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Nazareth D, Mohan K, Fewins H, Walshaw M. Evaluation of Gastric Emptying in Cystic Fibrosis Using Bedside Ultrasonography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2955-2962. [PMID: 30924192 DOI: 10.1002/jum.15001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/08/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Although gastric emptying rate (GER) influences incretin response and nutrient absorption, both defective in people with cystic fibrosis (CF), there are few studies in this group, and the circadian rhythm is unknown. We employed an ultrasonographic technique to assess GER in people with CF following liquid and mixed meals and also evaluated the circadian rhythm, compared to normal controls. METHODS Thirteen pancreatic-insufficient adults with CF and 10 healthy controls underwent a fasting oral glucose tolerance test (OGTT; liquid meal) and on a second visit underwent a fasting mixed meal test (MMT) thrice on the same day. GER was measured during the OGTT and each MMT using a 3.5-MHz abdominal transducer probe at baseline and 30, 60, 90, and 120 minutes. RESULTS Controls had normal GER for both OGTT and MMT. Compared to controls, people with CF had delayed GER60 for OGTT (mean 46%), which increased with time (P = .001), and also delayed GER90 for MMT in the morning (mean 56%), afternoon (58%), and evening (59%). The GER in the control group was better at all time points throughout the day compared to patients with CF. CONCLUSIONS This is the first study to use ultrasonography, an inexpensive bedside technique, to assess GER in adults with CF. For the first time, we have shown that adults with CF have delayed GER for both liquid and mixed meals, and this delay continues throughout the day.
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Affiliation(s)
- Dilip Nazareth
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, United Kingdom
| | - Kamlesh Mohan
- Liverpool Heart and Chest Hospital NHS Trust, Liverpool, United Kingdom
| | - Hilary Fewins
- Liverpool Heart and Chest Hospital NHS Trust, Liverpool, United Kingdom
| | - Martin Walshaw
- Adult CF Unit, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, United Kingdom
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Patient-reported symptoms and functioning as indicators of mortality in advanced cystic fibrosis: A new tool for referral and selection for lung transplantation. J Heart Lung Transplant 2016; 35:789-94. [DOI: 10.1016/j.healun.2016.01.1233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/02/2016] [Accepted: 01/26/2016] [Indexed: 11/24/2022] Open
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Ntimbane T, Mailhot G, Spahis S, Rabasa-Lhoret R, Kleme ML, Melloul D, Brochiero E, Berthiaume Y, Levy E. CFTR silencing in pancreatic β-cells reveals a functional impact on glucose-stimulated insulin secretion and oxidative stress response. Am J Physiol Endocrinol Metab 2016; 310:E200-12. [PMID: 26625901 DOI: 10.1152/ajpendo.00333.2015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/21/2015] [Indexed: 02/05/2023]
Abstract
Cystic fibrosis (CF)-related diabetes (CFRD) has become a critical complication that seriously affects the clinical outcomes of CF patients. Although CFRD has emerged as the most common nonpulmonary complication of CF, little is known about its etiopathogenesis. Additionally, whether oxidative stress (OxS), a common feature of CF and diabetes, influences CFRD pathophysiology requires clarification. The main objective of this study was to shed light on the role of the cystic fibrosis transmembrane conductance regulator (CFTR) in combination with OxS in insulin secretion from pancreatic β-cells. CFTR silencing was accomplished in MIN6 cells by stable expression of small hairpin RNAs (shRNA), and glucose-induced insulin secretion was evaluated in the presence and absence of the valuable prooxidant system iron/ascorbate (Fe/Asc; 0.075/0.75 mM) along with or without the antioxidant Trolox (1 mM). Insulin output from CFTR-silenced MIN6 cells was significantly reduced (∼ 70%) at basal and at different glucose concentrations compared with control Mock cells. Furthermore, CFTR silencing rendered MIN6 cells more sensitive to OxS as evidenced by both increased lipid peroxides and weakened antioxidant defense, especially following incubation with Fe/Asc. The decreased insulin secretion in CFTR-silenced MIN6 cells was associated with high levels of NF-κB (the major participant in inflammatory responses), raised apoptosis, and diminished ATP production in response to the Fe/Asc challenge. However, these defects were alleviated by the addition of Trolox, thereby pointing out the role of OxS in aggravating the effects of CFTR deficiency. Our findings indicate that CFTR deficiency in combination with OxS may contribute to endocrine cell dysfunction and insulin secretion, which at least in part may explain the development of CFRD.
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Affiliation(s)
- Thierry Ntimbane
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Geneviève Mailhot
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Schohraya Spahis
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Remi Rabasa-Lhoret
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada; Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Marie-Laure Kleme
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Melloul
- Department of Endocrinology, Hadassah University Hospital, Jerusalem, Israel; and
| | | | - Yves Berthiaume
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada; Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Emile Levy
- Research Centre, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada; Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada;
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Simonin-Le Jeune K, Le Jeune A, Jouneau S, Belleguic C, Roux PF, Jaguin M, Dimanche-Boitre MT, Lecureur V, Leclercq C, Desrues B, Brinchault G, Gangneux JP, Martin-Chouly C. Impaired functions of macrophage from cystic fibrosis patients: CD11b, TLR-5 decrease and sCD14, inflammatory cytokines increase. PLoS One 2013; 8:e75667. [PMID: 24098711 PMCID: PMC3787056 DOI: 10.1371/journal.pone.0075667] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 08/18/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Early in life, cystic fibrosis (CF) patients are infected with microorganisms. The role of macrophages has largely been underestimated in literature, whereas the focus being mostly on neutrophils and epithelial cells. Macrophages may however play a significant role in the initiating stages of this disease, via an inability to act as a suppressor cell. Yet macrophage dysfunction may be the first step in cascade of events leading to chronic inflammation/infection in CF. Moreover, reports have suggested that CFTR contribute to altered inflammatory response in CF by modification of normal macrophage functions. OBJECTIVES In order to highlight possible intrinsic macrophage defects due to impaired CFTR, we have studied inflammatory cytokines secretions, recognition of pathogens and phagocytosis in peripheral blood monocyte-derived macrophages from stable adult CF patients and healthy subjects (non-CF). RESULTS In CF macrophage supernatants, concentrations of sCD14, IL-1β, IL-6, TNF-α and IL-10 were strongly raised. Furthermore expression of CD11b and TLR-5 were sorely decreased on CF macrophages. Beside, no difference was observed for mCD14, CD16, CD64, TLR-4 and TLR1/TLR-2 expressions. Moreover, a strong inhibition of phagocytosis was observed for CF macrophages. Elsewhere CFTR inhibition in non-CF macrophages also led to alterations of phagocytosis function as well as CD11b expression. CONCLUSIONS Altogether, these findings demonstrate excessive inflammation in CF macrophages, characterized by overproduction of sCD14 and inflammatory cytokines, with decreased expression of CD11b and TLR-5, and impaired phagocytosis. This leads to altered clearance of pathogens and non-resolution of infection by CF macrophages, thereby inducing an exaggerated pro-inflammatory response.
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Affiliation(s)
- Karin Simonin-Le Jeune
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Institut de Recherche Santé Environnement & Travail (IRSET), Institut National de la Santé et de la Recherche Médicale (INSERM), U1085, team ‘Stress Membrane and Signaling’, F-35043 Rennes, France
| | - André Le Jeune
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Equipe Microbiologie "Risques Infectieux" EA 1254, F-35043 Rennes, France
| | - Stéphane Jouneau
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Institut de Recherche Santé Environnement & Travail (IRSET), Institut National de la Santé et de la Recherche Médicale (INSERM), U1085, team ‘Chemical contaminant immunity and inflammation’, F-35043 Rennes, France
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, F-35064 Rennes, France
| | - Chantal Belleguic
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, F-35064 Rennes, France
| | - Pierre-François Roux
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Institut de Recherche Santé Environnement & Travail (IRSET), Institut National de la Santé et de la Recherche Médicale (INSERM), U1085, team ‘Stress Membrane and Signaling’, F-35043 Rennes, France
| | - Marie Jaguin
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Institut de Recherche Santé Environnement & Travail (IRSET), Institut National de la Santé et de la Recherche Médicale (INSERM), U1085, team ‘Chemical contaminant immunity and inflammation’, F-35043 Rennes, France
| | - Marie-Thérèse Dimanche-Boitre
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Institut de Recherche Santé Environnement & Travail (IRSET), Institut National de la Santé et de la Recherche Médicale (INSERM), U1085, team ‘Stress Membrane and Signaling’, F-35043 Rennes, France
| | - Valérie Lecureur
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Institut de Recherche Santé Environnement & Travail (IRSET), Institut National de la Santé et de la Recherche Médicale (INSERM), U1085, team ‘Chemical contaminant immunity and inflammation’, F-35043 Rennes, France
| | - Caroline Leclercq
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Institut de Recherche Santé Environnement & Travail (IRSET), Institut National de la Santé et de la Recherche Médicale (INSERM), U1085, team ‘Stress Membrane and Signaling’, F-35043 Rennes, France
| | - Benoît Desrues
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, F-35064 Rennes, France
| | - Graziella Brinchault
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, F-35064 Rennes, France
| | - Jean-Pierre Gangneux
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Centre Hospitalier Universitaire de Rennes, Centre de Ressource et de Compétences de la Mucoviscidose, F-35064 Rennes, France
- Centre Hospitalier Universitaire de Rennes, Service de Parasitologie-Mycologie, F-35064 Rennes, France
| | - Corinne Martin-Chouly
- Université de Rennes 1, Structure Fédérative de Recherche Biosit, F-35043 Rennes, France
- Institut de Recherche Santé Environnement & Travail (IRSET), Institut National de la Santé et de la Recherche Médicale (INSERM), U1085, team ‘Stress Membrane and Signaling’, F-35043 Rennes, France
- * E-mail:
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Patria MF, Longhi B, Esposito S. Influenza vaccination in children with cystic fibrosis. Expert Rev Vaccines 2013; 12:415-20. [PMID: 23560921 DOI: 10.1586/erv.13.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cystic fibrosis (CF) is an inherited autosomal recessive disease characterized by progressive pulmonary damage and respiratory failure. It is known that bacterial infections play a critical role in the development of significant lung damage, whereas the role of respiratory viruses in CF pulmonary exacerbations and the relationship between viral infections and the progression of lung damage are uncertain. Health authorities throughout the world recommend influenza vaccination for CF patients. The aim of this review is to analyze the impact of seasonal and pandemic influenza on CF patients and data concerning influenza vaccination in order to assess the current situation and identify areas for future study. As data are limited, further well-constructed clinical studies of the effectiveness of influenza vaccination on the main clinical outcome measures of pulmonary function and nutritional status in patients with CF are required.
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Affiliation(s)
- Maria Francesca Patria
- Pediatric Clinic 1, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, Milan, Italy
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Rosario NA, Riedi CA. Cystic fibrosis and atopy. Allergol Immunopathol (Madr) 2013; 41:137-9. [PMID: 23265269 DOI: 10.1016/j.aller.2012.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 07/09/2012] [Accepted: 07/16/2012] [Indexed: 11/25/2022]
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Cost of cystic fibrosis: analysis of treatment costs in a specialized center in northern Italy. Adv Ther 2013; 30:165-75. [PMID: 23397400 DOI: 10.1007/s12325-013-0008-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Advances in cystic fibrosis (CF) therapy have resulted in improved survival and increasing treatment burden and costs. The economic impact of current treatment strategies for CF is poorly defined. METHODS The authors prospectively assessed direct medical costs (including hospitalizations, outpatient interventions, drugs, devices, dietetic products) in 165 consecutive CF patients (aged 5-39 years) seen between March and July 2009. RESULTS The mean annual cost/patient increased with age and lung disease severity from yy4,164 in children aged ≤5 years to yy30,123 in patients aged >5 years with severe lung disease (forced expiratory volume in 1 second [FEV1] <40% of predicted). The increase in costs involved all items, with a progressive increase in cost attributed to hospitalizations. CONCLUSION Treatment of CF is associated with relevant cost for the Italian National Healthcare Service. Costs of illness tend to increase progressively with age, suggesting that increasing economic resources should be allocated to the treatment of CF, given the increasing number of patients surviving into adulthood.
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Rowe SM, Borowitz DS, Burns JL, Clancy JP, Donaldson SH, Retsch-Bogart G, Sagel SD, Ramsey BW. Progress in cystic fibrosis and the CF Therapeutics Development Network. Thorax 2012; 67:882-90. [PMID: 22960984 PMCID: PMC3787701 DOI: 10.1136/thoraxjnl-2012-202550] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Cystic fibrosis (CF), the most common life-shortening genetic disorder in Caucasians, affects approximately 70 000 individuals worldwide. In 1998, the Cystic Fibrosis Foundation (CFF) launched the CF Therapeutics Development Network (CF-TDN) as a central element of its Therapeutics Development Programme. Designed to accelerate the clinical evaluation of new therapies needed to fulfil the CFF mission to control and cure CF, the CF-TDN has conducted 75 clinical trials since its inception, and has contributed to studies as varied as initial safety and proof of concept trials to pivotal programmes required for regulatory approval. This review highlights recent and significant research efforts of the CF-TDN, including a summary of contributions to studies involving CF transmembrane conductance regulator (CFTR) modulators, airway surface liquid hydrators and mucus modifiers, anti-infectives, anti-inflammatories, and nutritional therapies. Efforts to advance CF biomarkers, necessary to accelerate the therapeutic goals of the network, are also summarised.
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Affiliation(s)
- Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, 1819 University Boulevard (MCLM 768), Birmingham, AL 35294, USA.
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Dekkers JF, van der Ent CK, Kalkhoven E, Beekman JM. PPARγ as a therapeutic target in cystic fibrosis. Trends Mol Med 2012; 18:283-91. [PMID: 22494945 DOI: 10.1016/j.molmed.2012.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 03/06/2012] [Accepted: 03/12/2012] [Indexed: 12/31/2022]
Abstract
Cystic fibrosis (CF) is characterized by a proinflammatory pulmonary condition that may result from increased infections and altered intracellular metabolism in CFTR-deficient cells. The lipid-activated transcription factor peroxisome proliferator-activated receptor-γ (PPARγ) has well-established roles in immune cell function and inflammatory modulation and has been demonstrated to play an important role in the heightened inflammatory response in CF cells. Here, we summarize current literature describing PPARγ-dependent alterations of CF cells and discuss the potential of PPARγ ligands for treating CF.
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Affiliation(s)
- Johanna F Dekkers
- Department of Pediatric Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
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Suri HS, Yi ES, Nowakowski GS, Vassallo R. Pulmonary langerhans cell histiocytosis. Orphanet J Rare Dis 2012; 7:16. [PMID: 22429393 PMCID: PMC3342091 DOI: 10.1186/1750-1172-7-16] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 03/19/2012] [Indexed: 12/25/2022] Open
Abstract
Pulmonary Langerhans Cell Histiocytosis (PLCH) is a relatively uncommon lung disease that generally, but not invariably, occurs in cigarette smokers. The pathologic hallmark of PLCH is the accumulation of Langerhans and other inflammatory cells in small airways, resulting in the formation of nodular inflammatory lesions. While the overwhelming majority of patients are smokers, mechanisms by which smoking induces this disease are not known, but likely involve a combination of events resulting in enhanced recruitment and activation of Langerhans cells in small airways. Bronchiolar inflammation may be accompanied by variable lung interstitial and vascular involvement. While cellular inflammation is prominent in early disease, more advanced stages are characterized by cystic lung destruction, cicatricial scarring of airways, and pulmonary vascular remodeling. Pulmonary function is frequently abnormal at presentation. Imaging of the chest with high resolution chest CT scanning may show characteristic nodular and cystic abnormalities. Lung biopsy is necessary for a definitive diagnosis, although may not be required in instances were imaging findings are highly characteristic. There is no general consensus regarding the role of immunosuppressive therapy in smokers with PLCH. All smokers must be counseled on the importance of smoking cessation, which may result in regression of disease and obviate the need for systemic immunosuppressive therapy. The prognosis for most patients is relatively good, particularly if longitudinal lung function testing shows stability. Complications like pneumothoraces and secondary pulmonary hypertension may shorten life expectancy. Patients with progressive disease may require lung transplantation.
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Affiliation(s)
- Harpreet S Suri
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Amorim PG, Mendes TDB, Oliveira LSPD, Guerra-Júnior G, Ribeiro JD. [Growth hormone in children and adolescents with cystic fibrosis]. ARQUIVOS BRASILEIROS DE ENDOCRINOLOGIA E METABOLOGIA 2011; 55:671-676. [PMID: 22231968 DOI: 10.1590/s0004-27302011000900001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 10/28/2011] [Indexed: 05/31/2023]
Abstract
The recombinant human growth hormone (rhGH) can improve weight gain, physical growth, clinical and lung in cystic fibrosis (CF). However, the routine use, although promising, is not established in the literature. The objective of this study was to assess the benefits of rhGH in children and adolescents with CF. We conducted a systematic review in the database PubMed, Lilacs, SciELO and Cochrane, in the period 2000-2010, using the keywords: "cystic fibrosis", "growth hormone", "children" and "adolescents". We found 77 articles and included 11 randomized controlled trials, with 290 children and adolescents with CF. The short-term use (1-24 months) of rhGH improved the height, weight, growth rate, bone mineral content and components of pulmonary function. Adverse effects, like diabetes, were not observed in the studies. The short-term use of rhGH improved growth and body composition in patients with CF.
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Affiliation(s)
- Pollyana Garcia Amorim
- Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil.
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