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Einarsson GG, Sherrard LJ, Hatch JE, Zorn B, Johnston E, McGettigan C, O'Neill K, Gilpin DF, Downey DG, Murray M, Lavelle G, McElvaney G, Wolfgang MC, Boucher R, Muhlebach MS, Bradbury I, Elborn JS, Tunney MM. Longitudinal changes in the cystic fibrosis airway microbiota with time and treatment. J Cyst Fibros 2024; 23:252-261. [PMID: 38158284 DOI: 10.1016/j.jcf.2023.11.010] [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: 06/12/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Whether there is any benefit in integrating culture-independent molecular analysis of the lower airway microbiota of people with cystic fibrosis into clinical care is unclear. This study determined the longitudinal trajectory of the microbiota and if there were microbiota characteristics that corresponded with response to treatment or predicted a future pulmonary exacerbation. METHODS At least one sputum sample was collected from 149 participants enrolled in this prospective longitudinal multi-centre study and total bacterial density and microbiota community measurements were determined and compared with clinical parameters. RESULTS In 114 participants with paired samples when clinically stable, ∼8 months apart, the microbiota remained conserved between timepoints, regardless of whether participants received acute intravenous antibiotic treatment or not. In 62 participants, who presented with an acute exacerbation, a decrease in community richness correlated best with patient response to antibiotic treatment. Analysis of baseline samples from 30 participants who exacerbated within 4 months of their stable sample being collected and 72 participants who remained stable throughout the study showed that community characteristics such as lower richness at baseline may be predictive of an exacerbation in addition to several clinical parameters. However, lasso regression analysis indicated that only lung function (p = 0.014) was associated with a future exacerbation. CONCLUSIONS The airway microbiota remains stable over periods <1 year with modest shifts related to treatment apparent which might provide some additional insights to patient-level measurements.
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Affiliation(s)
| | | | - Joseph E Hatch
- University of North Carolina, Chapel Hill, NC, United States
| | - Bryan Zorn
- University of North Carolina, Chapel Hill, NC, United States
| | | | | | | | | | | | - Michelle Murray
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Gillian Lavelle
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Gerry McElvaney
- Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | | | - Richard Boucher
- University of North Carolina, Chapel Hill, NC, United States
| | | | - Ian Bradbury
- Frontier Science (Scotland) Ltd., Kincraig, United Kingdom
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Şişmanlar Eyuboglu T, Aslan AT, Asfuroglu P, Kunt N, Ersoy A, Kose M, Unal G, Pekcan S. Neutrophil lymphocyte ratio, mean platelet volume, and immunoreactive trypsinogen as early inflammatory biomarkers for cystic fibrosis in infancy: A retrospective cohort study. Pediatr Pulmonol 2023; 58:3106-3112. [PMID: 37530491 DOI: 10.1002/ppul.26628] [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: 03/27/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Airway inflammation starts in early life in cystic fibrosis (CF) and limited, objective markers are available to help identify infants with increased inflammation. We aimed to investigate neutrophil, lymphocyte ratio (NLR), mean platelet volume (MPV) and immunoreactive trypsinogen (IRT) to be a possible inflammatory biomarker for CF in infancy. METHODS This was a retrospective cohort study in three centers. Between January 2015 and December 2022, children with CF newborn screening (NBS) positivity and diagnosed as CF were included in the study. Correlation analysis were performed with NLR, MPV, IRT and follow-up parameters such as z-scores, modified Shwachman-Kulczycki score (mSKS) at the first, second, third and sixth ages and pulmonary function test (PFT) at the sixth age. RESULTS A total of 92 children with CF included in the study and 47.8% of them were female. There were no correlations between NLR, MPV and weight and height z-scores for all ages (p > 0.05), a negative correlation was found between MPV and body mass indexes (BMI) z-score at the age of 6 (r = -0.443, p = 0.038). No correlation was found between NLR, MPV and PFT parameters and mSKS at all ages (p > 0.05). There was a negative correlation between first IRT and BMI z-score at 6 years of age (r = -0.381, p = 0.046) and negative correlations between second IRT and weight and BMI z-score at the age of 6 (r = -0.462, p = 0.010; r = -0.437, p = 0.016, respectively). CONCLUSION Higher MPV and IRT levels during NBS period are associated with worse nutritional outcome which may reflect chronic inflammation. Children with higher MPV and IRT should be followed up closely in terms of chronic inflammation and nutritional status.
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Affiliation(s)
| | - Ayse Tana Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Pelin Asfuroglu
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nursima Kunt
- Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ali Ersoy
- Department of Pediatric Pulmonology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Mehmet Kose
- Department of Pediatric Pulmonology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Gokcen Unal
- Department of Pediatric Pulmonology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
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Rosenfeld M, Faino AV, Qu P, Onchiri FM, Blue EE, Collaco JM, Gordon WW, Szczesniak R, Zhou YH, Bamshad MJ, Gibson RL. Association of Pseudomonas aeruginosa infection stage with lung function trajectory in children with cystic fibrosis. J Cyst Fibros 2023; 22:857-863. [PMID: 37217389 DOI: 10.1016/j.jcf.2023.05.004] [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: 12/02/2022] [Revised: 02/25/2023] [Accepted: 05/06/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa (Pa) infection in cystic fibrosis (CF) is characterized in stages: never (prior to first positive culture) to incident (first positive culture) to chronic. The association of Pa infection stage with lung function trajectory is poorly understood and the impact of age on this association has not been examined. We hypothesized that FEV1 decline would be slowest prior to Pa infection, intermediate after incident infection and greatest after chronic Pa infection. METHODS Participants in a large US prospective cohort study diagnosed with CF prior to age 3 contributed data through the U.S. CF Patient Registry. Cubic spline linear mixed effects models were used to evaluate the longitudinal association of Pa stage (never, incident, chronic using 4 different definitions) with FEV1 adjusted for relevant covariates. Models contained interaction terms between age and Pa stage. RESULTS 1,264 subjects born 1992-2006 provided a median 9.5 (IQR 0.25 to 15.75) years of follow up through 2017. 89% developed incident Pa; 39-58% developed chronic Pa depending on the definition. Compared to never Pa, incident Pa infection was associated with greater annual FEV1 decline and chronic Pa infection with the greatest FEV1 decline. The most rapid FEV1 decline and strongest association with Pa infection stage was seen in early adolescence (ages 12-15). CONCLUSIONS Annual FEV1 decline worsens significantly with each Pa infection stage in children with CF. Our findings suggest that measures to prevent chronic infection, particularly during the high-risk period of early adolescence, could mitigate FEV1 decline and improve survival.
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Affiliation(s)
- Margaret Rosenfeld
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA.
| | - Anna V Faino
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Pingping Qu
- Seattle Children's Research Institute, Seattle, WA, USA
| | | | - Elizabeth E Blue
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William W Gordon
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Rhonda Szczesniak
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH USA
| | - Yi-Hui Zhou
- Bioinformatics Research Center and Department of Statistics, North Carolina State University, Raleigh, NC, USA; Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Michael J Bamshad
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, WA, USA; Brotman Baty Institute, Seattle, WA USA
| | - Ronald L Gibson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
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Llanos A, Achard P, Bousquet J, Lozano C, Zalacain M, Sable C, Revillet H, Murris M, Mittaine M, Lemonnier M, Everett M. Higher levels of Pseudomonas aeruginosa LasB elastase expression are associated with early-stage infection in cystic fibrosis patients. Sci Rep 2023; 13:14208. [PMID: 37648735 PMCID: PMC10468528 DOI: 10.1038/s41598-023-41333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
Pseudomonas aeruginosa is a common pathogen in cystic fibrosis (CF) patients and a major contributor to progressive lung damage. P. aeruginosa elastase (LasB), a key virulence factor, has been identified as a potential target for anti-virulence therapy. Here, we sought to differentiate the P. aeruginosa isolates from early versus established stages of infection in CF patients and to determine if LasB was associated with either stage. The lasB gene was amplified from 255 P. aeruginosa clinical isolates from 70 CF patients from the Toulouse region (France). Nine LasB variants were identified and 69% of the isolates produced detectable levels of LasB activity. Hierarchical clustering using experimental and clinical data distinguished two classes of isolates, designated as 'Early' and 'Established' infection. Multivariate analysis revealed that the isolates from the Early infection class show higher LasB activity, fast growth, tobramycin susceptibility, non-mucoid, pigmented colonies and wild-type lasR genotype. These traits were associated with younger patients with polymicrobial infections and high pFEV1. Our findings show a correlation between elevated LasB activity in P. aeruginosa isolates and early-stage infection in CF patients. Hence, it is this patient group, prior to the onset of chronic disease, that may benefit most from novel therapies targeting LasB.
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Affiliation(s)
- Agustina Llanos
- Antabio SAS, Biostep, 436, rue Pierre et Marie Curie, 31760, Labège, France.
| | - Pauline Achard
- Antabio SAS, Biostep, 436, rue Pierre et Marie Curie, 31760, Labège, France
| | - Justine Bousquet
- Antabio SAS, Biostep, 436, rue Pierre et Marie Curie, 31760, Labège, France
| | - Clarisse Lozano
- Antabio SAS, Biostep, 436, rue Pierre et Marie Curie, 31760, Labège, France
| | - Magdalena Zalacain
- Antabio SAS, Biostep, 436, rue Pierre et Marie Curie, 31760, Labège, France
| | - Carole Sable
- Antabio SAS, Biostep, 436, rue Pierre et Marie Curie, 31760, Labège, France
| | - Hélène Revillet
- Service de Bactériologie-Hygiène, CHU de Toulouse, Toulouse, France
- IRSD, INSERM, Université de Toulouse, INRAE, ENVT, UPS, Toulouse, France
| | - Marlène Murris
- Adult Cystic Fibrosis Centre, Pulmonology Unit, Hôpital Larrey, CHU de Toulouse, Toulouse, France
| | | | - Marc Lemonnier
- Antabio SAS, Biostep, 436, rue Pierre et Marie Curie, 31760, Labège, France
| | - Martin Everett
- Antabio SAS, Biostep, 436, rue Pierre et Marie Curie, 31760, Labège, France
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Kleinfelder K, Villella VR, Hristodor AM, Laudanna C, Castaldo G, Amato F, Melotti P, Sorio C. Theratyping of the Rare CFTR Genotype A559T in Rectal Organoids and Nasal Cells Reveals a Relevant Response to Elexacaftor (VX-445) and Tezacaftor (VX-661) Combination. Int J Mol Sci 2023; 24:10358. [PMID: 37373505 DOI: 10.3390/ijms241210358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Despite the promising results of new CFTR targeting drugs designed for the recovery of F508del- and class III variants activity, none of them have been approved for individuals with selected rare mutations, because uncharacterized CFTR variants lack information associated with the ability of these compounds in recovering their molecular defects. Here we used both rectal organoids (colonoids) and primary nasal brushed cells (hNEC) derived from a CF patient homozygous for A559T (c.1675G>A) variant to evaluate the responsiveness of this pathogenic variant to available CFTR targeted drugs that include VX-770, VX-809, VX-661 and VX-661 combined with VX-445. A559T is a rare mutation, found in African-Americans people with CF (PwCF) with only 85 patients registered in the CFTR2 database. At present, there is no treatment approved by FDA (U.S. Food and Drug Administration) for this genotype. Short-circuit current (Isc) measurements indicate that A559T-CFTR presents a minimal function. The acute addition of VX-770 following CFTR activation by forskolin had no significant increment of baseline level of anion transport in both colonoids and nasal cells. However, the combined treatment, VX-661-VX-445, significantly increases the chloride secretion in A559T-colonoids monolayers and hNEC, reaching approximately 10% of WT-CFTR function. These results were confirmed by forskolin-induced swelling assay and by western blotting in rectal organoids. Overall, our data show a relevant response to VX-661-VX-445 in rectal organoids and hNEC with CFTR genotype A559T/A559T. This could provide a strong rationale for treating patients carrying this variant with VX-661-VX-445-VX-770 combination.
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Affiliation(s)
- Karina Kleinfelder
- Cystic Fibrosis Laboratory "D. Lissandrini", Department of Medicine, Division of General Pathology, University of Verona, 37134 Verona, Italy
| | - Valeria Rachela Villella
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80138 Napoli, Italy
- CEINGE-Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy
| | - Anca Manuela Hristodor
- Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Carlo Laudanna
- Cystic Fibrosis Laboratory "D. Lissandrini", Department of Medicine, Division of General Pathology, University of Verona, 37134 Verona, Italy
| | - Giuseppe Castaldo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80138 Napoli, Italy
- CEINGE-Advanced Biotechnologies Franco Salvatore, 80145 Naples, Italy
| | - Felice Amato
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80138 Napoli, Italy
| | - Paola Melotti
- Cystic Fibrosis Centre, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy
| | - Claudio Sorio
- Cystic Fibrosis Laboratory "D. Lissandrini", Department of Medicine, Division of General Pathology, University of Verona, 37134 Verona, Italy
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Noni M, Katelari A, Poulou M, Ioannidis D, Kapasouri EM, Tzetis M, Doudounakis SE, Kanaka-Gantenbein C, Spoulou V. Frequencies of pathogenic CFTR variants in Greek cystic fibrosis patients with allergic bronchopulmonary aspergillosis and Aspergillus fumigatus chronic colonization: A retrospective cohort study. J Mycol Med 2023; 33:101326. [PMID: 36272381 DOI: 10.1016/j.mycmed.2022.101326] [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: 05/13/2021] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The clinical spectrum of Aspergillus fumigatus diseases in cystic fibrosis (CF) patients, including allergic bronchopulmonary aspergillosis (ABPA) and Aspergillus fumigatus chronic colonization, has recently gained attention due to its association with the progression of lung disease. Our aim was to examine whether there is a difference on pathogenic variant frequencies of the CFTR gene between CF patients with ABPA and those with A. fumigatus chronic colonization. MATERIAL AND METHODS Greek CF patients diagnosed with ABPA and/or A. fumigatus chronic colonization were grouped according to their CFTR genotype. Patients with "minimal" CFTR function were defined as carrying a combination of class I or II pathogenic variants, while patients with "residual" function as carrying at least one class III, IV, V or VI pathogenic variant. RESULTS Fifty-four CF patients were included and all except one were defined as having "minimal" CFTR function. Among the 108 CFTR alleles, 69 (63.9%) of pathogenic variants belonged to class II, and 32 (29.6%) to class I. Five patients had a history of both ABPA and A. fumigatus chronic colonization. No significant difference was detected among patients diagnosed only with ABPA (n = 29) and those who had only a positive history of A. fumigatus chronic colonization (n = 20). The median age of ABPA diagnosis was significantly lower than the median age of A. fumigatus chronic colonization (P = 0.011), while no significant difference was detected on median FEV1% predicted. DISCUSSION No significant differences were detected in the type of CFTR pathogenic variants among patients with ABPA and those with A. fumigatus colonization. Similar studies should be performed in larger CF populations of different ethnic origin to further confirm our results.
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Affiliation(s)
- Maria Noni
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece.
| | - Anna Katelari
- Institute of Child Health, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Myrto Poulou
- Department of Medical Genetics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Diomidis Ioannidis
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Efthymia-Maria Kapasouri
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Maria Tzetis
- Department of Medical Genetics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Christina Kanaka-Gantenbein
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Vana Spoulou
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Division of Infectious Diseases, "Aghia Sophia" Children's Hospital, Athens, Greece
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Infection dynamics of Stenotrophomonas maltophilia in patients with cystic fibrosis. J Infect 2023; 86:626-628. [PMID: 36822406 DOI: 10.1016/j.jinf.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
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Hillenaar T, Beekman J, van der Sluijs P, Braakman I. Redefining Hypo- and Hyper-Responding Phenotypes of CFTR Mutants for Understanding and Therapy. Int J Mol Sci 2022; 23:15170. [PMID: 36499495 PMCID: PMC9735543 DOI: 10.3390/ijms232315170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022] Open
Abstract
Mutations in CFTR cause misfolding and decreased or absent ion-channel function, resulting in the disease Cystic Fibrosis. Fortunately, a triple-modulator combination therapy (Trikafta) has been FDA-approved for 178 mutations, including all patients who have F508del on one allele. That so many CFTR mutants respond well to modulators developed for a single mutation is due to the nature of the folding process of this multidomain protein. We have addressed the question 'What characterizes the exceptions: the mutants that functionally respond either not or extremely well'. A functional response is the product of the number of CFTR molecules on the cell surface, open probability, and conductivity of the CFTR chloride channel. By combining biosynthetic radiolabeling with protease-susceptibility assays, we have followed CF-causing mutants during the early and late stages of folding in the presence and absence of modulators. Most CFTR mutants showed typical biochemical responses for each modulator, such as a TMD1 conformational change or an increase in (cell-surface) stability, regardless of a functional response. These modulators thus should still be considered for hypo-responder genotypes. Understanding both biochemical and functional phenotypes of outlier mutations will boost our insights into CFTR folding and misfolding, and lead to improved therapeutic strategies.
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Affiliation(s)
- Tamara Hillenaar
- Cellular Protein Chemistry, Bijvoet Centre for Biomolecular Research, Science for Life, Faculty of Science, Utrecht University, 3584 CS Utrecht, The Netherlands; (T.H.); (P.v.d.S.)
| | - Jeffrey Beekman
- Department of Pediatric Pulmonology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Member of ERN-LUNG, 3584 EA Utrecht, The Netherlands;
- Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, 3584 CT Utrecht, The Netherlands
- Centre for Living Technologies, Alliance TU/e, WUR, UU, UMC Utrecht, 3584 CB Utrecht, The Netherlands
| | - Peter van der Sluijs
- Cellular Protein Chemistry, Bijvoet Centre for Biomolecular Research, Science for Life, Faculty of Science, Utrecht University, 3584 CS Utrecht, The Netherlands; (T.H.); (P.v.d.S.)
| | - Ineke Braakman
- Cellular Protein Chemistry, Bijvoet Centre for Biomolecular Research, Science for Life, Faculty of Science, Utrecht University, 3584 CS Utrecht, The Netherlands; (T.H.); (P.v.d.S.)
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Rosenfeld M, Ostrenga J, Cromwell EA, Magaret A, Szczesniak R, Fink A, Schechter MS, Faro A, Ren CL, Morgan W, Sanders DB. Real-world Associations of US Cystic Fibrosis Newborn Screening Programs With Nutritional and Pulmonary Outcomes. JAMA Pediatr 2022; 176:990-999. [PMID: 35913705 PMCID: PMC9344390 DOI: 10.1001/jamapediatrics.2022.2674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
IMPORTANCE Newborn screening (NBS) for cystic fibrosis (CF) has been universal in the US since 2010, but its association with clinical outcomes is unclear. OBJECTIVE To describe the real-world effectiveness of NBS programs for CF in the US on outcomes up to age 10 years. DESIGN, SETTING, AND PARTICIPANTS This was a retrospective cohort study using CF Foundation Patient Registry data from January 1, 2000, to December 31, 2018. The staggered implementation of NBS programs by state was used to compare longitudinal outcomes among children in the same birth cohort born before vs after the implementation of NBS for CF in their state of birth. Participants included children with an established diagnosis of CF born between January 1, 2000, to December 31, 2018, in any of the 44 states that implemented NBS for CF between 2003 and 2010. Data were analyzed from October 5, 2020, to April 22, 2022. EXPOSURES Birth before vs after the implementation of NBS for CF in the state of birth. MAIN OUTCOMES AND MEASURES Longitudinal trajectory of height and weight percentiles from diagnosis, lung function (forced expiratory volume in 1 second, [FEV1] percent predicted) from age 6 years, and age at initial and chronic infection with Pseudomonas aeruginosa using linear mixed-effects and time-to-event models adjusting for birth cohort and potential confounders. RESULTS A total of 9571 participants (4713 female participants [49.2%]) were eligible for inclusion, with 4510 (47.1%) in the pre-NBS cohort. NBS was associated with higher weight and height percentiles in the first year of life (weight, 6.0; 95% CI, 3.1-8.4; height, 6.6; 95% CI, 3.8-9.3), but these differences decreased with age. There was no association between NBS and FEV1 at age 6 years, but the percent-predicted FEV1 did increase more rapidly with age in the post-NBS cohort. NBS was associated with older age at chronic P aeruginosa infection (hazard ratio, 0.69; 95% CI, 0.54-0.89) but not initial P aeruginosa infection (hazard ratio, 0.88; 95% CI, 0.77-1.01). CONCLUSIONS AND RELEVANCE NBS for CF in the US was associated with improved nutritional status up to age 10 years, a more rapid increase in lung function, and delayed chronic P aeruginosa infection. In the future, as highly effective modulator therapies become available for infants with CF, NBS will allow for presymptomatic initiation of these disease-modifying therapies before irreversible organ damage.
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Affiliation(s)
- Margaret Rosenfeld
- Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle
| | | | | | - Amalia Magaret
- Division of Pulmonary and Sleep Medicine, Seattle Children’s Hospital, Seattle, Washington,Department of Pediatrics, University of Washington, Seattle
| | - Rhonda Szczesniak
- Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
| | - Aliza Fink
- Cystic Fibrosis Foundation, Bethesda, Maryland,National Organization for Rare Disorders, Washington, District of Columbia
| | | | - Albert Faro
- Cystic Fibrosis Foundation, Bethesda, Maryland
| | - Clement L. Ren
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wayne Morgan
- Department of Pediatrics, University of Arizona, Tucson
| | - Don B. Sanders
- Department of Pediatrics, Indiana University, Indianapolis
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Zhai J, Emond MJ, Spangenberg A, Stern DA, Vasquez MM, Blue EE, Buckingham KJ, Sherrill DL, Halonen M, Gibson RL, Rosenfeld M, Sagel SD, Bamshad MJ, Morgan WJ, Guerra S. Club cell secretory protein and lung function in children with cystic fibrosis. J Cyst Fibros 2022; 21:811-820. [PMID: 35367162 PMCID: PMC9509401 DOI: 10.1016/j.jcf.2022.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/18/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Club cell secretory protein (CC16) exerts anti-inflammatory functions in lung disease. We sought to determine the relation of serum CC16 deficits and genetic variants that control serum CC16 to lung function among children with cystic fibrosis (CF). METHODS We used longitudinal data from CF children (EPIC Study) with no positive cultures for Pseudomonas aeruginosa prior to enrollment. Circulating levels of CC16 and an inflammatory score (generated from CRP, SAA, calprotectin, G-CSF) were compared between participants with the lowest and highest FEV1 levels in adolescence (LLF and HLF groups, respectively; N = 130-per-group). Single nucleotide variants (SNVs) in the SCGB1A1, EHF-APIP loci were tested for association with circulating CC16 and with decline of FEV1 and FEV1/FVC% predicted levels between ages 7-16 using mixed models. RESULTS Compared with the HLF group, the LLF group had lower levels of CC16 (geometric means: 8.2 vs 6.5 ng/ml, respectively; p = 0.0002) and higher levels of the normalized inflammatory score (-0.21 vs 0.21, p = 0.0007). Participants in the lowest CC16 and highest inflammation tertile had the highest odds for having LLF (p<0.0001 for comparison with participants in the highest CC16 and lowest inflammation tertile). Among seven SNVs associated with circulating CC16, the top SNV rs3741240 was associated with decline of FEV1/FVC and, marginally, FEV1 (p = 0.003 and 0.025, respectively; N = 611 participants, 20,801 lung function observations). CONCLUSIONS Serum CC16 deficits are strongly associated with severity of CF lung disease and their effects are additive with systemic inflammation. The rs3741240 A allele is associated with low circulating CC16 and, possibly, accelerated lung function decline in CF.
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Affiliation(s)
- Jing Zhai
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
| | - Mary J Emond
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Amber Spangenberg
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
| | - Debra A Stern
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
| | - Monica M Vasquez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
| | - Elizabeth E Blue
- Division of Medical Genetics, Department of Medicine, University of Washington, Seattle, WA, United States; Brotman-Baty Institute for Precision Medicine, Seattle, WA, United States
| | - Kati J Buckingham
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Duane L Sherrill
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
| | - Marilyn Halonen
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
| | - Ronald L Gibson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Margaret Rosenfeld
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Scott D Sagel
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michael J Bamshad
- Brotman-Baty Institute for Precision Medicine, Seattle, WA, United States; Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, WA, United States; Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Wayne J Morgan
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States; Department of Pediatrics, University of Arizona, Tucson, AZ, United States.
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States; Department of Medicine, University of Arizona, Tucson, AZ, United States.
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11
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Kavanagh EW, Green JJ. Toward Gene Transfer Nanoparticles as Therapeutics. Adv Healthc Mater 2022; 11:e2102145. [PMID: 35006646 DOI: 10.1002/adhm.202102145] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/24/2021] [Indexed: 12/17/2022]
Abstract
Genetic medicine has great potential to treat the underlying causes of many human diseases with exquisite precision, but the field has historically been stymied by delivery as the central challenge. Nanoparticles, engineered constructs the size of natural viruses, are being designed to more closely mimic the delivery efficiency of viruses, while enabling the advantages of increased safety, cargo-carrying flexibility, specific targeting, and ease in manufacturing. The speed in which nonviral gene transfer nanoparticles are making progress in the clinic is accelerating, with clinical validation of multiple nonviral nucleic acid delivery nanoparticle formulations recently FDA approved for both expression and for silencing of genes. While much of this progress has been with lipid nanoparticle formulations, significant development is being made with other nanomaterials for gene transfer as well, with favorable attributes such as biodegradability, scalability, and cell targeting. This review highlights the state of the field, current challenges in delivery, and opportunities for engineered nanomaterials to meet these challenges, including enabling long-term therapeutic gene editing. Delivery technology utilizing different kinds of nanomaterials and varying cargos for gene transfer (DNA, mRNA, and ribonucleoproteins) are discussed. Clinical applications are presented, including for the treatment of genetic diseases such as cystic fibrosis.
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Affiliation(s)
- Erin W. Kavanagh
- Departments of Biomedical Engineering, Ophthalmology, Oncology, Neurosurgery, Materials Science & Engineering, and Chemical & Biomolecular Engineering Translational Tissue Engineering Center and Institute for NanoBioTechnology Johns Hopkins University School of Medicine 400 North Broadway, Smith Building 5017 Baltimore MD 21231 USA
| | - Jordan J. Green
- Departments of Biomedical Engineering, Ophthalmology, Oncology, Neurosurgery, Materials Science & Engineering, and Chemical & Biomolecular Engineering Translational Tissue Engineering Center and Institute for NanoBioTechnology Johns Hopkins University School of Medicine 400 North Broadway, Smith Building 5017 Baltimore MD 21231 USA
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12
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Ramasli Gursoy T, Aslan AT, Asfuroglu P, Sismanlar Eyuboglu T, Cakir E, Cobanoglu N, Pekcan S, Cinel G, Dogru D, Ozcelik U, Yalcin E, Sen V, Ercan O, Kilinc AA, Yazan H, Altintas DU, Kartal Ozturk G, Bingol A, Sapan N, Celebioglu E, Tugcu GD, Ozdemir A, Harmanci K, Kose M, Emiralioglu N, Tamay Z, Yuksel H, Ozcan G, Topal E, Can D, Korkmaz Ekren P, Caltepe G, Kilic M, Ozdogan S. Clinical findings of patients with cystic fibrosis according to newborn screening results. Pediatr Int 2022; 64:e14888. [PMID: 34131975 DOI: 10.1111/ped.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a lethal recessive genetic disease caused by loss of function associated with mutations in the CF trans-membrane conductance regulator. It is highly prevalent (approximately 1 in 3,500) in Caucasians. The aim of this study was to compare demographic and clinical features, diagnostic tests, treatments, and complications of patients with CF whose newborn screening (NBS) with twice-repeated immune reactive trypsinogen testing was positive, normal, and not performed. METHODS In this study, 359 of all 1,488 CF patients recorded in the CF Registry of Turkey in 2018, who had been born through the process of NBS, were evaluated. Demographic and clinical features were compared in patients diagnosed with positive NBS (Group 1), normal (Group 2), or without NBS (Group 3). RESULTS In Group 1, there were 299 patients, in Group 2, there were 40 patients, and in Group 3, there were 20 patients. Among all patients, the median age at diagnosis was 0.17 years. The median age at diagnosis was higher in Groups 2 and 3 than in Group 1 (P = 0.001). Fecal elastase results were higher in Group 2 (P = 0.033). The weight z-score was lower and chronic Staphylococcus aureus infection was more common in Group 3 (P = 0.017, P = 0.004, respectively). CONCLUSIONS Frequency of growth retardation and chronic S. aureus infection can be reduced with an early diagnosis using NBS. In the presence of clinical suspicion in patients with normal NBS, further analyses such as genetic testing should be performed, especially to prevent missing patients with severe mutations.
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Affiliation(s)
- Tugba Ramasli Gursoy
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse Tana Aslan
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Pelin Asfuroglu
- Department of Pediatric Pulmonology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Erkan Cakir
- Department of Pediatric Pulmonology, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Nazan Cobanoglu
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Guzin Cinel
- Department of Pediatric Pulmonology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcin
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Velat Sen
- Department of Pediatric Pulmonology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Omur Ercan
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ayse Ayzit Kilinc
- Department of Pediatric Pulmonology, Istanbul University Cerrahpasa Medicine Faculty, Istanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Bezmialem University Faculty of Medicine, Istanbul, Turkey
| | - Derya Ufuk Altintas
- Department of Pediatric Allergy and Immunology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Gokcen Kartal Ozturk
- Department of Pediatric Pulmonology, Ege University Faculty of Medicine, Izmir, Turkey
| | - Aysen Bingol
- Department of Pediatric Allergy and Immunology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Nihat Sapan
- Department of Pediatric Allergy and Immunology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Ebru Celebioglu
- Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gokcen Dilsa Tugcu
- Department of Pediatric Pulmonology, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Ali Ozdemir
- Department of Pediatric Pulmonology, Ministry of Health Mersin City Hospital, Mersin, Turkey
| | - Koray Harmanci
- Department of Pediatric Allergy and Immunology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Mehmet Kose
- Department of Pediatric Pulmonology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zeynep Tamay
- Department of Pediatric Allergy, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Hasan Yuksel
- Department of Pediatric Allergy and Immunology, Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Gizem Ozcan
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Erdem Topal
- Department of Pediatric Allergy, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Demet Can
- Department of Pediatric Pulmonology, Balikesir University Faculty of Medicine, Balikesir, Turkey
| | | | - Gonul Caltepe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| | - Mehmet Kilic
- Department of Pediatric Allergy and Immunology, Firat University Faculty of Medicine, Elazig, Turkey
| | - Sebnem Ozdogan
- Department of Pediatric Pulmonology, Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey
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13
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Nayir Buyuksahin H, Yalçın E, Emiralioglu N, Hazırolan G, Ademhan Tural D, Ozsezen B, Sunman B, Guzelkas I, Dogru D, Ozcelik U, Kiper N. The effect of Pseudomonas aeruginosa eradication regimens on chronic colonization and clinical outcomes in pediatric patients with cystic fibrosis. Pediatr Int 2022; 64:e15249. [PMID: 36321341 DOI: 10.1111/ped.15249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/03/2022] [Accepted: 05/18/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Chronic Pseudomonas aeruginosa colonization (Pa-CC) affects cystic fibrosis (CF) progression, including pulmonary exacerbations and pulmonary function tests. There are few studies of the effects of eradication protocols on colonization time. Here, we aimed to evaluate the effect of eradication regimens on chronic colonization and assess the impact of Pa-CC on body mass index, lung functions, and pulmonary exacerbations. METHODS A retrospective review was conducted of medical records, over a period of 11 years, of children aged under 18 years with CF who had Pa-CC in our tertiary care pediatric hospital. RESULTS Pseudomonas aeruginosa was detected in 215 of our patients with CF during the study period. Forty-four patients with Pa-CC were recruited for the study. The eradication treatment for the initial acquisition of P. aeruginosa was inhaled antibiotics in 27 (61.4%) patients; the remainder were given intravenous antibiotics. It was observed that eradication treatment with either IV or inhaled antibiotics did not affect the time between the P. aeruginosa and the time of Pa-CC(P = 0.791). There was a non-significant decrease in the body mass index z-score from the Pa-IA to the last visit(P = 0.27), a significant decline in forced expiratory volume in 1 s (FEV1%) (P = 0.01) over time, and the annual number of exacerbations after colonization was significantly higher than before colonization (P = 0.03). CONCLUSIONS There was no difference between eradication regimens in delaying the age at Pa-CC. Pseudomonas aeruginosa colonization in patients with CF was also associated with poorer lung functions, lower body mass index, and more pulmonary exacerbation regardless of mucoid type. Consequently, to slow the progression of lung disease, we must prevent Pa-CC, which we can achieve with early eradication. Despite conventional eradication protocols, future studies need to evaluate those who fail to clear P. aeruginosa.
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Affiliation(s)
- Halime Nayir Buyuksahin
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Gulsen Hazırolan
- Department of Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Dilber Ademhan Tural
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Beste Ozsezen
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Birce Sunman
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ismail Guzelkas
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Deniz Dogru
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Ugur Ozcelik
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, School of Medicine, Hacettepe University, Ihsan Dogramaci Children's Hospital, Ankara, Turkey
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14
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Pseudomonas aeruginosa in the Cystic Fibrosis Lung. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1386:347-369. [DOI: 10.1007/978-3-031-08491-1_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Mésinèle J, Ruffin M, Kemgang A, Guillot L, Boëlle PY, Corvol H. Risk factors for Pseudomonas aeruginosa airway infection and lung function decline in children with cystic fibrosis. J Cyst Fibros 2021; 21:45-51. [PMID: 34629287 DOI: 10.1016/j.jcf.2021.09.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/31/2021] [Accepted: 09/22/2021] [Indexed: 12/11/2022]
Abstract
Background Cystic fibrosis (CF) lung disease is characterised by recurrent Pseudomonas aeruginosa (Pa) infections, leading to structural lung damage and decreased survival. The epidemiology of Pa infection and its impact on lung function in people with CF (pwCF), especially in recent birth cohorts, remain uncertain. Methods We included 1,231 French pwCF under 18 years of age. Age at initial acquisition (Pa-IA), chronic colonisation (Pa-CC), and duration from Pa-IA to Pa-CC were estimated using the Kaplan-Meier method. Demographic, clinical, and genetic characteristics were analysed as risk factors for Pa infection using Cox regression models. Lung function decline was assessed by modelling percent-predicted forced expiratory volume in 1 s (ppFEV1) before Pa infection, after Pa-IA, and after Pa-CC. Results Among the 1,231 pwCF, 50% had Pa-IA by the age of 5.1 years [95% confidence interval (CI) 3.8-6.2] and 25% had Pa-CC by the age of 14.7 years (95% CI 12.1 to ∞). We observed that CF-related diabetes and liver disease were risk factors for Pa, while gender, CFTR variants, and CF centre size were not. Genetic variants of TNF, DCTN4, SLC9A3, and CAV2 were confirmed to be associated with Pa. The annual rate of ppFEV1 decline before Pa was -0.38% predicted/year (95% CI -0.59 to -0.18), which decreased significantly after Pa-IA to -0.93% predicted/year (95% CI -1.14 to -0.71) and after Pa-CC to -1.51% predicted/year (95% CI -1.86 to -1.16). Conclusions We identified and replicated several risk factors associated with Pa infection and showed its deleterious impact on lung function in young pwCF. This large-scale study confirmed that Pa airway infection is a major determinant of lung disease severity.
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Affiliation(s)
- Julie Mésinèle
- Sorbonne Université, INSERM UMR S_938, Centre de Recherche Saint-Antoine (CRSA), Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, APHP, Hôpital Saint-Antoine, Paris, France
| | - Manon Ruffin
- Sorbonne Université, INSERM UMR S_938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Astrid Kemgang
- Sorbonne Université, INSERM UMR S_938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Loïc Guillot
- Sorbonne Université, INSERM UMR S_938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
| | - Pierre-Yves Boëlle
- Sorbonne Université, Inserm, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, APHP, Hôpital Saint-Antoine, Paris, France
| | - Harriet Corvol
- Sorbonne Université, INSERM UMR S_938, Centre de Recherche Saint-Antoine (CRSA), Paris, France; AP-HP, Hôpital Trousseau, Service de Pneumologie Pédiatrique, Paris, France.
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16
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Loukou I, Moustaki M, Sardeli O, Plyta M, Katsagoni CN, Douros K. Association of vitamin A status with lung function in children and adolescents with cystic fibrosis. Pediatr Investig 2021; 5:125-129. [PMID: 34179709 PMCID: PMC8212758 DOI: 10.1002/ped4.12270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/28/2021] [Indexed: 11/06/2022] Open
Abstract
IMPORTANCE Vitamin A (or retinol) has considerable antioxidative and anti-inflammatory attributes and it may have protective effects on the respiratory health of patients with cystic fibrosis (CF). This issue, however, remains controversial. OBJECTIVE The purpose of the present study was to investigate the relationship between serum retinol levels (SRL) and force expiratory volume in 1 second (FEV1) in patients with CF. METHODS All patients with pancreatic insufficiency attending the CF Department of "Agia Sofia" Children's Hospital in Athens, Greece, aged 6 to 19 years during the 2012-2016 period, who could perform spirometry effectively, were included in the study. The impact of SRL on FEV1 was examined longitudinally and analyzed with generalized estimating equations. RESULTS The study included 231 patients and 851 SRL measurements were performed. In 25 (3.2%) cases the SRL were below the 5th percentile of reference distribution; none was above the 95th percentile. The analysis showed that SRL was positively correlated with the FEV1 (P < 0.001). INTERPRETATION In this sample of children and adolescents with CF, vitamin A deficiency was rare. Our results suggest a positive relationship between SRL and FEV1.
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Affiliation(s)
- Ioanna Loukou
- Cystic Fibrosis Department“Agia Sofia” Children’s HospitalAthensGreece
| | - Maria Moustaki
- Cystic Fibrosis Department“Agia Sofia” Children’s HospitalAthensGreece
| | - Olympia Sardeli
- Pediatric Allergy and Respiratory UnitThird Department of Pediatrics“Attikon” University HospitalNational and Kapodistrian University of AthensSchool of MedicineAthensGreece
| | - Marina Plyta
- Cystic Fibrosis Department“Agia Sofia” Children’s HospitalAthensGreece
| | | | - Konstantinos Douros
- Pediatric Allergy and Respiratory UnitThird Department of Pediatrics“Attikon” University HospitalNational and Kapodistrian University of AthensSchool of MedicineAthensGreece
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17
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Anderson JD, Liu Z, Odom LV, Kersh L, Guimbellot JS. CFTR function and clinical response to modulators parallel nasal epithelial organoid swelling. Am J Physiol Lung Cell Mol Physiol 2021; 321:L119-L129. [PMID: 34009038 DOI: 10.1152/ajplung.00639.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
In vitro biomarkers to assess cystic fibrosis transmembrane conductance regulator activity are desirable for precision modulator selection and as a tool for clinical trials. Here, we describe an organoid swelling assay derived from human nasal epithelia using commercially available reagents and equipment and an automated imaging process. Cells were collected in nasal brush biopsies, expanded in vitro, and cultured as spherical organoids or as monolayers. Organoids were used in a functional swelling assay with automated measurements and analysis, whereas monolayers were used for short-circuit current measurements to assess ion channel activity. Clinical data were collected from patients on modulators. Relationships between swelling data and short-circuit current, as well as between swelling data and clinical outcome measures, were assessed. The organoid assay measurements correlated with short-circuit current measurements for ion channel activity. The functional organoid assay distinguished individual responses as well as differences between groups. The organoid assay distinguished incremental drug responses to modulator monotherapy with ivacaftor and combination therapy with ivacaftor, tezacaftor, and elexacaftor. The swelling activity paralleled the clinical response. In conclusion, an in vitro biomarker derived from patients' cells can be used to predict responses to drugs and is likely to be useful as a preclinical tool to aid in the development of novel treatments and as a clinical trial outcome measure for a variety of applications, including gene therapy or editing.
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Affiliation(s)
- Justin D Anderson
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Zhongyu Liu
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - L Victoria Odom
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Latona Kersh
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jennifer S Guimbellot
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama.,Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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18
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Sherrard LJ, Wee BA, Duplancic C, Ramsay KA, Dave KA, Ballard E, Wainwright CE, Grimwood K, Sidjabat HE, Whiley DM, Beatson SA, Kidd TJ, Bell SC. Emergence and impact of oprD mutations in Pseudomonas aeruginosa strains in cystic fibrosis. J Cyst Fibros 2021; 21:e35-e43. [PMID: 33775602 DOI: 10.1016/j.jcf.2021.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antimicrobial resistance in cystic fibrosis (CF) Pseudomonas aeruginosa airway infection is complex and often attributed to chromosomal mutations. How these mutations emerge in specific strains or whether particular gene mutations are clinically informative is unclear. This study focused on oprD, which encodes an outer membrane porin associated with carbapenem resistance when it is downregulated or inactivated. AIM Determine how mutations in oprD emerge in two prevalent Australian shared CF strains of P. aeruginosa and their clinical relevance. METHODS The two most common shared CF strains in Queensland were investigated using whole genome sequencing and their oprD sequences and antimicrobial resistance phenotypes were established. P. aeruginosa mutants with the most common oprD variants were constructed and characterised. Clinical variables were compared between people with or without evidence of infection with strains harbouring these variants. RESULTS Frequently found nonsense mutations arising from a 1-base pair substitution in oprD evolved independently in three sub-lineages, and are likely major contributors to the reduced carbapenem susceptibility observed in the clinical isolates. Lower baseline FEV1 %predicted was identified as a risk factor for infection with a sub-lineage (odds ratio=0.97; 95% confidence interval 0.96-0.99; p<0.001). However, acquiring these sub-lineage strains did not confer an accelerated decline in FEV1 nor increase the risk of death/lung transplantation. CONCLUSIONS Sub-lineages harbouring specific mutations in oprD have emerged and persisted in the shared strain populations. Infection with the sub-lineages was more likely in people with lower lung function, but this was not predictive of a worse clinical trajectory.
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Affiliation(s)
| | - Bryan A Wee
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | | | - Kay A Ramsay
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Keyur A Dave
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Claire E Wainwright
- Faculty of Medicine, The University of Queensland, Brisbane, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia; Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Australia
| | - Hanna E Sidjabat
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - David M Whiley
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Pathology Queensland Central Laboratory, Brisbane, Australia
| | - Scott A Beatson
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia; Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia; Australian Centre for Ecogenomics, The University of Queensland, Brisbane, Australia
| | - Timothy J Kidd
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia.
| | - Scott C Bell
- QIMR Berghofer Medical Research Institute, Brisbane, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Australia; Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, Australia; Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia.
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19
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Konishi CT, Long C. Progress and challenges in CRISPR-mediated therapeutic genome editing for monogenic diseases. J Biomed Res 2020; 35:148-162. [PMID: 33402545 PMCID: PMC8038532 DOI: 10.7555/jbr.34.20200105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
There are an estimated 10 000 monogenic diseases affecting tens of millions of individuals worldwide. The application of CRISPR/Cas genome editing tools to treat monogenic diseases is an emerging strategy with the potential to generate personalized treatment approaches for these patients. CRISPR/Cas-based systems are programmable and sequence-specific genome editing tools with the capacity to generate base pair resolution manipulations to DNA or RNA. The complexity of genomic insults resulting in heritable disease requires patient-specific genome editing strategies with consideration of DNA repair pathways, and CRISPR/Cas systems of different types, species, and those with additional enzymatic capacity and/or delivery methods. In this review we aim to discuss broad and multifaceted therapeutic applications of CRISPR/Cas gene editing systems including in harnessing of homology directed repair, non-homologous end joining, microhomology-mediated end joining, and base editing to permanently correct diverse monogenic diseases.
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Affiliation(s)
- Colin T Konishi
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Chengzu Long
- Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY 10016, USA.,Helen and Martin Kimmel Center for Stem Cell Biology, New York University Grossman School of Medicine, New York, NY 10016, USA.,Department of Neurology, New York University Grossman School of Medicine, New York, NY 10016, USA.,Department of Neuroscience and Physiology, New York University Grossman School of Medicine, New York, NY 10016, USA
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Jackson L, Waters V. Factors influencing the acquisition and eradication of early Pseudomonas aeruginosa infection in cystic fibrosis. J Cyst Fibros 2020; 20:8-16. [PMID: 33172756 DOI: 10.1016/j.jcf.2020.10.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/02/2020] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
In recent years considerable improvements have been made in increasing the life expectancy of patients with cystic fibrosis. New highly effective modulator therapies targeting the underlying defect in the cystic fibrosis transmembrane conductance regulator protein are expected to enhance lifespan even further. However, chronic Pseudomonas aeruginosa pulmonary infections continue to threaten CF patient lung health and mortality rates. Early and aggressive antibiotic eradication therapies targeting P. aeruginosa are standard practice, but these eradication therapies fail in 10-40% of patients. The reasons for P. aeruginosa eradication failure remain unclear. Thus, this review summarizes the evidence to date for pseudomonal acquisition and eradication failure in the cystic fibrosis lung. A complex combination of host and bacterial factors are responsible for initial establishment of P. aeruginosa pulmonary infections. Moreover, host and pseudomonal factors, polymicrobial interactions, and antimicrobial limitations in relation to P. aeruginosa eradication therapy failure are summarized.
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Affiliation(s)
- Lindsay Jackson
- Translational Medicine, Hospital for Sick Children, Toronto, Canada.
| | - Valerie Waters
- Translational Medicine, Hospital for Sick Children, Toronto, Canada; Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada
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21
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Risk factors for respiratory Aspergillus fumigatus in German Cystic Fibrosis patients and impact on lung function. Sci Rep 2020; 10:18999. [PMID: 33149181 PMCID: PMC7643137 DOI: 10.1038/s41598-020-75886-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/23/2020] [Indexed: 01/01/2023] Open
Abstract
Airway inflammation and chronic lung infections in cystic fibrosis (CF) patients are mostly caused by bacteria, e.g. Pseudomonas aeruginosa (PA). The role of fungi in the CF lung is still not well elucidated, but evidence for a harmful and complex role is getting stronger. The most common filamentous fungus in CF is Aspergillus fumigatus (AF). Age and continuous antibiotic treatment have been discussed as risk factors for AF colonisation but did not differentiate between transient and persistent AF colonisation. Also, the impact of co-colonisation of PA and AF on lung function is still under investigation. Data from patients with CF registered in the German Cystic Fibrosis Registry database in 2016 and 2017 were retrospectively analysed, involving descriptive and multivariate analysis to assess risk factors for transient or persistent AF colonisation. Age represented an independent risk factor for persistent AF colonisation. Prevalence was low in children less than ten years, highest in the middle age and getting lower in higher age (≥ 50 years). Continuous antibiotic lung treatment was significantly associated with AF prevalence in all age groups. CF patients with chronic PA infection had a lower lung function (FEV1%predicted), which was not influenced by an additional AF colonisation. AF colonisation without chronic PA infection, however, was significantly associated with a lower function, too. Older age up to 49 years and continuous antibiotic use were found to be the main risk factors for AF permanent colonisation. AF might be associated with decrease of lung function if not disguised by chronic PA infection.
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22
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Cui X, Wu X, Li Q, Jing X. Mutations of the cystic fibrosis transmembrane conductance regulator gene in males with congenital bilateral absence of the vas deferens: Reproductive implications and genetic counseling (Review). Mol Med Rep 2020; 22:3587-3596. [PMID: 33000223 PMCID: PMC7533508 DOI: 10.3892/mmr.2020.11456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/21/2020] [Indexed: 11/05/2022] Open
Abstract
Congenital bilateral absence of the vas deferens (CBAVD) is predominantly caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. CBAVD accounts for 2–6% of male infertility cases and up to 25% of cases of obstructive azoospermia. With the use of pre-implantation genetic diagnosis, testicular or epididymal sperm aspiration, intracytoplasmic sperm injection and in vitro fertilization, patients affected by CBAVD are able to have children who do not carry CFTR gene mutations, thereby preventing disease. Therefore, genetic counseling should be provided to couples receiving assisted reproductive techniques to discuss the impact of CFTR gene mutations on reproductive health. In the present article, the current literature concerning the CFTR gene and its association with CBAVD is reviewed.
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Affiliation(s)
- Xiangrong Cui
- Reproductive Medicine Center, Children's Hospital of Shanxi and Women's Health Center of Shanxi, Taiyuan, Shanxi 030001, P.R. China
| | - Xueqing Wu
- Reproductive Medicine Center, Children's Hospital of Shanxi and Women's Health Center of Shanxi, Taiyuan, Shanxi 030001, P.R. China
| | - Qiang Li
- Reproductive Medicine Center, Children's Hospital of Shanxi and Women's Health Center of Shanxi, Taiyuan, Shanxi 030001, P.R. China
| | - Xuan Jing
- Clinical Laboratory, Shanxi Province People's Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
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23
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Sismanlar Eyuboglu T, Dogru D, Çakır E, Cobanoglu N, Pekcan S, Cinel G, Yalçın E, Kiper N, Sen V, Selimoglu Sen H, Ercan O, Keskin O, Bilgic Eltan S, Alshadfan L, Yazan H, Altıntas DU, Sasihuseyinoglu AS, Sapan N, Cekic S, Cokugraş H, Kılınc AA, Ramaslı Gursoy T, Aslan AT, Bingol A, Başaran AE, Ozdemir A, Kose M, Hangul M, Emiralioglu N, Tugcu G, Yuksel H, Yılmaz O, Orhan F, Gayretli Aydın ZG, Topal E, Tamay Z, Suleyman A, Can D, Bal CM, Caltepe G, Ozcelik U. Clinical features and accompanying findings of Pseudo-Bartter Syndrome in cystic fibrosis. Pediatr Pulmonol 2020; 55:2011-2016. [PMID: 32364312 DOI: 10.1002/ppul.24805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pseudo-Bartter syndrome (PBS) is a rare complication of cystic fibrosis (CF) and there are limited data in the literature about it. We aimed to compare clinical features and accompanying findings of patients with PBS in a large patient population. METHODS The data were collected from the Cystic Fibrosis Registry of Turkey where 1170 CF patients were recorded in 2017. Clinical features, diagnostic test results, colonization status, complications, and genetic test results were compared in patients with and without PBS. RESULTS Totally 1170 patients were recorded into the registry in 2017 and 120 (10%) of them had PBS. The mean age of diagnosis and current age of patients were significantly younger and newborn screening positivity was lower in patients with PBS (P < .001). There were no differences between the groups in terms of colonization status, mean z-scores of weight, height, BMI, and mean FEV1 percentage. Types of genetic mutations did not differ between the two groups. Accompanying complications were more frequent in patients without PBS. CONCLUSION PBS was detected as the most common complication in the registry. It could be due to warm weather conditions of our country. It is usually seen in younger ages regardless of mutation phenotype and it could be a clue for early diagnosis of CF.
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Affiliation(s)
| | - Deniz Dogru
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Erkan Çakır
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Nazan Cobanoglu
- Department of Pediatric Pulmonology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sevgi Pekcan
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Guzin Cinel
- Department of Pediatric Pulmonology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ebru Yalçın
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nural Kiper
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Velat Sen
- Department of Pediatric Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Hadice Selimoglu Sen
- Department of Pulmonology, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Omur Ercan
- Department of Pediatric Pulmonology, Meram Medicine Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Ozlem Keskin
- Department of Pediatric Allergy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Sevgi Bilgic Eltan
- Department of Pediatric Allergy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Lina Alshadfan
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, İstanbul, Turkey
| | - Derya Ufuk Altıntas
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | | | - Nihat Sapan
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Sükrü Cekic
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Haluk Cokugraş
- Department of Pediatric Allergy and Pulmonology, Cerrahpasa Medicine Faculty, İstanbul University, İstanbul, Turkey
| | - Ayşe Ayzıt Kılınc
- Department of Pediatric Allergy and Pulmonology, Cerrahpasa Medicine Faculty, İstanbul University, İstanbul, Turkey
| | - Tugba Ramaslı Gursoy
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayse Tana Aslan
- Department of Pediatric Pulmonology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Aysen Bingol
- Department of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Abdurrahman Erdem Başaran
- Department of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ali Ozdemir
- Department of Pediatric Pulmonology, Mersin City Research & Training Hospital, Mersin, Turkey
| | - Mehmet Kose
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Melih Hangul
- Department of Pediatric Pulmonology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Nagehan Emiralioglu
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gokçen Tugcu
- Department of Pediatric Pulmonology, Ankara Children's Hematology Oncology Training and Research Hospital, Ankara, Turkey
| | - Hasan Yuksel
- Department of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Ozge Yılmaz
- Department of Pediatric Pulmonology, Allergy and Immunology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Fazıl Orhan
- Department of Pediatric Allergy, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Zeynep Gokce Gayretli Aydın
- Department of Pediatric Infectious Disease, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Erdem Topal
- Department of Pediatric Allergy, Faculty of Medicine, İnonu University, Malatya, Turkey
| | - Zeynep Tamay
- Department of Pediatric Allergy and Immunology, İstanbul Facultyof Medicine, İstanbul University, İstanbul, Turkey
| | - Ayse Suleyman
- Department of Pediatric Allergy and Immunology, İstanbul Facultyof Medicine, İstanbul University, İstanbul, Turkey
| | - Demet Can
- Department of Pediatric Pulmonology, Faculty of Medicine, Balıkesir University, Balıkesir, Turkey
| | - Cem Murat Bal
- Department of Pediatric Pulmonology, Doctor Lufti Kirdar Kartal Training and Research Hospital, ıstanbul, Turkey
| | - Gönül Caltepe
- Department of Pediatric Gastroenterology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Uğur Ozcelik
- Department of Pediatric Pulmonology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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24
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Loukou I, Moustaki M, Sardeli O, Plyta M, Douros K. Association of vitamin D status with lung function measurements in children and adolescents with cystic fibrosis. Pediatr Pulmonol 2020; 55:1375-1380. [PMID: 31338968 DOI: 10.1002/ppul.24460] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/09/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vitamin D status is considered a potential determinant of lung function in cystic fibrosis (CF). The aim of this retrospective longitudinal study was to investigate the decline of spirometric values in association with vitamin D status. METHODS The data regarding 25-hydroxy vitamin D (25OHD) serum levels, spirometric measurements (FEV1, FVC, FEF25-75%), and factors known to be associated with the decline of lung function in CF were retrospectively collected over a 5-year period. The spirometric indices were recorded as the best and the average value of each year, as well as the value, recorded concurrently or closely with 25OHD level measurement. RESULTS A significantly positive relationship was observed between 25OHD serum levels and the best annual value of FEV1 (P = .034), and the values of FEV1 (P = .010) and FVC (P = .018) measured concurrently or closely with serum 25OHD levels. The evolution of the best annual value of FEV1 was worse in patients with a mean 5-year value of 25OHD levels less than 20 ng/mL compared with patients with a mean 5-year value of ≥30 ng/mL (P < .001), or ≥20 to <30 (P < .001). There was no significant difference between patients with mean 5-year 25OHD levels ≥30 ng/mL and ≥20 to <30 ng/mL (P = .76). CONCLUSIONS Vitamin D status is associated with lung function in patients with CF. Levels of 25OHD above 20 ng/mL were associated with higher best annual FEV1.
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Affiliation(s)
- Ioanna Loukou
- Cystic Fibrosis Department, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Maria Moustaki
- Cystic Fibrosis Department, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Olympia Sardeli
- Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athen, Athens, Greece
| | - Marina Plyta
- Cystic Fibrosis Department, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Konstantinos Douros
- Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athen, Athens, Greece
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25
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Geurts MH, de Poel E, Amatngalim GD, Oka R, Meijers FM, Kruisselbrink E, van Mourik P, Berkers G, de Winter-de Groot KM, Michel S, Muilwijk D, Aalbers BL, Mullenders J, Boj SF, Suen SWF, Brunsveld JE, Janssens HM, Mall MA, Graeber SY, van Boxtel R, van der Ent CK, Beekman JM, Clevers H. CRISPR-Based Adenine Editors Correct Nonsense Mutations in a Cystic Fibrosis Organoid Biobank. Cell Stem Cell 2020; 26:503-510.e7. [PMID: 32084388 DOI: 10.1016/j.stem.2020.01.019] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 12/11/2019] [Accepted: 01/27/2020] [Indexed: 02/06/2023]
Abstract
Adenine base editing (ABE) enables enzymatic conversion from A-T into G-C base pairs. ABE holds promise for clinical application, as it does not depend on the introduction of double-strand breaks, contrary to conventional CRISPR/Cas9-mediated genome engineering. Here, we describe a cystic fibrosis (CF) intestinal organoid biobank, representing 664 patients, of which ~20% can theoretically be repaired by ABE. We apply SpCas9-ABE (PAM recognition sequence: NGG) and xCas9-ABE (PAM recognition sequence: NGN) on four selected CF organoid samples. Genetic and functional repair was obtained in all four cases, while whole-genome sequencing (WGS) of corrected lines of two patients did not detect off-target mutations. These observations exemplify the value of large, patient-derived organoid biobanks representing hereditary disease and indicate that ABE may be safely applied in human cells.
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Affiliation(s)
- Maarten H Geurts
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands; Oncode Institute, Hubrecht Institute, 3584 CT Utrecht, the Netherlands
| | - Eyleen de Poel
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands; Regenerative Medicine Utrecht, University Medical Center, Utrecht University, 3584 CT Utrecht, the Netherlands
| | - Gimano D Amatngalim
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands; Regenerative Medicine Utrecht, University Medical Center, Utrecht University, 3584 CT Utrecht, the Netherlands
| | - Rurika Oka
- Princess Maxima Center, 3584 CS Utrecht, the Netherlands; Oncode Institute, Princess Maxima Center, 3584 CS Utrecht, the Netherlands
| | - Fleur M Meijers
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands; Regenerative Medicine Utrecht, University Medical Center, Utrecht University, 3584 CT Utrecht, the Netherlands
| | - Evelien Kruisselbrink
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands; Regenerative Medicine Utrecht, University Medical Center, Utrecht University, 3584 CT Utrecht, the Netherlands
| | - Peter van Mourik
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands
| | - Gitte Berkers
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands
| | - Karin M de Winter-de Groot
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands
| | - Sabine Michel
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands
| | - Danya Muilwijk
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands
| | - Bente L Aalbers
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands
| | | | - Sylvia F Boj
- Hubrecht Organoid Technology, 3584 CM, Utrecht, the Netherlands
| | - Sylvia W F Suen
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands; Regenerative Medicine Utrecht, University Medical Center, Utrecht University, 3584 CT Utrecht, the Netherlands
| | - Jesse E Brunsveld
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands; Regenerative Medicine Utrecht, University Medical Center, Utrecht University, 3584 CT Utrecht, the Netherlands
| | - Hettie M Janssens
- Department of Pediatrics, division of Respiratory Medicine and Allergology, ErasmusMC-Sophia Children's Hospital, University Hospital Rotterdam, 3015 GD Rotterdam, the Netherlands
| | - Marcus A Mall
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Simon Y Graeber
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Ruben van Boxtel
- Princess Maxima Center, 3584 CS Utrecht, the Netherlands; Oncode Institute, Princess Maxima Center, 3584 CS Utrecht, the Netherlands
| | - Cornelis K van der Ent
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands
| | - Jeffrey M Beekman
- Department of Pediatric Respiratory Medicine, Wilhelmina Children's Hospital, University Medical Center, Utrecht University, 3584 EA Utrecht, the Netherlands; Regenerative Medicine Utrecht, University Medical Center, Utrecht University, 3584 CT Utrecht, the Netherlands.
| | - Hans Clevers
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW) and University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands; Oncode Institute, Hubrecht Institute, 3584 CT Utrecht, the Netherlands.
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26
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Chloride Conductance, Nasal Potential Difference and Cystic Fibrosis Pathophysiology. Lung 2019; 198:151-156. [PMID: 31734731 DOI: 10.1007/s00408-019-00293-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/05/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Cystic fibrosis (CF) is a multisystem genetic disease caused by dysfunction of the epithelial anionic channel Cystic Fibrosis Transmembrane conductance Regulator (CFTR). Decreased mucociliary clearance because of thickened mucus is part of the pulmonary disease pathophysiology. It is controversial if the thickened airway surface liquid (ASL) is caused by the deficient chloride secretion and excessive sodium (through ENaC) and water hyperabsorption from the periciliar fluid or by the lack of bicarbonate secretion with relative acidification of the ASL. Correlations between the magnitude of in vivo chloride conductance with phenotypic characteristics and CF genotype can help to elucidate these mechanisms and direct to new treatments. METHODS Nasal potential difference was measured in 28 CF patients (age from 0.3 to 28 year) and correlated with pulmonary function, pancreatic phenotype, pulmonary colonization and genotype severity. RESULTS The CFTR-chloride conductance was better in older patients (r = 0.40; P = 0.03), in patients with better pulmonary function (r = 0.48; P = 0.01), and was associated with genotype severity. Higher chloride diffusion in the presence of a favorable chemical gradient was associated with Pseudomonas aeruginosa negativity (P < 0.05). More negative NPDmax was associated with pancreatic insufficiency (P < 0.01) as well with genotype severity, but not with the pulmonary function. CONCLUSIONS The anion permeability through CFTR, mainly chloride, but bicarbonate as well, is the most critical factor in CF airway pathophysiology. Treatments primarily directed to correct CFTR function and/or airway acidity are clearly a priority.
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27
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A real world evaluation of the long-term efficacy of strategies to prevent chronic Pseudomonas aeruginosa pulmonary infection in children with cystic fibrosis. Int J Infect Dis 2019; 85:92-97. [PMID: 31132474 DOI: 10.1016/j.ijid.2019.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Children with cystic fibrosis (CF) are susceptible to chronic Pseudomonas aeruginosa (PA) infection. Early eradication of PA has proven short-term efficacy. No studies have evaluated the long- term impact of early eradication for CF patients, particularly those diagnosed by newborn screening (NBS). Our objective was to quantify the long-term impact of early PA eradication on the risk of chronic PA infection in children (0-18 years old) with CF prior to and following the introduction of a province-wide NBS program. METHODS This 20-year retrospective cohort study compared 94 patients eligible for treatment with inhaled tobramycin at first PA isolation ("recent cohort") with 27 historical controls ("historical cohort"). RESULTS A smaller proportion of patients in the recent cohort developed chronic PA (24% versus 78%; P<0.001); the adjusted risk of chronic infection was 2.90 (95%CI 1.47, 5.76; P=0.002) in the historical vs recent cohort. However, NBS was not independently associated with the risk of chronic PA infection after its introduction. CONCLUSIONS Early eradication of PA, irrespective of early diagnosis, is associated with reduced risk of chronic PA. However, concomitant improvements in medical care since the introduction of early eradication protocols may have contributed to these long-term observed benefits.
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28
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Sherrard LJ, Einarsson GG, Johnston E, O'Neill K, McIlreavey L, McGrath SJ, Gilpin DF, Downey DG, Reid A, McElvaney NG, Boucher RC, Muhlebach MS, Elborn JS, Tunney MM. Assessment of stability and fluctuations of cultured lower airway bacterial communities in people with cystic fibrosis. J Cyst Fibros 2019; 18:808-816. [PMID: 30905581 DOI: 10.1016/j.jcf.2019.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Routine clinical culture detects a subset of the cystic fibrosis (CF) airways microbiota based on culture-independent (molecular) methods. This study aimed to determine how extended sputum culture of viable bacteria changes over time in relation to clinical status and predicts exacerbations. METHODS Sputa from patients at a baseline stable and up to three subsequent time-points were analysed by extended-quantitative culture; aerobe/anaerobe densities, ecological indexes and community structure were assessed together with clinical outcomes. RESULTS Eighty patients were prospectively recruited. Sputa were successfully collected and cultured at 199/267 (74.5%) study visits. Eighty-two sputa from 25 patients comprised a complete sample-set for longitudinal analyses. Bacterial density, ecological indexes and clinical outcomes were unchanged in 18 patients with three sequential stable visits. Conversely, in 7 patients who had an exacerbation, total bacterial and aerobe densities differed over four study visits (P < .001) with this difference particularly apparent between the baseline visit and completion of acute antibiotic treatment where a decrease in density was observed. Bacterial communities were more similar within than between patients but stable patients had the least variation in community structure over time. Using logistic regression in a further analysis, baseline features in 37 patients without compared to 15 patients with a subsequent exacerbation showed that clinical measures rather than bacterial density or ecological indexes were independent predictors of an exacerbation. CONCLUSIONS Greater fluctuation in the viable bacterial community during treatment of an exacerbation than between stable visits was observed. Extended-quantitative culture did not provide prognostic information of a future exacerbation.
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Affiliation(s)
- Laura J Sherrard
- Halo Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK.
| | - Gisli G Einarsson
- Halo Research Group, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Elinor Johnston
- Halo Research Group, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Katherine O'Neill
- Halo Research Group, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Leanne McIlreavey
- Halo Research Group, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Stephanie J McGrath
- Halo Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Deirdre F Gilpin
- Halo Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Damian G Downey
- Halo Research Group, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK; Belfast Health and Social Care Trust, Belfast, UK
| | | | - Noel G McElvaney
- Respiratory Research Division, Department of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Richard C Boucher
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marianne S Muhlebach
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Stuart Elborn
- Halo Research Group, Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK; Imperial College and Royal Brompton Hospital and Harefield NHS Foundation Trust, London, UK
| | - Michael M Tunney
- Halo Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Johnson B, Ngueyep R, Schechter MS, Serban N, Swann J. Does distance to a cystic fibrosis center impact health outcomes? Pediatr Pulmonol 2018; 53:284-292. [PMID: 29359447 DOI: 10.1002/ppul.23940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/20/2017] [Indexed: 01/17/2023]
Abstract
INTRODUCTION This paper considers the impact of geographic distance from cystic fibrosis centers on lung function in children, young adults, and adults with cystic fibrosis. METHODS Clinical patient-level data on 20 351 patients from 1986 to 2011 were evaluated from the Cystic Fibrosis Foundation National Patient Registry. We measure distance using a patient's zip code centroid to the center where they received care. A heteroscedastic mixed effects model was used to capture the association of distance with longitudinal variation in patients' lung function. RESULTS Children, young adults, and adults in lower socioeconomic categories had a %FEV1 between 3 and 10 percentage-points lower than those living in higher income areas and those privately insured. For patients who changed distance categories, high distance was associated with lower lung function in young adults (P-value <0.001). For older patients we observed the reverse, suggesting that the choice to move farther away is associated with better health (P-value <0.001). For patients who did not change distance categories, only medium distance in children was significant (P-value = 0.01). Known confounding factors including age and CFTR mutation class were statistically significantly associated to health outcomes (P-value <0.001). CONCLUSIONS This study shows distance is not found to be associated with health lung function among patients whose distance category remained unchanged during the analysis. For patients who move, the association of health with distance depends on the age of the patient; adult patients further from their care center are healthier. Overall, we find that socioeconomic and genetic factors appear to impact health outcomes to a greater extent.
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Affiliation(s)
| | | | - Michael S Schechter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
| | - Nicoleta Serban
- Georgia Institute of Technology, H. Milton Stewart School of Industrial and Systems Engineering, Atlanta, Georgia
| | - Julie Swann
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, North Carolina
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Espel JC, Palac HL, Bharat A, Cullina J, Prickett M, Sala M, McColley SA, Jain M. The relationship between sweat chloride levels and mortality in cystic fibrosis varies by individual genotype. J Cyst Fibros 2017; 17:34-42. [PMID: 29221674 DOI: 10.1016/j.jcf.2017.11.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/09/2017] [Accepted: 11/09/2017] [Indexed: 01/20/2023]
Abstract
RATIONALE The association between CFTR genotype, sweat chloride and mortality has been inconsistent, but no previous analyses have examined the association stratified by individual genotypes. OBJECTIVES To evaluate the genotype-specific association between sweat chloride and mortality. METHODS The CFF Patient Registry was assessed and included all patients in the registry between 1996 and 2012 with at least one F508del allele. We excluded patients without a documented genotype or plausible sweat chloride level. The primary outcome was time to mortality during the observation period. We examined 15 genotypes using the three most prevalent alleles in each of 5 classes. We compared subgroups of sweat chloride using Kaplan-Meier curves, log-rank tests, and multivariable Cox PH models. The overall predictive value of sweat chloride on mortality was assessed using area under the receiver operating characteristic curves. MEASUREMENTS AND MAIN RESULTS 18,893 subjects met inclusion criteria. Sweat chloride distribution was similar across genotypes in patients with class 1 mutations, but was significantly different across genotypes in mutation classes 2-5. The R117H/F508del genotype patients demonstrated an association between sweat chloride and mortality (HR: 1.32 for every 10mmol/L increase in sweat chloride [95% CI 1.12-1.54]. There were also significant associations in patients with F508del/F508del, I507del/F508del, G551D/F508del and 2789+5G→A/F508del genotypes, though the clinical relevance for these genotypes is unclear. CONCLUSIONS There is significant variability in sweat chloride distribution across CFTR class 2-5 genotypes. The relationship between sweat chloride and mortality varies by genotype with a relatively strong relationship in R117H/F508del patients.
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Affiliation(s)
- Julia C Espel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Hannah L Palac
- Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Michelle Prickett
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Marc Sala
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Manu Jain
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
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Organization of Patient Management and Fungal Epidemiology in Cystic Fibrosis. Mycopathologia 2017; 183:7-19. [PMID: 29098487 PMCID: PMC7089279 DOI: 10.1007/s11046-017-0205-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/26/2017] [Indexed: 12/26/2022]
Abstract
The achievement of a better life for cystic fibrosis (CF) patients is mainly caused by a better management and infection control over the last three decades. Herein, we want to summarize the cornerstones for an effective management of CF patients and to give an overview of the knowledge about the fungal epidemiology in this clinical context in Europe. Data from a retrospective analysis encompassing 66,616 samples from 3235 CF patients followed-up in 9 CF centers from different European countries are shown.
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Pranke IM, Hatton A, Simonin J, Jais JP, Le Pimpec-Barthes F, Carsin A, Bonnette P, Fayon M, Stremler-Le Bel N, Grenet D, Thumerel M, Mazenq J, Urbach V, Mesbahi M, Girodon-Boulandet E, Hinzpeter A, Edelman A, Sermet-Gaudelus I. Correction of CFTR function in nasal epithelial cells from cystic fibrosis patients predicts improvement of respiratory function by CFTR modulators. Sci Rep 2017; 7:7375. [PMID: 28785019 PMCID: PMC5547155 DOI: 10.1038/s41598-017-07504-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/29/2017] [Indexed: 11/09/2022] Open
Abstract
Clinical studies with modulators of the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) protein have demonstrated that functional restoration of the mutated CFTR can lead to substantial clinical benefit. However, studies have shown highly variable patient responses. The objective of this study was to determine a biomarker predictive of the clinical response. CFTR function was assessed in vivo via nasal potential difference (NPD) and in human nasal epithelial (HNE) cultures by the response to Forskolin/IBMX and the CFTR potentiator VX-770 in short-circuit-current (∆IscF/I+V) experiments. CFTR expression was evaluated by apical membrane fluorescence semi-quantification. Isc measurements discriminated CFTR function between controls, healthy heterozygotes, patients homozygous for the severe F508del mutation and patients with genotypes leading to absent or residual function. ∆IscF/I+V correlated with CFTR cellular apical expression and NPD measurements. The CFTR correctors lumacaftor and tezacaftor significantly increased the ∆IscF/I+V response to about 25% (SEM = 4.4) of the WT-CFTR level and the CFTR apical expression to about 22% (SEM = 4.6) of the WT-CFTR level in F508del/F508del HNE cells. The level of CFTR correction in HNE cultures significantly correlated with the FEV1 change at 6 months in 8 patients treated with CFTR modulators. We provide the first evidence that correction of CFTR function in HNE cell cultures can predict respiratory improvement by CFTR modulators.
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Affiliation(s)
- Iwona M Pranke
- Inserm U1151 - CNRS UMR 8253 - team 2, Faculté de Médecine Paris Descartes, Paris, France
| | - Aurélie Hatton
- Inserm U1151 - CNRS UMR 8253 - team 2, Faculté de Médecine Paris Descartes, Paris, France
| | - Juliette Simonin
- Inserm U1151 - CNRS UMR 8253 - team 2, Faculté de Médecine Paris Descartes, Paris, France
| | - Jean Philippe Jais
- Biostatistics Department, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Françoise Le Pimpec-Barthes
- Service de Chirurgie Thoracique, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Ania Carsin
- Service de Pneumo-Pédiatrie, Hôpital de la Timonne, Marseille, France
| | | | - Michael Fayon
- Service de Pneumo-Pédiatrie, Hôpital Pellegrin, Bordeaux, France
| | | | | | - Matthieu Thumerel
- Service de Chirurgie Thoracique, Hôpital Pellegrin, Bordeaux, France
| | - Julie Mazenq
- Service de Pneumo-Pédiatrie, Hôpital de la Timonne, Marseille, France
| | - Valerie Urbach
- Inserm U1151 - CNRS UMR 8253 - team 2, Faculté de Médecine Paris Descartes, Paris, France
| | - Myriam Mesbahi
- Inserm U1151 - CNRS UMR 8253 - team 2, Faculté de Médecine Paris Descartes, Paris, France
| | - Emanuelle Girodon-Boulandet
- Service de génétique et biologie moléculaires, Hôpital Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandre Hinzpeter
- Inserm U1151 - CNRS UMR 8253 - team 2, Faculté de Médecine Paris Descartes, Paris, France
| | - Aleksander Edelman
- Inserm U1151 - CNRS UMR 8253 - team 2, Faculté de Médecine Paris Descartes, Paris, France
| | - Isabelle Sermet-Gaudelus
- Inserm U1151 - CNRS UMR 8253 - team 2, Faculté de Médecine Paris Descartes, Paris, France.
- Cystic Fibrosis Center, Hôpital Necker Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France.
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McGarry ME, Illek B, Ly NP, Zlock L, Olshansky S, Moreno C, Finkbeiner WE, Nielson DW. In vivo and in vitro ivacaftor response in cystic fibrosis patients with residual CFTR function: N-of-1 studies. Pediatr Pulmonol 2017; 52:472-479. [PMID: 28068001 PMCID: PMC5461115 DOI: 10.1002/ppul.23659] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 01/17/2023]
Abstract
RATIONALE Ivacaftor, a cystic fibrosis transmembrane conductance regulator (CFTR) potentiator, decreases sweat chloride concentration, and improves pulmonary function in 6% of cystic fibrosis (CF) patients with specific CFTR mutations. Ivacaftor increases chloride transport in many other CFTR mutations in non-human cells, if CFTR is in the epithelium. Some CF patients have CFTR in the epithelium with residual CFTR function. The effect of ivacaftor in these patients is unknown. METHODS This was a series of randomized, crossover N-of-1 trials of ivacaftor and placebo in CF patients ≥8 years old with potential residual CFTR function (intermediate sweat chloride concentration, pancreatic sufficient, or mild bronchiectasis on chest CT). Human nasal epithelium (HNE) was obtained via nasal brushing and cultured. Sweat chloride concentration change was the in vivo outcome. Chloride current change in HNE cultures with ivacaftor was the in vitro outcome. RESULTS Three subjects had decreased sweat chloride concentration (-14.8 to -40.8 mmol/L, P < 0.01). Two subjects had unchanged sweat chloride concentration. Two subjects had increased sweat chloride concentration (+23.8 and +27.3 mmol/L, P < 0.001); both were heterozygous for A455E and pancreatic sufficient. Only subjects with decreased sweat chloride concentration had increased chloride current in HNE cultures. CONCLUSIONS Some CF patients with residual CFTR function have decreased sweat chloride concentration with ivacaftor. Increased chloride current in HNE cultures among subjects with decreased sweat chloride concentrations may predict clinical response to ivacaftor. Ivacaftor can increase sweat chloride concentration in certain mutations with unclear clinical effect. Pediatr Pulmonol. 2017;52:472-479. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Meghan E McGarry
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, California
| | - Beate Illek
- Children's Hospital Oakland Research Institute, Oakland, California
| | - Ngoc P Ly
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, California
| | - Lorna Zlock
- Department of Pathology, University of California, San Francisco, California
| | - Sabrina Olshansky
- Children's Hospital Oakland Research Institute, Oakland, California.,College of Pharmacy, Touro University, Vallejo, California
| | - Courtney Moreno
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, California
| | - Walter E Finkbeiner
- Department of Pathology, University of California, San Francisco, California
| | - Dennis W Nielson
- Pediatric Pulmonology, Department of Pediatrics, University of California, San Francisco, California
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Ramsay KA, Sandhu H, Geake JB, Ballard E, O'Rourke P, Wainwright CE, Reid DW, Kidd TJ, Bell SC. The changing prevalence of pulmonary infection in adults with cystic fibrosis: A longitudinal analysis. J Cyst Fibros 2017; 16:70-77. [DOI: 10.1016/j.jcf.2016.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/20/2016] [Accepted: 07/23/2016] [Indexed: 12/29/2022]
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Early severe anemia as the first sign of cystic fibrosis. Eur J Pediatr 2016; 175:1157-1163. [PMID: 27496146 DOI: 10.1007/s00431-016-2752-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/27/2016] [Accepted: 07/12/2016] [Indexed: 01/17/2023]
Abstract
UNLABELLED Severe anemia is reported to occur rarely in patients with cystic fibrosis (CF). This study aimed to determine the factors associated with early severe anemia in infants with CF. This study included 231 infants with CF from 3 pediatric CF centers ten year period that were retrospectively reviewed in terms of severe anemia as the first sign of CF. Factors that could affect anemia, such as age, pancreatic insufficiency, mutations, vitamin A and E, and albumin level were evaluated. Clinical and laboratory findings in CF patients that presented with severe anemia and no respiratory symptoms were compared to those in CF patients that did not present with severe anemia. Severe anemia as the first sign of CF was noted in 17 of 231 patients. Patient age, prolonged PT/INR and the albumin level differed significantly between the 2 groups of patients (P < 0.001). Feeding pattern, pancreatic insufficiency, vitamin E and A levels, and the types of genetic mutations did not differ between the 2 groups. The mean hemoglobin level was 5.59 ± 0.21 g/dL and respiratory symptoms began a mean 6.3 months after diagnosis of CF in the anemia group. CONCLUSION In early infancy severe anemia in the absence of respiratory symptoms can be the first sign of CF. CF should be considered in the differential diagnosis of severe anemia in infants. Anemia can occur several months before respiratory symptoms in patients with CF and may be caused due to several reasons. WHAT IS KNOWN • Severe anemia as a first sign is reported to occur rarely in patients with cystic fibrosis. • Although anemia is well known in cystic fibrosis, factors that cause severe anemia are not known clearly. What is New: • This study shows the importance of severe anemia as the first sign of cystic fibrosis. • Anemia can occur several months before respiratory symptoms in patients with CF.
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Abstract
The cystic fibrosis (CF) transmembrane conductance regulator (CFTR) gene encodes an epithelial ion channel. Although one mutation remains the most common cause of CF (F508del), there have been more than 2000 reported variations in CFTR. For the most part, individuals who carry only one mutation (heterozygotes) have no symptoms; individuals who inherit deleterious mutations from both parents have CF. However, growing awareness of CFTR mutations that do not ever or do not always cause CF, and individuals with mild or single-organ system manifestations of CFTR-related disease have made this Mendelian relationship more complex.
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Reversible airway obstruction in cystic fibrosis: Common, but not associated with characteristics of asthma. J Cyst Fibros 2016; 15:652-9. [PMID: 26826913 DOI: 10.1016/j.jcf.2016.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 12/17/2015] [Accepted: 01/11/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND As asthma-like symptoms are common in CF, we evaluated reversible airway obstruction and associated characteristics. METHODS Retrospective analysis of charts including spirometry and bronchodilator response. RESULTS Of 190 CF patients (103 at Schneider's, 87 at Hadassah), aged 14.4 (4-76) years, median (range), 39% had reversible obstruction (ΔFEV1% predicted ≥12%), associated with younger age (p=0.01) and severe genotype (p=0.02). There was no association with family history of asthma, serum IgE, blood eosinophils, pancreatic status, FEV1<40% predicted, Aspergillus or pseudomonas infection. Of patients with reversible obstruction, 74% were on bronchodilator and 68% on inhaled corticosteroid therapy but 54% and 57% respectively receiving these therapies did not have reversible obstruction. CONCLUSIONS Reversible airway obstruction is common in CF, more frequent in younger patients and with severe genotype, with no correlation to markers of atopy or CF clinical severity. Bronchodilator and inhaled corticosteroid therapies are commonly prescribed even without reversible obstruction.
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Fine particulate matter exposure and initial Pseudomonas aeruginosa acquisition in cystic fibrosis. Ann Am Thorac Soc 2015; 12:385-91. [PMID: 25594356 DOI: 10.1513/annalsats.201408-400oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Increasing evidence suggests that exposure to ambient air pollution contributes to the severity of cystic fibrosis (CF) respiratory disease in school-age children and adults; however, the effects of air pollution on young children with CF are poorly understood. OBJECTIVES To investigate the association of exposure to fine particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5) and initial Pseudomonas aeruginosa acquisition in young children with CF. METHODS Retrospective analysis of initial Pseudomonas acquisition in children 6 years of age or younger, using Cystic Fibrosis Foundation National Patient Registry data from 2003 to 2009. PM2.5 exposure was estimated by inverse distance weighting methods based on air pollution monitors within 30 miles of place of residence, for the year before the patient's birth. Multivariable Weibull regression with interval-censored outcomes was done to evaluate the association of time to initial Pseudomonas acquisition and PM2.5 concentrations. MEASUREMENTS AND MAIN RESULTS A total of 3,575 children met inclusion criteria and 48% (n=1,711) acquired Pseudomonas at a median age of 15 months (25th-75th percentiles, 9-25 mo). An increase in PM2.5 exposure of 10 μg/m3 was associated with a 24% increased risk of Pseudomonas acquisition (95% confidence interval, 1-51%) during follow-up. Results were generally consistent across exposure metrics. CONCLUSIONS These results suggest that increased PM2.5 exposure is associated with earlier Pseudomonas acquisition in young children with CF and may play an important, previously unrecognized, role in the etiology of initial Pseudomonas infection.
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Association of meteorological and geographical factors and risk of initial Pseudomonas aeruginosa acquisition in young children with cystic fibrosis. Epidemiol Infect 2015; 144:1075-83. [PMID: 26449886 DOI: 10.1017/s0950268815002411] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Initial infection with the sentinel respiratory pathogen in children with cystic fibrosis (CF), Pseudomonas aeruginosa (Pa), is generally with environmental strains of this ubiquitous organism. The purpose of this study was to evaluate the associations between meteorological and geographical factors and risk of initial Pa acquisition in young children with CF. Using the U.S. Cystic Fibrosis Foundation Patient Registry from 2003 to 2009, 3463 patients met inclusion criteria, of which 48% (n = 1659) acquired Pa during follow-up. From multivariable Weibull regression, increased risk of Pa acquisition was associated with increasing temperature [hazard ratio (HR) per 1 °C: 1·13; 95% confidence interval (CI) 1·08-1·13], dew point (HR per 1 °C: 1·10, 95% CI 1·07-1·13), rainfall (HR per cm: 1·10, 95% CI 1·07-1·12), latitude (HR per 1 °C northing: 1·15, 95% CI 1·11-1·20), longitude (HR per 1 °C easting: 1·01, 95% CI 1·01-1·02) and elevation (HR per 100 m: 1·05, 95% CI 1·03-1·07). These results suggest that environmental factors may play a previously unrecognized role in the aetiology of initial Pa acquisition.
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Simpson SJ, Ranganathan S, Park J, Turkovic L, Robins-Browne RM, Skoric B, Ramsey KA, Rosenow T, Banton GL, Berry L, Stick SM, Hall GL. Progressive ventilation inhomogeneity in infants with cystic fibrosis after pulmonary infection. Eur Respir J 2015; 46:1680-90. [PMID: 26381521 DOI: 10.1183/13993003.00622-2015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 06/28/2015] [Indexed: 12/28/2022]
Abstract
Measures of ventilation distribution are promising for monitoring early lung disease in cystic fibrosis (CF). This study describes the cross-sectional and longitudinal impacts of pulmonary inflammation and infection on ventilation homogeneity in infants with CF.Infants diagnosed with CF underwent multiple breath washout (MBW) testing and bronchoalveolar lavage at three time points during the first 2 years of life.Measures were obtained for 108 infants on 156 occasions. Infants with a significant pulmonary infection at the time of MBW showed increases in lung clearance index (LCI) of 0.400 units (95% CI 0.150-0.648; p=0.002). The impact was long lasting, with previous pulmonary infection leading to increased ventilation inhomogeneity over time compared to those who remained free of infection (p<0.05). Infection with Haemophilus influenzae was particularly detrimental to the longitudinal lung function in young children with CF where LCI was increased by 1.069 units for each year of life (95% CI 0.484-1.612; p<0.001).Pulmonary infection during the first year of life is detrimental to later lung function. Therefore, strategies aimed at prevention, surveillance and eradication of pulmonary pathogens are paramount to preserve lung function in infants with CF.
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Affiliation(s)
- Shannon J Simpson
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Sarath Ranganathan
- Murdoch Children's Research Institute, Melbourne, Australia Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Judy Park
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Lidija Turkovic
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Roy M Robins-Browne
- Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - Billy Skoric
- Murdoch Children's Research Institute, Melbourne, Australia Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Kathryn A Ramsey
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Tim Rosenow
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Georgia L Banton
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Luke Berry
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Stephen M Stick
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia Department of Respiratory and Sleep Medicine, Princess Margaret Hospital for Children, Perth, Australia School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Graham L Hall
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
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Hoen AG, Li J, Moulton LA, O’Toole GA, Housman ML, Koestler DC, Guill MF, Moore JH, Hibberd PL, Morrison HG, Sogin ML, Karagas MR, Madan JC. Associations between Gut Microbial Colonization in Early Life and Respiratory Outcomes in Cystic Fibrosis. J Pediatr 2015; 167:138-47.e1-3. [PMID: 25818499 PMCID: PMC4674690 DOI: 10.1016/j.jpeds.2015.02.049] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 01/28/2015] [Accepted: 02/18/2015] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine patterns of microbial colonization of the respiratory and intestinal tracts in early life in infants with cystic fibrosis (CF) and their associations with breastfeeding and clinical outcomes. STUDY DESIGN A comprehensive, prospective longitudinal analysis of the upper respiratory and intestinal microbiota in a cohort of infants and young children with CF followed from birth was performed. Genus-level microbial community composition was characterized using 16S-targeted pyrosequencing, and relationships with exposures and outcomes were assessed using linear mixed-effects models, time-to-event analysis, and principal components analysis. RESULTS Sequencing of 120 samples from 13 subjects collected from birth to 34 months revealed relationships between breastfeeding, microbial diversity in the respiratory and intestinal tracts, and the timing of onset of respiratory complications, including exacerbations and colonization with Pseudomonas aeruginosa. Fluctuations in the abundance of specific bacterial taxa preceded clinical outcomes, including a significant decrease in bacteria of the genus Parabacteroides within the intestinal tract prior to the onset of chronic P aeruginosa colonization. Specific assemblages of bacteria in intestinal samples, but not respiratory samples, were associated with CF exacerbation in early life, indicating that the intestinal microbiome may play a role in lung health. CONCLUSIONS Our findings relating breastfeeding to respiratory outcomes, gut diversity to prolonged periods of health, and specific bacterial communities in the gut prior to respiratory complications in CF highlight a connection between the intestinal microbiome and health and point to potential opportunities for antibiotic or probiotic interventions. Further studies in larger cohorts validating these findings are needed.
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Affiliation(s)
- Anne G. Hoen
- Computational Genetics Laboratory, Institute for Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH 03755,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH 03755
| | - Jing Li
- Computational Genetics Laboratory, Institute for Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH 03755
| | - Lisa A. Moulton
- Division of Allergy and Pediatric Pulmonology, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon NH 03756
| | - George A. O’Toole
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
| | - Molly L. Housman
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH 03755
| | - Devin C. Koestler
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS 66160
| | - Margaret F. Guill
- Division of Allergy and Pediatric Pulmonology, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon NH 03756
| | - Jason H. Moore
- Computational Genetics Laboratory, Institute for Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH 03755
| | - Patricia L. Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114
| | - Hilary G. Morrison
- Josephine Bay Paul Center for Comparative Molecular Biology and Evolution, Marine Biological Laboratory, Woods Hole, MA 02543
| | - Mitchell L. Sogin
- Josephine Bay Paul Center for Comparative Molecular Biology and Evolution, Marine Biological Laboratory, Woods Hole, MA 02543
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH 03755
| | - Juliette C. Madan
- Division of Neonatology, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756
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BONGERS BARTC, WERKMAN MAARTENS, ARETS HGM, TAKKEN TIM, HULZEBOS HJ. A Possible Alternative Exercise Test for Youths with Cystic Fibrosis. Med Sci Sports Exerc 2015; 47:485-92. [DOI: 10.1249/mss.0000000000000440] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Oueslati S, Hadj Fredj S, Belhaj R, Siala H, Bibi A, Messaoud T. Preliminary study of haplotypes linked to the rare cystic fibrosis E1104X mutation. ACTA ACUST UNITED AC 2015; 102:86-93. [DOI: 10.1556/aphysiol.101.2014.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Terlizzi V, Carnovale V, Castaldo G, Castellani C, Cirilli N, Colombo C, Corti F, Cresta F, D'Adda A, Lucarelli M, Lucidi V, Macchiaroli A, Madarena E, Padoan R, Quattrucci S, Salvatore D, Zarrilli F, Raia V. Clinical expression of patients with the D1152H CFTR mutation. J Cyst Fibros 2015; 14:447-52. [PMID: 25583415 DOI: 10.1016/j.jcf.2014.12.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 12/17/2014] [Accepted: 12/18/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Discordant results were reported on the clinical expression of subjects bearing the D1152H CFTR mutation, and also for the small number of cases reported so far. METHODS A retrospective review of clinical, genetic and biochemical data was performed from individuals homozygous or compound heterozygous for the D1152H mutation followed in 12 Italian cystic fibrosis (CF) centers. RESULTS 89 subjects carrying at least D1152H on one allele were identified. 7 homozygous patients had very mild clinical expression. Over half of the 74 subjects compound heterozygous for D1152H and a I-II-III class mutation had borderline or pathological sweat test and respiratory or gastrointestinal symptoms; one third had pulmonary bacteria colonization and 10/74 cases had complications (i.e. diabetes, allergic bronchopulmonary aspergillosis, and hemoptysis). However, their clinical expression was less severe as compared to a group of CF patients homozygous for the F508del mutation. Finally, 8 subjects compound heterozygous for D1152H and a IV-V class mutation showed very mild disease. CONCLUSIONS The natural history of subjects bearing the D1152H mutation is widely heterogeneous and is influenced by the mutation in trans.
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Affiliation(s)
- Vito Terlizzi
- Dipartimento di Scienze Mediche Traslazionali, Sezione di Pediatria, Università di Napoli Federico II, Naples, Italy
| | - Vincenzo Carnovale
- Centro Fibrosi Cistica Adulti, Dipartimento di Scienze Traslazionali, Università di Napoli Federico II, Naples, Italy
| | - Giuseppe Castaldo
- CEINGE-Biotecnologie avanzate, Naples, Italy; Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università di Napoli Federico II, Naples, Italy
| | - Carlo Castellani
- Centro Fibrosi Cistica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Natalia Cirilli
- Centro Regionale Fibrosi Cistica, Dipartimento Materno-Infantile, Ospedali Riuniti Ancona, Ancona, Italy
| | - Carla Colombo
- Centro Fibrosi Cistica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Fabiola Corti
- Centro Fibrosi Cistica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Federico Cresta
- Centro Fibrosi Cistica, Dipartimento di Pediatria, IRCCS G. Gaslini, Genova, Italy
| | - Alice D'Adda
- Centro Fibrosi Cistica, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Marco Lucarelli
- Dipartimento di Biotecnologie Cellulari ed Ematologia, Istituto Pasteur Fondazione Cenci Bolognetti, Sapienza Università e Policlinico Umberto I, Rome, Italy
| | - Vincenzina Lucidi
- Unità di Fibrosi Cistica, IRCCS Ospedale Pediatrico Bambin Gesù, Rome, Italy
| | | | - Elisa Madarena
- Centro Fibrosi Cistica, Ospedale Giovanni Paolo II, Lamezia, Italy
| | - Rita Padoan
- Centro di supporto Fibrosi Cistica, Dipartimento di Pediatria, Università di Brescia, Brescia, Italy
| | - Serena Quattrucci
- Dipartimento di Pediatria, Centro Fibrosi Cistica, Sapienza Università e Policlinico Umberto I, Rome, Italy
| | - Donatello Salvatore
- Centro Fibrosi Cistica, Centro Pediatrico Bambino Gesù Basilicata, AOR San Carlo, Potenza, Italy
| | - Federica Zarrilli
- Dipartimento di Bioscienze e Territorio, Università del Molise, Isernia, Italy
| | - Valeria Raia
- Dipartimento di Scienze Mediche Traslazionali, Sezione di Pediatria, Università di Napoli Federico II, Naples, Italy.
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Uijterschout L, Swinkels DW, Akkermans MD, Zandstra T, Nuijsink M, Hendriks D, Hudig C, Tjalsma H, Vos R, van Goudoever JB, Brus F. The value of soluble transferrin receptor and hepcidin in the assessment of iron status in children with cystic fibrosis. J Cyst Fibros 2014; 13:639-44. [DOI: 10.1016/j.jcf.2014.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/20/2014] [Accepted: 03/24/2014] [Indexed: 01/07/2023]
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Bongers BC, Werkman MS, Takken T, Hulzebos EHJ. Ventilatory response to exercise in adolescents with cystic fibrosis and mild-to-moderate airway obstruction. SPRINGERPLUS 2014; 3:696. [PMID: 25512888 PMCID: PMC4254890 DOI: 10.1186/2193-1801-3-696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 11/14/2014] [Indexed: 02/08/2023]
Abstract
Data regarding the ventilatory response to exercise in adolescents with mild-to-moderate cystic fibrosis (CF) are equivocal. This study aimed to describe the ventilatory response during a progressive cardiopulmonary exercise test (CPET) up to maximal exertion, as well as to assess the adequacy of the ventilatory response for carbon dioxide (CO2) exhalation. Twenty-two adolescents with CF (12 boys and 10 girls; mean ± SD age: 14.3 ± 1.3 years; FEV1: 78.6 ± 17.3% of predicted) performed a maximal CPET. For each patient, data of a sex- and age matched healthy control was included (12 boys and 10 girls; mean ± SD age: 14.3 ± 1.4 years). At different relative exercise intensities of 25%, 50%, 75%, and 100% of peak oxygen uptake (VO2peak), breathing pattern, estimated ventilatory dead space ventilation (VD/VT ratio), minute ventilation (VE) to CO2 production relationship (VE/VCO2-slope), partial end-tidal CO2 tension (PETCO2), and the VE to the work rate (VE/WR) ratio were examined. VO2peak was significantly reduced in CF patients (P = 0.01). We found no differences in breathing pattern between both groups, except for a significantly higher VE at rest and a trend towards a lower VE at peak exercise in patients with CF. Significantly higher values were found for the estimated VD/VT ratio throughout the CPET in CF patients (P < 0.01). VE/VCO2-slope and PETCO2 values differed not between the two groups throughout the CPET. VE/WR ratio values were significantly higher in CF during the entire range of the CPET (P < 0.01). This study found an exaggerated ventilatory response (high VE/WR ratio values), which was adequate for CO2 exhalation (normal VE/VCO2-slope and PETCO2 values) during progressive exercise up to maximal exhaustion in CF patients with mild-to-moderate airway obstruction.
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Affiliation(s)
- Bart C Bongers
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands ; Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten S Werkman
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands ; De Kinderkliniek, Almere, The Netherlands
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Erik H J Hulzebos
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Fischer AJ, Singh SB, Adam RJ, Stoltz DA, Baranano CF, Kao S, Weinberger MM, McCray PB, Starner TD. Tracheomalacia is associated with lower FEV1 and Pseudomonas acquisition in children with CF. Pediatr Pulmonol 2014; 49:960-70. [PMID: 24166775 PMCID: PMC4711356 DOI: 10.1002/ppul.22922] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Accepted: 09/17/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Tracheomalacia (TM) occurs in approximately 1 in 2,100 children. Because the trachea develops abnormally in animal models of cystic fibrosis (CF), we hypothesized this may also occur in children with CF, increasing their risk of TM. PURPOSE To examine the prevalence and clinical consequences of TM in children with CF. METHODS We studied children with CF born between 1995 and 2012. TM was defined as dynamic collapse of the trachea, and the severity was recorded as described in the chart. The effect of TM on patient outcomes, including FEV1 , CT changes, and acquisition of CF pathogens, was assessed using a longitudinal patient dataset. RESULTS Eighty-nine percent of children with CF had at least one bronchoscopy (n = 97/109). Fifteen percent of these children had TM described in any bronchoscopy report (n = 15/97). Of the patients with TM, eight had meconium ileus (P = 0.003) and all were pancreatic insufficient. Pseudomonas aeruginosa infection occurred 1.3 years earlier among children with TM (P = 0.01). Starting FEV1 values by age 8 were diminished by over 18% of predicted for patients with TM. Life-threatening episodes of airway obstruction occurred in 3 of 15 patients with CF and TM, including one leading to death. Gender, prematurity, and hepatic disease were not associated with TM. No difference was observed in the frequency of bronchiectasis. CONCLUSIONS TM is significantly more common in infants and children with CF than in the general population and is associated with airway obstruction and earlier Pseudomonas acquisition.
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Daines C, VanDeVanter D, Khan U, Emerson J, Heltshe S, McNamara S, Anstead M, Langkamp M, Doring G, Ratjen F, Ramsey B, Gibson RL, Morgan W, Rosenfeld M. Serology as a diagnostic tool for predicting initialPseudomonas aeruginosa acquisition in children with cystic fibrosis. J Cyst Fibros 2014; 13:542-9. [PMID: 25027419 DOI: 10.1016/j.jcf.2014.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/14/2014] [Accepted: 06/16/2014] [Indexed: 01/15/2023]
Abstract
RATIONALE Pseudomonas aeruginosa (Pa) serology could potentially be a useful adjunct to respiratory culture methods for the detection of initial or early Pa infection in patients with cystic fibrosis (CF). OBJECTIVE To evaluate the utility of Pa serology to predict Pa isolation from respiratory (generally oropharyngeal) cultures in the subsequent 6 or 12 months among young children with CF from whom Pa had never been previously cultured. Pa serology was also evaluated in a group of healthy controls. METHODS Children ≤ 12 years of age without prior isolation of Pa from respiratory cultures participating in the Early Pseudomonal Infection Control EPIC Observational Study (EPIC OBS) had annual serum samples for measurement of antibodies against alkaline protease, elastase and exotoxin A using a commercial kit; controls had a single serum sample. Logistic regression with generalized estimating equations was used to characterize associations between log10 serum antibody titers and first isolation of Pa from a respiratory culture within the subsequent 6 or 12 months, with adjustment for sex and age. Receiver operating characteristic curves were used to optimize antibody titer cutpoints by age group. The diagnostic properties of each antibody were estimated using these optimized cutpoints. RESULTS Pa serology was evaluated in 582 children with CF (2084 serum samples) and 94 healthy controls. There was substantial overlap between serum antibody titers among controls, CF patients who did not acquire Pa (N = 261) and CF patients who did acquire Pa (N = 321). The maximum positive predictive value for first Pa positive culture within the ensuing 6 months was 76.2% and maximum negative predictive value was 72.1% for any antigen or combination of antigens; values were similar for 12 months. CONCLUSIONS Pa serology does not appear useful for predicting first Pa positive oropharyngeal culture among young CF patients.
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Affiliation(s)
- Cori Daines
- University of Arizona, Tucson, AZ 85724, United States.
| | - Donald VanDeVanter
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Umer Khan
- Seattle Children's Research Institute, Seattle, WA 98121, United States
| | - Julia Emerson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105-0371, United States
| | - Sonya Heltshe
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105-0371, United States
| | - Sharon McNamara
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105-0371, United States
| | - Michael Anstead
- Department of Pediatrics, University of Kentucky, Lexington, KY 40563-0284, United States
| | | | - Gerd Doring
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Felix Ratjen
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Bonnie Ramsey
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105-0371, United States
| | - Ronald L Gibson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105-0371, United States
| | - Wayne Morgan
- University of Arizona, Tucson, AZ 85724, United States
| | - Margaret Rosenfeld
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA 98105-0371, United States
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Psoter KJ, Rosenfeld M, De Roos AJ, Mayer JD, Wakefield J. Differential geographical risk of initial Pseudomonas aeruginosa acquisition in young US children with cystic fibrosis. Am J Epidemiol 2014; 179:1503-13. [PMID: 24875373 DOI: 10.1093/aje/kwu077] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Pseudomonas aeruginosa is the sentinel respiratory pathogen in cystic fibrosis patients. We conducted a retrospective study to examine whether state of residence affected risk of P. aeruginosa acquisition among US children under 6 years of age with cystic fibrosis by using data from the Cystic Fibrosis Foundation National Patient Registry, 2003-2009. The outcome was time to first isolation of P. aeruginosa from a respiratory culture. We used a Bayesian hierarchical Weibull regression model with interval-censored outcomes. Spatial random effects, included at the state level and modeled using an intrinsic conditional autoregressive prior, allowed estimation of the residual spatial correlation. The regression portion of the model was adjusted for demographic and disease characteristics potentially affecting P. aeruginosa acquisition. A total of 3,608 children met the inclusion criteria and were followed for an average of 2.1 (standard deviation, 1.6) years. P. aeruginosa was cultured in 1,714 (48%) subjects. There was a moderately elevated spatial residual relative risk. An estimated 95% credible interval for the residual hazard ratio under 1 of the fitted models was 0.64-1.57; the strongest positive association was observed in the Southern states. The fact that risk for P. aeruginosa acquisition displayed spatial dependence suggests that regional factors, such as climate, may play an important role in P. aeruginosa acquisition.
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Bar-On O, Mussaffi H, Mei-Zahav M, Prais D, Steuer G, Stafler P, Hananya S, Blau H. Increasing nontuberculous mycobacteria infection in cystic fibrosis. J Cyst Fibros 2014; 14:53-62. [PMID: 24917112 DOI: 10.1016/j.jcf.2014.05.008] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Revised: 05/10/2014] [Accepted: 05/12/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) are emerging infections in the CF population. AIMS To assess NTM infection prevalence and associated features in our CF clinic population. METHODS Patient records, 2002-2011, were reviewed for NTM infection. FEV1, pancreatic function, sputum microbiology, and serum cytokines were compared in patients with and without NTM infection. RESULTS Incidence rate of NTM infection increased from 0 in 2002 to 8.7% in 2011 (p<0.001). NTM infection prevalence increased 3-fold from 5% (4/79) in 2003 to 14.5% (16/110) in 2011 (p=0.05). Prevalence of chronic NTM lung disease has decreased somewhat since a peak in 2009, with institution of aggressive triple therapy. Of NTM-infected compared to uninfected patients, 88.2% vs. 60.3% had a known 'severe' CFTR genotype (p=0.04), 88.2% vs. 58.9% were pancreatic insufficient (p=0.02); 70.6% vs. 43.8% had chronic Pseudomonas aeruginosa (p=0.06); 75% vs. 32% had Aspergillus infection (p=0.007) and 23.5% vs 2.7% had allergic bronchopulmonary aspergillosis (p=0.01). Patients infected with Mycobacterium abscessus had increased TGF-β, TNF-α, IL-1β, IL-2, IL-4 and IL-5 levels (p<0.05). There was no difference in cytokine levels for all NTM infected compared to uninfected patients. M. abscessus comprised 46% of all NTM infections. Comparing M. abscessus versus other NTM, duration was 10.5 (1-118) months versus 1 (1-70) month, median (range) (p=0.004); lung disease occurred in 69% versus 17% (p=0.0004), with sputum conversion in 4/11 versus 5/6, respectively (NS). CONCLUSIONS NTM incidence and prevalence have increased dramatically in our CF clinic, associated with a severe CF genotype and phenotype. M. abscessus, the most prevalent NTM, caused prolonged infection despite therapy. There has been some decrease in the prevalence of NTM lung disease since 2009.
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Affiliation(s)
- Ophir Bar-On
- Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel
| | - Huda Mussaffi
- Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Meir Mei-Zahav
- Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Dario Prais
- Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Guy Steuer
- Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel
| | - Patrick Stafler
- Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Shai Hananya
- Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel
| | - Hannah Blau
- Graub CF Center, Pulmonary Institute, Schneider Children's Medical Center of Israel, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel Aviv, Israel.
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