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Evans IA, Sun X, Liang B, Vegter AR, Guo L, Lynch TJ, Zhang Y, Zhang Y, Yi Y, Yang Y, Feng Z, Park SY, Shonka A, McCumber H, Qi L, Wu P, Liu G, Lacina A, Wang K, Gibson-Corley KN, Meyerholz DK, Limoli DH, Rosen BH, Yan Z, Bartels DJ, Engelhardt JF. In utero and postnatal ivacaftor/lumacaftor therapy rescues multiorgan disease in CFTR-F508del ferrets. JCI Insight 2024; 9:e157229. [PMID: 38646935 DOI: 10.1172/jci.insight.157229] [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: 12/20/2023] [Accepted: 03/13/2024] [Indexed: 04/25/2024] Open
Abstract
Cystic fibrosis (CF) is caused by mutations in the CF transmembrane conductance regulator (CFTR) gene, with F508del being the most prevalent mutation. The combination of CFTR modulators (potentiator and correctors) has provided benefit to CF patients carrying the F508del mutation; however, the safety and effectiveness of in utero combination modulator therapy remains unclear. We created a F508del ferret model to test whether ivacaftor/lumacaftor (VX-770/VX-809) therapy can rescue in utero and postnatal pathologies associated with CF. Using primary intestinal organoids and air-liquid interface cultures of airway epithelia, we demonstrate that the F508del mutation in ferret CFTR results in a severe folding and trafficking defect, which can be partially restored by treatment with CFTR modulators. In utero treatment of pregnant jills with ivacaftor/lumacaftor prevented meconium ileus at birth in F508del kits and sustained postnatal treatment of CF offspring improved survival and partially protected from pancreatic insufficiency. Withdrawal of ivacaftor/lumacaftor treatment from juvenile CF ferrets reestablished pancreatic and lung diseases, with altered pulmonary mechanics. These findings suggest that in utero intervention with a combination of CFTR modulators may provide therapeutic benefits to individuals with F508del. This CFTR-F508del ferret model may be useful for testing therapies using clinically translatable endpoints.
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Affiliation(s)
| | | | - Bo Liang
- Department of Anatomy and Cell Biology, and
| | | | - Lydia Guo
- Department of Anatomy and Cell Biology, and
| | | | | | | | - Yaling Yi
- Department of Anatomy and Cell Biology, and
| | - Yu Yang
- Department of Anatomy and Cell Biology, and
| | - Zehua Feng
- Department of Anatomy and Cell Biology, and
| | | | | | | | - Lisi Qi
- Department of Anatomy and Cell Biology, and
| | - Peipei Wu
- Department of Anatomy and Cell Biology, and
| | | | | | - Kai Wang
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Katherine N Gibson-Corley
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David K Meyerholz
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Dominique H Limoli
- Department of Microbiology and Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Bradley H Rosen
- Department of Anatomy and Cell Biology, and
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ziying Yan
- Department of Anatomy and Cell Biology, and
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2
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Skłodowski K, Suprewicz Ł, Chmielewska-Deptuła SJ, Kaliniak S, Okła S, Zakrzewska M, Minarowski Ł, Mróz R, Daniluk T, Savage PB, Fiedoruk K, Bucki R. Ceragenins exhibit bactericidal properties that are independent of the ionic strength in the environment mimicking cystic fibrosis sputum. Front Microbiol 2023; 14:1290952. [PMID: 38045035 PMCID: PMC10693459 DOI: 10.3389/fmicb.2023.1290952] [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: 09/08/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
The purpose of the work was to investigate the impact of sodium chloride (NaCl) on the antimicrobial efficacy of ceragenins (CSAs) and antimicrobial peptides (AMPs) against bacterial and fungal pathogens associated with cystic fibrosis (CF) lung infections. CF-associated bacterial (Pseudomonas aeruginosa, Ochrobactrum spp., and Staphylococcus aureus), and fungal pathogens (Candida albicans, and Candida tropicalis) were used as target organisms for ceragenins (CSA-13 and CSA-131) and AMPs (LL-37 and omiganan). Susceptibility to the tested compounds was assessed using minimal inhibitory concentrations (MICs) and bactericidal concentrations (MBCs), as well as by colony counting assays in CF sputum samples supplemented with various concentrations of NaCl. Our results demonstrated that ceragenins exhibit potent antimicrobial activity in CF sputum regardless of the NaCl concentration when compared to LL-37 and omiganan. Given the broad-spectrum antimicrobial activity of ceragenins in the microenvironments mimicking the airways of CF patients, ceragenins might be promising agents in managing CF disease.
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Affiliation(s)
- Karol Skłodowski
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
| | - Łukasz Suprewicz
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
| | | | | | - Sławomir Okła
- Holy Cross Cancer Center, Kielce, Poland
- Institute of Health Science, Collegium Medicum, Jan Kochanowski University of Kielce, Kielce, Poland
| | - Magdalena Zakrzewska
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
| | - Łukasz Minarowski
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Poland
| | - Robert Mróz
- 2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Bialystok, Poland
| | - Tamara Daniluk
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
| | - Paul B. Savage
- Department of Chemistry and Biochemistry, Brigham Young University, Provo, UT, United States
| | - Krzysztof Fiedoruk
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
| | - Robert Bucki
- Department of Medical Microbiology and Nanobiomedical Engineering, Medical University of Białystok, Białystok, Poland
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Burgener EB, Cornfield DN. Delivering a New Future for People With Cystic Fibrosis. Pediatrics 2023; 152:e2023062985. [PMID: 37671451 PMCID: PMC10522926 DOI: 10.1542/peds.2023-062985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 09/07/2023] Open
Abstract
Treatment, prognosis, and quality of life for people with cystic fibrosis (CF) have improved steadily since the initial description of the disease, but most dramatically in the past decade. In 2021, the median predicted survival increased to 53 years, compared with 17 years in 1970. The recent improvement in outcomes is attributable to the advent of cystic fibrosis transmembrane regulator (CFTR) modulators, small molecules that enhance the function of defective CFTR protein. The first CFTR modulator, ivacaftor, received Food and Drug Administration approval in 2011 to treat a single CFTR variant, comprising only 4% of those affected by CF. With the demonstration of efficacy, drug approval has been expanded to other variants. Multiple CFTR modulators used in combination with ivacaftor augment efficacy and increase the number of CFTR variants amenable to therapy. Approval of elexecaftor/tezecaftor/ivacaftor in 2019 increased the number of individuals who could benefit from highly effective modulator therapy (HEMT) to ∼90% of the CF population in the United States. HEMT has been dramatically effective, with overall improvements in lung function, quality of life, nutritional status, and, in women, increased fertility. HEMT may delay the onset of other CF-related comorbidities. Although off-target effects, including hepatotoxicity, drug-drug interactions, and putative mental health issues can complicate use, modulator therapy has been generally well tolerated. Ten percent of people with CF have variants that are not amenable to modulator treatment. HEMT, despite its great cost and limited global access, has brought legitimate hope and changed the lives of a significant majority of individuals and families affected by CF in North America.
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Affiliation(s)
- Elizabeth B. Burgener
- Center for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David N. Cornfield
- Center for Excellence in Pulmonary Biology, Divisions of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Ong T, Albon D, Amin RS, Bailey J, Bandla S, Britto MT, Flath J, Gamel B, Powers M, Sabadosa KA, Saulitis AK, Thomas LK, Thurmond S, Seid M. Establishing a Cystic Fibrosis Learning Network: Interventions to promote collaboration and data-driven improvement at scale. Learn Health Syst 2023; 7:e10354. [PMID: 37448461 PMCID: PMC10336485 DOI: 10.1002/lrh2.10354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/16/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction A learning health network is a type of learning health system in which stakeholders use network organization to improve health and health care. Building on existing resources in the cystic fibrosis (CF) community, the Cystic Fibrosis Learning Network (CFLN) was designed to improve medical outcomes and quality of life through an intentional focus on achieving reliable evidence-based chronic care delivery and creating a system for data-driven collaborative learning. Methods We describe the development and growth of the CFLN considering six domains of a Network Maturity Grid: system leadership; governance and policy management; quality improvement (QI); engagement and community building; data and analytics; and research. We illustrate the impact of the CFLN experience on chronic care processes and indicators of collaborative infrastructure. Results The CFLN represents 36 accredited care centers in the CF Foundation Care Center Network caring for over 6300 patients. Of 6779 patient clinical care visits/quarter, 77% are entered into the CF Foundation Patient Registry within 30 days, providing timely means to track outcomes. Collaborative visit planning is occurring in 93% of clinical care visits to share agenda setting with patients and families. Almost all CFLN teams (94%, n = 34) have a patient/family partner (PFP), and 74% of PFPs indicate they are actively participating, taking ownership of, or leading QI initiatives with the interdisciplinary care team. In 2022, 97% of centers reported completing 1-13 improvement cycles per month, and 82% contributed to monthly QI progress reports to share learning. Conclusion The CFLN is a maturing, collaborative infrastructure. CFLN centers practice at an advanced level of coproduction. The CFLN fosters interdisciplinary and PFP leadership and the performance of consistent data-driven improvement cycles. CFLN centers are positioned to respond to rapid changes in evidence-based care and advance the practice of QI and implementation science on a broader scale.
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Affiliation(s)
- Thida Ong
- Division of Pulmonary and Sleep Medicine, Department of PediatricsUniversity of Washington, Seattle Children's HospitalSeattleWashingtonUSA
| | - Dana Albon
- Division of Pulmonary Medicine, Department of Internal MedicineUVACharlottesvilleVirginiaUSA
| | - Raouf S. Amin
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics CincinnatiChildren's Hospital Medical CenterCincinnatiOhioUSA
| | - Julianna Bailey
- Division of Pulmonary, Allergy and Critical Care MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Srujana Bandla
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Maria T. Britto
- James M. Anderson Center for Health Systems ExcellenceCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jonathan Flath
- Cystic Fibrosis Center, Division of Pulmonary, Allergy, Critical Care, and Sleep MedicineUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Breck Gamel
- Children's Health Pediatric Cystic Fibrosis Center DallasUTSWDallasTexasUSA
| | - Michael Powers
- Pediatrics Doernbecher Children's HospitalOHSUPortlandOregonUSA
| | | | - Anna K. Saulitis
- Adult and Pediatric Cystic Fibrosis Care CentersRush University Medical CenterChicagoIllinoisUSA
| | - Lacrecia K. Thomas
- Cystic Fibrosis Center Children's of AlabamaChildren's of AlabamaBirminghamAlabamaUSA
| | - Sophia Thurmond
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics CincinnatiChildren's Hospital Medical CenterCincinnatiOhioUSA
| | - Michael Seid
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics CincinnatiChildren's Hospital Medical CenterCincinnatiOhioUSA
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Palla JB. Disparities and therapeutic advances in cystic fibrosis. Pediatr Pulmonol 2023. [PMID: 37133222 DOI: 10.1002/ppul.26445] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/20/2023] [Indexed: 05/04/2023]
Abstract
Cystic fibrosis (CF) has seen a multitude of therapeutic advances targeting its downstream effects. This has led to a steady increase in survival over the past few decades. The recent development of disease-modifying drugs targeting the underlying CFTR mutation has revolutionized treatment for CF. Despite these advances, individuals with CF who are racial and ethnic minorities, from low socioeconomic status, or female sex have worse clinical outcomes. The inequitable access to CFTR modulators from cost and/or genetic eligibility has the potential to further worsen the existing health disparities seen within the CF community.
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Affiliation(s)
- John B Palla
- Division of Pulmonary and Sleep Medicine, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Zampoli M, Morrow BM, Paul G. Real-world disparities and ethical considerations with access to CFTR modulator drugs: Mind the gap! Front Pharmacol 2023; 14:1163391. [PMID: 37050905 PMCID: PMC10083423 DOI: 10.3389/fphar.2023.1163391] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
The third Sustainable Development Goal (SDG), to ensure healthy lives and promote well-being for all at all ages, has particular relevance and implementation challenges amongst people living with rare diseases such as cystic fibrosis (CF). Although the treatment and projected outcome of CF has significantly improved with the advent of CF transmembrane conductance regulator protein modulator (CFTRm) therapy, there remains significant global inequality with regards to access to these life-saving and life-altering drugs. Elexacaftor, tezacaftor, and ivacaftor (ETI) triple combination therapy, first licensed in the United States in 2019, has rapidly become the standard of care for children aged 6 years and older in most high-income countries for individuals with CFTR variants responsive to ETI. Negotiated agreements for access to ETI are currently in place in North America,Europe, Israel ,Australia and New Zealand. However, less priority has been given to negotiate agreements for access to CFTRm in low-middle income countries(LMIC) with significant CF populations such as Central and South America, India, the Middle East, and Southern Africa. These countries and individuals living with CF are therefore effectively being left behind, in direct conflict with the stated principle of the 2030 SDGs. In this review, we highlight the current global inequity in access to CFTRm drugs and its impact on widening disparities between high-income countries and LMIC in CF outcomes and survival. We further discuss the reasons for this inequity and explore the ethical- and human rights-based principles and dilemmas that clinicians, families, governments, and healthcare funders must consider when prioritizing fair and affordable access to expensive CFTRm drugs. Lastly, we propose possible solutions to overcoming the barriers to accessing affordable CFTRm drugs in LMIC and illustrate with examples how access to drug therapies for other conditions have been successfully negotiated in LMIC through innovative partnerships between governments and pharmaceutical industries.
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Affiliation(s)
- M. Zampoli
- Department of Paediatrics and Child Health and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- *Correspondence: M. Zampoli,
| | - B. M Morrow
- Department of Paediatrics and Child Health and Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
| | - G Paul
- Division of Pulmonary Medicine, Nationwide Children’s Hospital, Columbus, OH, United States
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7
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Hoppe JE, Zemanick ET, Martiniano SL. Evidence for Early Cystic Fibrosis Transmembrane Conductance Regulator Modulator Treatment for Children with Cystic Fibrosis Keeps Growing. Am J Respir Crit Care Med 2022; 206:1308-1310. [PMID: 35947636 PMCID: PMC9746855 DOI: 10.1164/rccm.202208-1507ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jordana E. Hoppe
- Department of PediatricsUniversity of Colorado Anschutz Medical CampusAurora, Colorado,Breathing InstituteChildren’s Hospital ColoradoAurora, Colorado
| | - Edith T. Zemanick
- Department of PediatricsUniversity of Colorado Anschutz Medical CampusAurora, Colorado,Breathing InstituteChildren’s Hospital ColoradoAurora, Colorado
| | - Stacey L. Martiniano
- Department of PediatricsUniversity of Colorado Anschutz Medical CampusAurora, Colorado,Breathing InstituteChildren’s Hospital ColoradoAurora, Colorado
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8
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Fitzgerald DA. In modulators we trust. Paediatr Respir Rev 2022; 42:1-2. [PMID: 35491312 DOI: 10.1016/j.prrv.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Dominic A Fitzgerald
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, NSW, 2145, Australia.
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Nowakowski A“XCH, Balasa G“E, Figueira MF, LaRosa F“TJ, Lawlor JMJ. Coming Full Circle: Reflections and Inspirations from a Cystic Fibrosis Patient Scientist Panel. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221086921. [PMID: 35420504 PMCID: PMC9016558 DOI: 10.1177/00469580221086921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Care for many progressive chronic diseases continues to improve, allowing
patients to survive and thrive for longer periods of time1. People
living with such conditions may now find themselves able to achieve long-term
goals in education and career development2. Many people now occupy
the dual roles of scientist and patient3. This commentary article
synthesizes experiences of scientists and advocates with the progressive genetic
disease cystic fibrosis (CF) who collaborated on a career development session
for the Cystic Fibrosis Foundation’s inaugural ResearchCon event in 2019. It
explores how such collaborations affirm and transform individual perspectives on
patient science and its importance in broader scientific research agenda
setting. We first share our own individual insights about the experience and
impact of the ResearchCon panel session before progressing to discussion and
future directions centering the shared insights from one another’s
reflections.
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Affiliation(s)
| | | | - Miriam F. Figueira
- Cystic Fibrosis Research and Treatment Center, University of North Carolina, Chapel Hill, NC, USA
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