1
|
Loel F, Keith M, Oliver W, Herd K, Hanna K, Matson A. Assessment of dietary intake in adults with cystic fibrosis pre and post commencement of Elexacaftor/Tezacaftor/Ivacaftor. Clin Nutr ESPEN 2025; 67:714-720. [PMID: 40287067 DOI: 10.1016/j.clnesp.2025.04.006] [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: 12/19/2024] [Revised: 04/01/2025] [Accepted: 04/14/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND & AIMS Elexacaftor, Tezacaftor, Ivacaftor has enhanced clinical outcomes, expected lifespan and quality of life for people with cystic fibrosis. Increased body mass index post- Elexacaftor, Tezacaftor, Ivacaftor is well documented, suggesting high-energy, high-fat recommendations may no longer be appropriate. This study aims to identify changes in dietary intake and nutritional parameters post gene modulator therapy Elexacaftor, Tezacaftor, Ivacaftor. METHODS A retrospective cohort study assessed diet and nutritional parameters of adults with cystic fibrosis (n = 40) pre- and post- Elexacaftor, Tezacaftor, Ivacaftor (9 ± 3 months). Dietary intake was analysed (24hr recalls), for total energy intake, macronutrient distribution, sodium, core food groups, and discretionary intakes being compared to Nutrition Guidelines for people with cystic fibrosis, and general population guidelines. RESULTS Total energy intake decreased from 139.3 to 116.6 kJ/kg/day (p = 0.012) and was below the estimated energy requirement for people with cystic fibrosis by 4457.3 kJ (p < 0.001), despite body mass index increasing (p=<0.001). Mean dietary sodium decreased from 3921.1 mg ± 1364.5 mg to 3517.1 mg ± 1251.7 mg (p = 0.028). Intake of protein was above, and total fat intake met the higher end of guidelines for people with cystic fibrosis. Saturated fat intake did not change (p = 0.403) however exceeded general guidelines of <10 % total energy intake in line with general population intake of 15.9 %. A decrease in discretionary foods (5.1-4.5 serves/d, p = 0.038) and increase in vegetable intake (interquartile range 1.0-2.9 to 1.5-3.7 serves/d, p = 0.036) was noted. Serum retinol levels increased from 1.7 μmol/L to 2.0 μmol/L (p = 0.003). CONCLUSION Dietary patterns of people with cystic fibrosis change following Elexacaftor, Tezacaftor, Ivacaftor commencement. While total energy intake decreased and vegetable intake increased, saturated fat and discretionary intake remained high, increasing risk of metabolic disease. An individualised approach is needed with modulator therapy and recognition that changing diet is a modifiable risk factor for chronic disease.
Collapse
Affiliation(s)
- Felicity Loel
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Brisbane, Queensland, Australia; Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia.
| | - Megan Keith
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Wenonah Oliver
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Karen Herd
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Brisbane, Queensland, Australia; Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Katherine Hanna
- School of Exercise and Nutrition Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Angela Matson
- Department of Nutrition and Dietetics, The Prince Charles Hospital, Brisbane, Queensland, Australia; Adult Cystic Fibrosis Centre, The Prince Charles Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
2
|
McNally E, Casey M. Sex disparities in cystic fibrosis in the era of highly effective modulator treatment. BMC Pulm Med 2025; 25:212. [PMID: 40316939 PMCID: PMC12046722 DOI: 10.1186/s12890-025-03621-0] [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: 09/06/2024] [Accepted: 03/24/2025] [Indexed: 05/04/2025] Open
Abstract
Cystic fibrosis (CF) is a genetic disorder characterized by progressive lung disease and extra-pulmonary manifestations with notable sex disparities in disease outcomes. In this review we summarize the underlying mechanisms driving this sex disparity, with a particular focus on the role of sex hormones on CF lung disease pathophysiology. We explore how the introduction of highly effective modulator therapies (HEMT) may impact sex differences in outcomes and assess whether they have the potential to close the sex gap. While treatment with HEMT has led to better outcomes in the CF population as a whole, females with CF continue to experience worse pulmonary morbidity than males. There is a need for continued research in this area, particularly into the influence and therapeutic potential of sex hormones.
Collapse
Affiliation(s)
- Emma McNally
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Michelle Casey
- Cystic Fibrosis Unit, Beaumont Hospital, Dublin , Ireland.
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
3
|
Enaud R, Languepin J, Lagarrigue M, Arrouy A, Macey J, Bui S, Dupuis M, Roditis L, Flumian C, Mas E, Mittaine M. Dietary intake remains unchanged while nutritional status improves in children and adults with cystic fibrosis on Elexacaftor/Tezacaftor/Ivacaftor. Clin Nutr 2025; 50:76-82. [PMID: 40378731 DOI: 10.1016/j.clnu.2025.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 04/19/2025] [Accepted: 04/24/2025] [Indexed: 05/19/2025]
Abstract
BACKGROUND Cystic fibrosis (CF) is a genetic disorder involving multi-organ dysfunction, with nutritional status playing a crucial role in disease progression. Cystic Fibrosis Transmembrane conductance Regulator (CFTR) modulator therapy, particularly the combination Elexacaftor/Tezacaftor/Ivacaftor (ETI), has shown numerous clinical benefits, including significant improvements in nutritional status. However, the factors driving this nutritional improvement, especially the potential role of increased dietary intake, remain underexplored. This study aimed to assess changes in nutritional status and dietary intake in patients with CF (pwCF) treated with ETI. METHODS 62 pwCF (36 children, 26 adults) were analyzed in a prospective, realworld, multicenter study (https://clinicaltrials.gov/study/NCT06072365). Dietary intakes were assessed via 3-day food diaries collected at baseline (M0) and one year after ETI treatment initiation (M12). RESULTS Over the first year of ETI treatment, Body Mass Index (BMI) significantly increased with a median BMI Z-score gain of 0.2 (IQR: 0.7) for children and median BMI gain of 1.0 kg/m2 (IQR: 1.8) for adults. Notably, these gains occurred without a significant increase in median daily caloric intake (2216 kcal (IQR: 750) at M0 vs. 2266 (IQR: 733) kcal at M12). Pancreatic enzyme requirements and calprotectin decreased significantly with ETI (p < 0.001 and p < 0.01, respectively), indicating improved pancreatic function and intestinal inflammation in some patients. Seven patients became overweight after one year of ETI. CONCLUSION ETI therapy enhances nutritional status in pwCF, independently of increased caloric intake. Further research is essential to refine dietary recommendations under ETI treatment, aiming to prevent overweight and obesity while optimizing health outcomes.
Collapse
Affiliation(s)
- R Enaud
- University of Bordeaux, INSERM U1045, Centre de Recherche Cardio-thoracique de Bordeaux, U1045, Bordeaux, France; Bordeaux University Hospital, CRCM pédiatrique, CIC 1401, Bordeaux, France
| | - J Languepin
- Limoges University Hospital, Paediatric Cystic Fibrosis Reference Center (CRCM), Limoges, France
| | - M Lagarrigue
- Centre de ressources et de compétences pour la mucoviscidose, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - A Arrouy
- Centre de ressources et de compétences pour la mucoviscidose, Hôpital des Enfants, CHU de Toulouse, Toulouse, France; Service de Gastroentérologie, Hépatologie, Nutrition et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - J Macey
- Bordeaux University Hospital, Adult CF center, France
| | - S Bui
- Bordeaux University Hospital, CRCM pédiatrique, CIC 1401, Bordeaux, France
| | - M Dupuis
- Adult Cystic Fibrosis Center, Pulmonology, CHU Toulouse, France
| | - L Roditis
- Centre de ressources et de compétences pour la mucoviscidose, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| | - C Flumian
- Centre d'Investigation Clinique 1436, CHU de Toulouse, Toulouse, France
| | - E Mas
- Centre de ressources et de compétences pour la mucoviscidose, Hôpital des Enfants, CHU de Toulouse, Toulouse, France; Service de Gastroentérologie, Hépatologie, Nutrition et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, Toulouse, France; Centre d'Investigation Clinique 1436, CHU de Toulouse, Toulouse, France; Institut de Recherche en Santé Digestive (IRSD), Université de Toulouse, INSERM, INRAE, ENVT, UPS, Toulouse, France.
| | - M Mittaine
- Centre de ressources et de compétences pour la mucoviscidose, Hôpital des Enfants, CHU de Toulouse, Toulouse, France
| |
Collapse
|
4
|
Caley LR, Gillgrass L, Zagoya C, Saumtally H, Duckstein F, H W, Mainz JG, Peckham DG. Longer term follow-up of abdominal symptoms (CFAbd-Score) after initiation of Elexacaftor / Tezacaftor / Ivacaftor in adults with cystic fibrosis. J Cyst Fibros 2025:S1569-1993(25)00010-4. [PMID: 39814671 DOI: 10.1016/j.jcf.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 01/09/2025] [Accepted: 01/11/2025] [Indexed: 01/18/2025]
Abstract
BACKGROUND Whether improvements in gastrointestinal (GI) symptoms observed with Elexacaftor/Tezacaftor/Ivacaftor (ETI) treatment are sustained in the longer-term requires exploration. This study investigated how GI-symptoms change with longer-term ETI use in pancreatic insufficient adults with cystic fibrosis (awCF). METHODS Participants completed up to three abdominal symptom questionnaires, employing the validated CFAbd-Score. Changes in total CFAbd-Score and its five domains, pain, gastroesophageal reflux-disease (GERD), disorders of bowel movement (DBM), disorders of appetite (DA) and quality of life (QOL), were analysed pre-ETI (T0) and at ≤1.5 years (T1) and 2-4 years of ETI-therapy (T2). RESULTS A total of 165 CFAbd-Scores from 68 participants were analysed (median age: 34 years; IQR: 28-39). Total CFAbd-Score significantly (p < 0.05) and clinically meaningfully decreased from 20.4 ± 1.6 pre-ETI (median:40 weeks pre-treatment) to 15.3 ± 1.9 and 16.8 ± 1.6 at T1 (median: 25 weeks of ETI) and T2 (median: 148 weeks of ETI), respectively. The CFAbd-Score´s domains DA and QoL only significantly decreased between T0 and T1, whereas DBM only significantly decreased after 2-4 years of ETI therapy (T2). GERD scores were significantly lower at both T1 and T2. CONCLUSION While GI symptoms in awCF significantly improve within the first 1.5 years of ETI-therapy, they appear to somewhat wane with longer-term use, despite GI-symptom burden still being lower compared to pre-ETI. However, we cannot differentiate whether this results from reduced adherence, a decrease in ETI effects, or long-term changes in diet, gut microbiota or symptom perception. The longer-term impact of ETI and other potential modulator therapies on GI symptoms requires ongoing monitoring.
Collapse
Affiliation(s)
- L R Caley
- Leeds Institute of Medical Research, University of Leeds, School of Medicine, Leeds, United Kingdom
| | - L Gillgrass
- The Leeds Adult CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - C Zagoya
- Brandenburg Medical School (MHB), University Hospital, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - H Saumtally
- The Leeds Adult CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - F Duckstein
- Brandenburg Medical School (MHB), University Hospital, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - White H
- Leeds Beckett University, Nutrition and Dietetics, Leeds, United Kingdom
| | - J G Mainz
- Brandenburg Medical School (MHB), University Hospital, Klinikum Westbrandenburg, Brandenburg an der Havel, Germany
| | - D G Peckham
- Leeds Institute of Medical Research, University of Leeds, School of Medicine, Leeds, United Kingdom; The Leeds Adult CF Unit, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.
| |
Collapse
|
5
|
Petit G, Coudert A, Hermann R, Truy E, Bonjour M, Reix P, Ayari S. Effects of Elexacaftor-Tezacaftor-Ivacaftor on Nasal and Sinus Symptoms in Children With Cystic Fibrosis. Pediatr Pulmonol 2025; 60:e27493. [PMID: 39868969 PMCID: PMC11771559 DOI: 10.1002/ppul.27493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 12/13/2024] [Accepted: 01/11/2025] [Indexed: 01/30/2025]
Abstract
BACKGROUND New CFTR Modulator triple therapy Elexacaftor-Ivacaftor-Tezacaftor (ETI) prove efficacy in pulmonary outcomes. However, its impact on nasal sinus symptoms in children has not been specifically studied. The aim of this study is to evaluate the impact of this therapy on nasal sinus symptomatology in children aged 6-12 years. METHODS A prospective, single-center cohort study was conducted over a 12-month follow-up period in children aged 6-12 years at the initiation of ETI therapy. The primary outcome was evolution of the SN-5 score, a validated pediatric questionnaire measuring quality of life related to nasal sinus symptoms. A decrease of 0.5 points is considered clinically significant. Secondary outcomes included changes in clinical examination findings (obstructive turbinate hypertrophy, polyps, presence of pus in the middle meatus, and externalized mucocele), quality of life measured by the Visual Analog Scale (VAS), and number of antibiotic courses during the study period. RESULTS Twenty-six patients were included between March and September 2023, with no lost to follow-up. The initial mean SN-5 score was 2.88 (95% CI {1.91; 3.85}). After 1 year, the mean SN-5 score was significantly lower (1.41, 95% CI {1.00; 1.88}, Delta = 1.47, p < 0.001). The VAS related to symptoms also improved (Delta = 1.7, p < 0.001), and the number of antibiotic courses decreased (25 vs. 69, p < 0.001). A trend toward improvement in clinical examination parameters was observed. CONCLUSION ETI therapy appears to significantly improve nasal sinus symptoms in children aged 6-12 years, as evidenced by improved quality-of-life scales and reduced antibiotic use.
Collapse
Affiliation(s)
- Guillaume Petit
- Hôpital Femme Mère EnfantHospices Civils de Lyon59 Boulevard PinelLyonFrance
| | - Aurélie Coudert
- Hôpital Femme Mère EnfantHospices Civils de Lyon59 Boulevard PinelLyonFrance
| | - Ruben Hermann
- Hôpital Femme Mère EnfantHospices Civils de Lyon59 Boulevard PinelLyonFrance
| | - Eric Truy
- Hôpital Femme Mère EnfantHospices Civils de Lyon59 Boulevard PinelLyonFrance
| | - Maxime Bonjour
- Hôpital Femme Mère EnfantHospices Civils de Lyon59 Boulevard PinelLyonFrance
| | - Philippe Reix
- Hôpital Femme Mère EnfantHospices Civils de Lyon59 Boulevard PinelLyonFrance
| | - Sonia Ayari
- Hôpital Femme Mère EnfantHospices Civils de Lyon59 Boulevard PinelLyonFrance
| |
Collapse
|
6
|
Davies JC, Polineni D, Boyd AC, Donaldson S, Gill DR, Griesenbach U, Hyde SC, Jain R, McLachlan G, Mall MA, Alton EWFW. Lentiviral Gene Therapy for Cystic Fibrosis: A Promising Approach and First-in-Human Trial. Am J Respir Crit Care Med 2024; 210:1398-1408. [PMID: 39236265 PMCID: PMC11716034 DOI: 10.1164/rccm.202402-0389ci] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 09/04/2024] [Indexed: 09/07/2024] Open
Abstract
Cystic fibrosis (CF) is a genetic disease caused by mutations in the CFTR (cystic fibrosis transmembrane conductance regulator) gene. Although CF is a multiorgan disease, the leading causes of morbidity and mortality are related to progressive lung disease. Current understanding of the effects of the broad spectrum of CFTR mutations on CFTR function has allowed for the development of CFTR modulator therapies. Despite the remarkable impact that these therapies have had, there remains a significant proportion of people with CF (estimated at 10-15% of the global CF population) who are genetically ineligible for, or intolerant of, current CFTR-targeting therapies and whose therapeutic needs remain unmet. Inhaled genetic therapies offer the prospect of addressing the unmet pulmonary treatment need in people with CF, with several approaches, including gene addition therapy (the focus of this review), RNA-based therapies, antisense oligonucleotides, and gene editing, being explored. Various nonviral and viral vectors have been investigated for CF gene addition therapy for mutation-agnostic restoration of CFTR function in the lungs. Lentiviral vectors offer the prospect of highly efficient and long-lasting gene expression, and the potential to be safely and, in contrast to other commonly used viral vectors, effectively redosed. A third-generation lentiviral vector pseudotyped with Sendai virus F and HN envelope proteins (rSIV.F/HN) has been developed for the treatment of CF. Promising preclinical results support the progression of this vector carrying a full-length CFTR transgene (BI 3720931) into a first-in-human clinical trial expected to begin in 2024.
Collapse
Affiliation(s)
- Jane C Davies
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- U.K. Respiratory Gene Therapy Consortium, Oxford, United Kingdom
| | - Deepika Polineni
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - A Christopher Boyd
- U.K. Respiratory Gene Therapy Consortium, Oxford, United Kingdom
- Centre for Genomic and Experimental Medicine, Institute of Genetics and Cancer, and
| | - Scott Donaldson
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Deborah R Gill
- U.K. Respiratory Gene Therapy Consortium, Oxford, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Uta Griesenbach
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- U.K. Respiratory Gene Therapy Consortium, Oxford, United Kingdom
| | - Stephen C Hyde
- U.K. Respiratory Gene Therapy Consortium, Oxford, United Kingdom
- Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Raksha Jain
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gerry McLachlan
- U.K. Respiratory Gene Therapy Consortium, Oxford, United Kingdom
- The Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marcus A Mall
- Department of Pediatric Respiratory Medicine, Immunology, and Critical Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Center for Lung Research (DZL) associated partner site, Berlin, Germany; and
- German Center for Child and Adolescent Health (DZKJ) partner site, Berlin, Germany
| | - Eric W F W Alton
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- U.K. Respiratory Gene Therapy Consortium, Oxford, United Kingdom
| |
Collapse
|
7
|
Swetland DV, Savant AP. Cystic fibrosis year in review 2023. Pediatr Pulmonol 2024; 59:3106-3116. [PMID: 39056532 PMCID: PMC11601032 DOI: 10.1002/ppul.27190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/23/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
This past year, there were many important advances for patients with cystic fibrosis (CF). Of the many publications related to CF in 2023, there was further evaluation of highly effective modulator therapy, new assessments and guidelines for clinical manifestations and therapies for CF, advances in newborn screening and diagnosis, and evaluation of outcomes for people with CF transmembrane conductance regulator-related metabolic syndrome/CF screen positive, inconclusive diagnosis. The aim of this review article is not to provide a full assessment of the wide range of articles published in 2023, but to provide a brief review of publication that may lead to changes in clinical care.
Collapse
Affiliation(s)
- David V. Swetland
- Department of PediatricsChildren's Hospital of New OrleansNew OrleansLouisianaUSA
- Department of PediatricsTulane UniversityNew OrleansLouisianaUSA
| | - Adrienne P. Savant
- Department of PediatricsChildren's Hospital of New OrleansNew OrleansLouisianaUSA
- Department of PediatricsTulane UniversityNew OrleansLouisianaUSA
| |
Collapse
|
8
|
Duus LS, Dons M, Thudium RF, Nielsen SD, Olsen MF, Qvist T, Lassen MCH, Skaarup KG, Johansen ND, Bluhme TMS, Katzenstein TL, Pressler T, Faurholt-Jepsen D, Biering-Sørensen T. Cardiac Structure and Function in People with Cystic Fibrosis. J Cyst Fibros 2024; 23:1138-1145. [PMID: 39343639 DOI: 10.1016/j.jcf.2024.09.012] [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: 01/19/2024] [Revised: 09/15/2024] [Accepted: 09/16/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND The extent of cardiac involvement in cystic fibrosis (CF) remains to be determined. The remarkable therapeutic advancements with new highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator treatment and subsequent increase in life expectancy substantiates further research. We aimed to explore the prevalence of cardiac alterations in people with CF (pwCF) compared to matched controls and investigate potential cardiovascular risk factors. METHODS In this cross-sectional study, 104 pwCF underwent clinical and echocardiographic assessment. All participants were matched 1:1 with controls from the general population. RESULTS Of 104 pwCF, 44 % were female, mean age was 34 years, and 93 % received CFTR modulator treatment. The prevalence of abnormal cardiac function in pwCF was 44 %, more than double the prevalence in controls. PwCF were found to have smaller left ventricular (LV) dimensions, worse LV diastolic function, and reduced right ventricle (RV) as well as LV systolic function. After multivariable adjustment, LV diastolic function as well as LV and RV systolic function remained poorer in pwCF as compared to controls. Male sex and decreasing FEV1/FVC ratio remained independently associated with abnormal cardiac function in pwCF (male sex: OR 3.94 (1.56; 9.95), p = 0.004 and FEV1/FVC ratio: OR 2.05 per 0.1 unit decrease (1.21; 3.52), p = 0.008, respectively). CONCLUSIONS Both left- and right-sided cardiac alterations were found in pwCF. After adjustments for risk factors, both RV and LV systolic measures remained altered in pwCF, compared to controls. Male sex and decreasing pulmonary function evaluated by FEV1/FVC-ratio were associated with abnormal cardiac function in pwCF.
Collapse
Affiliation(s)
- Lisa Steen Duus
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte. Hospital, Gentofte Hospitalsvej 8, 2900 Hellerup, University of Copenhagen, Denmark
| | - Maria Dons
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte. Hospital, Gentofte Hospitalsvej 8, 2900 Hellerup, University of Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Rebekka Faber Thudium
- Cystic Fibrosis Centre, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Viro-immunology Research Unit, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen, University of Copenhagen, Denmark; Cystic Fibrosis Centre, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mette F Olsen
- Cystic Fibrosis Centre, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Nutrition, Exercise and Sports, Faculty of Science, Nørre Allé 51, 2200 Copenhagen, University of Copenhagen, Denmark
| | - Tavs Qvist
- Cystic Fibrosis Centre, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mats C Højbjerg Lassen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte. Hospital, Gentofte Hospitalsvej 8, 2900 Hellerup, University of Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte. Hospital, Gentofte Hospitalsvej 8, 2900 Hellerup, University of Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte. Hospital, Gentofte Hospitalsvej 8, 2900 Hellerup, University of Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Thomas Mørk-Strøm Bluhme
- Cystic Fibrosis Centre, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Terese L Katzenstein
- Cystic Fibrosis Centre, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tacjana Pressler
- Cystic Fibrosis Centre, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200 Copenhagen, University of Copenhagen, Denmark; Cystic Fibrosis Centre, Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev & Gentofte. Hospital, Gentofte Hospitalsvej 8, 2900 Hellerup, University of Copenhagen, Denmark; Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Blegdamsvej 3B, 2200 Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| |
Collapse
|
9
|
Jarosz-Griffiths H, Caley L, Lara-Reyna S, Savic S, Clifton I, McDermott M, Peckham D. Heightened mitochondrial respiration in CF cells is normalised by triple CFTR modulator therapy through mechanisms involving calcium. Heliyon 2024; 10:e39244. [PMID: 39498005 PMCID: PMC11532250 DOI: 10.1016/j.heliyon.2024.e39244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 09/18/2024] [Accepted: 10/10/2024] [Indexed: 11/07/2024] Open
Abstract
Background Cystic fibrosis (CF) is associated with increased resting energy expenditure. However, the introduction of elexacaftor/tezacaftor/ivacaftor (ETI) has resulted in a paradigm shift in nutritional status for many people with CF, with increase body mass index and reduction in the need for nutritional support. While these changes are likely to reflect improved clinical status and an associated downregulation of energy expenditure, they may also reflect drug-induced alterations in metabolic perturbations within CF cells. We hypothesise that some of these changes relate to normalisation of mitochondrial respiration in CF. Methods Using wild-type (WT) and F508del/F508del CFTR human bronchial epithelial cell lines (HBE cell lines) and baby hamster kidney (BHK) cells we examined the impact of ETI on cellular metabolism. We monitored mitochondrial respiration, using Seahorse extracellular flux assays and monitored mitochondrial reactive oxygen species (mROS) and intracellular calcium levels by flow cytometry. Results Increased mitochondrial respiration was found in HBE cell lines and BHK cells expressing CFTR F508del/F508del when assessing basal, maximal, spare respiratory capacities and ATP production, as well as increased mitochondrial ROS generated via forward electron transport. ETI significantly decreased basal, maximal, spare respiratory capacity and ATP production to WT levels or below. Calcium blocker, BAPTA-AM normalised mitochondrial respiration, suggesting a calcium-mediated mechanism. ETI decreased intracellular calcium levels in CF cells to the same extent as BAPTA-AM, highlighting the importance of calcium and chloride in mitochondrial respiration in CF. Conclusions CF cell lines exhibit increased mitochondrial respiration, which can be downregulated by ETI therapy through mechanisms involving calcium.
Collapse
Affiliation(s)
| | - L.R. Caley
- Leeds Institute of Medical Research, University of Leeds, United Kingdom
| | - S. Lara-Reyna
- Institute of Microbiology and Infection, University of Birmingham, United Kingdom
| | - S. Savic
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
- Department of Clinical Immunology and Allergy, St James's University Hospital, United Kingdom
| | - I.J. Clifton
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - M.F. McDermott
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, United Kingdom
| | - D.G. Peckham
- Leeds Institute of Medical Research, University of Leeds, United Kingdom
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| |
Collapse
|
10
|
Bassi M, Strati MF, Spiandorello G, Scalas M, Cresta F, Calevo MG, d’Annunzio G, Castellani C, Minuto N, Maghnie M, Casciaro R. One-Year Effect of Elexacaftor/Tezacaftor/Ivacaftor Therapy on HbA1c Levels and Insulin Requirement in Patients with Insulin-Dependent Cystic Fibrosis-Related Diabetes: A Retrospective Observational Study. Life (Basel) 2024; 14:1309. [PMID: 39459609 PMCID: PMC11509452 DOI: 10.3390/life14101309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 10/14/2024] [Accepted: 10/15/2024] [Indexed: 10/28/2024] Open
Abstract
INTRODUCTION The impact of ETI therapy on pulmonary function and nutritional status has been widely studied; the literature on the possible outcomes on glycemic control and insulin requirement in patients affected by CFRD is controversial. AIM The main objective of our study was to evaluate HbA1c levels in patients with cystic fibrosis-related diabetes (CFRD) after one year of therapy with elexacaftor/tezacaftor/ivacaftor (ETI). The secondary objective was to study the changes in the total daily insulin dose (TDD), pulmonary function and metabolism in this population. MATERIALS AND METHODS A retrospective single-center observational study was conducted at the Regional Cystic Fibrosis Centre and Diabetology Centre of IRCCS Istituto Giannina Gaslini. The observation period was divided into four different time points: initiation (T0), 3 months (T3mo), 6 months (T6mo) and 12 months (T12mo) of ETI therapy. Demographic and clinical data were collected. The results were then stratified by genotype (homozygous or heterozygous F508del). RESULTS Twenty-eight patients with CFRD undergoing insulin therapy were included. TDD (IU) significantly decreased at T3mo and T6mo, but not at T12mo, whereas HbA1c decreased significantly at all three times. The number of hospitalizations and pulmonary exacerbations decreased significantly. CONCLUSION We demonstrated both improvement in glycemic control (by means of HbA1c) and insulin requirement in insulin-dependent CFRD patients after one year of ETI treatment.
Collapse
Affiliation(s)
- Marta Bassi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; (M.B.); (M.F.S.); (G.S.); (M.S.); (M.M.)
- Epidemiology and Biostatistics, Scientific Direction, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Marina Francesca Strati
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; (M.B.); (M.F.S.); (G.S.); (M.S.); (M.M.)
| | - Gaia Spiandorello
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; (M.B.); (M.F.S.); (G.S.); (M.S.); (M.M.)
| | - Marta Scalas
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; (M.B.); (M.F.S.); (G.S.); (M.S.); (M.M.)
| | - Federico Cresta
- Regional Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (F.C.); (C.C.); (R.C.)
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics, Scientific Direction, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | | | - Carlo Castellani
- Regional Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (F.C.); (C.C.); (R.C.)
| | - Nicola Minuto
- Pediatric Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Mohamad Maghnie
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16147 Genoa, Italy; (M.B.); (M.F.S.); (G.S.); (M.S.); (M.M.)
- Pediatric Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Rosaria Casciaro
- Regional Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy; (F.C.); (C.C.); (R.C.)
| |
Collapse
|
11
|
Hevilla F, Porras N, Girón MV, García-Olivares M, Padial M, Sánchez-Torralvo FJ, Olveira C, Olveira G. Impact of Elexacaftor-Tezacaftor-Ivacaftor Therapy on Body Composition, Dietary Intake, Biomarkers, and Quality of Life in People with Cystic Fibrosis: A Prospective Observational Study. Nutrients 2024; 16:3293. [PMID: 39408260 PMCID: PMC11478662 DOI: 10.3390/nu16193293] [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: 08/28/2024] [Revised: 09/25/2024] [Accepted: 09/27/2024] [Indexed: 10/20/2024] Open
Abstract
Background: The combination of elexacaftor-tezacaftor-ivacaftor modulators (ETI) has improved clinical outcomes for people with cystic fibrosis (pwCF). Objectives: This study aimed to evaluate changes in nutritional and morphofunctional assessments, as well as anxiety, depression symptoms, and quality of life, in pwCF after starting ETI therapy. Methods: This was a prospective observational study. We measured body composition (fat mass [FM] and fat-free mass [FFM]) using bioelectrical impedance analysis (BIA) and skinfold thickness measurements (SMs). We also assessed hand grip strength, dietary intake via surveys, blood and stool biomarkers, symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale [HADS], and quality of life through the Cystic Fibrosis Questionnaire-Revised (CFQR). Results: A total of 31 pwCF were evaluated. Significant improvements were observed in respiratory function and quality of life, alongside an average weight increase of approximately 5 kg (60% FM and 40% FFM). The prevalence of malnutrition, based on BMI and the FFM index, decreased significantly, while the rate of overweight/obesity increased. Biomarker analysis indicated better nutrient absorption and reduced intestinal inflammation, as evidenced by significant changes in faecal calprotectin, nitrogen, and fat levels, as well as blood lipid and vitamin profiles. Conclusions: Despite a reduction in caloric intake, an increase in weight was observed one year after initiating ETI. This increase was attributed to gains in both FM and FFM, suggesting improved metabolic efficiency and nutrient absorption. Both SM and BIA were found to be useful assessment tools. These findings indicate the need to modify the nutritional approach, focusing on the quality rather than the quantity of intake, and aiming for an appropriate body composition (FFM) rather than solely focusing on BMI.
Collapse
Affiliation(s)
- Francisco Hevilla
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
| | - Nuria Porras
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
| | - María Victoria Girón
- Unidad de Gestión Clínica de Neumología, Hospital Regional Universitario de Málaga, 29010 Malaga, Spain
| | - María García-Olivares
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
| | - Marina Padial
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
| | - Francisco José Sánchez-Torralvo
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
| | - Casilda Olveira
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Neumología, Hospital Regional Universitario de Málaga, 29010 Malaga, Spain
| | - Gabriel Olveira
- Departamento de Medicina y Dermatología, Facultad de Medicina, University of Malaga, 29010 Malaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), Plataforma Bionand, 29010 Malaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29007 Malaga, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
12
|
Bass R, Alvarez JA. Nutritional status in the era of highly effective CFTR modulators. Pediatr Pulmonol 2024; 59 Suppl 1:S6-S16. [PMID: 39105341 DOI: 10.1002/ppul.26806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 08/07/2024]
Abstract
Advances in cystic fibrosis (CF) diagnostics and therapeutics have led to improved health and longevity, including increased body weight and decreased malnutrition in people with CF. Highly effective CFTR modulator therapies (HEMT) are associated with increased weight through a variety of mechanisms, accelerating trends of overweight and obesity in the CF population. Higher body mass index (BMI) is associated with improved pulmonary function in CF, yet the incremental improvement at overweight and obese BMIs is not clear. Improvements in pulmonary health with increasing BMI are largely driven by increases in fat-free mass (FFM), and impact of HEMT on FFM is uncertain. While trends toward higher weight and BMI are generally seen as favorable in CF, the increased prevalence of overweight and obesity has raised concern for potential risk of traditional age- and obesity-related comorbidities. Such comorbidities, including impaired glucose tolerance, hypertension, cardiac disease, hyperlipidemia, fatty liver, colon cancer, and obstructive sleep apnea, may occur on top of pre-existing CF-related comorbidities. CF nutrition recommendations are evolving in the post-modulator era to more individualized approaches, in contrast to prior blanket high-fat, high-calorie prescriptions for all. Ultimately, it will be essential to redefine goals for optimal weight and nutritional status to allow for holistic health and aging in people with CF.
Collapse
Affiliation(s)
- Rosara Bass
- Division of Pediatric Gastroenterology Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica A Alvarez
- Division of Endocrinology, Lipids, and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
13
|
Marsh R, Santos CD, Yule A, Dellschaft NS, Hoad CL, Ng C, Major G, Smyth AR, Rivett D, van der Gast C. Impact of extended Elexacaftor/Tezacaftor/Ivacaftor therapy on the gut microbiome in cystic fibrosis. J Cyst Fibros 2024; 23:967-976. [PMID: 38749891 DOI: 10.1016/j.jcf.2024.05.002] [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: 01/22/2024] [Revised: 04/29/2024] [Accepted: 05/04/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND There is a paucity of knowledge on the longer-term effects of CF transmembrane conductance regulator (CFTR) modulator therapies upon the gut microbiome and associated outcomes. In a pilot study, we investigated longitudinal Elexacaftor/Tezacaftor/Ivacaftor (ETI) therapy on the gut microbiota, metabolomic functioning, and clinical outcomes in people with CF (pwCF). STUDY DESIGN Faecal samples from 20 pwCF were acquired before and then following 3, 6, and 17+ months of ETI therapy. Samples were subjected to microbiota sequencing and targeted metabolomics to profile and quantify short-chain fatty acid composition. Ten healthy matched controls were included for comparison. Clinical data, including markers of intestinal function were integrated to investigate relationships. RESULTS Extended ETI therapy increased core microbiota diversity and composition, which translated to gradual shifts in whole microbiota composition towards that observed in healthy controls. Despite becoming more similar over time, CF microbiota and functional metabolite compositions remained significantly different to healthy controls. Antibiotic treatment for pulmonary infection significantly explained a relatively large degree of variation within the whole microbiota and rarer satellite taxa. Clinical outcomes were not significantly different following ETI. CONCLUSIONS Whilst differences persisted, a positive trajectory towards the microbiota observed in healthy controls was found. We posit that progression was predominately impeded by pulmonary antibiotics administration. We recommend future studies use integrated omics approaches within a combination of long-term longitudinal patient studies and model experimental systems. This will deepen our understanding of the impacts of CFTR modulator therapy and respiratory antibiotic interventions upon the gut microbiome and gastrointestinal pathophysiology in CF.
Collapse
Affiliation(s)
- Ryan Marsh
- Department of Applied Sciences, Northumbria University, Newcastle, UK
| | | | - Alexander Yule
- School of Medicine, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, UK
| | | | - Caroline L Hoad
- Sir Peter Mansfield Imaging Centre, University of Nottingham, UK
| | - Christabella Ng
- School of Medicine, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, UK
| | - Giles Major
- School of Medicine, University of Nottingham, UK; Nestlé Institute of Health Sciences, Société des Produits Nestlé, Lausanne, Switzerland
| | - Alan R Smyth
- School of Medicine, University of Nottingham, UK; NIHR Nottingham Biomedical Research Centre, UK; School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, UK
| | - Damian Rivett
- Department of Natural Sciences, Manchester Metropolitan University, UK
| | - Christopher van der Gast
- Department of Applied Sciences, Northumbria University, Newcastle, UK; Department of Respiratory Medicine, Northern Care Alliance NHS Foundation Trust, Salford, UK.
| |
Collapse
|
14
|
Yalçın N, Akman ED, Karcıoğlu O, Allegaert K, Demirkan K, Damadoğlu E, Kalyoncu AF. Effect of Modulator Therapies on Nutritional Risk Index in Adults with Cystic Fibrosis: A Prospective Cohort Study. Nutrients 2024; 16:1811. [PMID: 38931166 PMCID: PMC11206541 DOI: 10.3390/nu16121811] [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: 04/29/2024] [Revised: 05/25/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Modulator therapies improve weight and body mass index (BMI) in cystic fibrosis (CF) patients. We aimed to compare the nutritional risk index (NRI) in adult CF patients receiving modulator (MT) or only non-modulator (conventional) therapies (non-MT). Methods: A single-center prospective cohort study was conducted between June and December 2023. The NRI based on weight gain and albumin was calculated at beginning and end of a 12-week period in both groups. This design was pragmatic, since it was based on individual patient access to MT for 12 weeks. Results: In total, 107 patients were included [mean (SD) age: 23.85 (4.98) years, 54.7% male, 46.7% MT]. In the MT group, mean (SD) weight (kg) and albumin (g/dL) increased significantly [changes: +3.09 (2.74) and +0.17 (0.37); p < 0.001]. In the non-MT group, weight and albumin decreased significantly [changes: -0.99 (1.73) and -0.12 (0.30); p < 0.001]. Compared to the MT group, baseline mean (SD) NRI in the non-MT group was significantly higher [100.65 (11.80) vs. 104.10 (10.10); p = 0.044]. At the end of the 12 weeks, mean (SD) NRI in the MT group was higher than in the non-MT group [104.18 (10.40) vs. 102.58 (12.39); p = 0.145]. In the MT group, the NRI category improved in 22 (44%), and worsened in 3 (6%) patients (p < 0.001). In the non-MT group, the NRI category improved in 2 (3.5%), and worsened in 10 (17.5%) patients (p < 0.001). Conclusions: This is the first study reporting on a positive effect of MT on NRIs, based on weight gain and albumin. Personalized nutrition and routine follow-up of adults with CF based on NRI is recommended prior to MT initiation.
Collapse
Affiliation(s)
- Nadir Yalçın
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06800 Ankara, Türkiye; (N.Y.); (E.D.A.); (K.D.)
| | - Esen Deniz Akman
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06800 Ankara, Türkiye; (N.Y.); (E.D.A.); (K.D.)
| | - Oğuz Karcıoğlu
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, 06800 Ankara, Türkiye; (O.K.); (E.D.); (A.F.K.)
| | - Karel Allegaert
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
- Child and Youth Institute, KU Leuven, 3000 Leuven, Belgium
- Department of Clinical Pharmacy, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, 06800 Ankara, Türkiye; (N.Y.); (E.D.A.); (K.D.)
| | - Ebru Damadoğlu
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, 06800 Ankara, Türkiye; (O.K.); (E.D.); (A.F.K.)
| | - Ali Fuat Kalyoncu
- Department of Pulmonary Medicine, Faculty of Medicine, Hacettepe University, 06800 Ankara, Türkiye; (O.K.); (E.D.); (A.F.K.)
| |
Collapse
|
15
|
Westhölter D, Haubold J, Welsner M, Salhöfer L, Wienker J, Sutharsan S, Straßburg S, Taube C, Umutlu L, Schaarschmidt BM, Koitka S, Zensen S, Forsting M, Nensa F, Hosch R, Opitz M. Elexacaftor/tezacaftor/ivacaftor influences body composition in adults with cystic fibrosis: a fully automated CT-based analysis. Sci Rep 2024; 14:9465. [PMID: 38658613 PMCID: PMC11043331 DOI: 10.1038/s41598-024-59622-2] [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: 01/30/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
A poor nutritional status is associated with worse pulmonary function and survival in people with cystic fibrosis (pwCF). CF transmembrane conductance regulator modulators can improve pulmonary function and body weight, but more data is needed to evaluate its effects on body composition. In this retrospective study, a pre-trained deep-learning network was used to perform a fully automated body composition analysis on chest CTs from 66 adult pwCF before and after receiving elexacaftor/tezacaftor/ivacaftor (ETI) therapy. Muscle and adipose tissues were quantified and divided by bone volume to obtain body size-adjusted ratios. After receiving ETI therapy, marked increases were observed in all adipose tissue ratios among pwCF, including the total adipose tissue ratio (+ 46.21%, p < 0.001). In contrast, only small, but statistically significant increases of the muscle ratio were measured in the overall study population (+ 1.63%, p = 0.008). Study participants who were initially categorized as underweight experienced more pronounced effects on total adipose tissue ratio (p = 0.002), while gains in muscle ratio were equally distributed across BMI categories (p = 0.832). Our findings suggest that ETI therapy primarily affects adipose tissues, not muscle tissue, in adults with CF. These effects are primarily observed among pwCF who were initially underweight. Our findings may have implications for the future nutritional management of pwCF.
Collapse
Affiliation(s)
- Dirk Westhölter
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Johannes Haubold
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Matthias Welsner
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Luca Salhöfer
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Johannes Wienker
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Svenja Straßburg
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
- Adult Cystic Fibrosis Center, Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen-Ruhrlandklinik, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Benedikt M Schaarschmidt
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sven Koitka
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Felix Nensa
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - René Hosch
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Marcel Opitz
- Institute for Artificial Intelligence in Medicine, University Hospital Essen, Essen, Germany.
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
| |
Collapse
|
16
|
Lieu N, Prentice BJ, Field P, Fitzgerald DA. Trials and tribulations of highly effective modulator therapies in cystic fibrosis. Paediatr Respir Rev 2023; 48:10-19. [PMID: 37914566 DOI: 10.1016/j.prrv.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 11/03/2023]
Abstract
Highly effective modulator therapies (HEMTs) have revolutionised the management approach of most patients living with cystic fibrosis (CF) who have access to these therapies. Clinical trials have reported significant improvements across multiorgan systems, with patients surviving longer. However, there are accumulating case reports and observational data describing various adverse events following initiation of HEMTs including drug-to-drug interactions, drug induced liver injury, Stevens-Johnson syndrome, and neurocognitive symptoms including psychosis and depression, which have required discontinuation of therapy. Current clinical trials are assessing efficacy in younger patients with CF, yet long-term studies are also required to better understand the safety profile in the real-world setting across all ages and the impact of HEMT dose alteration or discontinuation.
Collapse
Affiliation(s)
- Nathan Lieu
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia, 2145; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia.
| | - Bernadette J Prentice
- Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia, 2031; Discipline of Paediatrics and Child Health, UNSW, Sydney, New South Wales, Australia
| | - Penelope Field
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia, 2145; Department of Respiratory Medicine, Sydney Children's Hospital, Randwick, Sydney, New South Wales, Australia, 2031; Discipline of Paediatrics and Child Health, UNSW, Sydney, New South Wales, Australia
| | - Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia, 2145; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
17
|
Szentpetery SE. Evolving nutritional needs, obesity, and overweight status in cystic fibrosis. Curr Opin Pulm Med 2023; 29:610-614. [PMID: 37694679 DOI: 10.1097/mcp.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
PURPOSE OF REVIEW The nutritional landscape in cystic fibrosis has shifted dramatically in the era of CFTR modulator therapy. In this review, we will critically examine the literature on overweight and obesity in CF, current nutritional care unknowns and opportunities for further investigation or adaptation in clinical care. RECENT FINDINGS Results of clinical trial and real-world data reflect marked improvement in nutritional status and quality of life. Clinical outcomes including CF related diabetes and CF related liver disease appear positively impacted. Secondary impacts on cardiometabolic disease have been noted, especially in association with excessive weight gain. SUMMARY The prior approaches to optimizing nutrition in cystic fibrosis with caloric excess can likely be safely retired for many. As modulator access expands across the lifespan, a longitudinal focus on health maintenance should be considered.
Collapse
|