral gene transfer, and other treatments. Our results support the nPD representing a reliable method for testing treatment effects in both animal models and human patients, as well as for diagnosing CF. However, we also observed the need for improved reporting to ensure reproducibility of the experiments and quantitative comparability of the results within and between species (e.g., with meta-analyses). Currently, data gaps warrant further primary studies.
Collapse
Affiliation(s)
- Cathalijn Leenaars
- Institute for Laboratory Animal Science, Hannover Medical School, 30625 Hannover, Germany
| | - Christine Häger
- Institute for Laboratory Animal Science, Hannover Medical School, 30625 Hannover, Germany
| | - Frans Stafleu
- Department of Animals in Science and Society—Human-Animal Relationship, Utrecht University, 3584 CM Utrecht, The Netherlands
| | - Hendrik Nieraad
- Institute for Laboratory Animal Science, Hannover Medical School, 30625 Hannover, Germany
| | - André Bleich
- Institute for Laboratory Animal Science, Hannover Medical School, 30625 Hannover, Germany
| |
Collapse
|
3
|
Barillaro M, Gonska T. Assessing accuracy of testing and diagnosis in cystic fibrosis. Expert Rev Respir Med 2023:1-13. [PMID: 37190981 DOI: 10.1080/17476348.2023.2213438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Affiliation(s)
- Malina Barillaro
- Department of Physiology, University of Toronto, Toronto ON, Canada
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Tanja Gonska
- Translational Medicine, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, University of Toronto, Toronto ON, Canada
| |
Collapse
|
4
|
Niedermayr K, Gasser V, Rueckes-Nilges C, Appelt D, Eder J, Fuchs T, Naehrlich L, Ellemunter H. Personalized medicine with drugs targeting the underlying protein defect in cystic fibrosis: is monitoring of treatment response necessary? Ther Adv Chronic Dis 2022; 13:20406223221108627. [PMID: 35959505 PMCID: PMC9358561 DOI: 10.1177/20406223221108627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Cystic fibrosis (CF) is caused by two mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene. In the last years, drugs targeting the underlying protein defect like lumacaftor/ivacaftor (LUM/IVA) or tezacaftor/ivacaftor (TEZ/IVA) and more recently elexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) were admitted. Outcome parameters evaluating therapy response like forced expiratory pressure in 1 s (FEV1), body mass index (BMI) or the efficacy of CFTR function in sweat glands showed improvement in several cases. Other, CFTR biomarkers were analysed rarely. This prospective observational study was aimed at evaluating CFTR function in patients treated with different CFTR modulators together with common valid clinical outcome parameters at standardized appointments (day 0, week 2, 4, 16). We followed four patients with the same mutation (F508del-CFTR), sex, age and disease severity. Monitoring focused on lung function, gastrointestinal aspects and CFTR function of sweat glands, nasal and intestinal epithelium. Sweat tests were performed by pilocarpine iontophoresis. Nasal potential difference (NPD) measured transepithelial voltage in vivo and potential increased when CFTR function improved. Rectal biopsies were obtained for intestinal current measurements (ICM) ex vivo. Intestinal CFTR function was assessed by stimulating chloride secretion with different reagents. Response to CFTR modulators regarding clinical outcome parameters was rather variable. A sweat chloride reduction of 35.3 mmol/L, nasal CFTR rescue of 4.4% and fivefold higher CFTR function in the intestine was seen at week 16 post-LUM/IVA. Due to our monitoring, we identified a non-responder to LUM/IVA and TEZ/IVA. In case of ELX/TEZ/IVA, clinical parameters and CFTR bioassays improved and were concordant. Although our cohort is small, results emphasize that non-responders exist and conclusions could not be drawn if patients were not monitored. Data on CFTR function can confirm or disprove ongoing CFTR dysfunction and might be helpful selectively. Non-responders need other alternative therapy options as demonstrated with ELX/TEZ/IVA.
Collapse
Affiliation(s)
- Katharina Niedermayr
- Department for Child and Adolescent Health, University Clinic for Paediatrics III, Cystic Fibrosis Centre, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Tyrol, Austria
| | - Verena Gasser
- Department for Child and Adolescent Health, University Clinic for Paediatrics III, Cystic Fibrosis Centre, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Rueckes-Nilges
- Department of General Pediatrics and Neonatology, University Hospital of Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Dorothea Appelt
- Department for Child and Adolescent Health, University Clinic for Paediatrics III, Cystic Fibrosis Centre, Medical University of Innsbruck, Innsbruck, Austria
| | - Johannes Eder
- Department for Child and Adolescent Health, University Clinic for Paediatrics III, Cystic Fibrosis Centre, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa Fuchs
- Department for Child and Adolescent Health, University Clinic for Paediatrics III, Cystic Fibrosis Centre, Medical University of Innsbruck, Innsbruck, Austria
| | - Lutz Naehrlich
- Department of General Pediatrics and Neonatology, University Hospital of Giessen and Marburg, Campus Giessen, Giessen, Germany
| | - Helmut Ellemunter
- Department for Child and Adolescent Health, University Clinic for Paediatrics III, Cystic Fibrosis Centre, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
5
|
Naehrlich L. Have courage in using nasal potential difference for diagnostic decisions and clinical research. J Cyst Fibros 2020; 19:507-508. [PMID: 32593372 DOI: 10.1016/j.jcf.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Feulgenstrasse 12, D-35385 Giessen, Germany.
| |
Collapse
|
6
|
Pasricha ND, Smith AJ, Levin MH, Schallhorn JM, Verkman AS. Ocular Surface Potential Difference Measured in Human Subjects to Study Ocular Surface Ion Transport. Transl Vis Sci Technol 2020; 9:20. [PMID: 33117611 PMCID: PMC7571274 DOI: 10.1167/tvst.9.11.20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022] Open
Abstract
Purpose The epithelium lining the ocular surface, which includes corneal and conjunctival epithelia, expresses the prosecretory chloride channel cystic fibrosis transmembrane conductance regulator (CFTR) and the proabsorptive epithelial sodium channel (ENaC). Here, methodology was established to measure the millivolt (mV) potential differences at the ocular surface, called ocular surface potential difference (OSPD), in human subjects produced by ion transport. Methods OSPD was measured in human subjects in which a fluid-filled measuring electrode contacted a fluid pool created by eversion of the lateral lower eyelid, with a reference electrode placed subcutaneously in the forearm. Through the use of a high-impedance voltmeter, OSPD was measured continuously over 10 to 15 minutes in response to a series of perfusate fluid exchanges. Results Baseline OSPD (± SEM) in six normal human subjects was -21.3 ± 3.6 mV. OSPD depolarized by 1.7 ± 0.6 mV following the addition of the ENaC inhibitor amiloride, hyperpolarized by 6.8 ± 1.5 mV with a zero chloride solution, and further hyperpolarized by 15.9 ± 1.6 mV following CFTR activation by isoproterenol. The isoproterenol-induced hyperpolarization was absent in two cystic fibrosis subjects lacking functional CFTR. OSPD measurement produced minimal epithelial injury. Conclusions Our results establish the feasibility and safety of OSPD measurement in humans and demonstrate robust CFTR activity, albeit minimal ENaC activity, at the ocular surface. OSPD measurement may be broadly applicable to investigate fluid transport mechanisms and test drug candidates to treat ocular surface disorders. Translational Relevance To the best of our knowledge, this is the first measurement of the electrical potential generated by the ocular surface epithelium in human subjects, offering a new approach to study ocular surface function and health.
Collapse
Affiliation(s)
- Neel D Pasricha
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Alex J Smith
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.,Departments of Medicine and Physiology, University of California San Francisco, San Francisco, CA, USA
| | - Marc H Levin
- Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA, USA
| | - Julie M Schallhorn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA.,Francis I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
| | - Alan S Verkman
- Departments of Medicine and Physiology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
7
|
Alton EWFW, Boyd AC, Davies JC, Gill DR, Griesenbach U, Harman TE, Hyde S, McLachlan G. Gene Therapy for Respiratory Diseases: Progress and a Changing Context. Hum Gene Ther 2020; 31:911-916. [PMID: 32746737 DOI: 10.1089/hum.2020.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Eric W F W Alton
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,UK CF Gene Therapy Consortium, London, United Kingdom
| | - A Christopher Boyd
- UK CF Gene Therapy Consortium, London, United Kingdom.,Centre for Genomic and Experimental Medicine, IGMM, University of Edinburgh, Edinburgh, United Kingdom
| | - Jane C Davies
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,UK CF Gene Therapy Consortium, London, United Kingdom
| | - Deborah R Gill
- UK CF Gene Therapy Consortium, London, United Kingdom.,Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Uta Griesenbach
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,UK CF Gene Therapy Consortium, London, United Kingdom
| | - Tracy E Harman
- Gene Therapy Group, National Heart and Lung Institute, Imperial College London, London, United Kingdom.,UK CF Gene Therapy Consortium, London, United Kingdom
| | - Stephen Hyde
- UK CF Gene Therapy Consortium, London, United Kingdom.,Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Gerry McLachlan
- UK CF Gene Therapy Consortium, London, United Kingdom.,The Roslin Institute & R(D)SVS, Easter Bush Campus, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
8
|
Caldrer S, Bergamini G, Sandri A, Vercellone S, Rodella L, Cerofolini A, Tomba F, Catalano F, Frulloni L, Buffelli M, Tridello G, de Jonge H, Assael BM, Sorio C, Melotti P. Cystic fibrosis transmembrane conductance regulator functional evaluations in a G542X+/- IVS8Tn:T7/9 patient with acute recurrent pancreatitis. World J Clin Cases 2019; 7:3757-3764. [PMID: 31799301 PMCID: PMC6887611 DOI: 10.12998/wjcc.v7.i22.3757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/16/2019] [Accepted: 10/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute recurrent pancreatitis (ARP) is characterized by episodes of acute pancreatitis in an otherwise normal gland. When no cause of ARP is identifiable, the diagnosis of "idiopathic" ARP is given. Mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene increase the risk of ARP by 3- to 4-times compared to the general population, while cystic fibrosis (CF) patients present with a 40- to 80-times higher risk of developing pancreatitis.
CASE SUMMARY In non-classical CF or CFTR-related disorders, CFTR functional tests can help to ensure a proper diagnosis. We applied an individualized combination of standardized and new CFTR functional bioassays for a patient referred to the Verona CF Center for evaluation after several episodes of acute pancreatitis. The CFTR genotype was G542X+/- with IVS8Tn:T7/9 polymorphism. The sweat (Cl-) values were borderline. Intestinal current measurements were performed according to the European Cystic Fibrosis Society Standardized Operating Procedure. Recent nasal surgery for deviated septum did not allow for nasal potential difference measurements. Lung function and sputum cultures were normal; azoospermia was excluded. Pancreas divisum was excluded by imaging but hypoplasia of the left hepatic lobe was detected. Innovative tests applied in this case include sweat rate measurement by image analysis, CFTR function in monocytes evaluated using a membrane potential-sensitive fluorescent probe, and the intestinal organoids forskolin-induced swelling assay.
CONCLUSION Combination of innovative CFTR functional assays might support a controversial diagnosis when CFTR-related disorders and/or non-classical CF are suspected.
Collapse
Affiliation(s)
- Sara Caldrer
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
| | - Gabriella Bergamini
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Angela Sandri
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Silvia Vercellone
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
| | - Luca Rodella
- Endoscopic Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Angelo Cerofolini
- Endoscopic Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Francesco Tomba
- Endoscopic Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Filippo Catalano
- Endoscopic Surgery Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Luca Frulloni
- Department of Medicine, Pancreas Center, University of Verona, Verona 37134, Italy
| | - Mario Buffelli
- Department of Neurosciences, Biomedicine and Movement Sciences, Physiology Section University, Verona 37126, Italy
| | - Gloria Tridello
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Hugo de Jonge
- Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam 3015, Netherlands
| | - Baroukh Maurice Assael
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| | - Claudio Sorio
- Department of Medicine, General Pathology Division, Cystic Fibrosis Translational Research Laboratory “D. Lissandrini”, University of Verona, Verona 37134, Italy
| | - Paola Melotti
- Cystic Fibrosis Center, Azienda Ospedaliera Universitaria Integrata Verona, Verona 37126, Italy
| |
Collapse
|
9
|
Chloride Conductance, Nasal Potential Difference and Cystic Fibrosis Pathophysiology. Lung 2019; 198:151-156. [PMID: 31734731 DOI: 10.1007/s00408-019-00293-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Cystic fibrosis (CF) is a multisystem genetic disease caused by dysfunction of the epithelial anionic channel Cystic Fibrosis Transmembrane conductance Regulator (CFTR). Decreased mucociliary clearance because of thickened mucus is part of the pulmonary disease pathophysiology. It is controversial if the thickened airway surface liquid (ASL) is caused by the deficient chloride secretion and excessive sodium (through ENaC) and water hyperabsorption from the periciliar fluid or by the lack of bicarbonate secretion with relative acidification of the ASL. Correlations between the magnitude of in vivo chloride conductance with phenotypic characteristics and CF genotype can help to elucidate these mechanisms and direct to new treatments. METHODS Nasal potential difference was measured in 28 CF patients (age from 0.3 to 28 year) and correlated with pulmonary function, pancreatic phenotype, pulmonary colonization and genotype severity. RESULTS The CFTR-chloride conductance was better in older patients (r = 0.40; P = 0.03), in patients with better pulmonary function (r = 0.48; P = 0.01), and was associated with genotype severity. Higher chloride diffusion in the presence of a favorable chemical gradient was associated with Pseudomonas aeruginosa negativity (P < 0.05). More negative NPDmax was associated with pancreatic insufficiency (P < 0.01) as well with genotype severity, but not with the pulmonary function. CONCLUSIONS The anion permeability through CFTR, mainly chloride, but bicarbonate as well, is the most critical factor in CF airway pathophysiology. Treatments primarily directed to correct CFTR function and/or airway acidity are clearly a priority.
Collapse
|
10
|
Solomon GM, Bronsveld I, Hayes K, Wilschanski M, Melotti P, Rowe SM, Sermet-Gaudelus I. Standardized Measurement of Nasal Membrane Transepithelial Potential Difference (NPD). J Vis Exp 2018. [PMID: 30272672 DOI: 10.3791/57006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We describe a standardized measurement of nasal potential difference (NPD). In this technique, cystic fibrosis transmembrane conductance regulator (CFTR) and the epithelial sodium channel (ENaC) function are monitored by the change in voltage across the nasal epithelium after the superfusion of solutions that modify ion channel activity. This is enabled by the measurement of the potential difference between the subcutaneous compartment and the airway epithelium in the nostril, utilizing a catheter in contact with the inferior nasal turbinate. The test allows the measurement of the stable baseline voltage and the successive net voltage changes after perfusion of 100 µM amiloride, an inhibitor of Na+ reabsorption in Ringer's solution; a chloride-free solution containing amiloride to drive chloride secretion and 10 µM isoproterenol in a chloride-free solution with amiloride to stimulate the cyclic adenosine monophosphate (cAMP)-dependent chloride conductance related to CFTR. This technique has the advantage of demonstrating the electrophysiological properties of two key components establishing the hydration of the airway surface liquid of the respiratory epithelium, ENaC, and CFTR. Therefore, it is a useful research tool for phase 2 and proof of concept trials of agents that target CFTR and ENaC activity for the treatment of cystic fibrosis (CF) lung disease. It is also a key follow-up procedure to establish CFTR dysfunction when genetic testing and sweat testing are equivocal. Unlike sweat chloride, the test is relatively more time consuming and costly. It also requires operator training and expertise to conduct the test effectively. Inter- and intra-subject variability has been reported in this technique especially in young or uncooperative subjects. To assist with this concern, interpretation has been improved through a recently validated algorithm.
Collapse
Affiliation(s)
- George M Solomon
- Department of Medicine and the Gregory Fleming James Cystic Fibrosis Center, University of Alabama at Birmingham
| | - Inez Bronsveld
- Department of Pulmonology and Tuberculosis, University Medical Center Utrecht
| | - Kathryn Hayes
- Center for Experimental Medicine, Queens University, Northern Ireland
| | | | - Paola Melotti
- Centro Fibrosi Cistica, Azienda Ospedaliera Universitaria Integrata
| | - Steven M Rowe
- Department of Medicine and the Gregory Fleming James Cystic Fibrosis Center, University of Alabama at Birmingham
| | - Isabelle Sermet-Gaudelus
- Service de Pneumologie et Allergologie Pédiatriques and Center de Ressources et de Compétence de la Mucoviscidose, Hôpital Necker Enfants Malades; INSERM U 1151, Institut Necker Enfants Malades;
| |
Collapse
|
11
|
Gramegna A, Aliberti S, Seia M, Porcaro L, Bianchi V, Castellani C, Melotti P, Sorio C, Consalvo E, Franceschi E, Amati F, Contarini M, Gaffuri M, Roncoroni L, Vigone B, Bellofiore A, Del Monaco C, Oriano M, Terranova L, Patria MF, Marchisio P, Assael BM, Blasi F. When and how ruling out cystic fibrosis in adult patients with bronchiectasis. Multidiscip Respir Med 2018; 13:29. [PMID: 30151190 PMCID: PMC6101074 DOI: 10.1186/s40248-018-0142-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Bronchiectasis is the final result of different processes and most of the guidelines advocate for a careful evaluation of those etiologies which might be treated or might change patients’ management, including cystic fibrosis (CF). Main body CFTR mutations have been reported with higher frequency in bronchiectasis population. Although ruling out CF is considered as a main step for etiological screening in bronchiectasis, CF testing lacks of a standardized approach both from a research and clinical point of view. In this review a list of most widely used tests in CF is provided. Conclusions Exclusion of CF is imperative for patients with bronchiectasis and CFTR testing should be implemented in usual screening for investigating bronchiectasis etiology. Physicians taking care of bronchiectasis patients should be aware of CFTR testing and its limitations in the adult population. Further studies on CFTR expression in human lung and translational research might elucidate the possible role of CFTR in the pathogenesis of bronchiectasis.
Collapse
Affiliation(s)
- Andrea Gramegna
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Stefano Aliberti
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Manuela Seia
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Luigi Porcaro
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Vera Bianchi
- 3UOSD Genetica Medica, Medical Genetics Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Carlo Castellani
- 4Centro Fibrosi Cistica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paola Melotti
- 4Centro Fibrosi Cistica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Claudio Sorio
- 5Dipartimento di Patologia e Diagnostica, Università di Verona, Verona, Italy
| | - Enza Consalvo
- 2Medical Genetics Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Elisa Franceschi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Francesco Amati
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Martina Contarini
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Michele Gaffuri
- 6Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Luca Roncoroni
- 6Department of Otolaryngology and Head and Neck Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Barbara Vigone
- 7Scleroderma Unit, Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Angela Bellofiore
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Cesare Del Monaco
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Martina Oriano
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy.,9Molecular Medicine Department, University of Pavia, Viale Taramelli 3/b, 27100 Pavia, Italy
| | - Leonardo Terranova
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Francesca Patria
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Baroukh M Assael
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
| |
Collapse
|
12
|
De Wachter E, Thomas M, Wanyama SS, Seneca S, Malfroot A. What can the CF registry tell us about rare CFTR-mutations? A Belgian study. Orphanet J Rare Dis 2017; 12:142. [PMID: 28830496 PMCID: PMC5567473 DOI: 10.1186/s13023-017-0694-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/10/2017] [Indexed: 02/01/2023] Open
Abstract
Background CFTR2 provides clinical and functional information of the most common CFTR-mutations. Rare mutations (RMs) occur in only a few patients with limited reported clinical data. Their role in CF-disease liability is hardly documented. Methods Belgian CF-Registry 2013 data were analyzed to identify CF with at least 1 RM (CF+RM). Clinical data and sweat chloride of CF+RM were compared to CF-controls, carrying 2 class 1 to 3 mutations (CFclassic). Disease severity was compared between both groups. To avoid bias in the comparison, transplanted patients were excluded from each group. Results Seventy-seven CF+RM were identified (77/1183 = 6.5%). Sixty-four different RM were detected, of which 21 had not been previously reported. All RMs, corresponding to HGVS (Human Genome Variation Society) nomenclature, were listed in supplementary data. Seven transplanted CF+RM were excluded for further analysis. CF+RM had higher age at diagnosis [median (IQR)] [3.7 y (0.3–18.3) vs. 0.3y (0.1–2,0) (p < 0.0001)], lower sweat chloride [96 mmol/L (64–107) vs. 104 mmol/L (97–115) (p < 0.0001)], higher FEV1%pred [77%pred (58–96) vs. 68%pred (48–86) (p = 0.017)], were less frequently pancreatic insufficient [56% vs. 98% (p < 0.0001)], Pseudomonas aeruginosa colonized [24% vs. 44% (p = 0.0093)] and needed fewer IV antibiotics [36% vs. 51% (p = 0.041)] than CFclassic. However, a wide spectrum of disease severity was seen amongst CF+RM. Conclusions CF-patients with a RM cover 6.5% of the Belgian CF-population. Rare mutations can be found in severely ill patients, but more often in late diagnosed, pancreatic sufficient patients. Electronic supplementary material The online version of this article (doi:10.1186/s13023-017-0694-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- E De Wachter
- CF Clinic, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - M Thomas
- Belgian CF Registry, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - S S Wanyama
- Belgian CF Registry, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - S Seneca
- Department for Reproduction and Genetics, Centre of Medical Genetics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Malfroot
- CF Clinic, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| |
Collapse
|
13
|
De Boeck K, Vermeulen F, Dupont L. The diagnosis of cystic fibrosis. Presse Med 2017; 46:e97-e108. [PMID: 28576637 DOI: 10.1016/j.lpm.2017.04.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/18/2017] [Accepted: 04/27/2017] [Indexed: 01/09/2023] Open
Abstract
Establishing the diagnosis of cystic fibrosis (CF) is straight forward in the majority of patients: they present with a clear clinical picture (most frequently chronic respiratory symptoms plus malabsorption), the sweat chloride value is>60mmol/L and two known disease causing CFTR mutations are identified. In less than 5% of subjects, mainly those with a milder or limited phenotype, the diagnostic process is more complex, because initial diagnostic test results are inconclusive: sweat chloride concentration in the intermediate range, less than 2 CF causing mutations identified or both. These patients should be referred to expert centers where bioassays of CFTR function like nasal potential difference measurement or intestinal current measurement can be done. Still, in some patients, despite symptoms compatible with CF and some indication of CFTR dysfunction (e.g. only intermediate sweat chloride value), diagnostic criteria are not met (e.g. only 1 CFTR mutation identified). For these subjects, the term CFTR related disorder (CFTR-RD) is used. Patients with disseminated bronchiectasis, congenital bilateral absence of the vas deferens and acute or recurrent pancreatitis may fall in this category. CF has a very wide disease spectrum and increasingly the diagnosis is being made during adult life, mainly in subjects with milder phenotypes. In many countries, nationwide CF newborn screening (NBS) has been introduced. In screen positive babies, the diagnosis of CF must be confirmed by a sweat test demonstrating a sweat chloride concentration above 60mmol/L. To achieve the benefit of NBS, every baby in whom the diagnosis of CF is confirmed must receive immediate follow-up and treatment in a CF reference center. CF NBS is not full proof: some diagnoses will be missed and in some babies the diagnosis cannot be confirmed nor ruled out with certainty. Screening algorithms that include gene sequencing will detect a high number of such babies that are screen positive with an inconclusive diagnosis (CFSPID). Even in 2016, the most reliable and widely available diagnostic test for CF is the measurement of chloride concentration in sweat. The method of choice is sweat induction by pilocarpine iontophoresis, followed by sweat collection on a gauze or filter paper or in a Macroduct coil. Since mutation specific therapies have become available, it is important to identify the mutations responsible for CF in each individual patient.
Collapse
Affiliation(s)
- Kris De Boeck
- University of Leuven, Department of Pulmonology, 3000 Leuven, Belgium.
| | | | - Lieven Dupont
- University of Leuven, Department of Pulmonology, Leuven, Belgium
| |
Collapse
|
14
|
Solomon GM, Liu B, Sermet-Gaudelus I, Fajac I, Wilschanski M, Vermeulen F, Rowe SM. A multiple reader scoring system for Nasal Potential Difference parameters. J Cyst Fibros 2017; 16:573-578. [PMID: 28465124 DOI: 10.1016/j.jcf.2017.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 03/10/2017] [Accepted: 04/10/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nasal Potential Difference (NPD) is a biomarker of CFTR activity used to diagnose CF and monitor experimental therapies. Limited studies have been performed to assess agreement between expert readers of NPD interpretation using a scoring algorithm. METHODS We developed a standardized scoring algorithm for "interpretability" and "confidence" for PD (potential difference) measures, and sought to determine the degree of agreement on NPD parameters between trained readers. RESULTS There was excellent agreement for interpretability between NPD readers for CF and fair agreement for normal tracings but slight agreement of interpretability in indeterminate tracings. Amongst interpretable tracings, excellent correlation of mean scores for Ringer's Baseline PD, Δamiloride, and ΔCl-free+Isoproterenol was observed. There was slight agreement regarding confidence of the interpretable PD tracings, resulting in divergence of the Ringers and Δamiloride, and ΔCl-free+Isoproterenol PDs between "high" and "low" confidence CF tracings. CONCLUSION A multi-reader process with adjudication is important for scoring NPDs for diagnosis and in monitoring of CF clinical trials.
Collapse
Affiliation(s)
- George M Solomon
- Department of Medicine, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Bo Liu
- Department of Medicine, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Isabelle Sermet-Gaudelus
- Hôpital Necker-Enfants Malades, France; Université Paris René Descartes, Sorbonne Paris Cité, Paris, France
| | - Isabelle Fajac
- Université Paris René Descartes, Sorbonne Paris Cité, Paris, France; AP-HP, Hôpital Cochin, Service de Physiologie et Explorations Fonctionnelles, Paris, France
| | | | | | - Steven M Rowe
- Department of Medicine, The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
15
|
Van Gerven L, Alpizar YA, Steelant B, Callebaut I, Kortekaas Krohn I, Wouters M, Vermeulen F, Boeckxstaens G, Talavera K, Hellings PW. Enhanced chemosensory sensitivity in patients with idiopathic rhinitis and its reversal by nasal capsaicin treatment. J Allergy Clin Immunol 2017; 140:437-446.e2. [PMID: 28389389 DOI: 10.1016/j.jaci.2017.03.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 02/21/2017] [Accepted: 03/02/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The therapeutic action of capsaicin treatment in patients with idiopathic rhinitis (IR) is based on ablation of the transient receptor potential cation channel subfamily V, receptor 1 (TRPV1)-substance P nociceptive signaling pathway. However, the functional consequences of capsaicin treatment on nasal nerve activation and the association between the reduction in nasal hyperreactivity (NHR) and response to capsaicin treatment remain unknown. OBJECTIVE We sought to study the effects of capsaicin nasal spray on the afferent innervation of the nasal mucosa by monitoring trigeminal nerve activity in patients with IR and healthy control (HC) subjects. METHODS A double-blind, placebo-controlled randomized trial with capsaicin nasal spray was performed involving 33 patients with IR and 12 HC subjects. Before and at 4, 12, and 26 weeks after treatment, nasal mucosal potentials (NMPs) were measured while exposing the nasal mucosa of patients with IR and HC subjects to aerosols with increasing doses of the chemical irritants allyl isothiocyanate (AITC; also known as mustard oil) or capsaicin. The threshold for each compound was determined for each subject. The results of the NMP measurements were evaluated in parallel with the therapeutic response, visual analog scale scores for nasal symptoms, self-reported NHR, and mRNA expression of PGP9.5; TRPV1; transient receptor potential cation channel subfamily A, receptor 1 (TRPA1); TRPV4; transient receptor potential cation channel subfamily M, member 8 (TRPM8); and nerve growth factor (NGF) in nasal biopsy specimens. RESULTS AITC turned out to be the best stimulus because the coughing induced by capsaicin interfered with measurements. At baseline, the threshold for evoking changes in NMPs based on AITC was significantly lower for patients with IR compared with HC subjects (P = .0423). Capsaicin treatment of IR patients increased the threshold for the response to AITC at 4 and 12 weeks compared with placebo (P = .0406 and P = .0325, respectively), which returned to baseline by week 26 (P = .0611). This increase correlated with changes in visual analog scale major symptom (P = .0004) and total symptom (P = .0018) scores. IR patients with self-reported NHR at baseline showed a trend to being better responders to capsaicin treatment compared with patients with IR but without NHR (P = .10). CONCLUSION The lower threshold for AITC based on NMPs in patients with IR compared with HC subjects and the increased threshold for AITC after capsaicin treatment in patients with IR demonstrate the crucial role of TRPA1 and TRPV1 in IR pathophysiology. The strong correlation between the increase in AITC threshold in patients with IR and symptom reduction after capsaicin treatment demonstrates the clinical relevance of these findings.
Collapse
Affiliation(s)
- Laura Van Gerven
- Clinical division of Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Yeranddy A Alpizar
- Laboratory for Ion Channel Research and TRP Research Platform Leuven (TRPLe), Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Brecht Steelant
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Ina Callebaut
- Clinical division of Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Inge Kortekaas Krohn
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Mira Wouters
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - François Vermeulen
- Cystic Fibrosis Reference Centre, University Hospitals Leuven, Leuven, Belgium
| | - Guy Boeckxstaens
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Karel Talavera
- Laboratory for Ion Channel Research and TRP Research Platform Leuven (TRPLe), Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Peter W Hellings
- Clinical division of Otorhinolaryngology, Head & Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, University of Ghent, Ghent, Belgium; Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
16
|
Farrell PM, White TB, Derichs N, Castellani C, Rosenstein BJ. Cystic Fibrosis Diagnostic Challenges over 4 Decades: Historical Perspectives and Lessons Learned. J Pediatr 2017; 181S:S16-S26. [PMID: 28129808 DOI: 10.1016/j.jpeds.2016.09.067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Because cystic fibrosis (CF) can be difficult to diagnose, and because information about the genetic complexities and pathologic basis of the disease has grown so rapidly over the decades, several consensus conferences have been held by the US CF Foundation, and a variety of other efforts to improve diagnostic practices have been organized by the European CF Society. Despite these efforts, the application of diagnostic criteria has been variable and caused confusion. STUDY DESIGN To improve diagnosis and achieve standardization in terms and definitions worldwide, the CF Foundation in 2015 convened a committee of 32 experts in the diagnosis of CF from 9 countries. As part of the process, all previous consensus-seeking exercises sponsored by the CF Foundation, along with the important efforts of the European CF Society, were comprehensively and critically reviewed. The goal was to better understand why consensus conferences and their publications have not led to the desired results. RESULTS Lessons learned from previous diagnosis consensus processes and products were identified. It was decided that participation in developing a consensus was generally not inclusive enough for global impact. It was also found that many efforts to address sweat test issues were valuable but did not always improve clinical practices as CF diagnostic testing evolved. It also became clear from this review that premature applications of potential diagnostic tests such as nasal potential difference and intestinal current measurement should be avoided until validation and standardization occur. Finally, we have learned that due to the significant and growing number of cases that are challenging to diagnose, an associated continuing medical education program is both desirable and necessary. CONCLUSIONS It is necessary but not sufficient to organize and publish CF diagnosis consensus processes. Follow-up implementation efforts and monitoring practices seem essential.
Collapse
Affiliation(s)
- Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Nico Derichs
- CFTR Biomarker Center and Translational CF Research Group, CF Center, Pediatric Pulmonology and Immunology , Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | |
Collapse
|
17
|
Farrell PM, White TB. Introduction to "Cystic Fibrosis Foundation Consensus Guidelines for Diagnosis of Cystic Fibrosis". J Pediatr 2017; 181S:S1-S3. [PMID: 28129807 DOI: 10.1016/j.jpeds.2016.09.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | |
Collapse
|
18
|
Farrell PM, White TB, Ren CL, Hempstead SE, Accurso F, Derichs N, Howenstine M, McColley SA, Rock M, Rosenfeld M, Sermet-Gaudelus I, Southern KW, Marshall BC, Sosnay PR. Diagnosis of Cystic Fibrosis: Consensus Guidelines from the Cystic Fibrosis Foundation. J Pediatr 2017; 181S:S4-S15.e1. [PMID: 28129811 DOI: 10.1016/j.jpeds.2016.09.064] [Citation(s) in RCA: 460] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cystic fibrosis (CF), caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, continues to present diagnostic challenges. Newborn screening and an evolving understanding of CF genetics have prompted a reconsideration of the diagnosis criteria. STUDY DESIGN To improve diagnosis and achieve standardized definitions worldwide, the CF Foundation convened a committee of 32 experts in CF diagnosis from 9 countries to develop clear and actionable consensus guidelines on the diagnosis of CF and to clarify diagnostic criteria and terminology for other disorders associated with CFTR mutations. An a priori threshold of ≥80% affirmative votes was required for acceptance of each recommendation statement. RESULTS After reviewing relevant literature, the committee convened to review evidence and cases. Following the conference, consensus statements were developed by an executive subcommittee. The entire consensus committee voted and approved 27 of 28 statements, 7 of which needed revisions and a second round of voting. CONCLUSIONS It is recommended that diagnoses associated with CFTR mutations in all individuals, from newborn to adult, be established by evaluation of CFTR function with a sweat chloride test. The latest mutation classifications annotated in the Clinical and Functional Translation of CFTR project (http://www.cftr2.org/index.php) should be used to aid in diagnosis. Newborns with a high immunoreactive trypsinogen level and inconclusive CFTR functional and genetic testing may be designated CFTR-related metabolic syndrome or CF screen positive, inconclusive diagnosis; these terms are now merged and equivalent, and CFTR-related metabolic syndrome/CF screen positive, inconclusive diagnosis may be used. International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes for use in diagnoses associated with CFTR mutations are included.
Collapse
Affiliation(s)
- Philip M Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Clement L Ren
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | | | - Frank Accurso
- Section of Pediatric Pulmonology, Colorado School of Public Health, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Nico Derichs
- CFTR Biomarker Center and Translational CF Research Group, CF Center, Pediatric Pulmonology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Michelle Howenstine
- Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Susanna A McColley
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, and Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michael Rock
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Margaret Rosenfeld
- Seattle Children's Research Institute and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Isabelle Sermet-Gaudelus
- Centres de Ressources et de Compétences pour la Mucoviscidose, Institut Necker Enfants Malades/INSERM U1151, Hôpital Necker Enfants Malades, Paris, France
| | - Kevin W Southern
- Department of Women's and Children's Health, University of Liverpool, Institute in the Park, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | - Patrick R Sosnay
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
19
|
Michl RK, Tabori H, Hentschel J, Beck JF, Mainz JG. Clinical approach to the diagnosis and treatment of cystic fibrosis and CFTR-related disorders. Expert Rev Respir Med 2016; 10:1177-1186. [DOI: 10.1080/17476348.2016.1240032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
20
|
Abstract
The cystic fibrosis transmembrane conductance regulator (CFTR) gene was identified in 1989. This opened the door for the development of cystic fibrosis (CF) gene therapy, which has been actively pursued for the last 20 years. Although 26 clinical trials involving approximately 450 patients have been carried out, the vast majority of these trials were short and included small numbers of patients; they were not designed to assess clinical benefit, but to establish safety and proof-of-concept for gene transfer using molecular end points such as the detection of recombinant mRNA or correction of the ion transport defect. The only currently published trial designed and powered to assess clinical efficacy (defined as improvement in lung function) administered AAV2-CFTR to the lungs of patients with CF. The U.K. Cystic Fibrosis Gene Therapy Consortium completed, in the autumn of 2014, the first nonviral gene therapy trial designed to answer whether repeated nonviral gene transfer (12 doses over 12 months) can lead to clinical benefit. The demonstration that the molecular defect in CFTR can be corrected with small-molecule drugs, and the success of gene therapy in other monogenic diseases, is boosting interest in CF gene therapy. Developments are discussed here.
Collapse
Affiliation(s)
- Uta Griesenbach
- Department of Gene Therapy and the U.K. Cystic Fibrosis Gene Therapy Consortium, Imperial College, London SW3 6LR, United Kingdom
| | - Kamila M Pytel
- Department of Gene Therapy and the U.K. Cystic Fibrosis Gene Therapy Consortium, Imperial College, London SW3 6LR, United Kingdom
| | - Eric W F W Alton
- Department of Gene Therapy and the U.K. Cystic Fibrosis Gene Therapy Consortium, Imperial College, London SW3 6LR, United Kingdom
| |
Collapse
|
21
|
Abstract
Cystic Fibrosis (CF) is a rare, multisystem disease leading to significant morbidity and mortality. CF is caused by defects in the cystic fibrosis transmembrane conductance regulator protein (CFTR), a chloride and bicarbonate transporter. Early diagnosis and access to therapies provides benefits in nutrition, pulmonary health, and cognitive ability. Several screening and diagnostic tests are available to support a diagnosis. We discuss the characteristics of screening and diagnostic tests for CF and guideline-based algorithms using these tools to establish a diagnosis. We discuss classification and management of common "diagnostic dilemmas," including the CFTR-related metabolic syndrome and other CFTR-associated diseases.
Collapse
Affiliation(s)
- John Brewington
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, MLC 2021, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - J P Clancy
- Division of Pulmonary Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, MLC 2021, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| |
Collapse
|
22
|
Sad IR, Higa LYS, Leal T, Martins RDS, de Almeida AC, Ramos EG, de Cabello GMK, Peixoto MVM. Repeatability and Diagnostic Value of Nasal Potential Difference in a Genetically Admixed Population. J Clin Med Res 2015; 8:15-24. [PMID: 26668678 PMCID: PMC4676341 DOI: 10.14740/jocmr2312w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The genetic diversity of the Brazilian population results from three ethnic groups admixture: Europeans, Africans and Amerindians, thus increasing the difficulty of performing cystic fibrosis (CF) diagnosis. The nasal potential difference (NPD) evaluates the cystic fibrosis transmembrane conductance regulator (CFTR) and epithelial sodium channel (ENaC) activity. Despite being a useful CF diagnostic test and a biomarker of CFTR-modulator drugs, it is also highly operator dependent. Therefore, it may be difficult to get accurate results and to interpret them. Wilschanski and Sermet scores were proposed to address these issues. This study aimed to evaluate repeatability and diagnostic value of NPD parameters and Wilschanski and Sermet scores in a CF center in Rio de Janeiro. METHODS NPD was performed in 78 subjects. Maximal PD, amiloride response, total chloride response, and Wilschanski and Sermet scores were explored as means (confidence interval, CI). One-way ANOVA was used to compare mean differences and Scheffe test was used to pair-wise comparisons. Repeatability was evaluated by scatter and Bland-Altman plots. The Ethics Committee of the CF Center has approved the study protocol. Parents and adult participants signed an informed consent form. RESULTS Forty-eight healthy-volunteers, 19 non-CF and 11 CF patients were enrolled in this study. Significant differences were found when comparing CF patients' NPD parameters to the other two groups (P = 0.000). Moreover, no significant differences were found when parameters from non-CF patients were compared with those from healthy volunteers (P > 0.05). The means of NPD parameters and diagnostic scores of each group were in concordance with disease/non-disease conditions. The repeatability data - Wilschanski and Sermet and NPD - allow NPD to be performed in this Brazilian CF Center. CONCLUSIONS The present study gathered consistent data for Bland-Altman plots. The results of Wilschanski and Sermet diagnostic scores suggest that they were concordant with CF/non-CF conditions. More NPD tests should be performed in the Rio de Janeiro CF dynamic cohort to contribute to international NPD validation studies and to provide NPD as a biomarker in Brazil.
Collapse
Affiliation(s)
- Izabela Rocha Sad
- Pediatric Pulmonology, Pediatric Department, Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Laurinda Yoko Shinzato Higa
- Pediatric Pulmonology, Pediatric Department, Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Teresinha Leal
- Louvain Center for Toxicology and Applied Pharmacology (LTAP), Institut de Recherche Experimentale et Clinique (IREC) Universite Catholique de Louvain, Brussels, Belgium
| | - Raisa da Silva Martins
- Pediatric Pulmonology, Pediatric Department, Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Ana Claudia de Almeida
- Laboratory of Quantitative Methods, Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Eloane Goncalves Ramos
- Clinical Research Unit, Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| | - Giselda Maria Kalil de Cabello
- Laboratory of Human Genetics, Oswaldo Cruz Institute, Oswaldo Cruz Foundation/FIOCRUZ, Pavilhao Leonidas Deane, sala 611, Rio de Janeiro, Brazil
| | - Maria Virginia Marques Peixoto
- Laboratory of Quantitative Methods, Fernandes Figueira National Institute of Woman, Child and Adolescent Health, Oswaldo Cruz Foundation/FIOCRUZ, Rio de Janeiro, Brazil
| |
Collapse
|
23
|
Addy C, Downey DG, Elborn JS. Improvements in symptomatic treatment strategies for cystic fibrosis: delivering CF care in the 21st century. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2016.1107473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
24
|
Savant AP, McColley SA. 2014 year in review: Cystic fibrosis. Pediatr Pulmonol 2015; 50:1147-56. [PMID: 26347000 DOI: 10.1002/ppul.23309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/26/2015] [Accepted: 08/22/2015] [Indexed: 12/23/2022]
Abstract
In this article, we highlight cystic fibrosis (CF) research published in Pediatric Pulmonology during 2014, as well as related articles published in other journals.
Collapse
Affiliation(s)
- Adrienne P Savant
- Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Susanna A McColley
- Division of Pulmonary Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Stanley Manne Children's Research Institute, Illinois
| |
Collapse
|
25
|
A semi-blinded study comparing 2 methods of measuring nasal potential difference: Subcutaneous needle versus dermal abrasion. J Cyst Fibros 2015; 15:60-6. [PMID: 26190830 DOI: 10.1016/j.jcf.2015.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/22/2015] [Accepted: 06/24/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND According to European and US protocols, two nasal potential difference (NPD) measurement methods are considered acceptable, although they have not been formally compared: subcutaneous agar-filled needle with calomel (Ndl) and dermal abrasion with conducting cream and Ag/AgCl electrodes (Abr). We compared both in CF and healthy volunteers (HV), assessing their discriminative value and subject's preference. METHODS Twelve classic CF and 17 HV underwent both NPD methods, performed by one operator in random order. A written questionnaire, assessing preference, was completed after each test. Tracings were coded, scored in a semi-blinded fashion and categorised as CF/non-CF. RESULTS 110 tracings (56 Ndl/54 Abr) were collected: 42/110 scored CF and 68/110 non-CF, showing a good correlation. No significant preference for either method was reported. CONCLUSION Both NPD methods are similar in terms of discriminative value and subject's preference, comparing classical CF and HV. For diagnosing CF, the operator's preferred NPD-method may be used.
Collapse
|
26
|
van Koningsbruggen-Rietschel S, Naehrlich L. Cystic fibrosis transmembrane conductance regulator biomarkers in ‘real life’: can we evaluate individual efficacy of cystic fibrosis transmembrane conductance regulator therapy? Ther Adv Respir Dis 2015; 9:198-200. [DOI: 10.1177/1753465815579364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Giessen, Germany
| |
Collapse
|
27
|
Griesenbach U, Alton EW. Recent advances in understanding and managing cystic fibrosis transmembrane conductance regulator dysfunction. F1000PRIME REPORTS 2015; 7:64. [PMID: 26097737 PMCID: PMC4447040 DOI: 10.12703/p7-64] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cystic fibrosis is the most common autosomal recessive genetic disease in Caucasians and has been extensively studied for many decades. The cystic fibrosis transmembrane conductance regulator gene was identified in 1989. It encodes a complex protein which has numerous cellular functions. Our understanding of cystic fibrosis pathophysiology and genetics is constantly expanding and being refined, leading to improved management of the disease and increased life expectancy in affected individuals.
Collapse
|
28
|
Tiddens HAWM, Puderbach M, Venegas JG, Ratjen F, Donaldson SH, Davis SD, Rowe SM, Sagel SD, Higgins M, Waltz DA. Novel outcome measures for clinical trials in cystic fibrosis. Pediatr Pulmonol 2015; 50:302-315. [PMID: 25641878 PMCID: PMC4365726 DOI: 10.1002/ppul.23146] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 10/20/2014] [Accepted: 11/02/2014] [Indexed: 12/25/2022]
Abstract
Cystic fibrosis (CF) is a common inherited condition caused by mutations in the gene encoding the CF transmembrane regulator protein. With increased understanding of the molecular mechanisms underlying CF and the development of new therapies there comes the need to develop new outcome measures to assess the disease, its progression and response to treatment. As there are limitations to the current endpoints accepted for regulatory purposes, a workshop to discuss novel endpoints for clinical trials in CF was held in Anaheim, California in November 2011. The pros and cons of novel outcome measures with potential utility for evaluation of novel treatments in CF were critically evaluated. The highlights of the 2011 workshop and subsequent advances in technologies and techniques that could be used to inform the development of clinical trial endpoints are summarized in this review. Pediatr Pulmonol. © 2014 The Authors. Pediatric Pulmonology published by Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Harm A W M Tiddens
- Department of Pediatric Pulmonology and Allergology, Department of Radiology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Michael Puderbach
- Department for Diagnostic and Interventional Radiology, Hufeland Klinikum, Bad Langensalza, Germany
| | - Jose G Venegas
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Felix Ratjen
- Department of Pediatrics, Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Scott H Donaldson
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Stephanie D Davis
- Department of Pediatrics, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana
| | - Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Scott D Sagel
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Denver, Colorado
| | | | | |
Collapse
|
29
|
Nasal potential difference in cystic fibrosis considering severe CFTR mutations. DISEASE MARKERS 2015; 2015:306825. [PMID: 25667564 PMCID: PMC4312569 DOI: 10.1155/2015/306825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/10/2014] [Accepted: 12/11/2014] [Indexed: 12/23/2022]
Abstract
The gold standard for diagnosing cystic fibrosis (CF) is a sweat chloride value above 60 mEq/L. However, this historical and important tool has limitations; other techniques should be studied, including the nasal potential difference (NPD) test. CFTR gene sequencing can identify CFTR mutations, but this method is time-consuming and too expensive to be used in all CF centers. The present study compared CF patients with two classes I-III CFTR mutations (10 patients) (G1), CF patients with classes IV-VI CFTR mutations (five patients) (G2), and 21 healthy subjects (G3). The CF patients and healthy subjects also underwent the NPD test. A statistical analysis was performed using the Mann-Whitney, Kruskal-Wallis, χ2, and Fisher's exact tests, α = 0.05. No differences were observed between the CF patients and healthy controls for the PDMax, Δamiloride, and Δchloride + free + amiloride markers from the NPD test. For the finger value, a difference between G2 and G3 was described. The Wilschanski index values were different between G1 and G3. In conclusion, our data showed that NPD is useful for CF diagnosis when classes I-III CFTR mutations are screened. However, if classes IV-VI are considered, the NPD test showed an overlap in values with healthy subjects.
Collapse
|
30
|
Keenan K, Avolio J, Rueckes-Nilges C, Tullis E, Gonska T, Naehrlich L. Nasal potential difference: Best or average result for CFTR function as diagnostic criteria for cystic fibrosis? J Cyst Fibros 2014; 14:310-6. [PMID: 25300456 DOI: 10.1016/j.jcf.2014.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The current practice of averaging the nasal potential difference (NPD) results of right and left nostril measurements reduce inter-individual variability but may underestimate individual CFTR function. METHODS Best NPD response to Cl(-)-free and isoproterenol perfusion (=largest ΔPD(0Cl/Iso)) from the right and left nostril was compared to the average result in 13 cystic fibrosis (CF), 78 query-CF patients and 22 healthy controls from 2 cohorts. RESULTS Despite moderate to good correlation (p<0.001) between right and left measured ΔPD(0Cl/Iso), we observed large differences in some individuals. A comparison of average versus best ΔPD(0Cl/Iso) showed only moderate agreement (Giessen κ=0.538; Toronto κ=0.607). Averaging ΔPD(0Cl/Iso) showed a lower composite chloride response compared to best ΔPD(0Cl/Iso) and altered diagnostic NPD interpretation in 30 of 113 (27%) subjects. CONCLUSIONS The current practice of averaging the NPD results of right and left nostril measurements leads to an underestimation of the individual CFTR function and should be reconsidered.
Collapse
Affiliation(s)
- Katherine Keenan
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, University of Toronto and Physiology and Experimental Medicine, Research Institute, the Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Julie Avolio
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, University of Toronto and Physiology and Experimental Medicine, Research Institute, the Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | - Elizabeth Tullis
- Department of Medicine, University of Toronto and Division of Respirology and Keenan Research Centre of Li Ka Shing Knowledge Institute St. Michael's Hospital, Toronto, Ontario, Canada.
| | - Tanja Gonska
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, University of Toronto and Physiology and Experimental Medicine, Research Institute, the Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Giessen, Germany.
| |
Collapse
|
31
|
Bagheri-Hanson A, Nedwed S, Rueckes-Nilges C, Naehrlich L. Intestinal current measurement versus nasal potential difference measurements for diagnosis of cystic fibrosis: a case-control study. BMC Pulm Med 2014; 14:156. [PMID: 25280757 PMCID: PMC4199064 DOI: 10.1186/1471-2466-14-156] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/29/2014] [Indexed: 12/16/2022] Open
Abstract
Background Nasal potential difference (NPD) and intestinal current measurement (ICM) are functional CFTR tests that are used as adjunctive diagnostic tools for cystic fibrosis (CF). Smoking has a systemic negative impact on CFTR function. A diagnostic comparison between NPD and ICM and the impact of smoking on both CFTR tests has not been done. Methods The sweat chloride test, NPD, and ICM were performed in 18 patients with CF (sweat chloride >60 mmol/l), including 6 pancreatic sufficient (PS) patients, and 13 healthy controls, including 8 smokers. The NPD CFTR response to Cl-free and isoproterenol perfusion (Δ0Cl- + Iso) was compared to the ICM CFTR response to forskolin/IBMX, carbachol, and histamine (ΔIsc, forskolin/IBMX+ carbachol+histamine). Results The mean NPD CFTR response and ICM CFTR response between patients with CF and healthy controls was significantly different (p <0.001), but not between patients with CF who were PS and those who were pancreatic insufficient (PI). Smokers have a decreased CFTR response measured by NPD (p = 0.049). For ICM there is a trend towards decreased CFTR response (NS). Three healthy control smokers had NPD responses within the CF-range. In contrast to NPD, there was no overlap of the ICM response between patients with CF and controls. Conclusions ICM is superior to NPD in distinguishing between patients with CF who have a sweat chloride > 60 mmol/l and healthy controls, including smokers. Neither NPD nor ICM differentiated between patients with CF who were PS from those who were PI. Smoking has a negative impact on CFTR function in healthy controls measured by NPD and challenges the diagnostic interpretation of NPD, but not ICM. Electronic supplementary material The online version of this article (doi:10.1186/1471-2466-14-156) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | | | - Lutz Naehrlich
- Department of Pediatrics, Justus-Liebig-University Giessen, Feulgenstrasse 12, 35385 Giessen, Germany.
| |
Collapse
|
32
|
Sengar AS, Agarwal A, Singh MK. Cystic fibrosis: need for mass deployable screening methods. Appl Biochem Biotechnol 2014; 174:1127-36. [PMID: 24880895 DOI: 10.1007/s12010-014-0991-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 05/19/2014] [Indexed: 11/26/2022]
Abstract
Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. CFTR is a member of the adenosine triphosphate (ATP)-binding cassette superfamily of proteins and it functions as a chloride channel. CFTR largely controls the working of epithelial cells of the airways, the gastrointestinal tract, exocrine glands, and genitourinary system. Cystic fibrosis is responsible for severe chronic pulmonary disorders in children. Other maladies in the spectrum of this life-limiting disorder include nasal polyposis, pansinusitis, rectal prolapse, pancreatitis, cholelithiasis, insulin-dependent hyperglycemia, and cirrhosis. This review summarizes the recent state of art in the field of cystic fibrosis diagnostic methods with the help of CF literature published so far and proposes new research domains in the field of cystic fibrosis diagnosis.
Collapse
Affiliation(s)
- Aditya Singh Sengar
- Department of Electronics and Communication, The LNM Institute of Information Technology, Jaipur, 302031, India,
| | | | | |
Collapse
|