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Thakur S, Ankita, Dash S, Verma R, Kaur C, Kumar R, Mazumder A, Singh G. Understanding CFTR Functionality: A Comprehensive Review of Tests and Modulator Therapy in Cystic Fibrosis. Cell Biochem Biophys 2024; 82:15-34. [PMID: 38048024 DOI: 10.1007/s12013-023-01200-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 12/05/2023]
Abstract
Cystic fibrosis is a genetic disorder inherited in an autosomal recessive manner. It is caused by a mutation in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene on chromosome 7, which leads to abnormal regulation of chloride and bicarbonate ions in cells that line organs like the lungs and pancreas. The CFTR protein plays a crucial role in regulating chloride ion flow, and its absence or malfunction causes the production of thick mucus that affects several organs. There are more than 2000 identified mutations that are classified into seven categories based on their dysfunction mechanisms. In this article, we have conducted a thorough examination and consolidation of the diverse array of tests essential for the quantification of CFTR functionality. Furthermore, we have engaged in a comprehensive discourse regarding the recent advancements in CFTR modulator therapy, a pivotal approach utilized for the management of cystic fibrosis, alongside its concomitant relevance in evaluating CFTR functionality.
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Affiliation(s)
- Shorya Thakur
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Panjab, India
| | - Ankita
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Panjab, India
| | - Shubham Dash
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Panjab, India
| | - Rupali Verma
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Panjab, India
| | - Charanjit Kaur
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Panjab, India
| | - Rajesh Kumar
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Panjab, India
| | - Avijit Mazumder
- Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, UP, India
| | - Gurvinder Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Panjab, India.
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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
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3
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Pallenberg ST, Held I, Dopfer C, Minso R, Nietert MM, Hansen G, Tümmler B, Dittrich AM. Differential effects of ELX/TEZ/IVA on organ-specific CFTR function in two patients with the rare CFTR splice mutations c.273+1G>A and c.165-2A>G. Front Pharmacol 2023; 14:1153656. [PMID: 37050906 PMCID: PMC10083416 DOI: 10.3389/fphar.2023.1153656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/15/2023] [Indexed: 03/28/2023] Open
Abstract
Introduction: Evidence for the efficiency of highly-effective triple-CFTR-modulatory therapy with elexacaftor/tezacaftor/ivacaftor (ETI), either demonstrated in clinical trials or by in vitro testing, is lacking for about 10% of people with cystic fibrosis (pwCF) with rare mutations. Comprehensive assessment of CFTR function can provide critical information on the impact of ETI on CFTR function gains for such rare mutations, lending argument of the prescription of ETI. The mutation c.165-2A>G is a rare acceptor splice mutation that has not yet been functionally characterized. We here describe the functional changes induced by ETI in two brothers who are compound heterozygous for the splice mutations c.273+1G>C and c.165-2A>G.Methods: We assessed the effects of ETI on CFTR function by quantitative pilocarpine iontophoresis (QPIT), nasal potential difference measurements (nPD), intestinal current measurements (ICM), β-adrenergic sweat secretion tests (SST) and multiple breath washout (MBW) prior to and 4 months after the initiation of ETI.Results: Functional CFTR analysis prior to ETI showed no CFTR function in the respiratory and intestinal epithelia and in the sweat gland reabsorptive duct in either brother. In contrast, β-adrenergic stimulated, CFTR-mediated sweat secretion was detectable in the CF range. Under ETI, both brothers continued to exhibit high sweat chloride concentration in QPIT, evidence of low residual CFTR function in the respiratory epithelia, but normalized β-adrenergically stimulated production of primary sweat.Discussion: Our results are the first to demonstrate that the c.165-2A>G/c.273+1G>C mutation genotype permits mutant CFTR protein expression. We showed organ-specific differences in the expression of CFTR and consecutive responses to ETI of the c.165-2A>G/c.273+1G>C CFTR mutants that are probably accomplished by non-canonical CFTR mRNA isoforms. This showcase tells us that the individual response of rare CFTR mutations to highly-effective CFTR modulation cannot be predicted from assays in standard cell cultures, but requires the personalized multi-organ assessment by CFTR biomarkers.
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Affiliation(s)
- Sophia T. Pallenberg
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Hannover Medical School, Hannover, Germany
- *Correspondence: Sophia T. Pallenberg,
| | - Inka Held
- Kinderärzte Friesenweg—CF-Zentrum Altona (Ambulanz), Hamburg, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Rebecca Minso
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Hannover Medical School, Hannover, Germany
| | - Manuel M. Nietert
- Department of Medical Bioinformatics, University Medical Center Göttingen, Göttingen, Germany
| | - Gesine Hansen
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Hannover Medical School, Hannover, Germany
| | - Burkhard Tümmler
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Hannover Medical School, Hannover, Germany
| | - Anna-Maria Dittrich
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- German Center for Lung Research, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Hannover Medical School, Hannover, Germany
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4
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Tümmler B. Post-approval studies with the CFTR modulators Elexacaftor-Tezacaftor-Ivacaftor. Front Pharmacol 2023; 14:1158207. [PMID: 37025483 PMCID: PMC10072268 DOI: 10.3389/fphar.2023.1158207] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 03/07/2023] [Indexed: 03/31/2023] Open
Abstract
Triple combination therapy with the CFTR modulators elexacaftor (ELX), tezacaftor (TEZ) and ivacaftor (IVA) has been qualified as a game changer in cystic fibrosis (CF). We provide an overview of the body of literature on ELX/TEZ/IVA published between November 2019 and February 2023 after approval by the regulators. Recombinant ELX/TEZ/IVA-bound Phe508del CFTR exhibits a wild type conformation in vitro, but in patient's tissue a CFTR glyoisoform is synthesized that is distinct from the wild type and Phe508del isoforms. ELX/TEZ/IVA therapy improved the quality of life of people with CF in the real-life setting irrespective of their anthropometry and lung function at baseline. ELX/TEZ/IVA improved sinonasal and abdominal disease, lung function and morphology, airway microbiology and the basic defect of impaired epithelial chloride and bicarbonate transport. Pregnancy rates were increasing in women with CF. Side effects of mental status changes deserve particular attention in the future.
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Affiliation(s)
- Burkhard Tümmler
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Hannover Medical School, Hannover, Germany
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Ringshausen FC, Sauer-Heilborn A, Büttner T, Dittrich AM, Schwerk N, Ius F, Nährlich L, Welte T, Greer M. Lung transplantation for end-stage cystic fibrosis before and after the availability of elexacaftor-tezacaftor-ivacaftor, Germany, 2012-2021. Eur Respir J 2023; 61:13993003.01402-2022. [PMID: 36517178 DOI: 10.1183/13993003.01402-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Felix C Ringshausen
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| | - Annette Sauer-Heilborn
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| | - Tina Büttner
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Anna-Maria Dittrich
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Nicolaus Schwerk
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School (MHH), Hannover, Germany
| | - Fabio Ius
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School (MHH), Hannover, Germany
| | - Lutz Nährlich
- Department of Pediatrics, Justus-Liebig-University Giessen, and Universities of Giessen and Marburg Lung Center, German Center for Lung Research (DZL), Giessen, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
| | - Mark Greer
- Department of Respiratory Medicine, Hannover Medical School (MHH), Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- European Reference Network on Rare and Complex Respiratory Diseases (ERN-LUNG), Frankfurt, Germany
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Zampoli M, Verstraete J, Nguyen-Khoa T, Sermet-Gaudelus I, Zar HJ, Gonska T, Morrow BM. β-adrenergic sweat test in children with inconclusive cystic fibrosis diagnosis: Do we need new reference ranges? Pediatr Pulmonol 2023; 58:187-196. [PMID: 36193559 PMCID: PMC10092537 DOI: 10.1002/ppul.26179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/18/2022] [Accepted: 10/02/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Investigating inconclusive cystic fibrosis (CF) diagnosis in children is difficult without advanced cystic fibrosis transmembrane conductance regulator (CFTR) function tests. This study investigated the utility of beta (β)-adrenergic sweat test to exclude CF in participants with inconclusive diagnosis (CF suspects) in South Africa. METHODS β-adrenergic sweat test and sweat chloride tests (SCT) were performed simultaneously in CF suspects and adult controls (healthy, CFTR heterozygotes and CF). Cholinergic and β-adrenergic induced sweat rate was measured by evaporimetry (transepithelial water loss [TEWL]: g H2 O/m2 /h) following intradermal injections. Next-generation sequencing of CFTR was performed in CF suspects. CF diagnosis was defined by genotype. RESULTS Thirty-seven controls (10 healthy, 14 CF, 13 CFTR heterozygotes) and 32 CF suspects (26 children; 6 adults) were enrolled. Six were excluded from formal analyses due to β-adrenergic sweat test failure. In adults, evaporimetry was superior to SCT for diagnosis of CF with β-adrenergic:cholinergic ratio TEWL ≤ 0.05 achieving 100% sensitivity and specificity. Twenty-two CF suspect children (age range: 3.4-15.6 years) completed β-adrenergic sweat testing of which none had CF confirmed by genotyping: β-adrenergic:cholinergic ratio > 0.05 successfully excluded CF in all but one child who was CFTR heterozygous. Median peak β-adrenergic TEWL and β-adrenergic:cholinergic ratio in CFTR negative and CFTR heterozygous children was significantly lower than adult controls. CONCLUSION β-adrenergic sweat test is more accurate than SCT for excluding CF in children with inconclusive diagnosis. Established reference ranges for β-adrenergic sweat test may not be suitable for children due to lower β-adrenergic sweat secretion compared to adults.
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Affiliation(s)
- Marco Zampoli
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Janine Verstraete
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Thao Nguyen-Khoa
- Laboratories of Biochemistry and Newborn screening, Necker-Enfants Malades Hospital Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Référence Maladies Rares Mucoviscidose et Maladies apparentées. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Paris, France
| | - Isabelle Sermet-Gaudelus
- Centre de Référence Maladies Rares Mucoviscidose et Maladies apparentées. Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France.,Institut National de la Santé et de la Recherche Médicale U1151, Institut Necker Enfants Malades, Paris, France.,European Respiratory Network for Rare Diseases of the Lung
| | - Heather J Zar
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.,South African MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Tanja Gonska
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Toronto, and The Program of Translational Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Brenda M Morrow
- Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Nguyen-Khoa T, Hatton A, Drummond D, Aoust L, Schlatter J, Martin C, Ramel S, Kiefer S, Gachelin E, Stremler N, Cosson L, Gabsi A, Remus N, Benhamida M, Hadchouel A, Fajac I, Munck A, Girodon E, Sermet-Gaudelus I. Reclassifying inconclusive diagnosis for Cystic Fibrosis with new generation sweat test. Eur Respir J 2022; 60:13993003.00209-2022. [PMID: 35777769 DOI: 10.1183/13993003.00209-2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/19/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Thao Nguyen-Khoa
- INSERM U 1151, Institut Necker Enfants Malades, Paris, France.,Université de Paris, Paris, France.,Laboratoires de Biochimie & du Centre Régional de Dépistage Néonatal- Ile-de-France, Hôpital Necker-Enfants Malades, Paris, France.,Centre de Référence Maladies Rares, Mucoviscidose et Maladies Apparentées, Hôpital Necker Enfants Malades, Paris, France
| | - Aurélie Hatton
- INSERM U 1151, Institut Necker Enfants Malades, Paris, France
| | - David Drummond
- Centre de Référence Maladies Rares, Mucoviscidose et Maladies Apparentées, Hôpital Necker Enfants Malades, Paris, France.,Service de Pneumo-Allergologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Laura Aoust
- Centre de Référence Maladies Rares, Mucoviscidose et Maladies Apparentées, Hôpital Necker Enfants Malades, Paris, France.,Service de Pneumo-Allergologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Joël Schlatter
- Pharmacie Clinique, Hôpital Necker-Enfants Malades, Paris, France
| | - Clémence Martin
- Centre de Ressource et de Compétence de la Mucoviscidose (CRCM), Explorations-Fonctionnelles, Hôpital Cochin, Paris, France
| | - Sophie Ramel
- CRCM, Hôpital Hélio Marin, Fondation Ildys, Roscoff, France
| | - Sébastien Kiefer
- CRCM Pédiatrique, Hôpital de Mercy, Centre Hospitalier Régional Universitaire, Nancy, France
| | - Elsa Gachelin
- Service de Pédiatrie, Hôpital Félix-Guyon, Centre Hospitalier Universitaire, Saint Denis, France
| | | | | | - Asma Gabsi
- CRCM, Hôpital André Mignot, Le Chesnay, France
| | - Natascha Remus
- CRCM, Hôpital Inter-Communal de Créteil, Créteil, France
| | - Myriam Benhamida
- CRCM, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Alice Hadchouel
- INSERM U 1151, Institut Necker Enfants Malades, Paris, France.,Université de Paris, Paris, France.,Centre de Référence Maladies Rares, Mucoviscidose et Maladies Apparentées, Hôpital Necker Enfants Malades, Paris, France.,Service de Pneumo-Allergologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
| | - Isabelle Fajac
- Université de Paris, Paris, France.,Centre de Ressource et de Compétence de la Mucoviscidose (CRCM), Explorations-Fonctionnelles, Hôpital Cochin, Paris, France
| | - Anne Munck
- Laboratoires de Biochimie & du Centre Régional de Dépistage Néonatal- Ile-de-France, Hôpital Necker-Enfants Malades, Paris, France
| | - Emmanuelle Girodon
- INSERM U 1151, Institut Necker Enfants Malades, Paris, France.,Université de Paris, Paris, France.,Service de Médecine Génomique des Maladies de Système et d'Organe, Hôpital Cochin, Paris, France
| | - Isabelle Sermet-Gaudelus
- INSERM U 1151, Institut Necker Enfants Malades, Paris, France .,Université de Paris, Paris, France.,Centre de Référence Maladies Rares, Mucoviscidose et Maladies Apparentées, Hôpital Necker Enfants Malades, Paris, France.,Service de Pneumo-Allergologie Pédiatrique, Hôpital Necker-Enfants Malades, Paris, France
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Wine JJ. How the sweat gland reveals levels of CFTR activity. J Cyst Fibros 2022; 21:396-406. [DOI: 10.1016/j.jcf.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/05/2022] [Accepted: 02/05/2022] [Indexed: 10/19/2022]
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